Decreased serum levels of nutritional biochemical indices in healthy children with marginally delayed physical growth

Biochemical markers of nutritional status (albumin, transthyretin, insulin-like growth factor-I and zinc) were measured in slowly growing two- to five-year-old, low-income Parisian children whose weight-for-height or height-for-age z scores (WHZ or HAZ) were between — 1 and — 2 SD of the NCHS median. The results were compared to controls who were matched for age, sex, and ethnic origin with WHZ and HAZ between — 1 and + 2 SD. Mean serum levels of transthyretin, albumin and insulin-like growth factor-I and mean plasma zinc concentrations were significantly lower in the growth-impaired children than in the controls ( p = 0.002, p = 0.006, p = 0.015, and p = 0.035, respectively). While the height-retarded children had low mean serum insulin-like growth factor-I values, the weight-retarded subjects had decreased levels of albumin, transthyretin and zinc when compared to controls. Lower mean levels of nutritional markers in healthy, slowly growing children suggest that inadequate dietary intakes of zinc, protein and/or energy may result in marginal delays in weight and height gains.     

Users' awareness of factors associated with complications during pill use

This study compared the frequency of factors and diseases that contribute to the risks of oral contraceptive use among current users and non-users of oral contraception in order to evaluate the users' awareness of factors associated with complications during oral contraceptive use. Data from 5317 current users and 8863 non-users in the state of São Paulo, Brazil, were collected using questionnaires requesting information on the following variables: use of oral contraceptives, age, weight, smoking status, and the presence or history of hypertension, diabetes, cardiopathies, painful varicose veins, and epilepsy. Half of the users had some risk factors, and 17.4% were at high risk of complications from oral contraceptive use. Risk factors and diseases which appeared to be poorly known by the population as increasing the risk of oral contraceptive use were smoking, hypertension and painful varicose veins. Only a small percentage of the population appeared to know that these diseases and factors could increase the risk of health problems during oral contraceptive use. The results suggest a lack of information among users and providers on factors which are associated with an increased risk of health problems during use of oral contraceptives.

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Resumen Este estudio comparó la frecuencia de factores y enfermedades que contribuyen al riesgo de los anticonceptivos orales (AO) entre usuarias y no usuarias corrientes de anticonceptivos orales a fin de evaluar el grado de conocimiento entre las usuarias de los factores asociados con complicaciones durante el uso de AO. Se recopilaron datos de 5317 usuarias y 8863 no usuarias corrientes del Estado de S@o Paulo, Brasil, utilizando cuestionarios en los que se solicitabe información acerca de las siguientes variables: uso de AO, edad, peso, fumadora/no fumadora y la presencia o historia de hipertensión, diabetes, cardiopatías, várices dolorosas y epilepsia. La mitad de las usuarias tenían algunos factores de riesgo y el 17,4% de ellas corrían un alto riesgo de complicaciones por el uso de anticonceptivos orales. Los factores de riesgo y enfermedades que parecían ser poco conocidos por la población como tendientes a aumentar el riesgo del uso de anticonceptivos orales eran el fumar, la hipertensión y las várices dolorosas. Sólo un pequeño porcentaje de la población parecía saber que estas enfermedades y factores podían aumentar el riesgo de problemas de salud durante el uso de anticonceptivos orales. Los resultados sugieren una falta de información de las usuarias y proveedores con respecto a factores que están asociados con un riesgo mayor de problemas de salud durante el uso de anticonceptivos orales.

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Resumé Pour évaluer dans quelle mesure les utilisatrices et non utilisatrices de contraceptifs oraux sont sensibilisées aux facteurs associés à des complications, cette étude a comparé la fréquence des facteurs et des maladies qui contribuent au risque que présente l'utilisation de ces contraceptifs. Dans l'Etat de Sao Paulo (Brésil), des données ont été recueillies auprès de 5317 utilisatrices et 8863 non utilisatrices, au moyen de questionnaires demandant des renseignements concernant les variables suivantes: utilisation de contraceptifs oraux, âge, poids, tabagisme, présence ou antécédents d'hypertension, diabète, cardiopathies, varices douloureuses et épilepsie. La moitié des utilisatrices présentaient certains facteurs de risque et 17,4% des facteurs de risque élevé de complications résultant de l'utilisation de contraceptifs oraux. Les facteurs de risque et les maladies dont la population semblait mal connaître l'effet d'augmentation des risques qu'entrîne l'ingestion de contraceptifs oraux étaient le tabagisme, l'hypertension et les varices douloureuses. Un faible pourcentage seulement de la population paraissait savoir que ces maladies et facteurs pouvaient accroître les risques de problèmes de santé durant l'utilisation des contraceptifs oraux. Les résultats suggèrent que les utilisatrices et les pourvoyeurs des services de contraception ne sont pas suffisamment informés des facteurs associés à un risque accru de problèmes de santé durant l'utilisation des contraceptifs oraux.

     

Catheter ablation by low energy DC shocks for successful management of atrial flutter.

OBJECTIVE--To assess the effects of low energy ablation of the substrate for atrial flutter. DESIGN--Initial retrospective analysis of patients undergoing low energy ablation of the atrioventricular node for refractory atrial flutter (group 1) was followed by a prospective assessment of low energy ablation in the posterio-inferior right atrium for the same condition (group 2). SETTING--Tertiary referral centre for management of cardiac arrhythmias. PATIENTS--Seven men (aged 50-67 years) with refractory atrial flutter. INTERVENTIONS--Multiple (3-10) low energy DC shocks with a cumulative energy of 100-245 J in the region of the atrioventricular node in group 1 and 12-15 low energy DC shocks (cumulative energy 110-235 J) guided by the anatomical landmarks of the triangle of Koch and applied directly to the atrial wall. MAIN OUTCOME MEASURE--Freedom from recurrence of atrial flutter. RESULTS--In group 1 despite initial complete atrioventricular block in three patients, atrioventricular conduction had resumed in all by one month. All four, however, were in sinus rhythm at follow up six to 13 months later. Two of the three patients in group 2 were free of atrial flutter at follow up three to four months after ablation. CONCLUSION--Ablation of the atrial flutter substrate with low energy DC shocks is feasible. Precise electrophysiological mapping is not necessary.     

Evidence for superantigenic activity during murine malaria infection

TCR V beta usage was examined in C57BL/6 mice infected with Plasmodium yoelii. In addition to a polyclonal T cell activation, already described, a superantigenic-like activity was observed during the acute infection. This superantigenic activity induces a preferential deletion without prior expansion of CD4+ and CD8+ T cells bearing the TCR V beta 9 segment. The superantigen could be released by the parasite at different stages of its development since the deletion of V beta 9+ T cells was observed in blood and lymph nodes of mice infected either with sporozoites or with erythrocytic stages. Injection of sporozoite or parasitized erythrocytes to newborn mice led to a deletion and anergy of peripheral V beta 9+ T cells, without affecting thymic T cell populations. These observations suggest that the superantigen is released at very low concentrations during parasite development. The role of such parasite superantigenic activity in infectivity can be underlined by the observation that congenic BALB.D2 Mis1a mice lacking V beta 9 T cells are more susceptible to infection by P. yoelii.      

Anti-Trypanosoma-cruzi-proteinase antibodies and immunoprotection in experimental Chagas' disease.

To verify whether anti-Trypanosoma-cruzi-proteinase antibodies are able to play a role in the development of Chagas' disease, CBA/J and C57BL/6 mice were immunized with purified proteinase fractions: antibody production was studied and passive immunization experiments were carried out. No significant differences were observed in the titre, isotype composition and specificity of the antibodies produced by the mouse strains. Immune sera produced in one strain was able to protect mice of both strains, provided that the challenge did not exceed the number of parasites corresponding to 30-fold the LD50. The data presented suggest that anti-proteinase antibodies may play a role in immunoprotection.     

Ambulatory 24-hour esophageal pH monitoring

If 24-hour esophageal pH monitoring is to be a useful diagnostic tool, it must reliably discriminate gastroesophageal reflux patients despite daily variations in distal esophageal acid exposure. To address this issue, we studied 53 subjects (14 healthy normals, 14 esophagitis patients, and 25 patients with atypical symptoms) with two ambulatory pH tests performed within 10 days of each other. Intrasubject reproducibility of 12 pH parameters to discriminate the presence of abnormal acid reflux was determined. As a group, the parameters of percent time with pH<4 (total, upright, recumbent) were most reproducible (80%). Therefore, a subject was defined as having gastroesophageal reflux disease if at least one of these three values were abnormal. Intrasubject reproducibility for the diagnosis of reflux disease was 89% for the entire sample. Among subsets, the reproducibility was 93% for the normals and esophagitis patients and 84% for the atypical symptom patients. Total percent time with pH<4 was the single most discriminate pH parameter (85%) and nearly equaled that of the three combined parameters (89%). The intrasubject variability of this parameter was determined by the mean ±2sd of the relative differences between the two test results for all 53 subjects. Total percent time with pH<4 may vary between tests by a factor of 3.2-fold or less (218% higher to 69% lower). We conclude: (1) ambulatory 24-hr esophageal monitoring is a reproducible test for the diagnosis of gastroesophageal reflux disease; and (2) the large intrastudy variability in 24-hr total acid exposure may limit this test's usefulness as a measurement of therapeutic improvement.Supported, in part, by Public Health Services Grant AM 34200-01A1 from NIADDIK.     

A prospective, randomized, cross-over comparison of two methods of artificial insemination by donor on the incidence of conception: intracervical insemination by straw versus cervical cap

In a prospective, randomized study of insemination with donor semen, intracervical insemination by straw was compared with insemination using a cervical cap with an intracervical reservoir. A total of 91 patients completed 486 treatment cycles. There were no significant differences in age, parity, indication for insemination by donor, or method of cycle monitoring between women who became pregnant and those who did not conceive with either insemination method. In 236 standard intracervical insemination cycles, 14 patients became pregnant (5.9% per cycle), whereas 38 patients conceived in 250 cervical cap cycles (15.2% per cycle). Both the crude pregnancy rates and the cumulative pregnancy rates calculated by the Kaplan-Meier life-table method were significantly different (chi(2)-test, P < 0.001, and log-rank test, P < 0.005 respectively). Pregnancy rates in artificial insemination with cryopreserved donor semen may be improved by the use of a cervical cap when compared to cervical insemination by straw. The use of the cervical cap may prolong the exposure of the spermatozoa to the cervical mucus and prevent the backflow of semen into the vagina.      

Prevalence of Parkinson's disease in Cantalejo, Spain: a door-to-door survey.

We assessed the prevalence of Parkinson's disease in Cantalejo, Spain. In 1994, we screened 1,579 persons (age > or = 40 years) using a high-sensitivity method. Cases fulfilling established clinical criteria were followed for a minimum of 3 years. Prevalences were compared with those from other door-to-door surveys. We detected 27 individuals with parkinsonism, 20 of whom had Parkinson's disease. The prevalence of Parkinson's disease increased with age and, when age-adjusted to European standards, was 9.01 per 1,000 (age 40 years and over; 10.78 in men and 5.23 in women). Of the 11 men, three were in Hoehn & Yahr grades III-IV, but six of the nine women were more severely affected. Overall, we found 18 newly diagnosed cases of parkinsonism, 13 of which were Parkinson's disease, and the majority of which were in men aged 80 years or older with a mean duration of illness of 5 years. Our prevalence figures are the highest reported, apparently because of the inclusion of several very elderly men. Parkinson's disease in Cantalejo is less severe in men than in women, particularly in those newly diagnosed. Despite the low numbers, the high prevalence and sex-related pattern are unexplained but they probably relate to the high sensitivity of the screening method.