Dietary Reference Intakes: The New Basis for Recommendations for Calcium and Related Nutrients, B Vitamins, and Choline

Dietary Reference Intakes (DRIs) represent the new approach adopted by the Food and Nutrition Board to providing quantitative estimates of nutrient intakes for use in a variety of settings, replacing and expanding on the past 50 years of periodic updates and revisions of the Recommended Dietary Allowances (RDAs). The DRI activity is a comprehensive effort undertaken to include current concepts about the role of nutrients and food components in long-term health, going beyond deficiency diseases. The DRIs consist of 4 reference intakes: the RDA, which is to be used as a goal for the individual; the Tolerable Upper Intake Level (UL), which is given to assist in advising individuals what levels of intake may result in adverse effects if habitually exceeded; the Estimated Average Requirement (EAR), the intake level at which the data indicate that the needs for 50% of those consuming it will not be met; and the Adequate Intake (AI), a level judged by the experts developing the reference intakes to meet the needs of all individuals in a group, but which is based on much less data and substantially more judgment than that used in establishing an EAR and subsequently the RDA. When an RDA cannot be set, an AI is given. Both are to be used as goals for an individual. Two reports have been issued providing DRIs for nutrients and food components reviewed to date: these include calcium and its related nutrients: phosphorus, magnesium, vitamin D, and fluoride; and most recently, folate, the B vitamins, and choline. The approaches used to determine the DRIs, the reference values themselves, and the plans for future nutrients and food components are discussed. J Am Diet Assoc. 1998;98: 699–706.     

Ventriculoatrial Conduction Time During Bundle Branch Reentrant Beat Initiating Orthodromic Tachycardia: A Simple and Reliable Method for Localization of Accessory Pathways

VA Interval Via Accessory Pathway During Bundle Branch Reentry. Bundle branch reentrant (BBR) complex is commonly induced during programmed ventricular stimulation with single ex-trastimulus. In patients with atrioventricular accessory pathway, BBR beat frequently triggers orthodromic tachycardia. This study was designed to determine whether evaluation of the ventriculoatrial conduction time during BBR (VA_BBR) induced with right ventricular extrastimulation (i.e., left bundle branch block morphology) can separate left free-wall (LFW) accessory pathways from left posteroseptal (LPS) or right-sided pathways. Thirty-eight patients with single atrioventricular accessory pathways were included. There were 28 men and 10 women with a mean age of 26 years. The accessory pathway was localized in LFW in 23 patients (group I) and LPS in seven (group ID. Eight patients (group III) had pathways located in the right side. In each patient, VA_BBR was determined and compared with the following: (1) V₂A₂ interval exclusively via accessory pathway; and (2) ventriculoatrial conduction time during orthodromic tachycardia with narrow QRS complex (VA_NQ), left bundle branch block plus normal axis (VA_LB-NA) or left axis (VA_LB-LA). In group I, VA_BBR values (170–245 msec, mean 196.1 ± 20.5 msec) were 0–25 msec longer than V₂A₂ (170–245 msec, mean 191.3 ± 19.1 msec) and 45–125 msec greater than VA_NQ (100–155 msec, mean 125.6 ± 14.1 msec). VA_BBR was identical to VA_LB-LA but 25–55 msec greater than VA,_LB-NA (140–205 msec, mean 160.9 ± 20.8 msec). In group II, VA_BBR values (100–140 msec, mean 118.6 ± 14.3 msec) were 15–30 msec shorter than V₂A₂ (125–165 msec, mean 140.7 ± 14.3 msec) and 15–25 msec longer than VA_NQ (85–120 msec, mean 100.7 ± 12.0 msec). Comparing VA_BBR with VA_LB-NA or VA_LB-LA did not show any statistically significant difference. In group III, VA_BBR values were consistently shorter than V₂A₂ and identical to VA_NQ. Thus, assessment of VA_BBR is a simple and useful method that can be reliably utilized to differentiate LFW pathways from LPS or right-sided pathways. Furthermore, these data provide new insights into the electrophysiological characteristics of bundle branch reentry. (J Cardiovasc Electrophysiol, Vol. 1, pp. 121–131, April 1990)     

Pharmaceutics: The Effect of Dose on the Characterization of Aerodynamic Particle-size Distributions of Beclomethasone Dipropionate Metered-dose Inhalers

The aerodynamic particle-size distribution for two doses of a Becloforte metered-dose inhaler (MDI) was measured by use of a twin-stage impinger (TSI), the new multi-stage (five-stage) liquid impinger (MSLI) and the Andersen cascade impactor (ACI) (n = 5 for each apparatus). The mean (s.d.) fine-particle doses measured by the three techniques for the Becloforte MDI were 40.3 (1.2), 45.7 (0.5) and 41.8 (0–4)% w/w, respectively; the median mass aerodynamic diameters (MMAD) measured using the MSLI and the ACI were 3.50 and 3.73 μm, respectively. The MSLI fine particle (< 6.8 μm) doses for 2, 5, 10, 20, 30 and 40 doses from Becloforte MDIs (n = 5 for each dose) were 49.7 (0.7), 52.9 (1.2), 45.3 (0.6), 45.5 (0.71), 45.9 (0.7) and 46.4 (0.7)% w/w, respectively. Values obtained using the ACI (< 5.8 μm) were 40.8 (1.0), 41.0 (0.8), 44.4 (0.5), 43.1 (0.4), 42.8 (0.5) and 40.4 (0.4)% w/w (n = 4). MMAD values measured with the MSLI were 3.39, 3.46, 3.75, 3.91, 4.15 and 4.45 μm, respectively; using the ACI they were 3.46, 3.54, 3.61, 3.66, 3.73 and 3.85 μm. The results indicate that the measured aerodynamic particle-size distributions of beclomethasone dipropionate MDIs are affected by the dose dispensed and by the apparatus used for measurement.     

Four hundred consecutive cases of jaundice

A patient who becomes jaundiced, regardless of age, has approximately three and one-half chances of ten to recover.If the jaundice occurs in an individual who has reached middle age, his possible percentage of recovery is still smaller.Removal of a gallbladder and its contained stones at the proper time after diagnosis has been established will reduce the number of deaths due to common duct stones, malignancy of the gallbladder and the inflammatory group due to calculous disease of the viscus.     

TRIVIAL OR TERRIBLE? THE PSYCHOSOCIAL IMPACT OF PSORIASIS

Background. Psoriasis remains a chronic disease with lesions that are often extensive and disfiguring. While the potential for psychosocial morbidity and impairment are recognized, the literature remains equivocal with regard to the prevalence and degree of this impairment. Methods. The present study utilized a new questionnaire designed to assess the type and degree of psychosocial impairment present among psoriasis patients. The questionnaire was designed to assess major areas of psychosocial functioning and was completed by 64 patients undergoing outpatient treatment. Results. Approximately half the patients were found to have moderate to extreme levels of anxiety, depression, and anger. Patients reported experiencing these negative emotional sequelae both during their disease flares and during periods of remission. Patients were also found to have moderate to extreme levels of pruritus associated with their flares. Psychologic morbidity was positively associated with length of disease flare. Significant levels of social embarrassment, life disruption, and social withdrawal were found as well. Conclusions. Psoriasis does appear to cause significant psychosocial morbidity. Greater awareness by physicians and more comprehensive treatment addressing these psychosocial components may avert, or at least minimize, some of these negative sequelae.     

A Randomized, Double-Blind Comparison of Two Topical Anesthesic Formulations Prior to Electrodesiccation of Dermatosis Papulosa Nigra

BACKGROUND: Liposomal lidocaine 4% (L.M.X.4 cream, Ferndale Laboratories Inc., Ferndale, MI, USA) has been proposed as a more rapidly acting topical anesthetic than the eutectic mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA cream, AstraZeneca LP, Wilmington, DE, USA) for venipuncture and laser procedures. However, their anesthetic efficacy has not been previously compared for electrosurgical destruction of superficial skin lesions. OBJECTIVE: To test the hypothesis that L.M.X.4 and EMLA differ in anesthetic efficacy when applied under occlusion for 30 minutes prior to electrodesiccation of papules of dermatosis papulosa nigra. METHODS: Forty adults were randomly assigned to treatment with either agent for 30 minutes under Tegaderm. The study drug was administered for an additional 30 minutes if the electrodesiccation of the first few papules was too painful. RESULTS: One subject treated with EMLA versus none treated with L.M.X.4 experienced complete anesthesia after a single 30-minute application. Nineteen of 20 (95%) subjects treated with EMLA versus 18 of 20 (90%) subjects treated with L.M.X.4 required only a single application (p = .49). Pain scores after the initial 30-minute application (scale: 0 = none to 10 = very severe) were EMLA 3.3 +/- 2.2 (mean +/- SD) versus L.M.X. 4 2.9 +/- 2.0 (p = .46). CONCLUSION: EMLA and L.M.X.4 provide comparable levels of anesthesia after a single 30-minute application under occlusion prior to electrodesiccation of superficial skin lesions.     

Personal and Professional Support for Mothers of NICU and Healthy Newborns

Personal support provided by close social network members and professional support provided by nurses were studied in 83 postpartum mothers and newborns in neonatal intensive care units and newborn nurseries. Mothers perceived each type of support differently in terms of outcomes. Only personal support was significantly related to emotional affect and life satisfaction outcomes. Both personal and professional support were related to relationship satisfaction outcomes. Findings suggest that personal support and professional support be treated as separate concepts.