Cerebral Segmental Polyarteritis of Unknown Aetiology in Sheep

Vasculitis affecting the meningeal elastic arteries was identified in six sheep of various breeds during routine diagnostic investigation. The lesions consisted of multifocal intimal proliferation, thickening of the tunica media, multifocal infiltration of the media by inflammatory cells and more extensive perivascular accumulation of lymphocytes and plasma cells within the tunica adventitia. Fibrinoid necrosis affected an intergyral artery in one sheep. Immunohistochemistry failed to demonstrate pestivirus antigen associated with the lesions and no alternative aetiology was defined. Possible causes of meningeal segmental polyarteritis in sheep are discussed.     

Anticancer properties of panduratin A isolated from <Emphasis Type="Italic">Boesenbergia pandurata</Emphasis> (Zingiberaceae)

Extract of Boesenbergia pandurata (Kaempferia pandurata) (Zingiberaceae) has been used as a replacement for K. rotunda, the main ingredient of a popular traditional tonic called “jamu” especially for women in Indonesia. From our previous study, ethanolic extract of B. pandurata showed strong inhibitory effects on the growth of cancer cells, similar to ethanolic extract of Curcuma longa. C. longa and its bioactive compound, curcumin, have shown potential anticancer activity in in vitro and in vivo studies and have undergone clinical trials. Panduratin A, a chalcone derivative isolated from B. pandurata, was found to inhibit the growth of MCF-7 human breast cancer and HT-29 human colon adenocarcinoma cells with an IC₅₀ of 3.75 and 6.56 μg/ml, respectively. Panduratin A arrested cancer cells labelled with Annexin-V and propidium iodide in the G0/G1 phase and induced apoptosis in a dose-dependent manner. In an animal model study, male Sprague–Dawley rats were fed with AIN diet containing ethanolic extracts prepared from the equivalent of 4% by weight of dried rhizomes of B. pandurata and C. longa. Aberrant crypt foci (ACFs) were induced by two subcutaneous doses (15 mg/kg body weight) of azoxymethane (AOM) 1 week apart. The rats were killed 10 weeks later, and the ACFs were assessed in the colon. At the dose given to rats, it appeared that the extracts were not toxic. Total ACFs were slightly reduced by B. pandurata extract compared to control group but not significantly different. Extract of B. pandurata may have a protective effect against colon cancer but additional studies using different models, such as a breast cancer model, need to be carried out.     

Effect of viral respiratory tract infection on outcome of acute otitis media

We prospectively studied 271 infants and children (2 months to 7 years of age) with acute otitis media (AOM) for viral and bacterial causes, outcome at the end of therapy, and frequency of recurrence within 1 month. Comprehensive virologic methods, including viral antigen detection, cell culture, and serologic studies, were used to diagnose viral infection of the respiratory tract, middle ear, or both. Evidence of viral infection was found in 46% (124/271) of patients with AOM. Sixty-six patients (24%) had virus or viral antigen in the middle ear fluid; 50 of these patients (76%) also had bacteria in middle ear fluid, and 16 (24%) had virus alone. More patients with AOM and combined bacterial and viral infection (51%) had persistent otitis (3 to 12 days after institution of antibiotic treatment), compared with those with only bacterial otitis (35%; p = 0.05) or patients with only viral infection (19%; p less than 0.01). Of patients with only viral infection, 4 of 10 with virus in middle ear fluid had persistent otitis, compared with none of 11 patients who had virus only in nasal wash specimens or whose viral infection was diagnosed only by serologic studies. Our data suggest that viruses interact with bacteria and that concurrent viral infection can significantly worsen the clinical course of bacterial AOM. The presence of virus in middle ear fluid may contribute to the pathogenesis and outcome of bacterial AOM. The mechanism of these interactions deserve further investigation.     

Theory of Mind in Children with Autistic Disorder: Evidence of Developmental Progression and the Role of Verbal Ability

Abstract— The present study investigated theory of mind in two groups of autistic children with markedly different verbal mental ages but comparable nonverbal ability and chronological ages, using a range of theory of mind belief tasks. The aims were to look for evidence of developmental progression of theory of mind ability in autistic children and to examine the role played by verbal ability in task performance. The results showed hierarchical patterns of performance across tasks, suggesting a developmental sequence of emerging aspects of theory of mind ability. There was clear evidence that verbal ability is an important contributor to successful task performance.     

Developing a 'consultation quality index' (CQI) for use in general practice

BACKGROUND: The core values of general practice include holism and patient-centredness. None of the measures of quality of care in general practice presently capture the expression of these values at routine consultations. OBJECTIVES: The aim of the present study was to construct a 'consultation quality index' (CQI) which reflects the core values of general practice, using as proxies 'consultation length' and how well patients 'know the doctor' as process measures and 'patient enablement' as an outcome measure. METHODS: The CQI was constructed from data collected from 23 799 adult English-speaking patients consulting 221 doctors in four demographically contrasting areas of the UK during 2 weeks of March/April 1998. A total of 171 doctors who entered 50 qualifying consultations were allocated scores for the three component variables, and a total CQI was calculated. RESULTS: CQI scores were in the range 4-18. Validity was examined by looking at high and low scorers in greater detail and by searching for correlates with case mix, patient age and gender, and the deprivation scores of the practices concerned. Particular attention was paid to how registrars and doctors new to their practices scored. The scores of different doctors in the same practice were also noted. The results had strong face validity and were independent of case mix and deprivation. Reliability was gauged by examining similar work from a previous study which had collected information on consultation length and enablement over three time periods. High CQI scores were associated with smaller overall practice list sizes. CONCLUSIONS: We have outlined possible uses for the CQI as part of the packages assessing quality of care by doctors and practices. The measure may also have a part to play in recognizing poorly performing doctors. We suggest how CQI scores could contribute to an incentive scheme to reward good consulting practice. Further work is in hand to compare doctors' CQI scores with scores based on performance indicators constructed from routine NHS data on prescribing and preventive medicine.     

Use of pneumococcal polysaccharide vaccine in preventing otitis media in infants: different results between racial groups

A total of 133 children between 6 and 11 months of age with at least one episode of otitis media were given one of two pneumococcal vaccines. One vaccine contained 25 microns of types 1, 3, 6, 7, 14, 18, 19, and 23 and the other vaccine (control) contained 25 microns of types 2, 4, 5, 8, 9, 12, and 25. Follow-up care of the 65 black infants revealed significantly more otitis media visits in those infants receiving the control vaccine. Among the 68 white infants there was no difference between control and vaccine groups after vaccination.     

Comparison of patient and doctor responses to a total hip arthroplasty clinical evaluation questionnaire

BACKGROUND: Surgeons traditionally undertake a prospective evaluation of patients undergoing total hip arthroplasty in order to determine outcomes. The validity of doctor-derived data is questionable because of the potential for interobserver error, reporting bias, and differences between the perceptions of doctors and patients. Also, the use of doctor-derived data necessitates the use of costly outpatient services. Consequently, there are likely to be benefits associated with the use of patient-derived clinical evaluation data. However, few studies have focused on whether data obtained from the patient and doctor differ. METHODS: The agreement between patient and doctor responses on a sixteen-item total hip arthroplasty clinical evaluation questionnaire completed at more than 2900 clinical assessments was determined. Data from repeated assessments performed preoperatively and postoperatively enabled stratified analyses that were used to examine reasons for disagreement and factors influencing agreement. Agreement was measured with use of the kappa coefficient. RESULTS: For twelve of the sixteen items, the patient responses had acceptable agreement with the doctor responses. Some important differences between patient-derived and doctor-derived data were found. If the patient had other joint or health problems, had a revision total hip arthroplasty, or reported mild or moderate pain, there was a greater chance of reduced agreement on the pain items. Younger patients demonstrated better agreement with doctors than older patients did. CONCLUSIONS: Patients' perceptions of symptoms and outcomes after total hip arthroplasty are relatively similar to those of their doctor. There is minimum risk of misinterpreting outcomes data by replacing doctor-completed questionnaires with patient-completed questionnaires in uncomplicated total hip arthroplasty cases. For patients with comorbid joint problems or other health problems, and for those reporting substantial pain, direct physician involvement in the evaluation of pain is recommended. The selective use of patient-completed questionnaires has the potential to substantially reduce the costs of outcomes evaluation programs by minimizing doctor input. Pending revision of some of the items, the use of this patient-completed questionnaire is advocated.     

Role of nitric oxide in a toxin-induced model of haemolytic uraemic syndrome

The role of nitric oxide in the pathogenesis of glomerular thrombotic microangiopathy was explored using an established rat model in which ricin with or without lipopolysaccharide induced glomerular thrombosis. Ricin alone caused a small rise in the plasma concentration of nitric oxide (control 9.2±0.7 μM, ricin 23.3±6.3 μM at 7 h). This increase occurred after the development of glomerular thrombosis. Nitric oxide synthase (NOS) activity in the kidney showed no significant change from control values (control 5.66±2.7 pmol/min per ml homogenate, ricin 7.52±1.8 pmol/min per ml homogenate, total activity). When ricin and lipopolysaccharide were administered together, calcium-independent NOS activity increased whereas calcium-dependent activity decreased (1.22±2.6 pmol/min per ml homogenate). The increase in calcium-independent NOS activity correlated with a high plasma concentration of interleukin-1β in the ricin plus lipopolysaccharide group (4,036.83±1,001.5 pg/ml). These data indicate that thrombus formation in a rat model of haemolytic uraemic syndrome is independent of the effects of nitric oxide. Received: 16 November 1999 / Revised: 16 March 2000 / Accepted: 20 March 2000