Simultaneous Detection of BCL-2 Protein, Trisomy 12, Retinoblastoma and P53 Monoallelic Gene Deletions in B-Cell Chronic Lymphocytic Leukemia by Fluorescence in Situ Hybridization (FISH): Relation to Disease Status

Various genetic abnormalities are often found in B-CLL, but their relative importance in the pathogenesis and evolution of the disease has not been adequately clarified. We studied the expression of bcl-2 protein and the possible simultaneous occurrence of bcl-2 overexpression, trisomy 12 and the Rbl and p53 gene deletions in 38 patients with B-CLL by combining immunophenotyping and dual color interphase FISH. We also looked for correlation between the genetic abnormalities and clinical parameters such as stage, disease duration from diagnosis to the time of study and overall survival. High expression of the bcl-2 protein was found in 76.3% of the patients (29/38). Trisomy 12 was found in 37% of cases (14/38) and Rbl monoallelic gene deletion in 42% (16/38). The percentage of cells with hemizygous Rbl deletion ranged from 13 to 18%. Monoallelic deletion of p53 was found in 29% of cases (11/38). The number of cells with only one signal ranged from 28 to 98%. Patients in stage A had on average, less than one abnormality, while patients in stage C had 2.6 abnormalities. Patients appeared to accumulate genetic abnormalities with time. Bcl-2 overexpression was found early in the course of the disease. Trisomy 12 appeared later, at about the same time as Rbl deletion, but was not associated with adverse prognosis. Monoallelic deletion of p53 gene appeared rather late in the course of the disease and was associated with advanced stage. Despite the fact that more deaths occurred in the group of patients with three or four abnormalities and the presence of p53 gene deletion, differences in survival were not statistically significant, probably due to the limited number of patients in each group. A larger group of patients studied in a prospective manner will better clarify these issues in the future.     

Systematic review of the relationship between early introduction of solid foods to infants and the development of allergic disease

OBJECTIVE: To assess the evidence that early solid feeding (before age 4 months) increases the risk of allergic disease. DATA SOURCES: MEDLINE, the Cochrane Library, and the Drugs and Pharmacology section of EMBASE with key words "infant," "food," and "allergy." STUDY SELECTION: We found 2719 article citations and reviewed references of relevant articles. We critically evaluated the methods and results of articles that met inclusion criteria. We identified 13 studies that met inclusion criteria. There was only 1 controlled trial. DATA EXTRACTION: Allergic disease. DATA SYNTHESIS: Five studies found a positive association between early solid feeding and eczema, with a persistence of the association for 10 years in 1 study. Four studies found no association. One study found an association between early solid feeding and pollen allergy. We found no strong evidence to support the association between early solid feeding and the development of persistent asthma, persistent food allergy, allergic rhinitis, or animal dander allergy. CONCLUSIONS: Systematic review of available evidence suggests that early solid feeding may increase the risk of eczema. However, there are little data supporting an association between early solid feeding and other allergic conditions. Since many studies had problematic methods, additional controlled trials are needed to help guide physicians as they advise parents about the allergic risks of early introduction of solids.     

Primary language of parent is associated with disparities in pediatric preventive care

OBJECTIVES: To determine whether infants of parents whose primary language is not English are less likely to receive recommended preventive care than infants of parents whose primary language is English. STUDY DESIGN: We conducted a retrospective cohort study of all 38,793 1-year-old Medicaid-enrolled infants born in Washington state between January 1, 1999 and September 30, 2000. The main exposure was self-reported primary language of parents. Using multivariate regression, we estimated the relative risk of receiving appropriate and timely receipt of preventive care visits in the first year as recommended by the American Academy of Pediatrics and Washington state Medicaid. RESULTS: Fewer than 1 in 6 (15.4%) infants received all 6 recommended preventive care visits in their first year of life. Infants of parents whose primary language was not English were half as likely to receive all recommended preventive care visits compared with infants of parents whose primary language was English (adjusted relative risk = 0.53; 95% confidence interval = 0.49 to 0.58). This disparity was seen in white, Hispanic, and African-American infants, but not in Asian-American infants. CONCLUSIONS: Disparities based on primary language exist in receipt of recommended pediatric preventive care in white, Hispanic, and African-American infants enrolled in Medicaid.     

Prospective effect of community distress and subcultural orientation on mortality following life-threatening diseases in later life

We conducted a prospective and contextual study to examine the effects of community social-economic-physical distress and subcultural orientation on mortality following onset of 13 life-threatening diseases in later life. We also examined the inter-relationship between the effects of community social, economic and physical distress (i.e. poverty, physical disorder and low collective efficacy) and subcultural orientation (i.e. anomie and tolerance of risk behaviour) on the survival chances of seriously ill older patients. Three data sources were combined to construct the working sample: 1990 Census data, the 1994-95 PHDCN-CS, and the COSI data. Fifty-one ZIP code areas in Chicago and 12,672 elderly patients were studied. Community distress (HR = 1.04; 95% CI = (1.01, 1.07)) and anomie (HR = 1.26; 95% CI = (1.02, 1.54)) are found to be significantly and positively associated with a higher hazard of death. Moreover, community anomie contributes to the effect of community distress on post-hospitalisation mortality. The social, economic, physical and cultural environment in which people live appears to exert a significant impact on whether older people facing life-threatening illness live or die.