Characteristics and clinical predictors of minor head injury in children presenting to two Malaysian accident and emergency departments

INTRODUCTION

Paediatric minor head injuries (MHI) are just as common in both bigger and smaller towns in Malaysia. Urban-based MHI are due more to motor vehicular injuries compared to rural-based MHI which are mainly due to non-motor vehicular injuries. The main objectives of this study were to compare incidence of admitted patients to accident and emergency departments of hospitals in two different settings in Malaysia, namely: Ipoh (urban-based) and Kota Bharu (rural-based); and to correlate to demographical characteristics, types of accident, clinical signs and symptoms, radiological and computed tomography (CT) findings, management; and finally, to determine clinical predictors of intracranial injury in MHI.

METHODS

A cross-sectional study of 153 paediatric patients aged 2-18 years who were admitted to the Ipoh Hospital, Perak and 112 patients of the same age group admitted to Hospital Universiti Sains Malaysia, Kelantan were included in this study. The study period was between 1 January 1998 and 31 December 2001. Data collection was done prospectively. Chi-square and independent t-tests were applied to compare characteristics of patients admitted to these two hospitals. Backward stepwise multiple logistic regression was applied to determine clinical predictors of intracranial injury.

RESULTS

There were significant differences of age, race, types of accidents, clinical signs and symptoms, Glasgow coma scale (GCS), skull fracture and CT findings between two hospitals. Significant clinical predictors were headache (OR 20.8, 95 percent CI 3.9-25.2, p-value is less than 0.001), unequal pupils (OR 8.4, 95 percent CI 4.3-17.9, p-value is equal to 0.0413) and GCS score of 13 (OR =3.8, 95 percent CI 1.9-6.8, p-value is equal to 0.005). Skull fractures and intracranial injuries were more common in Kota Bharu due to children riding motorcycles without helmets than in Ipoh (p-value is less than 0.001).

CONCLUSION

In the rural Malaysian community, both the police and physicians must be alerted to the fact that unhelmeted children riding motorcycles are more likely to sustain morbidity than those in urban areas. More aggressive traffic policing of the village roads should be done by the relevant authorities.

Phase II trial of Oxaliplatin and 5-Fluorouracil/Leucovorin combination in epithelial ovarian carcinoma relapsing within 2 years of platinum-based therapy

OBJECTIVE

To evaluate the efficacy and toxicity of Oxaliplatin and 5-Fluorouracil (5-FU)/Leucovorin (LV) combination in ovarian cancer relapsing within 2 years of prior platinum-based chemotherapy in a phase II trial.

METHODS

Eligible patients had at least one prior platinum-based chemotherapy regimen, elevated CA-125 > or = 60 IU/l, radiological evidence of disease progression and adequate hepatic, renal and bone marrow function. Patients with raised CA-125 levels alone as marker of disease relapse were not eligible. Oxaliplatin (85 mg/m(2)) was given on day 1, and 5-Fluorouracil (370 mg/m(2)) and Leucovorin (30 mg) was given on days 1 and 8 of a 14-day cycle.

RESULTS

Twenty-seven patients were enrolled. The median age was 57 years (range 42-74 years). The median platinum-free interval (PFI) was 5 months (range 0-17 months) with only 30% of patients being platinum sensitive (PFI > 6 months). Six patients (22%) had two prior regimens of chemotherapy. A total of 191 cycles were administered (median 7; range 2-12). All patients were evaluable for toxicity. The following grade 3/4 toxicities were noted: anemia 4%; neutropenia 15%; thrombocytopenia 11%; neurotoxicity 8%; lethargy 4%; diarrhea 4%; hypokalemia 11%; hypomagnesemia 11%. Among 27 enrolled patients, 20 patients were evaluable for response by WHO criteria and 25 patients were evaluable by Rustin's CA-125 criteria. The overall response rate (RR) by WHO criteria was 30% (95% CI: 15- 52) [three complete responses (CRs) and three partial responses (PRs)]. The CA-125 response rate was 56% (95% CI: 37-73). Significantly, a 25% (95% CI: 9-53) radiological and a 50% (95% CI: 28-72) CA-125 response rate were noted in platinum resistant patients (PFI < 6 months). The median response duration was 4 months (range 3-12) and the median overall survival was 10 months.

CONCLUSION

Oxaliplatin and 5-Fluorouracil/Leucovorin combination has a good safety profile and is active in platinum-pretreated advanced epithelial ovarian cancer.

Spinal cord infarction secondary to intervertebral foraminal disease

STUDY DESIGN

The 5 year review of patients referred to one center.

OBJECTIVE

To report spinal cord infarction secondary to vascular occlusion from disease in a lower thoracic intervertebral foramen.

METHOD

The clinical and imaging findings of two cases with acute spinal cord dysfunction are presented.

SETTING

Midlands Centre for Spinal Injuries, England.

RESULTS

The CT and MR imaging features revealed lower thoracic unilateral foraminal occlusion due to acute facet joint septic arthritis in a diabetic patient, and secondary to chronic hypertrophic osteophytes in a second hypertensive individual. The presumed mechanism of infarction was occlusion of the artery of Adamkiewicz.

CONCLUSION

Foraminal disease in the lower thoracic levels needs to be entertained in cases of unexplained nontraumatic acute spinal cord dysfunction.

Micronutrients and its correlation with mental performance among schoolchildren in Bario, Sarawak: a preliminary study

Children who are born in a community with insufficient micronutrients, particularly iodine in remote rural areas are associated with low intellectual functions and mental retardation. The aim of this cross-sectional study is to determine the mental performance of the schoolchildren in Bario, a highland settlement of the Kelabit people in the district of Baram, Sarawak and to determine its correlation with the availability of iodine in the environment, as well as other micronutrients such as selenium, copper and manganese. A total of 25 schoolchildren in Bario age ranging from 7 to 12 years old participated in the study. Mental performance of the schoolchildren were tested using TONI-2 (Test of Nonverbal Intelligence--second edition), a cognitive ability measures with a response format which eliminates language and reduces motoric and cultural factors. The iodine levels from several wells, soils and salt found in Bario were determined using HPLC (software version 3.05.01) whilst serum levels of selenium, copper and manganese were measured using Graphite Furnace Atomic Absorption Spectrophotometer (GFAAS). The results showed that the median and mode scores of intelligence quotient for Bario were 82 and 75, respectively, whilst median and mode scores of intelligence percentile were 11.0 and 5.0, respectively. The maximum score achieved were at the average level with the quotient score between 90-110. It was found that salt produced from one of the wells in Bario contained high quantity of iodine. Based on standards established by the Trace Elements Laboratory, Roben Institute, University of Surrey, United Kingdom, schoolchildren in Bario are having sufficient blood levels of copper and a high selenium and manganese levels. Despite the remoteness of the study area, the schoolchildren in Bario, Sarawak showed higher mental performance compared to other isolated areas. This is probably correlated with the high micronutrients availability, particularly iodine, found naturally in Bario.

Immunopathogenesis of attenuated strain of chicken infectious anemia virus in one-day-old specific-pathogen-free chicks

In the present study, the immunopathogenicity of chicken anemia virus (CAV) vaccinal strain was studied in one-day-old specific-pathogen-free (SPF) chicks. Hematocrit values, histopathological changes in haemopioetic and lymphoid organs, ELISA for CAV antibodies and PCR for CAV genome were used as testing assays for the study. Vaccinated chicks showed signs of anemia, lower hematocrit values and histopathological lesions in liver in the form of hepatocytes swelling to Centro lobular necrosis and apoptosis. Histopathology change in spleen (depletion of lymphocytes and apoptosis) and thymus (depletion of thymocytes and apoptosis) together with variable degrees of seroconversion rate were observed along the 10 weeks of the experiment indicating 2 waves of immune response in vaccinated chicks compared to the control non-vaccinated group. Detection of CAV-DNA in the liver of vaccinated chicks indicated the presence of the virus, when the antibody levels were decreased in some chicks. There was a consistent correlation between the 4 parameters used. It is concluded that the attenuated CAV vaccine strain induces anemia and lesions in the lymphoid organs. The histopathology and PCR are useful tools for evaluation and quality assurance of CAV vaccines.

The Suicidal Behaviors Questionnaire-Revised (SBQ-R): validation with clinical and nonclinical samples

Past suicidal behaviors including ideation and attempts have been identified as significant risk factors for subsequent suicidal behavior. However, inadequate attention has been given to the development or validation of measures of past suicidal behavior. The present study examined the reliability and validity of a brief self-report measure of past suicidal behavior, the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Participants included psychiatric inpatient adolescents, high school students, psychiatric inpatient adults, and undergraduates. Logistic regression analyses provided empirical support for the usefulness of the SBQ-R as a risk measure of suicide to differentiate between suicide-risk and nonsuicidal study participants. Receiver operating characteristic (ROC) analyses indicated that the most useful cutoff scores on the SBQ-R were 7 for nonsuicidal samples, and 8 for clinical samples. Both the single SBQ-R Item 1 and SBQ-R total scores are recommended for use in clinical and nonclinical settings.

Development and initial validation of the Self-harm Behavior Questionnaire

Evaluation of suicide-related behaviors and thoughts about suicide with a newly developed self-report instrument is described. The Self-Harm Behavior Questionnaire (SHBQ; Gutierrez, 1998) generates detailed clinical information from an easy to administer and score self-report form. A sample of 342 participants were drawn from university undergraduate students enrolled in various psychology courses. Participants were then divided into a severe suicidal ideation group (n = 20) and a nonsuicidal control group (n = 20) to conduct subgroup and criterion-related validity analyses. Preliminary analyses indicate this new questionnaire is both valid and reliable when used with young adults drawn from a nonclinical population. The questionnaire should be of use to both clinicians and researchers due to the flexibility of the data generated.

Assessment of suicidal ideation in young men and women: the incremental validity of the MMPI-2 content scales

This study of 139 women and 75 men investigated the incremental validity of the MMPI-2 in assessing suicidal ideation by examining the unique contribution of the 15 content scales beyond what is provided by the 13 basic validity and clinical scales. A multivariate analysis of variance resulted in a significant difference on the validity, clinical, and content scales for young men and women. Women scored significantly higher than men on the Hypochondriasis, Depression, Conversion Hysteria, and Masculinity-Femininity scales and lower than men on the Hypomania, Fears, Anger, and Type A scales. The results of the hierarchical regression analyses indicated that for women, hopelessness and reasons for living; the Correction, Paranoia, Conversion Hysteria, Psychopathic Deviate, and Hypomania scales; and the Anger content scale contributed significantly to the prediction of suicidal ideation. For men, hopelessness, the Lie and Hypomania scales, and the Type A content scale contributed significantly to the prediction of suicidal ideation. Thus, it would appear that a different pattern of concerns and difficulties are manifested in young men and women related to suicidal ideation. Limitations of the present study and future directions for research are discussed.

Factor structure and psychometric properties of the brief Mizes Anorectic Cognitions questionnaire

The Mizes Anorectic Cognitions-Revised (MAC-R) questionnaire is a 24-item self-report instrument designed to assess cognitions associated with anorexia and bulimia nervosa. We examined the factor structure and psychometric properties of the MAC-R in a sample of 290 undergraduates. We found that a brief 3-factor oblique model (composed of 12 items) of the MAC-R provided acceptable fit to the present sample data. This model was largely invariant across male and female participants. The brief version of the MAC-R (the BMAC) and subscale scores correlated significantly with scores from related measures of eating disorders, showing evidence of concurrent validity. The BMAC total and subscales also showed evidence of discriminant validity by differentiating between empirically defined subclinical eating disorders and control participants. Both logistic regression and discriminant function analyses showed that only the self-control and self-esteem subscale was most useful in distinguishing between the subgroups.

Evaluation of Schistosoma mansoni retinoid X receptor (SmRXR1 and SmRXR2) activity and tissue distribution

Recently, we reported the identification of cDNA's encoding retinoid X receptor (RXR) homologues in Schistosoma mansoni. RXRs are known to be involved in the regulation of genes important for homeostasis and development. Previous studies indicated that SmRXR1 plays a role in the regulation of the female-specific gene, p14. Herein, we report that SmRXR2 also binds to cis-elements present in the p14 upstream region when evaluated in yeast reporter strains. SmRXR2 shows a pattern of recognition of cis-sequences present in the p14 gene upstream region different than SmRXR1. However, the SmRXR2 C (DNA binding) domain binds promiscuously in electrophoretic mobility shift assays to cis-elements of the p14 upstream region. The SmRXRs differ in their ability to activate transcription. The N-terminal A/B domain of SmRXR1 is necessary and sufficient for autonomous transcription activation function (AF) in yeast. SmRXR2 does not exhibit an equivalent autonomous AF. SmRXR1 and SmRXR2 fail to dimerize when investigated both in the yeast two-hybrid system and in immunoprecipitation experiments. In situ hybridization experiments using paraffin sections of adult worms demonstrate that SmRXR1 and SmRXR2 exhibit both common and unique cell type distribution which indicates that SmRXR1 and SmRXR2 both play a role in regulating gene expression in certain cells, yet each plays a distinct role in modulating the expression of genes in other cell types. Both SmRXR1 and SmRXR2 localize to vitelline cells. These studies provide a solid basis for improving our understanding of RXRs and their importance in female-specific gene regulation.

The multi-attitude suicide tendency scale: further validation with adolescent psychiatric inpatients

The present study was designed to examine the construct validity and psychometric properties of the Multi-Attitude Suicide Tendency Scale in adolescent psychiatric inpatients. This new scale has four subscales: attraction to life, repulsion by life, attraction to death, and repulsion by death. Confirmatory factor analysis of the scale items provided support for the fit of the 28-item, four-factor model. Results of logistic regression analyses revealed that high scores on the repulsion by life and the attraction to death subscales were useful in assessing the risk for suicide attempts. Results of the hierarchical regression analysis showed that high repulsion by life and low attraction to life subscale scores contributed to the prediction of scores on the suicide probability scale. We also examined gender differences on the four subscales and the psychological correlates of each subscale.

Identification and characterization of a Smad2 homologue from Schistosoma mansoni, a transforming growth factor-beta signal transducer

Smad proteins are essential intracellular signal transducers of the transforming growth factor-beta (TGF-beta) superfamily. The TGF-beta superfamily signals through phosphorylation and activation of R-Smad proteins, receptor-regulated Smads, by heteromeric complexes of ligand-specific type I and type II serine/threonine kinase receptors. R-Smads receive a signal from the activated receptor complex and transmit it to the nucleus. A cDNA was isolated that encodes a 649-amino acid protein found to be homologous to members of R-Smad subfamily with highest homology scored to clawed African frog and human Smad2. The Schistosoma mansoni homologue (SmSmad2) was overexpressed in bacteria as a Sj26-GST fusion protein and used to raise specific antibodies. The IgG fraction of the immunized rabbit serum identified 70- and 72-kDa protein bands in Western analysis of schistosome extracts. Treatment with alkaline phosphatase removed the 72-kDa band, which indicates that this band represents the phosphorylated form of schistosome Smad2. SmSmad2 was localized in the subtegument, parenchymal cells, and sex organs in both male and female worm cryosections. Similar results were also obtained from the analysis of the Smad2 mRNA distribution pattern revealed by in situ hybridization of adult worm pair paraffin sections. SmSmad2 mRNA levels were determined by reverse transcriptase-polymerase chain reaction in different mammalian host developmental stages and found to be constitutively expressed. SmSmad2 was also found to interact with a previously identified SmTbetaR-I, a serine/threonine type I kinase receptor. Furthermore, SmSmad2 was shown to undergo phosphorylation by constitutively active forms of SmTbetaR-I in vitro. In addition, SmSmad2 localized in the nuclei of mink lung epithelial cells upon treatment with TGF-beta(1). These data indicate that the SmSmad2 responds to the TGF-beta signals by interaction with receptor I, which phosphorylates it, whereupon it translocates into the nucleus presumably to regulate target gene transcription and consequently elicit a specific TGF-beta effect.

Alphafetoprotein in screening for congenital hypothyroidism

This study was conducted on 500 full-term neonates and 25 older patients with congenital hypothyroidism [CH], newly or previously diagnosed. Alphafetoprotein [AFP] was elevated in two neonates. In one, persistent elevation of AFP and thyroid stimulating hormone [TSH] with low thyroxine [T4] were found [congenital hypothyroidism]. In the other, AFP, TSH and T4 levels normalized [transient hypothyroidism]. The mean AFP level in new CH patients was significantly higher than in previously diagnosed patients, and was higher in CH patients than in controls. Significant relationships were found between AFP and T4, AFP and TSH, and AFP and age. AFP is a sensitive indicator of thyroid status and can be used as a screening test for hypothyroidism from the first day of life and in follow-up of CH patients.

Development and psychometric properties of the Student Worry Questionnaire-30

Described are the development and initial psychometric properties (Ns = 50 and 188) of a self-report measure, the Student Worry Questionnaire-30, for use with college undergraduates. Exploratory principal components analyses (Ns = 388, 350, and 396) with oblimin rotation indicated six domains of worrisome thinking, financial-related concerns, significant others' well-being, social adequacy concerns, academic concerns, and general anxiety symptoms. The total score and scale scores showed internal consistency of .80 to .94. Also, test-retest reliability analyses (.75 to .80) support consistency of responses over 4 wk. Strong evidence for convergent validity) was indicated. Confirmatory factor analysis confirmed the fit of the 6-factor oblique model. Limitations of the present studies, and directions for research are discussed.

Alphafetoprotein in screening for congenital hypothyroidism

This study was conducted on 500 full-term neonates and 25 older patients with congenital hypothyroidism (CH), newly or previously diagnosed. Alphafetoprotein (AFP) was elevated in two neonates. In one, persistent elevation of AFP and thyroid stimulating hormone (TSH) with low thyroxine (T4) were found (congenital hypothyroidism). In the other, AFP, TSH and T4 levels normalized (transient hypothyroidism). The mean AFP level in new CH patients was significantly higher than in previously diagnosed patients, and was higher in CH patients than in controls. Significant relationships were found between AFP and T4, AFP and TSH, and AFP and age. AFP is a sensitive indicator of thyroid status and can be used as a screening test for hypothyroidism from the first day of life and in follow-up of CH patients.

Identification and functional characterization of a member of the PUR-alpha family from Schistosoma mansoni

Schistosoma mansoni p14 gene encodes an eggshell precursor that is expressed only in vitelline cells of mature female worms in response to a male stimulus. The upstream region of the p14 gene contains several potential cis-acting regulatory sequences. We used the upstream region of the p14 gene as bait in a yeast-one-hybrid screen of a S. mansoni cDNA library to identify interacting proteins. We report the identification and characterization of a cDNA (S. mansoni PUR-alpha (SmPUR-alpha)) encoding a protein homologous to single-stranded DNA transcription activator PUR-alpha, that binds to the p14 upstream region and activates transcription of the HIS3 reporter gene in yeast. SmPUR-alpha has a predicted molecular mass of 30 kDa and shares an overall homology of 63% with mammalian PUR-alpha. The DNA binding domain of SmPUR-alpha is highly conserved. We show by gel shift assays that GST-SmPUR-alpha binds to oligonucleotides comprising the p14 upstream region. SmPUR-alpha binds preferentially to single-stranded DNA and also binds RNA. Unlike the mammalian homologue, SmPUR-alpha exhibits little specificity for the PUR element GGn, but shows strong preference for a sequence containing alternating pyrimidines. Our data support that SmPUR-alpha is a single-copy gene and through reverse transcriptase-polymerase chain reaction and in situ hybridization, we show that SmPUR-alpha is constitutively transcribed in many cell types and thus likely plays a role as a general transcription activator in schistosomes.

The Pain Catastrophizing Scale: further psychometric evaluation with adult samples

Previous studies with undergraduates have provided support for the reliability and oblique three-factor structure of a new scale, the Pain Catastrophizing Scale (PCS). We examined the reliability and validity of the PCS in adult community and pain outpatient samples. The PCS showed a high internal consistency in both groups. Using data from the community sample, confirmatory factor analyses showed that the PCS taps a single construct characterized by three related dimensions. Gender differences were obtained on the PCS total score in the community and the outpatient samples. The analyses also showed significant differences between the community and the outpatient samples on the PCS total and subscales. Overall, the results showed strong evidence of criterion-related, concurrent, and discriminant validity for the PCS in the community sample. Limitations of the present study are discussed.

Risk factors for eye complications in patients with diabetes mellitus: development and progression

A multicentre case-control study was conducted to identify and quantify risk factors that may influence the development and progression of diabetic retinopathy. A total of 200 diabetic patients with nonproliferative retinopathy were compared with 400 diabetic patients without any eye complications with regard to the development of diabetic retinopathy. They were also compared with 200 diabetic patients with major eye complications to study the progression of diabetic eye complications. Results showed that the progression of diabetic eye complications was preventable since all the variables significantly affecting the process of progression, except type of diabetes, were avoidable

Schistosoma mansoni phosphoenolpyruvate carboxykinase, a novel egg antigen: immunological properties of the recombinant protein and identification of a T-cell epitope

In schistosomiasis mansoni, hepatic granulomatous inflammation surrounding parasite eggs is mediated by CD4(+) T helper (Th) cells sensitized to schistosomal egg antigens (SEA). We previously showed that a prominent lymphoproliferative response of CD4(+) Th cells from schistosome-infected C57BL/6 (BL/6) mice was directed against a 62-kDa component of SEA. A partial amino acid sequence of the 62-kDa component was found to be identical with one present in the enzyme phosphoenolpyruvate carboxykinase (PEPCK). Based on this sequence, a cDNA clone containing the entire coding region of PEPCK was identified, and the full recombinant Schistosoma mansoni PEPCK (rSm-PEPCK) of 626 amino acids was purified from a prokaryotic expression system. rSm-PEPCK strongly stimulated a specific T-cell hybridoma, 4E6, as well as CD4(+) Th cells from SEA-immunized BL/6 mice and from infected BL/6, CBA, and BALB/c mice. In the infected mice, rSm-PEPCK elicited significant gamma interferon production as well as, to a lesser extent, production of interleukin-2 and -5. In BL/6 and BALB/c mice, the CD4(+) Th cell response to rSm-PEPCK was greater than that directed against the egg antigen Sm-p40; conversely, CBA mice responded better to Sm-p40 than to Sm-PEPCK. A 12-amino-acid region (residues 398 to 409: DKSKDPKAHPNS) was demonstrated to contain a T-cell epitope; synthetic peptides containing this epitope significantly stimulated specific hybridoma 4E6 and polyclonal CD4(+) Th cells. The identification and characterization of immunogenic egg components will contribute to the understanding and possible control of T-cell-mediated schistosomal disease.

Why young people do not kill themselves: the reasons for living inventory for adolescents

Assessed the reliability, validity, and predictive power of a new measure, the Reasons for Living Inventory for Adolescents (RFL-A; Osman et al., 1998). A group of 206 (101 boys and 105 girls) adolescent psychiatric inpatients completed the RFL-A, Minnesota Multiphasic Personality Inventory for Adolescents (Butcher et al., 1992), and a packet of self-report measures. Additional information about the patients including diagnosis and suicide status were obtained from their medical records. It was determined that the RFL-A is a valid and reliable measure of adolescent suicide risk potential. Additionally, the RFL-A possesses better predictive power than the Beck Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974). A discussion of the clinical and research utility of the RFL-A is included along with suggestions for future research.