Deficits in attention, motor control and perception (DAMP): a simplified school entry examination

OBJECTIVE: To suggest an empirically based school entry screening examination for the detection of deficits in attention, motor control and perception (DAMP) in 6-y-old children. MATERIAL AND METHODS: A population-based cohort of 113 children, 6-7 y of age (62 with and 51 without DAMP), compared on measures of attention, motor functions, language and cognition. RESULTS: Attention deficits were convincingly identified by both parents and paediatrician. The motor function tests clearly distinguished between the two groups. Linguistic and meta-linguistic tests demonstrated greater phonological processing difficulties in the DAMP group. The cognitive test revealed an overall lower IQ but no consistent characteristic pattern in the DAMP group. CONCLUSIONS: A simplified paediatric school entry examination test is suggested. Four motor tests (standing on one foot, Fog test, design copying and diadochokinesis) administered by the paediatrician, combined with a brief structured clinical observation and a structured parent interview, identified 80% of children with DAMP-and all those with severe DAMP-as well as a small number of false positives.     

Autoimmune haemolytic anaemia in a child with MHC class II deficiency

A 3 year old Turkish girl is described who was suffering from major histocompatibility complex (MHC) class II deficiency syndrome, which is characterised by the lack of expression of HLA class II antigens on mononuclear cells. The presence of HLA class II genes was demonstrable at the DNA level. Combined immunodeficiency was indicated by hypogammaglobulinaemia and the absence of delayed type hypersensitivity on skin testing. Further, she was unable to produce specific antibodies towards foreign antigens and suffered from recurrent pulmonary, gastrointestinal, and septic infections from the third month of life. The clinical course was complicated by a Coombs test positive haemolytic anaemia due to the production of autoantibodies against the rhesus "e' antigen, a non-glycosylated protein antigen. Haemolysis could be controlled by oral steroid treatment. This case is of interest as it shows that despite the absence of HLA class II antigens and combined immunodeficiency autoimmune reactions with production of specific autoantibodies directed to protein antigens are possible.     

Pain and anxiety during bone marrow aspiration/biopsy: Comparison of ratings among patients versus health-care professionals

PurposeTo assess pain and anxiety during bone marrow aspiration/biopsy (BMA) among patients versus health-care professionals (HCPs).Method235 adult hematologic patients undergoing BMA were included. BMA was performed by 16 physicians aided by nine registered nurses (RNs). Questionnaires were used to obtain patients and HCPs ratings of patients’ pain and anxiety during BMA. Patterns of ratings for pain and anxiety among patients HCPs were estimated with proportions of agreement P(A), Cohen’s kappa coefficient (κ), and single-measure intra-class correlation (ICC). We also explored if associations of ratings were influenced by age, sex, type and duration of BMA.ResultsThe P(A) for occurrence of rated pain during BMA was 73% between patients and RNs, and 70% between patients and physicians, the corresponding κ was graded as fair (0.37 and 0.33). Agreement between patients and HCPs regarding intensity of pain was moderate (ICC = 0.44 and 0.42). Severe pain (VAS > 54) was identified by RNs and physicians in 34% and 35% of cases, respectively. Anxiety about BMA outcome and needle insertion was underestimated by HCPs. P(A) between patients and RNs and patients and physicians regarding anxiety ranged from 53% to 59%. The corresponding κ was slight to fair (0.10–0.21). ICC showed poor agreement between patients and HCPs regarding intensity of anxiety (0.13–0.36).ConclusionsWe found a better congruence between patients and HCPs in pain ratings than in anxiety ratings, where the agreement was low. RNs and physicians underestimated severe pain as well as anxiety about BMA outcome and needle insertion.     

Acceptability of local made baits for oral vaccination of dogs against rabies in the Philippines

Background  

In the Philippines, traditional mass dog vaccination campaigns have only achieved limited and transient success in dog rabies control, mainly because a large segment of the dog population is not accessible for traditional parenteral vaccination. Oral vaccination of dogs has been suggested as a supplementary method to increase the overall vaccination coverage of the dog populations involved. For this purpose, it is necessary to identify a suitable bait that is readily accepted by local dogs and that can be prepared without high costs.     

Quantitative study of the immunoglobulin-containing cells in trephine samples of bone marrow

Immunoglobulin (Ig) was demonstrated in paraffin sections of 12 trephine bone marrow biopsies by means of the unlabelled antibody peroxidase-antiperoxidase (PAP) method. The Ig-containing cells, which were counted with the Reichert-Jung (Kontron) MOP-AMO₃ user-controlled image-analyser, were found to constitute approximately 4·2% of all the nucleated cells in the marrow, a figure significantly higher than those reported by previous workers.     

Patterns of monoclonal immunoglobulins and serum free light chains are significantly different in black compared to white monoclonal gammopathy of undetermined significance (MGUS) patients

Monoclonal gammopathy of undetermined significance (MGUS), the precursor to multiple myeloma, is more common in blacks than whites. The serum free light chain (sFLC) assay is an important prognostic test in MGUS, but no study has evaluated sFLC levels and ratios in black MGUS patients. One-hundred and twenty-five black MGUS patients at two urban centers were compared to the white population of the Mayo Clinic. The median age for blacks was 73 years [41-94] and 75% were male. The M-protein isotype in blacks was 81% IgG, 13% IgA, 2% IgM, and 4% biclonal compared to 70%, 12%, 16%, and 2%, respectively, in whites, (P < 0.0005). The median M-protein concentration for blacks was 0.44 gm/dL (trace-2.33) compared to 1.2 gm/dl in whites. An abnormal sFLC ratio was present in 45% of black compared to 33% of white (P = 0.01) patients. Using the Mayo Clinic risk model, black patients had a significantly lower proportion of higher risk MGUS compared to whites: low 43%, low-intermediate 45%, high-intermediate 10%, and high 2% (P = 0.014). Black patients with MGUS have significantly different laboratory findings compared to whites. The biologic basis for these disparities and their effect on prognostic assessment is unknown. Prognostic models based on these biomarkers should be used cautiously in nonwhite populations.