Megaloblastic Anaemia among Indians in Britain

A high incidence of megaloblastic anaemia, approximately threetimes that in white persons, has been found in Indian immigrantsin Britain. The clinical, haematological, and biochemical featuresof 25 patients are described. All but one of these were livingin the Southall area of Middlesex. In 15 cases the presentinghaemoglobin was less than 7 g/100 ml and three of these wereteenage girls. The majority (17 cases) were nutritional anaemias;the type of deficiency was variable and this group includedsome patients with vitamin B₁₈ deficiency, some with folic aciddeficiency, and some with deficiency of both vitamins. Amongthe remaining eight patients there were cases of perniciousanaemia, tropical sprue, gluten enteropathy, post-gastrectomyanaemia, and unexplained vitamin Bla malabsorption. Some ofthese conditions have previously been considered uncommon inAsiatic Indians.     

The Heterogeneity of the High Molecular Weight B12 Binder in Serum

The binding of vitamin B₁₂ by serum proteins was studied by separatingCo⁵⁷B₁₂-enriched serum by Sephadex gel filtration, column chromatographywith DEAE-cellulose, and paper electrophoresis. Each method of separationyielded two discrete B₁₂-binding fractions. However, the analysis of each serumby all three separation technics indicated that one of the fractions was, ineach case, bipartite.

The "high" molecular weight B₁₂-binding fraction defined by Sephadex gelfiltration consisted of transcobalamin I and just part of the transcobalamin IIfraction. The remaining portion of transcobalamin II was eluted from Sephadexgel in a "low" molecular weight fraction. Thus, transcobalamin II, equivalentto the -globulin B₁₂-binder, consisted of both "high" and "low" molecularweight components.

This suggests that there are at least three serum proteins that can bindvitamin B₁₂: two -globulins, together comprising the transcobalamin II fraction and differing in molecular weight; and transcobalamin I.

Submitted on November 4, 1968 Accepted on January 28, 1969     

The long-term learning effect of training in stage of change for smoking cessation: a three-year follow up of community pharmacy staff's knowledge and attitudes

Objective — A randomised controlled trial has already demonstrated that a training workshop on smoking cessation counselling for pharmacists and their assistants, based on the stage of change model, had a positive effect on the knowledge and attitudes of pharmacy personnel for at least a year, and was associated with increased and more useful counselling, and higher smoking cessation rates. An extension of the study aimed to monitor the duration of the training effect and so help to determine the optimum time span for refresher training. This paper reports the results of two further annual follow-ups. Method — A previously developed and validated self-completion questionnaire assessing knowledge and attitudes was re-administered to intervention and control personnel at 24 and 36 months. One hundred and thirty-four questionnaires were completed at 24 months (85 per cent response rate) and 124 (83 per cent) at 36 months. Setting — Community pharmacies in Grampian, Scotland, United Kingdom. Key findings — The training had a significant effect on knowledge for at least three years, since at both 24 and 36 months the intervention pharmacy teams had a significantly greater knowledge and understanding of the model than the controls (24 months, P=0.0001; 36 months, P=0.031). At 24 months, the intervention pharmacy teams were significantly more confident in their ability to counsel smokers (P=0.021) and were more positive about the outcome of smoking cessation counselling provided in community pharmacies (P=0.043). These attitudinal differences were no longer statistically significant at 36 months. Conclusion — This study has demonstrated the long-term benefit of the stage of change training over a three-year period, for both community pharmacists and their staff, on knowledge and attitudes.     

BLOOD TRANSFUSION: A POSSIBLE RISK FACTOR IN RETROLENTAL FIBROPLASIA

ABSTRACT. Clark, C, Gibbs, J. A. H., Maniello, R., Outerbridge, E. W., and Aranda, J. V. (Department of Newborn Medicine, McGill University, Montreal Children's Hospital Research Institute, Montreal, Quebec, Canada). Blood transfusion: A possible risk factor in retrolental Fibroplasia. Acta Paediatr Scand, 70:535,.–The effect of blood transfusion on the occurrence of RLF was evaluated in 58 infants who weighed less than 1 001 g at birth (Group I) and 70 oxygen treated infants of various birth weights (Group 11). Although there was no significant difference between Group 1 infants with or without exchange transfusion as to birth weight, gestational age, duration of oxygen therapy, peak Po₂'s, or multiple births, there was a significantly increased incidence of pre-retrolental fibroplasia in transfused over non-transfused Group II infants. When Group II infants were stratified for prematurity and oxygen duration, this difference persisted in those not already at risk for RLF. This increased incidence of retinopathy in transfused infants suggests that blood transfusion may be a risk factor in the pathogenesis of RLF.     

COLON CANCER AND POLYPS IN ACROMEGALY: INCREASED RISK ASSOCIATED WITH FAMILY HISTORY OF COLON CANCER

A cohort of 52 subjects diagnosed with acromegaly in southeastern Michigan and northern Ohio between 1935 and 1985 were followed to determine the incidence of colon cancer and polyps. Medical records were reviewed, subjects or their next-of-kin were interviewed, and screening examinations of the colon were offered to the living patients who were located. Data on demographics, personal histories of cancer and colon polyps, family history of colon cancer, and cure from acromegaly were obtained for both living and deceased subjects. The risk for colon cancer compared to the general population was estimated using standardized incidence ratios (SIRs). The expected number of cases was determined utilizing age, sex and race-specific rates provided by the cancer registry in southeastern Michigan. Among the 52 subjects, one could not be located and nine were deceased, none from colon cancer, with one known to have a history of colon polyps. Of 13 (31%) who declined the screening physical, one had a history of polyps and none reported a history of colon cancer. Two of 29 screened patients were found to have right-sided adenocarcinoma of the colon. Of the entire cohort, eight people (including one deceased) had a current or previous diagnosis of polyps, with five known to be histologically adenomatous. The SIR for colon cancer was 4.7 (95% confidence interval 0.6-17.1). Seven subjects, including the two with detected adenocarcinoma and four of the six living subjects with polyps only, reported a family history of colon cancer. The SIR for the subset of subjects with a family history of colon cancer was 29.1 (95% confidence interval of 3.5-104.6).(ABSTRACT TRUNCATED AT 250 WORDS)     

Impact of Programmed Sensitivity Safety Factor on Atrial Sensing in Children

The relationship between the pacemaker sensitivity safety factor (PSSF) and atrial under- or oversensing as documented by 24-hour Holter monitoring was examined. Our study comprised 78 transvenous fixed atrial leads implanted between 1983–1995 in 71 children. Overall, 210 Holter reports identified 143 (68%) Holters with normal atrial sensing function, 31 (15%) with undersensing, 32 (15%) with oversensing, and 4 (2%) with both problems. From 161 Holter reports in which the PSSF was available, the incidence of undersensing at a PSSF of 2.0 (range 1.5–2.4) was 25% (14/57). There was a dramatic decline in undersensing when the PSSF was 3 (3%) compared to a FSSF < 3 (21 %) (P < 0.001). A PSSF cut-off point of 2.0 best predicted occurrence of undersensing with a sensitivity of 79% and a specificity of 67%. Other variable were also examined by multiple logistic regression analysis, but only PSSF remained highly associated with undersensing (odds ratio [OR] = 0.6, P = 0.03). In contrast, PSSF did not have a significant role in predicting oversensing, but presence of sick sinus syndrome (OR = 10.5) or unipolar lead (OR = 5.6) were significantly associated with oversensing (P = 0.0001). The majority of undersensing problems can be avoided by routinely allowing for at least a threefold or more programmed sensitivity margin. Other factors may increase the risk of oversensing, regardless of the PSSF.