Secondary school and admission test grades as predictors of performance of medical students

The performance of three consecutive classes of students admitted to the Colleges of Medicine and Medical Sciences at King Faisal University was studied. All students took the high school graduation examination and sat the college admission test. It was found that performance on the admission test was a better predictor than high school grades in the first two levels of the medical curriculum. However, performance in a combination of certain high school and admission test subjects was a more powerful predictor of students' achievement at all levels. This study indicates that the college admission test is a useful additional tool in the process of medical student selection at this college. Further studies are needed, however, for the formulation of general recommendations.     

Current status of the medical treatment of children with juvenile rheumatoid arthritis.

Based on clinical experience and the aforementioned studies, a number of opinions can be entertained concerning the historically traditional conservative management of children with JRA. 1. Because the inflammatory changes of JRA on the bones and joints once established are irreversible in most children, there are ample theoretical reasons to start more effective therapy (if available) early. 2. Most of the currently available drugs control inflammation only partially or temporarily. 3. Most children stop taking the various SAARDS after approximately 2 years of disease because of lack of efficacy or the development of toxicity. 4. Whereas corticosteroids are the most potent and effective anti-inflammatory agents, long-term use in children, even in low dosage, is severely limited, especially by their effect on growth. 5. Methotrexate appears to be the most effective of the alternative agents and much safer than expected when used in the currently recommended protocol. 6. More effective therapy must await a better understanding of the pathogenesis of JRA, although currently available medications might be used more rationally by taking into consideration available pharmacologic studies.     

Resin-bonded bridges: 2. Treatment planning, clinical gases and failures.

This is the second paper in the two-part series which considers the developments and clinical techniques of resin-bonded bridges with the emphasis on methods for increasing success from a functional and aesthetic view point. Part 1 focused on the development and types of resin-bonded bridge and tooth preparation. This article describes the clinical application of this type of bridge and discusses failures.     

In situ resonance Raman spectroelectrochemistry of polypyrrole doped with dodecylbenzenesulfonate

In situ Raman spectroelectrochemistry was performed on cycled polypyrrole films incorporating dodecylbenzenesulfonate (DBS). It was found that under 457.9 nm excitation, the neutral form was resonant and the bands due to the neutral form of the polymer dominated the spectra. Spectra obtained using 514.5 nm excitation displayed a strong neutral contribution but bands due to the radical cation and dication were also visible. At 632.8 nm excitation, the bands assigned to the radical dication were dominant, with a noticeable contribution from the dication in the oxidised state. The strength of the radical cation contribution is unusual as it made only a weak contribution in the UV–vis adsorption spectra. The CC backbone stretching band between 1560 and 1590 cm^?1 was found to be made up of a contribution of bands due to the radical cation and neutral forms with a separate band at 1620 cm^?1 for the dication form. The results show that by carefully selecting the excitation wavelength, resonance Raman is a powerful tool for analysing the changes in oxidation states of a conducting polymer under potential cycling.     

Spasmodic torticollis: a case study

Torticollis is a term that describes abnormal posturing of the head secondary to the contraction of the neck musculature. Spasmodic torticollis is a rare form of this disorder that has been attributed to disturbances in the extrapyramidal system. It is a form of focal dystonia that primarily affects women in their forties and usually progresses slowly, leading to severe disability. Although the torticollis may be painful, the patient’s main preoccupation is usually with the deformity itself. The diagnosis is often delayed because of the unusual clinical presentation and these patients are frequently labelled as neurotic. The following report illustrates a case of torticollis and thoracolumbar scoliosis secondary to dystonia.     

Could interspecies differences in the protein binding of flavone acetic acid contribute to the failure to predict lack of efficacy in patients?

Summary We investigated the differences in plasma protein binding of flavone acetic acid (FAA) in mice and men in an attempt to explain the inter-species differences in response. In vitro data indicate both qualitative and quantitative differences in FAA protein binding: approximately 80% is bound in humans, with two different types of binding site identified; in mice, 70% is bound and only one binding site could be described. Protein binding is dose-dependent in both species. Plasma samples from 20 patients receiving FAA showed that most achieved levels that would be active in mice. We conclude that these differences in protein binding are insufficient to explain totally the observed differences in response.     

Balloon pulmonary valvuloplasty: results of the Valvuloplasty and Angioplasty of Congenital Anomalies Registry

Eight hundred twenty-two balloon pulmonary valvuloplasties were reported to the Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Before and after systolic outflow gradients were recorded in 784 valvuloplasties, and the gradient decreased from 71 +/- 33 to 28 +/- 21 mm Hg. The sites of residual obstructions could be ascertained in 196 patients. In these, the total systolic outflow gradients decreased from 85 +/- 41 mm Hg to 33 +/- 27 mm Hg. Of this total residual gradient, 16 +/- 15 mm Hg was transvalvar and 18 +/- 24 mm Hg was infundibular. The degree to which infundibular obstruction subsequently resolved was not determined in this study. The procedure was less effective in reducing outflow gradients in patients with dysplastic valves with or without Noonan's syndrome. There were 5 major complications (0.6%), including 2 deaths (0.2%), a cardiac perforation with tamponade (0.1%) and 2 tricuspid insufficiencies (0.2%). There were 11 minor complications (1.3%) and 21 incidents (2.6%). The incidence of major complications, minor complications and incidents was inversely related to age; it was substantially higher in infants and, in particular, neonates. Balloon pulmonary valvuloplasty is a safe and effective method of lowering pulmonary outflow gradients in infants, children and adults. Small transvalvar and varied infundibular gradients commonly are present at the end of the procedure. Assessing the full effect of the procedure requires intermediate-term follow-up and assessing the duration of relief requires long-term follow-up.     

Relationship Between Selected Overdrive Parameters and the Therapeutic Outcome and Tolerance of Atrial Overdrive Pacing

ATTUEL, P., et al. : Relationship Between Selected Overdrive Parameters and the Therapeutic Outcome and Tolerance of Atrial Overdrive Pacing. There is a paucity of information on the influence of selected overdrive parameters on the clinical efficacy and tolerance of atrial overdrive algorithms to suppress atrial tachyarrhythmias. Data from a completed clinical trial investigating a new DDD+ overdrive algorithm implemented in a permanent pacemaker were analyzed. One-hundred patients with standard pacing indications and atrial tachyarrhythmias were enrolled and followed for 6 months in DDD and 6 months in DDD+ mode in a randomized, crossover fashion. The overdrive step size was programmed at the discretion of the investigators between 4 and 12 beats/min, overdrive plateau length between 10 and 32 beats, and maximum overdrive rate between 100 and 160 beats/min. The effects of DDD+ versus DDD mode on burden and incidence of atrial tachyarrhythmias stored in the mode switch memory were examined as a function of the programmed overdrive parameters. An overdrive step size between 7 and 12 beats/min, and higher a maximum overdrive rate between 121 and 160 beats/min were slightly more effective than lower programmed values, though >500 randomized, crossover observations would have been necessary to verify statistical significance. Overdrive pacing related symptoms mandated early manual deactivation of overdrive pacing in 4.7% of 85 evaluated patients. Overdrive was disabled without testing tolerability of less aggressive overdrive values. There was no link between patient symptoms and programmed overdrive step size or overdrive plateau length values. (PACE 2003; 26[Pt. II]:257–263)