Prognosis of ocular myasthenia

A retrospective study of 108 patients with myasthenia gravis who had solely ocular symptoms and signs at onset was carried out to identify factors influencing prognosis. Increasing duration of pure ocular myasthenia was associated with a decreasing risk of late generalized symptoms; only 9 (15%) of the observed generalizations occurred after more than 2 years of solely ocular symptoms. Increasing age at onset was associated with greater risk of respiratory crisis or death caused by myasthenia, whereas patients younger at onset had a greater chance of a benign outcome. Neither systemic curare tests nor responses to repetitive nerve stimulation had prognostic value.     

Sufentanil, a very potent and extremely safe intravenous morphine-like compound in mice, rats and dogs.

Sufentanil (R 30 730), N-[4-methoxymethyl)-1-[2-(2-thienyl)ethyl]-4-piperidinyl]-N-phenylpropanamide, is a chemically novel, highly potent and extremely safe intravenous morphine-like agent in laboratory animals. In mice R 30 730 i.v. is 2304 times more potent than morphine (hot plate ED50's: 0.0028 and 6.45 mg/kg, respectively). The i.v. safety margin of R 30 730 in mice is 1 : 6 679 (LD50 = 18.7 mg/kg). Under the same experimental conditions the safety margin of pethidine is 1 : 7.97, of morphine 1 : 34.9 and of fentanyl 1 : 454. In rats R 30 730 i.v. is 4521 times more potent than morphine (tail withdrawal test ED50's: 0.00071 and 3.21 mg/kg, respectively). The i.v. safety margin of R 30 730 in rats is 1 : 25 211 (LD50 : 17.9 mg/kg). Under the latter experimental conditions the safety margin of pethidine is 1 : 4.80, of morphine 1 : 69.5 and of fentanyl 1 : 277. In dogs R 30 730 i.v. is 2429 times more potent than morphine (apomorphine antagonism test ED50's: 0.00028 and 0.68 mg/kg, respectively). The i.v. safety margin in dogs is approximately 1 : 50 000, the LD50 being +/- 14.0 mg/kg. All morphine-like effects of R 30 730 are immediately antagonized by nalorphine. These pharmacological findings are relevant in connection to the increasing interest for use of morphinomimetics in anesthesia.     

CEPHALIC VASOMOTOR AND HEART RATE MEASURES OE ORIENTING AND DEEENSIVE REELEXES

The problem of differentiating orienting (OR) and defensive reflexes (DR) was investigated by measurements of forehead-skin pulse amplitude (PA), forehead-skin blood content (BC), and heart rate (HR). Thirty male college students received 30 stimulations of .5 sec white noise at either 80 db or 120 db. Beat-by-beat analyses of the physiological measures indicated that both intensities of stimulation produced decreases in PA. Forehead BC showed larger increases to 120 db than to 80 db, and successive stimulations produced a change to overall decreases in BC at both intensities. HR acceleration occurred to both stimuli, and a short-latency deceleration occurred to 80 db. The results were interpreted as showing that cephalic vasoconstriction is the dominant response to auditory stimulation, and cephalic vasomotor responses do not differentiate between ORs and DRs. The short-latency HR deceleration and smaller HR acceleration differentiated the OR from the DR.     

Analytic processing elicits right ear superiority in monaurally presented speech

The latency to respond with the right hand to the initial phone of a monaurally presented CVC syllable is shorter when the stimulus is heard in the right ear than when it is heard in the left ear. This shows that superiority of the left hemisphere can be elicited in simple speech tasks with monaural stimulation. However, the latency to recognize the entire syllable is equally short regardless of ear and responding hand. This is consistent with the view that the left hemisphere is dominant only for tasks that require analysis of the internal structure of a stimulus.     

Troponin I in the diagnosis of acute myocardial infarction in pregnancy,labor, and post partum

Cardiac troponin I has become the marker of choice for the diagnosis of acute myocardial infarction. There are specific characteristics of this test that makes it desirable for the diagnosis of acute myocardial infarction in pregnancy, labor, and post partum.     

Effect of salbutamol on lung function parameters of healthy children

In the present study, the effect of 200 microg salbutamol compared to placebo was evaluated on lung function parameters of 37 healthy children aged 7-14 years. Salbutamol or placebo were administered, using a single blind study design, and spirometry was performed before and after 10 min of inhalation. At the time of the study, all children were symptom-free and had not suffered from any respiratory infection during the previous 4 weeks. The administration of salbutamol resulted in a significant increase of mean forced expiratory volume in 1 s (111%-115%, P<0.05), maximal expiratory flow at 50% of forced vital capacity (101%-110%, P<0.05) and maximal expiratory flow at 25 % of forced vital capacity (96%-115%, P<0.05). The administration of placebo resulted in no significant change in lung function parameters. CONCLUSION: The administration of 200 microg salbutamol results in the occurrence of a small but significant bronchodilation in healthy, non-asthmatic children.     

Aerosolized budesonide in asthmatic infants: a double blind study

The efficacy of nebulized budesonide (0.5 mg b.i.d.) against placebo was evaluated in the management of asthma in 23 infants, aged 3 to 17 months, using a double blind crossover design. After an initial treatment period of 2 weeks placebo and budesonide were randomly administered during two consecutive treatment periods of 1 month. The progress of the patients was monitored using diary score cards, the number of salbutamol doses needed during the treatment periods, clinical examinations using standardized scoring cards, and registration of parents' preference period. Although there was a tendency toward fewer wheezing periods during budesonide, the results of the diary score cards were not significantly different between the budesonide period and the placebo period. The number of salbutamol doses used was also the same during both periods. Clinical examination after budesonide revealed less rhinitis and a less pathological lung auscultation, but the difference between the two periods was also not significant. Furthermore, the parents' preference could not distinguish between budesonide and placebo. We conclude that the trends in favor of nebulized budesonide are not significant and do not suggest that the suspension is effective in severe infantile asthma.     

The methodology of the GUSTO cohort study: a novel approach in studying pediatric allergy

Growing Up in Singapore Towards healthy Outcomes (GUSTO) is Singapore's largest birth cohort study to date. The main aim of GUSTO is to evaluate the role of developmental factors in the early pathways to metabolic compromise. Detailed data is collected for a range of environmental exposures in the parents and offspring, and allergic disorders are among a number of outcomes assessed in infancy and childhood. Under the Allergy domain of GUSTO, this integrated study will describe the epidemiology of allergic manifestations and different phenotypes in the Asian context and help shed light on the association of metabolic disease to allergy. Epigenetic mechanisms and associations with other childhood disorders will also be explored. The aim of this report is to focus on methodology of GUSTO, and to suggest similar approaches (i.e., integrated cohort studies on pediatric allergy) worldwide. Recruitment commenced in 2009 with a cohort of 1,163 pregnant mothers in their first trimester. The mothers and children were followed throughout pregnancy and follow-up will continue until the child reaches 3 years of age. Preliminary results showed that 39.8% of the mothers had a personal history of having at least one allergic disease, which included asthma, eczema and allergic rhinitis. Further data collection and analyses are still ongoing. Allergy is a complex spectrum of disorders with numerous poorly-understood aspects. The ongoing GUSTO cohort study, with its longitudinal design and multi-disciplinary nature, may provide new insights into developmental influences on allergy. As a Singapore-based study, it will be the first integrated allergy cohort in Southeast Asia, of which recruitment started during pregnancy.