Oral sequelae of chemotherapy: an important teaching opportunity for oncology health care providers and their patients

 The object of this work was to conduct a rapid assessment of a teaching hospital's promotion of optimal oral health among its chemotherapy patients. A pilot study was undertaken, which included focus interviews with oncology clinic staff, a review of the fellowship training curriculum, and unobtrusive observations in the clinic setting. Charts were also audited for oncology patients who were probable chemotherapy candidates. A review of the data offered no evidence that oral health care was routinely addressed in a preventive context prior to the initiation of chemotherapy. Promotion of oral health care will help reduce the risk of oral sequelae of chemotherapy for patients and the subsequent impact of the oral sequelae on patients' chemotherapeutic regimen, thereby improving patients' chances of survival and improving their quality of life. Other teaching hospitals may wish to conduct a similar rapid assessment to determine whether they too could improve patient care and professional education in this area by incorporating pre-chemotherapy oral health evaluation and treatment into routine care for cancer patients. Published online: 18 November 1999     

Physical activity and sedentary behaviours of South Asian and white European children in inner city secondary schools in the UK

BACKGROUND: People of South Asian (SA) origin have an increased risk of premature coronary heart disease. In children of SA origin, there is an increased prevalence of obesity and evidence of insulin resistance. Risk factors for cardiovascular disease in children often persist into adulthood. Low levels of physical activity are likely to be linked to the rise in obesity. OBJECTIVE: To determine levels of physical activity and sedentary behaviours in secondary school pupils in the UK, including comparison of SA and white European (WE) children and those with and without a family history of cardiovascular disease. METHOD: Questionnaire survey conducted within an action research study in five inner city secondary schools serving a predominantly SA population. RESULTS: We obtained 3601 responses from 76% of eligible pupils. WE pupils were more likely to have walked to and from school compared to SAs. However, overall we identified low levels of physical activity and higher levels of inactive behaviours in both ethnic groups. Almost half (46%) of respondents spent four or more hours per day watching television or videos or playing computer games. An overall low level of active behaviour during school breaks was particularly emphasized in girls. We found no evidence of an association between physical activity levels and family history of cardiovascular disease. CONCLUSIONS: There is an urgent need for those with responsibility for young people's health, including parents, schools and community health providers, to consider and address the need for effective interventions to encourage increased physical activity levels.     

A colony assay for in vitro transformation by human T cell leukemia viruses type I and type II

We report here the development of a rapid and quantitative method for measuring in vitro T cell transformation by human T cell leukemia viruses type I (HTLV-I) and type II (HTLV-II). This method is based on our finding that cocultivation of lethally irradiated HTLV-producing cells with peripheral blood lymphocytes (PBLs) preactivated for 24 hours with phytohemagglutinin and interleukin-2 (IL-2) induces colony formation in methylcellulose-containing medium. Colonies of about 200 cells can be clearly distinguished from background aggregates within four to six days after cocultivation. These colonies gradually increase in size and reach 300 to 1,000 cells within 14 days after cocultivation. Cells of these colonies were infected, as evidenced by expression of viral p19 antigen and the presence of HTLV proviral sequences. These cells proved to be transformed in terms of IL-2- independent continuous growth in liquid medium. Colony formation was found to depend in a linear fashion upon the percentage of the infected cells present in the irradiated cell population and is sufficiently sensitive to detect as few as 1% of virus-producing cells.     

Toxicity from a clonidine suspension

Background

Clonidine is frequently prescribed to children. Clonidine overdose in children has resulted in major clinical effects and deaths.

Case Report

A 3.5-year-old male with a history of a seizure disorder and night terrors presented following difficulty walking, excessive sleeping, agitation when awake, and possible seizure activity. Chronic medications were valproic acid (VPA) and clonidine. On presentation, he alternated between poor responsiveness and agitation, with initial vitals: blood pressure, BP 144/76 mmHg; heart rate, 65 bpm; respiratory rate, 18 bpm; temperature 99.5°F; and pulse oximetry 96% on room air. VPA level was 35 μg/mL. A toxicology consult the next day noted a dry mouth, 2-mm pupils, intermittent gasping, and central nervous system (CNS) depression, with a diagnostic impression of clonidine overdose. The caregiver had been giving 1 mL (0.1 mg) qd of a pharmacy-compounded clonidine suspension by a provided syringe. The pharmacy procedure record agreed with the physicians order. The amount dispensed was a 30-day supply but the bottle was empty on day 19, leading us to suspect a possible accelerated dosing error. The concentration in the bottle thus could not be confirmed. The child slowly returned to his baseline state over 48 hours. A serum clonidine level drawn approximately 18 hours after his last dose later returned at 300 ng/mL (reference range = 0.5–4.5 ng/mL).

Case Discussion

Compounding and liquid dosing errors are common in children and may result in massive overdoses. There was an accelerated dosing error, but whether a compounding or suspension error or even an acute overdose occurred as well is unknown.

Conclusion

Particular care should be taken with medications that have low therapeutic indices, that are extemporaneously compounded, and are prepared as liquids, where medication errors are more likely.     

Sources of Arsenic and Fluoride in Highly Contaminated Soils Causing Groundwater Contamination in Punjab,Pakistan

Highly contaminated groundwater, with arsenic (As) and fluoride (F⁻) concentrations of up to 2.4 and 22.8 mg/L, respectively, has been traced to anthropogenic inputs to the soil. In the present study, samples collected from the soil surface and sediments from the most heavily polluted area of Punjab were analyzed to determine the F⁻ and As distribution in the soil. The surface soils mainly comprise permeable aeolian sediment on a Pleistocene terrace and layers of sand and silt on an alluvial flood plain. Although the alluvial sediments contain low levels of F, the terrace soils contain high concentrations of soluble F⁻ (maximum, 16 mg/kg; mean, 4 mg/kg; pH > 8.0). Three anthropogenic sources were identified as fertilizers, combusted coal, and industrial waste, with phosphate fertilizer being the most significance source of F⁻ accumulated in the soil. The mean concentration of As in the surface soil samples was 10.2 mg/kg, with the highest concentration being 35 mg/kg. The presence of high levels of As in the surface soil implies the contribution of air pollutants derived from coal combustion and the use of fertilizers. Intensive mineral weathering under oxidizing conditions produces highly alkaline water that dissolves the F⁻ and As adsorbed on the soil, thus releasing it into the local groundwater.     

Screening the human prepro-orexin gene in a single-centre narcolepsy cohort

BACKGROUND AND PURPOSE: Although the orexin system has an established role in narcolepsy, the mechanism of orexin deficiency in human cases is unknown. The strong association with human leukocyte antigen (HLA) DQB1*0602 suggests an autoimmune basis, but supporting evidence is lacking. Although data indicate that HLA status is not the sole genetic factor, only a single case of a functional orexin system mutation has been discovered, in a study with a selection bias designed to increase yield. In this study, we examined the prepro-orexin gene for mutations in a cohort of unrelated patients with narcolepsy from a national UK referral centre. PATIENTS AND METHODS: Subjects with a diagnosis of narcolepsy were recruited from a patient database. DNA samples were obtained using buccal smear kits. The prepro-orexin gene was amplified using polymerase chain reactions and screened for polymorphisms and mutations. RESULTS: Eighty-one patients were recruited, of whom 69 provided DNA samples. A previously described intronic single nucleotide polymorphism, of unlikely significance, was identified in one subject who had typical clinical and electrophysiological features of narcolepsy. It was located 16 base pairs downstream from exon 1. No other mutations were found. CONCLUSION: This result supports existing evidence which indicates that mutations of the prepro-orexin gene are rare and that the genetic contribution to the aetiology of human narcolepsy is likely to be complex.     

Spiral-shaped biliary endoprosthesis: initial study

A new flexible, spiral-shaped biliary endoprosthesis is described. This spiral endoprosthesis can negotiate acute angles, can be cut to any length, and has been specifically designed to deal with the problem of stent migration. The authors report their initial experience with this endoprosthesis in 14 patients.     

Precise measurements of intrauterine vascular structures at hysteroscopy in menorrhagia and during Norplant use

Using currently available equipment for panoramic hysteroscopy, the size of images viewed cannot be accurately judged because of the magnifying and distorting effects of the objective lens. This study has demonstrated that magnification by the hysteroscope lens can alter the apparent size of images by up to 27%. An additional effect of lens distortion can alter the apparent size of images viewed by up to 28%, depending on the position of the image in the field of view. These effects are independent and may be additive. Thus, the apparent size of intrauterine structures at hysteroscopy may bear little resemblance to their actual size. Image-correction methods are described which reduce the effects of image magnification on the apparent size of an object viewed through the hysteroscope to 7%, and the effect of distortion to 3 %. This technique can greatly improve the accuracy of measurement at hysteroscopy, and has been utilized in this study for the precise measurement of superficial endometrial vascular diameter (mean+/-SEM) in 34 Norplant users (120+/-11.6 microm) and 20 women with spontaneous menorrhagia (74+/-7.2 microm). It has also confirmed the presence of scattered dilated vessels (up to 777 microm in diameter) on the endometrial surface in some Norplant users.