Probability-based construction of reference ranges for ratios of log-gaussian analytes: an example from automated leukocyte counts

Reference ranges (RRs) are frequently used for interpreting laboratory values in clinical trials, assessing abnormality of laboratory results, and combining results from different laboratories. When a clinical laboratory measure must be derived from other tests, eg, the WBC differential percentage from the WBC count and WBC differential absolute count, a derivation of the RR may also be required. A naive method for determining RRs calculates the upper and lower limits of the derived test from the upper and lower limits of the measured values using the same algebraic formula used for the derived measure. This naive method and any others that do not use probability-based transformations do not maintain the distributional characteristics of the RRs. RRs derived in such a manner are deemed uninterpretable because they do not contain a specific proportion of the distribution. We propose a probability-based approach for the interconversion of RRs for ratios of 2 log-gaussian analytes. The proposed method gives a simple algebraic formula for calculating the RRs of the derived measures while preserving the probability relationships. The nonparametric method and a parametric method that takes the log transformation, estimates an RR, and then exponentiates are provided as comparators. An example that compares the commonly used naive method and the proposed method is provided on automated leukocyte count data. This provides evidence that the proposed method maintains the distributional characteristics of the transformed RR measures while the naive method does not.     

Immunotherapy in the management of sepsis

This work presents the role of Gram-negative bacteria endotoxins, pro- and anti-inflammatory cytokines and reactive oxygen species (ROS) in the complex and not fully explained pathogenesis of sepsis. The so-called "respiratory burst" of neutrophils and the antioxidant mechanisms of the host are also discussed. The work focuses on possible approaches to the management of sepsis connected with immunotherapy. Neutralization of endotoxin lipopolysaccharide (LPS), anti-tumor necrosis factor alpha (TNF-alpha) therapy with monoclonal antibodies or pentoxifylline (PTXF), as well as soluble recombinant cytokine agonists and antagonists used in clinical trials are taken into consideration. In addition, cytokine manipulation therapy, anti-adhesion techniques, glucocorticoides and antioxidant barrier interference are also described. So far there has been no immunotherapy of sepsis in children of proven clinical efficacy, which prompts an aggressive examination of the immune system aimed at affecting its function.     

'Men leave me as I cannot have children': women's experiences with involuntary childlessness

BACKGROUND: This study explores the concerns and experiences related to involuntary childlessness of infertile women living in a diverse cultural urban community in South Africa. METHODS: In-depth interviews were conducted with 30 women seeking treatment for involuntary childlessness. Women were interviewed at the time of their first visit to an infertility clinic in a tertiary referral centre. RESULTS: All women verbalized intense emotions about their involuntary childlessness. In addition, a large number of women experienced negative social consequences including marital instability, stigmatization and abuse. CONCLUSIONS: These findings demonstrate that infertility can have a serious effect on both the psychological well-being and the social status of women in the developing world. Furthermore, the study provides insight into the cultural context of involuntary infertility in South Africa. The delivery of good infertility care in a community requires awareness of the implications of infertility and insight into the context in which these occur. Since many of the negative social implications of infertility are probably rooted in low status women in the developing world, effective intervention will ultimately require social, economical and political changes.     

Oxygen saturation at rest,on exercise and during sleep in COPD patients undergoing pulmonary rehabilitation program. Two years prospective controlled study

The role of pulmonary rehabilitation (PR) in COPD patients is well established. However, the PR programs includes physical exercise that may deteriorate chronic hypoxemia. The objective of the study was to evaluate impact of a long term PR program on oxygen saturation at rest, on exercise and during sleep in COPD patients no receiving supplemental oxygenation. A two--year controlled study involved 27 rehabilitated (PR-COPD patients (6 females) aged 32-76 years, mean 58.1 years on average and 19 control (C-COPD patients (3 females) aged 58-83 years, mean 68. COPD patients participating in PR program patients were younger, had higher value of FVC and FEV1 and better results of METs during symptom-limited exercise test (ET, p = 0.007). They also had better results of transcutaneus oxygen saturation (SaO2) at rest (p = 0.02), a lower maximal decrease in SaO2 during ET(p = 0.003) and a higher value of medan SaO2 during (p = 0.02). Following PR program the number of METs achieved during ET increased in PR-COPD patients (p = 0.007) and did not change in C-COPD, p = NS. The SaO2 at rest did not change significantly in both groups. Maximal drop in SaO2 during ET decreased in PR-COPD patients (p = 0.02) and did not change in C-COPD(p = NS) group. Median SaO2 at sleep did not change in PR-COPD patients (p = NS) but it decreased in C-COPD patients (p = 0.02). The study indicates that long term PR does not deteriorate the resting diurnal hypoxaemia, it prevent COPD patients from time depending exacerbation of nocturnal hypoxaemia and can improve oxygen saturation on exertion. The results could be influenced by baseline differences between PR-COPD and C-COPD patients.     

Complex management of osteoporotic vertebral fracture

Background. Compression fractures of the thoraco-lumbar spine are the most common form of damage to the skeletal system caused by osteoporosis. These fractures are stable and do not produce neurological deficits. The intensity of the clinical symptoms depends on the degree of kyphotic distortion of the spine and the number of fractured vertebrae. Among the most serious consequences of such injuries are chronic pain, habituated poor body posture (deeper thoracic kyphosis with compensatory hyperlordosis in the lumbar spine), motor and functional limitations, reduced quality of life, and heightened risk of subsequent spinal fractures.
Material and methods. We analyzed a group of 26 patients treated for spinal fractures associated with osteoporosis, in order to evaluate the effectiveness of the treatment methods applied.
Conclusions. Our results indicate that the best outcomes are obtained when the period of immobility is reduced to a minimum and rehabilitation is commenced as early as possible.