Free testosterone levels in umbilical‐cord blood predict infant head circumference in females

Aim Fetal androgens influence fetal growth as well as postnatal neurocognitive ability. However, to our knowledge, no published study has prospectively examined the impact of early‐life androgens on infant brain growth. We report the association between circulating fetal androgen levels, measured from umbilical‐cord blood at birth, and a proxy measure of brain growth: head circumference. Method Participants were 82 unselected female infants from a large representative birth cohort (mean gestational age 39.4wks, SD 1.7). Umbilical‐cord blood was obtained at birth and analysed for androgen concentrations (total testosterone, androstenedione, dehyrdroepiandrosterone, and its sulphated metabolite). Head circumference and two other measures of growth – weight (mean 3311.4g, SD 461.3) and length – were measured within 3 days of birth and again at approximately 1 year of age (mean age 13.1mo, SD 1.1). Results Multivariate linear regressions found an inverse association between levels of free testosterone and growth in head circumference (correlation=?.24), even when adjusting for sociodemographic/obstetric covariates and head size at birth. Growth in weight and length could not be predicted by free testosterone concentration. Interpretation This is the first report of an association between prenatal androgen levels and postnatal growth in head circumference. These findings suggest that early‐life androgens may impact brain development during infancy.     

Interpretation of in-vitro thyroid function tests during pregnancy

Summary. In-vitro thyroid function tests are difficult to interpret in pregnancy because of, among other things, the effect of oestrogens on thyroid binding globulin (TBG) concentrations. In an attempt to clarify the position, serum concentrations of total thyroxine (T₄), free T₄, TBG, T₄/TBG ratio, tri-iodothyronine (T₃) and thyroid stimulating hormone (TSH) were measured. Total T₄ and TBG concentrations rose to above the non-pregnant reference range by 20 weeks. The T₄/TBG ratio fell to hypo-thyroid values by 20 weeks but although the free T₄ level was lower in the third trimester compared with values in the first and second trimesters, only a few subjects had hypothyroid values. The TSH values remained unchanged throughout pregnancy. The significance of these changes is discussed and reference ranges for these hormones at each trimester are provided.     

Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients

Objective:  To determine the prevalence of malnutrition in a population of elderly hospitalised patients and to explore health professionals' perceptions and awareness of signs and risks of malnutrition and treatment options available.
Subjects and design:  One hundred elderly patients and 57 health professionals from medical wards of a tertiary teaching hospital. Quantitative and qualitative study design using a validated malnutrition assessment tool (Mini Nutritional Assessment) and researcher-designed questionnaire to assess health professionals' knowledge of nutrition risk factors.
Main outcome measures:  Mini Nutritional Assessment score, nutrition risk category and themes in health professionals' knowledge and awareness of malnutrition and its risk factors.
Results:  Thirty per cent of patients were identified as malnourished while 61% were at risk of malnutrition. Documentation by health professionals of two major risk factors for malnutrition—recent loss of weight and appetite—were poor with only 19% and 53% of patients with actual loss of weight or appetite, respectively, identified by staff and only 7% and 9% of these patients, respectively, referred for dietetic assessment. While health professionals' knowledge of important medical risk factors for malnutrition was good, their knowledge of malnutrition risk factors such as recent loss of weight and loss of appetite was poor. Medical staff focused on biochemical factors when assessing nutrition status, while nursing staff focused on skin integrity and turgor.
Conclusion:  Malnutrition in elderly hospitalised patients remains a significant problem with low rates of recognition and referral by medical and nursing staff. Considerable scope exists to develop training and education tools and to implement an appropriate nutrition screening policy to improve referral rates to dietitians.     

A morphological comparison of interposed freeze-thawed skeletal muscle autografts and interposed nerve autografts in the repair of the rat facial nerve

Freeze-thawed co-axially aligned skeletal muscle autografts provide new concept in peripheral nerve repair, and are being investigated in the repair of mixed motor/sensory nerves. These grafts provide an orientated matrix of large basement membrane tubes through which regenerating axons can migrate and reinnervate the distal nerve. Using the buccal branch of the rat facial nerve as a model, we compared five freeze-thawed muscle autografts with five interposed nerve autografts. Some 300 days after grafting, the morphology of the distal nerve was evaluated. When the two groups were assessed morphometrically, it was found that nerve grafts showed a small but significant improvement over muscle grafts in respect of indices of the fibre maturation.     

NASPE POLICY STATEMENT The NASPE* BPEG** Defibrillator Code

BERNSTEIN, A.D., et al .: The NASPE/BPEG Defibrillator Code. A new generic code, patterned after and compatible with the NASPE/BPEG Generic Pacemaker Code (NBG Code) was adopted by the NASPE Board of Trustees on January 23, 1993. It was developed by the NASPE Mode Code Committee, including members of the North American Society of Pacing and Electrophysiology (NASPE) and the British Pacing and Electrophysiology Group (BPEG). It is abbreviated as the NBD (for NASPE/BPEG Defibrillator) Code. It is intended for describing the capabilities and operation of implanted cardioverter defibrillators (ICDs) in conversation, record keeping, and device labeling, and incorporates four positions designating: (1) shock location; (2) antitachycardia pacing location; (3) means of tachycardia detection; and (4) antibradycardia pacing location. An additional Short Form, intended only for use in conversation, was defined as a concise means of distinguishing devices capable of shock alone, shock plus antibradycardia pacing, and shock plus antitachycardia and antibradycardia pacing. (PACE, Vol. 16, September 1993)     

The immunogenicity of hookworm (Necator americanus) acetylcholinesterase (AChE) in man

A number of different but complementary approaches have been used to demonstrate the immunogenicity of Necator americanus acetylcholinesterase to infected individuals. Western blotting of parasite somatic extracts with human post-infection sera and a specific rabbit antiserum to AChE resulted in the development of almost identical antigen-recognition profiles. AChE-containing fractions produced by preparative iso-electric focusing were subsequently shown to be antigenic in ELISA using post-infection sera. This preliminary data was reinforced by the affinity-purification of AChE by immobilized post-infection IgG, and the immunoprecipitation of AChE activity from ES by post-infection IgG. Finally, AChE purified by affinity chromatography on edrophonium chloride was shown to be antigenic by Western blotting, and in ELISA, against post-infection sera, although a degree of re-activity was also seen with normal human sera. This data is discussed in the context of the host-parasite relationship.     

Unusual case report: Do violent dreams cause violent acts?

For most people most of the time nocturnal dreams seem to have a life of their own with little, if any, recognisable relevance to life in the waking state. Freud and other theorists have attempted to relate nocturnal dreams to underlying impulses and conflicts which also affect one's mental state when awake. In only a few mental disorders has the manifest content of dreams achieved widely accepted diagnostic significance. The case presented here demonstrates that a patient's tenuous hold on reality can allow manifest dream content to direct the patient's waking behaviour. In this case the dream content seemed to identify the potential victim and to prime the patient to take violent action. For the astute clinician, careful attention to violent dreams may help to anticipate both violent acts and specific victims and to make appropriate, preventive interventions.     

The Involvement of General Practitioners in the Care of Patients with Human Immunodeficiency Virus Infection: Current practice and Future Implications

The objective was to determine the current use of their generalpractitioner (GP) by patients with human immunodeficiency virus(HIV) infection and whether such patients would be interestedin having ‘shared care’ between a specialist HIVclinic and their GP. A questionnaire was administered to 203HIV-positive men attending the HIV outpatient clinic of a centralLondon teaching hospital. The main outcome measures were patientcharacteristics, numbers of patients registered with a GP, numbersof patients with a GP aware of their diagnosis, contacts withthe GP in the last year and level of interest and shared care.Eighty-five per cent of patients were registered with a GP ofwhom 67% knew of the diagnosis. Those diagnosed for more than2 years were significantly more likely to have an informed GP.A total of 73% of those registered had visited their GP in theprevious year although only 27% had visited for an HIV-relatedproblem. Only 19% had a GP actively involved in their HIV care.In all 51% of the patients indicated an interest in having sharedcare between the clinic and their GP. A high proportion of HIVpatients are registered with and attend a GP although they rarelyconsult for HIV-related problems. A significant proportion ofpatients expressed interest in having shared care suggestingthat there is the potential for increased GP involvement inthe care of patients with HIV infection.     

Interventional Radiology in the Treatment of Ureteric Complications in Transplant Kidneys

Eleven patients who had radiological procedures because of urinary leakage or ureteric obstruction in transplant kidneys are reviewed in order to judge the clinical efficacy of interventional radiological techniques in the management of these complications. Initial technical success was attained in 9/9 dilatation attempts and 17/21 (81%) stent placement attempts. It is thought that 9/11 (82%) patients benefited from the radiological attempts at treatment and at long term follow up 7 kidneys were still functioning, 3 failed due to rejection and one after failed renal artery surgery. The complication rate due to the radiological procedure was low, with one iatrogenic urine leak being the single major procedural complication. Two patients had urinary tract infections while stented and there were two patients with perirenal abscesses.