Implementation of a Multidisciplinary Inpatient Cardiology Service to Improve Heart Failure Outcomes in Guyana

Background

Guyana is a small developing country with a high burden of cardiovascular disease and extensive barriers to optimal care delivery. We investigated the effectiveness of a newly established multidisciplinary inpatient cardiology service in this setting.

METHODS OF ASSESSMENT USED IN ANKYLOSING SPONDYLITIS CLINICAL TRIALS: A REVIEW

Twenty non-steroidal anti-inflammatory drug (NSAID) trials inankylosing spondylitis (AS) were reviewed to assess the frequencywith which statistically significant differences had been detectedbetween active drug and either a placebo or an NSAID-free washoutperiod. Differences in pain severity were almost invariabilitydetected, irrespective of the scale employed. In contrast, significantdifferences in axial movement were rarely detected in placebocontrolled studies, and only about half of the variables detectedsignificant improvement with respect to a washout period. Fromour data it is difficult to differentiate whether the lack ofdifference with active therapy was due to inadequate samplesize, non-responsive patients, or insensitive outcome measures.However, it is not surprising that between-drug differencesare rarely detected in AS clinical trials of NSAIDs given ourcurrent inability to differentiate consistently an active treatmentfrom a placebo and an active treatment phase from a washoutperiod. KEY WORDS: Ankylosing spondylitis, Clinical trials, Non-steroidal anti-inflammatory drugs     

A comparison of the effects of maternally administered meptazinol and pethidine on neonatal acid-base status

Summary. A randomized double-blind study compared the effects of equi-analgesic doses of maternally administered meptazinol (1.5 mg/kg) and pethidine (1.5 mg/kg) on neonatal acid-base status. Heel-prick samples were taken for assessment of acid-base status at 10 and 60 min after delivery. Maternal antenatal history, details of labour and neonatal status at delivery were also recorded. Meptazinol produced less neonatal respiratory depression than pethidine: the mean 10 min acid-base data from 16 infants whose mothers received pethidine were indicative of a respiratory acidosis (pH 7.13, SD 0.08, P co₂,9.11, SD 2.2 kPa; standard bicarbonate 22.3, SD 3.1 mmol/1). This was not evident in the mean acid-base data from 16 infants whose mothers received meptazinol (pH 7.23, SD 0.07; P co₂ 6.83, SD 1.6 kPa; standard bicarbonate 20.9, SD 4.2 mmol/1). The mean pH and P co₂ in the two treatment groups were significantly different (P<0.002) at 10 min but not at 60 min after delivery.     

Primary splenic large cell anaplastic lymphoma associated with HIV infection

We report a case of primary splenic B-cell CD30 positive large cell anaplastic lymphoma developing in an HIV positive patient. The tumour cells expressed Epstein–Barr virus-associated antigens.     

Specificity of pepsin-catalyzed peptide bond synthesis

The rates of the pepsin-catalyzed synthesis of oligopeptides of the general type A-Phe-Leu-B by the condensation of A-Phe-OH with H-Leu-B have been determined by means of analytical high performance liquid chromatography. Variation of the A group led to large changes in the initial rates of the condensation reaction, and the effect of such changes was found to be similar to that previously found for the secondary specificity of pepsin in the hydrolysis of oligopeptide substrates. Replacement of the Phe and Leu residues of A-Phe-OH or H-Leu-B by other amino acid residues gave relative rates of synthesis in accord with the known primary specificity of the hydrolytic action of pepsin. Partially-acetylated pepsin, which exhibits enhanced hydrolytic activity, also catalyzed the condensation reaction more effectively. The results are discussed in relation to the potential utility and limitations of pepsin as a catalyst in the preparative synthesis of oligopeptides and to the problem of the mechanism of its action.