Do elder emergency department patients and their informants agree about the elder's functioning?

OBJECTIVE: To compare elder patients' and their informants' ratings of the elder's physical and mental function measured by a standard instrument, the Medical Outcomes Study Short Form 12 (SF-12). METHODS: This was a randomized, cross-sectional study conducted at a university-affiliated community teaching hospital emergency department (census 65,000/year). Patients >69 years old, arriving on weekdays between 10 AM and 7 PM, able to engage in English conversation, and consenting to participate were eligible. Patients too ill to participate were excluded. Informants were people who accompanied and knew the patient. Elder patients were randomized 1:1 to receive an interview or questionnaire version of the SF-12. The questionnaire was read to people unable to read. Two trained medical students administered the instrument. The SF-12 algorithm was used to calculate physical (PCS) and mental (MCS) component scores. Oral and written versions were compared using analysis of variance. The PCS and MCS scores between patient-informant pairs were compared with a matched t-test. Alpha was 0.05. RESULTS: One hundred six patients and 55 informants were enrolled. The patients' average (+/-SD) age was 77 +/- 5 years; 59 (56%; 95% CI = 46% to 65%) were women. There was no significant difference for mode of administration in PCS (p = 0.53) or MCS (p = 0.14) scores. Patients rated themselves higher on physical function than did their proxies. There was a 4.1 (95% CI = 99 to 7.2) point difference between patients' and their proxies' physical component scores (p = 0.01). Scores on the mental component were quite similar. The mean difference between patients and proxies was 0.49 (95% CI = 3.17 to 4.16). The half point higher rating by patients was not statistically significant (p = 0.79). CONCLUSIONS: Elders' self-ratings of physical function were higher than those of proxies who knew them. There was no difference in mental function ratings between patients and their proxies. Switching from informants' to patients' reports in evaluating elders' physical function in longitudinal studies may introduce error.

Influence of PGRs on carbohydrate content in Lipaphis erysimi (Kalt.).

Six compounds (IBA, chlorogenic acid, cytokinine, GA3, alar B-9 and maleic hydrazide) belonging to four different categories of plant growth hormones were used to study their effect on carbohydrate content in L. erysimi. The second instar nymphs (48 hr old) were given both dipping and leaf surface treatment with 1024 ppm concentration of compounds for two time intervals i.e. 48 and 96 hr. The carbohydrate content decreased after treatment with 4 of the plant growth regulators i.e. GA3, alar B-9, IBA and chlorogenic acid with maximum suppression in GA3 treatment. Cytokinine did not induce any derogatory influence on carbohydrate content. The treatment with maleic hydrazide, on the other hand enhanced the carbohydrate content. It could be concluded that the application of these PGRs affected the carbohydrate synthesis or metabolism.

Overlooked impacted dentures and their unusual complications.

Two interesting and unusual cases of overlooked impacted dentures in oesophagus, one for 3 months and the other for 2 years are reported. We also report the complications of Bilateral Recurrent Laryngeal Nerve Paralysis and Oesophageal Diverticuli due to prolonged obstruction by denture.

Effect of zinc supplementation on observed activity in low socioeconomic Indian preschool children.

OBJECTIVES: To investigate whether supplementation of zinc in preschool children is associated with improvement in observed activity levels. METHODS: On 2 consecutive days, we performed 5-hour observations with momentary time sampling (instant activity every 10 minutes) in children selected from an ongoing double-blind, randomized trial of zinc supplementation. The study was conducted in Kalkaji, a low-socioeconomic urban population of New Delhi with high diarrheal incidence and rates of malnutrition. A total of 93 children (48 zinc and 45 control) 12 to 23 months of age from an ongoing community-based, randomized, controlled trial received supplements for at least 1 month before study; 71% had received supplementation for more than 120 days. Zinc gluconate (10 mg of elemental zinc) was given daily, with both zinc and control groups receiving vitamins A, B1, B2, B6, D3, and E and niacinamide in addition. RESULTS: Outcomes were percentages of time spent in each of five activity levels and two groups representing high and low movement and overall rating by two activity scores. Children in the zinc group spent 72% more time performing activities in the high-movement group. Among the zinc-supplemented children, the activity rating by the children's activity rating score was 12% higher and by the energy expenditure score was 8.3% higher than in the control group. CONCLUSIONS: In conclusion, zinc supplementation, given along with selected vitamins, was associated with significantly greater activity levels in children. The relationship between the activity increase and locomotor development needs to be investigated, as do the long-term implications of zinc supplementation in terms of developmental status and school performance.

Ectopic meningioma of the paranasal sinuses.

An 11-year-old boy presented with epistaxis and proptosis. Plain X-ray revealed a bony mass in the nasal cavity. Computed tomography showed a high-density mass which at surgery turned out to be a meningioma.

Studies on experimental chlamydial mastitis in goat histoenzymology.

Two strains of Chlamydia psittaci (one isolated from aborted goat foetus and the other from brain of a buffalo calf that had died of meningoencephalitis) were injected intracisternally into six goats to produce experimental mastitis. Cryostat sections of 7-8 microns thickness, obtained from udder, teat, liver and kidney of infected and control animals were incubated for histoenzymic demonstration of alkaline-(AKPase), acid-(ACPase) and adenosine-tri-(ATPase) phosphatases; lactate-(LDH) and succinate-(SDH) dehydrogenases and for reduced nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-D). Results demonstrated that AKPase and NADPH-D declined while ACPase accumulated in acinar cells of udder while both NADPH-D and ACPase decreased in teat sinus epithelium. Hepatic canaliculi in perilobular areas of liver lobules registered complete absence of AKPase and ATPase. Hepatocytes and renal tubules accumulated LDH, SDH and NADPH-D. The interstitial connective tissue of udder and kidney presented higher levels of AKPase. Comparison of results with biochemical alterations in the level of these enzymes revealed striking discrepancies which seem to arise because of failure of biochemical procedures to discriminate between functional cells of tissue and inflammatory cells. The functional significance of histoenzymic alterations has been discussed.

Conflict behavior in Maudsley reactive and nonreactive rats: effects of noradrenergic neuronal destruction.

The present studies were designed to examine the effects of treatment with the noradrenergic neurotoxin N-(2-chloroethyl)-n-ethyl-2-bromobenzylamine HCl (DSP4; 65 mg/kg, IP) on conflict behavior in the Maudsley reactive (MR) and nonreactive (MNRA) rat strains. In daily 10-min sessions, water-restricted rats were trained to drink water from a tube that was occasionally electrified; electrification was signaled by the presence of a tone (7-s duration; ISI = 30 s). Consistent with previous reports, the number of shocks accepted by rats of the MR and MNRA strains did not differ initially, but MNRA rats exhibited a dramatic increase in punished responding relative to their MR counterparts over the course of several weeks of conflict testing. This MR vs. MNRA strain difference in punished responding did not exhibit extinction following discontinuation of CSD conflict behavior testing for a period of 6 weeks. Whether it was administered after conflict training or before, DSP4 treatment did not reduce the MR vs. MNRA strain difference in conflict behavior; rather, DSP4 treatment tended to increase the magnitude of the MR vs. MNRA difference in conflict behavior. The effects of DSP4 on norepinephrine (NE) and 5-hydroxytrypamine (5-HT) concentrations in the pons medulla region were determined in one group of conflict-experienced MR and MNRA rats (35 weeks after administration) and in a second group of naive MR and MNRA rats (3 weeks after administration). There were no MR vs. MNRA strain differences in NE or 5-HT concentrations in vehicle-treated rats. DSP4 treatment significantly reduced NE, but not 5-HT, concentrations when compared to control values; rats that were sacrificed 3 weeks following DSP4 administration exhibited a greater NE depletion than did rats sacrificed 35 weeks after DSP4 administration. Finally, there were no significant correlations between pons medulla region NE concentrations and conflict behavior in either strain alone or when the data from the two strains were combined. The present results are not consistent with the hypothesis that the MR vs. MNRA strain difference in conflict behavior is the result of strain differences in brain NE function.

Ocular chlamydial zoonosis: an experimental study in monkeys.

Two locally isolated strains of Chlamydia psittaci from faeces of apparently healthy sheep and conjunctiva of Holstein heifers suffering from conjunctivitis and pneumonia were used for ocular experimental studies in 7 Rhesus monkeys. Titrated (ELD50 10(3.6)/0.2 ml and 10(4.5)/0.2 ml) partially purified yolk sac suspension of each strain was instilled onto conjunctiva of each animal. The clinical and laboratory studies were followed till 8 weeks post-infection. Both the strains produced trachoma like follicles (0.3-0.5 mm dia) preferably on lower conjunctiva between 2-4 weeks of post-infection. Pannus was not observed in any of the experimental eye. Laboratory studies revealed a good correlation between reisolation, fluorescent antibody test and cytology between 2-4 weeks of post-infection. Highest complement fixing antibody titre 1:32 was recorded in 4 out of 7 animals. The studies indicated that both the animal strains had no barrier across ocular tissues in monkeys, vis-à-vis human conjunctiva.

Aneurysm of the internal carotid artery presenting as a parapharyngeal mass.

A case of saccular aneurysm of the internal carotid artery presenting as a parapharyngeal mass is being reported because of its rarity and the paucity of literature on the subject. Welling et al. (1983) evaluated 1118 aneurysms of the peripheral arteries seen over a 30-year period. Forty-one of these arose from the extracranial carotid system, only four of them being saccular aneurysms of the internal carotid artery. None of them presented with a parapharyngeal mass.