Measurement of the major ignored burden of multiple myeloma, pernicious anaemia and of other haematological conditions on partners and family members: A cross-sectional study

BACKGROUND

Having a haematological condition can adversely affect the quality of life (QoL) of family members/partners of patients. It is important to measure this often ignored burden in order to implement appropriate supportive interventions.

OBJECTIVE

To measure current impact of haematological conditions on the QoL of family members/partners of patients, using the Family Reported Outcome Measure-16 (FROM-16).

METHODS

A cross-sectional study, recruited online through patient support groups, involved UK family members/partners of people with haematological conditions completing the FROM-16.

RESULTS

183 family members/partners (mean age = 60.5 years, SD = 13.2; females = 62.8%) of patients (mean age = 64.1, SD = 12.8; females = 46.4%) with 12 haematological conditions completed the FROM-16. The FROM-16 mean total score was 14.0 (SD = 7.2), meaning 'a moderate effect on QoL'. The mean FROM-16 scores of family members of people with multiple myeloma (mean = 15.8, SD = 6.3, n = 99) and other haematological malignancies (mean = 13.9, SD = 7.8, n = 29) were higher than of people with pernicious anaemia (mean = 10.7, SD = 7.5, n = 47) and other non-malignant conditions (mean = 11, SD = 7.4, n = 56, p < .01). Over one third (36.1%, n = 183) of family members experienced a 'very large effect' (FROM-16 score>16) on their quality of life.

CONCLUSIONS

Haematological conditions, in particular those of malignant type, impact the QoL of family members/partners of patients. Healthcare professionals can now, using FROM-16, identify those most affected and should consider how to provide appropriate holistic support within routine practice.

Responsiveness and minimal important change of the Family Reported Outcome Measure (FROM-16)

BACKGROUND

The FROM-16 is a generic family quality of life (QoL) instrument that measures the QoL impact of patients' disease on their family members/partners. The study aimed to assess the responsiveness of FROM-16 to change and determine Minimal Important Change (MIC).

METHODS

Responsiveness and MIC for FROM-16 were assessed prospectively with patients and their family members recruited from outpatient departments of the University Hospital Wales and University Hospital Llandough, Cardiff, United Kingdom. Patients completed the EQ-5D-3L and a global severity question (GSQ) online at baseline and at 3-month follow-up. Family members completed FROM-16 at baseline and a Global Rating of Change (GRC) in addition to FROM-16 at follow-up. Responsiveness was assessed using the distribution-based (effect size-ES, standardized response mean -SRM) and anchor-based (area under the receiver operating characteristics curve ROC-AUC) approaches and by testing hypotheses on expected correlation strength between FROM-16 change score and patient assessment tools (GSQ and EQ-5D). Cohen's criteria were used for assessing ES. The AUC ≥ 0.7 was considered a good measure of responsiveness. MIC was calculated using anchor-based (ROC analysis and adjusted predictive modelling) and distribution methods based on standard deviation (SD) and standard error of the measurement (SEM).

RESULTS

Eighty-three patients with 15 different health conditions and their relatives completed baseline and follow-up questionnaires and were included in the responsiveness analysis. The mean FROM-16 change over 3 months = 1.43 (SD = 4.98). The mean patient EQ-5D change over 3 months = -0.059 (SD = 0.14). The responsiveness analysis showed that the FROM-16 was responsive to change (ES = 0.2, SRM = 0.3; p < 0.01). The ES and SRM of FROM-16 change score ranged from small (ES = 0.2; SRM = 0.3) for the distribution-based method to large (ES = 0.8, SRM = 0.85) for anchor-based methods. The AUC value was above 0.7, indicating good responsiveness. There was a significant positive correlation between the FROM-16 change scores and the patient's disease severity change scores (p < 0.001). The MIC analysis was based on data from 100 family members of 100 patients. The MIC value of 4 was suggested for FROM-16.

CONCLUSIONS

The results of this study confirm the longitudinal validity of FROM-16 which refers to the degree to which an instrument is able to measure change in the construct to be measured. The results yield a MIC value of 4 for FROM-16. These psychometric attributes of the FROM-16 instrument are useful in both clinical research as well as clinical practice.

Mapping of Family Reported Outcome Measure (FROM-16) scores to EQ-5D: algorithm to calculate utility values

OBJECTIVE

Although decision scientists and health economists encourage inclusion of family member/informal carer utility in health economic evaluation, there is a lack of suitable utility measures comparable to patient utility measures such those based on the EQ-5D. This study aims to predict EQ-5D-3L utility values from Family Reported Outcome Measure (FROM-16) scores, to allow the use of FROM-16 data in health economic evaluation when EQ-5D data is not available.

METHODS

Data from 4228 family members/partners of patients recruited to an online cross-sectional study through 58 UK-based patient support groups, three research support platforms and Welsh social services departments were randomly divided five times into two groups, to derive and test a mapping model. Split-half cross-validation was employed, resulting in a total of ten multinomial logistic regression models. The Monte Carlo simulation procedure was used to generate predicted EQ-5D-3L responses, and utility scores were calculated and compared against observed values. Mean error and mean absolute error were calculated for all ten validation models. The final model algorithm was derived using the entire sample.

RESULTS

The model was highly predictive, and its repeated fitting using multinomial logistic regression demonstrated a stable model. The mean differences between predicted and observed health utility estimates ranged from 0.005 to 0.029 across the ten modelling exercises, with an average overall difference of 0.015 (a 2.2% overestimate, not of clinical importance).

CONCLUSIONS

The algorithm developed will enable researchers and decision scientists to calculate EQ-5D health utility estimates from FROM-16 scores, thus allowing the inclusion of the family impact of disease in health economic evaluation of medical interventions when EQ-5D data is not available.

Unpacking COVID-19 Vaccine Attitudes: Exploring Hesitancy and Acceptance Among Undergraduate Students in Bangladesh

BACKGROUND

Vaccine hesitancy is a significant global health concern, and mass vaccination is essential in preventing the spread of COVID-19. Undergraduate students need to be prioritized for vaccination as they continue their academic curriculum physically. However, limited research explores vaccine hesitancy and acceptance among undergraduate students in Bangladesh. Therefore, this study evaluated vaccine hesitancy and acceptance among this population.

METHOD

A web-based cross-sectional study was conducted between May and June 2021 using a structured questionnaire to assess COVID-19 vaccine hesitancy and acceptance among undergraduate students in Bangladesh. The Oxford Covid-19 Vaccine Hesitancy Scale was used to measure vaccine hesitancy. The study used convenient sampling.

RESULT

Across the country, 334 undergraduate students participated in this study on COVID-19 vaccine acceptance, with a mean age of 22.4 years. Most participants were male and unmarried, most having spent four years at university. 89.52% of participants would accept a COVID-19 vaccine if it were suggested by educational institutions or available, while 4.49% refused to receive the COVID-19 vaccine. Participants showed low levels of vaccine hesitancy, with a mean score of 10.77 on the Oxford COVID-19 Vaccine Hesitancy Scale. Most participants had a positive attitude towards receiving the vaccine, with the majority wanting to get it as soon as it becomes available. No association was found between vaccine acceptance and participants' background characteristics.

CONCLUSION

Our study found a high level of vaccine acceptance among undergraduate students in Bangladesh, indicating that this group can be vaccinated quickly, significantly accelerating vaccination goals. However, further large-scale studies are recommended among vulnerable groups, including school and college students, to ensure vaccine preparedness.

A three-arm single blind randomised control trial of naïve medical students performing a shoulder joint clinical examination

BACKGROUND

Technological advances have previously been hailed as a new dawn in Higher Education, with the advent of 'massive open online courses' (MOOCs) and online learning. Virtual platforms have potential advantages such as accessibility and availability but simply transferring educational material to the online environment may not ensure high quality learning. Clinical examination is a fundamental principle of medical assessment, and this study aimed to assess the role of technology in teaching these skills.

AIMS/OBJECTIVES

To determine whether three teaching modalities were of equal efficacy in teaching examination of the shoulder joint to naïve medical students.

METHODS

Sixty-seven pre-clinical medical students naïve to large joint examination were recruited. Participants completed a learning style questionnaire and were then block randomised to three study: textbook study, face-to-face seminar, or video tutorial via online platform. The same examination technique was taught in all groups, with the intervention being the method of delivery All second year students were eligible for inclusion. The single exclusion criteria was previous exposure to clinical examination teaching. Students were assessed using a standardised scoring system at baseline (pre-intervention), and days 5 and 19 post-intervention (maximum score 30). Assessors were blinded to group allocation. The primary outcome was assessment score at day 5 post intervention.

RESULTS

There was no difference between the three groups at baseline assessment (mean scores 2.4 for textbook, 2.8 for face-to-face, and 3.1 for video; p = 0.267). Mean post-intervention scores were 16.5 textbook, 25.5 face-to-face, and 22.4 video (p < 0.001, η2 = .449). There was no change between day 5 and day 19 post-intervention assessment scores in any group (p = 0.373), Preferred learning style did not affect scores (p = 0.543).

CONCLUSION

Face-to-face teaching was the most effective method for teaching clinical examination of the shoulder. Technology can potentially increase accessibility and remove geographic barriers, but is not as effective if teaching techniques are simply mirrored in an online format. Online platforms allow in depth data analysis of how learners interact with educational material and this may have value in improving the design of online educational materials, and is a potential area for further research.

Clinical experience and psychometric properties of the Cardiff Acne Disability Index (CADI)

The Cardiff Acne Disability Index (CADI) is a questionnaire designed to measure the quality of life of teenagers and young adults with acne. It has been used clinically and within therapeutic research globally. This review aims to appraise all published data regarding the clinical and research experience of the CADI, its psychometric properties and validation, from its publication in 1992 until September 2020, in a single reference source. A literature search was conducted using MEDLINE via Ovid, PubMed, EBSCOhost, Web of Science and Scopus. All full articles in the English language were included. A total of 96 clinical studies were identified and analysed. The CADI has been used in 44 different countries, including four multinational studies, and has validated translations in 25 languages. Overall, 29 therapeutic interventions have used the CADI, demonstrating its responsiveness to change. The reliability of the CADI has been assessed in 14 studies through test-retest and internal consistency studies. In total, 57 studies have demonstrated aspects of its validity through correlation to other measures, and five studies have investigated the dimensionality of the CADI. There is evidence of high internal consistency, test-retest reliability, responsiveness to change and significant correlation with other objective measures. The minimal clinically important difference and validated score meaning bands have not yet been reported. This information is needed to improve the interpretability of CADI scores for clinical use and in research. The authors of the CADI have also rephrased Question 2 of the measure to ensure inclusivity.

Prevalence and characterization of extended-spectrum beta-lactamases producing Enterobacteriaceae in healthy children and associated risk factors

Background

Community acquired infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) had been increased. The fecal flora of children in the community represents a huge potential reservoir for ESBLs which are located on highly transmissible plasmids. This study examined the prevalence of ESBL-PE fecal carriage, antimicrobial susceptibility pattern, possible risk factors, and characterized the genes encoding these ESBL enzymes in Lebanese children community.

Methods

A total of 125 rectal swabs were taken from healthy children aged from 1 to 5 years. Detection of ESBLs was carried out using combination-disc method test and multiplex PCR. A questionnaire concerning child’s lifestyle and risk factors for ESBL carriage was illustrated.

Results

Thirty-one of 125 participants (24.8 %) carried ESBL-PE. Regular consumption of meat, and chicken were significantly associated with high carriage rate of ESBL-PE, while dairy products (milk, yogurt, cheese) association was non-significant. Intimate hygiene habits were found also affecting the carriage rate. Multiple bla genes were the most common, 48.4 % (15/31) of ESBL-PE carried both bla_CTX-M and bla_TEM, and 22.6 % (7/31) carried bla_CTX-M, bla_SHV, and bla_TEM, 29 % (9) carried bla_CTX-M only. Concerning CTX-M-types, CTX-M-9 was the most predominant (24/31) and mostly in combination with CTX-M-15 type.

Conclusion

High rate of colonization in healthy children with ESBL-PE was observed, regular consumption of dietary products from animal source (meat or chicken) were associated with this colonization in the community in non-hospitalized children. To our best knowledge it is the first study about regular consumption of dairy product as a risk factor for ESBL-PE community carriage, the first data about the carriage rate of ESBL-PE in community children in Lebanon and Middle East, and for the wide dissemination of CTX-M-9 type in this population.

The impact of new national guidelines on screening for gestational diabetes mellitus

Gestational diabetes mellitus (GDM) has important maternal and fetal implications. In 2010, the Health Service Executive published guidelines on GDM. We examined the impact of the new guidelines in a large maternity unit. In January 2011, the hospital replaced the 100 g Oral Glucose Tolerance Test (OGTT) with the new 75 g OGTT. We compared the first 6 months of 2011 with the first 6 months of 2010. The new guidelines were associated with a 22% increase in women screened from 1375 in 2010 to 1679 in 2011 (p < 0.001). Of the women screened, the number diagnosed with GDM increased from 10.1% (n=139) to 13.2% (n=221) (p<0.001).The combination of increased screening and a more sensitive OGTT resulted in the number of women diagnosed with GDM increasing 59% from 139 to 221 (p = 0.02).This large increase has important resource implications but, if clinical outcomes are improved, there should be a decrease in long-term costs.

SEX HORMONE STATUS IN MALE RATS AFTER EXPOSURE TO 50 HZ, 5 MTESLA MAGNETIC FIELD

The question of whether extremely low frequency magnetic fields can affect biological system has attracted attention. The theoretical possibility of such an interaction is often questioned and the site of interaction is unknown. The influence of extremely low frequency magnetic field of 50 Hz, 5 mTesla on sex hormone status was studied. 60 male albino rats were divided into 6 groups and were continuously exposed to 50 Hz, 5 mTesla magnetic field generated by magnetic field chamber for periods of 1, 2 and 4 weeks. For each experimental point, sham treated group was used as a control. Assay of serum testosterone LH, FSH, and prolactin were performed. Serum testosterone showed no significant changes. FSH showed significant increase than sham exposed group after 1 week magnetic field exposure. LH showed significant increase than sham exposed group only after 4 weeks magnetic field exposure, while serum prolactin hormone level showed a significant increase in all magnetic field exposed groups than sham exposed animals. Exposure to 50 Hz, 5 mTesla magnetic field for periods of 1, 2 and 4 weeks has no effect on testosterone level, some changes on FSH and LH serum levels and increase in serum prolactin level.

Effects of acute exposure to the radiofrequency fields of cellular phones on plasma lipid peroxide and antioxidase activities in human erythrocytes

Radiofrequency fields of cellular phones may affect biological systems by increasing free radicals, which appear mainly to enhance lipid peroxidation, and by changing the antioxidase activities of human blood thus leading to oxidative stress. To test this, we have investigated the effect of acute exposure to radiofrequency fields of commercially available cellular phones on some parameters indicative of oxidative stress in 12 healthy adult male volunteers. Each volunteer put the phone in his pocket in standby position with the keypad facing the body. The parameters measured were lipid peroxide and the activities of superoxide dismutase (SOD), total glutathione peroxidase (GSH-Px) and catalase. The results obtained showed that the plasma level of lipid peroxide was significantly increased after 1, 2 and 4 h of exposure to radiofrequency fields of the cellular phone in standby position. Moreover, the activities of SOD and GSH-Px in human erythrocytes showed significant reduction while the activity of catalase in human erythrocytes did not decrease significantly. These results indicate that acute exposure to radiofrequency fields of commercially available cellular phones may modulate the oxidative stress of free radicals by enhancing lipid peroxidation and reducing the activation of SOD and GSH-Px, which are free radical scavengers. Therefore, these results support the interaction of radiofrequency fields of cellular phones with biological systems.

Prolonged effect of liposomes encapsulating pilocarpine HCl in normal and glaucomatous rabbits

The possibility of using liposomes as an ophthalmic drug delivery carrier for the lipophilic drug, pilocarpine HCl, was investigated on the eyes of normal and glaucomatous pigmented rabbits. The intraocular pressure (IOP) of rabbits was measured, using a Shi&emptyv;tz tonometer, as a function of time after topical administration with free drug, neutral and negatively charged multilamellar vesicles (MLVs) encapsulating pilocarpine HCl. The results showed that administration with neutral MLVs displayed the most prolonged effect with respect to negatively charged MLVs and free drug. The efficiency of MLVs encapsulating pilocarpine HCl, measured using spectrophotometric technique, was found to be 96% in our modified preparations. The storage stability of MLVs encapsulating pilocarpine HCl was investigated by measuring phase transition and size distribution using light scattering technique. The results show that liposomes encapsulating pilocarpine HCl have kept their integrity and physicochemical properties for at least 15 months, which makes them suitable for commercial use.

Membrane solubilization in erythrocytes as a measure of radiation exposure to fast neutrons

Membrane solubilization and osmotic fragility of rat erythrocytes irradiated in vivo with fast neutron fluences ranging from 10(6) to 5 x 10(7) n cm(-2) using a 252Cf source were measured instantaneously using a light scattering technique. The solubilization of erythrocyte membrane by a non-ionic detergent, octylglucoside (OG), was found to exhibit a two stage transition from vesicular form to mixed micellar form in the range of detergent concentrations 1.5-7.8 mM. The coexistence phase, vesicular/mixed micellar, was shifted towards higher detergent concentrations with increase in the neutron fluence, indicating increasing membrane resistance to the detergent and hence change in the natural membrane permeation properties. The technique shows an adequate sensitivity in detecting membrane damage in erythrocytes and has potential as a biophysical marker of radiation exposure. The osmotic fragility of irradiated erythrocytes shows a decreasing trend with increasing irradiation fluence measured directly and two weeks post-irradiation. Blood films photographed two weeks post-irradiation show developed elliptocytosis and crenated cell anaemia.

A case of ipsilateral shoulder and elbow dislocation: an easily missed injury

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Serum-hydroxyapatite interaction in vitro

In a project to develop hydroxyapatites for bone replacement, biological and synthetic types were prepared at 600 degrees C, ground to 300-600 microns and immersed in a pooled human serum for periods up to 1 month at 4 degrees C to assess material interaction. It was found that the levels of calcium in the serum were reduced at 6 h immersion, followed by an increase to reach maximum at 48 h and then stability up to 1 month. Phosphorus levels showed the opposite behaviour. Both apatites showed similar trends, although higher values were recorded for the synthetic type, suggesting higher activity. Infrared spectral analysis complemented the biochemical values, where the optical densities (O.D.) of phosphate groups were reduced, reflecting the increased phosphorus in serum and denoting leaching. Also, O.D. values of both CO3(2-) and OH- groups were reduced at 10 h, then returned to original levels. Scanning electron microscopy revealed a spongy appearance parallel with reduced O.D. and higher levels of serum Ca2+. At longer periods (48 h) the concentric needles of hydroxyapatite are clearly shown to be deposited on biological apatite. Differences in responses were attributed to their original crystalline structure assessed by X-ray diffraction analysis, as well as pore analysis using a mercury porosimeter.

Rapid increase of both HIV-1 infection and syphilis among pregnant women in Nairobi, Kenya

OBJECTIVE

To determine the prevalence of HIV-1 and syphilis antibodies in a population of pregnant women in Nairobi, Kenya, between 1989 and 1991.

METHODS

As part of an ongoing prospective study on the effect of HIV-1 infection and sexually transmitted diseases, 4883 pregnant women were screened for HIV-1 and syphilis antibodies in one health-centre in Nairobi.

RESULTS

HIV-1 seroprevalence increased from 6.5 to 13.0% (P < 0.001) and syphilis seroreactivity from 2.9 to 5.3% (P = 0.002), while there was no change in gonococcal infection rates. The most rapid increase in HIV-1 prevalence was observed in women aged less than 25 years. There was no evidence of demographic fluctuations in the population during this time, or of changes in sexual behaviour, except that fewer women enrolled in 1991 reported having more than one sex partner, compared with women enrolled in 1989 (39.1 versus 20.0%; P = 0.0001). HIV-1-seropositive women were more likely to be seroreactive for syphilis than HIV-1-seronegative mothers (7.7 versus 3.2%; odds ratio = 2.5; 95% confidence interval, 1.7-3.8; P < 0.001), but there was no difference between the two groups in terms of gonorrhoea prevalence.

CONCLUSION

These data confirm an association between HIV-1 and syphilis infection, and indicate that both are spreading rapidly among women in Nairobi outside high-risk groups. Increased efforts to control both infections are urgently required.

Platelet-monoamine oxidase activity in Reye's syndrome

Platelet and liver monoamine oxidase (MAO) activity (mean +/- SD) was evaluated in patients with liver-biopsy-proven Reye's syndrome. MAO was measured by a radioenzymatic technique with [3H]tyramine as a substrate. A marked decrease in MAO activity [3.3 +/- 2.4 nmol of [3H]4-hydroxyphenylacetic acid formed X (mg protein)-1 X h-1] was observed in platelets on admission in all patients (n = 13) with Reye's syndrome when compared with hospitalized patients without liver disease (n = 8) [9.8 +/- 2.5 nmol of [3H]4-hydroxyphenylacetic acid formed X (mg protein)-1 X h-1] and with liver disease (n = 10) [9.1 +/- 2.0 nmol of [3H]4-hydroxyphenylacetic acid formed X (mg protein)-1 X h-1]. Following recovery from the disease, platelet MAO approached levels that were not significantly different from those of controls. Contrastingly, reduction of hepatic MAO in Reye's syndrome was similar to that seen in patients with liver disease of different etiologies. These studies suggest that reduced platelet MAO activity is a specific abnormality in Reye's syndrome, and it may be representative of generalized impairment of mitochondrial function in these patients. Furthermore, the pattern of liver and platelet MAO activity in Reye's syndrome may allow for the differentiation of this disease from other hepatopathologic conditions.

Separation of malignant plasma cells from the bone marrow of patients with myelomatosis

Complement-mediated lysis of bone marrow cells from patients with myelomatosis using a rabbit antiserum raised against normal peripheral blood mononuclear cells was found to greatly enrich the abnormal plasma cells. Cellular morphology was good and the cells were able to synthesize and secrete paraprotein. This was found to be a quick and useful method of preparing myeloma plasma cells for further studies of their metabolic properties.

Preparation and biodistribution of 99mTc-labeled tyramine iminodiacetic acid

The synthesis and biodistribution properties of 99mTc-labeled N-substituted tyramine, [N-(4-hydroxyphenethyl)iminodiacetic acid] are described. Tissue distribution studies in rats were indicative of high hepatic and kidney extraction, accompanied by rapid plasma and urinary clearance and minimal biliary excretion. These findings were substantiated by organ image analysis. The preliminary data indicate that this labeled material may represent a new class of radiopharmaceuticals for the evaluation of hepatic and renal functions.

Similarity between tyramine-induced neurotoxicity and the coma of Reye's syndrome

The objective of the present investigation was to determine whether or not tyramine induces coma in experimental animals with impaired mitochondrial monoamine oxidase function, and whether the coma in these animals was a function of increased cerebrospinal fluid (CSF) pressure. Ten mongrel dogs were treated (orally) daily with the monoamine oxidase-inhibiting drug, phenelzine (4.5 mg/kg), over a period of 1 month. The present studies indicated that in phenelzine-treated animals with liver disease and behavioral side effects (n = 4), the i.v. administration of tyramine (1 mg/kg) caused substantial elevation in CSF pressure that exceeded 30 mm Hg (initial pressure 12.5 +/- 2.1). This was followed by substantial accumulation of tyramine, dopamine and norepinephrine concentrations in CSF of these animals. The animals became comatose soon afterward. The administration of tyramine to pretreated (n = 10) or phenelzine-treated animals without liver disease (n = 6) caused only the expected transient increase in blood pressure but with no significant effect on CSF pressure of these animals. These animals recovered fully from the experiment without any ill effect. These studies suggest that tyramine may have obvious implications in the development of intracranial hypertension in Reye's syndrome.

Evaluation of transsphenoidal hypophysectomy in the management of patients with advanced malignant melanoma

Transsphenoidal hypophysectomy was performed in 13 patients with advanced malignant melanoma. Although three minor responses were observed, there were no complete or partial responses. All three patients with bone pain had a decrease in discomfort lasting 1-2 months. All five patients with minor responses or stable disease had postoperative decreases in the excretion of the dihydroxyphenylalanine (DOPA) metabolite 3-O-methyldopamine; all but one patient with clinical progression had postoperative increases in excretion. Average survival of those whose postoperative excretion fell (143 +/- days; range, 60-217+) was significantly longer (P less than 0.004) than that of those whose postsurgical values rose (30 days; range, 15-58).

Enrichment of erythroblasts from human bone marrow using complement-mediated lysis: measurement of ferritin

Sequential lysis of human bone marrow cells with a monoclonal antibody directed against myeloid cells (TG1) and a rabbit antiserum raised against peripheral blood mononuclear cells gave preparations in which 78-97% of the nucleated cells were erythroid, with a 24-77% recovery. Viability was high, morphology was good and the cells were able to divide and differentiate in culture. No metabolic experiments were carried out but the ferritin content of the erythroblasts was measured in four experiments and found to be about 200-2000 times higher than that found in normal erythrocytes. The H/S ratio was high in both erythroblasts and erythrocytes. Fractionation on the basis of density of two erythroblast preparations, one from a patient with sideroblastic anaemia and one from a patient with megaloblastic anaemia, showed that the most immature erythroblasts contained the highest content of ferritin and that this fell with maturation. The H/S ratio stayed the same or fell with maturation. It was concluded that this method would be valuable for the study of the role of erythroblast ferritin in normal and pathological situations.

Hepatorenal failure induced by tetracycline in dogs with portacaval shunt

The aim of the present investigation was to determine whether tetracycline accelerated the hepatic toxicity of portacaval anastomosis and whether this could be reflected by changes in pharmacokinetics of the drug. Side-to-side portacaval shunts were constructed and converted to end-to-side by ligating the hepatic side of the portal vein in dogs. The results of this study showed that the i.v. infusion of tetracycline (50 mg/kg) to shunted animals caused rapid deterioration in hepatic and renal functions followed by the eventual transition of these animals from stage I to stage II liver disease. This was reflected by a 3- to 6-fold increase in the serum level of bilirubin, alkaline phosphatase, serum glutamic-oxalacetic transaminase, blood urea nitrogen and creatinine as compared with the levels of those produced in serum of dogs before and after the construction of the shunt before the administration of tetracycline. Kinetic analysis revealed a significant prolongation in the elimination half-life (38.2 +/- 4.2 hr) of the shunted dogs as compared with controls (14.5 +/- 1.5 hr) after the i.v. administration of tetracycline. This was accompanied by an appreciable reduction of elimination rate constant. In contrast to shunted animals, control animals exhibited no behavioral side effects after the administration of tetracycline.

A two-step procedure for obtaining normal peripheral blood T-lymphocytes using continuous equilibrium density gradient centrifugation on percoll

Equilibrium centrifugation of either peripheral blood mononuclear cells or of pure lymphocytes (obtained by carbonyl iron or glass bead adherence removal of monocytes) on a continuous density gradient of Percoll yielded lymphocyte fractions containing between 92 and 99% T lymphocytes as shown by sheep red blood cell rosetting. B lymphocytes with surface immunoglobulin were found in the regions of low density (1.03-1.065 g/ml) and T lymphocytes in the regions of higher density (1.06-1.08 g/ml). TM lymphocytes with their characteristic positive 'dot' pattern of staining for non-specific esterase were also found mainly in regions of high density. It was concluded that Percoll continuous equilibrium density gradient centrifugation can be used to obtain T lymphocytes in high yield, with high viability and without metabolic changes which may occur after contact with sheep red blood cells. The esterase staining suggested that there was also some separation of T lymphocyte subsets.

Development and application of a radioimmunoassay for tetracycline

Antiserum against tetracycline was produced in rabbits immunized with a tetracycline hapten conjugated to bovine serum albumin. The antiserum was used to develop a radioimmunoassay for tetracycline. As little was 1 ng of tetracycline can be detected in one sample. The antitetracycline antiserum showed a considerable degree of specificity since it cross-reacted only with chlortetracycline (70%). However, its cross-reactivity with oxytetracycline, doxycycline, demeclocycline, methacycline and rolitetracycline was only negligible. The radioimmunoassay of tetracycline was used to measure the systemic bioavailability of orally administered tetracycline (25 mg/kg) to a group of mongrel dogs. Detectable levels of tetracycline were exhibited within 30 min and maximum plasma concentrations of the drug occurred within 3 to 4 hr after dose administration.

Evidence for central hypertyraminemia in hepatic encephalopathy

In mongrel dogs, the effect of end-to-side portacaval shunt on plasma, cerebrospinal fluid (CSF) and brain tyramine, tyrosine, dopamine, norepinephrine, and epinephrine were studied. It was found that the level of tyramine in plasma, CSF, and selected brain regions increased steadily after the construction of the shunts. These elevations became more pronounced when the dogs manifested symptoms of hepatic encephalopathy. In postshunted dogs with stage II and III hepatic encephalopathy, tyramine concentration in corpus striatum (1,312 +/- 371), hypothalamus (400 +/- 67.0), and midbrain (660 +/- 78.7 ng/g) was significantly (P less than 0.05) higher than the level in dogs with stage 0 and I hepatic encephalopathy and sham-operated dogs serving as controls (corpus striatum, 831 +/- 140; hypothalamus, 167 +/- 40.0; and midbrain, 132 +/- 37.4 ng/g). This was followed by a concomitant depletion of dopamine and norepinephrine in these brain regions (postshunt: dopamine 104 +/- 20.0, 3,697 +/- 977, and 105 +/- 14.1; norepinephrine 521 +/- 71.6, 81.6 +/- 13.7, and 218 +/- 31.7 ng/g; vs. sham group: dopamine 532 +/- 83.1, 8,210 +/- 1,126, and 192 +/- 35.0; norepinephrine 1,338 +/- 425, 124 +/- 21.3, and 449 +/- 89.7 ng/g) of encephalopathic dogs with portacaval shunt. Furthermore, tyramine, tyrosine, dopamine, and norepinephrine levels in plasma and CSF increased markedly as clinical features in the dogs' behavior characteristic of hepatic encephalopathy occurred, including hypersalivation, ataxia, flapping tremor, somnolence, and coma. Cerebral hypertyraminemia and a defect in sympathetic neurotransmission may contribute to the development of hepatic encephalopathy of liver disease.

Tyrosine transaminase activity in normal and cirrhotic liver

Most cirrhotics have tyrosinemia and subnormal tyrosine tolerance; in some the ability to metabolize p-hydroxyphenylpyruvic and homogentisic acids is impaired. In previous studies, the initial transamination appeared to be the rate-limiting step. In this study, hepatic tyrosine transaminase activity was compared in liver biopsies from eight noncirrhotic and ten cirrhotic subjects to determine whether the subnormal tyrosine tolerance was related to decreased maximal activity of this enzyme. Fasting plasma tyrosine in the cirrhotics (133 +/- 43 micromol/liter) was significantly higher (P less than 0.005) than in the noncirrhotic subjects (64 +/- 25 micromol/liter). Tyrosine transaminase activity in the cirrhotic livers (42 +/- 11 micromol PHPA/g liver/hr, or 0.47 +/- 0.1 micromol PHPA/mg protein/hr) was not significantly different from the enzyme activity in the noncirrhotic liver (43 +/- 7 micromol PHPA/g liver/hr, or 0.39 +/- .12 micromol PHPA/mg protein/hr.) Thus elevated tyrosine levels in cirrhotics cannot be explained by decreased tyrosine transaminase activity in the liver, and other explanations must be sought.

Melanoma detection by enzyme-radioimmunoassay of L-dopa, dopamine, and 3-O-methyldopamine in urine

This enzyme-radioimmunoassay for the measurement of L-dopa, dopamine, and 3-O-methyldopamine is based on the incubation of urine in the presence of catechol-O-methyltransferase, aromatic-L-amino-acid decarboxylase, and S-adenosylmethionine. The O-methylated dopamine metabolite formed, 3-O-methyldopamine, was characterized by radioimmunoassay. To evaluate the role of L-dopa metabolism in melanoma, we used the enzyme-radioimmunoassay to assess concentrations of L-dopa, dopamine, and 3-O-methyldopamine in urine from 10 healthy subjects, 10 hospitalized patients without melanoma and 28 patients with different degrees of melanoma. The effect of surgery for melanoma on urinary output of these catechols of melanoma patients was also evaluated. No significant difference in urinary L-dopa, dopamine, and 3-O-methyldopamine excretion rates was seen between normal subjects (L-dopa 1.3 +/- 0.3, dopamine 147 +/- 38, and 3-O-methyldopamine 31.4 +/- 13.6 microgram/24 h), hospitalized patients without melanoma, and amelanotic melanoma patients. However, the excretion rates for these metabolites in melanotic melanoma (L-dopa 5.6 +/- 1.2, dopamine 555 +/- 121, and 3-O-methyldopamine 178 +/- 40.3 microgram/24 h) were significantly (p < 0.005) higher than in control or amelanotic melanoma subjects. After surgery, there was a substantial decrease in urinary output of L-dopa and its metabolites by these patients.

Melanoma detection by enzyme-radioimmunoassay of L-dopa, dopamine, and 3-O-methyldopamine in urine

This enzyme-radioimmunoassay for the measurement of L-dopa, dopamine, and 3-O-methyldopamine is based on the incubation of urine in the presence of catechol-O-methyltransferase, aromatic-L-amino-acid decarboxylase, and S-adenosylmethionine. The O-methylated dopamine metabolite formed, 3-O-methyldopamine, was characterized by radioimmunoassay. To evaluate the role of L-dopa metabolism in melanoma, we used the enzyme-radioimmunoassay to assess concentrations of L-dopa, dopamine, and 3-O-methyldopamine in urine from 10 healthy subjects, 10 hospitalized patients without melanoma and 28 patients with different degrees of melanoma. The effect of surgery for melanoma on urinary output of these catechols of melanoma patients was also evaluated. No significant difference in urinary L-dopa, dopamine, and 3-O-methyldopamine excretion rates was seen between normal subjects (L-dopa 1.3 +/- 0.3, dopamine 147 +/- 38, and 3-O-methyldopamine 31.4 +/- 13.6 microgram/24 h), hospitalized patients without melanoma, and amelanotic melanoma patients. However, the excretion rates for these metabolites in melanotic melanoma (L-dopa 5.6 +/- 1.2, dopamine 555 +/- 121, and 3-O-methyldopamine 178 +/- 40.3 microgram/24 h) were significantly (p &lt; 0.005) higher than in control or amelanotic melanoma subjects. After surgery, there was a substantial decrease in urinary output of L-dopa and its metabolites by these patients.

Immune deficiency in Hodgkin and non-Hodgkin lymphoma

Forty-three previously untreated Egyptian patients with Hodgkin's disease and thirty-five patients with non-Hodgkin lymphoma were studied with several readily available tests of immune function, number of peripheral blood lymphocytes, delayed hypersensitivity to two recall antigens, in vitro blastoid transformation by PHA, the capacity of E-rosette formation and surface marker criteria. The results were correlated to the histology, stage of disease and to the presence of general symptoms and signs.

Tyrosine metabolism in cirrhosis

The aim of this study was to define the enzyme defect responsible for tyrosinemia in cirrhotic patients. The principal hepatic degradation pathway for tyrosine, tyrosine leads to p-hydroxyphenylpyruvic acid equilibrium homogentisic acid leads to CO2 was studied in 18 cirrhotic patients and eight controls. The classic method employed in elucidation of hereditary tyrosinosis was sued. Metabolic intermediates on the pathway were measured in the basal state, and following oral loading doses (50 mg/kg BW) of tyrosine, PHPA, and homogentisic acid. Cirrhotic patients showed a significant increase (p = 0.005) in fasting plasma tyrosine and in basal PHPA excretion and impaired tolerance to all three metabolites when compared to normals. Fifteen of the 18 cirrhotic patients showed tyrosine intolerance which was not accompanied by change in distal metabolites compared to their basal levels. Nevertheless 13 of the 18 did exhibit intolerance of either PHPA or homogentisic acid. We conclude that in contrast to the single complete defect in hereditary disorders of tyrosine metabolism, cirrhotic patients have partial defects at tyrosine transaminase, PHPA oxidase, and homogentisic acid oxidase, the initial step being rate-limiting.

Tyramine kinetics and metabolism in cirrhosis

Hypertyraminemia is common in hepatic cirrhosis and correlates in severity with encephalopathy. The mechanism of cirrhotic hypertyraminemia has not been established. The alternative possibilities are increased production from tyrosine and impaired degradation by monoamine oxidase. This investigation determined the pharmacokinetics of tyramine after an intravenous bolus injections of [3H]-tyramine (180--200 muCi 12 Ci/mmol sp act) in 13 cirrhotics and 9 controls. In normals, [3H]tyramine levels initially declined rapidly (alpha-phase) followed by a slower decline (beta-phase) with an average t 1/2 of 20.8 min. Average normal metabolic clearance rate and production rate were 13.2 liters/min and 15.4 microgram/min, respectively. In cirrhotic patients, the plasma disappearance curve for [3H]tyramine was qualitatively similar to that of the control subjects with no apparent different in beta-t 1/2 (17.2 min). The hypertyraminemia of cirrhosis resulted primarily from overproduction of tyramine, as the production rate (32.0 microgram/min) in these patients was significantly greater (P less than 0.05) than in controls, whereas the metabolic clearance rate remained normal (average 12.2 liters/min). A difference in ratio of tyramine metabolic products was noted as well. Cirrhotics had a high ratio of plasma 4-hydroxyphenylethanol:4-hydroxyphenylacetic acid (60:40 vs. 30:70) as compared with normals. Although the tyramine clearance rates are similar in normals and cirrhotics, different mechanisms may be responsible for catabolism.

Evidence for hypertyraminemia in Reye's syndrome

Utilizing a specific and sensitive radioimmunoassay, palsma and urine tyramine were measured in 14 consecutive patients with liver biopsy-proven Reye's syndrome. Plasma tyrosine was measured in 11 of these patients. The results revealed significant (P less than .003) elevation in plasma (3.4 +/- .52 ng/ml) (mean +/- SEM) and urine (1.00 +/- .26 mg/24 hr) tyramine as well as plasma tyrosine (204 +/- 52.5 mumole/liter) at the onset of the disease when compared to the levels of tyramine and tyrosine in a group of hospitalized patients without hepatic disorders. Furthermore, there was a positive correlation between plasma tyramine and days in coma (r = .86; P less than .001), and between plasma tyramine and tyrosine (r = 0.80; P less than .001). These data suggest that there is s substantial disturbance of tyrosine metabolism in Reye's syndrome and that the accumulation of this amino acid and its metabolite, tyramine, may contribute to the encephalopathy of this disease.

Decarboxylation to tyramine: an important route of tyrosine metabolism in dogs with experimental hepatic encephalopathy

Tyrosine metabolism via decarboxylation to tyramine was evaluated in dogs with functional end-to-side portacaval shunt. It was found that the endogenous plasma levels of both tyrosine and tyramine increased steadily after the construction of the shunt. These elevations became more pronounced when the dogs manifested symptoms of hepatic encephalopathy. In encephalopathic dogs, average endogenous plasma tyrosine and tyramine concentrations were 110.1 mumoles per liter and 7.6 ng per ml as compared to 55.4 and 1.2 in control dogs, respectively. The pattern of plasma concentrations of tyrosine and tyramine after an oral dose of L-tyrosine (50 mg per kg) was also investigated in control and shunted dogs. There was a progressive rise in peak levels of tyramine (to about 50-fold increase, at 6 weeks) after the construction of the shunt, as compared to levels obtained in pre- and at 1 and 4 weeks postoperatively (70.6 versus 1.20, 3.9, and 8.11 ng per ml). Similar observations were made with levels of plasma tyrosine. Six weeks after portacaval shunt, mean peak levels of plasma tyrosine, achieved at 5 hr after dose administration, were 450 as compared to 85 mumoles per liter obtained in preshunted dogs. These studies demonstrated a correlation between abnormalities in tyrosine metabolism and postshunt hepatic encephalopathy.

The measurement of 3-o-methyldopamine in urine and plasma by a rapid and specific radioimmunoassay

Antiserum against 3-O-methyldopamine (MD) was produced in rabbits immunized with MD hapten conjugated to hemocyanin. The antiserum was used to develop a radioimmunoassay (RIA) for MD. As little as 0.5 ng of MD in 0.1 ml can be detected. The major catecholamines and the phenolic aromatic amines (dopamine, norepinephrine, epinephrine, octopamine, and tyramine) and their metabolites (normetanephrine, metanephrine, homovanillic acid and 4-hydroxy-3-methxymandelic acid) did not bind significantly to the antibody. The RIA of MD was used to assay the endogenous level of MD in urine and plasma of hospitalized children. In children (7 mo to 13 yr), average concentration of MD in plasma was found to be 0.47 +/- 0.11 ng/ml, and in urine 0.15 +/- 0.05 microgram/mg of creatinine (45.0 +/- 16.3 microgram/24 hr). In children with neuroblastoma, there was a 3- to 10-fold increase in urinary excretion and plasma level of 3-O-methyldopamine. In adults, the average urine and plasma levels were found to be 87.4 +/- 3.4 microgram/24 hr and 0.6 +/- 0.2 ng/ml. The diagnostic applicability of the RIA of MD is discussed.