Four-week administration of nimesulide, a cyclooxygenase-2 inhibitor, improves endothelial dysfunction in the hindlimb vasculature of streptozotocin-induced diabetic rats

The aim of this study was to examine the effect of chronic administration of nimesulide, a cyclooxygenase-2 inhibitor, on endothelial dysfunction in streptozotocin-induced diabetic rats. Three groups of Sprague-Dawley rats (300–350 g, n = 6) were used. The first group served as normoglycemic control and the second and third groups were rendered diabetic by an intraperitoneal injection of streptozotocin (60 mg/kg). The third group received the selective COX-2 inhibitor, nimesulide (20 mg/kg/day), orally by gavage for 4 weeks while the second group received only drinking water and served as diabetic control. At the end of the treatment period, the rats were anesthetized with urethane (1.2 g/kg) and mean arterial pressure, heart rate and hindlimb blood flow were monitored. This was followed by the injection of acetylcholine (endothelium-dependent vasodilator, 0.1–0.8 μg/kg) and sodium nitroprusside (endothelium-independent vasodilator 1–4 μg/kg). Mean arterial pressure was significantly reduced and hindlimb vascular conductance was not significantly affected in the control diabetic group when compared to the normoglycemic control group. Nimesulide treatment did not cause any significant change in any of the measured hemodynamic parameters. Acetylcholine and sodium nitroprusside induced dose-dependent increases in hindlimb vascular conductance in control normoglycemic rats which were attenuated in diabetic control rats. Nimesulide reversed the attenuation of acetylcholine-induced increase in hindlimb vascular conductance. In conclusion, chronic administration of the selective COX-2 inhibitor, nimesulide improved endothelial dysfunction in the hindlimb vasculature of streptozotocin induced diabetic rats. This suggests that COX-2 products might be involved in the pathogenesis of endothelial dysfunction in streptozotocin-induced diabetic rats.     

The clinical characteristics of Asian and Caucasian patients on Bradford's Low Vision Register

AIM: To analyse the clinical characteristics of patients on the Bradford Low Vision Register with regards to the type (partially sighted or blind), sex, race, causes and age at registration. METHODS: All the data were obtained from the Morley Street Resource Centre, which keeps records of all registrations in the Bradford Metropolitan District. Information including postcode, date of birth, age, gender, ethnic group, degree, date of registration, cause of registration and age at registration were entered into a database. RESULTS: Of all registrations, 64% were blind and 36% were partially sighted. Asians were younger at registration and there were a significantly lower number of females compared to Caucasians. When data were analysed for the different age groups, in the older group of over 65 years, Asians showed significantly more diabetic retinopathy (26.1%) compared to Asians (7.8%), while Caucasians demonstrated significantly more glaucoma (C: 29.3%; A: 17.4%). In the younger age group (<30 years), the leading causes for Asians were retinitis pigmentosa and nystagmus while for Caucasians it was congenital cataracts and optic atrophy. The proportion of Asians registered was significantly lower than expected from the projected population estimates in Bradford. CONCLUSIONS: The study indicates significant differences in the clinical profiles of the two racial groups. The data do not follow the predictions from published population estimates, with Asians, especially females, being under-represented in the register.     

Ethnic variation in von Willebrand factor levels can influence the diagnosis of von Willebrand disease

The amount and function of von Willebrand factor (VWF), measured against a panel of laboratory tests, is the normal basis for the diagnosis of von Willebrand's disease (VWD). The normal range for each test is usually obtained by assaying samples from a cross section of the local population or from a manufacturer's kit insert. While collecting normal controls for another study, population from Durban in South Africa, with its distinct ethnic mix of Africans, Indians and Caucasians were also studied. Previously, Indians from their subcontinent have not been looked at separately and compared with Africans and Caucasians. It is confirmed in a previous study (Miller, Dilley, Richardson, Craig, Evatt. (2001) American Journal of Hematology 67, 125) that African Americans had significantly higher VWF:Ag and FVIII levels when compared with Caucasians. In addition, it was found that there was a significant difference in VWF:Ag levels between Indians and Africans, and between Caucasians and Africans, whereas no significant difference between Indians and Caucasians. Africans, Indians and Caucasians with blood group O showed significantly lower VWF:Ag and FVIII than the other ABO blood groups. Normal ranges of VWF for different blood groups are well established and this information should be utilized while considering a diagnosis of VWD. It is proposed here that the influence of racial origin should also be considered in the clinical and laboratory evaluation of VWD.     

A Fourier transform infrared spectroscopic and solid-state NMR study of bone mineral in osteogenesis imperfecta

Fourier transform infrared spectroscopy and ³¹P solid-state nuclear magnetic resonance spectroscopy were used to determine if any structural or compositional differences in osteogenesis imperfecta (OI) bone mineral could be detected that might help to explain the bone fragility observed in this disease. A previous study by Cassella et al. used an electron probe X-ray microanalytical technique to compare the calcium to phosphorus (Ca/P) molar ratios in normal bone and bone from patients with OI. It was demonstrated that bone from OI patients had a lower Ca/P molar ratio. This study demonstrated that OI bone mineral had a general hydroxyapatite structure and that isomorphous substitutions in the carbanoapatite lattice could account for the low Ca/P molar ratio. Received: December 28, 1999 / Accepted: March 22, 2000     

Economic development and women's blood pressure: field evidence from rural Mashonaland, Zimbabwe

A survey of 515 non-pregnant women at 12 geographically chosen research sites in rural Mashonaland shows significant differences in mean blood pressure, controlled by age cohorts. Three levels of economic development are identified: (1) the traditional economy on communal lands, with lowest blood pressure, (2) the wage economy in areas of large-scale commercial agriculture, with elevated blood pressure and (3) the wage economy in mining areas, with the highest elevation of blood pressure. The area is dominated by the primate city, Harare, up to distances of 300 km and beyond, from which forces of change and modernization emanate. It is seen that potassium, sodium and the sodium potassium ratio, are distance-related to Harare and that women's blood pressures tend to follow suit. The rise of body sodium in young persons at risk, often accompanied by declining potassium intake and other changes of modernization, suggest that more attention should be focused on rural areas in Africa, now in the throes of economic change.     

Elective laparoscopic appendicectomy for chronic right iliac fossa pain in children

AIM: To determine whether elective laparoscopic appendicectomy is justified for chronic right iliac fossa (RIF) pain of undetermined origin. METHODS: A retrospective audit of all laparoscopic appendicectomies between January 1997 and August 2003 was performed. The expanded medical audit system (EMAS) and a Microsoft Access database of operative records were used to identify patients with chronic RIF pain subjected to elective appendicectomy. Case notes were retrieved and analysed for patient profile, duration of symptoms including clinic visits and admissions, operative findings, histological analysis, and postoperative performance. A correlation between histological findings and final outcome was investigated. RESULTS: Ninety-eight patients underwent laparoscopic appendicectomy during the period of the study. A total of 11 cases with chronic RIF pain were identified. Nine were female and 2 male. Age ranged from 9 to 14 years with a mean of 11.9 years. The number of clinic visits and admissions for chronic RIF pain ranged from 2 to 8, with a mean of 4. Duration of symptoms ranged from 1 to 36 months, with a mean of 12.1 months. Detailed history, clinical examination, and serological and radiological investigations failed to reveal the cause of the pain in all cases. Patients were followed up in postoperative clinics for between 1 and 72 months, with a mean of 16.1 months. Histology of resected appendices showed acute inflammation (3 cases), fecoliths (2 cases), lymphoid hyperplasia (LH) (1 case), LH and a foreign body reaction (1 case), LH and mucosal hyperplasia (1 case), and Enterobius vermicularis parasites in 1 case. The appendix was normal in 2 cases. Eight patients had complete resolution of RIP pain. Seven of these had pathology within the appendix and 1 was histologically normal. Two patients with resolved RIF pain, but with pain elsewhere, had lymphoid hyperplasia noted within the appendix. One patient with persistent pain 6 years postoperatively had a normal appendix. CONCLUSION: This study demonstrates that a significant number of patients with chronic RIF pain have pathology within the appendix. The majority of these cases will benefit from elective appendicectomy. It is critical however that all other possible causes of pain in the RIF are excluded. Laparoscopy is an integral part of the diagnosis and management of this particularly difficult group of patients.     

Control strategies for Q fever based on results of pre-vaccination screening in Victoria, 1988 to 2001

OBJECTIVE: Data from Q fever pre-vaccination screening were analysed to determine the level of agreement between the two tests of immunity and between disease or vaccination history and immunity, trends in proportion of participants immune to Q fever, and the annual risk of infection. METHOD: Data from nearly 10,000 screening episodes between July 1988 and June 2001 on Victorian workers at high risk were assessed. RESULTS: Most participants were male (86%) and employed in Victorian abattoirs (81%). Agreement between results of tests for immunity was 'fair' (kappa=0.52). Self-reported history of vaccination or infection was a poor predictor of immunity. The proportion of positive blood and skin tests increased with years of exposure to animals/meat, but decreased over the 13-year period with shorter exposures. Hence the percentage requiring vaccination increased from 50% in 1998 to 90% in 2001. The average annual risk of infection among abattoir workers was 45.0 per 1,000 (95% CI 42.3-47.6), and 62.6 per 1,000 (95% CI 57.5-67.7) over the first 10 years of exposure. CONCLUSIONS: This is the first Australian study to estimate the annual risk of Q fever infection in abattoir workers. The study confirmed previous findings of poor agreement between screening tests and predictive value of history of vaccination/ exposure. Up to 90% of new entrants in high-risk workplaces will be susceptible to Q fever and require vaccination. IMPLICATIONS: Systematic post-marketing surveillance is needed to monitor adverse events to the vaccine, duration of protection and possible reasons for vaccine failures.     

Laparoscopic nephrectomy for unilateral multicystic dysplastic kidney in children

The contemporary management of children with unilateral multicystic dysplastic kidney remains controversial. With the potential risks of hypertension, infection, and malignant transformation of the dysplastic kidney, conservative management necessitates long-term review with frequent ultrasound scans, urine analyses, and blood pressure checks. Operative management has traditionally used open nephrectomy with its associated patient morbidity. The introduction of laparoscopic procedures has allowed the development of techniques that reduce patient morbidity, hospital stay, and analgesia requirement. This article reports a series of 13 children who underwent elective laparoscopic nephrectomy for unilateral multicystic dysplastic kidney and discusses the advantages this procedure has to offer for their management. The results for the initial seven patients in this series were presented to the British Association of Pediatric Endoscopic Surgeons Annual Meeting at St. Hilda’s College, Oxford, September 2002.