The use of a new logistic regression model for predicting the outcome of pregnancies of unknown location

BACKGROUND

The aim of this study was to generate and evaluate new logistic regression models from simple demographic and hormonal data to predict the outcome of pregnancies of unknown location (PULs).

METHODS

Data were collected prospectively from 185 consecutive women classified as having a PUL by transvaginal scan; blood was taken at presentation and 48 h later to measure serum progesterone and HCG. These women were followed-up until the outcome was established: an intrauterine pregnancy (IUP), an ectopic pregnancy (EP) or a failing PUL. Three multi-categorical logistic regression models were tested. M1 was based on the HCG ratio (rate of change in HCG over 48 h), M2 was based on the average progesterone level (the mean of the progesterone level at 0 and 48 h) and M3 was based on the patient's age.

RESULTS

A total of 102 failing PULs, 63 IUPs and 20 EPs were used in the training set to develop the new models. The best of these models, M3, gave a retrospective area under the receiver operating characteristic (ROC) curve of 0.984 for failing PUL, 0.995 for IUP and 0.920 for EP. All three models were tested prospectively on the test set of 196 cases. M1 outperformed M2 and M3 when tested prospectively. The area under the ROC curve (AUC) was 0.975 for failing PUL, 0.966 for IUP and 0.885 for EP. M1, for the detection of EP, had a sensitivity of 91.7%, a specificity of 84.2%, a positive likelihood ratio of 5.8, a positive predictive value of 27.5% and a negative predictive value of 99.4%.

CONCLUSIONS

The logistic regression model M1, can predict which PULs will become failing PULs, IUPs and, most importantly, EPs based on the patient's HCG ratio alone.

Epidemiology and Etiology of Intractable Epilepsy in Qatar

The medical records of 219 epileptic patients seen over a period of eight years were reviewed to determine the incidence and causes of intractable epilepsy amongst adults in Qatar: The incidence rate of hospital admission with uncontrolled epilepsy was calculated as 25per 100,000persons. Thirty-nine patients (18%) fulfilled the criteria for IE and the incidence of IE could be approximated at 4.5 per 100,000 persons. In the native Qatari population the approximated incidence of IE would be 1 in 100,000 persons per year, while in the expatriate population the rate would be 3.5 per 100,000 persons per year. The most common type of IE was idiopathic generalized epilepsy (75%) followed by symptomatic epilepsy (19%) and temporal lobe epilepsy (6%). To calculate the crude incidence of epilepsy in Qatar, the records were reviewed of 1217patients (aged 13-85 years) visiting the outpatient department or admitted to hospital because of a newly diagnosed epilepsy during the calendar year, 1st January-31st December 2001. These figures were extrapolated to an approximation of an incidence of 174 in 100,000 persons per year.

The presence of dental fluorosis in the permanent dentition in Doha

The main purpose of this study is to draw attention to the presence and the severity of dental fluorosis in Doha [Qatar] through the high level of registered cases of fluorosis found among the groups examined. Of 4800 people aged 8-50 years, 2654 [55.29%] had dental fluorosis of some degree. This problem urgently requires more studies throughout the country to provide an accurate assessment

The presence of dental fluorosis in the permanent dentition in Doha

The main purpose of this study is to draw attention to the presence and the severity of dental fluorosis in Doha (Qatar) through the high level of registered cases of fluorosis found among the groups examined. Of 4800 people aged 8-50 years, 2654 (55.29%) had dental fluorosis of some degree. This problem urgently requires more studies throughout the country to provide an accurate assessment.

Acetylcholinesterase and butyrylcholinesterase inhibitory activity of some Turkish medicinal plants

The chloroform:medianol (1:1) extracts of a number of the plant species belonging to eight families, namely Corydalis solida (L.) Swartz subsp. solida and Glaucium corniculatum (L.) J. H. Rudolph (Papaveraceae), Rhododendron ponticum L. subsp. ponticum and Rhododendron luteum Sweet. (Ericaceae), Buxus sempervirens L. (Buxaceae), Vicia faba L. (Fabaceae), Robinia pseudoacacia L. (Caeselpiniaceae), Tribulus terrestris L. and Zygophyllum fabago L. (Zygophyllaceae), Lycopodium clavatum L. (Lycopodiaceae), Fumaria vaillantii Lois., Fumaria capreolata L., Fumaria kralikii Jordan, Fumaria asepala Boiss., Fumaria densiflora DC., Fumaria flabellata L., Fumaria petteri Reichb. subsp. thuretii (Boiss.) Pugsley, Fumaria macrocarpa Boiss. ex Hausskn., Fumaria cilicica Hauskkn., Fumaria parviflora Lam. and Fumaria judaica Boiss. (Fumariaceae) were screened for their anticholinesterase activity on acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) enzymes by in vitro Ellman method at 10 microg/ml and 1 mg/ml concentrations. The extracts did not show any noticeable inhibitory activity against both of the enzymes at 10 microg/ml. The extracts of Rhododendron ponticum subsp. ponticum, Rhododendron luteum, Corydalis solida subsp. solida, Glaucium corniculatum, and Buxus sempervirens showed remarkable inhibitory activity above 50% inhibition rate on AChE at 1 mg/ml. Among them, Rhododendron ponticum subsp. ponticum, Corydalis solida subsp. solida and Buxus sempervirens were the most active extracts against BChE having 95.46 +/- 1.03%, 93.08 +/- 0.97%, and 93.45 +/- 0.88% inhibition rates, respectively. Among the extracts screened, all of the Fumaria extracts displayed highly potent inhibition against both of the enzymes at 1 mg/ml concentration compared to the standard.

Screening plant growth-promoting rhizobacteria for improving growth and yield of wheat

AIMS

Plant growth promoting rhizobacteria (PGPR) are commonly used as inoculants for improving the growth and yield of agricultural crops, however screening for the selection of effective PGPR strains is very critical. This study focuses on the screening of effective PGPR strains on the basis of their potential for in vitro auxin production and plant growth promoting activity under gnotobiotic conditions.

METHODS AND RESULTS

A large number of bacteria were isolated from the rhizosphere soil of wheat plants grown at different sites. Thirty isolates showing prolific growth on agar medium were selected and evaluated for their potential to produce auxins in vitro. Colorimetric analysis showed variable amount of auxins (ranging from 1.1 to 12.1 mg l-1) produced by the rhizobacteria in vitro and amendment of the culture media with l-tryptophan (l-TRP), further stimulated auxin biosynthesis (ranging from 1.8 to 24.8 mg l-1). HPLC analysis confirmed the presence of indole acetic acid (IAA) and indole acetamide (IAM) as the major auxins in the culture filtrates of these rhizobacteria. A series of laboratory experiments conducted on two cv. of wheat under gnotobiotic (axenic) conditions demonstrated increases in root elongation (up to 17.3%), root dry weight (up to 13.5%), shoot elongation (up to 37.7%) and shoot dry weight (up to 36.3%) of inoculated wheat seedlings. Linear positive correlation (r = 0.99) between in vitro auxin production and increase in growth parameters of inoculated seeds was found. Based upon auxin biosynthesis and growth-promoting activity, four isolates were selected and designated as plant growth-promoting rhizobacteria (PGPR). Auxin biosynthesis in sterilized vs nonsterilized soil inoculated with selected PGPR was also monitored that revealed superiority of the selected PGPR over indigenous microflora. Peat-based seed inoculation with selected PGPR isolates exhibited stimulatory effects on grain yields of tested wheat cv. in pot (up to 14.7% increase over control) and field experiments (up to 27.5% increase over control); however, the response varied with cv. and PGPR strains.

CONCLUSIONS

It was concluded that the strain, which produced the highest amount of auxins in nonsterilized soil, also caused maximum increase in growth and yield of both the wheat cv.

SIGNIFICANCE AND IMPACT OF STUDY

This study suggested that potential for auxin biosynthesis by rhizobacteria could be used as a tool for the screening of effective PGPR strains.

ATYPICAL PRESENTATION OF NEUROSYPHILIS

Abstract

Acetyl and butyrylcholinesterase-inhibiting triterpenoid alkaloids from Buxus papillosa

Three triterpenoid alkaloids, buxakashmiramine [(20S)-20-dimethylamino-4',6'-dimethoxy-5'-hydroxybenzoylamino-3beta-methyl-buxan-31-ol] (1), buxakarachiamine [(20S)-20-dimethylamino-2'-hydroxy-3beta-methyl-3'-methyl-butanoylamino-9,10-seco-buxa-9(11), 10(19)-dien-31-ol] (2) and buxahejramine [(20S)-20-dimethylamino-2'-hydroxy-3beta-methyl-3'-methyl-pentanoylamino-9,10-seco-buxa-9(11), 10(19)-dien-31-ol] (3) were isolated from the leaves of Buxus papillosa. Four known bases, cycloprotobuxine-C (4), cyclovirobuxeine-A (5), cyclomicrophylline-A (6) and semperviraminol (7) were isolated for the first time from this species. Their structures were established through extensive spectroscopic studies. Most of these compounds exhibited anticholinesterase activity.

Steroidal alkaloids from the leaves of Sarcococca coriacea of Nepalese origin

Two new steroidal alkaloids, (-)-vaganine D (1) [(20S)-20-(N,N-dimethylamino)-3 beta-(senecioylamino)-5 alpha-pregn-16-en-4 beta-yl acetate], and (+)-nepapakistamine A (2) [(20S)-20-(N-methylamino)-3 beta-(tigloylamino)-5 alpha-pregn-16-en-2 beta,4 beta-diacetate], were isolated from the leaves of Sarcococca coriacea. Their structures were elucidated on the basis of their spectral properties. Compounds 1 and 2 were found to be cholinesterase inhibitors.

A study of prevalence and comorbidity of depression in alcohol dependence

Depressive symptoms are wide spread in alcohol abusing patients of all ages and are much more common than diagnosable depressive disorder. Studies have reported that depression diagnosed in the current episode of alcoholism remits after two weeks of abstinence and detoxification from alcohol. Despite the high prevalence of depression in alcohol dependent individuals, the nature of the relationship between depressive disorder and alcohol abuse have been difficult to define. The present work was undertaken with the aim to study the prevalence and comorbidity of major depression in alcohol dependence. The sample comprised of 34 (32 males and 2 females) DSM-IV alcohol dependent patients admitted in the Psychiatry ward of T.U. Teaching Hospital, Kathmandu during one year study period. Diagnosis of major depressive episode was made according to DSMIV criteria. Severity of dependence on alcohol was assessed with the Severity of Alcohol Dependence Questionnaire and severity of depressive symptoms was rated on Hamilton Rating Scale for Depression. Repeat assessment was done on day 14. A high prevalence of major depression (41.7%) was found for the episode of drinking which led to hospitalization. However, within a few days of detoxification from alcohol, only few of them had depressive symptoms amounting to major depression (17.64%). There was no significant correlation between severity of alcohol dependence and depression. The findings suggest that the nature of depression found in those patients with alcohol dependence needs further exploration. It appears that clinicians exercise appropriate judgement in not prescribing antidepressant treatments for symptoms which may change within days, providing that alcohol is not consumed.

New norditerpenoid alkaloids from Aconitum falconeri

The roots of Aconitum falconeri have yielded two new norditerpenoid alkaloids, faleoconitine (1) and 3'-methoxyacoforestinine (2) along with the known compounds, karakoline, 3-hydroxy-2-methyl-4H-pyran-4-one, and 3,4-dimethoxymethylbenzoate, which have been isolated for the first time from this plant. The previously reported pseudaconitine (3) was also isolated. Compounds 1 and 3 were found to be moderate inhibitors of the enzyme acetylcholinesterase.

Early intervention to remove mesiodens and avoid orthodontic therapy

Recognition of dental anomalies is essential in determining appropriate treatment for each patient. Diagnosis and assessment of mesiodens are critical in avoiding complications such as blocking the eruption of the maxillary central incisors, cyst formation, and dilaceration of the permanent incisors. Collecting data for diagnostic criteria, utilizing diagnostic radiographs, and determining when to refer to a specialist are important steps in the treatment of mesiodens. Early diagnosis and timely intervention could reduce or eliminate the need for orthodontic treatment and prevent serious complications.

5-Azacytidine modulates gamma-glutamyltransferase and glutathione levels in two human prostatic adenocarcinoma cell lines

Two human prostate adenocarcinoma cell lines, LNCaP and PC-3, were used to study the effect of 5-azacytidine on GGT gene expression, via genomic DNA methylation, and GSH content. When the cells were treated with 5-azaC, the specific GGT activity increased in a dose and time-dependent manner and was accompanied by the elevation of intracellular glutathione content. Southern blot analysis of DNA digested with MspI or HpaII showed negative correlation between the methylation pattern of GGT DNA and GGT activity, either in control or 5-azaC treated cells. Reverse transcription-polymerase chain reaction (RT-PCR) analysis revealed that GGT mRNA types I are expressed and induced in a cell type-specific manner in control and 5-azacC treated cells respectively. Overall, our investigations suggest that DNA methylation and other mechanisms combine to regulate GGT gene expression in studied prostate adenocarcinoma derived cells.

Pelvic spleen masquerading as an ovarian neoplasm

A case of a 53-year-old perimenopausal woman who presented with an 18-month history of irregular vaginal bleeding is reported. Vaginal ultrasonography revealed a 10 x 7 cm pelvic mass with an increased blood flow. Her serum CA125 was within the normal range. At laparotomy a normal spleen was found within the pelvic cavity.

Serum lipids : new biological markers in depression ?

Several studies suggest that a low cholesterol concentration is associated with depression. The authors sought to determine whether an association exists between serum lipid concentrations and depression. 28 drug-naive patients of major depression diagnosed according to DSMlll- R criteria were included in the study and severity of depression was measured on Hamilton Rating Scale for Depression. Suicidal intent was assessed on Suicidal Intent Questionnaire. 28 normal healthy controls were selected and matched for age, sex and body-mass index with the depressives. Serum lipid estimations were done in each subject after 12 hours overnight fasting. The main finding of the study is that total serum cholesterol, serum triglycerides and serum LDL cholesterol are decreased while serum HDL cholesterol is increased in depression and these changes were more marked in depressed subjects with definite suicidal intent. On regression analysis, total serum cholesterol was the most important predictive variable of the severity of depression.

Active platelet 5-ht uptake in depressives treated with impramine and ect

Several studies have reported decreased platelet 5-HT uptake in patients of major depression. The present study was undertaken with the aim to study the active platelet 5-HT uptake in depressed patients and effect of treatment with imipramine/ECT on platelet 5-HT uptake in these patients. 30 patients of major depression and equal number of age and sex-matched controls were included in the study. The depressives received imipramine (N=15) or ECT (N=15). Pretreatment active platelet 5-HT uptake was lower in depressives. Treatment with imipramine resulted in significant decrease in 5-HT uptake while with ECT there was significant increase. The serotonergic mechanisms are discussed.

Ect and platelet 5ht uptake in major depression

Several studies have reported decreased platelet 5-HT uptake in patients of major depression. The mechanism of antidepressant action of ECT is not clear. The present work was undertaken with the aim to study the active platelet 5-HT uptake and the effect of ECT on it in patients of major depression. 15 patients of major depression (DSM-lll-R) and equal number of age and sex-matched controls were included in the study. Active platelet 5-HT uptake was determined before ECT, after a course of ECT and 7 days after last ECT. Platelet 5-HT uptake was. significantly lower in der essives than normal controls. After ECT treatment there was significant increase in 5-HT uptake which came down to pretreatment level after 1 week of last ECT. The effect of ECT on serotonergic system is discussed.

Obsessive - compulsive symptoms during clozapine treatment

Development of obsessive-compulsive symptoms during clozapine treatment in schizophrenics has been noted in few reports from west. In our cases, three schizophrenic patients resistant to typical antipsychotics developed obsessive-compulsive symptoms during clozapine treatment. Since clozapine is a potent 5-HT(2) receptor blocker, role of serotonergic systems in the development of obsessive-compulsive symptoms may be considered. It may be prudent to be vigilant for the emergence of obsessive-compulsive symptoms in all patients treated with clozapine.

Clinicoepidemiological features of adult leukemias in Pakistan

A total of 113 patients of leukemia, over 15 years of age, were seen in three different institutions from July, 1992 to June, 1994. There was an almost equal distribution of acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) (44 vs 43 cases respectively). Chronic lymphocytic leukemia (CLL) was the least common, accounting for 5% of all cases. Mean age in CLL was 59 years. Chronic myeloid leukemia (CML) was three times commoner than CLL with a younger age distribution (median age was 34 years). We conclude that the clinicoepidemiological features of adult leukemias differ considerably from that seen in the developed world. However, recruitment of patients needs to continue in order to define these features based on a larger patient population.

Treatment of acute and transient psychotic disorders with low and high doses of oral haloperidol

The apparent rationale for the popular use of high doses of neuroleptics in psychotic patients is to increase the degree and speed of therapeutic response .However, several recent reports have questioned these claims. The present study was undertaken with the aim to compare the efficacy of high and low oral doses of haloperidol in the treatment of acute and transient psychotic disorders. The sample comprised of forty patients of both sexes diagnosed as acute and transient psychotic disorder who were randomly assigned to high dose (20 mg/day) and low dose (5 mg /day) haloperidol groups with equal number of subjects (n=20) in both groups. Weekly assessment was done on Brief Psychiatric Rating Scale and Haloperidol Side-effects Check List (day 7, 14, 21, 28, 35 & 42). Both groups showed significant improvement in BPRS from baseline scores on all assessments. Comparison of the improvement rate in both study groups revealed no significant difference.

Mania in twins : a case report

A 19 year old patient presented with a first episode of mania. A year ago his twin brother had developed a similar illness. In the family, there was no other history of psychiatric disorders.