Initial development and validation of a mitochondrial disease quality of life scale

Mitochondrial diseases are a clinically diverse group of genetic disorders that often present to neurologists. Health related quality of life (HRQOL) is increasingly recognised as a fundamental patient based outcome measure in both clinical intervention and research. Generic outcome measures have been extensively validated to assess HRQOL across populations and different disease states. However, due to their inclusive construct, it is acknowledged that not all relevant aspects of a specific illness may be captured. Hence there is a need to develop disease specific HRQOL measures that centre on symptoms characteristic of a specific disease or condition and their impact. This study presents the initial conceptualisation, development and preliminary psychometric assessment (validity and reliability) of a mitochondrial disease specific HRQOL measure (Newcastle Mitochondrial Quality of life measure (NMQ)). NMQ is a valuable assessment tool and consists of 63 items within 16 unidimensional domains, each demonstrating good internal reliability (Cronbach's α≥0.83) and construct validity.

The effect of low and ultra-low dosages Thymoglobulin on peripheral T, B and NK cells in kidney transplant recipients

INTRODUCTION

Rabbit Anti-Thymocyte Globulin (r-ATG) is a polyclonal antibody preparation, used to prevent and treat acute rejection episodes after organ transplantation. However, despite more than 40 years of clinical use, the optimal dose of r-ATG is still not defined. To find a better balance between efficacy and infectious complications, we embarked on a controlled study and monitored the effect of low and ultra-low dosages Thymoglobulin (Genzyme) on peripheral T, B, and NK cells.

PATIENTS AND METHODS

Kidney transplant recipients received either 0.5 mg/kg, 1.0 mg/kg or 2.0 mg/kg on the first 3 consecutive days post-transplantation. Thus, total doses were 1.5 mg/kg, 3.0 mg/kg and 6.0 mg/kg. A total of 40 patients were enrolled, including 11 controls. All patients were treated with Prednisolon, Advagraf (Astellas) and Mycophenolate Mofetil (Roche). T (CD3+), B (CD19+) and NK (CD3-CD16+56+) cells were analyzed by flow cytometry. Baseline cell counts were compared to forty age and sex matched healthy persons. Post-transplantation cell counts of the 3 Thymoglobulin groups were compared to the 11 control patients, who received no induction therapy.

RESULTS

Absolute numbers of T, B, and NK cells were comparable in all patients pre-transplantation, but T and B cells were lower than in healthy persons (p=0.007 and p=0.0003, Mann Whitney test). In the first week, T cells and NK cells were significantly lower in all Thymoglobulin groups compared to controls. B cells were not affected. One month after Thymoglobulin NK cells had returned to control numbers in all groups, while T cells had already recovered to control counts in the 1.5 mg/kg group. During follow-up, T cells in the 3.0mg/kg group also returned to control values, but at one year the patients in the 6.0 mg/kg group still had significantly lower T cells (p=0.03). Patient and graft survival, rejection and infection incidence and renal function did not differ between groups.

CONCLUSION

Patients with end stage renal disease have significantly lower peripheral T and B cell counts than healthy persons. (Ultra-) low Thymoglobulin schedules deplete peripheral lymphocytes in a dose dependent way. Knowledge of the duration of this depletion contributes to finding the optimal immunosuppressive strategy for kidney transplant recipients.

Spontaneous rupture of a varicocoele

We present the case of a young male with an acute scrotal haematoma due to spontaneous rupture of a spermatic cord varicocoele confirmed by Doppler ultrasonography. After failure of conservative management, surgical exploration was performed with successful evacuation of the scrotal haematoma.

WITHDRAWN: Goat serum product "Aimspro" restores conduction in demyelinated human optic nerve fibres

Ahead of Print article withdrawn by publisher.

Frequency and impact of high-resolution monitor failure in a filmless imaging department

The purpose of this study was to assess the image quality and the rate of failure of the high-resolution (2,048 x 1536 pixel) monitors used for primary diagnosis in a filmless radiology department and to analyze the type of problems encountered as well as the action taken to repair the monitors. Data were collected from Picture Archival and Communication System (PACS) service logs to determine rates of monitor adjustment and replacement, the symptoms reported, and the action taken. Additionally, random surveys of the high-resolution monitors were performed using a standard test pattern to assess spatial and contrast resolution in the center and outer corners of the monitors. Analysis of monitor service records showed a high rate of monitor replacement (41% per year) resulting in a relatively short "life expectancy" (defined as average time required before replacement) of 2.4 years. Random surveys of monitor quality using a standard test pattern showed suboptimal image quality in approximately 54% of the monitors with moderate image quality degradation present in at least one region of 27% of the high-resolution monitors, despite our vendor's quality control program. The results of this study support our subjective impression and those of other colleagues in the PACS community of an unacceptably high monitor failure rate and persistent image quality problems with 2,000 pixel monitors used for primary diagnosis. The relatively high incidence of suboptimal quality monitors suggests that more frequent quality control should be performed using a test pattern particularly given the fact that radiologists often are unable to discern degradation of monitor performance using clinical images. The high incidence of problems with image quality on high-resolution monitors indicates that vendors need to develop better quality control in monitor design and testing. Radiologists should review briefly a test pattern on each monitor at the beginning of each day. A computer program should be incorporated into the PACS, which asks radiologists to evaluate a test pattern and records the results in a central database, which is communicated to the service engineers. Further studies should be evaluated to determine the clinical impact of monitor image degradation, which is relatively easily seen using a test pattern but may be difficult to discern on clinical images. Requests for proposals (RFPs) for PACS and service contracts must specify carefully requirements for monitor image quality and conditions under which the vendor is required to replace these monitors.

Characterization of a Trypanosoma brucei SR domain-containing protein bearing homology to cis-spliceosomal U1 70 kDa proteins

The protozoan parasite Trypanosoma brucei relies on trans-splicing of a common spliced leader (SL) RNA to maturate mRNAs. Using the yeast two-hybrid system a protein (TSR1IP) was identified that interacts with the T. brucei serine-arginine (SR) protein termed TSR1. TSR1IP shows homology to U1 70 kDa proteins, and contains an SR rich domain as well as an acidic/arginine domain homologous to the U1 70 kDa poly(A) polymerase inhibiting domain. This protein is localized in the nucleoplasm and excluded from the nucleolus in trypanosomal bloodstream and procyclic forms. Based on structural modelling predictions and on the identification of a RNA recognition motif (RRM), it was possible to demonstrate by the yeast three-hybrid system that TSR1IP interacts with the 5' splice region of the SL RNA. All the above characteristics suggest that TSR1IP could be involved in trans-splicing.

State-mandated voluntary newborn human immunodeficiency virus screening in a New York City Hospital

OBJECTIVE

To report the experience with state-mandated voluntary newborn human immunodeficiency virus (HIV) screening in a large university hospital.

METHODS

Retrospective analysis of delivery records and newborn HIV screening data for infants born between May 4, 1996, and January 31, 1997.

RESULTS

Of 3111 women, 40% had HIV testing during pregnancy, 28% had testing before pregnancy, 30% never had testing, and 2% gave no information. Most (91%) consented to postpartum newborn HIV testing, although rates varied by HIV counselor (range 81-96%, P < .001) and maternal HIV testing history (range 72-94%, P < .001). Maternal antepartum HIV testing rates varied by delivering physician (range 8-100%, P < .001) and by antepartum care site (clinics, 83%; faculty practices, 72%; private practices, 57%; P < .001). Fourteen HIV-exposed infants (0.46% of infants tested) were identified, 13 of whom were born to women known to be HIV positive before delivery. These women had received zidovudine prophylaxis according to Adult AIDS Clinical Trials Group 076 guidelines. All 14 infants subsequently tested negative for HIV. Human immunodeficiency virus-positive women were more likely than HIV-negative women to have received antepartum care in clinics (93% compared with 11%), have care paid by Medicaid (93% compared with 28%), and reside in high-risk areas (72% compared with 11%) (P < .001).

CONCLUSION

Newborn HIV screening has little incremental impact in settings with aggressive antepartum screening and/or low HIV infection rates. Interventions to increase antepartum HIV screening in the private sector should be implemented.

Assessment of an electronic mailing list for orthopaedic and trauma surgery

Medical electronic mailing lists have grown rapidly with the evolution of the Internet. The purpose of this paper was to assess the content and academic quality and of an electronic mail discussion list "Orthopod" dedicated to research in orthopaedic and trauma surgery. A retrospective analysis was undertaken of four months of web-based archive of communication through the Orthopod mailing list http:(/)/www.mailbase.ac.uk/lists/Orthopod. At the end of this study period there were 505 members of the Orthopod list. The main outcome measures of this paper were number of messages, type of messages, number of contributors, designation of contributor and number of topics referenced. On average 276 messages were posted each month. The mean number of messages per contributor per month only varied between 2.3 and 2.5. On average 54% of message threads contained at least one reference. At least 77% of the patient history and general threads had input from senior orthopaedic staff. The quantity of information on the Internet need not be a substitute for quality in orthopaedic and trauma surgery mailing lists. The Orthopod Electronic mail discussion list is another medium for the circulation of good quality surgical information. Orthopod provides a unique international electronic forum list for trauma and orthopaedic surgeons worldwide.

The epidemiology of prostate cancer in Jamaica

PURPOSE

Before this study, the highest reported incidence of prostate cancer in the world was thought to be among United States black men. The age adjusted rates in 1992 for United States black and white men were 249 and 182/100,000 respectively. The epidemiology of prostate cancer in Jamaica, a country of 2.5 million people of primarily African descent, was studied and compared with that of white and black Americans.

MATERIALS AND METHODS

The study included 1,121 cases of prostate cancer diagnosed from 1989 to 1994. Sources of information included the Jamaican Cancer Registry, government pathology laboratory, hospital and clinic records, and physician office records. Incidence rates were computed using data from the 1991 Jamaican census. Age adjustments were made using the 1970 United States standard population.

RESULTS

The average age adjusted incidence of prostate cancer in Kingston, Jamaica was 304/100,000 men. Median patient age at diagnosis was 72 years. More than 80% of the cases were pathologically confirmed. Of the patients 30% presented with acute urinary retention, 16% presented with bone metastases, 15% had gross hematuria at the time of diagnosis and an abnormal rectal examination suspicious for cancer was noted in 42%. Prostate specific antigen was measured in only 7% of cases in 1989 but in 48% of cases by 1994.

CONCLUSIONS

These data demonstrate that Jamaican men in Kingston have a high incidence of prostate cancer, much higher than even black Americans during a similar period. Furthermore, the cancers are more significant clinically with greater morbidity in Jamaica than in the United States.

The epidemiology of prostate cancer in Jamaica

PURPOSE

Before this study, the highest reported incidence of prostate cancer in the world was thought to be among United States black men. The age adjusted rates in 1992 for United States black and white men were 249 and 182/100,000 respectively. The epidemiology of prostate cancer in Jamaica, a country of 2.5 million people of primarily African descent, was studied and compared with that of white and black Americans.

MATERIALS AND METHODS

The study included 1,121 cases of prostate cancer diagnosed from 1989 to 1994. Sources of information included the Jamaican Cancer Registry, government pathology laboratory, hospital and clinic records, and physician office records. Incidence rates were computed using data from the 1991 Jamaican census. Age adjustments were made using the 1970 United States standard population.

RESULTS

The average age adjusted incidence of prostate cancer in Kingston, Jamaica was 304/100,000 men. Median patient age at diagnosis was 72 years. More than 80% of the cases were pathologically confirmed. Of the patients 30% presented with acute urinary retention, 16% presented with bone metastases, 15% had gross hematuria at the time of diagnosis and an abnormal rectal examination suspicious for cancer was noted in 42%. Prostate specific antigen was measured in only 7% of cases in 1989 but in 48% of cases by 1994.

CONCLUSIONS

These data demonstrate that Jamaican men in Kingston have a high incidence of prostate cancer, much higher than even black Americans during a similar period. Furthermore, the cancers are more significant clinically with greater morbidity in Jamaica than in the United States.

Easy visualization of the membranous urethral stump in radical prostatectomy

PURPOSE

Access to the urethral stump is sometimes difficult during radical retropublic prostatectomy.

MATERIALS AND METHODS

A 20F Foley catheter with the 5 ml. balloon inflated with 10 ml. in the bulbous urethra was used to elevate the urethral stump into the operative field.

RESULTS

Easy access to the urethral stump was achieved in all patients, which assisted with accurate anastomosis. There was decreased leakage of urine and no anastomotic stricture. No urethral trauma or incontinence was attributable to the technique.

CONCLUSIONS

This simple and safe technique allowed easy access to the urethral stump.