Transition care readiness among patients in a tertiary paediatric department.

INTRODUCTION: A smooth transition of healthcare for young people with chronic illnesses from paediatric to adult healthcare services is important to ensure optimal outcome. At the moment, there are no standard guidelines to assess a patient's readiness to transfer care. METHODS: A cross-sectional study using a self-administered questionnaire, adapted from UNC (University of North Carolina) TRxANSITION self-assessment tool was conducted to evaluate patients' transition care readiness in paediatric haematology and paediatric diabetes clinic. RESULTS: A total of 80 patients (37 thalassaemia and 43 diabetes) with the mean age of 21.2 (SD±4.3) years, were recruited during the 3-month study period. Majority of the patients have basic knowledge regarding their medications, and were able to comply with their follow-up. The mean total score obtained by the respondents on this questionnaire was 15.3 (SD±3.59). Self-management skills and knowledge on disease were the two poorly scored section; with mean score of 3.78 (SD±1.38) and 4.28 (SD±1.20) respectively. Overall, only 21 (26.2%) respondents obtained high score (score above 75th percentile). Seventy-five percent of the respondents admitted that they were not ready for transfer to an adult healthcare service yet at the time of the study. CONCLUSION: We suggest that patients with high score should be prepared for transition to adult facility whereas those with a low score need to be identified to ensure provision of continuous education.

Iron Polymaltose Complex in the Treatment of Iron Deficiency Anemia in Pregnancy.

Iron deficiency anaemia is a major public health problem in pregnancy. About 58% of pregnant women in developed countries are anaemic mainly due to iron deficiency resulting a serious negative consequences on children, mothers and eventually on the nation. This quasi-experimental multi centered study (Before after study) was done to evaluate the efficacy and tolerability of Iron Polymaltose Complex (IPC) in the treatment of iron deficiency anaemia and it was performed at the OPD of Bangladesh Medical College and two other clinics of Dhaka city from August 2011 to September 2013. A total of 80 (eighty) subjects were selected by purposive sampling as per inclusion and exclusion criteria. They were treated by Iron Polymaltose-IPC [47mg elemental iron + Folic Acid 0.5mg + Zinc 22.5mg - Once daily orally for 12 weeks]. At the beginning and after 12 weeks of intervention by Iron Polymaltose Complex (IPC) Hb%, Packed Cell Volume (PCV), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), Serum iron, and Serum ferritin were measured. Data were analyzed by SPSS version 13.0. Paired and unpaired 't' test was used to analyze differences within groups and between groups. Chi-square test was done to analyze primary efficacy parameters and adverse drug reactions (ADR). Most of the respondents were within the age group of 18-23 and 30-35 years (32.6% each). Significant differences were found by treatment with IPC for 12 weeks in Hb%, PCV, MCV, MCH, Serum iron, and Serum ferritin level. In iron deficiency anaemia during pregnancy IPC may be used as a safe and cost-effective therapeutic management.

Most individuals with either segmental or non-segmental vitiligo display evidence of bilateral cochlear dysfunction.

BACKGROUND: Vitiligo has been classified clinically into segmental vitiligo (SV) and nonsegmental vitiligo (NSV) and may also be associated with audiological abnormalities. OBJECTIVES: We examined cochlear function in ears of individuals with SV and NSV, including subjects with facial and nonfacial lesions, and in patients who have SV with unilateral facial involvement. METHODS: This study included 25 patients with SV and 28 patients with NSV. Fifteen age- and sex-matched healthy individuals served as controls. Cochlear function was studied using the distortion product otoacoustic emissions (DPOAEs). Data were analysed using SPSS. RESULTS: Sixty-four ears (60%) of patients with vitiligo had cochlear dysfunction while the control group exhibited no abnormalities. On comparing the cochlear dysfunction of patients with SV with patients with NSV, no statistically significant difference was found. The ears on both sides, affected and unaffected by vitiligo, in patients with SV showed cochlear dysfunction with no statistically significant difference in DPOAE. To determine the effect of the lesion side on cochlear function, we compared DPOAE amplitude using Student's t-test. The comparisons included NSV of the face vs. NSV on other areas, NSV of the face vs. SV of the face and SV of the face vs. SV of other areas. No statistically significant difference was found in these comparisons. CONCLUSIONS: Bilateral cochlear dysfunction is common in both NSV and SV and does not reflect the appearance of vitiligo in the skin. Our results underscore the important role of melanocytes and melanin in cochlear function, and suggest that the cochlear abnormalities in SV point to the presence of additional nonsegmental pathophysiological events underlying all forms of vitiligo.

Socio-demographic characteristics and risk factors of ante-partum fetal death in a tertiary care hospital in Dhaka City.

The objectives of this study were to assess the socio-demographic profile and to identify the risk factors of ante-partum fetal death which occurs after the age of viability of fetus. This prospective observational study was conducted in the Obstetrics and Gynaecology department of Ad-din Women Medical College Hospital from June 2009 to July 2010. A total of 14,015 pregnant patients were admitted in the study place after the age of viability, which was taken as 28 weeks of gestation for our facilities. Eighty-three (0.59%) of them were identified as intrauterine fetal death. Assessment of maternal socio-demographic characteristics and maternal-fetal risk factors were evaluated with a semi structured questionnaire which was pre-tested before executing in this study. Majority (81.92%, n=68) of the patients were below 30 years of age, 78.31% belonged to middle socioeconomic group. Almost 58% women had education below secondary school certificate (SSC) level and 28.91% took regular antenatal checkup. About 61.45% patients were multi-gravida. Most (59.04%) ante-partum deaths were identified below 32 weeks of pregnancy. Out of 83 patients, maternal risk factors were identified in 41(49.59%) cases where fetal risk factors were found in 16(19.27%) cases; no risk factors could be determined in rests. Hypertension (48.78%), diabetes (21.95%), hyperpyrexia (17.3%), abruptio placentae (4.88%) and UTI (7.36%) were identified as maternal factors; and congenital anomaly (37.5%), Rh incompatibility (37.5%), multiple pregnancy (12.5%) and post-maturity (12.5%) were the fetal risk factors. Here, proximal biological risk factors are most important in ante-partum fetal deaths. More investigations and facilities are needed to explain the causes of ante-partum deaths.

Maternal sociodemographic characteristics and risk factors of antepartum fetal death.

The objectives of this study were to assess the sociodemographic profile and to identify the risk factors of ante-partum fetal death which occurs after the age of viability of fetus. This prospective observational study was conducted in the Obstetrics department of Ad-din Women Medical College Hospital during the period of June, 2009 to July, 2010. A total of 14,015 pregnant patients were admitted in the study place after the age of viability, which was taken as 28 weeks of gestation for our facilities. Eighty-three (0.59%) of them were identified as intrauterine fetal death. Assessment of maternal sociodemographic characteristics and maternal-fetal risk factors were evaluated with a semi structured questionnaire pretested. Majority (81.92%, n=68) of the patients were below 30 years of age, 78.31% belonged to middle socioeconomic group. Almost 58% women had education below SSC level and 28.91% took regular antenatal checkup. About 61.45% patients were multigravida. Most (59.04%) ante-partum deaths were identified below 32 weeks of pregnancy. Out of 83 patients, maternal risk factors were identified in 41(49.59%) cases where fetal risk factors were found in 16(19.27%) cases; no risk factors could be determined in rests. Hypertension (48.78%), diabetes (21.95%), hyperpyrexia (17.3%), abruptio placentae (4.88%) and UTI (7.36%) were identified as maternal factors; and congenital anomaly (37.5%), Rh incompatibility (37.5%), multiple pregnancy (12.5%) and post-maturity (12.5%) were the fetal risk factors. Here, proximal biological risk factors are most important in ante-partum fetal deaths. More investigations and facilities are needed to explain the causes of antepartum deaths.

Isotopic effect study of propofol deuteration on the metabolism, activity, and toxicity of the anesthetic.

The use of isotopic substitution to delay the oxidative metabolism of the anesthetic propofol 1 was studied. The aromatic hydrogens of propofol 1 were replaced by deuterium to produce the mono- and trideuterated derivatives 4 and 5. In vitro metabolic studies on human hepatic microsomes showed no isotopic effect in the para hydroxylation of propofol, and 1, 4, and 5 display similar hypnotic activity and toxicity in mice.

A potential melanoma tracer: synthesis, radiolabeling, and biodistribution in mice of a new nitridotechnetium bis(aminothiol) derivative pharmacomodulated by a N-(diethylaminoethyl)benzamide.

Radioiodobenzamides are the best-known agents under study for the diagnosis of cutaneous melanoma and its metastases. We report the synthesis of a new BAT derivative radiopharmaceutical in which radioiodine is replaced by 99m-technetium. The cyclic intermediary methyl 4-[3-(4,4,7,7-tetramethyl-5,6-dithia-2, 9-diazacyclodecyl)-2-oxapropyl]benzoate (5) occurred in two different conformations identified by spectroscopic analysis. The final BAT ligand was radiolabeled using the nitridotechnetium core by a ligand-exchange reaction. Two different complexes were purified. After macroscopic 99-technetium synthesis, syn and anti isomers were identified. The global radiochemical yield was over 80%. The biodistribution of these two complexes was evaluated in mice bearing murine B16 melanoma. Extensive liver and kidney uptake was observed, but the benzamide tropism for the tumor was partially preserved.

Disposition and metabolism of a novel antineoplastic agent, 4-tert-butyl-[3-(2-chloroethyl)ureido]benzene, in mice.

1-Aryl-3-(2-chloroethyl)ureas are new agents that have shown promising cytotoxic and antineoplastic activities. In this work, we studied the disposition and metabolism of one of these molecules, 4-tert-butyl-[3-(2-chloroethyl)ureido]benzene (tBCEU). tBCEU was labeled with 14C and 13C in the urea function and in the chloroethyl moiety. After ip administration of the molecule labeled in the urea function, radioactivity was widely distributed in the whole organism, including the brain. HPLC analysis of plasma showed that tBCEU was extensively metabolized, with <20% being found in the plasma as unchanged tBCEU 1 hr after administration. One main metabolite was identified by NMR and MS analysis as N-[4-(2-hydroxy-1, 1-dimethylethyl)phenyl]urea, widely conjugated to glucuronic acid. The same metabolite was found in the urine. After administration of tBCEU labeled in the chloroethyl moiety, the same tissue affinities were observed, but the decrease of total radioactivity in blood and tissues was slower than that observed for the molecule labeled in the urea function. HPLC analysis of urine showed the presence of two main metabolites, identified by MS as thiodiacetic acid and its sulfoxide. From these results, we can deduce that the metabolic pathway of tBCEU involves N-dealkylation of the urea portion of the molecule and hydroxylation of the tert-butyl group. The strong cytochrome P450 reactivity of the carbon adjacent to the urea portion of tBCEU is probably related to particular sensitivity to oxidation at this position, based on the chemical structure of tBCEU. These results can explain the fact that the cytotoxic effect of tBCEU is not due to DNA alkylation, in contrast to that of its parent molecule, chloroethylnitrosourea.

Rat intestinal beta-carotene dioxygenase activity is located primarily in the cytosol of mature jejunal enterocytes.

The purposes of this study were to determine the location of beta-carotene dioxygenase (EC 1.13.11.21) activity within the rat gastrointestinal tract, within the villus and within enterocytes, and to identify the metabolites produced in each intestinal fraction. In Wistar female rats, maximal activity was detected in the cytosol (74-93% of the total cellular activity) of mature functional enterocytes harvested from the jejunum (67% of the intestinal activity). The specific activity, expressed in pmol of retinoids/(h x mg protein) rose from 49 +/- 3 in the stem cells to 199 +/- 12 in the mature functional cells (P < 0.05). Thus the intestinal beta-carotene cleavage activity might be regulated during the enterocyte maturation process. By using HPLC with diode array and radioactive detectors, retinal, and in the presence of NAD+, retinoic acid, were identified as the only metabolites produced. No beta-12'-, 10'-, and 8'-apo-carotenals were detected, even when various enzyme sources were tested. These results suggest that the major, if not the sole, pathway for the formation of vitamin A from beta-carotene in the rat intestine is central cleavage.