Recognition of actual periods of nocturnal rest from 24-hour heart rate profile

Inability to delineate exactly periods of nocturnal sleep and diurnal wakefulness during 24-hour blood pressure (BP) monitoring causes reporting of erroneous BP values for these periods. We suggested a simple mathematical algorithm for detection of periods of nocturnal rest determined as period of low values of cardiac rhythm using data of BP monitoring itself. AIM: To compare novel method of recognition of periods of sleep with 2 standard techniques: use of fixed time interval between 23 and 7 hours (1), or period of sleep according to patient's diaries (2). Reproducibility of nocturnal BP lowering between two 24-hour intervals during 48-hour blood pressure monitoring was used as a measure of precision of determination of diurnal/nocturnal BP. METHODS: Ambulatory 48-hour BP monitoring was carried out in 33 patients with uncomplicated stage II hypertensive disease. Automatic analysis of BP monitoring data was performed with the use of specially designed computer application. Standard deviation (SD) of differences (SDD) between pairs of nocturnal BP lowering during 48 hours was used as a measure of reproducibility. RESULTS: Reproducibility of values obtained with novel algorithm (SDD for systolic/diastolic BP 6.7/8.2 mm Hg) was substantially better than those obtained with standard methods (1) and (2) (SDD 13.0/14.8 and 13.5/18.3 mm Hg, respectively). CONCLUSION: The proposed method of recognition of the period of nocturnal rest substantially improved precision of automatic analysis of 24-hour BP monitoring.     

Recurrent recurrent gallstone ileus

We describe the second reported case of three consecutive episodes of gallstone ileus and ask the question whether recurrent gallstone ileus justifies definitive surgery to the fistula itself or can be safely managed by repeated enterotomies.     

Psychoimmune Interactions in Women of Reproductive Age with Endometriosis

Psychoimmune interactions were studied in women of reproductive age with endometriosis. Pronounced immunological shifts manifested in a shift of the T-cellular immunity, resulting in imbalanced production of pro- (IL-1β, IL-2, IFN-γ) and anti-inflammatory (IL-4) cytokines. Significant correlations between the severity of mental shifts and immunopathogenetic factors in the studied patient population demonstrated the psychoneuroimmune nature of endometriosis.     

‘Working together’ - A new approach to Reviewing the Quality of Postgraduate Medical Training Posts in Northern Ireland?

Many of us are involved in the education and training of junior doctors. Maintaining and improving the quality of such training is the common goal of all medical educators, including those working in the Northern Ireland Medical and Dental Training Agency (NIMDTA) and within our hospitals – the Local Education Providers (LEPs). The development of NIMDTA’s Placement Quality Initiative (PQI) aims to create a more collaborative working relationship between NIMDTA and the LEPs, working together, to achieve a shared goal and develop and implement strategies to improve current practice. We review the PQI process, from both a trainee and trainer’s perspective, and ascertain if this approach has facilitated positive, reproducible changes in training programmes that are felt at ground level.     

Comparative assessment of validity and reliability of the Oral Impacts on Daily Performance (OIDP) frequency scale: a cross‐sectional survey among adolescents in Davanagere city,Karnataka, India

Abstract: Aim: To evaluate reliability and validity of an abbreviated version of the Oral Impact on Daily Performance (OIDP) questionnaire and to analyse the interrelationship between OIDP scores, socio‐demographic characteristics and oral health status among high school children in Davanagere city, Karnataka, India. Materials and methods: This cross‐sectional survey was conducted with 900 school children aged between 12 and 15. The subjects were randomly selected from six high schools. Selected subjects completed a survey instrument predesigned to measure subjective oral health indicators including the eight‐item OIDP frequency scores. The study participants were clinically examined for dental caries, and they completed a self‐administered questionnaire about demographic information and oral behaviours. Results: 44% of the students reported at least one oral impact in the previous 6 months. The reliability of the instrument was measured in terms of Cronbach’s alpha for the OIDP frequency. It was found to be 0.81. Eating was the most common performance affected (33%) followed by cleaning teeth (22%) and speaking (20%). The severity of impacts was low for relaxing and carrying out works. Conclusion: The OIDP frequency score has acceptable psychometric properties in the context of an oral health survey among high school children of Davanagere city, Karnataka, India.     

Prognostic importance of blast cell DNA content in childhood acute lymphoblastic leukemia

Using flow cytometric techniques, we determined the pretreatment distribution of DNA content in propidium iodide-stained leukemic blasts from 205 children with "standard-risk" acute lymphoblastic leukemia (ALL). Risk assignment was based on an initial WBC count less than 100 X 10(9)/L, no thymic mass, no meningeal leukemia, and lymphoblasts lacking sheep erythrocyte receptors or surface immunoglobulin. A single aneuploid leukemic line was detected in 74 cases (36.1%): 70 hyperdiploid and four hypodiploid. For hyperdiploid cases, the DNA index (DI, or ratio of the DNA content of leukemic v normal G0/G1 cells) ranged from 1.06 to 2.0 (median, 1.20). A secondary leukemic line with hyperdiploid cellular DNA content was identified in 21 cases with diploid primary lines. Children whose primary leukemic line showed a DI greater than or equal to 1.16 (n = 57) had significantly better responses to treatment than did those with either a diploid DI (n = 130; P = .002) or values in the range of 1.01 to 1.15 (n = 14; P = .001). The relative risk of failure for hyperdiploid cases with DI greater than or equal to 1.16, corresponding to greater than or equal to 53 chromosomes, was one-third that of the other two groups. Treatment responses of patients with both diploid and hyperdiploid lines were identical to those associated with single diploid lines, but significantly worse than those associated with single hyperdiploid lines with DI greater than or equal to 1.16 (P = .016). The most favorable prognostic variables selected by a Cox proportional hazards model were: DI greater than or equal to 1.16 (P = .001), white race (P = .022), WBC less than or equal to 25 X 10(9)/L (P = .032), age between 2 and 9 years (P = .075), and hemoglobin less than 7.0 g/dL (P = .094). DNA index greater than or equal to 1.16 retained its significant prognostic impact even after adjustment for other variables (P = .001). With the combination of DI greater than or equal to 1.16 and WBC less than or equal to 25 X 10(9)/L, one can identify a group of children with ALL who have a low probability of relapse when treated with current therapy. If they remain disease-free after longer follow-up, it may be advisable to treat them with less intensive, hence less toxic, chemotherapy than patients with higher WBC counts or lower DI values.     

Interaction of stem cell factor and its receptor c-kit mediates lodgment and acute expansion of hematopoietic cells in the murine spleen

The phenotypes of mice that harbor a defect in the genes encoding either stem cell factor (SCF) or its receptor, c-kit, indicate that this ligand/receptor pair is necessary for maintenance of normal hematopoiesis in the adult. Our objective was to determine whether SCF, like erythropoietin, is necessary for acute erythroid expansion during recovery from hemolytic anemia. Monoclonal antibody ACK2, which recognizes the murine c-kit receptor, was used to selectively block the hematopoietic growth-promoting effects of SCF. Mice were treated with phenylhydrazine on day 0 and day 1 to induce hemolytic anemia and also received no antibody, control IgG, or ACK2 on day 0. The mice were killed on day 3 and the hematocrit (Hct), reticulocyte count, and numbers of erythroid and myeloid hematopoietic progenitor cells (colony- forming unit-erythroid [CFU-E], burst-forming unit [BFU]-E, and CFU- granulocyte-macrophage [GM]) were quantitated in the femoral marrow and spleen using hematopoietic colony-forming assays. Induction of hemolytic anemia with phenylhydrazine resulted in a drop in the Hct from approximately 50% to 30%, and an approximate 8- to 10-fold increase in the reticulocyte count. The numbers of CFU-E increased modestly in the femur, and approximately 25- to 50-fold in the spleen, in comparison with normal mice. BFU-E and CFU-GM values did not increase in the femur but expanded 6- to 10-fold in the spleen, in comparison with normal mice. This confirms that much of the erythroid expansion in response to hemolytic anemia occurs in the murine spleen. Neutralizing quantities of the ACK2 antibody reduced femoral CFU-E, BFU- E, and CFU-GM content to less than half that found in phenylhydrazine- treated control mice and nearly totally ablated splenic hematopoiesis. These results suggest that c-kit receptor function may be required for optimal response to acute erythropoietic demand and that erythropoiesis in the splenic microenvironment is more dependent on SCF/c-kit receptor interaction than is erythropoiesis in the marrow microenvironment. Because expansion of late erythropoiesis in the spleen was preferentially blocked, we tested the hypothesis that homing of more primitive hematopoietic cells to the spleen was dependent on c-kit receptor function. Lethally irradiated mice were injected with marrow cells obtained from mice that had received phenylhydrazine plus control IgG or with marrow cells obtained from mice that had received phenylhydrazine plus ACK2. In parallel experiments, normal murine marrow cells were treated in vitro with control IgG or with ACK2 and were injected into lethally irradiated mice. The fraction of BFU-E and CFU-GM retrieved from the marrow and spleen of the recipient mice 4 hours later was reduced by approximately 75% when progenitor cells had been exposed to ACK2, in comparison with control IgG. These data suggest that interaction of SCF with the c-kit receptor affects the homing behavior of hematopoietic progenitor cells in the adult animal.