Validity of self-reports of reasons for hospitalization by young adults and risk factors for discordance with medical records: the Coronary Artery Risk Development in Young Adults (CARDIA) Study

This research focused on the validity of young adults' (mean age=33 years; standard deviation, 3.9) self-reports of reasons for hospitalization and factors affecting validity in a longitudinal cohort study of over 5,000 young adults in four US cities (1985-1998). Self-reported reasons were considered discordant if they differed from those in medical records. Of the 321 self-reported hospitalizations, overall concordance was 92.5%; concordance ranged from 80% for infections to 100% for injuries/fractures and procedures/surgeries. There were no significant differences among mail, telephone, or face-to-face methods of collecting self-reports. In generalized estimating equations analyses, Black race (odds ratio=4.23, 95% confidence interval: 1.72, 10.40; p=0.002) and intravenous drug use (odds ratio=6.06, 95% confidence interval: 1.17, 31.22; p=0.03) were positively associated with discordance. Nonetheless, self-reports by Blacks were 90.0% concordant. Self-reports by Whites were 95.7% concordant. These results suggest that young adults' self-reported reasons for hospitalization are overwhelmingly concordant with medical records. This has important implications, since obtaining medical records has become more costly and logistically difficult.     

Modelling and multivariable control in anaesthesia using neural-fuzzy paradigms. Part I. Classification of depth of anaesthesia and development of a patient model

OBJECTIVE: The first part of this research relates to two strands: classification of depth of anaesthesia (DOA) and the modelling of patient's vital signs. METHODS AND MATERIAL: First, a fuzzy relational classifier was developed to classify a set of wavelet-extracted features from the auditory evoked potential (AEP) into different levels of DOA. Second, a hybrid patient model using Takagi-Sugeno Kang fuzzy models was developed. This model relates the heart rate, the systolic arterial pressure and the AEP features with the effect concentrations of the anaesthetic drug propofol and the analgesic drug remifentanil. The surgical stimulus effect was incorporated into the patient model using Mamdani fuzzy models. RESULTS: The result of this study is a comprehensive patient model which predicts the effects of the above two drugs on DOA while monitoring several vital patient's signs. CONCLUSION: This model will form the basis for the development of a multivariable closed-loop control algorithm which administers "optimally" the above two drugs simultaneously in the operating theatre during surgery.     

Oxidative stress: the old enemy in Alzheimer's disease pathophysiology

The complex nature and genesis of oxidative damage in Alzheimer disease can be partly answered by mitochondrial and redox-active metal abnormalities. By releasing high levels of hydrogen peroxide, dysfunctional mitochondria propagate a series of interactions between redox-active metals and oxidative response elements. In the initial phase of disease development, amyloid-beta deposition and hyperphosphorylated tau may function as compensatory responses and downstream adaptations to ensure that neuronal cells do not succumb to oxidative injuries. However, during the progression of the disease, the antioxidant activity of both agents evolves into pro-oxidant activity representing a typical gain-of-function transformation, which can result from an increase in reactive species and a decrease in clearance mechanisms.     

Screening detected celiac disease in children with type 1 diabetes mellitus: effect on the clinical course (a case control study)

OBJECTIVE: To investigate clinical and metabolic characteristics of diabetic children with screening detected celiac disease in a multicenter case-control study. METHODS: Cases: 98 diabetic patients were diagnosed as having silent celiac disease by screening with endomysial antibodies and subsequent biopsy. Controls: two controls in the same center were chosen, (stratified by age and age-at-diabetes onset) who were negative for endomysial antibodies (n = 195). Height, weight, HbA1c, insulin dosage and acute complications were documented for at least 1 year of follow up. RESULTS: Mean age of diabetes manifestation was 6.5 +/- 4.1 years and diagnosis of celiac disease was made at 10.0 +/- 5.4 years. Biopsy showed total or subtotal mucosal atrophy in 74 patients. The mean observation period after the diagnosis of celiac disease was 3.3 +/- 1.9 years. Mean HbA1c levels were similar between cases and controls (8.63% +/- 1.45% versus 8.50% +/- 1.39%; P = 0.35). There was also no difference in the frequency of severe hypoglycemia, ketoacidosis and the applied insulin dosage (P = 0.45). Body mass index-standard deviation score at celiac disease diagnosis (0.57 +/- 1.24 versus 0.52 +/- 1.07) and height-standard deviation score (0.14 +/- 1.13 versus 0.30 +/- 0.95) did not differ between cases and controls. After diagnosis of celiac disease, weight gain was diminished in boys with celiac disease compared with their controls (P < 0.05). Female cases also had a lower body mass index than female controls (P = 0.067). CONCLUSION: In a cohort of diabetic children, silent celiac disease had no obvious effect on metabolic control but negatively influenced weight gain.     

Herpes simplex virus esophagitis in immunocompetent children

OBJECTIVES: To review clinical, laboratory, endoscopic and histologic features, treatment and outcome of immunocompetent children with Herpes simplex virus esophagitis. METHODS: Retrospective analysis of the medical records of six children (five males) referred to our unit between 1997-2001. RESULTS: The median age at presentation was 4 years. Fever was present in all, odynophagia/dysphagia in five, retrosternal pain in four, vomiting in three, drooling in two and irritability and drowsiness in one. The median time between the onset of symptoms and the diagnosis was 6.5 days. Endoscopy, performed in all, showed friable mucosa and erosive-ulcerative involvement, with histology showing inflammation and ulcerated esophagitis. Tissue viral culture was performed in five patients and was positive in three, and polymerase chain reaction was positive in two of four tested. Serology was consistent with primary Herpes simplex virus infection in all. All received nasogastric feeding and acyclovir. The outcome was very good. CONCLUSIONS: This is an uncommon and under-recognized condition in the immunocompetent child. The most common symptoms are sometimes not diagnostic, particularly in very young children. The presence of unusual clinical signs may lead to a difficult and delayed diagnosis. Treatment with acyclovir may have hastened the resolution of symptoms, but a controlled clinical study was not performed.     

Effects of estrogen on muscarinic acetylcholine receptors in the rat hippocampus

The aim of the present study was to investigate whether different estrogen manipulations have effects on the expression of muscarinic acetylcholine receptors (mAChRs) in the adult female rat hippocampus. Hippocampus was obtained from rats in proestrus (control), ovariectomized for 2, 10 and 15 days, ovariectomized for 15 days and treated with 17beta-estradiol for 7 days, and treated with 17beta-estradiol immediately after ovariectomy for 21 days. Rats' estrogen status was monitored by measuring estradiol plasma levels and uterus relative weight. [3H]quinuclidinyl benzilate ([3H]QNB) binding studies indicated that ovariectomy time-dependently increases the number of mAChRs in hippocampus when compared to those obtained from control rats. Estradiol treatments for 21 days avoid the effect of ovariectomy. However, the estradiol treatments for 7 days after 15 days of ovariectomy slightly change the number of mAChRs. In conclusion, these results showed that ovariectomy time-dependently increases mAChRs number in the rat hippocampus. In addition, these data suggest that treatment with estradiol initiated within a specific period of time after the loss of ovarian function may be effective at preventing specific effects of hormone deprivation on hippocampus.     

Oxidative stress affects synaptosomal gamma-aminobutyric acid and glutamate transport in diabetic rats: the role of insulin

Evidence suggests that oxidative stress is involved in the pathophysiology of diabetic complications and that insulin has a neuroprotective role in oxidative stress conditions. In this study, we evaluated the in vitro effect of insulin in the susceptibility to oxidative stress and in the transport of the amino acid neurotransmitters gamma-aminobutyric acid (GABA) and glutamate in a synaptosomal fraction isolated from male type 2 diabetic Goto-Kakizaki (GK) rat brain cortex. The ascorbate/Fe(2+)-induced increase in thiobarbituric acid reactive substances (TBARSs) was similar in Wistar and GK rats and was not reverted by insulin (1 micromol/l), suggesting that other mechanisms, rather than a direct effect in membrane lipid peroxidation, may mediate insulin neuroprotection. Diabetes did not affect GABA and glutamate transport, despite the significant decrease in membrane potential and ATP/ADP ratio, and insulin increased the uptake of both GABA and glutamate in GK rats. Upon oxidation, there was a decrease in the uptake of both neurotransmitters and an increase in extrasynaptosomal glutamate levels and in ATP/ADP ratio in GK rats. Insulin treatment reverted the ascorbate/Fe(2+)-induced decrease in GABA accumulation, with a decrease in extrasynaptosomal GABA. These results suggest that insulin modulates synaptosomal GABA and/or glutamate transport, thus having a neuroprotective role under oxidizing and/or diabetic conditions.