Letter to the editor about “Effects of fruit and vegetables on metabolic syndrome: a systematic review and meta-analysis of randomized controlled trials” by Shin JY,Kim JY,Kang HT,Han KH,Shim JY published online in 2015 May 6

The letter to the editor presents methodological issues about the search strategy, adequate reporting of meta-analysis, and statistical details of the referred article.     

Immunization coverage among predominantly Hispanic children, aged 2-3 years, in central Los Angeles

PURPOSE: To assess the immunization status of young children in a predominantly Hispanic region in and around downtown Los Angeles, and factors associated with complete immunization by age 24 months. METHODS: The information was gathered in a two-stage cluster survey with probability proportionate to estimated size (PPS) sampling of 30 clusters at the first stage, and simple random sampling of a constant number of children at the second stage. Vaccination coverage was determined by a review of the home immunization (HI) card, or of clinic records. RESULTS: Of the 270 sampled children, 91.5% were Hispanic and 6.7% were Black. Home telephone numbers were not available in 24.8% of the homes, and 34.1% reported having no health insurance. Vaccination coverage was over 90% for the first three doses of Diphtheria, tetanus toxoids and pertussis/ diphtheria, tetanus toxoids and acellular pertussis vaccine (DTP/DTaP)/Diphtheria and tetanus toxoids vaccine (DT), first two doses of poliovirus (Polio) vaccine, first dose of measles, mumps and rubella (MMR) vaccine, and first two doses of hepatitis B (Hep B) vaccine. Yet, by age 24 months, only 72.2% of the children had received the combined series of 4:3:1 (i.e., four DTP/DTaP/DT, three Polio, one MMR). This was further reduced to 64.4% for the combined series of 4:3:1:3:3 (i.e., four DTP/DTaP/ DT, three Polio, one MMR, three Haemophilus influenzae type b (Hib), three Hep B). Factors associated with completed on-time vaccination were having an HI card available during the interview and being enrolled in Supplemental Nutrition Program for Women, Infants and Children (WIC). CONCLUSIONS: While vaccination levels for individual antigens were found to be high, more emphasis needs to be placed on getting preschool children vaccinated on-time according to the Recommended Childhood Immunization Schedule.     

Organochlorine pesticide residues in human breast milk from southwest Greece: associations with weekly food consumption patterns of mothers

Breast milk samples were collected from 112 mothers who resided in southwest Greece during the years 1995-1997. The following chemicals, which were present in some of the milk samples, were quantified by gas chromatography: residues of lindane (i.e., alpha-hexachlorocyclohexane [BHC], beta-BHC, gamma-BHC), delta-BHC, 1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene (p,p-DDE), 1,1-dichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDD, and 1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane (p,p'-DDT). With the assistance of a qualified dietitian, the mothers also completed a 7-d food-frequency questionnaire and provided additional personal information (e.g., educational level, profession, previous or present residence, use of pesticides, treatment of dermal scabies). Concentrations of gamma-BHC (i.e., lindane) were present in 57.1% of the samples (mean concentration = 0.58 microg/l [whole milk], range = nondetectable to 10.86 microg/l). Concentrations of alpha-BHC, beta-BHC, delta-BHC, p,p'-DDD, and p,p'-DDT were detected in 16%, 39.3%, 11.6%, 41%, and 55.3% of the samples, respectively. Moreover, p,p'-DDE, which was detected in all samples, ranged from 0.33 to 278 microg/l. Typically, the amounts of gamma-BHC and sigma-DDTs in breast milk were below the established acceptable daily intake value. Nonetheless, 3 of the 112 samples contained concentrations of sigma-DDT derivatives that exceeded the acceptable daily intake value established by the World Health Organisation in 1987. Concentrations of insecticides in breast milk were affected by dietary habits. Some women who consumed 7 (or more) portions of fresh vegetables per week had gamma-BHC concentrations in whole milk that exceeded 0.15 microg/l (odds ratio = 1.23 [95% confidence interval = 1.05, 1.44]; p = .006). The concentrations of DDT derivatives were associated with the portions of fish, chicken, fruits, milk, and potatoes consumed each week.     

Design and synthesis of novel biologically active thrombin receptor non-peptide mimetics based on the pharmacophoric cluster Phe/Arg/NH2 of the Ser42-Phe-Leu-Leu-Arg46 motif sequence: platelet aggregation and relaxant activities

The identification of the thrombin receptor has promoted the interest for the development of new therapeutic agents capable of selectively inhibiting unwanted biological effects of thrombin on various cell types. In this study we have designed and synthesized two series of new thrombin receptor antagonists based on the thrombin receptor motif sequence S42FLLR46, one possessing two (Phe/Arg) pharmacophoric groups and the other possessing three (Phe/Arg/NH2). N-(6-Guanidohexanoyl)-N'-(phenylacetyl)piperazine (1), N-(phenylacetyl)-4-(6-guanidohexanoylamidomethyl)piperidine (2), and N-(phenylacetyl)-3-(6-guanidohexanoylamido)pyrrolidine (3) (group A) carry the two pharmacophoric side chains of Phe and Arg residues incorporated on three different templates (piperazine, 4-aminomethylpiperidine, and 3-aminopyrrolidine). Compounds with three pharmacophoric groups (group B) were built similarly to group A using the same templates with the addition of an extra methylamino group leading to (S)-N-(6-guanidohexanoyl)-N'-(2-amino-3-phenylpropionyl)piperazine (4), (S)-N-(2-amino-3-phenylpropionyl)-4-(6-guanidohexanoylamidomethyl)piperidine (5), and (S)-N-(2-amino-3-phenylpropionyl)-3-(6-guanidohexanoylamido)pyrrolidine (6). Compounds were able to inhibit thrombin-induced human platelet activation even at low concentrations. In particular, among compounds in group A, compound 3 was found to be the most powerful thrombin receptor activation inhibitor, showing an IC50 of approximately 0.11 mM on platelet aggregation assay. Among compounds in group B, compound 4 was the most powerful to inhibit thrombin-induced platelet aggregation, showing an IC50 of approximately 0.09 mM. All compounds were also found to act as agonists in the rat aorta relaxation assay. Interestingly, the order of potency of these compounds as agonists of the endothelial thrombin receptor was the inverse of the order of potency of the same compounds as antagonists of the platelet thrombin receptor. Such compounds that are causing vasodilation while simultaneously inhibiting platelet aggregation would be very useful in preventing the installation of atherosclerotic lesions and deserve further investigation as potential drugs for treating cardiovascular diseases. The above findings coupled with computational analysis molecular dynamics experiments support also our hypothesis that a cluster of phenyl, guanidino, and amino groups is responsible for thrombin receptor triggering and activation.     

Executive dysfunction, heart disease burden, and remission of geriatric depression.

This study investigated the relationship of executive impairment and heart disease burden to remission of major depression among elderly patients. A total of 112 elderly subjects suffering from major depression received treatment with citalopram at a target daily dose of 40 mg for 8 weeks. Diagnosis was assigned using the Research Diagnostic Criteria and the DSM-IV Criteria after an interview with the Schedule for Affective Disorders and Schizophrenia. Executive dysfunction was assessed with the Initiation/Perseveration subscale of the Dementia Rating Scale (DRS) and the Color-Word Stroop test. Medical burden, including heart disease burden, was rated with the Cumulative Illness Rating Scale, and disability with Philadelphia Multilevel Instrument. Both abnormal initiation/perseveration and abnormal Stroop scores were associated with low remission rates of geriatric depression. Similarly, heart disease burden and baseline severity of depression also predicted low remission rates. The relationship of heart disease burden to remission was not mediated by executive dysfunction. Impairment in other DRS cognitive domains, disability, medical burden unrelated to heart disease did not significantly influence the outcome of depression in this sample. Executive dysfunction and heart disease burden constitute independent vulnerability factors that increase the risk for chronicity of geriatric depression. The findings of this study provide the rationale for investigation of the role of specific frontostriatal-limbic pathways in predisposing to geriatric depression or worsening its course.     

Long-term EEG monitoring in epilepsy diagnosis

EEG long-term monitorings were carried out in 149 patients using a portable 4-channel miniature recorder system. In most cases EEG was recorded for 48 hours. In addition to preceding routine EEG controls, long-term EEG monitoring disclosed epileptic phenomena in 32.7% of patients suspected for epileptic seizures from their history. This gain of information was based mainly on the detection of abnormal potentials or epileptic seizures appearing during sleep. Using EEG long-term recording numerous EEG routine controls could be replaced which otherwise are often necessary for ensuring the diagnosis of epilepsy. If the patient's history, however, gives only poor reason to believe epileptic seizures, positive findings in EEG long-term monitorings are unlikely. Consequently, careful evaluation of the patient's history is crucial for the indication of this laborious examination. As the limited number of recorder channels may cause false negative results, normal findings should be utilized with caution. Only the sum of all clinical and neurophysiological data should be used for exclusion of suspected epilepsy. The second, even more important application of EEG long-term recordings is the special examination of patients with known epilepsy, such as studies of the circadian profiles of epileptic excitability, documentation of seizure frequency, and electrographic analysis of the course of seizure. Therapy control of epileptic patients can be improved by such informations. In view of the large amount of data which results from long-term recordings, computer assisted methods supporting the visual analysis are necessary. In this regard the continuous spectral analysis of the EEG long-term recordings proved to be highly useful.