Costs of vitamin A supplementation: the opportunity for integration with immunization in Ghana

Health service information intended for the planning and/ormonitoring of district health programmes should be up to date,precise and obtained by judicious use of available resources.Employing a rapid assessment type of design, this study quicklyand inexpensively investigated the cost implications of integratingvitamin A supplementation with immunization. It also assessedits potential for achieving adequate supplementation coverage.The study was conducted in the Bolgatanga-Frafra district ofnorthern Ghana in 1991. The average health service cost perchild for full immunization plus vitamin A supplementation wasUS$6.47. The additional cost of providing vitamin A to a fullyimmunized child in Bolgatanga-Frafra district, using a mobileclinic approach that provided integrated curative and preventivematernal and child health care, including immunization, wasUS$0.02. There was no additional monetary cost to the patientand an average additional indirect cost to the patient of twominutes in waiting The study concluded that the pattern of utilizationof immunization services in the district presented an opportunityfor achieving significant vitamin A supplementation coverage.     

Synthesis and biological activity of substance P analogues

The synthesis of the hexapeptide [Glu⁶]SP_6-11 and its glycosylated analogue at the Glu⁶γ-carboxyl position by solution procedures according to several strategies is discussed. The biological activity of SP, [GIu⁶]SP_6-11 (VI) and [Glu(β-d -Glcp)⁶]SP_6-11 (VIII) have been determined and compared to SP by the GPI and RVD assays. The introduction of a β-d -glucopyranosyl moiety at the sixth position of the [Glu⁶]SP_6-11 did not affect to a great extent the in vitro activity pattern of the parent hexapeptide.     

The Use of High-Frequency Ultrasound in the Evaluation of Superficial and Nodular Basal Cell Carcinomas

BACKGROUND: Frequencies of 20 MHz may be appropriate to visualize basal cell carcinomas (BCCs) including their tumor thickness and margins. Histologic comparisons to sonographic images are related at all levels of the epidermis and corium. OBJECTIVE: The objective was to evaluate whether high-frequency ultrasound (HFUS) proved to be an inexpensive and noninvasive modality to adequately delineate tumor margins under favorable circumstances. MATERIALS AND METHODS: Fifty superficial and nodular BCCs of various locations were scanned using a 20-MHz ultrasound device. Tumors were delineated, excised with 4-mm surgical margins, and sent for histologic clearance. Morpheaform, recurrent BCCs, BCCs in areas difficult to scan, and BCCs with specific properties were excluded from this study. RESULTS Clinical and ultrasonic measurements correlated well in terms of width, depth, and length (p<.0005). Of 50 BCCs, 45 were clear after margin assessment with HFUS. Five BCCs depicted extension past 4-mm surgical margins and returned with positive margins. CONCLUSION: HFUS delineated tumor margins adequately, and it appeared to depict subclinical extension past 4 mm on less aggressive BCC variants. It could be warranted if clinical or histologic diagnosis is uncertain. The strong association between clinical and ultrasonic measurements initiates more successful forms of therapy, risk-stratifies specific subgroups of patients, and prevents overall morbidity.     

ETHANOL AND DIET-INDUCED ALTERATIONS IN KUPFFER CELL FUNCTION

The effects of 6 weeks of alcohol feeding on phagocytic, metabolicand secretory functions as well as gene expression of hepaticKupffer cells were evaluated in vitro using cultured Kupffercells isolated from male Sprague-Dawley rats. The rats werefed either Teklad pelleted rat chow or the 1982 Lieber-DeCarliliquid diet containing 6% ethanol (36% calories) or the sameliquid diet with maltose-dextrin isocalorically substitutedfor the alcohol. Weight gain was greatest in the chow-fed animalsand least in those receiving ethanol. The alcohol-containingdiet stimulated Kupffer cell phagocytosis, mitochondrial reductionof Mil, secretion of tumor necrosis factor (TNF) and expressionof TNF mRNA. However, each of these cell functions was alsoenhanced by the control Lieber-DeCarli liquid diet alone andthe stimulating effect of the control diet often exceeded thatinduced by ethanol. The results suggest that early in chronicalcohol consumption, the immune system may be stimulated byethanol, and that during studies of ethanol-induced changesin immune system function, close attention must be given topotentially confounding effects of the diet.     

Structure activity of C-terminal modified analogs of Ac-CCK-7

Previous work indicates that both the C-terminal phenylalanine amide and the tryptophan moieties of chole-cystokinin (CCK) are critical pharmacophores for interaction with either the A or B receptor subtypes. We have examined a series of analogs of Ac-CCK-7 [Ac-Tyr(SO₃H)-Met-Gly-Trp-Met-Asp-Phe³³-NH₂] (2) in which the phenyl ring of the C-terminal Phe-NH₂ has been modified. Compounds were assessed in binding assays using homogenated rat pancreatic membranes and bovine striatum as the source of CCK-A and CCK-B receptors respectively and for anorectic activity after intraperitoneal administration to rats. Substitution of a number of cycloalkyi or bicyclic aryl moieties for the phenyl ring of phenylalanine³³ including cyclopentyl (20), cyclohexyl (21), cyclooctyl (23), 2-(5,6,7,8-tetrahydro)naphthyl (26), 2-naphthyl (27), and 1-naphthyl (29) led to analogs with 10–70 times the anorectic potency of 2. The anorectic activity of 21 was blocked by the specific CCK-A receptor antagonist MK-329. Other bulky aliphatic groups in place of the phenylalanine³³ aromatic ring such as isopropyl, 2-adamantyl and cyclohexylmethyl gave derivatives similar to 2 in potency. While most of the new compounds were comparable to CCK in binding assays, 23, 26, 27 and 29 were exceptionally potent with IC₅₀s 10^-11-10^-14 M in the pancreas. Compounds 23 and 29 were further evaluated for their ability to stimulate amylase secretion and found to have potencies similar to that of CCK. The dissociation between potency in the binding and amylase secretion assays suggests that they may interact with a high affinity binding site which is not coupled to amylase secretion. We conclude that CCK receptors possess a generous hydrophobic pocket capable of accommodating large alkyl groups in place of the side chain of phenylalanine³³ and that the pharmacological profile of CCK analogs can be tailored by appropriate exploitation of this finding.     

Renin, aldosterone and renal haemodynamics in cirrhosis with ascites

The interrelationships between the renin-angiotensin-aldosterone system, renal haemodynamics and urinary sodium excretion were investigated in fifty-six non-azotaemic cirrhotics with ascites. In twelve additional patients the renal renin secretion rate was also studied. Plasma renin activity and concentration and plasma aldosterone ranged from normal to very high values. There was a significant inverse relationship between plasma aldosterone and the urinary sodium excretion. Plasma aldosterone showed a highly significant direct correlation with plasma renin activity, and plasma renin concentration was closely and directly related to the estimated renin secretion rate. Neither plasma renin activity, plasma renin concnetration nor the estimated renin secretion rate correlated with the renal plasma flow or the glomerular filtration rate. These results suggest that in non-azotaemic cirrhosis with ascites the renin-angiotensin-aldosterone system is an important factor influencing sodium excretion, increased plasma renin and aldosterone concentrations are mainly due to an increased secretion rate, and total renal perfusion is not a major factor influencing renin secretion.     

A study of local immunity in psoriasis

We have studied biopsies of lesional skin with monoclonal and polyclonal antibodies to determine the nature of the infiltrate in different forms of psoriasis. In guttate psoriasis the number of Langerhans cells (LC) was not increased and CD8+ cells predominated, however, most CD4+ cells were activated. In erythrodermal psoriasis some CDI+ cells were found in the dermis although CD8+ cells predominated and were activated. In palmo-plantar psoriasis LC were found in the epidermis and superficial dermis and CD4+ cells were more numerous than CD8+ cells, some in turn expressing HLA-DR. In flexural psoriasis the LC formed clusters in the epidermis, and activated CD4+ cells predominated. In psoriasis vulgaris CD4+ cells predominated over CD8+ although the latter were activated. Our observations tend to support Valdimarsson's hypothesis on the immune basis of psoriasis, but we believe that two cycles coexist in psoriasis--one inflammatory and the other immunological--and that interaction between these leads to epidermal hyperproliferation.     

LONG-TERM RESULTS OF LOWER ENERGY TRANSURETHRAL MICROWAVE THERMOTHERAPY

Purpose

We evaluate long-term results of lower energy transurethral microwave thermotherapy (Prostasoft 2.0*) and identify pretreatment characteristics that predict a favorable outcome.*Technomed Medical Systems, Lyon, France.

Materials and Methods

Between December 1990 and December 1992, 231 patients with lower urinary tract symptoms were treated with lower energy transurethral microwave thermotherapy. Subjective and objective voiding parameters were collected from medical records and a self-administered questionnaire. Kaplan-Meier plots were constructed to assess the risk of re-treatment.

Results

Of the patients 41% underwent invasive re-treatment within 5 years of followup and 17% were re-treated with medication. The re-treatment-free period was somewhat longer in patients with a peak flow rate greater than 10 ml. per second, a Madsen score 15 or less, a post-void residual volume 100 ml. or less and age greater than 65 years at baseline. Prostate volume did not modify the outcome. No incontinence was caused by transurethral microwave thermotherapy, 8% had recurrent urinary tract infection and 8% had retrograde ejaculation. Only 1 patient had a urethral stricture after transurethral microwave thermotherapy.

Conclusions

At 5 years after transurethral microwave thermotherapy 41% of the patients received instrumental treatment. Patients with a lower Madsen score and lower residual volume, and those with higher peak flow and age were somewhat better responders to lower energy transurethral microwave thermotherapy.     

Clinical Applicability of in vivo Reflectance Confocal Microscopy for the Diagnosis of Actinic Keratoses

BACKGROUND In vivo reflectance confocal microscopy (RCM) has been used for evaluation of the morphologic features of nonmelanoma skin cancer. The application of RCM for diagnosis of basal cell carcinoma has been reported; however, the evaluation of actinic keratoses (AKs) has only been the subject of preliminary studies.
STUDY GOAL The goal of this study was to evaluate the applicability of RCM in the diagnosis of AK in correlation with routine histology.
MATERIALS AND METHODS Forty-four Caucasians with a minimum of one AK participated in this study. Evaluation consisted of clinical examination, RCM, and routine histology, including a total of 46 AKs in the final analysis. Ten normal skin sites served as controls. RCM features of AK included parakeratosis, architectural disarray, and keratinocyte pleomorphism. Following blinded evaluations, sensitivity/specificity, kappa analysis, and Spearman's correlation were performed on all parameters.
RESULTS Sensitivity/specificity values of RCM features ranged from 80% to 98.6%. The presence of architectural disarray and cellular pleomorphism appeared to be the best predictor of AK.
CONCLUSION In summary, RCM may be a promising technology for the noninvasive detection of AK and as adjunct tool to clinical diagnosis and monitoring. However, the preliminary nature of this study warrants further investigations.