Increased primary tooth size in a 47,XXY male: a first case report

Increased tooth size has previously been reported in association with Klinefelter syndrome. However, until now, this observation has been restricted to the permanent dentition. In this paper, we report increased mesio-distal width in the primary incisor and molar teeth of a 47,XXY male.

Effect of hens fed dietary flaxseed with and without a fatty liver supplement on hepatic, plasma and production characteristics relevant to fatty liver haemorrhagic syndrome in laying hens

1. Two long-term experiments were conducted with Single Comb White Leghorn (SCWL) hens (line UCD-003) predisposed to fatty liver haemorrhagic syndrome (FLHS). The first investigated the effect of adding a fatty liver supplement to the diet of laying hens prior to the onset of lay, and continuing either until peak production or throughout 39 weeks into lay. The second experiment, lasting 9 months into lay, investigated the effect of adding a fatty liver supplement, with or without 100 g/kg dietary ground flaxseed, to the diet. Body weight, feed intake, plasma triglycerides (in experiment 2) and egg production were measured throughout the experiment. Liver weight, liver fat content, liver malondialdehyde (MDA) content and liver haemorrhage score and fatty acid content of liver fat (in experiment 2) were measured at the end of each experiment. 2. In experiment 1, hens given diets containing the fatty liver supplement had higher egg production and eggshell strength, but there was no difference in liver parameters including MDA content or haemorrhage score compared with controls. 3. At the end of experiment 2, hens on 100 g/kg flaxseed diets had lower body weight, liver weight, liver dry matter and fat content, and plasma triglyceride concentrations than hens given the control diets. 4. Liver haemorrhage score was positively correlated with liver weight, but not with liver fat content, plasma triglyceride concentration or liver MDA content. This suggests that reducing the liver lipid content or feeding fatty liver supplements may not be as effective in controlling FLHS as controlling the size of the liver.

Participation and chronic disease self-management: Are we risking inequitable resource allocation?

The Ottawa Charter for Health Promotion supported the empowerment of individuals to participate in their health care and have control over their health. For older adults with chronic conditions, the Chronic Disease Self-Management Program has been widely adopted as an adjunct to existing healthcare options. A growing body of literature has supported the positive impact of self-management programs on outcomes for people with a range of chronic conditions. However, evidence also suggests that participation in these programs is biased. This paper draws on pilot data to describe the profile of those people who inquire, enrol, attend, and complete CDSM courses in Queensland, Australia. As expected, there was evidence that males, Indigenous people, people of non-English speaking background, and those with multiple responsibilities were less likely to participate. Most importantly, participation was affected by a self-selection bias associated with health status. Those who were either unwell or well at the time of the course were unlikely to attend, minimising the preventative value of the CDSM program. Further, CDSM evaluation studies are likely to be inherently flawed and the distribution of health resources can become inequitable.

General anaesthesia for exodontia in children: experience of a dental teaching hospital in relation to changes in national guidance

OBJECTIVES

To examine, in relation to changes in national guidance, trends in the provision of general anaesthesia for exodontia in children.

DESIGN

Retrospective analysis of hospital records.

SETTING

University Dental Hospital, Cardiff, UK.

METHODS

Data were drawn from records of services provided in each of four index months during 1989, 1991, 1997 and 1999 (the years immediately preceding/following the Poswillo Report of 1990 and the General Dental Council's revised guidance of 1998).

RESULTS

In the first year after publication of the Poswillo report, there was a 19.6% increase in use of 'chair case' general anaesthesia over the four index months. Subsequently, upon the emergence of additional providers, patient flow in 1997 had fallen to 65.8% of that seen at baseline. Following the General Dental Council's revised guidance of 1998, there was a further reduction in the provision of 'chair case' general anaesthesia (to 40.8% of that seen at baseline).

CONCLUSIONS

In this unit, throughput of children receiving general anaesthesia for exodontia has fluctuated in periods marked by changing national guidance. However, it is not possible to attribute such fluctuations in patient flow solely to this factor.

Comparison of male and female junior athletes' self-perceptions and body image

Few studies have examined sex differences in body perceptions in sports where the pressure to display a certain physique is reduced. The aim of the present study was to investigate sex differences in physical self-perceptions and body image in junior athletes who are involved in sprint kayaking, a sport where a low body weight is relatively unimportant. 12 male and 13 female members (aged 13-17 yr.) of the British Canoe Union Junior Development Squad for sprint-kayak racing completed the Physical Self-perception Profile for Children and the Multidimensional Body-Self Relations Questionnaire. Multivariate analysis of variance indicated that girls reported significandy higher Sports Competence and lower Appearance Orientation scores than boys. This study has raised a number of issues surrounding the physical self-perceptions and body image of junior athletes involved in a power- and strength-based sport. It seems that male athletes may also experience pressures to conform to a male version of a 'beautiful body'.

The selective serotonin reuptake inhibitor paroxetine is effective in more generalized and in less generalized social anxiety disorder

RATIONALE

The DSM-IV includes the specifier "generalized" to refer to social anxiety disorder (social phobia) patients if the fears include "most social situations". The focus on interventions such as the selective serotonin reuptake inhibitors (SSRIs) for generalized social anxiety disorder arguably runs the risk that inadequate treatment will be provided to patients with the non-generalized or discrete subtypes. There are, however, few data to address whether more generalized and less generalized subgroups of social anxiety disorder differ in response to medication.

OBJECTIVE

To compare response of more generalized and less generalized social anxiety disorder to pharmacotherapy.

METHODS

Data from three randomized placebo-controlled double-blind multicenter trials of the SSRI paroxetine in social anxiety disorder were pooled. Response on the Clinical Global Impression Global Improvement item was analyzed using logistic regression, and change in total Liebowitz Social Anxiety Score was analyzed using analysis of variance, with both models incorporating treatment (paroxetine vs placebo), subgroup (more generalized vs less generalized), demographic, and clinical variables.

RESULTS

The prevalence of more generalized social anxiety disorder was higher in females than in males. However, there was no significant difference in terms of age or clinical characteristics (duration of condition, baseline pulse, mean arterial blood pressure). At treatment endpoint there were significant treatment effects (for paroxetine vs placebo), but no significant subgroup effects (for more generalized vs less generalized).

CONCLUSIONS

Although the current database is limited insofar as few patients with discrete social anxiety disorder would have been included, it is helpful in addressing the value of medication for patients lying on the spectrum from generalized to non-generalized and discrete social anxiety disorder. Paroxetine was effective in both more generalized and in less generalized social anxiety disorder.

[Identification of mutation in the gene cystic fibrosis transmembrane regulator (CFTR) in Chilean patients with cystic fibrosis]

BACKGROUND

Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the CFTR gene, that codes for a chloride channel located in the apical surface of epithelial cells. The main role of this protein is the regulation of chloride transport, and secondarily, of sodium and water to the extracellular space. More than 900 gene mutations have been described, and their relative frequency in different populations depends on their ethnic origin.

AIM

To report the findings of Chilean patients with cystic fibrosis, in whom the presence of 20 common mutations was analyzed.

PATIENTS AND METHODS

Fifty seven patients with established diagnosis or suspicion of CF were studied. The simultaneous identification of 20 mutations and the normal delta F508 allele was done using polymerase chain reactions with a commercial assay.

RESULTS

Eight mutations were found. Fifty patients fulfilled diagnostic criteria proposed by the Consensus Panel of the CF Foundation and 66% of alleles were identified in this group. delta F508 mutation was found in 45%. We did not identify mutations in any of the remaining 7 patients.

CONCLUSIONS

Our results suggest that the majority of undetected mutations are associated with atypical phenotypes or that some patients in this series could have other diseases. We recommend to include mutation analysis in the evaluation of Chilean patients with CF. It is useful to establish prognosis and genetic counselling.

Emotion work in midwifery: a review of current knowledge

AIM OF THE PAPER

To review the literature relating to emotional labour in the workplace and identify potential sources of emotion within midwifery work.

RATIONALE

There is substantial evidence to indicate that the quality of the relationship between midwife and woman is significant in determining the quality of the childbirth experience for women. Despite this, there is a notable lack of research regarding midwives' experiences of participating in this relationship, and even less regarding the emotional issues involved.

METHOD

Literature review of relevant midwifery, nursing and sociological literature. Discussion of the theoretical perspectives provided by sociological and nursing research relating to the management of emotion at work and critical consideration of their application to an analysis of midwifery work.

FINDINGS

Although these theoretical perspectives may offer significant insights of relevance to midwifery, there is much more that needs to be uncovered. Midwifery work has the potential for creating high levels of emotion work and current changes in the organization of United Kingdom (UK) maternity care may further increase this.

CONCLUSION

It is essential that midwives develop their understanding of emotion at work in order to improve their own working lives, and to meet the needs of childbearing women and their families. More research is needed in this field to develop a body of knowledge to inform midwifery education and practice.

Repair of incisional hernias

Incisional hernias develop in up to 11% of surgical abdominal wounds with a possible recurrence following repair of 44%. We describe our experience with a combined fascial and prosthetic mesh repair. Thirty-five patients (16M:19F) have been treated. The original operation was bowel related in 19 cases, gynaecological in 8, hepatopancreaticobiliary in 3 patients, aortic aneurysm repair in 2 and involved a thoraco-laparotomy in 3. The incisions were midline in 26 cases, transverse in 6, paramedian in 2 and rooftop in one patient. The hernias were considered subjectively to be large in 15, medium in 14 and small in 6 of the patients. A proforma was completed for each patient noting intra-operative and post-operative complications, post-operative hospital stay and analgesic requirements. Post-operative complications included seroma formation in 6 patients, deep vein thrombosis in one and a non-fatal pulmonary embolism in another. One patient developed a wound haematoma and one had a superficial wound infection. Post-operative in-hospital stay ranged from 1 to 27 days with a mean of 6.2 days. Of the 35 patients 33 were available for follow-up. Follow-up was for a median of 20.3 months (range 6.0 to 54.1 months). Two of these (6%) patients reported a persistent lump and one (3%) reported persistent pain but none of the remaining 33 was found to have a recurrence. We advocate this technique because it is applicable to all hernias, most of the mesh is behind the rectus sheath and has 2 points of fixation, it is relatively pain-free allowing early mobilisation, has a modest complication rate and a low recurrence rate.

Crystal structure of the catalytic domain of human bile salt activated lipase

Bile-salt activated lipase (BAL) is a pancreatic enzyme that digests a variety of lipids in the small intestine. A distinct property of BAL is its dependency on bile salts in hydrolyzing substrates of long acyl chains or bulky alcoholic motifs. A crystal structure of the catalytic domain of human BAL (residues 1-538) with two surface mutations (N186D and A298D), which were introduced in attempting to facilitate crystallization, has been determined at 2.3 A resolution. The crystal form belongs to space group P2(1)2(1)2(1) with one monomer per asymmetric unit, and the protein shows an alpha/beta hydrolase fold. In the absence of bound bile salt molecules, the protein possesses a preformed catalytic triad and a functional oxyanion hole. Several surface loops around the active site are mobile, including two loops potentially involved in substrate binding (residues 115-125 and 270-285).

Bacteriological and histological profile of turkeys condemned for cyanosis

Canadian Food Inspection Agency (CFIA) has adopted the term cyanosis to describe a category of condemnation for poultry that is dark but has no other condemnable lesions. Two case-control studies (n = 30 pairs; n = 65 pairs) of 18-wk-old tom turkeys were conducted. A case was defined as a carcass condemned by the veterinary inspector for cyanosis, and a control carcass was one that passed inspection. Microbiological tests were conducted on samples of Pectoralis major and Gastrocnemius lacteralis. A modified Rappaport Vassiliadis medium was used for Salmonella, and a Petrifilm method was used to assess aerobic counts, coliform counts, and Escherichia coli. The Salmonella (qualitative) test was negative for all cases and controls, and there were no significant differences between the aerobic counts, coliform counts, and E. coli counts of case and control carcasses. Two pathologists conducted a blind histopathological study: there were no lesions compatible with those of septicemia-toxemia, as defined by CFIA and the USDA, nor any significant histopathological differences between the skin, P. major, G. lateralis, kidney, liver, spleen, small intestine, pancreas, lung, and heart of cases and controls. The inter-rater agreement between pathologists ranged from good to excellent (Kappa = 0.7 to 1.0). In the absence of important lesions and microbial contamination, carcasses with this color change alone should be suitable for human consumption.

Interpretation of fine-needle aspirates processed by the ThinPrep technique: cytologic artifacts and diagnostic pitfalls

The improvement in quality of cytologic preparations with the use of the ThinPrep methodology has been well-documented, but the cytologic artifacts resulting from this technique have not been adequately described. This study describes and illustrates the cytologic artifacts introduced by the ThinPrep technique when used on fine-needle aspirates (FNAs), and evaluates these artifacts as potential diagnostic pitfalls. We reviewed a total of 120 FNAs simultaneously processed by both conventional smears and ThinPrep. FNAs were obtained from the following sites: lymph node (27), breast (23), soft-tissue sites (20), salivary glands (13), gastrointestinal tract (10), lung (9), thyroid gland (13), liver (3), adrenal gland (1), and kidney (1). The ThinPrep smears were consistently devoid of obscuring elements, and the cells were adequately preserved and evenly dispersed. However, we noted some cytomorphologic alterations that should be recognized to avoid erroneous diagnoses. The size of cell clusters was decreased, large branching sheets were fragmented, and there were more single cells, resulting in apparent discohesion. Small cells such as lymphocytes tended to aggregate. All cells were generally smaller and occasionally spindled, the chromatin detail was attenuated, and nucleoli were more prominent. Intranuclear inclusions were difficult to visualize. Background matrix was often altered in both quantity and quality. Extracellular particles, small mononuclear cells, red blood cells, and myoepithelial cells were markedly decreased in number. The pathologist should be cautious in interpreting FNAs prepared using ThinPrep if that is the only methodology employed. Familiarity with artifacts is essential to avoid misinterpretations.

Consumer demand in the purchase and prescription of sugar-free medicines

OBJECTIVES

To determine the current level of consumer demand in the purchase and prescription of sugar-free paediatric medicines.

DESIGN

Data were collected by administered questionnaire.

SETTING

The study was conducted in a Hospital Paediatric Dentistry Unit and a Community Dental Clinic, both within the Bro Taf area of south-east Wales.

SAMPLE AND METHODS

The parents of 240 children attending for routine dental care responded to one of two short questionnaires, depending on whether their child had received a liquid oral medicine in the preceding month.

RESULTS

Although aware of the benefits of sugar-free medicines, parents did not appear to be attempting to exercise the power of consumer demand to its full potential. They were more likely to ask a pharmacist (or pharmacist's assistant) than their general medical practitioner for a sugar-free medicine.

CONCLUSIONS

We must continue to promote sugar-free medicines. While increasing the importance that health professionals attach to such products, future campaigns should also aim to increase consumer demand.

Crystal structure of streptokinase beta-domain

Streptokinase, a 47 kDa secreted protein of hemolytic strains of streptococci, is a human plasminogen activator and contains three structural domains linked by flexible loops. We describe here the crystal structure of the isolated streptokinase middle (SKbeta) domain determined at 2.4 A resolution. Among the functionally important structural features is a putative binding site for a kringle domain of plasminogen located at the tip of a fully exposed hairpin loop. The distribution of genetically conserved residues of SKbeta is strongly correlated with their functions. The extensive interface of the SKbeta dimer suggests that such dimers may also exist in solution for free SKbeta.

A double-blind placebo-controlled trial of paroxetine in the management of social phobia (social anxiety disorder) in South Africa

BACKGROUND

Social phobia, also known as social anxiety disorder, is a highly prevalent disorder with significant morbidity. Patients with social phobia frequently develop co-morbid psychiatric disorders such as depression and substance abuse, and the disorder impacts significantly on social and occupational functioning. It has been suggested that the selective serotonin reuptake inhibitors (SSRIs) are useful in the management of this disorder, but few controlled trials have been undertaken in this regard. There are also few data on the pharmacotherapy of social phobia in South Africa.

METHODS

A double-blind randomised placebo-controlled multi-site flexible-dose trial of paroxetine was undertaken over 12 weeks among patients with a primary diagnosis of social phobia. Primary response measures were the Global Improvement item on the Clinical Global Impression scale (CGI) and mean change from baseline in the patient-rated Liebowitz Social Anxiety Scale (LSAS) total score. Ninety-three patients participated at 9 South African sites; their data are reported here.

RESULTS

There was a significant drug effect on both the CGI Global Improvement score and the LSAS at 12 weeks. In addition, there was no significant difference in overall rate of adverse experiences between those on paroxetine and those on placebo.

CONCLUSIONS

Paroxetine is both effective and safe in the acute treatment of social phobia. The findings here are consistent with those of previous controlled studies of the SSRIs as well as with previous work done in the USA on the use of paroxetine in the treatment of this disorder. Early diagnosis and treatment of social phobia should be encouraged. However, further research on long-term pharmacotherapy of social phobia is needed.

Computer-controlled endoscopic performance assessment system

We have devised an advanced computer-controlled system (ADEPT) for the objective evaluation of endoscopic task performance. The system's hardware consists of a dual gimbal mechanism that accepts a variety of 5.0-mm standard endoscopic instruments for manipulation in a precisely mapped and enclosed work space. The target object consists of a sprung base plate incorporating various tasks. It is covered by a sprung perforated transparent top plate that has to be moved and held in the correct position by the operator to gain access to the various tasks. Standard video endoscope equipment provides the visual interface between the operator and the target-instrument field. Different target modules can be used, and the level of task difficulty can be adjusted by varying the manipulation, elevation, and azimuth angles. The system's software is designed to (a) prompt the surgeon with the information necessary to perform the task, (b) collect and collate data on performance during execution of specified tasks, and (c) save the data for future analysis. The system was alpha and beta tested to ensure that all functions operated correctly.

Assessing the validity of intercensal comparisons of indigenous Australians, 1986-96

"The credibility of analysis of 1996 Census data on indigenous Australians hinges on who the people are who have changed their indigenous identification between the last two censuses. The number of people who identify as indigenous in either the Post-Enumeration Survey or the census is more stable than the prima facie evidence indicates. Also, the continuing low levels of education among the indigenous population means that self-identification signifies that one is, more than likely, disadvantaged. While it is difficult to say with absolute certainty that census statistics accurately reflect the economic status of the indigenous population, they are sufficiently credible to be taken at face value."

Oral health advice: reported experience of mothers of children aged 5 years and under referred for extraction of teeth under general anaesthesia

AIMS

To examine the reported receipt of oral health education among mothers of children who required the extraction of teeth under general anaesthesia.

DESIGN

Cross-sectional study using questionnaires completed at interview.

SAMPLE

150 mothers of children aged 5 or younger who had been referred for extraction of teeth under general anaesthesia.

SETTING

Dental School, University of Wales College of Medicine.

RESULTS

27% of mothers recalled receiving advice from their dentist about dental care during their pregnancy. With regard to their child's oral health, 48% had received dietary advice and 31% oral hygiene advice from the same source. All children lived in areas with suboptimal water fluoride levels; 27% of mothers had been advised by their dentist to give their child fluoride supplements. Few of the mothers recalled receiving advice about oral health from their health visitor.

Correlation of body mass index with thoracic and abdominal panniculus

Obesity can play a significant role in chronic diseases, sudden unexpected death, and morbid obesity may be important as a cause of death for forensic pathologists. Our study attempted to determine if there is a correlation between panniculus measurements and body mass index (BMI) since BMI has been used in most studies to categorize obesity. Using data obtained from a review of 524 adult autopsies conducted at the University of Michigan from 1990 to 1992 we were able to show a correlation between both thoracic and abdominal panniculus and BMI (r2 = 0.335 and 0.296 respectively) which is statistically significant (p = 10(-47) and 10(-41) respectively). A prospective study confirmed the correlation (r2 = 0.552 for thoracic and 0.436 for abdominal panniculus) when the measurements were taken at the xyphoid process and 3 cm below the umbilicus. Using these data we calculated a panniculus index (PI) which is equal to the thoracic + abdominal panniculus in centimeters divided by the square of the height (in meters). The PI strongly correlated with BMI and was able to predict obesity. Using a BMI cutoff of 39 for morbid obesity, a PI value of 4.07 for females and 3.25 for males predicted morbid obesity with the probability of a false positive less than or equal to 2.5%. Mild and severe obesity could also be determined using the PI. Based on these data we've concluded that a concise mathematical relationship does exist between BMI and panniculus measurements. Therefore panniculus measurements can be used either as a surrogate measurement of morbid obesity or to support BMI calculations.

HIV vaccine acceptance among heterosexual clients of a sexually transmitted diseases clinic

We evaluated the willingness of clients at a large urban sexually transmitted diseases (STD) clinic in the southeastern United States to participate in future trials of preventive vaccines for HIV type 1 (HIV-1). A single trained interviewer administered an oral survey instrument to STD clinic clients over a 4-week enrollment period. The participants were 167 randomly selected clients (90 men and 77 women), most of whom were young, African-American heterosexuals. Risk behaviors for HIV-1 infection were highly prevalent. Overall, 67% of clients expressed willingness to consider participation in an HIV-1 vaccine trial. By univariate analysis, prior HIV-1 testing was significantly associated with willingness to participate (P = 0.04). Multivariate analysis revealed that female gender (P = 0.05) and prior HIV-1 testing (P = 0.03) were significant predictors of willingness to participate.