Iron, folate, and vitamin B12 status in the elderly by gender and ethnicity

ObjectiveNational Health and Nutrition Examination Survey 2001-2002 data were used to examine gender and ethnicity relationships to iron, folate, and vitamin B₁₂ status, and anemia in 1770 elderly persons.MethodsDependent variables included dietary intakes and biochemical measures of iron, folate, and vitamin B₁₂ status, and hemoglobin. t Tests were performed using SUDAAN software (version 9.0; Research Triangle Institute International, Research Triangle Park, North Carolina). The relationships of gender and ethnicity to adequacy of iron, folate, and vitamin B₁₂status, and anemia were investigated using x² tests.ResultsMales had significantly higher nutrient intakes and better biochemical measures of iron status but lower biochemical measures of folate and vitamin B₁₂. Whites were significantly more likely to have nutrient intakes higher than those recommended by the Food and Nutrition Board. No clear pattern of biochemical measures of iron status was seen among the ethnic groups, and there was no significant relationship between iron status and ethnicity. Biochemical measures of folate status were significantly higher in whites and Mexican Americans than in blacks. No significant relationships were found between folate status and ethnicity. Mean serum vitamin B₁₂ was significantly higher in blacks than in whites and was lowest in other Hispanics who were significantly more likely to be vitamin B₁₂ deficient. Blacks had significantly lower mean hemoglobin values than whites and were significantly more likely to be anemic.ConclusionsBased on biochemical measures, elderly males are at higher risk of folate and vitamin B₁₂ deficiencies. Ethnicity was not significantly related to either iron or folate status. Other Hispanics were significantly more likely to be vitamin B₁₂ deficient.     

Molecular investigations to improve diagnostic accuracy in patients with ARC syndrome

Arthrogryposis, Renal dysfunction and Cholestasis (ARC) syndrome is a multi-system autosomal recessive disorder caused by germline mutations in VPS33B. The detection of germline VPS33B mutations removes the need for diagnostic organ biopsies (these carry a>50% risk of life-threatening haemorrhage due to platelet dysfunction); however, VPS33B mutations are not detectable in approximately 25% of patients. In order further to define the molecular basis of ARC we performed mutation analysis and mRNA and protein studies in patients with a clinical diagnosis of ARC. Here we report novel mutations in VPS33B in patients from Eastern Europe and South East Asia. One of the mutations was present in 7 unrelated Korean patients. Reduced expression of VPS33B and cellular phenotype was detected in fibroblasts from patients clinically diagnosed with ARC with and without known VPS33B mutations. One mutation-negative patient was found to have normal mRNA and protein levels. This patient's clinical condition improved and he is alive at the age of 2.5 years. Thus we show that all patients with a classical clinical course of ARC had decreased expression of VPS33B whereas normal VPS33B expression was associated with good prognosis despite initial diagnosis of ARC.     

Genome analysis shows a common evolutionary origin for the dominant strains of Mycobacterium tuberculosis in a UK South Asian community

We have investigated the Mycobacterium tuberculosis strain types present in the South Asian population of the UK, in which tuberculosis is particularly prevalent. In contrast to the widespread Beijing strains which have the variable number tandem repeats (VNTR) profile 42435, isolates with the VNTR profile 42235, jointly with 02335 or 42234 profiles, appear more frequently in tuberculosis patients of South Asian ethnic origin (SA-strains) in the UK than in any other ethnic group. Using microarray-based comparative genomics to distinguish total or partially deleted genes, we found that three of the common deleted regions in the SA-strains were identical to some deleted genes in the strain CH, which caused an outbreak among South Asian patients in Leicester in 2001 but were different from genomic deletions found in Beijing/W strains. Analysis of some of the deleted regions revealed differences in comparison to the strain CH including the polymorphism in some of the PE/PPE and Esat-6 genes, which may be responsible for the diversity of antigenic variation or differences in the activation of the host immune response. Interrupted genes or the replacement by insertion elements was confirmed in some of the deleted genomic regions. Our results are consistent with the hypothesis that the SA-strains may present common features, implying a common origin for this group of strains.     

Physico-chemical characterisation of PLGA nanoparticles after freeze-drying and storage

Nanoparticles represent promising carriers for controlled drug delivery. Particle size and size distribution of the particles are important parameters for the in vivo behaviour after intravenous injection and have to be characterised precisely. In the present study, the influence of lyophilisation on the storage stability of poly(d,l lactic-co-glycolic acid) (PLGA) nanoparticles, formulated with several cryoprotective agents, was evaluated. Nanoparticles were prepared by a high pressure solvent evaporation method and freeze-dried in the presence of 1%, 2%, and 3% (m/v) sucrose, trehalose, and mannitol, respectively. Additionally, to all samples containing 3% of the excipients, l-arginine hydrochloride was added in concentrations of 2.1% or 8.4% (m/V). Dynamic light scattering (DLS), analytical ultracentrifugation and transmission electron microscopy (TEM) were used for particle characterisation before and after freeze-drying and subsequent reconstitution. In addition, glass transition temperatures were determined by differential scanning calorimetry (DSC), and the residual moisture of the lyophilisates was analysed by Karl Fischer titration. It was demonstrated that 1% sucrose or 2% trehalose were suitable to maintain particle integrity after reconstitution of lyophilised PLGA nanoparticles. The storage stability study over 3 months showed notable changes in mean particle size, size distribution, and residual moisture content, depending on the composition of the formulation.     

Reliability and validity of the Chinese version of the Fatigue Scale-Adolescent

Fatigue, rated by adolescents as the most distressing symptom experienced during cancer treatment, is essential to the successful clinical care of patients of every culture and nationality. Efforts to provide relief from such symptom, in any area of the world, have been hampered by the lack of reliable and valid instruments used to measure fatigue. Our aims were to examine the semantic, conceptual, and normative equivalence of the Chinese version of the Fatigue Scale-Adolescent (FS-A-C) to the original Fatigue Scale-Adolescent (FS-A) and to estimate the reliability and validity of the FS-A-C. We recruited 51 Taiwanese adolescents in various stages of different types of cancer in this cross-sectional study. Results indicated that the initial panel estimates of semantic, conceptual, and normative equivalence of the FS-A-C with the original instrument (FS-A) were positive. The FS-A-C had acceptable internal consistency (Cronbach alpha =.89) and moderate-to-high content validity (content validity index ranges from 87% to 100%). In addition, the FS-A-C achieved known-groups validity (anemic adolescents reporting higher fatigue than nonanemic adolescents do) and initial construct validity (a significant association between the FS-A-C and the Anxious/Depressed subscale). Its use in measuring the intensity of fatigue in adolescents is likely to yield accurate assessments of their fatigue that could prompt clinical efforts to relieve their fatigue-related distress.     

Dexamethasone alters sleep and fatigue in pediatric patients with acute lymphoblastic leukemia

BACKGROUND: Dexamethasone improves the cure rate of childhood acute lymphoblastic leukemia (ALL) but causes physical and behavioral adverse events. The objective of the current study was to determine the effect of dexamethasone exposure on sleep and fatigue in pediatric patients with ALL. METHODS: One hundred pediatric patients with low-risk or standard-risk ALL were enrolled on 1 of 3 protocols (St. Jude Total XV, Children's Oncology Group [COG] 9904, or COG 9905) at 3 institutions. The mean age of the cohort was 9.24 +/- 3.23 years (range, 5.03-18.14 years). The majority of patients were white (79%) males (62%) with standard-risk ALL (63%). The cohort was divided into 4 subgroups: St. Jude low-risk, St. Jude standard-risk, COG low-risk, and COG standard-risk. Patients wore a wrist actigraph to monitor sleep activity during 2 consecutive 5-day periods: During the first period, they did not receive dexamethasone; and, during the second period, they did. Patients and their parents completed fatigue instruments on Days 2 and 5 of each period, and parents completed sleep diaries. RESULTS: Actual sleep minutes, sleep duration, total daily nap minutes, and fatigue increased significantly during the dexamethasone treatment for 3 to 4 of the subgroups. Total daily nap minutes increased significantly for both standard-risk groups during the dexamethasone treatment. Parents reported significant increases in their child's nighttime awakenings, restless sleep, and nap time during dexamethasone treatment. CONCLUSIONS: Dexamethasone treatment during continuation therapy for childhood ALL significantly and adversely altered sleep and fatigue, confirming that sleep and fatigue are behavioral responses to dexamethasone.     

Intensive therapy for life-threatening medical complications of haematological malignancy

The medical records of 22 consecutive adult admissions to an intensive care unit (ICU) with life-threatening complications of haematological malignancy, or its treatment, are reviewed. Twenty patients (91%) were in acute respiratory failure, and 17 of the 22 patients required intermittent positive pressure ventilation (IPPV). The in-unit mortality was 55%, but only 4 patients (18%) survived to leave the hospital. Although the unit mortality appeared to be related to the acute physiology score (APS), this small series did not demonstrate a clear relationship between the APS and long-term survival (discharge from hospital). There were, however, significant differences in the number of organ systems involved between those who died on the ICU and those who returned to the ward, as well as between those who survived to leave hospital and those who died. No patient with more than three systems involved became a long-term survivor. All long-term survivors had either reasonable peripheral white cell counts throughout or their bone marrow showed significant recovery prior to discharge from the ICU. Unresponsive malignant disease and a failure to recover bone marrow function were major factors in those patients who died shortly after discharge from the ICU. Although long-term survival rates are low and are probably largely determined by the progress of the underlying malignancy, intensive care was life-saving in four patients, three of whom are alive several years after discharge.