The use of fresh frozen plasma for reproduction in severe factor V deficiency.

OBJECTIVE: Severe factor V (FV) deficiency is rare. There are case reports describing pregnancy outcomes in women with FV deficiency and one case report of successful pregnancy following the use of fresh frozen plasma (FFP) in several cycles of ovulation induction and intrauterine insemination and at delivery. The authors report another case to support the use of FFP for reproduction. CASE: A 27-year-old woman with severe FV deficiency was given FFP at the time of ovulation induced with clomiphene citrate, human menopausal gonadotropin (hMG), and human chorionic gonadotropin. Intrauterine insemination (IUI) was done 35 hours later. She became pregnant with twins and delivered vaginally at 36 weeks of gestation with the prophylactic use of FFP. CONCLUSION: Fresh frozen plasma can be offered for reproduction to women with severe FV deficiency.

High prevalence of vitamin D deficiency among healthy Saudi Arabian men: relationship to bone mineral density, parathyroid hormone, bone turnover markers, and lifestyle factors.

SUMMARY: In this cross-sectional study, the prevalence of vitamin D deficiency [serum 25-hydroxyvitamin D (25(OH)D) <50 nmol/L] was 87.8% among Saudi Arabian men. There was a linear inverse relationship between serum 25(OH)D and intact parathyroid hormone (PTH) levels, but without a threshold of 25(OH)D at which intact PTH values plateaued. INTRODUCTION: Vitamin D insufficiency and/or deficiency has now reached epidemic proportions and has been linked to low bone mineral density (BMD), some lifestyle factors, and obesity in adults. This relationship is not well documented in Saudi Arabian men. This study examines the relationship between vitamin D status, intact parathyroid hormone (intact PTH), and lifestyle factors among Saudi Arabian men. METHODS: This cross-sectional study involved 834 men aged 20-74 years living in Jeddah area who were randomly selected and medically examined. Men had their BMD (lumbar spine (L1-L4) and neck femur), 25(OH)D, intact PTH, and other parameters measured according to detailed inclusion criteria. RESULTS: Deficiency (25(OH)D<50 nmol/L) and insufficiency (≥50-75 nmol/L) were present in 87.8% and 9.7%, respectively. Deficiency was common among older and obese men with no education and sedentary lifestyle sampled during summer and spring. Serum 25(OH)D showed an inverse linear relationship with intact PTH, but there was no threshold of serum 25(OH)D at which PTH levels plateaued. There was a positive correlation between BMD values at both lumbar spine (L1-L4) (P < 0.023) and neck femur (P < 0.036) and serum 25(OH)D levels, respectively. CONCLUSIONS: Functionally significant vitamin D deficiency affects BMD and bone turnover markers among Saudi Arabian men and is largely attributed to older age, obesity, sedentary lifestyle, no education, poor exposure to sunlight, smoking, and poor dietary vitamin D supplementation. The data suggest that an increase in PTH cannot be used as a marker for vitamin D deficiency.

Decreased serum sclerostin levels in patients with primary hyperparathyroidism: a cross-sectional and a longitudinal study.

UNLABELLED: Decreased serum sclerostin was evident in patients with primary hyperparathyroidism and was inversely related to parathyroid hormone (PTH). Sclerostin normalized earlier than biochemical bone turnover markers (BTMs) following parathyroidectomy. INTRODUCTION: There is limited information on the changes of serum sclerostin in conditions with chronic PTH excess in humans. The main objectives of the present study were to: (1) examine cross-sectionally the changes of serum sclerostin levels in patients with primary hyperparathyroidism (PHPT), (2) study the time course changes in serum sclerostin in PHPT patients following parathyroidectomy (PTX) followed up longitudinally for 12 months, and (3) compare the changes in serum sclerostin to that of BTMs. METHODS: We studied 60 PHPT patients and compared them with 74 PTX patients together with 268 age- and sex-matched healthy controls. Also, we followed 27 PTX patients longitudinally at 2, 4, 6, 10, 30, 60, 180, and 360 days postoperatively. Serum sclerostin, BTMs, and minerals were measured. Also, bone mineral density was determined by dual energy X-ray absorptiometry. RESULTS: Patients with PHPT exhibited significantly lower mean serum sclerostin [mean, in picomoles per liter; 95% confidence interval (CI)] (28.98; 27.94-30.03) than that obtained for PTX patients (37.01; 35.75-38.27) and healthy controls (46.22; 45.13-47.31) (P < 0.0001, for each case), respectively. Serum PTH inversely correlated with serum sclerostin (r = -0.651, P < 0.0001). Serum sclerostin was normalized in PTX patients by the tenth day postoperatively and remained within the expected reference range thereafter. CONCLUSIONS: Significantly decreased serum sclerostin was evidenced in PHPT patients as compared with PTX and euparathyroid controls. The inverse PTH and sclerostin relationship suggests that sclerostin is downregulated by PTH in humans. Serum sclerostin normalized earlier than BTMs following parathyroidectomy.

Vitamin D status in relation to obesity, bone mineral density, bone turnover markers and vitamin D receptor genotypes in healthy Saudi pre- and postmenopausal women.

UNLABELLED: The various factors that may contribute to vitamin D deficiency or insufficiency were examined among healthy Saudi pre- and postmenopausal women. Vitamin D deficiency was highly prevalent among studied Saudi women with obesity, poor sunlight exposure, poor dietary vitamin D supplementation and age as the main risk factors. INTRODUCTION: The various factors that may contribute to vitamin D deficiency or insufficiency in relation to bone health among Saudi women are not known. The main objectives of the present study were to determine the factors influencing vitamin D status in relation to serum 25-hydroxyvitamin D (25(OH)D), intact parathyroid hormone (PTH), bone turnover markers (BTMs), bone mineral density (BMD), and vitamin D receptor genotype (VDR) in healthy Saudi pre- and postmenopausal women. METHODS: A total number of 1,172 healthy Saudi women living in the Jeddah area were randomly selected and studied. Anthropometric parameters, socioeconomic status, sun exposure index together with serum levels of 25(OH)D, calcitriol, intact PTH, Ca, PO4, Mg, creatinine, albumin, and biochemical BTMs were measured. BMD was measured by a dual energy X-ray absorptiometry and VDR genotypes were also determined. RESULTS: About 80.0% of Saudi women studied exhibited vitamin D deficiency (serum 25(OH)D<50.0 nmol/L) with only 11.8% of all women were considered with adequate vitamin D status (serum 25(OH)D>75 nmol/L). Secondary hyperparathyroidism was evident in 18.5% and 24.6% in pre- and postmenopausal women with 25(OH)D<50 nmol/L. Serum 25(OH)D was lower (P<0.001) and intact PTH higher (P<0.001) in the upper quintiles of body mass index (BMI) and waist-to-hip ratio (WHR). Multiple linear regression analysis showed that BMI, sun exposure index, poor dietary vitamin D supplementation, WHR, and age were independent positive predictors of serum 25(OH)D values. CONCLUSIONS: Vitamin D deficiency is highly prevalent among healthy Saudi pre-and postmenopausal women and largely attributed to obesity, poor exposure to sunlight, poor dietary vitamin D supplementation, and age.

Lycopene nanoparticles promotes osteoblastogenesis and inhibits adipogenesis of rat bone marrow mesenchymal stem cells.

OBJECTIVE: Lycopene is a carotenoid and antioxidant with potent singlet oxygen quenching ability that reduces oxidative stress and promotes bone health. However, the cellular mechanisms by which lycopene influences bone metabolism are not known. MATERIALS AND METHODS: The present study investigated the effects of lycopene nanoparticles on the differentiation of rat bone marrow-derived mesenchymal stem cells into osteoblasts or adipocytes. RESULTS: In osteogenic medium, lycopene supplementation dose-dependently enhanced osteoblast differentiation, as evidenced by the transcription of Alpl, Runx2, Col1a1, Sp7, and Bglap, higher alkaline phosphatase activity, osteocalcin secretion and extracellular matrix mineralisation seen with Alizarin red S staining, and increased haem oxygenase levels. By contrast, lycopene in adipogenic medium inhibited adipocyte differentiation evidenced by decreases in the transcription of Tnfsf11, Tnfrsf11b, Pparg, Lpl, and Fabp4 and reduced fat accumulation observed by Oil Red O staining. CONCLUSIONS: Lycopene nanoparticles may promote bone health and are considered as a potential candidate for the prevention and/or treatment of bone loss conditions.

The effect of cigarette or sheesha smoking on first-trimester markers of Down syndrome.

OBJECTIVE: To investigate the influence of cigarette or sheesha smoking on first-trimester markers of Down syndrome. DESIGN: A prospective observational study. SETTING: Primary care centres and antenatal clinics of Maternity and Children Hospital, King Abdulaziz University Hospital and New Jeddah Clinic Hospital, Jeddah, Saudi Arabia. POPULATION: Women with a singleton pregnancy who were either nonsmokers (n = 1736) or cigarette smokers (n = 420) or sheesha smokers (n = 181). METHODS: Fetal nuchal translucency thickness (fetal NT), maternal serum free beta-human chorionic gonadotrophin (free beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A) were measured at 11 weeks 0 days to 13 weeks 6 days of gestation in all women. Women were grouped according to smoking status, confirmed by maternal serum cotinine measurements, and analyte levels between groups were compared. MAIN OUTCOME MEASURES: Fetal NT, maternal serum free beta-hCG, PAPP-A and cotinine measurements. RESULTS: Compared with nonsmoking women, fetal NT was significantly increased and free beta-hCG and PAPP-A levels were significantly decreased in both cigarette and sheesha smokers. There were significant relationships between all three markers and the number of sheeshas consumed per day. CONCLUSIONS: Cigarette and sheesha smoking significantly affect first-trimester markers of Down syndrome (fetal NT, free beta-hCG and PAPP-A). Correction for this effect in women who smoke might improve the effectiveness of first-trimester screening for Down syndrome in these women. The underlying mechanism(s) relating smoking to the changes in first-trimester markers require further studies.

The transport of glutamine into rat mesenteric lymphocytes.

The transport of glutamine into isolated rat mesenteric lymphocytes was studied. This transport appears to be dependent upon the Na+ gradient. The Km for glutamine transport was about 1.0 mM. A large number of amino acids were shown to inhibit the rate of transport of both serine and glutamine into lymphocytes. The transport of glutamine was competitively inhibited by serine and that for serine was similarly inhibited by glutamine. In contrast, histidine and 2-(methylamino)isobutyrate inhibited the transport of both serine and glutamine noncompetitively. It is concluded that glutamine is transported into rat mesenteric lymphocytes by a process similar to System ASC described for other cells.

Metabolism of glucose, glutamine, long-chain fatty acids and ketone bodies by lungs of the rat.

The maximum activities of some key enzymes of metabolism were studied in lungs of fed and 48-h-starved rats. The maximum activity of hexokinase in the lung is similar to that of other tissues of the body, but lower than that of phosphorylase and 6-phosphofructokinase. High activities of glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase were found in lung tissue, suggesting the importance of the pentose phosphate pathway in the lung. The activities of hexokinase and 6-phosphofructokinase were decreased whereas that of phosphorylase increased in response to starvation. Of the enzymes of the tricarboxylic acid cycle whose activities were measured, that of oxoglutarate dehydrogenase was the lowest, yet its activity (approximately 4.2 nmol/min per mg protein at 37 degrees C) was considerably greater than the flux through the cycle (0.46 nmol/min per mg protein at 37 degrees C; calculated from oxygen consumption by incubated lung slices). The activities of both oxoglutarate dehydrogenase and citrate synthase were decreased by starvation. The activities of 3-oxoacid CoA-transferase and acetoacetyl-CoA thiolase were low in lung tissue compared to those of other tissues (eg kidney, brain) and that of 3-hydroxybutyrate dehydrogenase was very low. The activity of carnitine palmitoyl transferase is higher in the lung, suggesting that fatty acids (and possibly acetoacetate) could provide acetyl-CoA as substrate for the tricarboxylic acid cycle. Very low rates of utilization of 3-hydroxybutyrate were observed during incubation of lung slices, but that of oleate was 1.2 nmol/h per mg of protein.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of experimental hypothyroidism on the control of 6-phosphofructo-1-kinase activity in rat jejunal mucosa.

Changes in the activity of 6-phosphofructo-1-kinase (PFK, EC 2.7.1.11) from the epithelial cells of rat small intestine during experimental hypothyroidism were studied. Hypothyroidism resulted in significant decreases in the plasma concentrations of total tri-iodothyronine, free tri-iodothyronine, total thyroxine, free thyroxine and insulin. These changes were associated with a significant increase in the plasma concentration of thyrotropin. The total activity and activity ratios (activity at 0.5 mM fructose 6-phosphate at pH 7.0/activity at pH 8.0 (v0.5/V)) of jejunal PFK of hypothyroid rats were significantly diminished as compared to control rats. PFK of hypothyroid rats was more sensitive to inhibition by ATP. The mucosal enzyme of both control and hypothyroid state was sensitive to stimulation by AMP and fructose 2,6-bisphosphate. It is concluded that during hypothyroidism the rate of glycolytic pathway in the small intestine is reduced as a result of a fall in glucose uptake, and the subsequent kinetic changes of PFK are primarily to maintain the concentrations of fructose 6-phosphate (and glucose 6-phosphate) during the reduced glycolytic flux. These changes in PFK activity may be caused by changes in plasma insulin concentrations, glucose utilization and fructose 2,6-bisphosphate concentrations.

Glutamine and ketone-body metabolism in the small intestine of starved peak-lactating rats.

1. The effect of starvation on the metabolism of gut glutamine and ketone-bodies of peak lactating, non-lactating and virgin rats was investigated. 2. The arterial blood ketone-body concentration was increased by approximately 7-, 6- and 13-fold in 48 h-starved virgin, non-lactating and lactating rats, respectively. 3. The arterial blood glutamine concentration was decreased by approximately 32% in 48 h-starved lactating rats (p less than 0.001). 4. The maximal activity of phosphate-dependent glutaminase was increased or decreased in the small intestine of fed or 48 h-starved peak-lactating rats, respectively. 5. Portal drained viscera blood flow increased by approximately 25% in peak-lactating rats. 6. Arteriovenous difference measurements for ketone-bodies across the gut of 48 h-starved rats showed an increase in net uptake of ketone-bodies by approximately 10-, 17- and 29-fold in virgin, non-lactating and lactating rats, respectively. 7. Glutamine was extracted by the gut of peak-lactating rats at a rate of 487 nmol/100 g of body wt. which was greater by approximately 33% (p less than 0.001) than that of virgin or non-lactating animals. In peak lactating rats, 48 h-starvation resulted in marked decreases in the rates of glutamine removal from the circulation (p less than 0.001) which was accompanied by decreased rates of release of glutamate, alanine and ammonia.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of starvation and streptozotocin-induced diabetes on the activity of phosphofructokinase in the epithelial cells of rat colon.

The regulation of phosphofructokinase in the colonic mucosa of 48 h-starved and streptozotocin-induced diabetic rats was investigated. The specific activities of phosphofructokinase from colonic mucosa of starved and diabetic rats were found to be diminished compared with normal controls. The enzyme obtained from the colonic mucosa of normal, diabetic and starved rats showed sigmoidal velocity curves with respect to fructose-6-phosphate, with apparent Km values of 0.6, 0.62 and 0.7 mM, respectively. However, the present results indicated that phosphofructokinase from the epithelial cells of rat colon is not regulated in a manner similar to that of the intestinal enzyme, which was shown to be highly regulated.

Calcium-regulating hormones and parathyroid hormone-related peptide in normal human pregnancy and postpartum: a longitudinal study.

OBJECTIVES: To evaluate calcium-regulating hormones and parathyroid hormone-related peptide (PTHrP) in normal human pregnancy and postpartum in women not deficient in vitamin D. DESIGN: A prospective longitudinal study was conducted in pregnant Saudi women during the course of pregnancy (n = 40), at term and 6 weeks postpartum (n = 18). Maternal concentrations of serum calcidiol and calcitriol were determined, together with those of serum intact-parathyroid hormone (PTH), PTHrP, calcitonin, osteocalcin, human placental lactogen (hPL), prolactin, vitamin D binding protein, alkaline phosphatase, calcium, phosphate and magnesium. A group of non-pregnant women (n = 280) were included for comparative purposes. RESULTS: The calcidiol concentrations decreased (mean +/- S.D.) significantly from 54 +/- 10 nmol/l in the first trimester to 33 +/- 8 nmol/l in the third trimester (P < 0.001) and remained decreased at term and postpartum (both P < 0.001). The calcitriol concentration increased through pregnancy, from 69 +/- 17 pmol/l in the first trimester to 333 +/- 83 pmol/l at term (P < 0.001). Intact-PTH concentrations increased from 1.31 +/- 0.25 pmol/l in the first trimester to 2.26 +/- 0.39 pmol/l in the second trimester, but then declined to values of the first trimester and increased significantly postpartum (4.02 +/- 0.36 pmol/l) (P < 0.001). PTHrP concentration increased through pregnancy from 0.81 +/- 0.12 pmol/l in the first trimester to 2.01 +/- 0.22 pmol/l at term and continued its increase postpartum (2.63 +/- 0.15 pmol/l) (P < 0.001). Significant positive correlations were evident between PTHrP and alkaline phosphatase up to term (r = 0.051, P < 0.001) and between PTHrP and calcitriol (r = 0.46, P < 0.001), osteocalcin (r = 0.23, P < 0.05) and prolactin (r = 0.41, P < 0.05) during pregnancy. Osteocalcin started to increase from 0.13 +/- 0.01 nmol/l in the second trimester, through pregnancy and postpartum (P < 0.001). Calcitonin was increased more than twofold by the second trimester compared with the first trimester (P < 0.001) and subsequently decreased (P < 0.001). Prolactin concentrations were significantly greater in the second (6724 +/- 1459 pmol/l) and third (8394 +/- 2086 pmol/l) trimesters compared with values before pregnancy (P < 0.001). hPL, increased throughout the course of pregnancy, reaching a maximum at term (7.61 +/- 2.57 microIU/ml). There was no direct correlation between serum calcitriol concentrations during pregnancy and serum prolactin (r = -0.12, P < 0.19) or serum hPL (r = 0.17, P < 0.21). Significant changes were observed in the serum concentrations of calcium and phosphate, but not in that of magnesium, during the course of pregnancy; calcium concentrations showed a maximal decrease at term. CONCLUSIONS: Changes in serum PTHrP during the course of pregnancy, at term and postpartum have been demonstrated, suggesting that the placenta (during pregnancy) and mammary glands (postpartum) are the main sources of PTHrP. No support for the concept of 'physiological hyperparathyroidism' of pregnancy could be demonstrated in the present work. The pregnancy-induced increase in calcitriol concentration may thus be the primary mediator of the changes in maternal calcium metabolism, but the involvement of other factors cannot be excluded.

Glutamine and glucose metabolism in human peripheral lymphocytes.

The metabolism of glutamine and glucose in resting and concanavalin A-stimulated human peripheral lymphocytes was investigated. Glutamine was metabolized at a high rate by resting and mitogen-stimulated human peripheral lymphocytes and the major end-products of glutamine metabolism were glutamate, aspartate, CO2, and ammonia: the carbon from glutamine may contribute about 21% to respiration. Concanavalin A enhanced the formation of all end-products except glutamate, indicating that more glutamine was metabolized beyond the stage of glutamate in the mitogen-stimulated cells. Mitogenic stimulation caused an increase in the rates of glucose utilization, lactate production and 14CO2 from variously labeled [14C] glucose. Concanavalin A caused an increase in the oxidation of pyruvate as indicated by the enhanced release of 14CO2 from [2-14C]-, [3,4-14C]-, and [6-14C]-glucose. When both glucose and glutamine were presented to the cells, the rates of utilization of both substrates increased and the increased rates of glucose and glutamine utilization could be accounted for mainly by increased rates of lactate and glutamate production, respectively.

Glutamine metabolism in skeletal muscle of septic rats.

The metabolism of skeletal muscle glutamine was studied in rats made septic by cecal ligation and puncture technique. Blood glucose was not significantly different in septic rats, but lactate, pyruvate, glutamine, and alanine were markedly increased. Conversely, blood ketone body concentrations were markedly decreased in septic rats. Both plasma insulin and glucagon were markedly elevated in septic rats. Sepsis increased the rates of glutamine production in muscle, but without marked effects on skin and adipose tissue preparations, with muscle production accounting for over 87% of total glutamine produced by the hindlimb. Sepsis produced decreases in the concentrations of skeletal muscle glutamine, glutamate, 2-oxoglutarate, and adenosine monophosphate (AMP). The concentrations of ammonia, pyruvate, and inosine monophosphate (IMP) were increased. Hindlimb blood flow showed no marked change in response to sepsis, but was accompanied by an enhanced net release of glutamine and alanine. The maximal activity of glutamine synthetase was increased only in quadriceps muscles of septic rats, whereas that of glutaminase was decreased in all muscles studied. Tyrosine release from incubated muscle preparation was markedly increased in septic rats; however, its rate of incorporation was markedly decreased. It is concluded that there is an enhanced rate of production of glutamine from skeletal muscle of septic rats. This may be due to changes in efflux and/or increased intracellular formation of glutamine; these suggestions are discussed.

Effect of glutamine-supplemented total parenteral nutrition on the small bowel of septic rats.

In order to study the effect of total parenteral nutrition (TPN) with or without glutamine supplementation in septic rats, septic Wistar albino rats were randomly assigned to receive 0.23 g of nitrogen and 113 kJ (100 g BW)(-1) per day in the form of amino acids with (group 2) or without (group 1) glutamine supplementation or 10% (w/v) glucose only (group 3). After 4 days of TPN treatments, rats receiving glutamine-supplemented TPN had a cumulative nitrogen balance of -24.4 +/- 3.3 mg N, which was significantly (P < 0.001) better compared to other TPN-treated groups. Septic rats of group 2 survived sepsis significantly (P < 0.001) better than those in groups 1 and 3. Glutamine-supplemented TPN treatment resulted in significant increases in jejunal weight (P < 0.001), DNA and protein contents (P < 0.001), villous height (P < 0.001) and crypt depth (P < 0.001) when compared with septic rats of group 1. Septic rats of group 2 extracted and metabolised glutamine by the small bowel at higher rates (P < 0.001) than that observed in septic rats of group 1. Increases in jejunal glutaminase (38.2%, P < 0.001) and decreases in glutamine synthetase (41.7%, P < 0.001) activities were observed in response to glutamine-supplemented TPN treatment. It is concluded that the administration of glutamine-supplemented TPN is beneficial to the small bowel of septic rats.

The value of nutritional assessment methods in surgical patients living in Saudi Arabia.

Several methods have been propsed to assess nutritional status of patients in relation to post-operative complications including instant nutritional assessment (INA) and prognostic nutritional index (PNI). Weight loss (WL) has also been related to post-operative morbidity. A prospective study was conducted to evaluate the prognostic ability of INA, PNI and WL in 300 patients affected by major and semi-major surgeries. Post-operative sepsis occurred in 28 (9.3%) patients. Of the 300 patients studied, 91 (30.2%) had WL 10%; 12 patients were septic. Of the 28 septic patients indentified, 24 (85.7%) were within the high-risk group as identified by PNI characterisation. When both serum albumin and total lymphocyte count were abnormal, sepsis rate was 100%. All methods had a Youden index greater than one. Therefore, WL should be the first parameter assessed, and if WL is > 10%, then INA can be used to assess the patient further.

The role of high rates of glycolysis and glutamine utilization in rapidly dividing cells.

The rates of utilization of both glucose and glutamine are high in rapidly dividing cells such as enterocytes, lymphocytes, thymocytes, tumour cells; the oxidation of both glucose and glutamine is only partial, glucose to lactate and glutamine to glutamate, alanine or aspartate; and these partial processes are termed glycolysis and glutaminolysis respectively. Both processes generate energy and also provide precursors for important biosynthetic processes in such cells. However, the rates of utilization of precursors for macromolecular biosynthesis are very low in comparison to the rates of partial oxidation, and energy generation per se may not be the correct explanation for high rates of glycolysis and glutaminolysis in these cells since oxidation is only partial and other fuels can be used to generate energy. Both the high fluxes and the metabolic characteristics of these two processes can be explained by application of quantitative principles of control as applied to branched metabolic pathways (Crabtree & Newsholme, 1985). If the flux through one branch is greatly in excess of the other, then the sensitivity of the flux of the low-flux pathway to regulators is very high. Hence, it is suggested that, in rapidly dividing cells, high rates of glycolysis and glutaminolysis are required not for energy or precursor provision per se but for high sensitivity of the pathways involved in the use of precursors for macromolecular synthesis to specific regulators to permit high rates of proliferation when required - for example, in lymphocytes in response to a massive infection.

Paediatric burn injuries in the Jeddah area of Saudi Arabia: a study of 197 patients.

A prospective study was conducted on paediatric thermal injury patients admitted to the Burns Unit at King Fahd Hospital, Jeddah, Saudi Arabia over a 2-year period (December 1985 to December 1987). A total of 197 patients (out of 319) were paediatric, aged up to 18 years. Infants and toddlers accounted for 59.4 per cent and adolescents for 14.2 per cent. Scalding and flame injuries accounted for 98 per cent with most injuries occurring at home (97.5 per cent) and the overall paediatric mortality rate was 4.4 per cent.

Burn injuries in the Jeddah area of Saudi Arabia: a study of 319 cases.

Three hundred and nineteen patients with different types of burns were studied at King Fahd Hospital, Jeddah, Saudi Arabia over a 2-year period (December, 1985 to December, 1987). Scalding was the most common cause (56.4 per cent) of burn injuries compared with 41.4 per cent of patients who sustained flame injury; 84.6 per cent of the thermal injuries occurred at home, with children (less than or equal to 18 years of age) being affected most frequently (61.8 per cent). The overall mortality was 9.4 per cent.

Fructosamine as a screening-test for gestational diabetes mellitus: a reappraisal.

Fructosamine, glycosylated hemoglobin (HbA1c) and serum total proteins were measured in normal nondiabetic pregnant women (n = 170) at three stages of pregnancy (14-18, 24-28, and 32-40 weeks of gestation). No significant correlation was found between fructosamine and either HbA1c or total plasma proteins. Only early in pregnancy (less than 20 weeks of gestation) was a correlation found between fructosamine and fasting blood glucose (r = 0.40, P less than 0.05). There was also no correlation between either tests (i.e. fructosamine and HbA1c) and fetal birthweight. The value of fructosamine measurement in the detection of diabetes in pregnancy was further tested in a group of high-risk patients (n = 98) for developing carbohydrate intolerance. It is concluded that fructosamine has limited value as a screening test for gestational diabetes mellitus, particularly for the mild form of the glucose intolerance.