Total-and lipid-associated sialic acid in serum and thrombocytes in patients with chronic heart failure

ObjectivesTo investigate and discuss the total-, lipid-associated, and thrombocyte-sialic acid levels in chronic heart failure (CHF) patients.Design and methodsThirty-one chronic heart failure patients and 38 healthy controls were included in the study. Serum total sialic acid (TSA), lipid associated sialic acid (LASA), thrombocyte sialic acid (TrSA) were determined together with the traditional inflammation and prognostic markers.ResultsSerum TSA levels were significantly higher in patient group (3.08 ± 0.33 mmol/L) than control group (2.60 ± 0.17 mmol/L). Serum LASA, homocysteine, high-sensitivity CRP, brain natriuretic peptide and erythrocyte sedimentation rate were also significantly higher in patient group. TrSA levels were not significant between the groups.ConclusionTSA and LASA levels increase in CHF, independent from coronary artery disease. TrSA levels were not found to be a prognostic or valuable marker for CHF patients. Acute phase response and lipid associated portions of SA are thought to be responsible for SA rise in CHF.     

Caries status and treatment needs in South Africa: report of the 1999-2002 National Children's Oral Health Survey.

A third national children's oral health survey was conducted in South Africa between July 1999 and June 2002. OBJECTIVE AND METHODOLOGY: One of the objectives of the survey was to determine the prevalence and severity of dental caries and the treatment needs for dental caries in 4- to 5-, 6-, 12- and 15-year-old South African school children. The sample comprised 30876 children from the nine provinces of South Africa. RESULTS: The results of the survey show that 39.7 per cent of the 6-year-old group were caries free. This figure, 39.7 per cent, is below the goal of 50 per cent set by the Department of Health for 6-year-old children in South Africa for the year 2000. The DMFT of 1.1 for the 12-year-old group on the other hand was below the goal of 1.5 set for South Africa for the year 2000. The highest DMFT/dmft scores were recorded in the Western Cape Province and the lowest in the Limpopo Province. More than 80 per cent of caries in children go untreated while the greatest need for treatment in South African school children was for preventive services, restorations and extractions. The results for the 12-year-old-group show a reduction in dental caries severity in the permanent dentition in that the DMFT decreased from 2.5 in 1982 to 1.1 for the current survey. CONCLUSIONS: Although dental caries severity in South Africa is classified as low by WHO standards, the high levels of untreated caries in all age groups in South Africa is a cause for concern.     

The developing world of pre-operative optimisation: a systematic review of Cochrane reviews

Pre-operative optimisation is a heterogenous group of interventions aimed at improving peri-operative outcomes. To understand the evidence for pre-operative optimisation in the developing world, we systematically reviewed Cochrane reviews on the topic according to the Human Developmental Index (HDI) of the country where patient recruitment occurred. We used summary statistics and cartograms to describe the HDI, year of publication, timing of pre-operative intervention and risk of bias associated with each included trial. We assessed the impact of multinational trials on the risk of bias introduced by countries of differing HDI. Four-hundred and nine trials representing 51 countries and 89,389 randomly allocated participants were summarised in this review. Four-hundred and nineteen out of 451 (93%) trial populations (i.e. a group of study participants from one country) were from high and very high HDI countries. The median (IQR [range]) HDI of countries were 0.862 (0.806–0.892 [0.445–0.949]). Three of the 409 included trials were multinational, representing 32 countries and 37,736 out of 89,389 (42.2%) included participants. Africa was the least represented continent, with only 4 included trials and 566 participants, of which 62.3% were from one multinational trial. The overall risk of bias was high or unclear in 381 out of 409 (93%) trials. Inclusion of multinational trials decreased the proportion of trial populations introducing high or unclear risk of bias by 9.4% (95%CI 5.1–13.7; p < 0.0001). Half of the world's population live in low- and middle-HDI countries. This population is poorly represented in systematically reviewed evidence on pre-operative optimisation. Multinational trials increase the knowledge contribution from low- and middle-HDI countries and decrease risk of bias in systematic reviews.     

Hepatic manifestations in Still's disease

In children, as in adults, Still's disease usually presents with a hectic fever, a characteristic rash and arthralgia or arthritis. Visceral involvement is however classical; the hepatic manifestations were studied with respect to two cases. Biochemical changes are common, often mild: the commonest abnormality is cytolysis. Jaundice is less frequent and hepatic involvement may in exceptional cases be life threatening, usually in cases of serious polyvisceral disease often with disseminated intravascular coagulation. These manifestations may be spontaneous or secondary to salicylate therapy; the anatomical changes are the same; the salicylate would therefore seem rather to unmask and aggravate an underlying hepatic abnormality.     

Furosemide dynamics in conscious rabbits: Modulation by angiotensin II

Summary The aim of this study was to investigate the effects of an infusion of angiotensin II (50 ng/kg/min) on furosemide pharmacodynamics and kinetics in the conscious rabbit. The protocol included a 90-minute phase to estimate the glomerular filtration rate and the renal plasma flow, followed by a 60-minute phase where 5 mg/kg (n=12) or 10 mg/kg (n=9) of furosemide were administered. During the pre-furosemide phase, compared to control rabbits, angiotensin II increased natriuresis and diuresis. In the presence of angiotensin II, the furosemide-induced natriuresis decreased, that is, it was 174±14 versus 95±25 µmol/min (p<0.05) and 187±17 versus 89±21 µmol/min (p<0.05) for the 5 and the 10 mg/kg doses, respectively. The infusion of angiotensin II decreased renal plasma flow without modifying the glomerular filtration rate, thus the filtration fraction was increased. Angiotensin II increased the area under the furosemide plasma concentrations as a function of time since it decreased its systemic clearance. However, furosemide urinary excretion rate was not altered and its renal clearance decreased slightly without reaching statistical significance. It is concluded that angiotensin II decreases the response to furosemide and the mechanism underlying this effect is related to the pharmacodynamics rather than the kinetics of the diuretic.     

Tuberculosis in Patients Infected with Human Immunodeficiency Virus 1. A Retrospective Multicentre Study of 123 Cases in France

SUMMARY In order to study the epidemiological, clinical, and progressivecharacteristics of TB in HIV-infected individuals, a retrospectivestudy was conducted in nine infectious disease centres of universityhospitals located in the southern half of France. Among the5730 HIV-seropositive in- and out-patients, 123 (2.1 per cent)had TB (121 infections caused by M. tuberculosis, 2 by M. bovis).Tuberculosis was pulmonary in 53 patients (43.1 per cent), extrapulmonaryin 36 patients (29.3 per cent), and combined in 34 patients(27.6 per cent). There was no statistically significant differenceamong these three locations as to the mean CD4 count/mm³ (160±17),the type of antituberculosis therapy, the length of treatment(10.8±0.6 months) and the outcome. Fifty-two (45.2 percent) patients received an initial antituberculosis therapeuticregimen of four drugs: isoniazid, rifampicin, ethambutol, pyrazinamide;54 (46.9 per cent) were started on three drugs: isoniazid, rifampicin,ethambutol; and nine (7.8 per cent) received a two-drug combination:isoniazid, rifampicin. Fourteen of 75 patients subsequentlyreceived secondary preventive therapy. The mean follow-up timewas 252±290 days. Clinical healing was obtained in 57.7per cent of patients. Forty-six patients died, 33 during treatment:23 from AIDS and eight from TB (in the first 3 weeks of treatment).Five patients suffered from relapses due to poor treatment compliance.Patients had a good prognosis if tuberculosis was diagnosedearly.     

The liver in infectious mononucleosis

Summary 1. Twenty-two patients with infectious mononucleosis were studied by liver biopsy and paper electrophoresis of the serum proteins. The findings were compared with a similar group of 30 patients with infectious hepatitis.2. The essential histologic features of infectious mononucleosis were the presence in the hepatic sinusoids and portal tracts of chronic inflammatory cells resembling small lymphocytes, with essentially no parenchymal cell damage. Admixed with this lymphocytic infiltrate, but in relatively minimal numbers, were a few plasma cells and polymorphonuclear leukocytes. In addition, in infectious mononucleosis there were, with rare exceptions, no lipochrome-containing Kupffer cells. Thus, in the majority of cases, the histologic picture was distinct from that seen in infectious hepatitis. Only in comparing a few of the more severe infectious mononucleosis cases with subsiding infectious hepatitis cases was there any tendency for the two pictures to merge, and the distinction on histologic grounds between the two entities could be made in the great majority of cases.3. The most commonly seen abnormalities in the paper electrophoretic patterns of sera obtained from patients with infectious mononucleosis were decreased albumin, increased gamma globulin, not infrequent but variable changes in alpha₂ globulin, and the presence of abnormal proteins migrating with mobilities intermediate to alpha₂ and beta, and beta and gamma globulins. The abnormalities observed in infectious hepatitis were similar to those of infectious mononucleosis, except that in hepatitis alpha₂ globulin was decreased more consistently, gamma globulin increased less frequently, and beta globulin, which was normal in practically all the cases of infectious mononucleosis, was increased in a considerable number of cases.4. Treatment of patients with infectious mononucleosis need not include prolonged bed rest and restriction of activity in an effort to avoid the development of chronic liver disease.