Feasibility and Acceptability of Mindfulness-based Stress Reduction and Prenatal Sleep Classes for Poor Prenatal Sleep Quality: Pilot Randomized Controlled Trial.

OBJECTIVES: The main objectives of the current paper were to examine the feasibility, acceptability, and adherence of a remotely delivered intervention consisting of mindfulness-based stress reduction plus prenatal sleep classes (MBSR+PS) compared with treatment as usual (TAU). METHOD: In this pilot randomized controlled trial, 52 pregnant women with poor sleep quality were randomized to MBSR+PS or TAU. MBSR was delivered through eight weekly 2.5-hour sessions, and PS was delivered through eight weekly 30-minute sessions. PS content drew material from cognitive behavioral therapy for insomnia tailored for the perinatal period and from a mindfulness- and acceptance-based lens. Participants completed endpoint measures 10-12 weeks after randomization. RESULTS: We surpassed all acceptability targets, including the percentage of eligible participants willing to be randomized (96%), percentage of participants who initiated treatment (88%), and satisfaction scores (Client Satisfaction Questionnaire-8 score M = 28.04, SD = 3.6). We surpassed all feasibility targets, including our enrollment target, retention rate (92%), and measure completion (96%). Finally, we surpassed adherence targets, including MBSR and PS session attendance (≥80%). Though sleep outcomes were exploratory, increases in sleep efficiency were greater in the MBSR+PS group relative to TAU (SMD=.68). CONCLUSIONS: Patient-reported poor sleep quality during pregnancy has high public health significance because it is common, consequential, and under-treated. The current feasibility and acceptability data for using remotely delivered MBSR and PS to improve prenatal sleep quality are encouraging and warranting future research that is sufficiently powered and designed to provide efficacy data. In addition, exploratory sleep outcomes offer preliminary evidence that this sleep program may improve sleep efficiency during pregnancy.

Effect of process-induced common bean hardness on structural properties of in vivo generated boluses and consequences for in vitro starch digestion kinetics.

In the present study, we evaluated the effect of process-induced common bean hardness on structural properties of in vivo generated boluses and the consequences for in vitro starch digestion. Initially, the impact of human mastication on the particle size distribution (PSD) of oral boluses from common beans with different process-induced hardness levels was investigated through a mastication study. Then the effect of structural properties of selected boluses on in vitro starch digestion kinetics was assessed. For a particular process-induced hardness level, oral boluses had similar PSD despite differences in masticatory parameters between participants of the mastication study. At different hardness levels, a clear effect of processing (P<0·0001) was observed. However, the effect of mastication behaviour (P=0·1141) was not significant. Two distinctive fractions were present in all boluses. The first one was a cotyledon-rich fraction consisting of majorly small particles (40-125 µm), which could be described as individual cells based on microscopic observations. This fraction increased with a decrease in process-induced hardness. The second fraction (>2000 µm) mostly contained seed coat material and did not change based on hardness levels. The in vitro starch digestion kinetics of common bean boluses was only affected by process-induced hardness. After kinetic modelling, significant differences were observed between the reaction rate constant of boluses generated from the hardest beans and those obtained from softer ones. Overall this work demonstrated that the in vitro nutritional functionality of common beans is affected to a greater extent by structural properties induced by processing than by mechanical degradation in the mouth.

Disruption of proteome by an oncogenic fusion kinase alters metabolism in fibrolamellar hepatocellular carcinoma.

Fibrolamellar hepatocellular carcinoma (FLC) is a usually lethal primary liver cancer driven by a somatic dysregulation of protein kinase A. We show that the proteome of FLC tumors is distinct from that of adjacent nontransformed tissue. These changes can account for some of the cell biological and pathological alterations in FLC cells, including their drug sensitivity and glycolysis. Hyperammonemic encephalopathy is a recurrent problem in these patients, and established treatments based on the assumption of liver failure are unsuccessful. We show that many of the enzymes that produce ammonia are increased and those that consume ammonia are decreased. We also demonstrate that the metabolites of these enzymes change as expected. Thus, hyperammonemic encephalopathy in FLC may require alternative therapeutics.

Spontaneous Epidural and Corpus Callosum Hemorrhage in Sickle Cell Disease - An Unusual Presentation in a Ghanaian Patient.

Spontaneous intracranial bleed in sickle cell disease is a rare presentation and complication of the disease, with a few cases presenting with epidural hematoma. We present an 18-year-old boy with sickle cell, hemoglobin FS, who presented with non-traumatic scalp swelling, headaches, and vomiting six days following an episode of vaso-occlusive crisis with bone pain. A head CT scan showed extensive epidural hematoma with mass effect and acute corpus callosum bleed. The patient, however, had a cardiac arrest with unsuccessful resuscitation before neurosurgical interventions could be instituted. Of all reported cases, none has reported associated bleeding in the corpus callosum, making our case the firstwith such a combination, possibly worsening the outcome.

Gamma Irradiation and Male Glossina austeni Mating Performance.

An area-wide integrated pest management (AW-IPM) strategy with a sterile insect technique (SIT) component has been proposed for the management of African animal trypanosomosis (AAT) in South Africa. In preparation for the SIT, the mating performance of colony reared Glossina austeni males under influencing factors such as radiation dose and the development stage that is exposed to radiation, was assessed under laboratory and semi-field conditions. The radiation sensitivity of G. austeni colonized 37 years ago when treated as adults and late-stage pupae was determined. Radiation doses of 80 Gy and 100 Gy induced 97-99% sterility in colony females that mated with colony males treated as adults or pupae. Males irradiated either as adults or pupae with a radiation dose of 100 Gy showed similar insemination ability and survival as untreated males. Walk-in field cage assessments indicated that a dose of up to 100 Gy did not adversely affect the mating performance of males irradiated as adults or late stage pupae. Males irradiated as adults formed mating pairs faster than fertile males and males irradiated as pupae. The mating performance studies indicated that the colonized G. austeni males irradiated as adults or late stage pupae will still be suited for SIT.

Prognostic value of some serum protein fractions as Early Index of Clinical Recovery in Pulmonary Tuberculosis subjects.

BACKGROUND: Malnutrition is an important risk factor for pulmonary tuberculosis and can result to adverse treatment outcomes. AIM: This was a cross-sectional study designed to assess prognostic value of some serum protein fractions in pulmonary tuberculosis (PTB) subjects at Oron, Akwa Ibom State, Nigeria. Thirty (30) TB subjects on Anti-tuberculosis therapy, thirty (30) drug naive TB subjects and thirty (30) apparently healthy control subjects aged 21-52 (35 ± 16) years were conveniently recruited. METHODS: Total protein and albumin were measured colourimetrically, Albumin-globulin ratio was calculated while demographic data was obtained using questionnaire. RESULTS: BMI (kg/m2), Albumin (g/dl) and AGR were significantly lower in TB subjects with or without ATT when compared with control subjects (p < 0.000 respectively), but higher in PTB subjects on ATT when compared with drug naive PTB subjects (p = 0.000 respectively). Serum Total protein (g/dl) level in PTB subjects with or without ATT was significantly higher when compared with controls (p = 0.004) while globulin (g/dl) level was lower in PTB subjects on ATT when compared with drug naive PTB subjects (p = 0.000). CONCLUSION: Decreased BMI in TB subjects signifies reduction in muscle mass and wasting precipitated by PTB infection, while depleted albumin and AGR suggests high degree of malnutrition. Increased albumin and AGR in PTB subjects on ATT suggests improvement with ATT. Assessment of serum albumin and AGR may serve as affordable and early index of clinical recovery in PTB subjects especially in resource limited settings, and may be more reliable than the traditionally used BMI.

Prevalence, seasonal and geographical distribution of parasitic diseases in dogs in Plateau State Nigeria: a 30-year retrospective study (1986-2015).

Parasitic diseases of dogs are now major economic and public health issues in Nigeria due to indiscriminate reproduction of dogs, lack of appropriate policies on pet ownership and diseases control as well as inadequate veterinary care. In order to understand the prevalence, seasonal variation and distribution of parasitic diseases of dogs in this region of Nigeria, the present study conducted a 30-year retrospective analysis in the referral veterinary centre, Vom, and analysed data using the Chi square test and the factor analysis. Of the 26,844 dogs handled between January 1986 and December 2015, 17,663 (65.8%) had different parasitic diseases. Yearly distribution of parasitic diseases varied significantly (p < 0.0001) and ranged between 52.0 and 85.4%. Age, seasonal and disease specific prevalence rates ranged between 2.8 and 80.5%. Prevalence rates in females 78.2% (95% CI 77.6-78.9) and indigenous breed 70.0% (95% CI 69.2-70.7) were significantly higher (p < 0.0001) from those of the males 47.2% (95% CI 46.2-48.1) and exotic breeds of dogs 60.7% (95% CI 59.8-61.6), respectively. Ancylostomosis was the most prevalent (15.9%) disease while Barkin Ladi recorded the highest regional prevalence. It is pertinent to enact appropriate disease control policies and observe control programmes including vector control and improved hygiene to curtail the economic and public health threats associated with these diseases.

Polymorphism at the avpr1a locus in male prairie voles correlated with genetic but not social monogamy in field populations.

Integrative studies of genetics, neurobiology and behaviour indicate that polymorphism in specific genes contributes to variation observed in some complex social behaviours. The neuropeptide arginine vasopressin plays an important role in the regulation of a variety of social behaviours, including social attachment of males to females, through its action on the vasopressin 1a receptor (V1aR). In socially monogamous prairie voles (Microtus ochrogaster), polymorphism in the length of microsatellite DNA within the regulatory region of the gene (avpr1a) encoding the V1aR predicts differences among males in neural expression of V1aRs and partner preference under laboratory conditions. However, understanding the extent to which V1aR mediates variation in prairie vole social and reproductive behaviour observed in nature requires investigating the consequences of avpr1a polymorphism and environmental influences under ecologically relevant conditions. We examined the relationship between avpr1a length polymorphism and monogamy among male prairie voles living in 0.1 ha enclosures during a time similar to their natural lifespan. We found no evidence that avpr1a genotype of males predicts variation in social monogamy measured in the field but some indices of social monogamy were affected by population density. Parentage data indicated that a male's avpr1a genotype significantly influenced the number of females with which he sired offspring and the total number of offspring sired. Total brain concentrations of V1aR mRNA were not associated with either male behaviour or avpr1a genotype. These data show that melding ecological field studies with neurogenetics can substantially augment our understanding of the effects of genes and environment on social behaviours.

Progress towards international adoption of the World Health Organization ultrasound classification of cystic echinococcosis.

Cystic echinococcosis (CE) is a global parasitic zoonosis for which ultrasound (US) is the gold standard modality for diagnosis. In 2003, the WHO published a standardized US classification of CE, on which WHO treatment guidelines are based. In 2014, global adoption of the classification was questioned by a publication which indicated that, between 2004 and 2014, only half of studies utilizing a classification used the WHO classification. More recent studies have demonstrated that the WHO classification best reflects the natural history of CE, and is used with high reliability by experts in the field; despite these attributes, the classification's impact is ultimately limited by the extent of its adoption. A PubMed search using the terms "Echinococcus granulosus ultrasound," "Echinococcus granulosus classification," "cystic echinococcosis ultrasound," and "cystic echinococcosus classification" revealed publications on human CE utilizing a US classification. Classification(s) used, year of publication, and the country of the first author's institution were recorded. From 2004 to 2010, the WHO classification was used in 50% or fewer of included publications for 6 of the 7 years. After 2011, it appeared in a low of 75% (2013) to a high of 96% (2017) of included publications. Of all included studies published from 2004 to 2017, the WHO classification was referenced in 18% (3 of 17) from Africa, 64% (32 of 50) from Asia, 79% (89 of 113) from Europe, 89% (8 of 9) from North America, and 100% (9 of 9) from South America. Findings suggest that the WHO classification has been progressively taking preference to other classifications, with rate of adoption depending on continent of origin of the research. Residual use of the classification developed by Dr. Hassen Gharbi of Tunisia in 1982, used widely prior to development of the WHO classification (which reversed two stages in Gharbi's classification in order to more closely reflect the natural history of CE) suggests that adoption of a new classification takes time and varies regionally.

The influence of temperature and humidity on the flight activity of Culicoides imicola both under laboratory and field conditions.

BACKGROUND: Insight into the factors that regulate the circadian host-seeking flight activity of Culicoides vectors (Diptera: Ceratopogonidae) will be of importance to assess the risk of transmission of Culicoides-borne pathogens. This study aimed to determine the impact of temperature and humidity on the flight activity of Culicoides imicola Kieffer, and other livestock associated Culicoides species, under both laboratory and field conditions. METHODS: Batches of 500 field-collected C. imicola females were acclimatized at a predetermined range of temperatures (10-29 °C) and relative humidity (34-85%). After acclimatization, these females, prompted by a light source, were allowed to escape through a transparent plastic funnel into a paper cup, where they were counted after an hour. Flight activity under field conditions was determined seasonally by hourly light trap collections done overnight at four sites near cattle. RESULTS: Experiments conducted at various test conditions in the laboratory indicated that flight activity started at 13 °C. Peak in activity was observed between 16 °C to 18 °C, and temperatures above 20 °C seemingly inhibit flight. Under field conditions, a peak in numbers collected was observed immediately after sunset. With mean nocturnal temperatures below 19 °C, more than 74% of the Culicoides were collected within two to three hours after sunset. With mean nocturnal temperature above 19 °C, the peak in numbers at sunset was sustained until after midnight, with somewhat higher numbers collected after midnight once temperatures dropped below 20 °C. No peak in numbers was observed at dawn. Although very low numbers were collected during the day, which partly may have been a result of the collecting method, Culicoides were present throughout periods of 24 hours. Humidity seemed to play a minor role in the regulation of flight activity. CONCLUSIONS: Abundance and species diversity results as obtained in this study indicated a high level of risk of virus transmission in the first hours following sunset. A strong relationship was found between host-seeking activity, and hence trap efficiency, and within limits, temperature. Light traps primarily measure flight activity and may as such underestimate adult abundance of C. imicola if deployed at temperatures outside thresholds of 16-20 °C.

Incidence trends, rates, and ethnic variations of primary CNS tumors in Texas from 1995 to 2013.

BACKGROUND: Although rare, primary central nervous system (CNS) tumors are associated with significant morbidity and mortality. Texas is a representative sample of the United States population given its large population, ethnic disparities, geographic variations, and socio-economic differences. This study used Texas data to determine if variations in incidence trends and rates exist among different ethnicities in Texas. METHODS: Data from the Texas Cancer Registry from 1995 to 2013 were examined. Joinpoint Regression Program software was used to obtain the incidence trends and SEER*Stat software was used to produce average annual age-adjusted incidence rates for both nonmalignant and malignant tumors in Texas from 2009 to 2013. RESULTS: The incidence trend of malignant primary CNS tumors in whites was stable from 1995 to 2002, after which the annual percent change decreased by 0.99% through 2013 (95% CI, -1.4, -0.5; P = .04). Blacks and Asian/Pacific Islanders showed unchanged incidence trends from 1995 to 2013. Hispanics had an annual percent change of -0.83 (95% CI, -1.4, -0.2; P = .009) per year from 1995 through 2013. From 2009 to 2013, the incidence rates of nonmalignant and malignant primary CNS tumors were highest among blacks, followed by whites, Hispanics, Asians, and American Indians/Alaskan Natives. CONCLUSIONS: Consistent with the 2016 Central Brain Tumor Registry of the United States report, the black population in Texas showed the highest total incidence of CNS tumors of any other race studied. Many factors have been proposed to account for the observed differences in incidence rate including geography, socioeconomic factors, and poverty factors, although the evidence for these external factors is lacking.

Cystic echinococcosis in Turkana, Kenya: 30 years of imaging in an endemic region.

Cystic echinococcosis (CE), a widespread, complex zoonosis, causes chronic disease associated with high morbidity. The pastoral Turkana people of Kenya have one of the highest prevalence rates of CE in the world. Between 1983 and 2015, a CE control program in the Turkana region used ultrasound (US) screening surveys and surgical outreach visits to evaluate CE prevalence and treat those with the disease. As the gold standard modality for diagnosing CE, US reveals a great deal of information about the disease in affected populations. The aim of this study is to discuss the characteristics of untreated CE in the Turkana people as revealed by US data collected during the CE control program and evaluate disease presentation, factors influencing the risk of transmission, and the timeline of disease progression. Data were obtained from written patient notes from US screenings and images; cysts were classified using the World Health Organization (WHO) standardized US classification of CE. Findings include greater prevalence of cysts, later stages of cysts, and multiple cysts in older age groups, with no multiple cysts occurring in patients under six years of age, which are consistent with the assertion that rates of exposure, transmission, and infection increase with age in endemic regions. Findings also raise questions regarding the timeline of disease progression, and factors potentially influencing disease transmission within this and other endemic populations. A comprehensive survey focusing on cultural and community observations (e.g., changing behaviors, hygienic practices, etc.) may provide more detailed information regarding factors that facilitate transmission.

The natural history of cystic echinococcosis in untreated and albendazole-treated patients.

The World Health Organization (WHO) treatment protocols for cystic echinococcosis (CE) are based on the standardized ultrasound (US) classification. This study examined whether the classification reflected the natural history of CE in untreated and albendazole-treated patients. Data were collected during mass US screenings in CE endemic regions among transhumant populations, the Turkana and Berber peoples of Kenya and Morocco. Cysts were classified using the WHO classification. Patient records occurring prior to treatment, and after albendazole administration, were selected. 852 paired before/after observations of 360 cysts from 257 patients were analyzed. A McNemar-Bowker χ2 test for symmetry was significant (p<0.0001). 744 observations (87.3%) maintained the same class, and 101 (11.9%) progressed, consistent with the classification. Regression to CE3B occurred in seven of 116 CE4 cyst observations (6.0%). A McNemar-Bowker χ2 test of 1414 paired before/after observations of 288 cysts from 157 albendazole-treated patients was significant (p<0.0001). 1236 observations (87.4%) maintained the same class, and 149 (10.5%) progressed, consistent with the classification. Regression to CE3B occurred in 29 of 206 CE4 observations (14.1%). Significant asymmetry confirms the WHO classification's applicability to the natural history of CE and albendazole-induced changes. Regressions may reflect the stability of CE3B cysts.

Evaluation of radiation sensitivity and mating performance of Glossina brevipalpis males.

BACKGROUND: Area-wide integrated pest management strategies that include a sterile insect technique component have been successfully used to eradicate tsetse fly populations in the past. To ensure the success of the sterile insect technique, the released males must be adequately sterile and be able to compete with their native counterparts in the wild. METHODOLOGY/PRINCIPAL FINDINGS: In the present study the radiation sensitivity of colonised Glossina brevipalpis Newstead (Diptera; Glossinidae) males, treated either as adults or pupae, was assessed. The mating performance of the irradiated G. brevipalpis males was assessed in walk-in field cages. Glossina brevipalpis adults and pupae were highly sensitive to irradiation, and a dose of 40 Gy and 80 Gy induced 93% and 99% sterility respectively in untreated females that mated with males irradiated as adults. When 37 to 41 day old pupae were exposed to a dose of 40 Gy, more than 97% sterility was induced in untreated females that mated with males derived from irradiated pupae. Males treated as adults with a dose up to 80 Gy were able to compete successfully with untreated fertile males for untreated females in walk-in field cages. CONCLUSIONS/SIGNIFICANCE: The data emanating from this field cage study indicates that, sterile male flies derived from the colony of G. brevipalpis maintained at the Agricultural Research Council-Onderstepoort Veterinary Institute in South Africa are potential good candidates for a campaign that includes a sterile insect technique component. This would need to be confirmed by open field studies.

Haematological, Biochemical and Antioxidant Changes in Wistar Rats Exposed to Dichlorvos Based Insecticide Formulation Used in Southeast Nigeria.

The indiscriminate use of pesticide is a treat to non-target organisms. This study evaluates the haematological and biochemical changes induced by inhalation of local Nigerian dichlorvos insecticide on rats. The rats were randomly assigned to a control group which received only food and water and a test group which, in addition to food and water, was exposed to the pesticide for a period of 4 h daily for 28 days, after which exposure was discontinued for seven days. Five animals were sacrificed from each group on days 1, 7, 14, 21, 28 and 35, and blood was collected by cardiac puncture for haematological, biochemical and antioxidant analysis. Results obtained showed lowered values of red blood cell count (RBC), packed cell volume (PCV), haemoglobin, mean cell haemoglobin (MCH) and mean cell haemoglobin concentration (MCHC) (p < 0.05) with increased white blood cell count (WBC) and platelet counts after day 14 when compared to the control group. Liver enzymes aspartate amino transaminase (AST) and alanine amino transaminase (ALT) were higher in the exposed rats compared to the control group (p < 0.05). Urea and creatinine concentrations increased significantly after day 1 and at day 28, while superoxide dismutase (SOD), gluthathione (GSH) and catalase (CAT) activity increased significantly compared to the control after day 1, day 14 and day 21, respectively. The RBC, PCV and haemoglobin values of all exposed rats were restored to normal following withdrawal of the pesticide, though AST, ALT, urea, creatinine and, glutathione values remained significantly high compared to the control. Inhalation of the local insecticide is toxic to the blood, liver and kidney of laboratory rats and may be deleterious to human health following long-term exposure.

Possible over-wintering of bluetongue virus in Culicoides populations in the Onderstepoort area, Gauteng, South Africa.

Several studies have demonstrated the ability of certain viruses to overwinter in arthropod vectors. The over-wintering mechanism of bluetongue virus (BTV) is unknown. One hypothesis is over-wintering within adult Culicoides midges (Diptera; Ceratopogonidae) that survive mild winters where temperatures seldom drop below 10 °C. The reduced activity of midges and the absence of outbreaks during winter may create the impression that the virus has disappeared from an area. Light traps were used in close association with horses to collect Culicoides midges from July 2010 to September 2011 in the Onderstepoort area, in Gauteng Province, South Africa. More than 500 000 Culicoides midges were collected from 88 collections and sorted to species level, revealing 26 different Culicoides species. Culicoides midges were present throughout the 15 month study. Nine Culicoides species potentially capable of transmitting BTV were present during the winter months. Midges were screened for the presence of BTV ribonucleic acid (RNA) with the aid of a real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) assay. In total 91.2% of midge pools tested positive for BTV RNA. PCR results were compared with previous virus isolation results (VI) that demonstrated the presence of viruses in summer and autumn months. The results indicate that BTV-infected Culicoides vectors are present throughout the year in the study area. Viral RNA-positive midges were also found throughout the year with VI positive midge pools only in summer and early autumn. Midges that survive mild winter temperatures could therefore harbour BTV but with a decreased vector capacity. When the population size, biting rate and viral replication decrease, it could stop BTV transmission. Over-wintering of BTV in the Onderstepoort region could therefore result in re-emergence because of increased vector activity rather than reintroduction from outside the region.

A genetic analysis of the 63E-64A genomic region of Drosophila melanogaster: identification of mutations in a replication factor C subunit.

We have performed an F2 genetic screen to identify lethal mutations within the 63E-64A genomic region. We have isolated 122 mutations in 20 different complementation groups. Of these groups, 16 are represented by multiple alleles. We have also established that the Rop and Ras2 genes are located within the 63E-64A genomic domain at 64A10,11. We have sequenced 10.2 kb of DNA surrounding this gene pair and find that in addition to Rop and Ras2 there is another gene located within this DNA sequence. The gene product, which we have named Rfc40, shows 68% identity to the 40-kDa subunit of replication factor C. We find that the members of one complementation group (13 alleles) derived from our screen correspond to mutations in the Rop gene, whereas the members of another (five alleles) correspond to mutations in the Rfc40 gene. In addition we have isolated 11 new mutant alleles of the disembodied gene.

Array comparative genomic hybridisation analysis of boys with X linked hypopituitarism identifies a 3.9 Mb duplicated critical region at Xq27 containing SOX3.

INTRODUCTION: Array comparative genomic hybridisation (array CGH) is a powerful method that detects alteration of gene copy number with greater resolution and efficiency than traditional methods. However, its ability to detect disease causing duplications in constitutional genomic DNA has not been shown. We developed an array CGH assay for X linked hypopituitarism, which is associated with duplication of Xq26-q27. METHODS: We generated custom BAC/PAC arrays that spanned the 7.3 Mb critical region at Xq26.1-q27.3, and used them to search for duplications in three previously uncharacterised families with X linked hypopituitarism. RESULTS: Validation experiments clearly identified Xq26-q27 duplications that we had previously mapped by fluorescence in situ hybridisation. Array CGH analysis of novel XH families identified three different Xq26-q27 duplications, which together refine the critical region to a 3.9 Mb interval at Xq27.2-q27.3. Expression analysis of six orthologous mouse genes from this region revealed that the transcription factor Sox3 is expressed at 11.5 and 12.5 days after conception in the infundibulum of the developing pituitary and the presumptive hypothalamus. DISCUSSION: Array CGH is a robust and sensitive method for identifying X chromosome duplications. The existence of different, overlapping Xq duplications in five kindreds indicates that X linked hypopituitarism is caused by increased gene dosage. Interestingly, all X linked hypopituitarism duplications contain SOX3. As mutation of this gene in human beings and mice results in hypopituitarism, we hypothesise that increased dosage of Sox3 causes perturbation of pituitary and hypothalamic development and may be the causative mechanism for X linked hypopituitarism.

What are representative survival rates for out-of-hospital cardiac arrest? Insights from the New Haven (Conn) experience.

BACKGROUND: Survival rates from out-of-hospital cardiac arrests due to ventricular fibrillation or pulseless ventricular tachycardia vary greatly. The majority of published reports indicate a survival range from 11% to 33%, depending on the area of observation. Two recent series from major metropolitan centers describe markedly less favorable outcomes and have led to speculation that dense urbanization may contribute to worse outcomes. METHODS: Examination of a consecutive series of out-of-hospital cardiac arrests in New Haven, Conn, a city of 127,000 people and 55 km2 with a two-tiered emergency response system. All cases of nontraumatic cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia occurring outside of a hospital between January 1988 and June 1989 were considered. That city's emergency medical system employs emergency medical technicians and paramedics. Standard resuscitation techniques were employed; high-dose epinephrine and interposed abdominal counterpulsations were not routine interventions. The main outcome measure was survival to hospital discharge. RESULTS: Three (4.0%) of 75 patients survived cardiac arrest and were discharged alive from the hospital. Two (5.3%) of 38 witnessed arrests resulted in hospital discharges. Patient demographics were typical of those reported from other cities that have published outcomes data. Few patients (16%) received bystander-initiated cardiopulmonary resuscitation. CONCLUSION: There is increasing evidence that previously recognized standards for resuscitation success may not be present in certain types of municipalities, including this northeastern city. A registry of outcomes from out-of-hospital cardiac arrests would help to clarify the true national experience.

Endoscopic Evaluation of Upper and Lower Gastro-Intestinal Bleeding.

INTRODUCTION: A myriad of pathologies lead to gastro-intestinal bleeding (GIB). The common clinical presentations are hematemesis, melena, and hematochezia. Endoscopy aids localization and treatment of these lesions. AIMS: The aim was to study the differential diagnosis of GIB emphasizing the role of endoscopy in diagnosis and treatment of GIB. PATIENTS AND METHODS: A prospective study of patients with GIB referred to the Endoscopy unit of two health facilities in Port Harcourt Nigeria from February 2012 to August 2014. The variables studied included: Demographics, clinical presentation, risk score, endoscopic findings, therapeutic procedure, and outcome. Data were collated and analyzed using SPSS version 20 software. RESULTS: A total of 159 upper and lower gastro-intestinal (GI) endoscopies were performed during the study period with 59 cases of GI bleeding. There were 50 males and 9 females with an age range of 13-86 years (mean age 52.4 ± 20.6 years). The primary presentations were hematochezia, hematemesis, and melena in 44 (75%), 9 (15%), and 6 (10%) cases, respectively. Hemorrhoids were the leading cause of lower GIB seen in 15 cases (41%). The majority of pathologies in upper GIB were seen in the stomach (39%): Gastritis and benign gastric ulcer. Injection sclerotherapy was successfully performed in the hemorrhoids and a case of gastric varices. The mortality recorded was 0%. CONCLUSION: Endoscopy is vital in the diagnosis and treatment of GIB. Gastritis and Haemorrhoid are the most common causes of upper and lower GI bleeding respectively, in our environment.