Reversal of primary and pseudo-primary T wave abnormalities by ventricular pacing. A novel manifestation of cardiac memory

Aims  

“Cardiac memory” refers to abnormal T waves (TW) appearing after transient periods of altered ventricular depolarization. The aim of the study was to test the hypothesis that in the presence of abnormal TW, short periods of tailored ventricular pacing (VP) can be followed by normalization of ventricular repolarization.     

Social and cultural factors in the successful control of tuberculosis.

The burden of tuberculosis on the public health is staggering. Worldwide, annual incidence of new cases is estimated to be about 8 million. Almost 3 million deaths occur yearly. Early case identification and adherence to treatment regimens are the remaining barriers to successful control. In many nations, however, fewer than half those with active disease receive a diagnosis, and fewer than half those beginning treatment complete it. The twin problems of delay in seeking treatment and abandonment of a prescribed regimen derive from complex factors. People's confusion as to the implications of the tuberculosis symptoms, costs of transportation to clinic services, the social stigma that attaches to tuberculosis, the high cost of medication, organizational problems in providing adequate followup services, and patients' perception of clinic facilities as inhospitable all contribute to the complexity. Sociocultural factors are emphasized in this report because hitherto they have not been adequately explored. Salient among those sociocultural factors is the health culture of the patients. That is, the understanding and information people have from family, friends, and neighbors as to the nature of a health problem, its cause, and its implications. A knowledge of the health culture of their patients has become a critical tool if tuberculosis control programs are to be successful. Several anthropological procedures are recommended to help uncover the health culture of people served by tuberculosis clinics.     

Dyskinesias associated with atomoxetine in combination with other psychoactive drugs

Toxicity experience with atomoxetine, a selective norepinephrine reuptake inhibitor approved for Attention Deficit Hyperactivity Disorder (ADHD), is limited. We report two cases of neurologic complications requiring hospitalization in patients when atomoxetine was added to other psychoactive drugs. A 9-year-old taking clonidine and dextroamphetamine developed psychosis, abnormal involuntary movements, and insomnia. An 18-year-old also initiating venlafaxine developed facial tics, tremors, and speech disturbance. Acute symptoms did not respond to diphenhydramine in either case, but resolved after atomoxetine and other medications were discontinued. Possible explanations include atypical atomoxetine effect, excess atomoxetine or metabolites due to poor metabolizer status (CYP 2D6 polymorphism/deficiency), a drug-drug interaction leading to elevated drug levels or to excess synaptic norepinephrine or dopamine. Serotonin syndrome is a possibility in the second case, but not the first. Clinicians should be aware of emergent dyskinesias when combining atomoxetine with dopaminergic, noradrenergic, or serotonergic medications.     

Meniscal tear repaired with Fast-Fix sutures: clinical results in stable versus ACL-deficient knees

Aim  

The aim of this prospective study was to analyze the results of meniscal tears repaired with Fast-Fix All-inside suture in stable versus anterior cruciate ligament (ACL)-deficient knees.     

Sex dependent effect of chronic ethanol consumption in rats on hepatic microsome mediated mutagenicity of benzo[a]pyrene

The effect of chronic ethanol consumption by rats on hepatic microsomal metabolism of the procarcinogen benzo[a]pyrene (B[a]P) was investigated both with respect to induction of microsomal arylhydrocarbon hydroxylase (AHH) activity and activation of B[a]P to a mutagen. In female rats, chronic ethanol ingestion produced a 42% increase in AHH activity (P < 0.01), as measured in isolated microsomes, and also resulted in a significantly enhanced capacity (P < 0.01) of these microsomes to activate B[a]P to a mutagen detectable in the Ames bacterial mutagenesis assay. Hepatic microsomes from male rats on the other hand did not exhibit any significant differences, either in AHH activity or in their capacity to activate B[a]P to a mutagen after chronic ethanol feeding.     

Variation in the choice of treatment in two Mexican communities

This paper examines the relationship between lay illness beliefs, accessibility of Western health-care sources, and rates of physician utilization in two neighboring rural communities in Mexico. One of these communities—Pichátaro—has restricted access to sources of a physician's treatment, while the other—Uricho—has, comparatively, good access to physician's services, including some available at no cost. Data from illness case histories collected from samples of households in each town show the Uricho people to consult a physician in nearly twice as many cases. Systematically-elicited data on the illness beliefs of informants from each town are compared in order to evaluate two competing views of the relationship between adherence to traditional ethnomedical beliefs and the choice of a physician's treatment. One of these—the ‘conceptual-incompatibility’ hypothesis—emphasizes the importance of congruence between clients' conceptions of illness and scientific medical theory as a criterion for the choice of a physician's treatment. Accordingly, it would predict that, in comparison with the Pichátaro sample, the higher rate of use of a physician's treatment by the Uricho people should be accompanied by a greater orientation toward Western medicine in their beliefs. The second position—that emphasizing accessibility of services—would argue that traditional illness beliefs do not represent a primary barrier to the choice of a physician's treatment, and therefore differences in the beliefs of the two groups need not be anticipated and do not constitute a necessary prerequisite for the more frequent choice of a physician's treatment among the Uricho people. The findings from the illness belief interviews offer little support for the conceptual-incompatibility position. No basis is found upon which to claim significant differences between the responses of the two groups. This leads to the conclusion that the substantial variation in the use of a physician's treatment between the two samples, a consequence of differential access to such treatment, occurs without corresponding degrees of variation in residents' illness beliefs. Some reasons for this lack of divergence are discussed, and limits on the applicability of the study's findings are outlined.     

In vitro and in vivo inhibitory effect of ethanol and acetaldehyde on O6-methylguanine transferase

Human and rat O⁶-methylguanine transferase (O⁶MeGT) are inhibitedin vitro by ethanol at concentrations of 10 to 50 mM and byacetaldehyde, the first metabolite of ethanol, at concentrationsas low as 0.01 µM. Several other enzymes, including glyceraldehyde-3-phosphatedehydrogenase and yeast alcohol dehydrogenase, which like O⁶MeGThave cysteines in their active sites, were not inhibited byacetaldehyde at the levels that inhibited O⁶MeGT. Disulfiram,an acetaldehyde dehydrogenase inhibitor, enhanced the inhibitoryeffect of ethanol in vivo. These results indicate that the inhibitoryeffect of ethanol on O⁶MeGT activity is mediated primarily viaits metabolite, acetaldehyde.     

Mutagenic activity in gastric juice and urine of subjects with chronic atrophic gastritis, gastric epithelial dysplasia and gastric cancer

Gastric juice and urine samples from consecutive patients who underwent endoscopy for upper GI tract complaints were examined for the presence of mutagens. Patients endoscopically and histologically diagnosed as having either chronic atrophic gastritis (CAG) or gastric cancer (GC) had higher than normal levels of mutagens in their gastric juice and urine. The gastric juice pH of these patients was also elevated and, in the case of the CAG patients, contained detectable levels of nitrites. No correlation was however found between gastric mutagen levels and urinary mutagen excretion in the individuals examined.     

Diagnostic markers of ovarian cancer by high-throughput antigen cloning and detection on arrays

A noninvasive screening test would significantly facilitate early detection of epithelial ovarian cancer. This study used a combination of high-throughput selection and array-based serologic detection of many antigens indicative of the presence of cancer, thereby using the immune system as a biosensor. This high-throughput selection involved biopanning of an ovarian cancer phage display library using serum immunoglobulins from an ovarian cancer patient as bait. Protein macroarrays containing 480 of these selected antigen clones revealed 65 clones that interacted with immunoglobulins in sera from 32 ovarian cancer patients but not with sera from 25 healthy women or 14 patients having other benign or malignant gynecologic diseases. Sequence analysis data of these 65 clones revealed 62 different antigens. Among the markers, we identified some known antigens, including RCAS1, signal recognition protein-19, AHNAK-related sequence, nuclear autoantogenic sperm protein, Nijmegen breakage syndrome 1 (Nibrin), ribosomal protein L4, Homo sapiens KIAA0419 gene product, eukaryotic initiation factor 5A, and casein kinase II, as well as many previously uncharacterized antigenic gene products. Using these 65 antigens on protein microarrays, we trained neural networks on two-color fluorescent detection of serum IgG binding and found an average sensitivity and specificity of 55% and 98%, respectively. In addition, the top 6 of the most specific clones resulted in an average sensitivity and specificity of 32% and 94%, respectively. This global approach to antigenic profiling, epitomics, has applications to cancer and autoimmune diseases for diagnostic and therapeutic studies. Further work with larger panels of antigens should provide a comprehensive set of markers with sufficient sensitivity and specificity suitable for clinical testing in high-risk populations.