Genetic linkage of systemic lupus erythematosus with chromosome 11q14 (SLEH1) in African-American families stratified by a nucleolar antinuclear antibody pattern

Systemic lupus erythematosus (SLE) is an autoimmune disease with complex genetics. We evaluated pedigrees multiplex for SLE that had an affected with antinucleolar antibodies to increase the homogeneity for genetic linkage analysis. We found a significant linkage effect on chromosome 11q14 at marker D11S2002 in African-American Pedigrees. This effect produced a maximum LOD score of 5.62 using a dominant inheritance model with 95% penetrance in males and 99% penetrance in females. The results were supported by multipoint linkage analysis. Fine mapping of the region with two additional markers within 6 cM of D11S2002 further provided evidence of linkage in this region. Linkage at D11S2002, named SLEH1, was previously found in some of these same African-American pedigrees multiplex for SLE, but who were stratified by hemolytic anemia (Kelly et al, submitted). In conclusion, an important SLE susceptibility gene, SLEH1 at 11q14, is identified in African-Americans when stratifying pedigrees by antinucleolar autoantibodies.

Refractory heterotopic ossification with complications

BACKGROUND

Heterotopic ossification (HO) following spinal cord injury can lead to various complications, including venous thrombosis, autonomic dysreflexia, and pressure ulcers. We report refractory, complicated HO in a 19-year-old man with C8 incomplete tetraplegia. He first presented at 9 weeks postinjury with fever and swelling of his right leg. Ultrasound indicated a deep venous thrombosis (DVT). Persistent symptoms prompted triple-phase bone scan and magnetic resonance imaging (MRI), which revealed HO compressing the right external iliac vein and no evidence of DVT. The HO was complicated by hypercoagulability.

CLINICAL COURSE

The HO was refractory to oral indomethacin and etidronate; therefore, intravenous etidronate was instituted, resulting in only a transient decrease in alkaline phosphatase. Local irradiation of the right hip did not decrease the activity of HO. The patient was discharged on oral etidronate, indomethacin, and warfarin. This complicated case raises issues regarding early diagnosis and aggressive treatment of HO, as well as treatment of associated hypercoagulability.

Characterization and regulation of constitutive transport intermediates involved in trafficking from the trans-Golgi network

Transport vesicles or containers (TCs) mediate constitutive protein transport between the trans-Golgi network (TGN) and the plasma membrane. A key question is the nature and regulation of these transport containers or intermediates. We have used a trans-Golgi network resident, TGN38, to investigate TC formation. TGN38 is a recycling membrane glycoprotein that moves to the cell surface via constitutive membrane traffic and returns via the endosomal pathway. An in vitro assay to measure TC formation was devised using rat liver Golgi membranes, cytosolic factors and ATP. Transport intermediates containing TGN38 were produced and found to be smooth vesicles and tubules of up to 200 nm in length. These membrane-enclosed structures contain different constitutively secreted membrane glycoproteins, including molecules involved in immune functions such as MHC Class I and the polymeric Ig receptor, showing that these intermediates correspond to TCs that have been previously identified in vivo. Importantly, TC formation can be stimulated or inhibited by protein kinase and phosphatase inhibitors, showing regulation by intracellular signalling pathways.

A critical evaluation of current protocols for the follow-up of women treated for gynecological malignancies: a pilot study

This retrospective review was undertaken to determine the efficacy of routine follow-up in the detection and management of recurrent cancer. The case notes of all women attending a regional cancer center who were diagnosed with cancer in 1997 were reviewed. Of 81 new cancers followed up for a median of 42 months (range 36-48), 14 have recurred after curative treatment and there were six cases of persistent disease. The median number of clinic visits per patient was 3.5 (range 1-16). Eight recurrences (57.1%) were diagnosed at scheduled outpatient appointments, three (2 l.4%) presented to the general practitioner (GP), and three were seen as emergencies in hospital. Seventeen patients with persistent/recurrent disease have died and three are alive with disease. The median time from initial presentation to disease recurrence was 12 months (range 5-25) and the median time from recurrence to death was 5 months (range 1-20). The longest interval between onset of symptoms and diagnosis of recurrence (4 months) occurred in those presenting at scheduled outpatient clinics. This study demonstrates that the current follow-up protocol is associated with delays in diagnosing recurrence, because symptomatic patients postpone seeking help until their scheduled visit. We have therefore commenced a prospective study evaluating other models of follow-up.

Evidence for prebudding arrest of ER export in animal cell mitosis and its role in generating Golgi partitioning intermediates

During mitosis the interconnected Golgi complex of animal cells breaks down to produce both finely dispersed elements and discrete vesiculotubular structures. The endoplasmic reticulum (ER) plays a controversial role in generating these partitioning intermediates and here we highlight the importance of mitotic ER export arrest in this process. We show that experimental inhibition of ER export (by microinjecting dominant negative Sar1 mutant proteins) is sufficient to induce and maintain transformation of Golgi cisternae to vesiculotubular remnants during interphase and telophase, respectively. We also show that buds on the ER, ER exit sites and COPII vesicles are markedly depleted in mitotic cells and COPII components Sec23p, Sec24p, Sec13p and Sec31p redistribute into the cytosol, indicating ER export is inhibited at an early stage. Finally, we find a markedly uneven distribution of Golgi residents over residual exit sites of metaphase cells, consistent with tubulovesicular Golgi remnants arising by fragmentation rather than redistribution via the ER. Together, these results suggest selective recycling of Golgi residents, combined with prebudding cessation of ER export, induces transformation of Golgi cisternae to vesiculotubular remnants in mitotic cells. The vesiculotubular Golgi remnants, containing populations of slow or nonrecycling Golgi components, arise by fragmentation of a depleted Golgi ribbon independently from the ER.

A microbiological study of Papillon-Lefévre syndrome in two patients

AIM

To analyse the microflora of subgingival plaque from patients with Papillon-Lefévre syndrome (PLS), which is a very rare disease characterised by palmar-plantar hyperkeratosis with precocious periodontal destruction.

METHODS

Bacterial isolates were identified using a combination of commercial identification kits, traditional laboratory tests, and gas liquid chromatography. Some isolates were also subjected to partial 16S rDNA sequencing. Plaque samples were also assayed for the presence of Porphyromonas gingivalis, Prevotella intermedia, and Actinobacillus actinomycetemcomitans in a quantitative enzyme linked immunosorbent assay (ELISA) using monoclonal antibodies.

RESULTS

The culture results showed that most isolates were capnophilic and facultatively anaerobic species-mainly Capnocytophaga spp and Streptococcus spp. The latter included S. constellatus, S. oralis, and S. sanguis. Other facultative bacteria belonged to the genera gemella, kingella, leuconostoc, and stomatococcus. The aerobic bacteria isolated were species of neisseria and bacillus. Anaerobic species included Prevotella intermedia, P. melaninogenica, and P. nigrescens, as well as Peptostreptococcus spp. ELISA detected P gingivalis in one patient in all sites sampled, whereas A. actinomycetemcomitans was detected in only one site from the other patient. Prevotella intermedia was present in low numbers.

CONCLUSIONS

Patients with PLS have a very complex subgingival flora including recognised periodontal pathogens. However, no particular periodontopathogen is invariably associated with PLS.

A province-wide needs assessment of oncology health care professionals in psychosocial oncology

BACKGROUND

Oncology professionals still lack the knowledge and skills to provide effective psychosocial care. Continuing education (CE) aimed at addressing this lack may improve the provision of psychosocial care to patients and their families.

METHODS

The authors conducted a province-wide cross-sectional mail survey of oncology health care professionals [oncologists (MDs), nurses (RNs) and radiation therapists (RTs)] and assessed psychosocial orientation, self-assessed knowledge, and motivation to learn about psychosocial oncology. In addition, they sought factors that might influence professionals' willingness to attend CE programs.

RESULTS

In total, 241 surveys were completed and returned. Psychosocial orientation was highest in the RN subgroup. MDs rated their knowledge to deal with specific psychosocial issues higher than did RNs and RTs, while their motivation to learn more about providing psychosocial care was significantly lower. Seventy-three percent of respondents indicated that they would like CE in psychosocial oncology. Self-reported motivation to learn was the most significant factor associated with this interest.

CONCLUSION

These findings raise questions about perceived learning needs and aided in the development of an interprofessional curriculum in psychosocial oncology.

Can assessment of psychosocial orientation assist continuing education program development in psychosocial oncology?

BACKGROUND

A pilot study was designed to aid in the development of a formal, interdisciplinary curriculum in psychosocial oncology for front-line health care professionals.

METHOD

A 190-item questionnaire was distributed to psychosocial (PP) and non-psychosocial (NPP) oncology professionals attending a psychosocial skills workshop. A 38-item attitudinal survey of psychosocial orientation was used in an attempt to identify unperceived needs of the learners.

RESULTS

Of the 150 questionnaires distributed, 104 (69%) were completed and returned. Overall scores for satisfaction with the workshop were high, and significantly higher in the PP group. No interdisciplinary difference existed in the preferred learning formats for future events, and both groups preferred interactive, experiential forums for developing skills relevant to patient management. The two groups' perceived learning needs differed. NPPs wanted to focus on skills such as communication, counseling, crisis intervention, palliative care, and coping with life-threatening illness. The attitudinal survey results demonstrated a significant difference between the psychosocial orientations of PPs and NPPs and suggested that NPPs would benefit from: 1) information to correct misconceptions about patients' psychosocial needs and experiences, 2) demonstrations of how to overcome contextual barriers to the delivery of psychosocial care.

CONCLUSIONS

Front-line oncology professionals in many disciplines are interested in continuing education in psychosocial oncology. The attitudinal survey provided insight into unperceived learning needs that can help in designing future curricula. Its value as a tool to measure impact of these programs is worthy of future study.

Transgenic modeling of a cardiac troponin I mutation linked to familial hypertrophic cardiomyopathy

Multiple mutations in cardiac troponin I (cTnI) have been associated with familial hypertrophic cardiomyopathy. Two mutations are located in the cTnI inhibitory domain, a highly negatively charged region that alternately binds to either actin or troponin C, depending on the intracellular concentration of calcium. This region is critical to the inhibition of actin-myosin crossbridge formation when intracellular calcium is low. We modeled one of the inhibitory domain mutations, arginine145-->glycine (TnI(146Gly) in the mouse sequence), by cardiac-specific expression of the mutated protein in transgenic mice. Multiple lines were generated with varying degrees of expression to establish a dose relationship; the severity of phenotype could be correlated directly with transgene expression levels. Transgenic mice overexpressing wild-type cTnI were generated as controls and analyzed in parallel with the TnI(146Gly) animals. The control mice showed no abnormalities, indicating that the phenotype of TnI(146Gly) was not simply an artifact of transgenesis. In contrast, TnI(146Gly) mice showed cardiomyocyte disarray and interstitial fibrosis and suffered premature death. The functional alterations that seem to be responsible for the development of cardiac disease include increased skinned fiber sensitivity to calcium and, at the whole organ level, hypercontractility with diastolic dysfunction. Severely affected lines develop a pathology similar to human familial hypertrophic cardiomyopathy but within a dramatically shortened time frame. These data establish the causality of this mutation for cardiac disease, provide an animal model for understanding the resultant pathogenic structure-function relationships, and highlight the differences in phenotype severity of the troponin mutations between human and mouse hearts.

The manganese cation disrupts membrane dynamics along the secretory pathway

The endoplasmic reticulum and Golgi apparatus play key roles in regulating the folding, assembly, and transport of newly synthesized proteins along the secretory pathway. We find that the divalent cation manganese disrupts the Golgi apparatus and endoplasmic reticulum (ER). The Golgi apparatus is fragmented into smaller dispersed structures upon manganese treatment. Golgi residents, such as TGN46, beta1,4-galactosyltransferase, giantin, and GM130, are still segregated and partitioned correctly into smaller stacked fragments in manganese-treated cells. The mesh-like ER network is substantially affected and peripheral ER elements are collapsed. These effects are consistent with manganese-mediated inhibition of motor proteins that link membrane organelles along the secretory pathway to the cytoskeleton. This divalent cation thus represents a new tool for studying protein secretion and membrane dynamics along the secretory pathway.

Physical activity among African American and Latino middle school girls: consistent beliefs, expectations, and experiences across two sites

Physical inactivity is a major public health concern. Low levels of physical activity are reported in many subgroups of women including adolescent girls. More data are needed to better understand factors related to physical activity participation in adolescent girls. Therefore, we explored adolescent girls' reasons for participating and not participating in physical activity. Two independent samples were taken in California and Texas; the total sample included thirty-four African American and Latino girls. Six focus groups were conducted by trained facilitators. Based on independent qualitative analyses, six replicated themes emerged from the focus groups. Fun, social support, and concern with body image facilitated participation in activity. In contrast, negative experiences in physical education classes, concerns about appearance after activity, and lack of opportunity impeded participation in activity. Overall, the girls showed an interest in physical activity and identified activity motivators and barriers. We discuss the implications of our findings for future research.

Genetic manipulation of the rabbit heart via transgenesis

BACKGROUND

Transgenesis using cardiac-specific expression has been valuable in exploring cardiac structure-function relationships. To date, cardiac-selective studies have been confined to the mouse. However, the utility of the mouse is limited in certain, possibly critical, aspects with respect to cardiovascular function.

METHODS AND RESULTS

To establish the potential validity of transgenic methodology for remodeling a larger mammalian heart, we explored cardiac-selective expression in transgenic rabbits. The murine alpha- and beta-cardiac myosin heavy chain gene promoters were used to express a reporter gene, and transgene expression was quantified in cardiac, skeletal, and smooth muscles as well as in nonmuscle tissues. Although neither promoter exactly mimics endogenous patterns of myosin heavy chain expression, both are able to drive high levels of transgene expression in the cardiac compartment. Neither promoter is active in smooth muscle or nonmuscle tissues.

CONCLUSIONS

Directed organ-specific expression is feasible in a larger animal with existing reagents, and cardiac-selective transgenic manipulation is possible in the rabbit.

Muscle activities used by young and old adults when stepping to regain balance during a forward fall

The current study was undertaken to determine if age-related differences in muscle activities might relate to older adults being significantly less able than young adults to recover balance during a forward fall. Fourteen young and twelve older healthy males were released from forward leans of various magnitudes and asked to regain standing balance by taking a single forward step. Myoelectric signals were recorded from 12 lower extremity muscles and processed to compare the muscle activation patterns of young and older adults. Young adults successfully recovered from significantly larger leans than older adults using a single step (32.2 degrees vs. 23.5 degrees ). Muscular latency times, the time between release and activity onset, ranged from 73 to 114 ms with no significant age-related differences in the shortest muscular latency times. The overall response muscular activation patterns were similar for young and older adults. However older adults were slower to deactivate three stance leg muscles and also demonstrated delays in activating the step leg hip flexors and knee extensors prior to and during the swing phase. In the forward fall paradigm studied, age-differences in balance recovery performance do not seem due to slowness in response onset but may relate to differences in muscle activation timing during the stepping movement.

Loss-of-function mutations in the cathepsin C gene result in periodontal disease and palmoplantar keratosis

Papillon-Lefèvre syndrome, or keratosis palmoplantaris with periodontopathia (PLS, MIM 245000), is an autosomal recessive disorder that is mainly ascertained by dentists because of the severe periodontitis that afflicts patients. Both the deciduous and permanent dentitions are affected, resulting in premature tooth loss. Palmoplantar keratosis, varying from mild psoriasiform scaly skin to overt hyperkeratosis, typically develops within the first three years of life. Keratosis also affects other sites such as elbows and knees. Most PLS patients display both periodontitis and hyperkeratosis. Some patients have only palmoplantar keratosis or periodontitis, and in rare individuals the periodontitis is mild and of late onset. The PLS locus has been mapped to chromosome 11q14-q21 (refs 7, 8, 9). Using homozygosity mapping in eight small consanguineous families, we have narrowed the candidate region to a 1.2-cM interval between D11S4082 and D11S931. The gene (CTSC) encoding the lysosomal protease cathepsin C (or dipeptidyl aminopeptidase I) lies within this interval. We defined the genomic structure of CTSC and found mutations in all eight families. In two of these families we used a functional assay to demonstrate an almost total loss of cathepsin C activity in PLS patients and reduced activity in obligate carriers.

Working & breastfeeding: a contemporary workplace dilemma

The benefits of breastfeeding are well known and widely documented. What we are only beginning to understand is the significant impact of returning to work on the experience of breastfeeding. This article describes workplace issues, discusses current literature and examines the range of influences that impact on women's decisions about working and breastfeeding.

Ready for birth--but what about breastfeeding?

This paper examines and discusses a range of influences on the experience of breastfeeding. Primarily, the impact of antenatal education, the experience of labour, birth and postnatal problems on the initiation and duration of breastfeeding are discussed.

Transgenic over-expression of a motor protein at high levels results in severe cardiac pathology

Transgenesis has become a useful tool in effecting a complete or partial remodeling of the cardiac contractile apparatus. Although gene dosage effects were initially a concern, recent data showed that the heart is able to accommodate varying levels of transgenic over-expression without detectable ill effects. The present study was designed to test the limits of the transgenic paradigm in terms of the production of a cardiac phenotype due simply to the over-expression of a contractile protein. To this end, eight lines of mice which express an isoform of the essential myosin light chain 1 that is normally found in the adult ventricle (ELC1v) were generated. Overt phenotype was correlated both with the level of expression/protein replacement and copy number of the transgene. Two of the lines showed essentially complete replacement of the atrial isoform (ELC1a) with ELC1v. However, the phenotypes of the two lines differed dramatically. The line with the lower copy number (37 copies), and moderate over-expression (16 fold) showed no overt pathology while a line with very high copy number (94 copies) and extremely high levels of over-expression (27-50 fold) developed a significant atrial hypertrophy, dilation and cardiomyopathy. These data indicate that very high expression levels of a contractile protein can cause a cardiac pathology that is unrelated to its degree of replacement in the sarcomere and the unique role(s) it may assume in motor protein function.

Living with a cardioverter defibrillator in the community

Internal cardioverter defibrillators are increasingly used for the treatment of life threatening arrhythmias. Patients and their families have described many emotional and psychological consequences of living with these devices. The impact on family members of providing high levels of support can lead to stress-related problems, yet their needs are often underestimated or overlooked.

Prevalence of autoantibodies to ribosomal P proteins in juvenile-onset systemic lupus erythematosus compared with the adult disease

OBJECTIVE

To determine the prevalence of anti-ribosomal P (anti-P) proteins in several groups of patients with juvenile-onset systemic lupus erythematosus (SLE) in comparison with the prevalence in adult SLE.

METHODS

Serum samples were pooled together from 3 cohorts of patients with juvenile-onset SLE in 3 different medical centers and from a miscellaneous group of juvenile-onset SLE patients whose samples were sent by regional physicians. Sera were studied for the presence of anti-P using 2 assays: Western blot with ribosomes as antigen, and an enzyme-linked immunosorbent assay with the COOH-terminal 22 amino acids of the ribosomal P protein in a multiantigenic peptide format as antigen. Sera found positive by both tests were considered positive for anti-P antibodies. Findings from similar studies involving a large cohort of patients with adult-onset SLE from Oklahoma City were used for comparison.

RESULTS

The prevalence of anti-P antibodies in the pooled sample of juvenile-onset SLE sera was 45 of 108, or 42%, while in the adult cohort from Oklahoma City, 20 of 260, or 7.7%, were positive for anti-P (odds ratio [OR] 9.6, P < 10(-8) by Fisher's exact test). In addition, it was shown that 12 of 13 patients with both anti-P and anti-double-stranded DNA (anti-dsDNA) in the juvenile SLE cohort had nephritis, while only 8 of 22 patients without both antibodies were nephritic (OR 21.0, P < 10(-8)). It was also shown that in 9 illustrative cases, the levels of anti-P and anti-dsDNA antibodies usually varied together and in concordance with the clinical activity as measured by the SLE Disease Activity Index (SLEDAI). Finally, anti-P-positive and anti-P-negative patients had a similar prevalence of anti-dsDNA, anti-Ro/SSA, and anti-La/SSB antibodies, but patients with anti-P had a higher prevalence of anti-U1 RNP and anti-Sm (P = 0.041 and P = 0.0385, respectively, by Fisher's exact test).

CONCLUSION

Antibodies to ribosomal P protein are more prevalent in juvenile-onset SLE than in adult-onset SLE. Levels of antibodies to ribosomal P protein vary with the clinical disease activity as measured by the SLEDAI, often in concordance with the levels of anti-dsDNA. The presence of both anti-P and anti-dsDNA antibodies was powerfully associated with nephritis in the cohort of patients for whom comprehensive clinical and serologic data were available.

Perceiving and representing both health and the environment: an exploratory investigation

This article describes an exploratory study that examined the perceptions of both health and environment among men and women in higher and lower status areas in Hamilton, Canada. Situated in the literatures on health perceptions and environmental concerns, it not only describes health and environment perceptions, but also explores their interconnections, arguing that concern for self is more salient than that for any other, including environment, and that this salience is predicated on notions of control and responsibility. The article concludes by speculating on reasons for these findings by suggesting an empirically derived cultural model for representation of health-environment relations and the bases of information processing in this arena.

Caring for patients with an ICD

The internal cardioverter defibrillator corrects life-threatening arrhythmias by providing antitachycardia pacing, pacing for bradycardia, and cardioversion or defibrillation shocks. However, there is little warning that the device may fire, which can cause physical, social and psychological problems for the patient. Nurses caring for ICD patients in the community and in hospital need to know what it is like to live with this device, how it works and the implications for other treatments.

Association of a phosphatidylinositol-specific 3-kinase with a human trans-Golgi network resident protein

The eukaryotic trans-Golgi network (TGN) is a key site for the formation of transport vesicles destined for different intracellular compartments [1]. A key marker for the mammalian TGN is TGN38/46 [2]. This integral membrane glycoprotein cycles between the TGN and the cell surface and is implicated in recruitment of cytosolic factors and regulation of at least one type of vesicle formation at the mammalian TGN [2] [3]. In this study, we have identified a phosphatidylinositol (PtdIns)-specific 3-kinase activity associated with the human orthologue (TGN46), which is sensitive to lipid kinase inhibitors. Treatment of HeLa cells with low levels of these inhibitors reveals subtle morphological changes in TGN46-positive compartments. Our findings suggest a role for PtdIns 3-kinases and presumably for the product, PtdIns 3-phosphate (PtdIns3P), in the formation of secretory transport vesicles by mechanisms conserved in yeast and mammals.

Role of myelin basic protein and proteolipid protein genes in multiple sclerosis: single strand conformation polymorphism analysis of the human sequences

Susceptibility to multiple sclerosis (MS) is widely held to have a strong genetic component. While the identities of genes conferring susceptibility are currently unknown, possible candidates include those genes coding for proteins which function in central nervous system (CNS) myelin. Two such genes are the human myelin basic protein (MBP) and proteolipid protein (PLP) genes, whose products make up approximately 80% of the total protein in CNS myelin. The association of a variable number tandem repeat (VNTR) 5' to the human MBP gene with MS has been the subject of conflicting reports. Here we test the hypothesis that mutations in the human MBP and PLP genes might be associated with MS by examining the entire expressed sequence of both genes by single strand conformation polymorphism (SSCP) analysis, using a panel of 71 MS patients and 71 controls. We have also re-examined the VNTR region in patients and controls. Three base changes were found in the human PLP gene and nine base changes in the human MBP gene; these were essentially equally distributed between patients and controls. No preferential distribution of various alleles of the VNTR between patients and controls was found. Although intronic and regulatory regions have not been examined, it would appear unlikely that mutations in these genes coding for the two major CNS myelin proteins contribute significantly to genetic susceptibility to MS.

Molecular remodeling of cardiac contractile function

A number of techniques are now available that allow the contractile apparatus of the heart to be altered in a defined manner. This review focuses on those approaches that result in germ-line transmission of the remodeling event(s). Thus the desired modifications can be propagated stably throughout multiple generations and result in the creation of stable, new animal models. Necessarily, such stable changes need to be performed at the level of the genome, and two distinct but complementary approaches have been developed: transgenesis and gene targeting. Each results in the stable modification of the mammalian genome. Via gene targeting or gene ablation of sequences encoding various components of the sarcomere, the contractile apparatus of the heart can be altered dramatically. Ablating a gene may lead to a loss in function, which can help establish a function of the candidate sequence. Gene targeting can also be used to effect changes in the sequences encoding a functional domain of the contractile protein or at a single-amino acid residue, resulting in the establishment of precise structure-function relationships. With the use of transgenesis, the contractile apparatus of the heart can also be significantly remodeled. These approaches are rapidly creating a group of animals in which altered contractile protein complements will lead to a fundamental understanding of the structure-function relationships that underlie the function of the heart at the molecular, biochemical, whole organ, and whole animal levels.

Correlation of clinical and hematologic profiles with bone marrow responses in typhoid fever

Thirty-six adult patients with typhoid fever were studied. Severe, moderate, and mild typhoid fevers were observed in 17 (47.2%), 17 (47.2%), and two (5.6%) patients, respectively. Twenty-eight (77.8%) had either isolated anemia (i.e., anemia unaccompanied by other blood component cytopenias) or mixed cytopenias. Three patients (8.3%) had pancytopenia. Sixteen patients (44.5%) had either total or partial bone marrow suppression. In five (31.3%) with partial suppression, the effect of bone marrow suppression was not reflected in peripheral blood. Sixteen (48.5%) of 33 had peripheral blood cytopenias that were not accompanied by concurrent bone marrow suppression, suggesting a peripheral mechanism responsible for the blood dyscrasia in those cases. No patient had evidence of disseminated intravascular coagulopathy. There was no correlation between clinical severity of disease and bone marrow changes. Bone marrow/peripheral blood changes did not influence the outcome of the disease, since all the patients recovered fully after treatment.

Living on the edge--patients with an automatic internal cardioverter defibrillator (AICD): implications for nursing practice

Automatic internal cardioverter defibrillator (AICD) therapy is an expanding treatment option for patients experiencing sudden cardiac death events [Author: is this the correct term? It sounds as if they have in fact died. Could we say 'experiencing sudden, potentially fatal, cardiac events'?]. The paper outlines the background to the technique and the nursing care of such patients and their families. It recommends that future nursing research should focus on exploring the impact, on the patients and their families, of living with this device.