A year of rapid slide-culture in health centres: novelty wears off

Usage of rapid slide-culture for streptococci was observed in health centres one year after its introduction and first evaluation. The proportion of culture sore-throat patients returned to the original 55% level after an initial period of enthusiasm. The proportion of antibiotic prescriptions remained unchanged at 40%, and rationality of treatment did not increase. Doctors' decisions were based mostly on clinical assessment, while patients' opinions were unpopular decision aids. Evaluation of new tests should extend beyond specificity and sensitivity to their effect on diagnostic and treatment decisions in actual working environments. An observation done shortly after a method has been introduced may be biased by the enthusiasm for novelty, which could be called the "honey-moon effect".

Acid-base chemistry of vitamin B6 compounds in methanol

The enzymatic reactions involving pyridoxal 5'-phosphate (PLP) can be simulated in solutions; thus, this system forms a favorable model for understanding the requirements of the enzymatic catalysis. We have studied in methanol protonic equilibria of the imines formed between PLP or salicylaldehyde (SA) and various amino acids, using UV and NMR spectroscopy. A glass electrode and an operational pH* scale were used to control acidity. The first protonation of the phosphate of PLP imines can be detected by UV spectroscopy with pK* at 10.8, proved by [31P]-NMR. The second protonation of phosphate (pK* at 4.8) is accompanied by increased hydrolysis of the imines. The imines of aspartate deviate from the imines of nondicarboxylic amino acids indicating that the beta-carboxyl of aspartate is internally hydrogen-bonded. PLP-2-aminobutanol Schiff base does not show with [1H]-NMR at pH* 7 separate peaks for ketoenamine-enolimine tautomers even at -90 degrees C, SA-phenylalanine shows an unidentified absorption at 350-380 nm. This was tentatively assigned a trans structure.

Rapid throat-culture as diagnostic aid: ineffective in decreasing antibiotic prescriptions

An overnight slide-culture for the detection of group A streptococci was introduced in a Finnish health centre. The number of patients from whom a throat culture was obtained increased from 55% to 70% with the new method. Despite this increase, the prescribing habits of primary care physicians did not change. Treatment was in most cases (84-90% of those treated) still initiated before culture results were available, and antibacterial medication was discontinued only occasionally (1-3%). Physicians usually decided the treatment during the first consultation. These findings contradict earlier studies where prescriptions decreased during rapid culture. Use of throat cultures as diagnostic aid should be reconsidered, especially when more rapid methods now are available.

Low TSH-response to TRH in a former endemic goiter area

During 30 yr of iodine prophylaxis endemic goiter in school children had disappeared in the Savonlinna area which has been the location of continuous surveillance in the East of Finland. In adults goiter is still found to some extent especially in older people. The iodine intake has increased from about 50 to 300 micrograms per day during these yr and the thyroidal uptake of radioactive iodine has decreased from over 60% to between 20 and 30%. However, there is a significant difference in this regard between nongoitrous individuals and goiter patients. In the present study comprising only goiter patients it was found that the thyroidal uptake was significantly higher in the group of patients with a subnormal response to TRH. These patients also had larger goiters and more palpable thyroid nodules than those with a normal response to TRH. The mean age was significantly higher (60.3 yr) as compared to that in the group which had a TSH-response to TRH of greater than 20 mU/l, smaller glands and less thyroid nodules (45.1 yr). The data fit well with the reports on increasing autonomy with increasing age in nontoxic goiter.

General practice research from developing countries: health or medicine?

At the 11th WONCA conference in June 1986 13% of the first authors of presentations came from developing countries. Presentations from or about developing countries were analysed in an attempt to compare the external resources with those in industrial countries, and to find out how primary care physicians in the developing countries see themselves, their work and the health care system. Solo works were presented equally often from authors in industrial and developing countries, but groups from industrial countries were more often multidisciplinary and larger. Most studies from developing countries were done in urban surroundings. Half of the presentations studied material from primary health care, while 44% were oriented more narrowly toward medical care. Most of the techniques described were suitable for primary care. Teamwork and intersectoral collaboration were discussed in half of the studies coming from primary health care, while traditional medicine was mentioned only occasionally.

Colorimetric determination of beta-cyclodextrin: two assay modifications based on molecular complexation of phenolphtalein

The decolorization of phenolphtalein upon complexation to cyclodextrins was studied to measure beta-cyclodextrin concentrations. Several factors possibly affecting the self-life of the dye were tested. By making the assays in 0.1 M NaCO3 solution beta-cyclodextrin concentrations down to 6 microM (SNR = 2) could be determined while the practical assay range reached up to 0.06 mM. In this form the method was unaffected by acyclic oligosaccharides and directly applicable to cyclodextrin assays in complex starch hydrolyzates. The method was further modified to be used in a flow-injection analyzator and the results were comparable to those obtained by HPLC analyses after prepurification of the samples.

Multivariate prognostication in bacterial meningitis of childhood

A multivariate method for prognosticating the outcome of bacterial meningitis was computerized on the basis of initial clinical and laboratory data in 123 patients. The model, based on likelihood ratios, is simple and rapid. At the time of diagnosis, it predicted the outcome correctly in 104/123 cases (85%) in the basic group and in 67/98 independent controls (68%). The sensitivity of the method in predicting death or mild to severe neurological sequelae was 83% in both groups. The predictive value of a calculated good prognosis was 94% in the basic group and 97% in the control group, and that of a calculated poor prognosis was 63% and 26%, respectively. The predictive system can be used for rapid assessment of prognosis in individual patients and for comparisons between groups.

Further decrease in thyroidal uptake and disappearance of endemic goitre in children after 30 years of iodine prophylaxis in the east of Finland

Endemic goitre of moderate severity was mainly found in the east of Finland in the 1930's. Studies in the 1950's showed an average daily iodine intake of 65-70 micrograms in the west and 50-65 micrograms in the east of the country. The use of iodized salt was introduced in the late 1940's but added only 15 micrograms of iodine to the daily intake. In the late 1950's iodine prophylaxis was intensified and the use of salt containing 25 mg KI/kg was recommended. In 1978 about 95% of all household salt used in the Savonlinna area was iodized. This region in the east of Finland has been used as an area of surveillance and studies have been carried out there in 1959, 1969 and 1979. During this period the thyroidal uptake decreased from 67 to 23% in non-goitrous subjects and from 62 to 28% in goitre patients the difference between the two last figures being statistically significant. The goitre patients also had significantly higher serum thyroxine and triiodothyronine levels. During the same period the urinary excretion of stable 127I increased from 45 micrograms to about 250 micrograms a day. Concomitantly the goitre prevalence among school children has decreased. Having been in the early 1950's in most parts 15-30% it is generally now 1-4%. It seems that the iodine intake is now adequate and that the endemia is gradually subsiding.

The effect of intravenously administered Palerol and Litalgin on the contraction of the human gallbladder

One ampule of Palerol and one of Litalgin (combination preparations with vagolytic, smooth-muscle relaxing, and analgesic effects) were injected intravenously in a double-blind study in random order to 19 patients having a routine oral cholecystography. Palerol had a significant dilatation effect on the smooth muscle of the contracted gallbladder, but Litalgin only prevented further contraction caused by fatty meals. Side effects were minimal. Palerol seems to be useful in acute gallstone attacks.

Prazosin enhances the antihypertensive effects of beta-blockers during isometric and dynamic exercise

Eighteen hypertensive (WHO I-II) outpatients volunteering for an open comparative cross-over trial were treated with the non-selective beta-blocker sotalol (80 mg b.i.d.) the beta-selective atenolol (50 mg b.i.d.) alone and each in combination with prazosin (3-5 mg b.i.d.) for 4 to 8 weeks each in balanced order. The blood pressure (BP) and heart rate (HR) were measured sitting and standing as well as during relatively heavy dynamic (ergometer) and isometric (sustained handgrip) exercises. The four-week treatment with sotalol lowered the HR without much influence on the BP. Atenolol similarly lowered the HR but was somewhat more active on the BP. Both beta-blockers failed to modify the pressor responses to exercise significantly. The addition of prazosin to beta-blockers improved their efficacy. Lowered BP values were recorded during dynamic and even isometric work, partly due to lowered baseline BP levels. The side effects were generally mild, and no excessive hypotension was encountered. The results suggest that the antihypertensive combination of the vasodilator, prazosin, with moderate doses of beta-blockers may be valuable in helping patients to maintain lower blood pressures during daily physical stress.

Heart volume and physical fitness of parturients

One hundred and three primigravidae were studied to establish the correlation between physical fitness and heart volume. Twenty-three of the mothers were allocated at random to the exercise group and 21 to control group 1, between the 10th and 14th weeks of pregnancy. In addition, 59 mothers were allocated to control group 2, which was formed two weeks before term. The exercise group underwent a rather strenuous training programme during pregnancy. Physical fitness was measured by work tests on a bicycle ergometer two weeks before term. The heart volume was determined radiologically on the 6th day post partum. There was a positive correlation between physical fitness and the relative heart volume, which was greatest when physical fitness was measured by a method which takes the level of training into consideration. The relative heart volume of the exercise group was almost significantly greater than that of control group 1. The physical performance of the exercise group was very significantly greater than in the control groups. There was no significant correlation between either physical fitness or relative heart volume and the duration of pregnancy or the weight of newborn.