Pregnancy outcome in patients with raised blood glucose due to a heterozygous glucokinase gene mutation.

AIM: To assess determinants of fetal growth in the offspring of pregnant women with hyperglycaemia due to a heterozygous glucokinase (GCK) gene mutation. METHODS: Details of gestational age at delivery, fetal birth weight and maternal antenatal treatment were collected from patients and retrospective case note review of 82 offspring born to 42 women with GCK gene mutations and 31 offspring born to 13 unaffected normoglycaemic women with an affected partner. Fetal genotype was determined using direct sequencing from either a mouth swab or a blood sample. RESULTS: In mothers with GCK mutations, non-mutation-carrying offspring were heavier than mutation-carrying offspring (corrected birth weight 3.9 +/- 0.6 vs. 3.2 +/- 0.8 kg; P < 0.001) and more likely to be macrosomic (> 4.0 kg; 39% vs. 7%, P = 0.001). There was no difference in corrected birth weight between offspring of insulin- and diet-treated women (3.7 +/- 0.7 vs. 3.8 +/- 0.6 kg; P = 0.1), although insulin-treated mothers delivered earlier (37.5 +/- 1.7 vs. 38.9 +/- 2.3 weeks; P < 0.001) due to increased obstetric intervention. CONCLUSIONS: Offspring of women with GCK mutations are at increased risk of macrosomia and its obstetric consequences. Fetal birth weight is predominantly altered by fetal genotype and not treatment of maternal hyperglycaemia with insulin. This probably reflects the large effect of a fetal GCK mutation on fetal insulin secretion and the difficulty in reducing the regulated maternal glycaemia caused by a glucose sensing defect in people with GCK mutations.

Fluoride intake of infants in New Zealand.

Since the fluoride (F-) intake of New Zealand infants and young children is not known, a study was designed to determine and compare the F- intake of infants, aged 11 to 13 months, residing in fluoridated (F) and non-fluoridated (NF) areas. Parents of 60 infants duplicated quantitatively and qualitatively all food and drink that the infants ingested during a three-day period. The acid-diffusible F- content in the liquid homogenate was isolated by the HMDS-HCl diffusion technique (Taves, 1968) and measured by a fluoride electrode. The ionic F- in samples of breast milk was measured directly by the electrode. In the F area, the F- content of the food and drinks of 31 subjects ranged from 0.130 to 0.679 mg/kg (mean, 0.320; SD, 0.168); in the NF areas, the F- content of the food and drinks of 29 subjects ranged from 0.036 to 0.281 mg/kg (mean, 0.095; SD, 0.053). The dietary intake ranged from 0.089 to 0.549 mg F/day (0.009-0.056 mg F/kg bw) in the F area, and from 0.038 to 0.314 mg F/day (0.004-0.038 mg F/kg bw) in the NF area. Including F- from tablets and toothpastes, total intake ranged from 0.093 to 1.299 mg F/day (0.009-0.150 mg F/kg bw) and from 0.039 to 0.720 mg F/day (0.004-0.061 mg F/kg bw) in F and NF areas, respectively. The mean dietary intake of infants in the F area was about half the recommended "optimal" range; in the NF areas, the dietary intake was five to seven times less than the optimal.(ABSTRACT TRUNCATED AT 250 WORDS)

Purification and properties of a protease from developing porcine dental enamel.

A protease of molecular weight 29,000 was isolated and purified using ammonium sulphate precipitation, lentil lectin-Sepharose affinity chromatography and DEAE-5PW ion-exchange chromatography. The protease had an unusual amino acid composition including 5% serine, 6% proline and 20% tyrosine. It was a glycoprotein containing 12-15% carbohydrate by weight. Activity was optimal at 40-45 degrees C using [3H]-acetyl casein substrate and at 40-55 degrees C using [3H]-acetyl enamel protein substrate. It was irreversibly denatured at 80 degrees C and above. With [3H]-acetyl casein the pH optimum was 8.0-8.5 and with [3H]-acetyl enamel protein it was 6.0-8.0. There was no activity below pH 5.0, and irreversible denaturation occurred at pH 4.0 and below. No autodegradation occurred with storage at 4 degrees C for 30 days at pH 7.0. Phenylmethylsulphonyl fluoride, mercuric chloride, and p-aminobenzoic acid completely inactivated the protease. The enzyme had no requirement for calcium. The sites of cleavage of the oxidized B-chain of insulin were the Cys-Gly and Arg-Gly bonds. The enzyme was therefore an endopeptidase. Cleavage of Na-benzoyl-L-arginine ethyl ester, but not Na-benzoyl-L-tyrosine ethyl ester, suggests that the protease is of the trypsin family. On the basis of its physical and enzymic properties the protease is a serine proteinase and, consistent with existing terminology, has been named proteinase pemB.

Phase I safety & preliminary acceptability of nonoxynol-9 vaginal pessary as a vaginal microbicide in low risk women in Pune, India.

BACKGROUND & OBJECTIVES: Though nonoxynol-9 (N-9) is available in India as a spermicidal pessary, data on its safety as a potential microbicide among Indian women are not available. Nonoxynol-9 containing compounds have shown anti-HIV activity in in vitro studies and protection against cervical infections. Nonoxynol-9 is being extensively evaluated as a vaginal microbicide world-wide. We assessed the safety and preliminary acceptability of nonoxynol-9 pessary as a vaginal microbicide in women at low risk for human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs). METHODS: Twenty three HIV seronegative women enrolled in the study were given Today pessarys containing 5 per cent of nonoxynol-9 for vaginal use at bedtime for 14 days. Colposcopy was done at enrollment and on day 14 and speculum examination on day 7 to assess the local toxicity. RESULTS: Most of the women (16/23, 69.6%) did not experience any symptoms of genital irritation. The remaining 7 (30.4%, 95% CI 11.6-49.2) women reported 11 episodes of mild irritative symptoms of short duration. On clinical examination, three adverse events were reported of which one could have been product related. Eight (34.8%) women showed willingness to use the product for protection against HIV transmission if it was approved. INTERPRETATION & CONCLUSION: Nonoxynol-9 vaginal pessary was found to be safe and acceptable in once daily dose in low risk women after consecutive use for 14 days. Willingness for future use, if found safe and effective for HIV prevention was shown by 8 (34.8%) women.

The prevalence and impact of dental pain in 8-year-old school children in Harrow, England.

OBJECTIVE: To assess the prevalence, severity and impact of dental pain. DESIGN: Cross-sectional survey. SETTING: Schools in the London Borough of Harrow, England, in the summer term of 1995. SUBJECTS AND METHODS: The base population were all 2,300 8-year-old school children in Harrow. A cluster sampling of schools based on quotas from all postcode areas in Harrow was used. Data were collected through interviews with the children. MAIN OUTCOME MEASURES: Prevalence of previous toothache; prevalence of toothache in the previous 4 weeks; prevalence of toothache in the previous 4 weeks which resulted in a visit to the dentist, in stopping playing, eating, sleeping, going to school and taking painkillers. RESULTS: Of the 664 sample of children in the participating schools, 589 were interviewed (88.7%). The frequency of previous toothache was 47.5% (95% CI, 44-52) and dental pain caused crying in 17.7% (95% CI, 15-21) of children. 7.6% (95% CI, 5-11) of children had pain in the previous 4 weeks (45 children). Among these 45 children, this recent pain resulted in a visit to the dentist in 41.9% (19 children, i.e. 3.2% of all children), in stopping playing in 26.7% (12 children, i.e. 2.0% of all children), eating in 73.3% (33 children, i.e. 5.6% of all children), sleeping in 31.1% (14 children, i.e. 2.4% of all children) and in going to school in 11.1% (5 children, i.e. 0.8% of all children). CONCLUSION: Toothache in children is a sizeable problem in Harrow and had substantial consequences for children and their guardians. Freedom from disabling dental pain/discomfort is an outcome indicator of oral health and could be used as an explicit goal by dental systems. It is important to note however, that the present study did not assess the extent to which the dental pain was associated with avoidable dental problems as opposed to normal physiological processes. It is important that future work try and separate the prevalence of dental pain caused by physiological from avoidable pathological factors. In addition, future work is needed to assess how effectively and efficiently dental services are responding to people suffering with dental pain.

An examination of students' attitudes toward the elderly.

A study, employing Kogan's Old People Scale, was conducted to investigate undergraduate pharmacy students' attitudes toward the elderly. A total of 266 students from one school of pharmacy in their last three years of schooling comprised the sample. Demographic and experiential factors with the aged also were examined as to their relationship with the students' attitudes, but only one of these variables was found to be significant. Female students had a significantly more favorable attitude toward the aged than males. Overall the results showed that the students had a favorable attitude toward the elderly, which was consistent with other studies employing college students, but which was in contrast to other health professionals and medical and dentistry students. A discussion is made as to why this difference exists and the importance of future research in this area.

Family, culture, and health practices among migrant farmworkers.

Migrant farmworkers and their families have restricted access to health and human services because of their frequent relocation between states, language and cultural barriers, and limited economic and political resources. Living and working in substandard environments, these families are at greater risk for developing chronic and communicable disease. In an assessment of health patterns among 225 migrant workers and their families, using personal observations, unstructured interviews, and individual and state health records, children's immunizations were found to be current, but dental caries and head lice were epidemic. Among adults, almost one third tested positive for tuberculosis exposure. Urinary tract infections were the most common health problem among women. Primary and secondary prevention were almost nonexistent because funds for these services were not readily available. The patriarchal system contributes to these problems by limiting access to family-health and social service needs. Although providing comprehensive health care to migrant communities presents unique challenges, nurses can demonstrate their effectiveness in reducing morbidity through strategic interventions and alternative uses of health delivery systems.

Differential profiles of soluble proteins during the initiation of morphogenesis in Candida albicans.

Candida albicans is a dimorphic fungus that can grow either as yeast or as mycelia. The mycelial form may be required for tissue penetration and therefore may have a role in pathogenesis. The protein profiles of the cell-free S100 fraction from budding yeast cells and germ tube-forming cells (an early stage of the transition between yeast and mycelia) were evaluated using two-dimensional polyacrylamide gel electrophoresis (2-D PAGE). Yeast growth or germ tube formation was induced in carbon-starved cells at 37 degrees C by either glucose, galactose or N-acetylglucosamine at pH 4.5 or pH 6.7. More than 400 constitutively synthesised polypeptides were identified on 2-D PAGE by silver staining. A few polypeptides which seem to reflect the release from carbon starvation were detected, but no polypeptides unique to either morphology were observed. Fractionation of S100 preparations by polyethylenimine or heparin-agarose affinity chromatography, which have been used to detect DNA-binding proteins, revealed several proteins that were synthesised on the resumption of cell growth or in response to pH difference. Heparin-agarose also bound novel polypeptides in the size range 130-200 kDa that were preferentially synthesised in germ tube-forming cells. These results suggest that any protein factors that might exert a regulatory role early in germ tube formation are of low abundance, and that a minor group of soluble proteins involved in C. albicans morphogenesis may be differentially synthesised.

Substrate specificity and mode of action of a cellulase from Aspergillus niger.

The mode of action and substrate specificity of a cellulase purified from Aspergillus niger were examined. The enzyme showed little capacity to hydrolyse highly ordered cellulose, but readily attacked soluble cellulose derivatives and amorphous alkali-swollen cellulose. Activity towards barley glucan and lichenin was greater than with CM-cellulose. Low activity was detected with CM-pachyman (a substituted beta-1,3-glucose polymer) and xylan. Activity towards yeast glucan, mannan, ethlene glycol chitin, glycol chitosan, laminarin, polygalacturonic acid and pectin could not be demonstrated. Cellobiose and p-nitrophenyl beta-D-glucoside were not hydrolysed, whereas the rate of hydrolysis of the higher members of the reduced cellulodextrins increased with chain length. The central bonds of cellotetraosylsorbitol and cellopentaosylsorbitol were the preferred points of clevage. Kinetic data indicated that the specificity region of the cellulase is five glucose units in length. The evidence indicates that the cellulase is an endoglucanase.

Peanut sensitivity as a cause of burning mouth.

A patient with a history of a burning tongue together with discomfort of the labial and buccal mucosae was given an elimination diet and skin patch tests to determine the allergen in her diet. The patient was identified as being intolerant of an aqueous peanut extract. Three allergens in peanut butter were identified, the one with greatest reactivity being a heat-stable, water-soluble, nonglycosylated protein with a molecular weight in excess of 10 kD. Modification of her diet has resulted in resolution of the oral problem.