Erythroblastosis Fetalis Produced by Anti-k

We report an instance of transfusion-induced anti-k so severe that three intrauterine intravascular fetal transfusions were required. The pretransfusion circulating hemoglobin level in the fetus was 60 g/l and hematocrit was 0.19. This, to our knowledge, is the first example of the rare alloantibody, anti-k, producing erythroblastosis so severe that fetal transfusions were required in order to prevent hydrops fetalis from developing. Anti-k alloimmunization, which in a period of 20 years and 8 months occurred only once in 3,246 alloimmunized pregnancies in Manitoba, can cause severe fetal disease. The k-alloimmunized pregnant woman should be managed in the same manner as the D-, c-, or K-alloimmunized pregnant woman.     

Where the brain grows old: decline in anterior cingulate and medial prefrontal function with normal aging

Even healthy adults worry about declines in mental efficiency with aging. Subjective changes in mental flexibility, self-regulation, processing speed, and memory are often cited. We show here that focal decreases in brain activity occur with normal aging as measured with fluorodeoxyglucose and positron emission tomography. The largest declines localize to a medial network including the anterior cingulate/medial prefrontal cortex, dorsomedial thalamus, and sugenual cingulate/basal forebrain. Declining metabolism in this network correlates with declining cognitive function. The medial prefrontal metabolic changes with aging are similar in magnitude to the hypometabolism found in Mild Cognitive Impairment or Alzheimer's disease. These results converge with data from healthy elderly indicating dysfunction in the anterior attention system. The interaction of attention in the anterior cingulate cortex with memory in the medial temporal lobe may explain the global impairment that defines dementia. Despite the implications for an aging population, the neurophysiologic mechanisms of these metabolic decreases remain unknown.     

A common polymorphism decreases low-density lipoprotein receptor exon 12 splicing efficiency and associates with increased cholesterol

Single nucleotide polymorphisms (SNPs) that alter exon splicing efficiency are an emerging class of functional genetic variants. Since mutations in low-density lipoprotein receptor (LDLR) are a primary cause of familial hypercholesterolemia, we evaluated whether LDLR SNPs may alter splicing efficiency and cholesterol homeostasis. A SNP within LDLR exon 12, rs688, was identified in silico as neutralizing a putative exon splicing enhancer. Studies in human liver samples established that this SNP was associated with significantly decreased LDLR exon 12 splicing efficiency in women in vivo. In vitro minigene splicing studies qualitatively replicated these in vivo results and demonstrated that rs688 specifically modulates splicing efficiency. These effects on splicing may be physiologically relevant because the presence of the rs688 minor allele associates with increased total and LDL-cholesterol in female members of the Framingham Offspring Study. The largest rs688-associated cholesterol differences were observed in pre-menopausal women. In summary, these studies identify an LDLR SNP present in approximately 60% of Caucasians that is associated with significant 10% increases in total and LDL-cholesterol in pre-menopausal women.     

Peer Reviewed: State-Level Prevalence of Cigarette Smoking and Treatment Advice, by Disability Status, United States, 2004

Introduction

To our knowledge, no study has determined whether smoking prevalence is higher among people with disabilities than among people without disabilities across all U.S. states. Neither do we know whether people with disabilities and people without disabilities receive the same quality of advice about tobacco-cessation treatment from medical providers.

Methods

We analyzed data from the 2004 Behavioral Risk Factor Surveillance System to estimate differences between people with and people without disabilities in smoking prevalence and the receipt of tobacco-cessation treatment advice from medical providers.

Results

We found that smoking prevalence for people with disabilities was approximately 50% higher than for people without disabilities. Smokers with disabilities were more likely than smokers without disabilities to have visited a medical provider at least once in the previous 12 months and to have received medical advice to quit. More than 40% of smokers with disabilities who were advised to quit, however, reported not being told about the types of tobacco-cessation treatment available.

Conclusion

Ensuring that people with disabilities are included in state-based smoking cessation programs gives states an opportunity to eliminate health disparities and to improve the health and wellness of this group. Ways to reduce unmet preventive health care needs of people with disabilities include provider adoption of the Public Health Service''s clinical practice guideline for treating tobacco use and dependence and the provision of smoking cessation services that include counseling and effective pharmaceutical treatment.     

The Diabetes Detection Initiative: a pilot program of selective screening

OBJECTIVE: To identify adults who might have undiagnosed type 2 diabetes. METHODS: Using social marketing methods, we identified the characteristics and preferences of the pilot communities. Risk assessment tests were developed to reflect these preferences. Clinics with registries provided quantitative evaluation data and all clinics shared qualitative data. RESULTS: Baseline and intervention period data showed that the number of newly detected cases of diabetes increased by 11.5 per month for the 8 registry clinics. CONCLUSION: Findings have advanced our understanding of screening by identifying ways of improving the identification of undiagnosed diabetes.