Quantitative Study of the Beliefs and Attitudes Toward Organ Donation and the Opt-Out System Among the Sikh Community in the United Kingdom.

In the United Kingdom, there is a paucity donors from ethnic minorities; however, the number of recipients from ethnic minorities is increasing annually. Following implementation of the opt-out system (OOS) in Wales, a wider debate has started whether the system should be adopted elsewhere in the United Kingdom. We studied Sikh opinion with regard to organ donation and the OOS. METHODS: An anonymous survey was completed by Sikhs in phase 1 paper-based forms and in phase 2 online questionnaires. Data were analyzed using multinomial regression. RESULTS: A total of 268 responses were analyzed; 82.8% said they would donate an organ to anyone; however, 62.1% were not registered organ donors and of those not registered 57.6% did not have sufficient knowledge about the donation process. On multinomial regression, independent variables associated with acceptability of organ donation were awareness of organ shortage, knowing a donor in the immediate family, higher education level, and knowing a successful transplant recipient (all P < .05). Approximately 1 in 2 Sikhs do not understand presumed consent and a majority of 60.1% disagree with the OOS. CONCLUSIONS: Significant barriers exist to donation; there is lack of awareness of the OOS and donation process. Targeted intervention is required to address these barriers.

Serial composition of human milk in preterm and term mothers.

Human milk samples were collected from 86 mothers induced in the study on days 3, 7, 14 and 28 of lactation. The mothers were divided into three groups on the basis of gestation viz. group 1: 37-41 weeks (n=41), group II: 33-36 (n=23) and group III: <33 weeks gestation (n=22). All the samples were analysed for the estimation of fat, lactose and protein. The results obtained from the investigations were statistically analysed. The analysis of the results revealed a lower amount of fat and lactose in preterm milk as compared to term milk (p<0.01). These were found to increase in amount with increasing postnatal age (p<0.05). The protein levels were observed to be significantly higher in preterm than term milk (p<0.01). These were observed to decrease significantly with increase in postnatal age (p<0.01).

Gap-junctional communication in mouse cumulus-oocyte complexes: implications for the mechanism of meiotic maturation.

The mechanisms underlying the hormonal stimulation of meiotic maturation are not understood. The most prevalent hypothesis is that hormone-induced maturation is stimulated by an increase in the intracellular messengers, cAMP or Ca2+. This study investigated whether Ca2+ transients in somatic cells can lead to Ca2+ transients in the oocyte, and whether hormones that stimulate meiotic maturation of mouse oocytes in vitro and in vivo stimulate an increase in intracellular Ca2+. Of a range of potential agonists of Ca2+ release, ATP and UTP were the only agents that stimulated Ca2+ release in cumulus cells. ATP-induced Ca2+ release is from intracellular stores, as the response is not blocked by chelation of extracellular Ca2+, but is inhibited by the Ca2+-ATPase inhibitor, thapsigargin. ATP and UTP are equipotent, consistent with the receptor being of the P2Y2 type. Confocal microscopy was used to show that ATP-induced Ca2+ release in cumulus cells leads to a Ca2+ increase in the oocyte. Inhibition of gap-junctional communication using carbenoxolone, as assayed by dye transfer, inhibited the diffusion of the Ca2+ signal from the cumulus cells to the oocyte. Thus, provided that a Ca2+ signal is generated in the somatic cells in response to maturation-inducing hormones, it is feasible that a Ca2+ transient is generated in the oocyte. However, FSH and EGF, both of which stimulate maturation in vitro, have no effect on Ca2+ in cumulus--oocyte complexes. Furthermore, LH, which leads to meiotic maturation in vivo, did not stimulate Ca2+ release in acutely isolated granulosa cells from preovulatory mouse follicles. These studies indicate that ATP may play a role in modulating ovarian function and that diffusion of Ca2+ signals through gap junctions may provide a means of communication between the somatic and germ cells of the ovarian follicle. However, our data are not consistent with a role for Ca2+-mediated communication in hormone-mediated induction of meiosis in mice.

Febrile status epilepticus as the first presentation of cortical developmental malformation: report of 2 cases.

Cortical developmental malformations are an important cause for epilepsy. The epileptic disorder usually begins with sporadic seizures, followed by gradually increasing seizure frequency and culminating in epilepsia partialis continua. We report the de-novo occurrence of focal status epilepticus accompanying hyperpyrexia in two male children, aged 18 months and 4 years. One child had prior neuro-developmental delay, while in the other, developmental milestones were normal. In both instances, there were no seizures prior to the presenting neurological illness. Cerebrospinal fluid examination was normal in both the cases. Magnetic resonance imaging revealed extensive pachygyria in one patient and focal cortical thickening in the other. Therefore, cortical developmental malformation may be suspected as an underlying aetiology in children presenting with de-novo status epilepticus and hyperpyrexia.

Orbital cellulitis due to occult orbital lymphangioma.

A 12-year-old female patient with atypical orbital and periorbital cellulitis was found to have an occult lymphangioma of the orbit. Recognition of this entity provided an explanation for the atypical features of the case and guided appropriate medical management.

The Nidek MK-2000 microkeratome system.

PURPOSE: To assess flap thickness and the performance of the Nidek MK-2000 microkeratome during laser in situ keratomileusis (LASIK). METHODS: Three hundred seventy consecutive eyes of patients undergoing LASIK had the depth of flaps measured via subtractive pachymetry. All flaps were created using two different model numbers of the Nidek MK-2000 microkeratome. Both 130-microm and 160-microm depth plates were evaluated. Microkeratome-induced complications were also recorded. RESULTS: Buttonhole flaps and free flaps were not seen in this study. One short flap occurred and suction could not be obtained in two eyes. The mean flap thickness obtained using the 130-microm depth plate for model number 121 was 129 +/- 21.8 microm. The mean flap thickness obtained using the 160-microm depth plate for model number 121 was 150 +/- 29.6 microm. The mean flap thickness obtained using the 130-microm depth plate for model number 65 was 152 +/- 25 microm. The mean flap thickness obtained using the 160-microm depth plate for model number 65 was 173 +/- 26.9 microm. CONCLUSION: The Nidek MK-2000 microkeratome is safe and creates flaps of predictable thickness.

Efficacy of high-level disinfectants for reprocessing GI endoscopes in simulated-use testing.

BACKGROUND: There has been recent public concern regarding the adequacy of current practices for flexible endoscope reprocessing. High-level disinfection is defined by the Food and Drug Administration (FDA) as a minimum of 6-log reduction of mycobacteria under a worst-case scenario. Several agents are currently approved by the FDA, but published data on their relative efficacies against mycobacteria are lacking. The objective of this study was to determine the efficacy of these agents for high-level disinfection. METHODS: In simulated-use testing, video endoscopes (5 colonoscopes and 5 duodenoscopes) were each inoculated with 9.0 x 10(7) colony-forming units of Mycobacterium chelonae. Cleaning was performed by using a standardized protocol. Each endoscope was then subjected to chemical disinfection with Cidex (2.0% glutaraldehyde) at 20 degrees C for 20 minutes, Sporox (7.5% hydrogen peroxide) at 20 degrees for 30 minutes, and Steris 20 (0.2% peracetic acid) at 50 degrees C to 56 degrees C for 12 minutes using the Steris System 1 processor. Although not FDA-approved, tests were also conducted by using 70% isopropyl alcohol at 20 degrees C for 20 minutes. These results were compared with disinfection with ethylene oxide gas. All channels were sampled for M chelonae before and after manual cleaning and after disinfection. RESULTS: Cleaning alone resulted in an average log reduction of 3. Cidex, Sporox, Steris 20, ethylene oxide gas, and isopropyl alcohol, in combination with manual cleaning, each achieved a 6-log or greater reduction of the mycobacterial inoculum. No organisms were recovered from any channel after reprocessing with ethylene oxide and Steris 20. CONCLUSIONS: Commercially available high-level disinfectants are equally efficacious for reprocessing flexible GI endoscopes when used in conjunction with cleaning and in accordance with recommended guidelines.

Dark-adapted Pupil Sizes in a Prospective Evaluation of Laser in situ Keratomileusis Patients.

PURPOSE: This study presents the results of scotopic pupil size measurement in a group of laser in situ keratomileusis (LASIK) patients and the implications this value has for night vision symptoms and treatment zones. METHODS: This was a prospective study measuring the dark-adapted pupil of 218 patients using a handheld pupillometer. RESULTS: The mean scotopic pupil size was 5.66 mm with a standard deviation of 1.04 mm. Pupils ranged in size from 3.00 mm to 9.00 mm. CONCLUSION: Results suggest that a number of patients may have seotopic pupil size well beyond the treatment zones commonly used or available in refractive laser systems. Treating with an ablation zone that is smaller than the mesopic pupil will often result in night vision disturbances. Next generation technology such as the Nidek EC-5000 excimer laser can incorporate larger treatment diameters in order to reduce the incidence of halos and glare at night. [J Refract Surg 2000; 16(suppl):S239-S241].

Familial occurrence of pseudoexfoliation in Canada.

BACKGROUND: Genetic factors may play an important role in pseudoexfoliation syndrome. We describe the familial occurrence of pseudoexfoliation in Canadian families. METHODS: Probands with pseudoexfoliation were referred to a tertiary care glaucoma service in Ottawa because of a family history of pseudoexfoliation or glaucoma, or both. Probands and family members who agreed to participate underwent a systematic interview and eye examination. The pseudoexfoliation status was classified as affected, suspect or unknown based on preestablished criteria for the diagnosis of pseudoexfoliation and glaucoma. RESULTS: Thirty-four members of 10 families were assessed (18 affected, 2 suspect and 14 status unknown). Six families had two or more generations with pseudoexfoliation, and four families had one generation affected. There was a predominance of females among the affected subjects (17:1), and transmission in all cases appeared to be maternal. Eight of the families were of Irish/Scottish ancestry. Nine (50%) of the affected subjects had cardiovascular disease. Affected subjects tended to be older than suspects and those whose status was unknown (mean age 77, 67 and 55 years respectively). Seven subjects were affected unilaterally and 11 bilaterally. Affected subjects had moderate angle pigmentation in both eyes (mean +2.7, where 0 = no pigment and +4 = dense homogeneous pigment). The mean intraocular pressure in both eyes was higher for the affected subjects (23.1 [standard deviation (SD) 8.6] mm Hg) than for the suspects (16.8 [SD 6.1] mm Hg) and those of unknown status (16.8 [SD 2.9] mm Hg). An enlarged cup:disc ratio was seen in the affected subjects (mean 0.62). Eleven (61%) of the affected subjects had open angles on gonioscopy, and five had occludable angles and required peripheral iridectomy. Ten (56%) of the affected subjects were classified as having glaucoma, and 14 (78%) had evidence of cataract formation in at least one eye. INTERPRETATION: Pseudoexfoliation appears to be transmitted matrilineally, which raises the possibility of mitochondrial inheritance, X-linked inheritance or autosomal inheritance with genomic imprinting. A larger study of families with pseudoexfoliation is necessary to clarify the mode of transmission and to identify the gene(s) involved in the etiology of this disorder.

Selective laser trabeculoplasty v argon laser trabeculoplasty: a prospective randomised clinical trial.

AIMS: To compare the effectiveness of selective laser trabeculoplasty (SLT, a 532 nm Nd:YAG laser) with argon laser trabeculoplasty (ALT) in lowering the intraocular pressure (IOP) in patients with medically uncontrolled open angle glaucoma. METHODS: A prospective randomised clinical trial was designed. Patients were randomised to treatment with either SLT or ALT and were evaluated at 1 hour, 1 week, 1, 3, and 6 months post-laser. RESULTS: There were 18 eyes in each group. Baseline characteristics were similar in both groups. In the SLT group the mean IOP at baseline, 1, 3, and 6 months was 22.8 (SD 3.0), 20.1 (4.6), 19.3 (6.0), and 17.8 (4.8) mm Hg, respectively. In the ALT group, the mean IOP at baseline, 1, 3, and 6 months was 22.5 (3.6), 19.5 (4.7), 19.6 (5.6), and 17.7 (3.3) mm Hg, respectively. There was a greater anterior chamber reaction, 1 hour after SLT v ALT (p< 0.01). Patients with previous failed ALT had a better reduction in IOP with SLT than with repeat ALT (6.8 (2. 4) v 3.6 (1.8) mm Hg; p = 0.01). CONCLUSION: SLT appears to be equivalent to ALT in lowering IOP during the first 6 months after treatment. There is a slightly greater anterior chamber reaction 1 hour after SLT. Patients with previous failed ALT had a significantly greater drop in IOP when treated with SLT v ALT. These results need to be confirmed with a larger sample size.

Is pseudoexfoliation syndrome inherited? A review of genetic and nongenetic factors and a new observation.

Pseudoexfoliation (PEX) syndrome is the commonest identifiable cause of open-angle glaucoma worldwide. PEX is characterized clinically by small whitish deposits of fibrillar-granular material in the anterior segment of the eye. Despite its prevalence and potential for ophthalmic morbidity, surprisingly little is known about the etiology and pathogenesis of PEX. This article reviews the literature and presents evidence regarding genetic and nongenetic arguments for the etiology of pseudoexfoliation. Lines of evidence that support a genetic basis for PEX include transmission in two-generation families, twin studies, an increased risk of PEX in relatives of affected patients, and HLA studies. Nearly all pedigrees in the literature, and our own experience with PEX families in Iceland and Canada, suggest maternal transmission, raising the possibilities of mitochondrial inheritance, X-linked inheritance, and autosomal inheritance with genomic imprinting. A number of nongenetic factors have also been evaluated for their possible implication in the development of PEX. These include ultraviolet light, autoimmunity, slow virus infection, and trauma. It is possible that a combination of genetic and nongenetic factors may be involved in the etiology and pathogenesis of PEX, i.e. it may be a multifactorial disorder. Further studies with larger numbers of patients are needed to delineate more clearly the contribution of genetic (nuclear DNA, mitochondrial DNA or both) and nongenetic factors to the development of pseudoexfoliation syndrome and pseudoexfoliation glaucoma.

Ultrastructural localization of wheat germ agglutinin binding sites on the sperm surface of water buffalo (Bubalus bubalis). A fracture label study.

In the present study we have examined the plasma membrane surface organization employing fluorescein isothiocyanate linked wheat germ agglutinin (WGA) of the cauda epididymal and ejaculated spermatozoa of water buffalo. Intramembrane particle distribution pattern in the various segments of the spermatozoa has also been observed. WGA-ovomucoid gold has been used to study the distribution of sialoproteins on the sperm surface. With fracture label, WGA receptor sites have been identified on the fractured membrane halves of the sperm plasma membrane overlying the acrosome as well as the middle piece and the principle piece.

Maturation, capacitation, and metabolism of goat spermatozoa using magnetic resonance methods.

The ability of intact cells to reduce spin labels has been utilized to characterize the activity of spermatozoa of goat. The kinetics of reduction of TEMPO has been found to be sensitive to the quantity, quality and state of epididymal maturation of the spermatozoa. Presence of alcohol caused activation and Gossypol acetic acid left sperm activity unaltered. Electron spin resonance (ESR) and 31P Nuclear magnetic resonance (NMR) indicate that the period of in vitro capacitation requires optimization. 31P NMR spectra indicate a good correlation with the progressive maturation of the cells.

Capacitated and acrosome reacted spermatozoa of goat (Capra indicus): a fluorescence and electron microscopic study.

Plasma membrane alterations accompanying in vitro capacitation and acrosome reaction of goat spermatozoa were studied using lectin labelling, scanning electron microscopy, and freeze-fracture methods. Fluorescein isothiocyanate linked lectins namely; Canavalia ensiformis (ConA), Maclura pomifera (MPA), Arachis hypogaea (PNA), Glycine max (SBA) and Triticum vulgaris (WGA) agglutinin were used to examine the distribution of surface carbohydrates during these two events. The head and the sperm tail reveal altered lectin labelling features after capacitation and acrosome reaction. After capacitation the surface coat components for MPA, SBA, and WGA are shed from the spermatozoon head. ConA receptors on the head are retained after capacitation but are partially shed in the acrosome reacted spermatozoa. SBA receptor sites appear on the sperm tail of the capacitated spermatozoa. Unusual morphological changes attending capacitation involve the sperm tail-end which develops a novel entity, which we have termed 'spatula'. The 'spatula' shows strong binding with ConA and WGA only. In the acrosome reacted spermatozoa the spatulated tail-end unwinds with a concomitant loss of lectin labelling. Highly ordered membrane particles, 'ladders' of the middle piece of the epididymal sperm tail, disappear and IMP clearings appear on the middle piece and in the spatulated ends of the capacitated spermatozoa. But in the acrosome reacted sperm IMPs reappear and are randomly disposed on the middle-piece and are clustered in small patches on the principal-piece. IMP free areas appear on the plasma membrane covering the acrosome and the outer acrosomal membrane (OAM) of the capacitated spermatozoa. The plasma membrane and OAM fuse at multiple foci and appear as acrosomal 'ghosts' which remain associated with the sperm head even after acrosome reaction.

Spectroscopic and microscopic studies of buffalo-bull (Bubalus bubalis) spermatozoa.

We have examined the epididymal (caput, corpus and cauda) and ejaculated spermatozoa of bufallo-bull (Bubalus bubalis) employing microscopic and spectroscopic techniques. Fluorescein isothiocyanate conjugated lectins namely concanavalin A (Con A), Dolichos biflorus (DBA), Maclura pomifera (MPA), peanut agglutinin (PNA), soybean agglutinin (SBA) and wheat germ agglutinin (WGA) were used to study the changes in the sperm surface carbohydrate make up as the spermatozoa mature. Quantitative analysis of the lectin binding was made flow cytometrically. 31P-NMR (nuclear magnetic resonance) spectra of the sperms obtained from different regions (head, body and tail) of the epididymis and of the ejaculate were analyzed to assess their metabolic activity. And the kinetics of spin label reduction of these samples was monitored with ESR (electron spin resonance) spectroscopy. These observations are supplemented with the electron microscopic (SEM and TEM) examination of the epididymal and ejaculated spermatozoa.

Changes in the lectin binding sites on the testicular, epididymal, vas, and ejaculated spermatozoon surface of dog.

Changes in the localization of sperm surface glycocomponents of testicular, epididymal, vas deferens, and ejaculated spermatozoa of dog (Canis domesticus) were studied employing fluorescein isothiocyanate conjugated lectins viz., Concanavalin A (ConA), Triticum vulgaris (WGA), Maclura pomifera (MPA), and Arachis hypogaea (PNA) agglutinins. The plasma membrane clothing the acrosome of the testicular, epididymal, and vas deferens spermatozoa shows reactivity with all the lectins used. However, in the ejaculated spermatozoa, the entire sperm surface shows reactive sites for ConA, WGA, and PNA. Variation in the labelling of the cytoplasmic droplet in different stages of spermatozoon transit in the epididymis has been discussed.

Plasma membrane alterations of maturing goat (Capra indicus) spermatozoa: lectin-binding and freeze-fracture study.

A qualitative and quantitative analysis of lectin-binding sites has been undertaken on spermatozoa recovered from different regions of the epididymis of the goat (Capra indicus) using fluorescein isothiocyanate-linked lectins (Bauhinia purpurea BPA, Concanavalin A Con A, Dolichos biflorus DBA, Maclura pomifera MPA, Arachis hypogaea or peanut agglutinin PNA, Glycine max or soyabean agglutinin SBA, Ulex europaeus UEA, and Triticum vulgaris or wheat-germ agglutinin WGA), in conjunction with scanning and transmission electron microscopy, and freeze-fracture techniques. Flow cytometric analysis has also been used to quantitize binding affinity. Spermatozoa from caput to cauda epididymidis show no significant variation in lectin-binding ability, but the samples removed from the corpus epididymidis contain a greater number of binding sites. The passage of spermatozoa through the epididymidis is accompanied by a redistribution of the plasma membrane lectin-receptors covering the sperm head and tail. Receptors for BPA, DBA, PNA and SBA are specifically restricted to the anterior region of the acrosome in caudal spermatozoa. Freeze-fracture replicas, examined to study changes in organisation of intramembranous particles of the plasma membrane during sperm maturation, reveal distinct changes in their distribution in the acrosome, post-acrosome and spermatozoon tail, especially in the corpus and cauda epididymidis.

Parental attitudes towards epilepsy.

Parents of 352 children with history of epilepsy were interviewed by a pretested, open ended questionnaire to ascertain the nature of first aid care during an epileptic fit, complications arising out of this care, and parents' perceptions regarding causes of epilepsy. The commonest form of care provided was to force liquids by mouth (50.6%), followed by pressure over body to restrain convulsive movements (13.0%) or to put some object to force the teeth open (11.9%). The various causes of epilepsy according to the parents were: due to an evil spirit (26.7%0, heritable causes (13.9%), physical or mental weakness (6.6%) and brain damage (5.9%). The need of imparting knowledge and clear understanding about epilepsy among parents is emphasized.