Elevated sleep arousal thresholds in enuretic boys: clinical implications

Enuretic children are described as difficult to arouse from sleep. We studied auditory sleep arousal thresholds in enuretic boys and report on die clinical implications of these findings. Fifteen enuretic and 18 control subjects (7–12-year-old males) were studied in a sleep laboratory for four consecutive nights using standard polysomnographic recording techniques. Sleep was undisturbed for the initial two nights and waking thresholds were measured on the following two nights. Enuretic children wet most frequently in the first two-thirds of the night. Arousal attempts were successful 39.7% of the time in controls and only 9.3% of the time in enuretics. In conclusion, enuretic males were more difficult to arouse than age-matched controls. The elevated arousal thresholds may be due to delayed maturation. Treatment programmes that rely on awakening should be aware of these features.     

Biologic effects of leukocytes present in transfused cellular blood products

A considerable literature has accumulated over the past decade indicating that leukocytes present in allogeneic cellular blood components, intended for transfusion, are associated with adverse effects to the recipient. These include the development of febrile transfusion reactions, graft-versus-host disease, alloimmunization to leukocyte antigens, and the immunomodulatory effects that might influence the prognosis of patients with a malignancy. Moreover, it has become evident that such leukocytes may be the vector of infectious agents such as CMV, HTLV-I/II, and EBV as well as other viruses. An interesting development that has occurred coincidentally in transfusion medicine is that agencies responsible for the provision of blood products are being designated manufacturers of biologicals. The trend among manufacturers of biologicals is to try to produce pure products to provide for the specific therapeutic need of patients. Thus, with the realization that allogeneic leukocytes and their products may have adverse biologic activities, there is increasing pressure from various sources for the reduction of the leukocyte content in allogeneic blood components to minimize the occurrence of their adverse effects. Although the threshold leukocyte number below which these effects might no longer occur is still to be determined, a 2 to 3 log10 leukocyte reduction, provided by the currently available commercial leukocyte filters, has been shown to reduce the frequency of many of such reactions. On the other hand, the immunosuppressive effects produced by the infusion of allogeneic leukocytes might be beneficial for some patients, ie, for the maintenance of kidney allografts, in possibly reducing the relapse rate in patients with inflammatory bowel diseases, and in ameliorating recurrent spontaneous abortion. Moreover, therapeutic granulocyte transfusions may be of benefit in certain well- defined categories of patients infected with bacteria, yeast, and/or fungi. These include neonates with bacterial sepsis associated with bone marrow failure as well as severely neutropenic leukemic patients with an infection unresponsive to appropriate and specific antibiotic therapy. Many of the results obtained with the use of leukocyte depletion filters are tantalizing, but the actual clinical benefit of leukodepletion has not been established in most instances, because much of the available data are retrospective or from uncontrolled clinical trials. Moreover, issues of cost-effectiveness and quality control have not been considered adequately. Properly designed prospective clinical trials are essential to provide data with which to answer such questions and also to help define the optimal conditions required for the preparation of blood components ultimately destined for clinical use. Only with the availability of such data can sound decisions be made about the clinical value of leukodepletion.     

Risk factors for HIV infection among women in Dodoma region,Tanzania

Ｉｎｔｈｉｓｐａｐｅｒ ,ｗｅｒｅｐｏｒｔｅｄｒｉｓｋｆａｃｔｏｒｓａｓｓｏｃｉａｔｅｄｗｉｔｈＨＩＶｉｎｆｅｃｔｉｏｎａｍｏｎｇｗｏｍｅｎａｎｄｔｈｅｉｒｉｍｐｌｉｃａｔｉｏｎｓｆｏｒＡＩＤＳｐｒｅｖｅｎｔｉｏｎｅｆｆｏｒｔｓｉｎｔｈｅＤｏｄｏｍａｒｅｇｉｏｎ ,Ｔａｎｚａｎｉａ .1　ＳＵＢＪＥＣＴＳＡＮＤＭＥＴＨＯＤＳ1.1　Ｔｈｅｐｏｐｕｌａｔｉｏｎａｎｄｓａｍｐｌｅｓｅｌｅｃｔｉｏｎ　ＴｈｅｓｔｕｄｙｗａｓｃｏｎｄｕｃｔｅｄｉｎｔｈｅＤｏｄｏｍａｒｅｇｉｏｎ ,ｗｈｉｃｈｈａｓａｎｅｓｔｉｍａｔｅ…     

Risk factors for early termination of breast feeding in Brazil

A prospective study was undertaken to identify possible factors related to the duration of breast feeding. Two hundred and thirty-eight mothers who had delivered normal single babies with birth weights greater than 2.5 kg and had initiated breast feeding were randomly selected at the maternity hospital, Hospital de Clinicas de Porto Alegre, Brazil, and followed by mail questionnaires until termination of breast feeding, or until the end of the first year. If no reply was received, telephone contact or home visits were made. The group of mothers who stopped breast feeding prior to the end of the third month was compared with those who extended breast feeding beyond three months with respect to socioeconomic, biological, environmental, medical and psychological factors. The variables with a significant coefficient of association with early termination of breast feeding were maternal education, past experience with breast feeding, help of a maid, help with housework provided by a relative, breast feeding orientation during prenatal care and encouragement from the husband. These factors act simultaneously, with interactions among them.     

Optimization of the effects of physical and health resort factors in ischemic heart disease and arterial hypertension

The authors presented and discussed the results of the use of the natural and instrumental physical methods for therapy, prevention and rehabilitation of 280 patients with coronary heart disease (CHD) and 300 patients with arterial hypertension (AH). The efficacy of the optimized use of a number of physical factors (precardial and segmental massage, low frequency magnetic field) was shown in the CHD and AH patients by the short- and long-term follow-up results. The authors substantiated the appropriateness of expanding the concept "nonpharmacological" methods proceeding from its practical meaning at the present-day stage of CHD and AH control.     

'Late onset' ornithine transcarbamylase deficiency: function of three purified recombinant mutant enzymes

Although many mutations in the ornithine transcarbamylase gene have been correlated with 'late onset' of hyperammonemia in patients, the effects of these mutations on enzyme function are largely unknown. Three recurrent mutations (R40H, R277W and R277Q) found in patients with 'late onset' disease were incorporated into 'mature' human ornithine transcarbamylase cDNA and overexpressed in Escherichia coli. The three recombinant mutant enzymes were purified to homogeneity on an affinity column and their biochemical characteristics were compared to the wild type enzyme. The R277W and R277Q mutants display markedly reduced affinity for L-ornithine, loss of substrate inhibition, alkaline shift of pH optimum, and reduced thermal stability compared to the wild type enzyme. These differences, particularly the reduced affinity for L-ornithine, are sufficient to account for their biochemical effects. In contrast, the 'mature' R40H mutant was biochemically indistinguishable from the wild type enzyme in vitro.