Multifocal motor neuropathy: Response to human immune globulin

Multifocal motor neuroparrhy (MMN) is a progressive disorder producing asymmetrical weakness and muscle wasting. Case reports suggest that patients with MMN improve after cyclophosphamide therapy, but not after prednisone or plasmapheresis, Because MMN is likely to be immune mediated, we investigated the therapeutic response to human immue globulin (HIG) in an open, uncontrolled trial. Nine patients, ages 28 to 58 years, had chronic, progressive, asymmetrical, predominantly distral, limb weakness for 5 to 18 years, Sensation was normal, and reflexes were reduced asymmetrically. All had physiological evidence of multifocal motor demyelination with partial motor conduction block, and 7 had elevated serun titers of anti-GMI IgM antibody. All patients were treated with HIG, 106 to 2.4 gm/ kg., given intravenously over 3 to 5 days. Strength inproved in all patients 3 10 days after treatment, with improvement peaking at 2 weeks and lasting for an average of 2 months. The range of functional improvement veried from dramatic to mild. The degree of partial motor conduction block was reduced, at least partially, in 7 to 8 patients. The serum anti-GM1 antibody titers did not change. Repeated courses of HIG resulted in similar improvements. We conculde that HIg may be an effective therapy for patients with MMN.     

The relationship between congenital cardiovascular malformations and spontaneous abortion in preceding pregnancy

Previous studies have shown an increased frequency of spontaneous abortions in the pregnancy preceding a fetus or a newborn with neural tube defect (NTD) compared with a normal newborn. One explanation of this observation is the trophoblastic cell rest hypothesis put forward by Knox and Clarke, suggesting a teratogenic interaction between the developing embryo and pathological remnants of a previous pregnancy. The other explanation is that the previously lost fetus was also affected with neural tube defect. The aim of this study was to verify whether this observation is also valid for congenital cardiovascular malformations (CCVM). Demographic and obstetric data of 99 mothers (58 Jewish and 41 Bedouin) of newborns who died in the neonatal period from isolated CCVM were compared with those of 103 mothers (48 Jewish and 55 Bedouin) of newborns who died of congenital defects other than NTD and CCVM. Spontaneous abortions in the preceding pregnancy were found in 32% of the cases with CCVM compared with 14% of cases with other defects (ODs) ( P  = 0.0012; odds ratio = 3.1, 95% confidence interval 1.5–6.4). This significant difference was independent of maternal age and number of pregnancies or deliveries. No difference was found between Jews and Bedouins. As there is no indication in the literature that fetuses with isolated CCVM tend to be spontaneously aborted, our findings are more supportive of the trophoblastic cell rest theory.     

Prevalence of oral and facial pain and discomfort: preliminary results of a mail survey

Abstract A mail survey was undertaken to estimate the prevalence of oral and facial pain and discomfort in the City of Toronto. Self-complete questionnaires were sent to a random sample of 1014 persons drawn from the voter's list. Replies were received from 72% of those eligible. Overall, 53% of respondents had experienced some pain or discomfort in the 4 wk prior to the completion of the questionnaire. The most common kinds of pain and discomfort reported were pain in the teeth with hot or cold fluids (28.8%), sore and bleeding gums (26.3%) and toothache (14.1 %). Pain in jaws, face and oral mucosa was reported by less than 10% of the subjects. While much of the pain experienced by the respondents was classified as mild, half (50.1%) said that it was moderately severe or severe. Only 40% of those reporting pain had sought the advice of a dentist or doctor. Sex differences in the reporting of pain were small and statistically non-significant, although age differences were marked and significant. The younger age groups were more likely to report both pain and discomfort than the older age groups. The survey has revealed a substantial amount of oral and facial pain in the community, much of which is not subject to professional attention.     

Promoting professionalism through an online professional development portfolio: successes, joys, and frustrations.

Medical educators strive to promote the development of a sound professional identity in learners, yet it is challenging to design, implement, and sustain fair and meaningful assessments of professionalism to accomplish this goal. The authors developed and implemented a program built around a Web-based Professional Development Portfolio (PDP) to assess and document professional development in medical students at New York University School of Medicine. This program requires students to regularly document their professional development through written reflections on curricular activities spanning preclinical and clinical years. Students post reflections, along with other documents that chronicle their professional growth, to their online PDP. Students meet annually with a faculty mentor to review their portfolios, assess their professional development based on predetermined criteria, and establish goals for the coming year. In this article, the authors describe the development of the PDP and share four years of experience with its implementation. We describe the experiences and attitudes of the first students to participate in this program as reported in an annual student survey. Students' experiences of and satisfaction with the PDP was varied. The PDP has been a catalyst for honest and lively debate concerning the meaning and behavioral manifestations of professionalism. A Web-based PDP promoted self-regulation on an individual level because it facilitated narrative reflection, self-assessment, and goal setting, and it structured mentorship. Therefore, the PDP may prepare students for the self-regulation of the medical profession--a privilege and obligation under the physician's social contract with society.     

Chlamydia pneumoniae community-acquired pneumonia: A review of 62 hospitalized adult patients

Summary In a prospective study,Chlamydia pneumoniae was identified as the etiological agent in 62 (17.9%) of 346 adult patients hospitalized over the course of one year for community-acquired pneumonia at the Soroka Medical Center in Beer-Sheva, Israel. The diagnosis ofC. pneumoniae infection was based on serological testing of antibodies by the MIF technique. In 43 of these patients (69.4%), at least one other etiological agent, in addition toC. pneumoniae for community-acquired pneumonia was identified.Streptococcus pneumoniae was identified in 34 patients withC. pneumoniae (54.8%), as an additional causative factor in infection. Community-acquired pneumonia patients withC. pneumoniae were significantly older than non-C. pneumoniae patients (p=0.03), had a higher APACHE II score on admission (p<0.05), a higher rate of positive blood cultures (p=0.02), and longer periods of hospitalization (p=0.022). Seven patients with pureC. pneumoniae infection recovered, despite treatment which is not considered to be specific forC. pneumoniae. It was concluded thatC. pneumoniae is a common etiological agent for community-acquired pneumonia in our region, particularly in the elderly, and is characterized by a high rate of concomitant infections with other pulmonary pathogens. No specific clinical or radiological pattern was discerned that could distinguish betweenC. pneumoniae community-acquired pneumonia and non-C. pneumoniae community-acquired pneumonia.

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Ambulant erworbene Pneumonien durchChlamydia pneumoniae: Übersicht über 62 stationär behandelte erwachsene Patienten

Zusammenfassung Unter 346 im Rahmen einer prospektiven Studie erfaßten Patienten mit ambulant erworbener Pneumonie fanden sich 62 Fälle (17,9%), bei denenChlamydia pneumoniae als der verantwortliche Erreger identifiziert wurde. Die Studie lief über einen Zeitraum von einem Jahr am Soroka Medical Center in Beer-Sheva, Israel. Die Diagnose basierte auf dem serologischen Nachweis von anti-C. pneumoniae Antikörpern mit der MIF-Technik. Bei 43 dieser Patienten fand sich mindestens noch ein zusätzlicher Erreger (69,4%). Bei 34 Patienten wurdeStreptococcus pneumoniae isoliert (54,8%). Patienten mit einerC. pneumoniae-Infektion waren signifikant älter als Patienten, bei denenC. pneumoniae nicht der Erreger war (p=0,03), diese Patienten hatten außerdem bei Einweisung einen höheren APACHE Score (p<0,05), häufiger positive Blutkulturen (p=0,02) und mußten länger stationär behandelt werden (p=0,022). Obwohl keine erregerspezifische Behandlung vorgenommen worden war, erholten sich 7 Patienten, die an einerC. pneumoniae Pneumonie erkrankt waren. Wir schließen aus den Daten, daßC. pneumoniae in unserer Region ein häufiger Pneumonieerreger ist, der vorwiegend ältere Personen befällt. Typischerweise besteht eine hohe Rate an Begleitinfektionen mit anderen Pneumonieerregern. Wir fanden kein spezifisches radiologisches Muster oder klinische Konstellationen, die eine Unterscheidung zwischenC. pneumoniae-Pneumonie und Pneumonien anderer Ätiologie ermöglichen würden.

     

The role of the resource teacher in child care programs: An Ontario study

Resource teachers are one group of professionals involved in the mainstreaming of young children into child care programs. While the responsibilities of resource teachers have been generally outlined by the province of Ontario, little is known about what, in fact, resource teachers are doing in practice. This discussion paper summarizes the results of two sets of questionnaires sent to resource teachers in the province of Ontario. It was found that resource teachers spend the majority of their time in direct contact with children, followed by contact with parents, and then administrative duties. The resource teachers felt challenged by their work with parents and families. Coordinating services and supporting families were areas mentioned. The implications of the findings for the development of training programs for resource teachers are discussed.