Efficacy and acceptability of the new oral phosphate binder Lenziaren(®) in healthy cats fed a renal diet.

The efficacy and acceptability of the new oral phosphate binder Lenziaren(®) (SBR759) were evaluated in healthy cats fed with a commercial diet containing low amounts of phosphate ('renal diet'). Lenziaren(®) at 0.125, 0.25, 0.5 and 1 g/day was compared to a reference product Lantharenol(®) (3.0 g/day) and a placebo in a masked, randomized, parallel-group design study in 36 cats (n = 6 per group). All products were mixed with the ration which was fed once daily for 28 days. Lenziaren(®) produced significant dose-related reductions in serum and urine phosphate concentrations, faecal apparent phosphorus digestibility and fractional urinary phosphate excretion. Cats administered Lenziaren(®) consumed significantly less food than the placebo group, but this had no negative impact on body weight or acceptability assessments. When compared to the positive control, Lantharenol(®) , Lenziaren(®) was significantly more acceptable (0.125, 0.5 and 1.0 g/day doses), was associated with higher food consumption (0.125, 0.5 and 1.0 g/day doses) and had greater efficacy in reducing serum phosphate (0.5 and 1.0 g/day) and urine phosphate concentrations (1.0 g/day). In conclusion, Lenziaren(®) was an effective oral phosphate binder in healthy cats fed with a renal diet. Lenziaren(®) was well accepted and tolerated. Dosages of 0.25-1.0 g/cat per day are recommended for clinical testing.

Burns in young children: a retrospective matched cohort study of health and developmental outcomes.

BACKGROUND: Unintentional injuries are a major cause of death and disability in childhood. Most burns are unintentional, the majority occurring in pre-school children. Little is known about the outcomes of young children following burns. The purpose of this study was to examine the presenting features of burned children and compare their health and developmental outcomes with controls. METHODS: Children under 3 years admitted to the Welsh Regional Burns Centre between September 1994 and August 1997 were studied up to their sixth birthday (final data collection 2003) to ascertain the nature, course and cause of their burn. One hundred and forty-five burned children were matched with 145 controls. Their physical, psychosocial and educational health status was compared. Retrospective data were gathered from hospital notes, social services, emergency department databases, child health surveillance records and schools. RESULTS: Burns peaked at age 13-18 months were typically sustained by scalding, drink spillage and contact with hot objects. They occurred most frequently at mealtimes and 89.7% were judged to be unintentional. There was a high rate of non-attendance for follow-up - 24%. The families of children admitted with burns were more likely to have moved home than those of controls (P = 0.001). By age 6 significantly more cases were admitted to hospital with an unrelated condition (P = 0.018). There were no differences between the cases and controls in immunization status, development, school attendance and educational progress up to the age of 6 years (P > 0.05). CONCLUSIONS: We found important findings in relation to unintentional injury prevention and also noted markers that may indicate inequalities in health service utilization between cases and controls. There were no major differences between developmental and educational outcomes in the two groups.

Development of a measure of the health-related quality of life of children in public care.

OBJECTIVES: To validate PedsQL for children in public care and develop an 'in-care' module. DESIGN AND SETTING: Questionnaire development and validation. Questionnaires were completed in placement. A total of 69 children in public care (aged 8-18 years) and their carers were recruited through routine paediatric assessments, and 662 children not in public care were recruited from local schools. MEASURES: Self- and proxy-report versions of PedsQL generic module and the 'in-care' module. RESULTS: Cronbach's alpha for the generic module ranged from 0.66 to 0.88 and from 0.74 to 0.90 for self- and proxy-report respectively. Lower scores were reported for children in care compared with peers living at home for proxy- and self-report. Proxy- and self-report correlation ranged from 0.43 to 0.60 (P < 0.001). Cronbach's alpha for the in-care module was 0.87 and 0.91 for self- and proxy-report respectively. Proxy- and self-report scores showed significant correlation with generic module scores. The highest correlations were seen with sub-scales measuring Psychosocial Functioning (e.g. Emotional Functioning: Pearson's r = 0.67 and 0.59, P < 0.001 for self- and proxy-report respectively). Proxy- and self-report correlation was 0.45 (P < 0.001). CONCLUSIONS: We found PedsQL generic module and the newly developed 'in-care' module to have excellent internal reliability for self- and proxy-report. Validity was established for both measures and significant correlation found between child and proxy ratings. Although further testing of the measures is recommended, both have potential value in assessing the success of placements and could provide a reliable and valid tool for individual patient analysis in clinical practice and for research with this group.

Standards in school toilets--a questionnaire survey.

BACKGROUND: Children often say they have problems with their toilets in school. Educationalists and health workers need to be aware of potential difficulties, to try and improve these facilities for school children. The objective of this study was to assess the perception children have of the toilet facilities in their schools and whether or not this influences their use of them. METHODS: An interviewer-administered questionnaire was given to children attending community audiology clinics and their parents. RESULTS: Eighty-seven children from 65 schools were surveyed. Poorly maintained and unhygienic facilities were described to which access was restricted. A significant proportion of children were bullied or teased. Forty per cent would never open their bowels using the toilets in school. CONCLUSION: The same standards for toilet facilities in the workplace should apply to schools. Substandard facilities may contribute to the suppression of the 'call to stool', leading to chronic constipation. Infectious illnesses may be more easily spread.

Prevalence and clinical characteristics of lymphangioleiomyomatosis (LAM) in patients with tuberous sclerosis complex.

The true prevalence of pulmonary lymphangioleiomyomatosis (LAM) in patients with tuberous sclerosis complex (TSC) is unknown. The prevalence of LAM, radiological features, and lung function in patients with TSC was measured. The presence of LAM, as defined by the presence of cysts by high-resolution chest computed tomography (HRCT) scan, was determined in patients with TSC without prior pulmonary disease (Group 1). To determine the significance of early detection, severity of disease in screened patients (Group 1) was compared with that in patients with TSC with a prior diagnosis of LAM (Group 2). Forty-eight patients with TSC and no prior history of LAM were screened. Of the 38 females, 13 (34%) had LAM; LAM was absent in males. Lung function was preserved in patients with TSC who were found to have LAM by screening. In patients previously known to have LAM, FEV(1) and DL(CO) correlated inversely with severity of disease as assessed by CT scan. The prevalence of LAM in women with TSC was 34%, approximately 10-fold that previously reported, consistent with a large hitherto unrecognized subclinical population of patients at risk for pulmonary complications.

Prognostic significance of pulmonary lymphangioleiomyomatosis histologic score.

Correlations were made between clinical and follow-up data and histopathologic findings in 105 women (mean age +/- standard deviation, 38.3 +/- 9.0 years) with pulmonary lymphangioleiomyomatosis (LAM). The actuarial survival (to pulmonary transplantation or death) of the patients from the time of lung biopsy was 85.1% and 71.0% after 5 and 10 years respectively. The histologic severity of LAM, graded as a LAM histologic score (LHS), was determined on the basis of semiquantitative estimation of the percentage of tissue involvement by the two major features of LAM: the cystic lesions and the infiltration by abnormal smooth muscle cells (LAM cells) in each case: LHS-1, <25%; LHS-2, 25% to 50%; and LHS-3, >50%. Analysis using the Kaplan-Meier method revealed significant differences in survival for patients with LHS-1, -2, and -3 (p = 0.01). The 5-and 10-year survivals were 100% and 100% for LHS-1, 81.2% and 74.4% for LHS-2, and 62.8% and 52.4% for LHS-3. Increased degrees of accumulation of hemosiderin in macrophages also were associated with higher LHS scores (p = 0.029) and a worse prognosis (p = 0.0012). Thus, the current study suggests that the LHS may provide a basis for determining the prognosis of LAM.

Electro-oculography, electroretinography, visual evoked potentials, and multifocal electroretinography in patients with vigabatrin-attributed visual field constriction.

PURPOSE: Symptomatic visual field constriction thought to be associated with vigabatrin has been reported. The current study investigated the visual fields and visual electrophysiology of eight patients with known vigabatrin-attributed visual field loss, three of whom were reported previously. Six of the patients were no longer receiving vigabatrin. METHODS: The central and peripheral fields were examined with the Humphrey Visual Field Analyzer. Full visual electrophysiology, including flash electroretinography (ERG), pattern electroretinography, multifocal ERG using the VERIS system, electro-oculography, and flash and pattern visual evoked potentials, was undertaken. RESULTS: Seven patients showed marked visual field constriction with some sparing of the temporal visual field. The eighth exhibited concentric constriction. Most electrophysiological responses were usually just within normal limits; two patients had subnormal Arden electro-oculography indices; and one patient showed an abnormally delayed photopic b wave. However, five patients showed delayed 30-Hz flicker b waves, and seven patients showed delayed oscillatory potentials. Multifocal ERG showed abnormalities that sometimes correlated with the visual field appearance and confirmed that the deficit occurs at the retinal level. CONCLUSION: Marked visual field constriction appears to be associated with vigabatrin therapy. The field defects and some electrophysiological abnormalities persist when vigabatrin therapy is withdrawn.

Injury and poisoning episodes and conditions: National Health Interview Survey, 1997.

OBJECTIVE: This report provides a descriptive overview of the first year of data from the injury section of the redesigned National Health Interview Survey. It documents the Survey's design methodologies and presents detailed national estimates of nonfatal injury and poisoning episodes for 1997. METHODS: Data for the U.S. civilian noninstitutionalized population were collected using Computer Assisted Personal Interview (CAPI). The data on all medically attended injuries and poisonings occurring to any family member during the 3-month period prior to the interview were obtained from an adult member of the family. RESULTS: In 1997, 34.4 million medically-attended episodes of injury and poisoning were reported, resulting in an age-adjusted rate of 128.9 episodes per 1000 persons. Injury episodes resulted in 40.9 million injury conditions for a rate of 153.7 conditions per 1,000 persons. Falls were the leading external cause of injury, followed by episodes resulting from being struck by or against a person or an object, transportation, overexertion, cutting and piercing instruments, and poisoning. Sprains and strains were the most frequently reported injury condition followed by open wounds, fractures, and contusions. Upper extremity and lower extremity injuries were the leading body regions for these conditions. Leisure activities and paid work were most often reported as the activities the person was engaged in when the injury episode occurred, and. the home was the most likely place for the injury to have occurred. CONCLUSION: The redesigned NHIS is a useful source of information about medically-attended nonfatal injuries and poisonings. A single year now provides enough data to produce stable national estimates on details of injury and poisoning episodes.

Triage issues in an out-of-hospital birth center.

Effective triage in an out-of-hospital birth center helps low-risk women avoid high-risk care. Background issues include the contributions of evidence-based practice, informed consent, patient education, problem-focused documentation, after-hours access to client data, and the value of intuition. Telephone triage, immediate referral, birth center management, and follow-up with counseling are outlined for common out-of-hospital triage problems: first trimester bleeding, nausea and vomiting, second and third trimester bleeding, urinary tract symptoms, decreased fetal movement, contractions < 37 weeks, rupture of membranes, contractions > or = 37 weeks, and "emergency" delivery.

Endothelial nitric oxide synthase as a potential susceptibility gene in the pathogenesis of emphysema in alpha1-antitrypsin deficiency.

A role for endothelial nitric oxide synthase (NOS3) in the susceptibility of individuals with alpha1-antitrypsin (alpha1AT) deficiency to destructive lung disease was evaluated. Six polymorphic sites were identified within the NOS3 gene (i.e., -924A/G, -788C/T, -691C/T, 774C/T, 894G/T, and 1998C/G). The genotype distribution was determined in 339 patients and 94 control individuals. Frequency of the 774T allele in severely affected individuals was 0.417 versus 0.269 in control subjects (P = 0.018), whereas the 894T allele frequency was 0.427 versus 0.280 in control subjects (P = 0.024). Patients with less severe lung disease had the 774T and 894T allele frequencies of 0.289 and 0.344, respectively, similar to frequencies in a control group (P > 0.3). No direct correlation between pulmonary function and five other NOS3 polymorphisms was observed. Thus, functional allelic variants that are in linkage disequilibrium with the 774C/T and 894G/T may be present in the specified genomic area. These data are consistent with a modulatory role for NOS3 in destructive lung disease associated with alpha1AT deficiency.

Initial UK experience of the levonorgestrel-releasing contraceptive intravaginal ring.

A study was performed to establish the tolerance, acceptability and associated efficacy of a levonorgestrel-releasing intravaginal ring (IVR) in a sample of British women requiring contraception. This was achieved with an open non-randomized prospective study of 1710 women aged 18-40 years, recruited in 75 centers geographically spread around the UK using an IVR designed to release 20 microg/day of levonorgestrel. Assessments were made at baseline, after 6 weeks, after 3 months and then 3-monthly. After initial insertion of the IVR, it was changed at 3-monthly intervals. A total of 1591 women were eligible for analysis, with 572 available after 12 months and 34 after 24 months of use. Life-table analysis revealed pregnancy rates of 5.1% and 6.5% at 12 months and 24 months, respectively. The IVR was rated as acceptable or very acceptable as a form of contraceptive by 60.7% of women at 12 months. The most common adverse events were menstrual disturbance, headache and vaginal discharge. No significant pattern of biochemical, hematological, microbiological or cytological abnormalities was found but vaginal erythematous lesions were noted at some centers. This IVR was found to be a generally well-accepted method of contraception with a failure rate comparable to some other progestogenonly methods. On this basis, further development of hormone-releasing intravaginal rings is justified.

No direct clinical relevance of the human leucocyte antigen (HLA) system in clozapine-induced agranulocytosis.

The clinical use of clozapine in psychiatry is restricted by the associated risk of agranulocytosis. This risk is significantly higher than that associated with conventional antipsychotic medications. In order to identify a possible parameter to detect susceptible individuals before treatment, 103 patients with a history of clozapine-induced granulocytopenia or agranulocytosis and 95 matched control patients were typed for human leucocyte antigen (HLA)-A, -B, -C, -DR, -DQ and for a number of neutrophil-specific alloantigens. No significant association between certain HLA alleles or neutrophil antigens and susceptibility to clozapine-induced granulocytopenia or agranulocytosis was observed.

Investigation of three patients with the "ring syndrome", including familial transmission of ring 5, and estimation of reproductive risks.

We report three cases of ring chromosome 5 [r(5)], two familial (mother and daughter) and one sporadic. The phenotype resembled that of the "ring syndrome" with prenatal onset of short stature, growth retardation, mild facial dysmorphism and normal psychomotor development. Extended metaphase and prometaphase chromosome preparations using G-, R- and Q-banding and scanning electron microscopy (SEM) failed to demonstrate deletion in the ring 5. Flow karyotype using the FACS cell sorter and peak area analysis showed the r(5) to be in the same position as the normal chromosome 5. The deletion that is presumably associated with ring formation appears to involve less that one megabase of DNA. In the "complex" rings, high resolution SEM showed fragile sites at the 5q34 and 5q35 region with frequent deletions at that site. A literature survey suggests that when a parent carries a ring chromosome about 80% of recognised pregnancies result in live birth. Of these, about half have a normal phenotype and karyotype, and half inherit the parental ring; about half of those acquiring the ring (20%) show significant mental retardation.

The change in the rate of muscle protein metabolism of rats from weaning to 90 days of age.

1. Protein synthesis, net deposition and breakdown was studied in the gastrocnemius muscles of growing rats between weaning and 90 days of age. 2. Fractional protein synthetic rates declined from 30.02% at 25 days to 7.41% at 90 days. 3. The rate of protein degradation follows a similar pattern to that of protein synthesis. A linear relationship was found. 4. The break in the growth curve between 30 and 31 days was also observed in protein metabolism.