When to act--the appropriateness of cardiovascular disease intervention

Nearly 13 million people die each year from cardiovascular diseasesand half of these deaths occur in developing countries. Thisarticle reviews the appropriateness of cardiovascular diseaseintervention and focuses on decision-making and the perpetualquestion: When is it more appropriate to act on available evidencerather than to await further evidence? A fundamental and justifiedprinciple in science is trying to falsify all formulated hypotheses.This sceptical or conservative approach can, however, hampersocial development. It is therefore important for the scientistto distinguish between his role as a scientist and as a memberof society. Medical, epidemiological and economic aspects areconsidered together with an assessment of the feasibility ofdifferent intervention strategies. This review, like many others,indicates that population-based interventions combined withan improved high-risk strategy are appropriate from society'spoint of view in spite of the fact that there are several unsettledquestions which call for further research.     

Behaviors and attitudes associated with eating disorders: perceptions of college athletes about food and weight

This study surveyed male and female athletes from 22 midwesterncolleges and universities regarding behaviors and attitudesassociated with anorexia nervosa and bulimia nervosa. The responserate was 66% (N= 695) and the findings indicated that the bodyimage of some athletes may be distorted; one-seventh perceivedthemselves as fat even though they were not. Many athletes seemedpreoccupied with food and weight; almost one-third reportedroutinely thinking about food and weight and more than one-thirdreported dramatic annual weight fluctuations (9 lb or greater)related to bingeing and fasting. Athletes also did not feelin control when they ate and their habits related to food consumptionappeared to be extreme; one-tenth reported a lack of controlwhen they ate, more than one-third binged, one-twentieth ateuntil they were physically ill, and a similar proportion preferrednot to eat in the presence of others. In addition, it was foundthat as many men as women athletes reported these perceptionsbut significant sex differences were noted for specific items.It was suggested that behaviors and attitudes be viewed on acontinuum with normals at one end, eating disordered individuals at the other end,and college athletes in between. Health education that focuseson behaviors and attitudes as symptoms of eating disorders wasrecommended for athletes and those working closely with athletes.Future research was suggested to determine reasons for the undesirablebehaviors and attitudes and to study the onset, development,long-term effects and whether these behaviors and attitudeslead to an eating disorder.     

Growth and development in rats and deficiency of magnesium and pyridoxine

Eight-eight female weanling Sprague-Dawley rats were fed diets containing either 650 or 150 mg magnesium/kg diet and 7.0 or 3.5 mg pyridoxine-HCl/kg diet, in a 2 x 2 factorial arrangement, during growth, gestation, and lactation. The objective of the study was to determine whether concurrent dietary deficiencies of magnesium and pyridoxine were synergistic, additive, or antagonistic with regards to effects on reproductive performance, growth, and development of offspring, and tissue content of magnesium and calcium. Body weight of dams and pups was not different between groups until day 9 of lactation, at which point those animals in either low magnesium group weighed less than the other. Litter size and birth weight were not different. Development, as measured by timing of unfolding of the external ear, opening of both eyes, and clinical emergence of incisors, was delayed in pups from litters in the low magnesium groups. A synergistic effect on delay of onset of ear unfolding by deficiency of both magnesium and pyridoxine was observed. Calcium content of heart and kidney from dams was increased in the low magnesium groups. Renal calcium was not further increased by the level of pyridoxine deficiency in this study. The calcium to magnesium ratio in heart from pups was higher in those from litters in the low magnesium and pyridoxine group than in the others. Results indicate that simultaneous deficiencies of magnesium and pyridoxine may impair function synergistically. Because these two nutrients are often reported to be presented in inadequate amounts in diets of women in their reproductive years, the potential exists for impaired reproductive success.     

Removal of surface bacteria by irrigation

We examined the efficacy of various irrigation solutions delivered through a power irrigator to remove bacteria from three different surfaces. Titanium, stainless-steel, and cortical bone surfaces were coated with three different bacterial species: Staphylococcus aureus, Pseudomonas aeruginosa, and Staphylococcus epidermidis. They were then irrigated with 1 L of fluid delivered by jet lavage. The fluids tested were normal saline and solutions of bacitracin, neomycin, and soap. One set of specimens was not irrigated, as a control. After irrigation, the specimens were sonicated to remove residual bacteria, and the sonicate was quantitatively cultured to allow evaluation of the amount of residual bacteria on the surface. The results showed that removal of bacteria reflects an interaction between bacterial species, surface characteristics, and irrigation solution. Fewer bacteria were present in all the irrigation groups than in the control. Soap solution was as good as or better than any other solution at removing all three types of bacteria from all three surfaces, although not all of the pairwise comparisons were statistically significant. There was a significant advantage to soap solution over antibiotic irrigant or saline alone in removing Staphylococcus epidermidis from metallic surfaces. The use of a soap solution for irrigation seems to improve the removal of some bacteria from some surfaces in this experimental model and may represent a better type of irrigation additive.     

Extracranial-intracranial bypass surgery for the management of vasospasm after subarachnoid hemorrhage

A case is presented which demonstrates the potential utility of the extracranial-intracranial bypass procedure for the treatment of vasospasm after subarachnoid hemorrhage. Extracranial-intracranial bypass surgery offers another alternative to the treatment of patients with vasospasm who have failed aggressive medical management.     

Disc haemorrhages and glaucoma in a general ophthalmic practice

The composition of the clientele from an ophthalmological practitioner's office is described with special reference to the occurrence of glaucoma and disc haemorrhages (h in singular; hh in plural). This study could not be planned as an epidemiological survey and gives no clue to sensitivity or specificity of hh in glaucoma. During a period of about 10 years ending with 1986 there were 731 patients with h and/or glaucoma. When detected, 185 patients had h but no glaucoma, 33 had both h and glaucoma and 513 had glaucoma but no h. During the follow-up period hh were detected in 83 cases of glaucoma, and glaucoma developed in 27 cases with hh. The detection rate of hh among glaucoma was low but steady, indicating that hh may occur at any stage of the glaucoma process. This study shows no predilection for hh in cases with general hypertension or diabetes, nor is the frequency of hh among pseudoexfoliation cases significantly lower than among cases without this stigma.     

Ocular side effects of isotretinoin therapy

Isotretinoin (Accutane Capsules) is a synthetic vitamin A compound used for treatment of recalcitrant cystic acne. It has numerous ocular toxic side effects which include anterior segment inflammation, dry eye syndrome, contact lens intolerance, altered refraction, photosensitivity, and reduced night vision. Eye care practitioners should be aware of these potential side effects and be prepared to communicate with the prescribing physician if side effects present.