Problems in the Measurement of Putative Serum Immune Complexes by the Method of Beaumont

ABSTRACT: A methodological investigation of the procedure used by Beaumont et al for measuring a “serum immune complex” precipitated by 25% ammonium sulfate and alleged to contain an ethynyl-estradiol binding immunoglobulin has found major problems with reproducibility and with the correlation of total protein as measured by the Lowry method and the IgG content as determined by a specific nephelometric procedure.     

A computer-based test item-bank for cognitive assessment of medical students during a clinical medicine clerkship

The development and utilization of multiple-choice test items and the utilization of computer technology have significantly altered evaluation practices in medical schools. This paper describes the development and implementation of a computer-based multiple-choice test item-bank for use in a junior medicine clerkship. The computer program, ITEMBANK, is an interactive system that stores and edits test items and constructs and prints an original copy of each test. Tests can be produced almost immediately by the clerical staff and the total developmental costs have been minimal. The program has reduced the amount of teaching time required to develop tests, and has enhanced the learning of essential information by medical students and residents. Teaching staff and student response has been enthusiastic and positive. Statistically significant Pearson correlation coefficients have been obtained between student performance on these tests and clinical evaluation and NBME Part II scores. The program has made a valuable contribution to the improvement of evaluation procedures in the Internal Medicine clerkship.     

THE GENETICS OF ALCOHOLISM: IS THERE AN INHERITED SUSCEPTIBILITY TO ALCOHOL-RELATED PROBLEMS?

Alcoholism and alcohol-related disorders have a pronounced familialtendency. There has been considerable debate over many yearsas to whether this represents transmission of genetic traitsor the influence of family environment on drinking behaviour.Studies of adopted children and of monozygotic compared withdizygotic twins show a modest but definite genetic influenceon drinking habits and, at least in men, on the occurrence ofpsychosocial problems related to alcohol abuse. There is evidencefor two types of alcoholism, one that is highly heritable andanother that shows a lesser degree of inheritance and requiresenvironmental stressors for it to be manifest. The mechanismsby which such genetic influences are expressed are unknown althoughthe metabolism of alcohol and many of its physiological effectsare partly genetically determined. No biological markers havebeen associated convincingly with a predisposition to alcoholismbut absence of an isoenzyme of aldehyde dehydrogenase, whichoccurs in 50% of Oriental populations, has been related to thealcohol-flush reaction which may have an aversive effect onalcohol consumption. This may explain the low incidence of alcoholproblems in Oriental countries. Genetic factors have long been thought to be responsible forthe variation in susceptibility to the physical sequelae ofchronic alcohol consumption such as cirrhosis and cardiomyopathy.Women develop many complications of alcoholism, especially liverdisease, after a shorter period of drinking and at a lower dailyalcohol intake than men, and this is partly related to differencesinbody size and composition and in hormonal status. Several hiitocompatibility(HLA) antigens have been linked to susceptibility to cirrhosis.The association for most is relatively weak but HLA-B8 and DR3are associated with accelerated development of cirrhosis, possiblyby stimulating cytotoxic immune reactions to alcohol-damagedliver cells. Little is known about what genetic factors mightpredispose to other alcohol-related diseases. Further work into the mechanisms by which genetic factors influencethe development of alcoholism and susceptibility to its complicationsmay help identify agents that interfere with these processes.Total abstinence from alcohol may be advisable for family membersof subjects with the highly heritable form of alcoholism. Untilmore is known about individual safe limits for drinking everyoneshould be advised to keep below 80g alcohol/day (for men) or40g/day (for women).     

Pilo-sebaceous duct physiology

We have used surface microscopy to measure the pil-sebaceous duct orifices at different sites in 150 subjects. Our data have shown that there are more pilo-sebaceous units on the face compared to the back and that these exists are smaller on the face. Despite the small exit the sebum excretion rate per gland on the forehead was not significantly different from that on the back. Thus the number of pilo-sebaceous duct units and the pilo-sebaceous canal exit size are possible factors in the localization of acne.     

What nephrologists need to know about diagnostic test accuracy articles

Systematic reviews of randomized controlled trials are well‐recognized as the best evidence for an intervention and are also becoming more available for diagnostic test evaluation. In the absence of a well‐conducted and well‐reported systematic review clinicians must rely on primary studies to determine how best to interpret and understand diagnostic test information. Diagnostic test studies are abundant in the published literature; however, there are considerable limitations to the information provided in many of these papers and careful appraisal is required before the findings can be applied to individual patients. The current paper provides a framework for determining bias, clinical applicability and erroneous findings within a paper, allowing greater efficiency in selecting studies and deciding on the value of the information reported in them.     

Importance of Dietary Fiber in Childhood

Dietary fiber has important health benefits in childhood, especially in promoting normal laxation. Currently, children consume amounts of dietary fiber that appear to be inadequate for optimal health promotion and disease prevention. It is prudent to recommend that children older than 2 years of age increase dietary fiber intake to an amount equal to or greater than their age + 5 g/day. According to the “age + 5” rule dietary fiber intake would increase from 8 g/day at age 3 years to 25 g/day by age 20 years. After age 20, dietary fiber levels of 25 to 35 g/day are recommended. Dietary fiber intake should be increased gradually in childhood by increasing consumption of a variety of fruits, vegetables, legumes, cereals, and other whole-grain products. Although very high fiber intake in childhood could have adverse effects, the potential health benefits of a moderate increase in dietary fiber substantially outweigh the possible risks, especially in highly industrialized countries such as the United States. A safe range of dietary fiber intake for children may be between age + 5 and age + 10 g/day. This range is considered safe even for children and adolescents with marginal intakes of some vitamins and minerals; should provide enough dietary fiber for normal laxation; and may provide enough added dietary fiber to help prevent chronic diseases.J Am Diet Assoc. 1995; 1140-1146, 1149.