The aim of this study was to investigate the accuracy and reproducibility of experienced and inexperienced examiners using 3 automated periodontal probes (Florida Pocket Probe, Florida Disk Probe, Peri Probe) in comparison with 3 conventional periodontal probes (Marquis, Williams and EN-15 probes). Test blocks of aluminium had 30 holes of diameter 1.10 mm and depths ranging from 2.75 to 10.0 mm. machined with a tolerance of +/- 0.01 mm. 8 experienced examiners and 8 inexperienced examiners were selected to perform duplicate measurements on the blocks over 6 visits using each of the 6 probes. 1 automated and 1 conventional probe were used at each examination. The % accuracy and reproducibility for each of the duplicate measurements was calculated and analysed using Friedman 2-way analysis of variance and the Wilcoxon matched pairs test. On average, all probes showed high reproducibility, with the Florida Disk Probe, the Florida Pocket Probe and the Williams probe ranked best and the other 3 probes were less reproducible. On average, all probes showed a high degree of accuracy, automated probes were ranked best and were significantly better than conventional probes. Experience had little effect on reproducibility, with only the Peri Probe showing significant differences at the 5% level between the groups. Experience appeared to be more important for accuracy, as experienced examiners were more accurate than inexperienced examiners, with significant differences at the 5% level for the EN-15, Florida Disk Probe and Peri Probe. However, inexperienced examiners were significantly more accurate using the Williams probe. This in vitro study has shown that automated probes offer increased accuracy over conventional probes and the Florida Pocket and disk probes compare well with conventional probes for reproducibility.
1. Sex steroids have been shown to regulate the biosynthesis of 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD). 2. In vitro studies showed that oestradiol (E2) or testosterone (T) can interfere with the bioassay of enzyme activity, but not progesterone (P4). 3. For in vivo studies, the activity of 11 beta-HSD in the testis of normal and adrenalectomized (ADX) adult male Wistar rats was determined following a daily IM injection of sex steroids for 7 days. 4. The 11 beta-HSD activity was significantly reduced (P < 0.01) either by E2 or T in normal and ADX rats. The enzyme activity in normal rats given both T and E2 was even lower (P < 0.001) than when E2 was given alone. 5. P4 given to normal and ADX rats increased the enzyme activity higher than normal (P < 0.001). 6. The presence of corticosteroids influenced the effects of E2, but not of T and P4, on 11 beta-HSD activity. 7. E2 and T downregulate 11 beta-HSD activity, whereas P4 increased it. E2 did not act through lowering T level.
Glomus tumors occurring synchronously in the subungual region and the pulp of a fingertip are extremely uncommon. Awareness of this will lead to early diagnosis and treatment.
MeSH terms: Female; Fingers*; Glomus Tumor/pathology*; Glomus Tumor/surgery; Humans; Middle Aged; Nail Diseases/pathology*; Nail Diseases/surgery; Radiography; Soft Tissue Neoplasms/pathology*; Soft Tissue Neoplasms/surgery; Neoplasms, Second Primary/pathology*; Neoplasms, Second Primary/surgery
The majority of patients with dysthyroid eye disease have an acquired colour vision defect. However, no psychophysical investigation of selective damage to colour or flicker pathways has been carried out. In order to clarify the nature of the visual pathology, we have used a psychophysical technique (spectral sensitivity) to selectively stimulate the chromatic and achromatic mechanisms. Spectral spots of size 1 degree presented at a rate of 1 Hz on a bright 1000 td white background are detected by the chromatic mechanism but a rate of 25 Hz reveals the achromatic mechanism. Fifteen patients (28 eyes) between the ages of 50-70 years were tested. The study showed that all patients had reduced spectral sensitivity, either 1 Hz, 25 Hz or both. The patients with reduced 1 Hz or 25 Hz spectral sensitivity only had a shorter systemic and ocular duration of the condition, had no proptosis, normal intraocular pressures in primary gaze, slightly higher intraocular pressures on upgaze, normal visual field plots and FM 100-Hue error scores higher than the normal age-matched values. The patients with reduced both 1 Hz and 25 Hz spectral sensitivities had a longer systemic and ocular duration of the condition, had proptosis, normal intraocular pressures in primary position, higher intraocular pressures on upgaze and higher FM 100-Hue error scores than the age-matched normals and those in Groups 1 and 2. A total of 50% of patients in Group 3 had defective visual field plots. These data suggest that there is a damage of the large achromatic fibres and small chromatic fibres in dysthyroid eye disease. The mechanism of the damage could be one of ischaemic or mechanical or both.
A 35 year old man with a fatal Campylobacter jejuni infection is described. He had HbE/beta zero thalassaemia and had undergone splenectomy nine months previously for hypersplenism; he also had chronic hepatitis C infection. He presented with high grade fever but no gastrointestinal symptoms and rapidly progressed to septicaemic shock and hepatic encephalopathy despite treatment with penicillin, gentamicin, and, later, chloramphenicol and ceftazidime. Only one case of Campylobacter jejuni septicaemia occurring post-splenectomy has been reported previously, also in an iron overloaded thalassaemia patient. Unusual Gram negative bacilli must be covered by the chosen antibiotic regimen when splenectomised thalassaemic patients present with high grade fever.
Forty-nine isolates of Burkholderia pseudomallei from sporadic cases of melioidosis in Malaysia over the past 18 years were examined by BamHI ribotyping and pulsed-field gel electrophoresis (PFGE) of XbaI digests of total deoxyribonucleic acid (DNA). Twenty-four patients had septicaemic melioidosis with a mortality of 70%; mortality in the non-septicaemic disease was 16%. Five ribotype patterns were identified, 2 of which accounted for 90% of all isolates. PFGE revealed a number of different strains within these ribotypes, but some pairs of isolates from unrelated cases gave closely similar DNA profiles. These results are in agreement with Australian studies which showed a high prevalence of a few ribotypes of B. pseudomallei which are further divisible by genotyping, in areas where melioidosis is endemic.
A study was undertaken to develop the use of survivorship methods in characterizing the magnitude of culling and in testing for differences in culling among dairy herds. A prospective observational study was conducted on nine herds representing 19482 cows. The cull rate derived from survivorship data was estimated as the weighted slope of the cumulative proportion of cows remaining in a herd after first parturition, where cumulative proportion was computed using a cohort life-table with intervals of 1 month. Cull rates ranged from 9.0-13.8% per 12 months of age, compared with culling density rates of 22.2-39.7 culled per 100 cow-years. Comparison of ranks of density rates, weighted-slope rates and median ages at culling among the herds illustrated that the measures were not interchangeable. An advantage of a survivorship approach to measuring culling was illustrated by the use of the Cox proportional hazards model that tested for differences in cull rates among herds. Results suggested that variation in culling among herds during the first lactation, and particularly during the first part of the first lactation, may be an important consideration in future studies of optimal culling practices. In addition to being able to compare culling among herds, a survivorship approach to measuring culling provides an estimate of the rate of removal that is not biased by age, in contrast to currently used methods.
MeSH terms: Age Factors; Aging/physiology; Animals; Animal Husbandry/methods*; Cattle/physiology*; Dairying/methods*; Female; Lactation/physiology; Prospective Studies; Cohort Studies; Life Tables; Survival Rate*
The objectives of this study were to evaluate the time delays between the onset of symptoms and admission to hospital and provision of thrombolytic therapy in patients with suspected acute myocardial infarction; and to examine the accuracy of the clinical diagnosis and the therapeutic decision on thrombolysis in these patients. An observational study of 96 patients with suspected myocardial infarction was undertaken over a period of 15 months in the Coronary Care Unit of Hospital Kuala Terengganu. Seventy per cent of the patients arrived in the hospital within 6 hours of the onset of symptoms. After arrival in the emergency room, it took a median time of 85 minutes before the administration of thrombolytic therapy. Of the 67 patients who were given thrombolysis, 46 were treated within 6 hours of the onset of symptoms. About a quarter of patients said that they had delayed seeking treatment at the hospital. Treatment delays occurring in the hospital were mainly due to admission procedures as well as late diagnosis. Eighty-one patients had confirmed myocardial infarction of whom 59 received thrombolytic therapy. Eight patients receiving thrombolytic therapy had no confirmation of myocardial infarctions. Improvements in diagnostic accuracy and reduction of delays in the provision of thrombolytic therapy could be achieved by better training of health care staff as well as by further streamlining of admission procedures.
MeSH terms: Clinical Protocols; Coronary Care Units; Humans; Malaysia; Medical Audit; Myocardial Infarction/diagnosis; Myocardial Infarction/drug therapy*; Time Factors; Thrombolytic Therapy*
Infection is an important cause of morbidity and mortality in immunocompromised patients. The high risk of infection is not only the consequence of the underlying disease but also the result of the diagnostic, monitoring and therapeutic procedures performed on these patients. Infections may be exogenous or endogenous in origin. The prevention of exogenous infections requires a high standard of hygiene. As many infections are acquired in hospitals, an effective control of nosocomial infection programme is crucial in preventing infections in the immunocompromised. Prevention of endogenous infections involves suppression of the aerobic bacterial flora (selective decontamination) and measures to maintain gastrointestinal epithelial integrity to reduce risk of translocation of intestinal flora. Boosting the host immunity through passive and active immunisation should also be considered. Prevention of infection in the immunocompromised is no easy task and requires a multidisciplinary approach.
Falciparum malaria may have infected Homo sapiens (and perhaps H erectus) in the Asia Pacific region for more than 100,000 years. This estimate is based on the gene frequency of alpha-thalassaemia, the protection it affords against falciparum malaria and assumptions of untreated mortality from the infection. Up until the end of the 19th century, there was a high mortality from malaria in the coastal parts of Malaya, but the malaria control campaign, begun in 1901 at Klang, was described by Sir Ronald Ross as the first successful antimalarial work in the (then) British Empire. This was extended to Singapore in 1911. When the Far Eastern Association of Tropical Medicine held its Fifth Biennial Congress in Singapore in 1923, malaria was still a major killing disease in parts of Malaya and Sarawak. The mechanism of life-threatening malaria involves cytoadherence of parasitised erythrocytes in microvascular beds, a process enhanced by the products of macrophage activation induced by malarial pyrogen. Improvements in the chemotherapy of life-threatening falciparum malaria with chloroquine and quinine have been countered by the emergence of resistant strains. Artemisinin derivatives may become the treatment of choice during the coming decade. Apart from traditional anti-mosquito methods, control of malaria now involves the use of insecticide-impregnated bed nets, new entomological strategies, including genetic manipulation of mosquitoes and selective chemoprophylaxis. Antigenic diversity and antigenic variation of the malaria parasite have so far defeated attempts to produce an effective vaccine.
Two hundred eleven patients with small- to moderate-sized native patent ductus arteriosus underwent closure using Gianturco coils, employing the transvenous multiple catheter approach. Short-term results showed a high rate of complete occlusion and a potential long-term complication of mild left pulmonary artery stenosis in a small number of patients.
Pseudo-first-order rate constants obtained for methanolysis of ionized phenyl salicylate (PS(-)) at constant [MeOH], [MeCN], [NaOH] or [KOH], and [KBr] and at 35 degrees C show a decrease with the increase in [CTABr] (where CTABr represents cetyltrimethylammonium bromide) from 0.0-0.01 M. These observed data obey a pseudophase model of the micelle. The micellar binding constants (K(S)) of PS(-), pseudo-first-order rate constants (k(M)) for methanolysis of PS(-) in the micellar pseudophase and cmc are almost unchanged with the change in [NaOH] from 0.005-0.050 M. The increase in [KBr] from 0.0 to 0.3 M at 0.01 M KOH decreases K(S) from 5140 to 653 M(-)(1) and cmc from 1.9 x 10(-)(4) to 0.2 x 10(-)(4) M. Pseudo-first-order rate constants, k(M), are almost independent of [KBr] at 0.01 M KOH.
A simple high-performance liquid chromatographic method using fluorescence detection was developed for the determination of acyclovir in human plasma. The method entailed direct injection of the plasma sample after deproteination. It is both specific and sensitive with a detection limit of 30 ng/ml at a signal-to-noise ratio of 3:1, and is thus suitable for use in pharmacokinetic studies of acyclovir. The method had a mean absolute recovery of 96%, while the within-day and between-day coefficients of variation and percentages error were all less than 8%. The calibration curve was linear over a concentration range of 62.5-4000 ng/ml.
MeSH terms: Acyclovir/blood*; Acyclovir/pharmacokinetics; Antiviral Agents/blood*; Antiviral Agents/pharmacokinetics; Biological Availability; Chromatography, High Pressure Liquid; Humans; Male; Sensitivity and Specificity; Spectrometry, Fluorescence; Reproducibility of Results
The toxicities of ROUNDUP and its component chemicals, glyphosate (N-phosphonomethylglycine) and polyoxyethyleneamine (POEA), were determined at 0, 1, 3, 6 and 24 h following administration to rats. The intratracheal administration of glyphosate (0.2 g/kg), POEA (0.1 g/kg), a mixture of glyphosate (0.2 g/kg) + POEA (0.1 g/kg), or ROUNDUP (containing 0.2 g/kg glyphosate and 0.1 g/kg POEA) elicited immediate respiratory effects which were more severe and which lasted longer in the groups receiving the POEA-containing preparations than in the glyphosate alone group. By 1 h, all test preparations had caused deaths, but more occurred from the POEA-containing preparations than from glyphosate. The po administration of POEA (1 g/kg), the mixture of glyphosate (2 g/kg) +POEA (1 g/kg), or ROUNDUP (containing 2 g/kg glyphosate and 1 g/kg POEA) produced diarrhea and blood-stained weeping from noses. Death was only seen from POEA at 24 h. Glyphosate (2 g/kg po) produced transient diarrhea without nose bleeds; POEA caused diarrhea at 1 h; and the mixture of POEA + glyphosate produced diarrhea later that increased in severity with time. Bloody nose secretions were seen only with the preparations that contained POEA. No deaths, respiratory effects or bloody nose secretions occurred in controls given saline. Both POEA and glyphosate caused lung hemorrhages and lung epithelial cell damage with po or intratracheal exposures. These results indicate POEA and preparations that contained POEA were more toxic than glyphosate.
The aim of the present study was to determine the risk factors for Helicobacter pylori in a dyspeptic Malaysian population. A cross-sectional survey of 1060 consecutive patients presenting with dyspepsia at the Endoscopic Unit, University Hospital, Kuala Lumpur, Malaysia from January 1994 to July 1995 was undertaken. All patients answered a detailed questionnaire and underwent endoscopy, with two antral biopsies taken for diagnosis of H. pylori using a rapid urease test. An overall H. pylori prevalence of 49.0% was recorded. Helicobacter pylori prevalence in relation to the major endoscopic diagnoses were as follows: non-ulcer dyspepsia (NUD) 31.2%; duodenal ulcer (DU) 91.4%; and gastric ulcer (GU) 74.1%. The prevalence among the races were as follows: Malay 16.4%; Chinese 48.5%; and Indians 61.8%. Multiple logistic regression analysis identified the following as independent risk factors: > 45 years old 1.5 (1.1,2.0); male gender 1.6 (1.2,2.1); ethnic group: Chinese 2.5 (1.7,3.7); Indians 4.9 (3.2,7.5); level of education: low 2.3 (1.5,3.5); middle 1.7 (1.1,2.6); and smoking 1.6 (1.2,2.3). Analysis was also performed on DU, GU and non-UD patients separately; in both DU and GU patients, H. pylori prevalence was high regardless of age, sex, race or level of education. However, in DU patients, Indian race had an independent risk factor (Odds ratio = 7.8 (1.2,48.4)). The findings in the NUD group reflected the findings in the ¿all patients' group; > 45 years old, male gender, Indian and Chinese race, and low level of education were also significant, independent risk factors. The overall differences in H. pylori prevalence between the different subgroups were mainly due to differences in the NUD group. The increased risk of H. pylori infection in Chinese and Indians points to either an inherent ethnic genetic predisposition or to socio-cultural practices peculiar to the particular race which may be responsible for transmission of the infection.
Strains of Aeromonas hydrophila isolates from skin lesions of the common freshwater fish, Telapia mossambica, were screened for the presence of plasmid DNA by agarose gel electrophoresis and tested for susceptibility to 10 antimicrobial agents. Of the 21 fish isolates examined, all were resistant to ampicillin and sensitive to gentamycin. Most isolates were resistant to streptomycin (57%), tetracycline (48%) and erythromycin (43%). While seven of 21 isolates harboured plasmids, with sizes ranging from 3 to 63.4 kilobase pair (kb), it was only possible to associate the presence of a plasmid with antibiotic resistance (ampicillin and tetracycline) in strain AH11. Both the plasmid and the associated antimicrobial resistance could be transferred to an Escherichia coli recipient by single-step conjugation at a frequency of 4.3 x 10(-3) transconjugants per donor cell.
Human herpesvirus-6 exists in two forms, HHV-6A which has not been clearly associated with any disease, and HHV-6B, the causative agent of exanthem subitum. The two variants have been distinguished by techniques such as dot blotting and restriction fragment length polymorphism of PCR products. This study aims to establish the prevalence of HHV-6A and HHV-6B in carcinoma tissues using variant-specific oligonucleotide probes. A total of 73 archived carcinoma biopsies from the oral, salivary gland, larynx, breast and cervix were obtained with seven histologically normal controls. In situ hybridization was carried out with nonradioactively labelled variant-specific probes. Samples that hybridized with both variant A and B probes were subjected further to nested PCR and digested with HindIII to distinguish the variants. A hybridization signal was observed in 76.2% of oral carcinoma tissue and 75.0% of salivary gland carcinoma tissue. In contrast, only 33.3% of cervical carcinoma tissue were positive for HHV-6 DNA. A hybridization signal was noted in all 4 laryngeal carcinoma tissues studied. However, the 10 breast carcinoma tissues studied were negative, as was the histologically normal tissue. The virus possesses tumourigenic potential and demonstrates virus transactivating properties. The frequency of HHV-6 variants in certain tumours suggest a cofactorial role in multistep carcinogenesis. While PCR amplifies selectively the predominant variant in a sample, this was not seen by in situ hybridization. The in situ hybridization technique allowed the localization of both HHV-6A and HHV-6B in the nuclei of transformed regions.