Sensitivity of effect variables in rheumatoid arthritis: A meta-analysis of 130 placebo controlled NSAID trials controlled NSAID trials

In a meta-analysis of placebo controlled NSAID trials, the sensitivity of the effect variables was calculated as the correlation coefficient and as the difference between drug and placebo, divided by the placebo group standard deviation. The patient's global evaluation was the most sensitive variable overall. Pain was more sensitive than Ritchie's index. Several variables may be omitted from clinical trials, especially if two active drugs are being compared. For example, the best maximum estimate for the difference in ESR between NSAADs and placebo was 1.0 mm/hr (95% confidence interval −1.5 to 3.4 mm/hr), and for joint size 0.44% (−1.0 to 1.9%), corresponding to a quarter of a millimeter for each of the 10 joints usually measured. It is suggested to record only the patient's global evaluation, pain, and morning stiffness.     

Immunophenotyping of childhood acute lymphoblastic leukemia in Saudi Arabia: Second look

Geographical variations in the incidence of disease are of considerable theoretical and practical importance. It has been claimed that the distribution of acute lymphoblastic leukemia (ALL) phenotypes in Saudi Arabia is different from that recorded in the Western literature. One hundred and twelve (112) patients under 15 years of age, diagnosed as ALL between January 1992 and May 1994 had immunophenotypes performed on their blast cells. Common ALL (cALL) together with pre-B-ALL, formed 86.5% of the total; B-cell 3%, T-cell 6% and null cell 4.5%. These figures are not significantly different from the Western literature. A previous claim from this institution in 1990, that both null and B-cell ALL were significantly increased compared with elsewhere, is not supported by the present figures. Age and sex distribution, and FAB classification, L1 77%, L2 20% and L3 3%, were also of the same order as described elsewhere and, in particular, there was no increase in the frequency of L3 subtype.     

Interrelationship between secretion, protein phosphorylation and intracellular Ca2+ concentration in platelets stimulated by thrombin or thromboxane A2 analogue

The interrelationship between ATP-secretion, protein phosphorylation and intracellular Ca²⁺ concentration ([Ca²⁺]i) was studied in both ³²P and quin 2 loaded human platelets stimulated by thrombin or thromboxane A₂ analogue (STA₂). In platelets stimulated by thrombin, the degree of 47,000 dalton polypeptides (P47) phosphorylation was observed in completely dose-related manner, regardless of the amount of [Ca²⁺]i. In the same condition, the degree of myosin light chain (P20) phosphorylation, however, was well correlated with ATP secretion and [Ca²⁺]i, when platelets were stimulated by lower dose of thrombin. The similar results were obtained in platelets stimulated by STA₂. These findings suggested that P20, but not P47, phosphorylation in activated platelets is mediated by a rise of [Ca²⁺]i and is well correlated with the secretory reaction. It was unlikely that P47 phosphorylation plays any role in promoting platelet activation.     

Throat pain and pharyngeal packing: a controlled randomized double-blind comparison between gauze and tampons

In order to determine whether patients having pharyngeal packing experience more or less post-operative throat pain when tampons were used, 80 patients were randomized into two groups to receive either gauze or tampon pharyngeal packing. A third control group of 40 patients were intubated but did not have any throat packs. Post-operative throat pain was subjectively rated at both 6 hours and at 24 hours by an independent observer. Thirty-eight per cent of patients had moderate or severe throat pain in the gauze group, whilst in the tampon and control groups these amounted to only 15% and 1% respectively. A significantly higher proportion of patients also had a moderate or severe sore throat at 24 hours in the former group. Intubation alone resulted in a sore throat post-operatively in 50% of patients, but 85% of those had a mild sore throat only. No differences in pain ratings in any group could be shown between men or women or between age groupings. Endotracheal intubation often causes post-operative throat pain which is exacerbated by the use of pharyngeal packing. The results presented suggest that tampons are a safe, effective alternative to gauze and result in less severe post-operative throat pain.     

Attitudes toward psychiatry among Irish final year medical students

This study investigated the attitudes of medical students towards psychiatry, both as a subject on the medical curriculum and as a career choice. Three separate questionnaires previously validated on medical student populations were administered prior to and immediately following an 8-week clinical training programme. The results indicate that the perception of psychiatry was positive prior to clerkship and became even more so on completion of training. On completion of the clerkship, there was a rise in the proportion of students who indicated that they might choose a career in psychiatry. Attitudes toward psychiatry correlated positively with the psychiatry examination results. Those that intended to specialise in psychiatry achieved significantly higher examination scores in the psychiatry examination.     

Gynandroblastoma of ovary with juvenile granulosa cell component and heterologous intestinal type glands

An ovarian gynandroblastoma in a 15-year-old girl is described. The predominant component was juvenile granulosa cell tumour. Areas of adult granulosa cell tumour and Sertoli cell elements were also present. Stromal theca and luteinised cells were identified. An additional histological finding was the presence of heterologous intestinal type glands. There was positive immunohistochemical staining of juvenile and adult granulosa cell areas with inhibin and MIC2 antibodies. Electronmicroscopy showed a close ultrastructural resemblance between tumour cells in granulosa and Sertoli cell areas, in spite of differences in architectural pattern, suggesting that both morphological components may derive from a single cell of origin. The tumour demonstrates a unique combination of elements which has not previously been described.     

The use of deep inspiration preceding the valsalva maneuver and rapid expiration in color doppler imaging of the lower extremity veins

Deep inspiration preceding Valsalva maneuver and rapid expiration immediately following it (DIVE) enhance venous blood flow on color Doppler flow imaging (CDI). The effect of DIVE was assessed in 115 consecutive lower extremity examinations. Of these, 95 or 115 (83%) had negative CDI sonograms, and 20 of 115 (17%) had partially (six of 115) or completely (14 of 115) occluding deep vein thrombosis. DIVE enhanced venous blood flow in 68% of the negative cases, resulting in transient venous distention, and/or more complete color filling, and/or greater spectral flow velocities. The 14 cases with completely occluding thrombi showed no response to DIVE. Six cases with partially occluding thrombi showed moderate to mild response to DIVE, with improved color delineation of the residual patent lumen around the thrombus. The authors conclude that DIVE facilitates deep venous CDI, especially when compression cannot be used to augment venous flow.     

The patient's daily activities in acute psychiatric care

The patient's daily activities in acute psychiatric care
This study is part of a research project entitled:'Towards patient-focused nursing on an acute psychiatric ward'. The aim of the project is to describe the changes taking place in nursing activities during a research project. This paper is a qualitative analysis of the patient's daily activities in acute psychiatric care. The data were collected by observing, selectively, seven patients for 61 h. The constant comparative method was used in data analysis. On the basis of the data analysis, the categories listed below were identified.
1 The core category of the patient's daily activities was'being a patient'.
2 Being a patient mainly consisted of being alone without meaningful activities.
3 Participating in the daily routines of the ward consisted of being alone while being together with others.
4 Being together was initiated by either the patient or the nurse. The aim of being together was to satisfy the acute basic needs of the patients.
5 Being together on the initiative of the nurse meant participating in the daily routines of the ward.
Because the data were collected by observation, no insight into the patients'desires, expectations and thoughts could be presented. The findings challenged the nursing staff to develop a more therapeutic daily routine in acute psychiatric care. It was also of importance to change the patients'meaningless existence into a meaningful participation in the daily activities on the ward.     

A neural network confirms that physical exercise reverses EEG changes in depressed rats

The use of an artificial neural network (ANN) system to differentiate the EEG power density spectra in depressed from normal rats was tried. The beneficial effects of chronic physical exercise in reducing the effects of stress and therefore depression was also to be tested in animals by the same method. In this study, rats were divided into 4 groups, subjected to (i) chronic stress (D group); (ii) chronic exercise by treadmill running (EO group); (iii) exercise with stress (ES group) and (iv) handling (C group). The prefrontal cortical EEG, EMG and EOG were recorded simultaneously on paper and the digitized EEG signals were also stored in the hard-disk of a PC-AT through an ADC. After filtering the digitize signals, the EEG power spectra were calculated by an FFT routine. Three successive 4 s artefact-free epochs were averaged. The REM and NREM sleep periods as well as the awake period signals were analyzed separately. The FFT values from each of the 3 states, in the 4 groups of animals were tested by an ANN with 30 first layer neurons and a 2nd layer of a majority-vote-taker. The ANN could distinguish the depressed from the normal rats' EEG very well in REM (99%) sleep, NREM (95%) sleep and awake (81%) states. In most of the cases it identified the exercised rats' EEG as normal.     

Efficacy and tolerability of estraderm MX, a new estradiol matrix patch

Objectives: To assess the efficacy and tolerability of a new matrix patch delivering 0.05 mg estradiol per day (Estraderm MX 50) in postmenopausal women with moderate to severe postmenopausal symptoms. Methods: A multicenter, double-blin, randomized, between-patient, placebo controlled trial in 109 postmenopausal women was carried out. Patches were applied twice weekly for 12 weeks. Patients were assessed at 4, 8 and 12 weeks of treatment. The primary efficacy variable was change from baseline in mean number of moderate to severe hot flushes (including night sweats) per 24 h during the last 2 weeks of treatment. Other variables included Kupperman Index, local and systemic tolerability. Plasma concentrations of estradiol (E2), estrone (E1) and estrone sulfate (E1S) were determined before and after treatment. Results: Estraderm MX was significantly superior to placebo (P < 0.001) in reducing mean number of moderate to severe hot flushes (including night sweats) per 24 h after 4, 8 and 12 weeks of treatment. The estimate of treatment group differences after 12 weeks was 4.2 hot flushes (95% confidence interval: 2.6–5.5). Estraderm MX also significantly reduced Kupperman Index at all time points compared to placebo (P < 0.001). Estraderm MX induced increases in mean E2, E1 and E1S plasma levels as expected (E2: baseline 2.7 pg/ml, 12 weeks 38.9 pg/ml; E1: baseline 18.8 pg/ml, 12 weeks 41.6 pg/ml; E1S: baseline 235.6 pg/ml, 12 weeks 765.1 pg/ml). Overall rates of adverse experiences were similar for Estraderm MX and placebo. The number of patients reporting skin irritation was low and similar in both groups. Conclusions: Estraderm MX 50, a new matrix patch, offers an effective and well tolerated dosage form for transdermal delivery of 0.05 mg E2 per day.