Patients with IgA nephropathy have increased serum galactose-deficient IgA1 levels

Immunoglobulin A (IgA) nephropathy is the most prevalent form of glomerulonephritis worldwide. A renal biopsy is required for an accurate diagnosis, as no convenient biomarker is currently available. We developed a serological test based upon the observation that this nephropathy is characterized by undergalactosylated IgA1 in the circulation and in mesangial immune deposits. In the absence of galactose, the terminal saccharide of O-linked chains in the hinge region of IgA1 is terminal or sialylated N-acetylgalactosamine. A lectin from Helix aspersa, recognizing N-acetylgalactosamine, was used to develop an enzyme-linked immunosorbent assay that measures galactose-deficient IgA1 in serum. The median serum lectin-binding IgA1 level was significantly higher for 153 Caucasian adult patients with IgA nephropathy without progression to end-stage renal disease as compared with that for 150 healthy Caucasian adult controls. As the lectin-binding IgA1 levels for the controls were not normally distributed, the 90th percentile was used for determination of significant elevation. Using a value of 1076 U/ml as the upper limit of normal, 117 of the 153 patients with IgA nephropathy had an elevated serum lectin-binding IgA1 level. The sensitivity as a diagnostic test was 76.5%, with specificity 94%; the positive predictive value was 88.6% and the negative predictive value was 78.9%. We conclude that this lectin-binding assay may have potential as a noninvasive diagnostic test for IgA nephropathy.     

Abnormalities in brain biochemistry associated with lack of dystrophin: studies of the mdx mouse.

Biochemical abnormalities have been reported in dystrophin-deficient muscle of boys with Duchenne (severe Xp21) muscular dystrophy or in the murine (mdx) model of the disease. These abnormalities include altered energy metabolism and responses to osmotic shock. In contrast, the situation in brain is less well understood and it is probable that dystrophin is playing a different role (or roles) in this organ. In this study we conclude that the elevation in choline-containing compounds reported in mdx brain is confined to cerebellum and hippocampus in older (> 6 months) mice. We report alterations in glucose metabolism in mdx brain under normal, awake conditions, and a reduced response of brain metabolism to the gamma-aminobutyric acid(A) receptor agonist muscimol. Using brain cortical slices we found no difference in the response of dystrophic tissue to hypoosmotic shock, but increased, substrate-dependent oxygen consumption rates at low oxygen partial pressures.     

Subclinical infection as a cause of inflammation in preeclampsia

Preeclampsia, a pregnancy-exclusive hypertensive disorder, is the major cause of maternal and perinatal mortality, with a greater importance in developing countries. The role of inflammation in the pathogenesis of preeclampsia has been the object of recent studies by our group. We have described elevated levels of inflammatory markers (tumor necrosis factor alpha, interleukin-6, and C-reactive protein) in preeclamptic patients and demonstrated that Latin-American women present a higher degree of inflammation than women from developed countries. We have results that suggest that chronic subclinical infections and insulin resistance are the most probable causes of the increased inflammation in preeclampsia. Moreover, we showed that early treatment of urinary and vaginal infections decreased the incidence of preeclampsia. We also have evidence that suggests that inflammation leads to endothelial dysfunction, predisposing women to develop preeclampsia. Increased levels of inflammation markers and endothelial dysfunction are found in the early stages of pregnancy in women who later on develop preeclampsia. Appropriate prenatal care programs, including screening and treatment of urinary, vaginal, and periodontal infections in early pregnancy and prevention of factors that predispose to insulin resistance, such as excessive weight gain during pregnancy, may reduce the incidence of preeclampsia in Latin-American women.     

Developing more positive attitudes towards mental health nursing in undergraduate students: part 1 – does more theory help?

Negative attitudes towards mental illness and the mental health nursing profession have deterred many undergraduate nursing students from considering this area as an attractive career option. Positive clinical experience has been identified as the most important factor in producing more favourable attitudes. While the quantity of theory is identified as important, its impact on attitudes has not been examined through research. This study compared two groups of students undertaking different numbers of theoretical and clinical hours in mental health nursing to determine if this increase has an impact on nursing students' attitudes. Anonymous questionnaires were distributed to the total population of students following completion of the theoretical component of the programme but prior to clinical experience. The questionnaire was designed to assess: (1) nursing student's preparedness for and attitudes towards the mental health field; (2) consumers of mental health services; and (3) the students' career preferences. This first paper in a two-part series examines the impact of theoretical hours and suggests that while other attitudes are fairly similar between the two groups, the group exposed to more theory exhibited significantly more positive attitudes towards psychiatric nursing as a career.     

Optimizing the design of visual analogue scales for assessing quality of life: a semi-qualitative study among Chinese-speaking Singaporeans

Objectives Current recommendations for visual analogue scale (VAS) design are largely derived from studies on pain assessment. We evaluated respondent preferences for VAS design for health‐related quality of life (HRQoL) assessment. Methods In‐depth interviews were conducted among Chinese‐speaking rheumatology outpatients and caregivers (age ≥ 21 years) to determine preferences for the following: (1) VAS orientation (horizontal/vertical); (2) length of instructions (long/intermediate/short); (3) scale range (0–10/0–100 points); (4) indicator for computerized touchscreen VAS (bar/column). Responses in subjects expressing a preference were compared using tests of proportions. Results Among 101 subjects, more subjects preferred a horizontal over a vertical format (48 vs. 37, P = 0.23; 16 no preference), and intermediate length over long/short instructions (44 vs. 14 vs. 31, P = 0.004; 12 no preference). A scale range of 0–10 was preferred over 0–100 (62 vs. 21, P < 0.001; 18 no preference). A bar indicator was preferred over a column for computerized touchscreen VAS (54 vs. 44, P = 0.31; 3 no preference). Only presence of chronic medical conditions influenced subject preference [odds ratio (95% confidence interval): 3.9 (1.6–9.6), P = 0.002]. Conclusion Chinese‐speaking subjects preferred a 0–10‐point VAS with intermediate length instructions for HRQoL assessment. Thus, a 0–10‐point VAS with intermediate length instructions may be more useful for HRQoL assessment among Chinese subjects.     

Saying it in song: music therapy as a carer support intervention

The burdens experienced by informal caregivers are likely to increase in the context of the UK's ageing demographic, and the movement towards more home-based care for those with long-term, chronic or palliative illnesses. This article combines an overview of our understanding of caregiving and carer support interventions, with an outline of the evidence base for music therapy in palliative care. Case material from the author's experiences of songwriting with a carer is used to provide a practical insight into how this emerging palliative care discipline may have the potential to alleviate carer burden, and enhance wellness. More research to explore the efficacy of music therapy as a carer support intervention is recommended.