Validity of the 'Ten Questions' for screening serious childhood disability: results from urban Bangladesh

A survey of 2576 children aged two to nine years was carried out in Dhaka, Bangladesh, as part of a collaborative study to test the validity of a questionnaire (the Ten Questions) for screening severe childhood disabilities in community settings. Approximately 7% of the children were positive on the screen and this rate was slightly higher in boys than girls. The sensitivity, specificity and negative predictive value of the Ten Questions were perfect or nearly perfect for severe and moderate (serious) disabilities. The positive predictive value was only 22% for serious disabilities, but 70% of children classified as false positives were found to have mild disabilities or other conditions (such as ear infections) for which early detection and treatment could be beneficial. No major age or gender differences in the validity of the questionnaire were apparent, but this finding needs additional study and confirmation with studies based on larger samples. In general, the results indicate that the Ten Questions is a valid tool for screening serious disabilities in children and can potentially improve the efficiency of health services by reducing the number of children requiring attention from professionals. Future studies using the Ten Questions should foster greater attention to the dimensions of childhood disability as a public health problem in the less developed world.     

Diagnostic value of 24-hour simultaneous EEG and ECG monitoring of patients with heart diseases and atypical consciousness disorders]

In 24 patients with diagnostically not clear, short, recurrent episodes of consciousness disturbances and heart diseases and/or a history of arrhythmia simultaneous 24-hour recording was done of eeg and ecg. In the differential diagnosis epilepsy was considered, especially since in most cases routine eeg records demonstrated slight episodic changes. During 24-hour recording in 8 cases typical episodes of consciousness disturbances developed but in none of them these episodes were associated with arrhythmia which ruled out their cardiogenic origin. In 2 cases EEG recording served for establishing the diagnosis of partial complex seizures, 2 patients had hyperventilation syncope, one had TIA, in the remaining 3 cases absence of eeg and ecg changes during these episodes and coexistence of anxiety neurosis suggested functional origin. So the combined 24-hour eeg+ecg recording made possible establishing of diagnosis in 1/3 of these patients, enabling adequate treatment to be instituted.     

An appraisal of the appropriateness of the indications for hysterectomy.

Over a five-year period, 197 hysterectomies were performed at King Khalid University Hospital (KKUH). Indications for the procedures vary from menstrual disorders and symptomatic fibroids to ovarian malignancy. The most common indication was found to be menorrhagia. Among multiple pre-operative indications, only the first listed major indication for hysterectomy was chosen. There were 145 abdominal and 52 vaginal hysterectomies and all were elective gynaecological procedures, majority of which were performed on women in their fourth and fifth decades of life. Verification of pre-operative diagnosis, when correlated with pathological findings, showed that some of the indications for the procedure deserve a more critical reappraisal. Since hysterectomy carries substantial economic and medical consequences, indications for undertaking the procedure deserve more careful scrutiny given the surgical and nonsurgical options that are currently available. There may be a need, therefore, to assess the appropriateness or otherwise of the use of hysterectomy in many of the patients in future.     

Alternating copolymerization of carbon dioxide and propylene oxide in the presence of organometallic catalysts

Carbon dioxide and propylene oxide (PO) were copolymerized using diethylzinc in addition with benzenedi- and triols, aliphatic diols and triols, and aminophenols as catalyst systems. A large amount of CO₂/PO alternating copolymer, {poly(propylene carbonate), poly(oxycarbonyloxypropylene), of high molecular weight was obtained using the homogeneous (C₂H₅)₂Zn/pyrogallol (2:1 by mole) system ( 1 ). The (C₂H₅)₂Zn/o-aminophenol system ( 2 ) (also homogeneous) appeared to be much less active in the copolymerization of CO₂ with PO than the former one. From the other studied systems, that appeared to be heterogeneous, (C₂H₅)₂Zn/resorcinol (1:1 by mole) was the most active one, but less active than the system 1 . Further, the copolymerization of CO₂ and PO was studied in the presence of the (C₂H₅)₂Zn/resorcinol (1:1 by mole) system at various temperatures and in reaction media of different basicity. On the basis of the obtained results of the copolymerization of CO₂ with PO and of measurements of the quantity of ethane evolved in the reactions between the catalytic systems' components, structures of several catalysts, particularly homogeneous ones, are suggested and some aspects of the copolymerization mechanism are discussed.     

In vitro activity of caspofungin compared to amphotericin B, fluconazole, and itraconazole against Candida strains isolated in a Turkish University Hospital.

We investigated the in vitro activity of caspofungin compared to amphotericin B, fluconazole, and itraconazole against clinical strains of Candida spp. (n =239). Antifungal susceptibility tests were done in accordance with NCCLS M27-A2 microdilution method and the results were read after 24 and 48 h. In general, 24 h MIC readings were similar to those at 48 h for most isolates and all antifungal agents. Caspofungin was active against all species tested. Caspofungin MICs of Candida parapsilosis were slightly higher than those for other Candida spp. Caspofungin MIC (microg/ml) ranges at 24 h for C. albicans, C. glabrata, C tropicalis, C. parapsilosis, C kefyr, C krusei, C. lusitaniae, C. norvegensis, C. guilliermondii and C. lipolytica were 0.06-2, 0.125-2, 0.125-2, 1-4, 0.125-2, 1-2, 0.5-2, 0.5-1, 0.5-2 and 1-2, respectively. Eagle (paradoxical) effect was observed in 31 and 8% of the isolates at highest concentrations of caspofungin and itraconazole, respectively. The activity of caspofungin against fluconazole- and/or itraconazole-resistant isolates was similar to that detected for the susceptible ones. We conclude that caspofungin appears as a promising antifungal agent with enhanced activity against Candida, including the azole-resistant strains.     

Genotypic analysis of Mycobacterium tuberculosis in Bangladesh and prevalence of the Beijing strain

Genotypic analysis was performed on 48 Mycobacterium tuberculosis complex strains collected from a hospital in Dhaka city. Deletion analysis showed that the isolates were all M. tuberculosis; 13 of them were found to be of the "ancestral" type, while 35 were of the "modern" type, indicating that both endemic (ancestral type) and epidemic (modern type) strains cause tuberculosis in Bangladesh. Genotyping based on the spoligotype and variable-number tandem repeats (VNTR) of mycobacterial interspersed repetitive units (MIRU) was also done. A total of 34 strains (71%) were grouped by spoligotyping into nine different clusters; the largest comprised 15 isolates of the Beijing genotype, whereas the remaining eight clusters consisted of two to five isolates. MIRU-VNTR typing detected 32 different patterns among 44 tested strains, and the 15 Beijing strains were further discriminated by MIRU-VNTR typing (7 distinct patterns for the 15 isolates). These results indicate that MIRU-VNTR typing, along with spoligotyping and deletion analysis, can be used effectively for molecular epidemiological studies to determine ongoing transmission clusters; to our knowledge, this is the first report about the type of strains prevailing in Bangladesh.     

Investigations on the catalytic systems diethylzinc/Di- and trihydroxybenzenes in the copolymerization of carbon dioxide with propylene oxide

Investigations on the reactions of diethylzinc ( 1 ) with resorcinol ( 2 ) and phloroglucinol ( 8 ) were carried out for different mole ratios of the reactants. It was found that the reaction of 1 with 2 at a mole ratio of 1:1 is a two step process. In the first step 1 reacts very rapidly with half of applied 2 yielding di(ethylzinc) resorcinolate ( 6 ), which then reacts slowly with the remaining amount of 2 . It was found that zinc 3-ethylzincoxyphenolate resorcinolate ( 5 ) formed in the second step is an active catalyst of the copolymerization reaction of carbon dioxide with propylene oxide. The reaction of 1 with 8 shows a similar course.     

Vinyl monomer complexes in copolymerization processes. Studies on the complexes of acrylonitrile and methyl methacrylate with lewis acids

Complexes of acrylonitrile and of methyl methacrylate with various Lewis acids, 1 and 2 , were studied by means of IR, NMR, and UV spectroscopy. The influence of the Lewis acid strength on the induction effect and on the delocalization of π-electrons in the complexed monomer molecule was established. As the relative acidity of the complexing agent is increased, the inductive effect of the nitrile or of the carbonyl group in the complex molecule rises, whereby the electron density on the carbon atom in β-position in the vinyl group diminishes. Complexation of the monomer also results in increased delocalization of π-electrons in the molecule. In the complexes with moderately strong Lewis acids like CH₃AlCl₂ and C₂H₅AlCl₂, delocalization of π-electrons seems to reach its maximum. The methyl methacrylate-C₂H₅AlCl₂ complex was found to give a charge-transfer complex with 1,5-cyclooctadiene. On the basis of the present spectroscopic studies and of earlier studies on copolymerization of acryl monomers with butadiene, the delocalization of π-electrons in the complexed monomer molecule is believed to be one of the major factors controlling the rate of copolymerization.