Missed opportunities for the prevention of cardiovascular disease among British hypertensives in primary care.

BACKGROUND: High-risk strategies for the prevention of cardiovascular disease (CVD) among hypertensive patients require knowledge of the prevalence and interaction of modifiable risk factors to ensure effective targeting of interventions. Comparatively little is known of risk-factor profiles and their modification among hypertensives in primary care. AIM: The present study was designed to explore relationships between patients' knowledge of CVD risk factors, their perception of personal risk and health behaviours, and their use of lifestyle interventions. METHOD: A cross-sectional survey of 2676 men and women with mild to moderate hypertension (diastolic blood pressure 95-115 mmHg), and their general practitioners, recruited from 1044 general practices throughout the UK, was conducted. RESULTS: Levels of modifiable risk factors were high, although there was considerable variation by age and sex; most (98.5%) patients had at least one additional CVD risk factor. A lower standard of living was associated with a higher prevalence of 'unhealthy' behaviours. Out of those with a current lifestyle problem, 85% of obese patients, 59% of smokers, 47% of excess drinkers, 49% of those with dietary risk factors and 32% of inactive patients claimed to have adopted healthier behaviours within the past 3 months. Older subjects and those with a lower standard of living were less likely to acknowledge risks, and those who did were less likely to report improving their lifestyles. While 71% of patients recalled receiving lifestyle advice, the coverage and targeting of specific interventions was generally poor. Overall, 60% of the sample had received advice on weight control, 47% on diet, 38% on exercise, 38% on smoking and 36% on alcohol. Women and older people were less likely to be given relevant counseling, and there was no evidence of targeting with respect to subjects' social class, level of hypertension or duration of diagnosis. CONCLUSION: Lifestyle interventions are welcomed and are viewed as helpful by patients receiving them. Potential health gains among high-risk hypertensives are being lost because of poor targeting and coverage of those at greatest risk.     

G-Trisomie bei akuter Erythroleukämie

Zusammenfassung Es wird über einen Fall akuter Erythroleukämie mit G-Trisomie berichtet und die mögliche Bedeutung hereditärer Faktoren für die Manifestation akuter Leukämien diskutiert.

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Summary The cytogenetic analyses of direct bone marrow preparations in a 53 years old male with acute erythroleukaemia of 9 months disease history, revealed persistently a G-trisomy in a dominant cell line with 47 chromosomes. The peripheral blood culture preparations with phytohaemagglutinin exhibited normal diploid cell line.The frequent occurrence of akute leukaemia in Down's syndrome tempts to implicate that leukaemia with G-Trisomy having no signs of Down's syndrome is a somatic mutation initiated by some unknown hereditary recessive genes mechanisms.

     

Measuring handicap: the London Handicap Scale, a new outcome measure for chronic disease.

OBJECTIVE--To develop a handicap measurement scale in a self completion questionnaire format, with scale weights allowing quantification of handicap at an interval level of measurement. DESIGN--Adaptation of the International Classification of Impairments, Disabilities and handicaps into a practical questionnaire incorporating the dimensions of handicap mobility, occupation, physical independence, social integration, orientation, and economic self sufficiency and scale weights derived from interviews with a general population sample, with the technique of conjoint analysis. SETTING--Two general practices in different areas of London. SUBJECTS--240 adults aged 55-74 years randomly selected from the practices, 101 (42%) of whom agreed to be interviewed, and 79 (78%) of whom completed the exercise. MAIN MEASURES--Rating of severity of handicap associated with 30 hypothetical health scenarios on a visual analogue scale, from which was derived a matrix of scale weights ("part utilities") relating to different levels of disadvantage on each dimension, with a formula for combining them into an overall handicap score. Severity scores measured directly for five scenarios not used to derive the scale weights were compared with those calculated from the formula to validate the model. RESULTS--The part utilities obtained conformed with the expected hierarchy for each dimension, confirming the validity of the method. The measured severities and those calculated from the formula for the five scenarios used to validate the model agreed closely (Pearson's r = 0.98, p = 0.0009; Kendall's tau = 1.00, p = 0.007). CONCLUSIONS--This interval level handicap measurement scale will be useful in assessing both specific therapies and health services, in clinical trials, in analyses of cost effectiveness, and in assessments of quality assurance.     

Laparoscopic Assisted Cystectomy and Lymphadenectomy for Bladder Cancer: Initial Experience

This study discusses our initial experience in the field of laparoscopic management of bladder carcinoma. Ten patients with invasive bladder tumors of variable histology and ranging from stage T2 to T3b were submitted to this procedure. Intraoperative assessment, lateral dissection, posterior dissection, anterior dissection, and urethral transection were achieved laparoscopically. The specimen retrieval and continent pouch construction was performed through a limited abdominal incision. This new regimen allows precise radical lymphadenectomy, early postoperative mobility, fewer wound complications, and shorter hospital stay. The early postoperative results of this procedure are encouraging. Modification and continuous refinement of the technique is still ongoing.     

An epizootic of Rift Valley fever in Egypt in 1997

An epizootic of Rift Valley fever (RVF) occurred in Egypt between April and August 1997. The signs among infected cattle and sheep were high fever, icterus, bloody diarrhoea and abortion. Aborted sheep foetuses and sera from the affected herds were collected in the Aswan and Assiut Provinces, Upper Egypt, for virological and serological examination. A cytopathic effect was detected in Vero cell cultures 48 h after inoculation with the foetal liver and spleen suspensions. The same suspensions caused paralysis and mortalities two to three days post intracerebral injection in mice. The isolated virus was identified using an agar gel precipitation test (AGPT) and a direct fluorescent antibody technique. Serological examination revealed that all tested sheep (57) and cattle (93) gave positive results to serological tests, using a complement fixation (CF), serum neutralisation (SN) and indirect immunofluorescence assay; while only 48 (84.2%) out of 57 sheep sera and 69 (74.2%) out of 93 cattle sera gave positive results using an AGPT. Titration of the serum samples indicated that SN is more sensitive than CF. Importation of infected ruminants, especially camels from the Sudan, is the principal source of infection. Aswan, the nearest Egyptian province to the Sudan, is the focus of RVF virus infection in Egypt. As a result of high insect populations, the epizootics of RVF have usually occurred during the summer in Egypt. Reoccurrence of epizootics from time to time indicates failure of the applied RVF vaccination programme in Egypt.     

Calcium bioavailability of selected Egyptian foods with emphasis on the impact of fermentation and germination

The bioavailability of calcium (Ca) was assessed in 11 foodstuffs of plant or animal origin using rat feeding experiments and the criteria used for assessing the bioavailability were femur Ca and calcium efficiency. The bioavailability of Ca was found to be highest in fishes (Melouha) and cheeses (Mesh) fermented under local processing techniques. Germination of faba beans also enhanced the bioavailability of calcium to a mean value quite comparable to those of some dairy products, such as cottage cheese. The present study clearly demonstrates that the processes of fermentation and germination of selected foods are associated with an enhancement in the bioavailability of calcium. It is suggested that the breakdown of complex proteins under the fermentation or germination process is the underlying mechanism of action.     

Glucose and leucine kinetics in idiopathic ketotic hypoglycaemia.

AIMS: To investigate glucose and leucine kinetics in association with metabolic and endocrine investigations in children with ketotic hypoglycaemia (KH) in order to elucidate the underlying pathophysiology. METHODS: Prospective interventional study using stable isotope tracer in nine children (mean age 4.23 years, range 0.9-9.8 years; seven males) with KH and 11 controls (mean age 4.57 years, range 0.16-12.3 years; four males). RESULTS: Plasma insulin levels were significantly lower in KH compared to subjects in the non-KH group. Plasma ketone body levels were significantly higher in KH than in non-KH. Basal metabolic rate was significantly higher in subjects with KH (45.48+/-7.41 v 31.81+/-6.72 kcal/kg/day) but the respiratory quotients were similar in both groups (KH v non-KH, 0.84+/-0.05 v 0.8+/-0.04. Leucine oxidation rates were significantly lower in children with KH (12.25+/-6.25 v 31.96+/-8.59 micromol/kg/h). Hepatic glucose production rates were also significantly lower in KH (3.84+/-0.46 v 6.6+/-0.59 mg/kg/min). CONCLUSIONS: KH is caused by a failure to sustain hepatic glucose production rather than by increased glucose oxidation rates. Energy demand is significantly increased, whereas leucine oxidation is reduced.