Stages of development and injury: An epidemiological survey of young children presenting to an emergency department

Background  

The aim of our study was to use a local (Glasgow, west of Scotland) version of a Canadian injury surveillance programme (CHIRPP) to investigate the relationship between the developmental stage of young (pre-school) children, using age as a proxy, and the occurrence (incidence, nature, mechanism and location) of injuries presenting to a Scottish hospital emergency department, in an attempt to replicate the findings of a recent study in Kingston, Canada.     

A novel GLRA1 mutation in a recessive hyperekplexia pedigree.

We report the identification of a novel Y228C mutation within the M1 trans-membrane domain of the GLRA1 subunit of the glycine receptor responsible for a severe recessive hyperekplexia phenotype in a Kurdish pedigree.     

Analysis of cryo-electron microscopy images does not support the existence of 30-nm chromatin fibers in mitotic chromosomes in situ

Although the formation of 30-nm chromatin fibers is thought to be the most basic event of chromatin compaction, it remains controversial because high-resolution imaging of chromatin in living eukaryotic cells had not been possible until now. Cryo-electron microscopy of vitreous sections is a relatively new technique, which enables direct high-resolution observation of the cell structures in a close-to-native state. We used cryo-electron microscopy and image processing to further investigate the presence of 30-nm chromatin fibers in human mitotic chromosomes. HeLa S3 cells were vitrified by high-pressure freezing, thin-sectioned, and then imaged under the cryo-electron microscope without any further chemical treatment or staining. For an unambiguous interpretation of the images, the effects of the contrast transfer function were computationally corrected. The mitotic chromosomes of the HeLa S3 cells appeared as compact structures with a homogeneous grainy texture, in which there were no visible 30-nm fibers. Power spectra of the chromosome images also gave no indication of 30-nm chromatin folding. These results, together with our observations of the effects of chromosome swelling, strongly suggest that, within the bulk of compact metaphase chromosomes, the nucleosomal fiber does not undergo 30-nm folding, but exists in a highly disordered and interdigitated state, which is, on the local scale, comparable with a polymer melt.     

Wellness Programmes

The evidence suggests that there are benefits associated with wellness programmes but there are methodological limitations with the current state of studies which prohibit strong conclusions in favour of wellness programmes. Concepts of ‘holistic health’ and ‘traditional’ or ‘alternative health’ care have emerged in the past decade as challenges to conventional medical therapies. Wellness programmes may emerge as adjunctive or complementary modalities in primary care, both for the management of chronic illnesses and for the prevention of debilitating diseases. Although the scientific evidence in the form of randomised controlled trials is not conclusive, there is no doubt that a wide spectrum of ‘wellness’ activities are popular and attracting increased public interest. Further knowledge and understanding of wellness programmes, either as a whole or in their multitude of interventions, is important for primary-care physicians as these programmes may address many psychosocial and spiritual issues in patient care.     

Clinical review: Mass casualty triage – pandemic influenza and critical care

Worst case scenarios for pandemic influenza planning in the US involve over 700,000 patients requiring mechanical ventilation. UK planning predicts a 231% occupancy of current level 3 (intensive care unit) bed capacity. Critical care planners need to recognise that mortality is likely to be high and the risk to healthcare workers significant. Contingency planning should, therefore, be multi-faceted, involving a robust health command structure, the facility to expand critical care provision in terms of space, equipment and staff and cohorting of affected patients in the early stages. It should also be recognised that despite this expansion of critical care, demand will exceed supply and a process for triage needs to be developed that is valid, reproducible, transparent and consistent with distributive justice. We advocate the development and validation of physiological scores for use as a triage tool, coupled with candid public discussion of the process.     

Strategies for achieving a high response rate in a home interview survey

Background  

Response rates in surveys have been falling over the last 20 years, leading to the need for novel approaches to enhance recruitment. This study describes strategies used to maximise recruitment to a home interview survey of mothers with young children living in areas of high deprivation.     

Glucose export from the brain in man: evidence for a role for astrocytic glycogen as a reservoir of glucose for neural metabolism

We report transients of netexport of glucose from brain with jugular glucose content exceeding arterial by up to 5.3 mmol·1⁻¹ in 19 children undergoing cardiopulmunary bypass surgery. The magnitude of the release implies the presence of a glucose reservoir in brain, the most likely candidate being astrocytic glycogen. These data provide evidence that astrocytic glycogen can be exported as glucose, permitting spatial and temporal modulation of glucose delivery to neurons.     

Wiskott Aldrich syndrome: an immunodeficiency syndrome not rare in Western Australia

Wiskott Aldrich syndrome, a combined cellular and humoral X-linked immunodeficiency, is generally considered to be rare. The aim of this study was to ascertain the true prevalence in the paediatric population in Western Australia, describe the clinical features, and summarise the current literature on this unusual condition. All cases of Wiskott Aldrich syndrome presenting to Princess Margaret Hospital in Perth during the period from January 1960 to January 1990 were identified by a retrospective review of case records and by interviewing hospital immunology, haematology and general clinical staff. Nine cases of Wiskott Aldrich syndrome are described, demonstrating that the prevalence of Wiskott Aldrich syndrome in Western Australia is nine times that expected from previous reports. Death occurred in a number of patients before the correct diagnosis was recognised. The clinical features in this group are quite variable. Low isohaemagglutinins, elevated IgE, blunted DTH skin multitest, and very low CDS numbers are however consistent features. Wiskott Aldrich syndrome may be more prevalent than previously recognised, and should be considered in males with thrombocytopenia and infection.