Follow up of victims of fabricated illness (Munchausen syndrome by proxy)

Fifty four children were studied 1-14 (mean 5.6) years after fabrications of illness had been identified. Thirty of the 54 children were living in families with their biological mothers and 24 were with other family members or in substitute families. Further fabrications were identified for 10 children who had been living with their mothers and there were 'other concerns' for a further eight children. Thirteen children residing with mother and 14 not residing with mother at follow up had a range of disorders including conduct and emotional disorders, and problems related to school, including difficulties in attention and concentration and non-attendance. Overall, 20 children (49% of those successfully followed up) had outcomes that were considered to be unacceptable.     

Subthreshold Oscillations Induced By Spinal Nerve Injury In Dissociated Muscle And Cutaneous Afferents Of Mouse DRG

Whole cell patch-clamp recordings were obtained from dissociated mouse lumbar dorsal root ganglion (DRG) neurons. Recordings were made from control neurons and neurons axotomized by transection of the corresponding spinal nerve 1-2 days prior to dissociation. Medium to large muscle and cutaneous afferent neurons were identified by retrograde transport of True Blue or Fluoro-Gold injected into the corresponding peripheral tissue. Action potentials were classified as non-inflected spikes (A(0)) and inflected spikes (A(inf)). High-frequency, low-amplitude subthreshold membrane potential oscillations were observed in 8% of control A(0) neurons, but their incidence increased to 31% in the nerve injury group. Fifty percent of axotomized muscle afferent A(0) cells displayed oscillations, while 26% of axotomized cutaneous afferents exhibited oscillations. Lower-frequency oscillations were also observed in a small fraction (4%) of A(inf) neurons on strong depolarization. Their numbers were increased after the nerve injury, but the difference was not statistically significant. The oscillations often triggered burst firing in distinct patterns of action potential activity. These results indicate that injury-induced membrane oscillations of DRG neurons, previously observed in whole DRG of rats, are present in dissociated DRG neurons of the adult mouse. Moreover, these observations indicate that both muscle and cutaneous afferents in the A(beta) size range give rise to injury-induced membrane oscillations, with muscle afferents being more prone to develop oscillations.     

Antibody to Hepatitis B Surface Antigen in Vaccinated Health Care Workers

Background

Health care workers (HCWs) in Armed Forces are immunised against Hepatitis B virus (HBV), however they are not subjected to anti-HBs (antibody to Hepatitis B surface antigen) assessment after primary vaccination. The present study was undertaken to determine the protection offered by HBV vaccine in HCW.

Methods

Cross-sectional study was carried out at tertiary care hospital. A total 146 HBV vaccine compliant HCW were evaluated for quantitative anti-HBs by enzyme immune assay.

Result

129 (88.4%) subjects had protective levels of anti-HBs. Higher age at vaccination was an important risk factor in low vaccine response. Decline in anti-HBs with time was evident. Anti-HBs levels were more than 10mIU/ml in subjects even after 11 years of primary vaccination. There was no difference in protection in booster and non booster groups.

Conclusion

Age is the most important factor in HBV vaccine response. Booster dose of HBV vaccine is not necessary in healthy HCW for atleast ten years after primary vaccination. The study recommends early primary vaccination of HCW and ‘initial’ anti-HBs assay for confirmation of vaccine response.Key Words: Anti-Hepatitis B surface antigen, Health care workers, Hepatitis B virus vaccine     

急性缺血再灌注肾损伤过程中Mg2+及K+协同胰岛素的对抗效应

目的:在肾移植术后可能发生急性缺血再灌注性肾损伤.作者前期实验表明在肾缺血再灌注期间注射胰岛素可减轻缺血再灌注肾损伤,在此基础上,在胰岛素溶液中加入天冬氨酸钾镁,观察Mg2 ,K 协同胰岛素对家兔急性肾缺血再灌注损伤的影响,并分析其可能机制.方法:实验于2002-02/04在泸州医学院生理实验室完成,动物实验方法符合动物伦理学要求.①实验材料及方法:选用健康成年日本大耳白兔27只,按随机数字表法分为3组(n=9),即缺血再灌注组、缺血再灌注胰岛素处理组及对照组,前两组采用钳夹肾动脉法建立急性肾缺血再灌注肾损伤模型,缺血再灌注胰岛素处理组再灌注的同时给予胰岛素溶液,含胰岛素3 U/kg,葡萄糖1.5 g/kg,K 4 mg/kg,Mg2 1.7 mg/kg.②实验评估:分别观察3组动物缺血再灌注2 h,48 h后,血清尿素氮、血糖、血清及肾组织中丙二醛含量以及肾组织超微结构变化.结果:23只动物进入结果分析.①肾缺血再灌注48 h后,缺血再灌注组血清尿素氮含量显著高于对照组(P＜0.01),缺血再灌注胰岛素处理组与对照组差异无显著性意义(P＞0.05).②缺血再灌注组血清及肾组织中丙二醛含量显著高于对照组(P＜0.05),缺血再灌注胰岛素处理组丙二醛含量显著低于缺血再灌注组(P＜0.05).③缺血再灌注2 h后,3组动物血糖均较术前增高,但以缺血再灌注组增高更为显著,与对照组比较差异具有显著性意义(P＜0.05),缺血再灌注胰岛素处理组与对照组差异无显著性意义(P＞0.05).④对照组肾组织超微结构正常,缺血再灌注组肾组织呈变性和坏死改变,缺血再灌注胰岛素处理组肾组织轻度变性.结论:Mg2 ,K 可协同胰岛素减轻家兔急性缺血再灌注性肾损伤,其作用途径可能和降低血糖、抗自由基损伤、改善能量代谢、减轻钙超载、防止低血钾等因素有关.     

Simulation and its role in medical education

Medical education is increasingly laying emphasis on a curriculum based on cognitive, psychomotor, and affective domains of learning which were originally proposed nearly 50 years ago. These reforms are framed around best standards of care, error management and patient safety, patient autonomy, and resource allocation. There is a worldwide shift in the method of medical education towards experiential (‘hands-on’) medical learning; however, applying this concept to real patients is less acceptable to society and is subject to legal and ethical issues.     

Mild idiopathic lateral cerebral ventricular dilatation in utero: sonographic evaluation

The authors prospectively studied 20 fetuses with mild dilatation of the lateral cerebral ventricles but no other detectable central nervous system abnormality. One case (5%) occurred in a diabetic pregnancy, and three (15%) involved twin pregnancies. Fifteen (75%) fetuses were male, and one (5%) had trisomy 21. Postnatal follow-up at 15-31 months showed a normal outcome in eight cases (40%), an uncertain prognosis in four cases (20%), and death in eight cases (40%). Serial antenatal sonograms were obtained in 17 cases. Among the eight cases with a normal outcome, seven demonstrated no additional sonographic abnormalities and six showed resolution of the ventricular dilatation antenatally. Conversely, all 12 fetuses with demise or an uncertain prognosis demonstrated additional sonographic abnormalities, and six showed stable or progressive ventricular dilatation on follow-up sonograms. Since mild idiopathic lateral ventricular dilatation has a widely variable prognosis, antenatal detection of this finding warrants search for additional findings and follow-up sonography.