The association between serological and dietary vitamin D levels and hepatitis C-related liver disease risk differs in African American and white males.

BACKGROUND: Vitamin D may affect the severity of HCV-related liver disease. AIM: To examine the association between serum vitamin D levels and advanced liver disease in a multiethnic US cohort of HCV patients, and account for dietary and supplemental intake. METHODS: We measured serum 25-hydroxyvitamin D levels and used FibroSURE-ActiTest to assess hepatic pathology in a cohort of HCV-infected male veterans. We estimated and adjusted for daily intake of vitamin D from diet using a Dietary History Questionnaire, and dispensed prescriptions prior to study enrolment. We used race-stratified logistic regression analyses to evaluate the relationship between serum vitamin D levels and risk of advanced fibrosis (F3/F4-F4) and advanced inflammation (A2/A3-A3). RESULTS: A total of 163 African American (AA) and 126 White non-Hispanics were studied. Overall, ~44% of AAs and 15% of Whites were vitamin D deficient (<12 ng/mL) or insufficient (12-19 ng/mL); 4% of AAs and 9% of White patients had an elevated level (>50 ng/mL). Among AAs, patients with elevated serum vitamin D levels had significantly higher odds of advanced fibrosis (OR = 12.91, P = 0.03) than those with normal levels. In contrast, AAs with insufficient or deficient levels had > two-fold excess risk of advanced inflammation (P = 0.06). Among White males there was no association between vitamin D levels and advanced fibrosis (F3/F4-F4) or inflammation (A2/A3-A3) risk. CONCLUSIONS: We observed potential differences in the association between vitamin D levels and degree of HCV-related hepatic fibrosis between White and African American males. Additional research is necessary to confirm that high serum vitamin D levels may be associated with advanced fibrosis risk in African American males, and to evaluate whether racial differences exist in HCV-infected females.

Optic Atrophy in End-Stage Giant Axonal Neuropathy: A Case Report.

A 32-year-old woman with a history of biopsy-proven giant axonal neuropathy (GAN) and no past ocular history presented after failing a vision-screening test conducted by her primary doctor. Bilateral optic atrophy was observed on fundus examination with cup-to-disc ratio of 0.7. Kinetic visual fields showed moderate constriction in both eyes. Optical coherence tomography (OCT) of the retinal nerve fibre layer (RNFL) exhibited diffuse thinning, a pattern atypical of glaucomatous or nutritional optic atrophy and most likely secondary to the optic atrophy associated with GAN. Serial OCT to monitor RNFL thickness may offer a non-invasive means of monitoring progression in GAN for future therapeutic studies.

The GABA rho1 subunit interacts with a cellular retinoic acid binding protein in mammalian retina.

Interactions between the intracellular domain of ligand-gated membrane receptors and cytoplasmic proteins play important roles in their assembly, clustering, and function. In addition, protein-protein interactions may provide an alternative mechanism by which neurotransmitters activate intracellular pathways. In this study, we report a novel interaction between the GABA rho1 subunit and cellular retinoic acid binding protein in mammalian retina that could serve as a link between the GABA signaling pathway and the control of gene expression in neurons. The interaction between the intracellular loop of the human GABA rho subunit and cellular retinoic acid binding protein was identified using a CytoTrap XR yeast two-hybrid system, and was further confirmed by co-precipitation of the human GABA rho subunit and cellular retinoic acid binding protein from baboon retinal samples. The cellular retinoic acid binding protein binding domain on the human rho1 subunit was located to the C-terminal region of human GABA rho subunit, and the interaction of the human GABA rho subunit with cellular retinoic acid binding protein could be antagonized by a peptide derived from within the binding domain of the rho1 subunit. Since cellular retinoic acid binding protein is a carrier protein for retinoic acid, we investigated the effect of GABA on retinoic acid activity in neuroblastoma cells containing endogenously expressed cellular retinoic acid binding protein. In the absence of the rho1 receptor, these cells showed enhanced neurite outgrowth when exposed to retinoic acid and GABA had no effect on their response to retinoic acid. In contrast, cells stably transfected with the human rho1 subunit showed a significantly reduced sensitivity to retinoic acid when exposed to GABA. These results suggest that the GABA receptor subunit effectively altered gene expression through its interaction with the cellular retinoic acid binding protein pathway.

Assessment and management of dysphagia.

Swallowing problems are common in hospital inpatients and may affect morbidity and mortality. Accurate assessment of dysphagia is important, allowing optimal management and minimizing potential complications. This article considers the methods of swallow assessment available and ways in which problems can be addressed.

Change in level of physical activity and risk of all-cause mortality or reinfarction: The Corpus Christi Heart Project.

BACKGROUND: The role of physical activity (PA) in reducing the risk of all-cause mortality or reinfarction after a first myocardial infarction (MI) remains unresolved, particularly for minority populations. The association between change in level of PA and risk of death or reinfarction was studied in 406 Mexican American and non-Hispanic white women and men who survived a first MI. METHODS AND RESULTS: MI patients were interviewed at baseline and annually thereafter about PA, medical history, and risk factors of coronary heart disease. Change in level of PA after the index MI was categorized as (1) sedentary, no change (referent group), (2) decreased activity, (3) increased activity, and (4) active, no change. Over a 7-year period, the relative risk (95% CI) of death was as follows: 0.21 (0.10 to 0.44) for the active, no change group; 0.11 (0.03 to 0.46) for the increased activity group; and 0.49 (0.26 to 0.90) for the decreased activity group. The relative risk of reinfarction was as follows: 0.40 (0.24 to 0.66) for the active, no change group; 0.22 (0.09 to 0.50) for the increased activity group; and 0.93 (0.59 to 1.42) for the decreased activity group. CONCLUSIONS: These findings are consistent with a beneficial role of PA for Mexican American and non-Hispanic white women and men who survive a first MI and have practical implications for the management of MI survivors.

Cytomegalovirus colitis after autologous transplantation for multiple myeloma.

Bone marrow or stem cell transplantation is an established therapy for haematological malignancies. We report a cytomegalovirus (CMV) IgG +ve 56-year-old patient who underwent autologous rescue with CD34(+) selected peripheral blood stem cells as part of consolidation therapy for multiple myeloma and subsequently developed CMV colitis. In contrast to infection secondary to human immunodeficiency virus (HIV), CMV colitis has not previously been described in this context. We discuss this case and issues arising from it related to the use of CD34+ selected stem cells for transplantation.

Searching for preventable causes of child mortality in Texas: trends in the major causes from 1987 through 1996.

We ranked the underlying causes of child deaths in Texas from 1989 through 1991 for the groups aged 1 through 4, 5 through 9, 10 through 14, and 15 through 19 years. External causes (injuries) accounted for 66% of child deaths, and 5 accounted for at least 100 deaths each: motor vehicle accidents, homicide, suicide, drowning, and burns. Of the deaths that had potential for primary prevention, more than 95% involved accidents, suicide, and homicide. Of the smaller number of deaths that had potential for secondary prevention, treatment of infectious conditions had the greatest potential. From 1987 through 1996, child deaths from all causes averaged 2498 per year. Natural causes averaged 871 per year; external causes averaged 1627 per year. Among the external causes, annual averages for accidents were 1089 deaths; for motor vehicle accidents, 703; for homicide, 334; and for suicide, 187. We used linear regression analyses to estimate trends in deaths and mortality rates. The only categories that experienced an increased number of deaths, despite a 12% increase in the population, were deaths from all causes in the adolescent age groups; from natural causes in all but the group aged 1 through 4 years; from external causes in the adolescent age groups; from suicide in all but the group aged 1 through 4 years; and from homicide in all age groups. The increased number of deaths was often lower than the increase in the population, resulting in lower mortality rates. The only mortality rates that increased were those from all causes in the group aged 15 through 19 years; from natural causes, in both adolescent age groups; from suicide, in the group aged 10 through 14 years; and from homicide, in all but the group aged 5 through 9 years. These trends suggest that primary prevention of child deaths in Texas should focus on external causes, particularly motor vehicle accidents, homicides, and suicides.

Sex and ethnic differences in use of myocardial revascularization procedures in Mexican Americans and non-Hispanic whites: the Corpus Christi Heart Project.

Age-adjusted rates of percutaneous transluminal coronary angioplasty (PTCA) and aortocoronary bypass surgery (ACBS) were determined for Mexican American (MA) and non-Hispanic white (NHW) patients hospitalized for coronary heart disease. Hypotheses of equal receipt of procedures between gender and ethnic groups were tested. Following myocardial infarction (MI), women were less likely than men to receive either procedure (22 versus 32%, p < 0.01), and MA were less likely than NHW to receive PTCA (13 versus 23%, p < 0.01) but not ACBS. After adjustment for extent of disease and other potential confounders, ethnic groups differed marginally in receipt of PTCA but not ACBS, while gender differences were not significant. Although women received revascularization procedures less frequently than men, this difference did not persist after controlling for extent of coronary artery disease by angiography: therefore, these observed differences in delivery of health care services may be appropriate. Mexican Americans received PTCA, but not ACBS, less frequently than NHW. This selective ethnic difference in receipt of PTCA does not appear to be associated with the extent of disease or other medical characteristics, and may represent inappropriate bias in delivery of health care services.

Greater incidence of hospitalized myocardial infarction among Mexican Americans than non-Hispanic whites. The Corpus Christi Heart Project, 1988-1992.

BACKGROUND: Since Mexican Americans have adverse patterns of risk factors for myocardial infarction relative to non-Hispanic whites, the incidence of myocardial infarction should be greater among Mexican Americans than among non-Hispanic whites. This expectation conflicts with reports generated from death certificate registries. METHODS AND RESULTS: Data regarding myocardial infarction attacks and incident events were collected for a 4-year period in the Corpus Christi Heart Project, a population-based surveillance project for hospitalized coronary heart disease events. For both women and men, Mexican Americans experienced greater hospitalization rates for both attacks and incident events than non-Hispanic whites. Age-adjusted attack rate ratios comparing Mexican Americans with non-Hispanic whites were 1.59 (95% CI, 1.05 to 2.41) and 1.31 (95% CI, 1.18 to 1.45) among women and men, respectively. Corresponding incidence ratios were 1.52 (95% CI, 1.28 to 1.80) and 1.25 (95% CI, 1.10 to 1.42). CONCLUSIONS: This is the first report documenting greater incidence of hospitalized myocardial infarction among Mexican Americans than among non-Hispanic whites, a biologically plausible finding given the risk factor patterns observed in the Mexican-American population. Public health planners and clinicians should be aware of the importance of myocardial infarction as a health problem in the Mexican-American population. Culturally appropriate prevention strategies should be developed for and tested in Mexican-American populations.

Women and Mexican Americans receive fewer cardiovascular drugs following myocardial infarction than men and non-Hispanic whites: the Corpus Christi Heart Project, 1988-1990.

Mortality following myocardial infarction (MI) is greater among women than men and among Mexican Americans than non-Hispanic whites. Because therapy can affect mortality following MI, we examined differences in discharge therapy among these groups. Data regarding discharge therapy of 982 patients in the Corpus Christi Heart Project showed that women received fewer cardiovascular drugs than men, and Mexican Americans received fewer cardiovascular drugs than non-Hispanic whites. In multivariate analysis adjusting for age, cigarettes smoking, diabetes, hypertension, congestive heart failure, and serum cholesterol, the odds ratio for receipt of cardiovascular medications was 0.51 (95% CI: 0.28-0.93) for women versus men and 0.62 (0.3-1.15) for Mexican Americans versus non-Hispanic whites. Beta-blockers were prescribed rarely. Thus, treatment differences between ethnic and gender groups were observed following MI. Further research is needed to determine both the reasons for these differences and the extent to which these differences contribute to the observed survival patterns following MI.

Higher levels of social support predict greater survival following acute myocardial infarction: the Corpus Christi Heart Project.

Although low levels of social support have been related to mortality from coronary heart disease, little is known about the role of social support among Mexican Americans. The authors therefore examined the relationship between social support and long-term survival in the Corpus Christi Heart Project. They developed a social support scale that used data collected during in-hospital interviews of 292 Mexican Americans and 304 non-Hispanic Whites who survived a myocardial infarction for more than 28 days. The scale incorporated three measures: marital status; if not married, whether living alone; and whether advised to seek help. During an average follow-up period of 43 months, 115 participants died. Survival following myocardial infarction was greater for those with high or medium social support than for those with low social support. With age, gender, ethnicity, education, employment, smoking, diabetes, hypertension, and hypercholesterolemia included in a proportional hazards regression model, the relative risk of mortality was 1.89 (95% CI, 1.20-2.97) for those with low social support. But when the two ethnic groups were analyzed separately, low social support was no longer a significant predictor of mortality for non-Hispanic Whites, whereas for Mexican Americans, the relative risk of mortality was 3.38 (95% CI, 1.73-6.62) for those with low social support.

Probing sensory and associative semantics for animals and objects in normal subjects.

Neuropsychological studies of patients with "category-specific" semantic memory disorders have fuelled a debate concerning the organisation of knowledge. In particular it has been suggested that the reported double dissociation between knowledge of animals and living things on the one hand, and objects on the other, reflects a more fundamental division of semantic representation into functional-associative and sensory-visual domains. The present study attempted to investigate whether there were systematic differences along these dimensions in normal subjects using a sentence-verification technique. It was found that response times were significantly longer for verification of statements concerning the sensory attributes of objects than for statements about their associative attributes. In the case of animals, there were no differences in response latency to associative or sensory statements. In the light of this previously unreported fractionation within verbal semantics, the possible consequences for models of semantic memory are discussed.

A population-based assessment of the use and effectiveness of thrombolytic therapy. The Corpus Christi Heart Project.

Little is known regarding the use and effectiveness of thrombolytic therapy in community settings, especially regarding the receipt of therapy by Mexican Americans. Thus, we examined the factors associated with receipt of thrombolysis and the survival experience of recipients and nonrecipients in the Corpus Christi Heart Project. The Corpus Christi Heart Project is a population-based surveillance program for hospitalized myocardial infarction among Mexican-American and non-Hispanic white women and men residing in Corpus Christi, Texas. Multivariate regression analyses were used to identify factors associated with receipt of thrombolytic therapy and to assess the association between receipt of thrombolytic therapy and mortality. During a 2-year period, 1199 patients hospitalized for myocardial infarction were identified; 159 (13.3%) received thrombolysis. Among "ideal" candidates for thrombolytic therapy, 74 (35.1%) of 211 received such therapy. Women were less likely to receive thrombolysis than men, and Mexican Americans were less likely to received thrombolysis than non-Hispanic whites. Patients for whom there was a delay of more than 4 hours between onset of symptoms and arrival at the hospital were also less likely to receive thrombolysis. Recipients of thrombolytic therapy experienced lower mortality over 56 months following myocardial infarction than did nonrecipients (20.5 versus 33.2%, P < 0.01). Use of thrombolytic therapy was less frequent among women and Mexican Americans than among men and non-Hispanic whites, and was limited by delay between onset of symptoms and arrival at the hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

The relation of diabetes to the severity of acute myocardial infarction and post-myocardial infarction survival in Mexican-Americans and non-Hispanic whites. The Corpus Christi Heart Project.

The effect of diabetes on survival after myocardial infarction (MI) was examined in a prospective population-based study of individuals hospitalized with MI in a bi-ethnic community of Mexican-Americans and non-Hispanic whites. Among Mexican-Americans, 54% (331 of 610) had diabetes compared with 33% (192 of 589) of non-Hispanic whites (P < 0.001). Among those with diabetes, the prevalence of a history of a cardiac event before the index admission was significantly higher (odds ratio = 1.4, 95% confidence interval [CI] 1.1-1.8) than among nondiabetic subjects. During the index hospitalization, diabetic subjects received cardiac catheterization less frequently than did nondiabetic subjects (45.1 vs. 51.5%, P = 0.03). Diabetic subjects had lower estimated ejection fractions, and the number of coronary arteries with significant obstruction (> 75%) was higher (P < 0.001). The peak creatine phosphokinase and creatine phosphokinase myocardial isoenzyme (CK-MB) levels were similar in diabetic and nondiabetic subjects. Despite a similar infarct size, diabetic subjects had a higher incidence of congestive heart failure (relative ratio = 2.2, 95% CI 1.7-2.8), more adverse indexes of short-term and long-term prognosis, and a longer average hospital stay (12.1 vs. 8.9 days, P < 0.01). After adjustment for age, sex, and ethnicity, the cumulative risk for total mortality, over 44 months of follow-up, was 37.4% among diabetic compared with 23.3% among nondiabetic subjects (P < 0.001). Diabetic subjects had a higher 28-day case-fatality rate post-MI as well as higher long-term mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Greater case-fatality after myocardial infarction among Mexican Americans and women than among non-Hispanic whites and men. The Corpus Christi Heart Project.

Age-adjusted 28-day case-fatality rates were higher among Mexican Americans than among non-Hispanic whites and higher among women than among men hospitalized for definite or possible myocardial infarction in Corpus Christi, Nueces County, Texas, from May 1, 1988, through April 30, 1990. The authors therefore examined whether these higher case-fatality rates were associated with greater prevalence of previously diagnosed coronary heart disease or diabetes; with greater age, frequency of definite myocardial infarction, or congestive heart failure; with higher values of indicators of severity of infarction, including peak creatine phosphokinase levels and scales prognostic of early mortality after myocardial infarction; and with differences in receipt of in-hospital therapy. The overall 28-day case-fatality rate among 1,228 patients hospitalized for myocardial infarction during a 24-month period was 7.3%. After adjustment for age; diabetes; myocardial infarction class (definite vs. possible); congestive heart failure; the Norris and Peel severity indices; peak total creatine phosphokinase; and receipt of thrombolytic therapy, aspirin, calcium channel blockers, beta-blockers, anticoagulants, angioplasty, and bypass surgery, the risk of 28-day case-fatality for Mexican Americans in relation to non-Hispanic whites was 1.49 (95% confidence interval 0.92-2.40). The corresponding risk for women in relation to men was 1.80 (95% confidence interval 1.12-2.89). These findings should alert clinicians to the high-risk status of these groups of patients.

Mortality after hospitalization for myocardial infarction among Mexican Americans and non-Hispanic whites: the Corpus Christi Heart Project.

We compared short- and long-term mortality among 334 Mexican Americans and 348 non-Hispanic whites hospitalized for myocardial infarction in the Corpus Christi Heart Project. Age-adjusted 28-day case fatality rates were 37% and 68% greater among Mexican-American women (6.7%) and men (6.2%) than among their non-Hispanic white counterparts (4.9% and 3.7%). Age-adjusted all-cause mortality rates over the next 25-month period, among those who survived the initial 28 days, were similar among Mexican-American and non-Hispanic white women (17.8% and 18.1%), but were 70% higher among Mexican-American men than among non-Hispanic white men (17.4% and 10.2%, respectively). Age-adjusted 25-month coronary mortality rates among initial 28-day survivors were 40% greater among Mexican-American women than among non-Hispanic white women (12.5% vs 9.0%), and 129% greater among Mexican-American men than among non-Hispanic white men (11.4% vs 5.0%, respectively). Thus, nearly all measures of post-myocardial infarction mortality indicated a survival disadvantage for Mexican Americans compared to non-Hispanic whites.

Acute myocardial infarction and coronary heart disease mortality among Mexican Americans and non-Hispanic whites in Texas, 1980 through 1989.

We calculated acute myocardial infarction and chronic coronary heart disease mortality rates for Mexican Americans and non-Hispanic whites in Texas for the 10-year period from 1980 through 1989 in an examination of ethnicity-related differences in death rates and trends according to vital statistics for the state of Texas. During the study period, acute myocardial infarction mortality decreased significantly in all four sex-ethnic groups, between 5.1% and 7.4% per year. Chronic coronary heart disease mortality rates decreased less, but significantly, for women in both ethnic groups, decreasing 3.4% and 1.8% per year for Mexican-American and non-Hispanic white women, respectively. We found no significant trend of changes in chronic coronary heart disease mortality rate among men in either ethnic group. For both acute myocardial infarction and chronic coronary heart disease mortality, rates were significantly lower among Mexican-American men than among non-Hispanic white men. Age-adjusted rate ratios for Mexican-American men in relation to non-Hispanic white men were 0.78 (95% CI: 0.65-0.93) and 0.75 (0.65-0.86) for acute myocardial infarction and chronic coronary heart disease mortality, respectively. No significant ethnicity-related mortality difference was seen among women. This previously observed interaction of ethnicity and sex in relation to coronary heart disease mortality remains unexplained. Despite apparently adverse cardiovascular risk factor profiles, Mexican Americans have acute myocardial infarction and chronic coronary heart disease mortality rates equal to or lower than their non-Hispanic white counterparts on the basis of death certificate data. This paradox deserves further attention.