A pilot randomized controlled trial of time-intensive cognitive-behaviour therapy for postpartum obsessive-compulsive disorder: effects on maternal symptoms, mother-infant interactions and attachment.

BACKGROUND: There is increasing recognition that perinatal anxiety disorders are both common and potentially serious for mother and child. Obsessive-compulsive disorder (OCD) can be triggered or exacerbated in the postpartum period, with mothers reporting significant effects on parenting tasks. However, there is little evidence concerning their effective treatment or the impact of successful treatment on parenting. METHOD: A total of 34 mothers with OCD and a baby of 6 months old were randomized into either time-intensive cognitive-behaviour therapy (iCBT) or treatment as usual (TAU). iCBT took place after randomization at 6 months postpartum and was completed by 9 months. Maternal symptomatology, sensitivity in mother-infant interactions and parenting were assessed at baseline and reassessed at 12 months postpartum. At 12 months attachment was also assessed using Ainsworth's Strange Situation Procedure. A healthy control group of mothers and infants (n = 37) underwent the same assessments as a benchmark. RESULTS: iCBT was successful in ameliorating maternal symptoms of OCD (controlled effect size = 1.31-1.90). However, mother-infant interactions were unchanged by treatment and remained less sensitive in both OCD groups than a healthy control group. The distribution of attachment categories was similar across both clinical groups and healthy controls with approximately 72% classified as secure in each group. CONCLUSIONS: iCBT is an effective intervention for postpartum OCD. Sensitive parenting interactions are affected by the presence of postpartum OCD and this is not improved by successful treatment of OCD symptoms. However, the overall attachment bond appears to be unaffected. Longitudinal studies are needed to explore the impact of postpartum OCD as the child develops.

Special-Fed Veal: Separable components, proximate composition, and nutrient analysis of selected raw and cooked, wholesale and retail cuts.

Nutrition research continues to be important for consumers to make informed food purchasing decisions and is used in nutrition policy decisions. The objective of this study was to analyze the nutrient concentration of raw and cooked cuts from special-fed veal calves to update nutrient data in the USDA National Nutrient Database for Standard Reference (SR) Release 27. Packages of wholesale (whole loin roasts, center-cut hindshanks and ground veal) and retail veal cuts (osso buco foreshanks, loin chops, leg cutlets and shoulder blade chops) were randomly collected in original vacuum packaging from six U.S. suppliers. Packages were shipped to the Colorado State University Meat Laboratory for cut dissection, cooking, and nutrient analysis. Composites of lean, external fat and seam fat were formed for analysis of proximate, fatty acid, vitamin and mineral composition. Results from this study identified additional fatty acids, established choline concentration, and provided updated veal nutrient composition information for inclusion in USDA SR 27.

Effects of ractopamine hydrochloride on the growth performance and carcass characteristics of heavy-weight finishing pigs sent for slaughter using a 3-phase marketing strategy.

A total of 2,158 crossbred pigs was used to evaluate the effects of feeding 7.4 mg/kg ractopamine hydrochloride (RAC) on the growth performance and carcass characteristics of heavy-weight finishing pigs sent to slaughter using a 3-phase marketing strategy. The study was performed from 121.0 ± 4.28 kg to 144.5 ± 4.73 BW using a randomized complete block design (blocking factor was d of start on test) with 2 treatments (0 vs. 7.4 mg/kg RAC). Pigs were housed in a commercial wean-to-finish facility in groups of approximately 25 (44 groups/treatment), with ad libitum access to feed and water throughout the study, and pen weights of pigs were recorded at the start (d 0), and on d 7, 21, and 35 of study. Pigs were sent for slaughter according to the following marketing strategy: 1) after 7 d on RAC, the heaviest 16% of each pen was sent for slaughter (Phase 1), 2) after 21 d on RAC, the next 40% of each pen was sent for slaughter (Phase 2), and 3) after 35 d on RAC, the remaining 44% of each pen was sent for slaughter (Phase 3). Pigs were selected for slaughter by visual appraisal and shipped to a commercial facility where standard carcass measurements (HCW, LM depth, and backfat depth) were measured. Overall, feeding RAC increased (P < 0.001) ADG (18.8%) and G:F (23.7%) compared to the control, but lowered (P < 0.001) ADFI (3.3%). In addition, feeding RAC increased (P < 0.001) HCW (3.9 kg), carcass yield (0.7% units), LM depth (5.0%), and predicted lean content (1.0% units), and reduced backfat depth (6.3% lower) compared to controls. With each subsequent phase of marketing, the magnitude of improvements in response to feeding RAC decreased for ADG (43.1, 20.9, and -3.1% for Phase 1, 2, and 3, respectively) and G:F (37.5, 25.8, and 6.4% for Phase 1, 2, and 3, respectively); however, improvements in HCW (1.6, 4.5, and 4.2 kg for Phase 1, 2, and 3, respectively), carcass yield (0.2, 0.6, and 0.9% units for Phase 1, 2, and 3, respectively), LM depth (2.3, 5.7, and 5.2% for Phase 1, 2, and 3, respectively), and predicted lean content (0.2, 1.0, and 1.3% units for Phase 1, 2, and 3, respectively) generally increased from feeding RAC. These results suggest that while improvements in growth performance from feeding RAC will generally decline after 21 d of feeding, improvements in carcass traits, particularly carcass yield and lean content, will continue with feeding RAC until d 35.

Nutrient database improvement project: Separable components and proximate composition of raw and cooked retail cuts from the beef loin and round.

Beef nutrition research has become increasingly important domestically and internationally for the beef industry and its consumers. The objective of this study was to analyze the nutrient composition of ten beef loin and round cuts to update the nutrient data in the USDA National Nutrient Database for Standard Reference. Seventy-two carcasses representing a national composite of Yield Grade, Quality Grade, sex classification, and genetic type were identified from six regions across the U.S. Beef short loins, strip loins, tenderloins, inside rounds, and eye of rounds (NAMP # 173, 175, 190A, 169A, and 171C) were collected from the selected carcasses and shipped to three university meat laboratories for storage, retail fabrication, and raw/cooked analysis of nutrients. Sample homogenates from each animal were analyzed for proximate composition. These data provide updated information regarding the nutrient status of beef, in addition, to determining the influence of Quality Grade, Yield Grade, and sex classification on nutrient composition.

Acidic epinephrine analogues derived from 1H, 3H-2,1,3-benzothiadiazole 2,2-dioxide and from trifluoromethanesulfonanilide. A new synthesis of 1H,3H-2,1,3-benzothiadiazole 2,2-dioxide.

Treatment of N,N'-dibenzyl-1,2-diaminobenzene (2) successively with thionyl chloride and then m-chloroperbenzoic acid gave N,N'-dibenzyl-1H,3H-2,1,3-benzothiadiazole 2,2-dioxide (4), which gave (via routes analogous to standard epinephrine syntheses) four bicyclic catecholamine analogues 7a-d. Hydrogenolysis of 4 yielded the parent heterocycle 5 in the first practicable synthesis avoiding expensive sulfamide (Scheme I). The trifluoromethanesulfonamidoacetophenones 8m and 8p on similar elaboration gave triflanilide catecholamine analogues 14m, 14p,17m, and 17p (Scheme II). 4,4'Dimethoxybenzhydrylamine (15) is recommended for the regiospecific synthesis of primary amines from epoxides (Scheme II). Series 7,14, and 17 were inactive in animal cardiovascular screens. Selected compounds were also screened in bronchodilator and in in vitro dopamine-, clonidine-, and prazosin-receptor binding assays as appropriate; again no activity was observed. Steric lipophilicity, and acidity factors are discussed, and the inactivity is ascribed to the high acidity of both systems (pKa approximately equal to 4).

Neodymium-YAG laser vitreolysis in sickle cell retinopathy.

Six patients with proliferative sickle cell retinopathy and vitreous bands were treated with the neodymium-YAG (Nd-YAG) laser to accomplish lysis of avascular traction bands or to clear the media in front of the macula. Transection of bands was possible in five of the six cases but in two of these the effect was only partial. Three cases were satisfactorily treated with the Nd-YAG laser application alone, two eventually required conventional vitreoretinal surgery, and one patient's condition stabilized despite failure of the treatment. Complications from the treatment occurred in three cases and included subretinal (choroidal) hemorrhage, preretinal hemorrhage, microperforation of a retinal vein, and focal areas of damage to the retinal pigment epithelium. Neodymium-YAG vitreolysis may be a useful modality in carefully selected patients with proliferative sickle cell retinopathy, but potentially sight-threatening complications may occur.

Calcification of Bruch's membrane in angioid streaks with homozygous sickle cell disease.

Histochemical and light and electron microscopic studies of two eyes of a patient with homozygous sickle cell disease and angioid streaks demonstrated heavy calcification and breaks in Bruch's membrane. We were unable to demonstrate iron deposition by histochemical techniques or transmission electron microscopy. These studies suggest that calcification rather than iron deposition is the major factor leading to brittleness of Bruch's membrane in patients with hemolytic anemia and angioid streaks.

A randomized clinical trial of scatter photocoagulation of proliferative sickle cell retinopathy.

A randomized prospective clinical trial of argon laser scatter photocoagulation therapy for proliferative sickle cell retinopathy was performed on 116 patients (174 eyes) in Kingston, Jamaica. Ninety-nine eyes were treated with scatter photocoagulation and 75 eyes served as controls. The average length of follow-up was 42 months for the control eyes and 47 months for the treated eyes. Prolonged loss of visual acuity was statistically significantly reduced in the treated eyes. The incidence of vitreous hemorrhage was also significantly reduced in the treated eyes after controlling for the previously defined risk factors of vitreous hemorrhage and extent of proliferative sickle cell retinopathy at entry into the study. There were no complications associated with argon laser scatter photocoagulation. Scatter photocoagulation of proliferative sickle cell retinopathy is currently the most effective and safe way to treat patients with sea fan neovascularization.

The definition and identification of need for health care.

Some definitions of need for health care as a basis of planning health services are discussed. A model proposed by Donabedian (1974) relating need to resources is used to consider the problems faced by the Resource Allocation Working Party (RAWP) (Department of Health and Social Security, 1976). The paper concludes that need should be defined in relation to the procedures available to meet it and the resources that permit those procedures to be used. The procedures include the whole gamut of prevention and screening, cure and care, research and development. This necessarily raises moral and ethical issues which stretch beyond the limits of medicine and concern patients, their relatives, and the public in general. Neither the medical profession nor the lay public can be expected to help define need for health care unless they understand the underlying issues. This is a challenge to those responsible for professional and public education.

Primary association of HLA-B51 with Behçet's disease in Ireland.

AIMS/BACKGROUND: While a primary association of HLA-B51 with Behçet's disease (BD) in Japanese and Mediterranean patients supports an immunogenetic predisposition, this link is unclear in north western Europe. This study assessed HLA associations with BD, and HLA-B51 with certain clinical characteristics, in the Republic of Ireland, which has an ethnically homogeneous population. METHODS: HLA-A, HLA-B, and HLA-DR typing was performed in 24 BD patients, conforming to International Study Group criteria, and in blood donors, as controls. Patient records were retrospectively reviewed and patients reassessed clinically. RESULTS: A highly significant HLA-B51 association (corrected exact p value = 0.002, relative risk = 6.3) with BD was determined, despite a low B51 prevalence (25%) in patients. No other HLA type was associated. There was a significant B51 link with male sex in BD patients but no association with age at first manifestation/diagnosis, eye involvement, cyclosporin A therapy, or poor visual acuity was determined. CONCLUSIONS: This study supports a HLA-B51 immunogenetic predisposition, similar to Japanese patients, in Irish BD in an ethnically homogeneous population in north western Europe. However, owing to a low prevalence of B51 positivity in BD patients in Ireland, a multifactorial pathogenesis is suggested.

Epiretinal membranes in sickle cell disease.

Epiretinal membranes at the macula were seen in 4% of the eyes of 355 patients with homozygous sickle cell (SS) disease and sickle cell haemoglobin-C (SC) disease under the age of 60 years. The presence of proliferative sickle retinopathy (PSR), the extent of involvement of PSR, and vitreous haemorrhage all constitute risk factors for the formation of epiretinal membranes. The occlusion of PSR lesions by treatment appears to reduce the risk of epiretinal membranes being formed.

Bietti's tapetoretinal degeneration with marginal corneal dystrophy (crystalline retinopathy): case report.

A patient with Bietti's tapetoretinal degeneration and marginal corneal dystrophy is reported on. Refractile deposits found in both the retina and cornea are the most striking feature of this condition. Apart from a slight reduction in left visual acuity there were no visual symptoms. The dark adapted electroretinogram was abnormal. No metabolic disturbance was detected.

Outcome of iatrogenic choroidal neovascularisation in sickle cell disease.

Choroidal neovascularisation developed in 62/66 (94%) eyes followed up for a mean period of 11.2 years after treatment with xenon arc feeder vessel coagulation for proliferative sickle retinopathy (PSR). In 27 eyes the neovascularisation was chorioretinal alone and in 35 eyes choriovitreal. Chorioretinal neovascularisation (CRN) was a benign complication but may convert to choriovitreal neovascularisation (CVN). Late sequelae of CVN included vitreous haemorrhage, posterior vitreous face fibrosis, and tractional retinal detachment. Visual loss (of greater than or equal to 3 Snellen lines for greater than or equal to 3 months) occurred in nine eyes affected by choroidal neovascularisation, though because of other pathology this could not always be attributed to the choroidal neovascularisation. The incidence of visual loss in CVN affected eyes was significantly greater, by survival curve analysis, than in eyes affected by CRN alone. Permanent visual loss from tractional retinal detachment definitely attributable to CVN occurred in 2/35 (6%) eyes.

Treatment of iatrogenic choriovitreal neovascularisation in sickle cell disease.

The effect of scatter photocoagulation on the perfusion of iatrogenic choriovitreal neovascularisation (CVN) has been assessed by a randomised trial in 35 CVN lesions in 18 eyes with proliferative sickle retinopathy. No difference in size or vascularity of CVN lesions was apparent between the nine treated and nine control eyes over a median follow-up of 42 months. Scatter photocoagulation by the stated protocol was not effective in the treatment of CVN.

Iris atrophy in sickle cell disease.

Iris atrophy, of unknown origin and believed to be secondary to the vaso-occlusive process of sickle cell disease, has been observed in 25 eyes of 22 patients (two SS disease, 20 SC disease). The crude prevalence was highest in males with SC disease, in whom 14.7% of patients were affected. Iris atrophy was closely associated with proliferative sickle retinopathy in the same eye. Analysis of haematological indices failed to reveal any significant differences between patients with and without iris atrophy. The characteristics and distribution of iris atrophy are described as well as the histopathology in one 68-year-old male patient with SS disease.

Diabetic retinopathy in Down's syndrome.

AIM: To determine the prevalence of diabetic retinopathy in patients with Down's syndrome and diabetes mellitus. METHODS: Nine patients with Down's syndrome and diabetes mellitus were assessed. Factors recorded included type and duration of diabetes, level of diabetic control, blood pressure, urinalysis, and results of ophthalmological examination. RESULTS: The duration of diabetes ranged from 8 to 41 years (mean 17.6 years). All had satisfactory glycaemic control and blood pressure measurements on the low side of normal (mean 106.6/70 mm Hg). One patient had early background diabetic retinopathy. The remainder had no evidence of diabetic retinopathy. CONCLUSION: The low prevalence of diabetic retinopathy in these Down's syndrome patients, despite the long duration, is an interesting finding. It suggests some inherent protective factor against the development of diabetic retinopathy in this patient subgroup.

Prevalence of diabetic retinopathy in patients with diabetes mellitus diagnosed after the age of 70 years.

AIMS/BACKGROUND: A hospital based prevalence study was undertaken to estimate the prevalence of diabetic retinopathy (DR) in patients diagnosed as having diabetes mellitus after the age of 70 years. The prevalence of visually threatening retinopathy at the time of diagnosis of diabetes was also determined. The association between prevalence of DR and duration of diabetes mellitus, mode of treatment, HbA1c levels, presence of hypertension, and sex of patient was examined and a comparison was drawn between this study and earlier prevalence studies of DR in older type II diabetics. METHODS: Using data on the Irish Diabetic Retinopathy Register located in the Mater Misericordiae Hospital, Dublin, all patients who were diagnosed as having type II diabetes mellitus after the age of 70 years were invited to attend for ophthalmic review. Medical records were examined to determine the duration of diabetes mellitus, mode of treatment, recent HbA1c levels, and the presence of systemic hypertension. RESULTS: Of the 150 patients examined, 21 (14%) had some form of DR and 10 of these patients (6.6%) had visually threatening retinopathy or previously treated visually threatening retinopathy. Five patients (3.3%) presented with visually threatening retinopathy at the time of diagnosis of diabetes. Those patients with DR had a significantly higher median duration of diabetes (5.0 years) compared with those patients without DR (3.5 years). A significantly higher proportion of patients with DR required treatment with insulin and a correspondingly lower proportion of patients without DR were controlled on diet alone. There was no significant association between prevalence of DR and HbA1c levels, systemic hypertension, or sex of patient. There was a lower overall prevalence of DR in comparison with earlier studies. CONCLUSIONS: The prevalence of DR in these elderly type II diabetics is lower than than previously reported in patients with type II disease but a small percentage of patients had visually threatening retinopathy at presentation. Longer duration of diabetes and insulin use were associated with a significantly increased prevalence of DR. All elderly type II diabetic patients require thorough ophthalmic examination near to the time of first presentation and thereafter at regular intervals.

Sickle cell retinopathy in Jamaican children: further observations from a cohort study.

Serial retinal examinations were performed in children aged 5 years and older and fluorescein angiography/angioscopy in children 6 years and older participating in a cohort study of sickle cell disease. There were 1229 patient years of observation among 389 children aged 5-13 years. Peripheral retinal vessel closure was present in approximately 50% of children with SS and SC genotypes at age 6 years and increased to affect 90% of children by age 12 years. A matched pair analysis, comparing groups with minimal and complete closure, indicated that complete closure was associated with significantly lower total haemoglobin and fetal haemoglobin levels and significantly lower weight in SS disease, whereas in SC disease the risk factors appeared to be high mean cell volume and low platelet count. Proliferative retinopathy was rare, occurring only once in an 8-year-old boy with SC disease, despite 592 patient years of observation in children over this age.

Immunogenetics and clinical phenotype of sympathetic ophthalmia in British and Irish patients.

BACKGROUND/AIMS: Sympathetic ophthalmia (SO) is a classic example of autoimmune disease where human leucocyte antigen (HLA) genomic associations could provide further understanding of mechanisms of disease. This study sought to assess HLA genetic polymorphism in British and Irish patients with SO, and to assess whether HLA gene variants are associated with clinical phenotype or disease severity. METHODS: High resolution DNA based HLA typing using polymerase chain reaction sequence specific primers was performed in 27 patients with SO and 51 matched healthy controls. Clinical phenotype and markers of disease severity were determined prospectively in 17 newly diagnosed patients and from medical record review and repeat clinical examination in 10 previously diagnosed patients. RESULTS: HLA-Cw*03 (p=0.008), DRB1*04 (p=0.017), and DQA1*03 (p=0.014) were significantly associated with SO. For class II alleles at higher resolution, only HLA-DRB1*0404 (relative risk (RR) = 5.6, p = 0.045) was significantly associated with SO. The highest relative risk for any of the associated haplotypes was with HLA-DRB1*0404-DQA1*0301 (RR=10.9, p=0.019). Patients with the DRB1*04-DQA1*03 associated haplotype were significantly more likely to develop SO earlier, with fewer inciting ocular trauma events, and to require more systemic steroid therapy to control inflammatory activity. CONCLUSIONS: Sympathetic ophthalmia is associated with HLA-DRB1*04 and DQA1*03 genotypes in white patients, similar to Japanese patients. Differences in DRB1*04 gene variant associations (-0404 in Britain and Ireland and -0405 in Japan) may have implications for HLA peptide binding in disease initiation. The DRB1*04-DQA1*03 haplotype is a marker of increased SO susceptibility and severity, as in Vogt-Koyanagi-Harada disease, which also has similar clinicopathological and HLA associations.