South African Institute of Drug-Free Sport Position Statement on CBD (Cannabidiol) and THC (Tetrahydrocannabinol)

Cannabidiol (CBD) and Tetrahydrocannabinol (THC) have become easily available to athletes over the years. Using these substances may inadvertently expose an athlete to the possibility of an adverse analytical finding (a "positive" test) and a sanction. Athletes need to understand the risk of an anti-doping rule violation or adverse analytical finding should these products be used, especially if no therapeutic use exemption exists. This position statement attempts to clarify the use of CBD and THC and their associated risks with Anti-Doping Rule Violations (ADRV) in the athletic population. The South African Sports Medicine Association supports this position statement.

Acetabular fracture after cycling related falls: High index of suspicion is required to avoid missing the injury on plain radiographs

Cycling participation as a medium of transport and as a competitive sport has steadily increased in recent decades. Traumatic injuries secondary to falls and collisions occur relatively frequently. Fractures of the hip and pelvis are uncommon with no studies to date reporting their exact incidence in this sport. Injuries specific to the acetabulum are reported even less frequently. We present four cases that highlight the insidious nature of acetabular fractures in cyclists and document their management and recovery. The number of acetabular fractures following falls from bicycles directly onto the lateral hip result in a relatively high number of fractures. Many of these may be missed due to the absence of findings on plain x-ray imaging.It is therefore important to have a high index of suspicion for hip and pelvis fractures when treating cycling related traumatic injuries.

The pattern of non-contact injuries in a South African professional football team

Background

The incidence, pattern and severity of non-contact injuries in European football has been researched extensively. In South African football only two studies have been conducted to date and with disparate outcomes. Further research into injury rates in South African football is therefore warranted.

Objectives

To determine the incidence and pattern of non-contact injuries in a South African professional football team during the course of a single season (2016-2017) in relation to competition exposure, training load and playing position.

Methods

Thirty-four male professional football players belonging to a single team competing in the Premier Soccer League (PSL) in South Africa were studied. Non-contact time-loss injuries (total training and match injuries) were recorded. Injury incidence, location, severity, type, and playing position (defender, midfielder, attackers, goalkeepers) during either match play or training were recorded.

Results

The non-contact incidence was 52 injuries with an injury rate of 3.74 per 1 000 exposures (training and competition). Competitions resulted in an incidence of 26.4 injuries per 1 000 exposure and training incidence 2.08 injuries per 1 000 exposures. Hamstring, groin and quadriceps injuries were the most frequently injured locations and muscle-tendon injuries accounted for the majority of injuries. The majority of injuries (52%) occurred during match play while 48% occurred during training. The greatest absolute number of injuries were sustained by midfielders (50%), followed by defenders (33%) and attackers (17%). However, relative to player numbers, the greatest number of injuries during match play were for defenders (44%), attackers (32%) and midfielders (24%). During training attackers sustained the most injuries (39%), followed by defenders (31%) and midfielders (30%). Goalkeepers did not sustain any non-contact injuries during the duration of the study.

Conclusion

The non-contact injury incidence in South African professional football players is similar to European football players. Hamstrings and groin injuries are predominant and were sustained throughout the competitive season. Defenders sustained the most non-contact injuries within the team relative to exposure time compared to attackers and midfielders. To our knowledge, injuries relative to player position have not been reported previously.

Impact of the COVID-19 pandemic on surgical care in the Netherlands

BACKGROUND

The COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands.

METHODS

A nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018-2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates.

RESULTS

Some 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018-2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001).

CONCLUSION

The reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.

A tale of two sit-bones: The cyclist's ischial hygroma (Perineal nodular induration)

The ischial hygroma, also known as a perineal nodular induration, is a relatively rare and mostly cycling-specific injury that is often incorrectly diagnosed and managed. Here two cases with divergent managements are described to highlight the spectrum of treatment available to manage this condition. The presentation, assessment and management of two cases of perineal nodular induration are discussed. The management options, namely surgical excision vs conservative management, with saddle pressure mapping highlight that there is no single optimal method and that a multidisciplinary approach should be applied to treat these injuries successfully. Perineal nodular induration should be investigated appropriately to exclude less benign causes of perineal masses. Conservative management and surgical excision can both be successful. Clinicians should be familiar with the assessment and management of this relatively rare but debilitating condition in competitive cyclists.

Case report: Pathological fracture of the manubrium sternum of unknown aetiology

A 26-year-old male professional football player presented with sternal discomfort after performing upper limb exercises. X-rays and a computed tomography (CT) scan of the manubrium sternum indicated an area of lysis with a fracture line. An MRI showed bone marrow oedema as well as presternal and retrosternal soft tissue mass. An incision biopsy of the site and the soft tissue were performed under general anaesthesia. Additional investigations included a bone marrow biopsy from the left iliac crest, a full blood count and C-reactive protein test, all of which were normal. The morphological features were mostly in keeping with a healing fracture site, and the investigations revealed no evidence of a tumour or structural abnormality. In bone injuries, where the level of force is not commensurate with the degree of injury or where the anatomical area and other factors in the presentation are unusual, they require careful investigation. Treating physicians should actively exclude the multitude of potential causes when investigating pathological fractures

Case report: Pathological fracture of the manubrium sternum of unknown aetiology

A 26-year-old male professional football player presented with sternal discomfort after performing upper limb exercises. X-rays and a computed tomography (CT) scan of the manubrium sternum indicated an area of lysis with a fracture line. An MRI showed bone marrow oedema as well as presternal and retrosternal soft tissue mass. An incision biopsy of the site and the soft tissue were performed under general anaesthesia. Additional investigations included a bone marrow biopsy from the left iliac crest, a full blood count and C-reactive protein test, all of which were normal. The morphological features were mostly in keeping with a healing fracture site, and the investigations revealed no evidence of a tumour or structural abnormality. In bone injuries, where the level of force is not commensurate with the degree of injury or where the anatomical area and other factors in the presentation are unusual, they require careful investigation. Treating physicians should actively exclude the multitude of potential causes when investigating pathological fractures

Static versus dynamic kinematics in cyclists: A comparison of goniometer, inclinometer and 3D motion capture

Kinematic measurements conducted during bike set-ups utilise either static or dynamic measures. There is currently limited data on reliability of static and dynamic measures nor consensus on which is the optimal method. The aim of the study was to assess the difference between static and dynamic measures of the ankle, knee, hip, shoulder and elbow. Nineteen subjects performed three separate trials for a 10-min duration at a fixed workload (70% of peak power output). Static measures were taken with a standard goniometer (GM), an inclinometer (IM) and dynamic three-dimensional motion capture (3DMC) using an eight camera motion capture system. Static and dynamic joint angles were compared over the three trials to assess repeatability of the measurements and differences between static and dynamic values. There was a positive correlation between GM and IM measures for all joints. Only the knee, shoulder and elbow were positively correlated between GM and 3DMC, and IM and 3DMC. Although all three instruments were reliable, 3D motion analysis utilised different landmarks for most joints and produced different means. Changes in knee flexion angle from static to dynamic are attributable to changes in the positioning of the foot. Controlling for this factor, the differences are negated. It was demonstrated that 3DMC is not interchangeable with GM and IM, and it is recommended that 3DMC develop independent reference values for bicycle configuration.

Reduction of advanced liver fibrosis by short-term targeted delivery of an angiotensin receptor blocker to hepatic stellate cells in rats

There is no effective therapy for advanced liver fibrosis. Angiotensin type 1 (AT1) receptor blockers attenuate liver fibrogenesis, yet their efficacy in reversing advanced fibrosis is unknown. We investigated whether the specific delivery of an AT1 receptor blocker to activated hepatic stellate cells (HSCs) reduces established liver fibrosis. We used a platinum-based linker to develop a conjugate of the AT1 receptor blocker losartan and the HSC-selective drug carrier mannose-6-phosphate modified human serum albumin (losartan-M6PHSA). An average of seven losartan molecules were successfully coupled to M6PHSA. Rats with advanced liver fibrosis due to prolonged bile duct ligation or carbon tetrachloride administration were treated with daily doses of saline, losartan-M6PHSA, M6PHSA or oral losartan during 3 days. Computer-based morphometric quantification of inflammatory cells (CD43), myofibroblasts (smooth muscle alpha-actin [alpha-SMA]) and collagen deposition (Sirius red and hydroxyproline content) were measured. Hepatic expression of procollagen alpha2(I) and genes involved in fibrogenesis was assessed by quantitative polymerase chain reaction. Losartan-M6PHSA accumulated in the fibrotic livers and colocalized with HSCs, as assessed by immunostaining of anti-HSA and anti-alpha-SMA. Losartan-M6PHSA, but not oral losartan, reduced collagen deposition, accumulation of myofibroblasts, inflammation and procollagen alpha2(I) gene expression. Losartan-M6PHSA did not affect metalloproteinase type 2 and 9 activity and did not cause apoptosis of activated HSCs.

CONCLUSION

Short-term treatment with HSC-targeted losartan markedly reduces advanced liver fibrosis. This approach may provide a novel means to treat chronic liver diseases.

A novel submaximal cycle test to monitor fatigue and predict cycling performance

OBJECTIVE

The purpose of this study was to determine the reliability and predictive value of performance parameters, measured by a new novel submaximal cycle protocol, on peak power and endurance cycling performance in well-trained cyclists.

METHODS

Seventeen well-trained competitive male road racing cyclists completed four peak power output (PPO) tests and four 40-km time trials (40-km TT). Before each test, all cyclists performed a novel submaximal cycle test (Lamberts and Lambert Submaximal Cycle Test (LSCT)). Parameters associated with performance such as power, speed, cadence and rating of perceived exertion (RPE) were measured during the three stages of the test when cyclists rode at workloads coinciding with fixed predetermined heart rates. Heart rate recovery (HRR) was measured after the last stage of the test.

RESULTS

Parameters measured during the second and third stages of the LSCT were highly reliable (intraclass correlation range: R=0.85-1.00) with low typical error of measurements (range: 1.3-4.4%). Good relationships were found between the LSCT and cycling performance measured by the PPO and 40-km TT tests. Mean power had stronger relationships with measures of cycling performance during the second (r=0.80-0.89) and third stages (r=0.91-0.94) of the LSCT than HRR (r=0.55-0.68).

CONCLUSIONS

The LSCT is a reliable novel test which is able to predict peak and endurance cycling performance from submaximal power, RPE and HRR in well-trained cyclists. As these parameters are able to detect meaningful changes more accurately than VO(2max), the LSCT has the potential to monitor cycling performance with more precision than other current existing submaximal cycle protocols.

Growth and mating of Cryptococcus neoformans var. grubii on woody debris

A total of 36 Cryptococcus neoformans strains originating from South Africa were screened for wood degrading enzymes. All strains tested positive for cellulase activity while none where capable of xylan degradation. Three C. neoformans var. grubii strains, originating from clinical and environmental samples, representing the same genotype (VNI/AFLP1-C. neoformans var. grubii) and MATalpha, were evaluated for growth on debris of two common tree species in South Africa: Acacia mearnsii and Eucalyptus camaldulensis. The mating capability of all the C. neoformans strains was evaluated on similar debris. Strains grown on A. mearnsii yielded substantially greater yeast populations. A total of 26%, 6%, 46%, and 80% of the 36 C. neoformans strains tested were either able to mate or develop filaments when crossed on A. mearnsii and E. camaldulensis debris, V8 juice, and yeast carbon base (YCB) agar, respectively. Filamentation and monokaryotic fruiting was observed in 3% of strains when C. neoformans was cultured on either A. mearnsii, E. camaldulensis debris, or YCB. The results indicate that this fungus is capable of completing its life cycle and can produce basidiospores on woody debris. In the future, these findings should be considered when studying the epidemiology, microbial ecology, and proposed infection process of this global pathogen.

Previous experience influences pacing during 20 km time trial cycling

OBJECTIVE

To investigate how experience and feedback influence pacing and performance during time trial cycling.

DESIGN

Twenty-nine cyclists performed three 20 km cycling time trials using a Computrainer. The first two time trials (TT1 and TT2) were performed (1) without any performance feedback (n = 10), (2) with accurate performance feedback (n = 10) or (3) with false feedback showing the speed to be 5% greater than the actual speed (n = 9). All participants received full feedback during the third time trial (TT3), and their performance and pacing data were compared against TT2.

RESULTS

Completion time, average power and average speed did not change among the false feedback group, but their pacing strategy did change as indicated by a lower average cadence, 89.2 (SD 5.2) vs 96.4 (6.8) rpm, p<0.05, and higher power during the first 5 km (SMD = 39, 36, 36, 27 and 27 W for 1-5 km respectively). Pacing changed among the blind feedback group indicated by a faster completion time, 35.9 (3.1) vs 36.8 (4.4) min, p<0.05, and power increases during the final 5 km (SMD = 14, 13, 18, 23 and 53 W for 16-20 km respectively). No performance or pacing changes were observed among the accurate feedback group.

CONCLUSIONS

Pacing is influenced by an interaction between feedback and previous experience. Conscious cognitive processes that lead to ratings of perceived exertion and pacing appear to be influenced by previous experience.

Exercising with reserve: exercise regulation by perceived exertion in relation to duration of exercise and knowledge of endpoint

OBJECTIVE

The purpose of this study was to examine ratings of perceived exertion (RPE) and performance during repetitive maximal effort 40 km time trials as well as after an intervention that aimed to decrease certainty about the remaining distance of the exercise bout. In addition, we examined the RPE during exercise bouts of markedly different duration.

METHODS

Part 1: 12 well-trained, competitive-level cyclists completed five 40 km time trials. During the final time trial all feedback was withheld until the final kilometre. In addition, to cause confusion about the remaining distance, they were asked to report their RPE at random intervals from 18 km to 38 km. Part 2: 6 well-trained, recreation-level cyclists randomly completed a 5 km, 10 km, 40 km and 100 km time trial.

RESULTS

Part 1: Mean RPE increased during the first four trials and decreased during the final trial. The rate of RPE progression increased in linearity during the first four trials and became more conservative in the final trial. These changes were directly related to performance. Part 2: Mean RPE for longer duration trials (40 km, 100 km) were lower during the first half of trial duration but matched those of shorter trials in the final 20%.

CONCLUSIONS

Increased familiarity of the exercise bout and certainty about its endpoint are associated with a more aggressive RPE strategy that produces a superior exercise performance. Certainty about the endpoint and the duration of exercise affect both the RPE strategy and performance.

Delayed cord clamping in preterm infants delivered at 34 36 weeks' gestation: a randomised controlled trial

BACKGROUND

Even mild iron deficiency and anaemia in infancy may be associated with cognitive deficits. A delay in clamping the cord improves haematocrit levels and results in greater vascular stability and less need for packed cell transfusions for anaemia in the first period after birth. Follow-up data on haemoglobin levels after the neonatal period were not available.

OBJECTIVE

To provide neonatal and follow-up data for the effects of early or delayed clamping of the cord.

METHODS

37 premature infants (gestational age 34 weeks, 0 days-36 weeks, 6 days) were randomly assigned to one of two groups in the first hour after birth, and at 10 weeks of age. In one group the umbilical cord was clamped within 30 seconds (mean (SD) 13.4 (5.6)) and in the other, it was clamped at 3 minutes after delivery. In the neonatal period blood glucose and haemoglobin levels were determined. At 10 weeks of age haemoglobin and ferritin levels were determined.

RESULTS

The late cord-clamped group showed consistently higher haemoglobin levels than the early cord-clamped group, both at the age of 1 hour (mean (SD) 13.4 (1.9) mmol/l vs 11.1 (1.7) mmol/l), and at 10 weeks (6.7 (0.75) mmol/l vs 6.0 (0.65) mmol/l). No relationship between delayed clamping of the umbilical cord and pathological jaundice or polycythaemia was found.

CONCLUSION

Immediate clamping of the umbilical cord should be discouraged.

Diabetes mellitus: a risk factor affecting visual outcome in branch retinal vein occlusion

PURPOSE

The prognosis of visual acuity (VA) after branch retinal vein occlusion (BRVO) in patients with diabetes mellitus is unknown compared to the VA in non-diabetic patients with BRVO. The aim of this study was to evaluate the visual outcome of BRVO in diabetic and non-diabetic patients.

METHODS

A retrospective case-control study of diabetic and non-diabetic patients with BRVO was performed. VA and commonly known risk factors and complications of BRVO were compared in a follow-up period of at least 1 year.

RESULTS

A total of 28 eyes of patients with diabetes and 49 eyes of non-diabetic patients with BRVO were included. One year after BRVO, the VA in the patients with diabetes decreased significantly more than that of the non-diabetic patients. During the second year after BRVO, the VA did not change significantly in either group. BRVO in patients with diabetes occurs at an earlier age. Diabetic patients needed more outpatient visits.

CONCLUSIONS

The VA 1 year after BRVO in patients with diabetes is worse compared to the VA in patients without diabetes. The VA stabilizes 1 year after onset in both groups. Diabetic patients tend to need more frequent follow-up in order to treat the sequelae of BRVO.

[Test set for the evaluation of hearing and speech development after cochlear implantation in children]

BACKGROUND

Since autumn 1998 the multicenter interdisciplinary study group "Test Materials for CI Children" has been compiling a uniform examination tool for evaluation of speech and hearing development after cochlear implantation in childhood.

METHODS USED

After studying the relevant literature, suitable materials were checked for practical applicability, modified and provided with criteria for execution and break-off. For data acquisition, observation forms for preparation of a PC-version were developed.

RESULTS

The evaluation set contains forms for master data with supplements relating to postoperative processes. The hearing tests check supra-threshold hearing with loudness scaling for children, speech comprehension in silence (Mainz and Göttingen Test for Speech Comprehension in Childhood) and phonemic differentiation (Oldenburg Rhyme Test for Children), the central auditory processes of detection, discrimination, identification and recognition (modification of the "Frankfurt Functional Hearing Test for Children") and audiovisual speech perception (Open Paragraph Tracking, Kiel Speech Track Program). The materials for speech and language development comprise phonetics-phonology, lexicon and semantics (LOGO Pronunciation Test), syntax and morphology (analysis of spontaneous speech), language comprehension (Reynell Scales), communication and pragmatics (observation forms). The MAIS and MUSS modified questionnaires are integrated.

CONCLUSIONS

The evaluation set serves quality assurance and permits factor analysis as well as controls for regularity through the multicenter comparison of long-term developmental trends after cochlear implantation.

The nigrostriatal dopaminergic system in familial early onset parkinsonism with parkin mutations

Nigrostriatal dopaminergic function and cerebral energy metabolism were measured with PET in two brothers with early-onset parkinsonism caused by mutation of the parkin gene. Energy metabolism did not differ, but the nigrostriatal dopaminergic pattern was clearly different than that of sporadic PD. Thus parkinsonism in these two patients was shown to be pathophysiologically different than PD.

Prevalence of symptomatic intracranial aneurysm and ischaemic stroke in pseudoxanthoma elasticum

BACKGROUND

Pseudoxanthoma elasticum (PXE) is an heritable connective tissue disorder with clinical manifestations of the ocular, dermal, and cardiovascular system. The purpose of this study was to investigate the prevalence of symptomatic intracranial aneurysms (IAs) and ischaemic stroke (IS) in PXE.

METHODS

The records of 100 patients with PXE were retrieved. All patients were contacted and data on complications were collected. The literature was reviewed regarding PXE, ISs, and IAs.

RESULTS

No patient with PXE had a symptomatic IA as presenting symptom. One patient presented with an IS. During follow-up of 94 of the 100 patients (mean follow-up 17.1 years, range 1-49 years), none presented a symptomatic IA (3,168 retrospective patient observation years and 1, 602 prospective patient observation years). Upper gastrointestinal haemorrhage during follow-up occurred in 17 patients, in 1 patient during aspirin use. One patient has IS as presenting symptom and a recurrence during follow-up, and 7 patients had IS during follow-up. All were caused by small-vessel disease. The relative risk of IS in PXE under 65 years compared with the general population was 3.6 (95% confidence interval 3.3-4.0).

CONCLUSIONS

On the basis of the currently available data, an association between symptomatic IAs and PXE is unlikely. However, the incidence of IS, due to small-vessel disease, was increased. Antiplatelet therapy in patients with PXE may lead to a high incidence of upper gastrointestinal haemorrhages.

Mutations in ABCC6 cause pseudoxanthoma elasticum

Pseudoxanthoma elasticum (PXE) is a heritable disorder of the connective tissue. PXE patients frequently experience visual field loss and skin lesions, and occasionally cardiovascular complications. Histopathological findings reveal calcification of the elastic fibres and abnormalities of the collagen fibrils. Most PXE patients are sporadic, but autosomal recessive and dominant inheritance are also observed. We previously localized the PXE gene to chromosome 16p13.1 (refs 8,9) and constructed a physical map. Here we describe homozygosity mapping in five PXE families and the detection of deletions or mutations in ABCC6 (formerly MRP6) associated with all genetic forms of PXE in seven patients or families.

Alcaligenes xylosoxidans endophthalmitis 8 months after cataract extraction

PURPOSE

To report a case of Alcaligenes xylosoxidans endophthalmitis and to increase awareness of its potential as an intraocular pathogen.

METHODS

An 80-year-old woman in good general health developed A. xylosoxidans endophthalmitis 8 months after an uncomplicated cataract extraction performed at another institution. Eventually, vitrectomy with removal of the intraocular lens and capsule was performed because of recurrent disease after intravitreal antibiotic injections.

RESULTS

Microbiologic examination of the vitreous biopsies and capsule disclosed A. xylosoxidans, a motile, gram-negative rod resistant to many antibiotics.

CONCLUSION

A. xylosoxidans should be considered as a cause of low-grade endophthalmitis after cataract surgery.

Cognitive style and the interpretation of organisational change

The ability of individuals to interpret change is considered to be a criterion for successful organisational change. Accordingly the influence of a specific infra-individual variable, i.e. cognitive style (field dependence and independence) on the sensitivity to identify change needs, was assessed. For this purpose the Organisational Change Interpretation Scale (OCIS) was constructed. The OCIS in conjunction with the Hidden Figures Test, a measure of field independence, and the Field Dependence Questionnaire, a measure of field dependence, were administered to 307 managers within 14 industries. It was found that the cognitive restructuring process as measured by the Hidden Figures Test, explains 72% of the variance of the interpretation of change, as measured by the OCIS. It was concluded that the OCIS could be utilised as a selection instrument for the identification of change agents.Opsomming Die vermoe van individue om verandering te interpreteer, kan as kriterium vir suksesvolle organisasie verandering beskou word. Op grond hiervan is die invloed van 'n spesifieke intra-individuele veranderlike, naamlik kognitiewe styl (veldafhanklikheid en -onafhanklikheid) op die sensitiwiteit vir die identifisering van veranderingsbehoeftes, ondersoek. Vir hierdie doel is die Organisasie Verandering Interpretasieskaal (OVIS) gekonstrueer. Die OVIS is in samehang met die Versteekte Figure Toets as meting van veldonafhanklikheid, en die Veldafhanklikheidsvraelys as meting van veldafhanklikheid, op 307 bestuurders in 14 industriee geadministreer. Daar is bevind dat die kognitiewe herstruktureringsproses, soos gemeet deur die Versteekte Figure Toets, 72% van die variansie in die interpretasie van verandering, soos gemeet deur die OVIS, verklaar. Die afleiding word gemaak dat die OVIS onder andere nuttig as keuringsinstrument ter identifisering van veranderingsagente gebruik kan word.

A locus for autosomal recessive pseudoxanthoma elasticum, with penetrance of vascular symptoms in carriers, maps to chromosome 16p13.1

Pseudoxanthoma elasticum (PXE) is a heritable systemic disorder characterized by calcification of the elastic fibers of the connective tissue. Symptoms are predominantly noted in the eye, the skin, and the cardiovascular system, resulting in visual loss, skin lesions, and life-threatening vascular disease. In the study we combined homozygosity mapping and genome scanning with 374 markers in affected individuals from a PXE family from a genetically isolated population in The Netherlands. Initial homozygosity in two or three patients was found with up to 20 markers, among which D16S292 located in 16p13.1. Upon refined and more extensive family screening of the latter region, close linkage without recombination was found with the marker D16S764 (Zmax = 6.27). Despite clear autosomal recessive inheritance of the ocular symptoms in PXE, vascular symptoms appear in 40%-50% of the heterozygotes.

Reliability of drug histories in a specialized geriatric outpatient clinic

To examine the reliability of drug histories of elderly outpatients, records of 122 frail elderly patients in a geriatric outpatient evaluation clinic were reviewed. Drug histories were taken by an internist during an initial clinical evaluation and by a nurse practitioner during a home visit. Home and office drug lists disagreed in 39 cases (32%). Roughly equal numbers of "extra" drugs were listed in the two settings. Number of medications (especially two or more), number of active medical problems (especially four or more), and depression were significant, independent predictors of an unreliable drug history. Neither dementia nor living situation was a significant predictor of an unreliable drug history. The only drugs associated with an unreliable history were megavitamins, beta-blockers, and centrally-acting antihypertensive agents. Using the home list as the reference, there were equal numbers of omission errors and commission errors in the office drug histories. Strategies to optimize the reliability of office drug histories need further investigation.

C.A. Nothardbiblioteek

As instructed by the Central Board of the South African Nursing Association during 1985, an investigation was launched into the function of the C.A. Not hard Library, namely to provide optimal information to members. The underlying philosophy concerned with the establishment of the library was to provide a service which is not available elsewhere. The investigation revealed however, that various training institutions in the country meet this need. As a result of the findings, as presented in the article, the C.A. Northard Library was closed on 1 December 1985 as a lending library. A unique Nursing reference library is being established in its place, with the emphasis in the future on the S. A. Nursing Association’s role in the promotion of Nursing research.

[The Duffy system: a population genetics study in Portugal, Guinea-Bissau and Brazil]

2225 blood samples from Portugal (classed according to historical provinces), 301 blood samples from Guinea-Bissau (classed in tribes) and 697 blood samples from Brazil (classed according to colour of skin) have been tested in the Duffy system. The Portuguese seem to be a sufficiently uniform and autonomous population. This is also true for the (non-rejected) blood-samples from Guinea-Bissau. The Brazilians differ in accordance with their colour of skin. The expected relations between Portugal and its former colonies can be proved. The Duffy system is suited for the distinction of black and non-black populations and enables to recognize extraneous admixtures.