Erythrocyte sedimentation rate during steady state, painful crisis and infection in children with sickle cell disease.

OBJECTIVE: To evaluate Erythrocyte Sedimentation Rate in children with sickle cell disease. METHODS: Erythrocyte Sedimentation Rate was performed in 95 children with sickle cell disease during the period from December 1992 to June 1999. Patients were classified into 4 groups. Patients in the steady state (group 1), painful crisis (group 2), mild infection (group 3) and moderate/severe infection (group 4). Comparison between the groups was performed using ANOVA and ANCOVA. RESULTS: There were 55 males (58%) and 40 females (42%) with a mean age of 79.1 months. The mean Erythrocyte Sedimentation Rate values for the various groups were as follows: Group 1 (n=10); mean Erythrocyte Sedimentation Rate is 5 mm/hr (+/-4.6) and was significantly the lowest (p<0.05), group 2 (n=44); mean Erythrocyte Sedimentation Rate is 25.8 mm/hr (+/-16.3), group 3 (n=18); mean Erythrocyte Sedimentation Rate is 28.1 mm/hr (+/-25.8), while group 4 (n=23); mean Erythrocyte Sedimentation Rate is 99.2 mm/hr (+/-33.5) and was significantly the highest (p<0.05). Two cut-off values for the Erythrocyte Sedimentation Rate (> or = 30 mm/hr then > or = 50 mm/hr) were considered to evaluate their specificity and sensitivity for moderate/severe infection. CONCLUSION: Although the Erythrocyte Sedimentation Rate is low in sickle cell disease, it does increase during painful crisis and infection and it is a useful indicator of moderate/severe infection.

Knowledge assessment about AIDS among primary health care centers female attendees and health care providers in Abha - Kingdom of Saudi Arabia.

Full text is available as a scanned copy of the original print version.

Promotion of mental health as a function of different service agencies.

INTRODUCTION: There is a reliable evidence that personnel working in a variety of settings beyond mainstream mental health services can make an important contribution to the prevention of mental health problems. AIM: To assess the ability of personnel in different sectors including schools, school health unit and Primary Health Care (PHC) centers to recognize the risks and signs of deteriorating mental health among vulnerable people. The roles played by these personnel in the area of mental health were also defined. METHODS: A descriptive approach was used to carry out this study in different service agencies located in Abha region. These included female secondary schools, female school health units and all PHC centers. Questionnaires were mailed to teachers, physicians and nurses. The questionnaires contained queries about warning signs of poor mental health and high-risk groups for mental disorders. RESULTS: It was shown that 50% of school teachers in the sample were good at picking up signs of mental distress while others felt that they did not have the skills in this field nor was it their role to do so. The majority of physicians and nurses (66.03%) in school health unit and PHC centers identify family problems as predictor of mental disorders. From the stand point of the primary care provided by health centers, early diagnosis of cases and provision of treatment were considered unimportant compared to the role of case referral as stated by 15.38% and 53.84% of workers, respectively. RECOMMENDATIONS: It is recommended that the role of these services be expanded to develop skills in dealing with common mental problems.

Reducing the inappropriate use of parenteral nutrition in an acute care teaching hospital.

BACKGROUND: Parenteral nutrition (PN) is a form of nutrition that can be life-saving, but its use has inherent risks and it is expensive. Nutrition support teams have been shown to reduce both the rate of complications and excessive use of PN. METHODS: Criteria were established to evaluate the appropriateness of PN use in a 487-bed community teaching hospital. A prospective study of 50 consecutive patients, who received either central or peripheral PN, was conducted. RESULTS: The 50 patients received 469 days of PN. We found that 233 (49.7%) of the 469 days of PN were avoidable. This resulted in the creation of a formal approval process that required prior approval by a physician-directed multidisciplinary advisory committee before PN could be instituted. The amount of PN subsequently decreased from 500 patient days of PN per month to less than 100. CONCLUSIONS: This study supports the idea that inappropriate use of PN can be reduced by physician education plus the continuing oversight of a physician-directed multidisciplinary advisory group.

The peripheral modulation of duodenal and colonic motility in rats by the pancreatic polypeptide-fold family: neuropeptide Y, peptide YY, and pancreatic polypeptide.

Neuropeptide Y (NPY), peptide YY (PYY), and pancreatic polypeptide (PP) altered intraluminal pressure in the duodenum and colon of fasted anesthetized rats following intravenous bolus administration. There were rapid increases in intraluminal pressure of the duodenum and colon of anesthetized rats following peripheral injections of NPY, PYY and PP. Administration (IV) of NPY, PYY, and PP increased intraduodenal pressure +1.8, +3.2, and +3.7 mmHg compared to saline baseline. Prazosin, an alpha-2 adrenergic antagonist, did not alter the response of the duodenum of urethane-anesthesized rats to any of the PP-fold peptides following peripheral administration. Yohimbine, an alpha 2-adrenergic antagonist, attenuated the excitatory response of rat duodenum following NPY (IV) but did not alter the duodenal response to PP (IV). Intravenous NPY, PYY, and PP increased intracolonic pressure +2.0, +3.3, and +6.2 mmHg compared to saline baseline. In the presence of prazosin, an alpha 1-adrenergic antagonist, the intraluminal pressure of the colon increased +2.6, +2.4, and +8.1 mmHg compared to saline baseline by NPY, PYY, and PP (IV), respectively. In the presence of alpha 2-adrenergic blockade by yohimbine, NPY, PYY, and PP (IV) increased intraluminal pressure of the colon +4.2, +2.9, and +2.5 mmHg compared to saline baseline. The response of the duodenum to the excitatory effect of PYY (IV) was enhanced in the presence of yohimbine. Duodenal and colonic tone were modulated by the PP-fold peptides following peripheral administration. The alpha-adrenergic nervous system played only a minor role in the modulation of GI motility by the PP-fold peptides at peripheral sites.

Neuropeptide Y, peptide YY, and pancreatic polypeptide modulate duodenal and colonic motility at a thoracic spinal site in rats.

Neuropeptide Y, PYY, and PP (200 pmol) alter intraluminal pressure in the duodenum and colon of rats following their administration into the thoracic (T8-T10) region of the spinal cord. Neuropeptide Y decreases the tone of the duodenum and the colon following intrathecal (T8-T10) administration prior to an increase in tone to baseline or greater. There is no effect on intraluminal pressure of either the duodenum or the colon following intrathecal administration of NPY or PP into the lumbar (L4-L5) region of the spinal cord. Following intrathecal (T8-T10) administration of PYY and PP, increases in intraduodenal pressures are observed (+2.1 and +3.0 mmHg from saline baseline). Phasic contractions of the duodenum are increased following intrathecal administration of PYY into the thoracic spinal cord of rats. Neuropeptide Y, PYY, and PP increase intracolonic pressure +2.2, +3.3, and +3.7 mmHg from saline baseline, respectively. Phasic contractions of the colon are increased following PP intrathecal thoracic administration. Responsiveness of the duodenum or colon to the different ligands of the PP-fold peptide family in the absence of alpha-adrenergic blockade did not vary. The increases in intraluminal pressure of the duodenum and colon following intrathecal administration of the PP-fold peptides are attenuated by both alpha-1 adrenergic (prazosin) and alpha-2 adrenergic (yohimbine) blockade. There is a difference in responsiveness of the colon between the ligands of the PP-fold family in the presence of the alpha-2 adrenergic blockade. The findings of this study indicate that duodenal and colonic motility are modulated by the PP-fold peptides at thoracic spinal sites via alteration of sympathetic outflow.