Why should pediatric rheumatology be recognized as a separate subspecialty: an open letter to medical councils and government agencies

Some pediatric rheumatologists in the West may take for granted that pediatric rheumatology (PR) is a recognized subspecialty. Yet pediatric rheumatology has been accepted as a subspecialty in the United States only since 1990. There are still countries where many pediatric subspecialties are not given official recognition and support, including PR. This lack of recognition delays and impedes the development of PR, appropriate musculoskeletal and rheumatic teaching in medical schools, and optimal diagnosis and treatment for children with these illnesses. In the opinion of editorial staff, each country where pediatric rheumatology is reasonably well developed as a subspecialty has an obligation to help our pediatric rheumatologists elsewhere gain recognition, support, and respect. The Pediatric Rheumatology European Society (PReS) and the Pediatric Rheumatology International Trial Organization (PRINTO) have been leaders in this effort, but in many countries, pediatric rheumatology is still not recognized. This editorial offers rationales and justifications for medical and governmental entities accrediting pediatric rheumatology as a separate subspecialty that may aid in these efforts.     

A performance-based method for early identification of medical students at risk of developing academic problems

The authors studied three classes at the Albert Einstein College of Medicine and found that students' performances on examinations administered during the third month (November) of medical school were highly predictive of their subsequent performances during the first two years of medical school. The investigation had two components: (1) a retrospective study of the classes of 1988 and 1989, which found that students' November grades from three first-year courses predicted 76% of the variance in the year-one weighted aggregate score and 41% for the year-two score, and (2) a prospective study of the class of 1992, in which three November of year one examination scores of the students in the lowest quarter of the class were highly predictive of their encountering substantial academic problems, with a sensitivity of .77 and a specificity of .99. This performance-based method was found to be more powerful than using the scores on the 1977 version of the Medical College Admission Test or the students' undergraduate grade-point averages, or both, in identifying individual students who were academically at risk.     

Effect of sucrose ingestion on plasma glutamate concentrations in humans administered monosodium L-glutamate

Plasma glutamate concentrations in human subjects are markedly lower when monosodium L-glutamate (MSG) is ingested in consomme with starch than when ingested in consomme alone. This study investigated whether sucrose had a similar effect. Six normal adult subjects (three male, three female) ingested two servings of beef consomme each providing 50 mg MSG/kg body weight in a randomized crossover design. One serving of consomme contained no added carbohydrate; the other provided 0.5 g sucrose/kg body weight. Ingestion of the consomme without sucrose significantly (p less than 0.05) increased the mean plasma glutamate concentration from baseline (4.44 +/- 0.97 mumol/dl) to a peak value of 18.1 +/- 6.99 mumol/dl 30 min after dosing. The area under the plasma glutamate concentration-time curve was 553 +/- 238 mumol/dl X min. When the consomme contained 0.5 g sucrose/kg body weight, both the mean peak plasma glutamate concentration (5.48 +/- 2.19 mumol/dl) and the area under the curve (105 +/- 46 mumol/dl X min) were significantly lower. These data confirm that metabolizable carbohydrate has a significant effect on plasma glutamate concentration response after MSG loading.     

Social and psychological factors associated with adolescents'' self-acceptance of occlusal condition

Studies using plaster models of teeth and photographs simulating the full range of occlusal conditions have found high agreement between measures of adolescent social acceptability of these conditions and perceived need for orthodontic treatment. This study examined the association between adolescents' acceptability of their own occlusal condition, severity of malocclusion, and likelihood of undergoing orthodontic treatment. The factors predicting the acceptability of occlusal condition of 13-yr-olds, as assessed by the SASOC scale, were measurements of acceptability of general physical appearance, and the severity of occlusal condition. Variability in SASOC scores appeared to be independent of gender, socioeconomic status, and ethnicity. Gender, and severity of occlusal condition were important differences between subjects who had received, planned, or were undergoing orthodontic treatment, and those who had not. Neither SASOC scores nor perceived need for treatment accounted for a significant proportion of the variance between these groups. Although adolescents seeking orthodontic treatment had a greater severity of malocclusion than those not, little difference was observed between these groups in acceptance of occlusal condition.     

Second-trimester sex hormone-binding globulin and subsequent development of pre-eclampsia.

OBJECTIVE: To investigate whether maternal plasma sex hormone-binding globulin (SHBG) concentrations are reduced in women who subsequently develop pre-eclampsia. METHODS: This was a cross-sectional study, carried out at antenatal clinics in seven hospitals in and around London. Healthy women underwent uterine artery Doppler velocimetry as a screening method for pre-eclampsia at 22-24 weeks of gestation. The first group (408 women) had normal uterine artery Doppler waveforms (mean uterine artery pulsatility index (PI) below 1.6). The second group (274 women) had increased impedance to flow in the uterine arteries (mean PI above the 95th centile, 1.6). Maternal plasma SHBG concentrations were measured retrospectively using a competitive chemiluminescent immunoassay. Pre-eclampsia was as defined by the International Society for the Study of Hypertension in Pregnancy. RESULTS: Plasma SHBG concentrations in the 80 (11.7%) women who subsequently developed pre-eclampsia were significantly lower than in the 585 (85.8%) women with normal pregnancy outcomes (median 336, range 142-674 nmol/l vs. median 336, range 142-674 nmol/l, p = 0.001). There was a strong correlation between SHBG concentrations and body mass index (r =-0.232246, p < 0.0001). There were no significant differences in maternal plasma SHBG concentrations in women with abnormal uterine artery Doppler (n = 274) compared with controls (n = 408) (median 324, range 101-635 nmol/l vs. median 336, range 142-674 nmol/l, p = 0.09). CONCLUSION: Maternal plasma SHBG concentrations are reduced in women who subsequently develop pre-eclampsia.