Effects of short-term step aerobics exercise on bone metabolism and functional fitness in postmenopausal women with low bone mass.

Measurement of bone turnover markers is an alternative way to determine the effects of exercise on bone health. A 10-week group-based step aerobics exercise significantly improved functional fitness in postmenopausal women with low bone mass, and showed a positive trend in reducing resorption activity via bone turnover markers. INTRODUCTION: The major goal of this study was to determine the effects of short-term group-based step aerobics (GBSA) exercise on the bone metabolism, bone mineral density (BMD), and functional fitness of postmenopausal women (PMW) with low bone mass. METHODS: Forty-eight PMW (aged 58.2 ± 3.5 years) with low bone mass (lumbar spine BMD T-score of -2.00 ± 0.67) were recruited and randomly assigned to an exercise group (EG) or to a control group (CG). Participants from the EG attended a progressive 10-week GBSA exercise at an intensity of 75-85 % of heart rate reserve, 90 min per session, and three sessions per week. Serum bone metabolic markers (C-terminal telopeptide of type 1 collagen [CTX] and osteocalcin), BMD, and functional fitness components were measured before and after the training program. Mixed-models repeated measures method was used to compare differences between the groups (α = 0.05). RESULTS: After the 10-week intervention period, there was no significant exercise program by time interaction for CTX; however, the percent change for CTX was significantly different between the groups (EG = -13.1 ± 24.4 % vs. CG = 11.0 ± 51.5 %, P < 0.05). While there was no significant change of osteocalcin in both groups. As expected, there was no significant change of BMD in both groups. In addition, the functional fitness components in the EG were significantly improved, as demonstrated by substantial enhancement in both lower- and upper-limb muscular strength and cardiovascular endurance (P < 0.05). CONCLUSION: The current short-term GBSA exercise benefited to bone metabolism and general health by significantly reduced bone resorption activity and improved functional fitness in PMW with low bone mass. This suggested GBSA could be adopted as a form of group-based exercise for senior community.

Knowledge that upper respiratory tract infection resolves on its own is associated with more appropriate health-seeking behaviour and antibiotic cognition.

INTRODUCTION: This study aims to study whether knowledge that upper respiratory tract infection (URTI) resolves on its own is associated with more appropriate antibiotic cognition and treatment-seeking behaviour in adult patients seeking consultation for upper respiratory tract symptoms in all nine polyclinics of the National Healthcare Group in Singapore. METHODS: A prospective study of 595 adult patients who attended for URTI symptoms of less than seven days duration was performed. We collected data using an interviewer-administered structured questionnaire eliciting the participant's personal and demographical data, his knowledge about URTI, past experience with URTI and treatment-seeking behaviour for this current episode of URTI. These variables were then regressed against the variable "URTI resolves on its own", adjusting for "antibiotics relieve URTI faster", "antibiotic used unnecessarily for URTI", "recovery faster with antibiotics" for antibiotic cognition; and "number of days with URTI", "first line of action: self-medicate", "reason for attendance: felt unwell", "reason for attendance: get well faster" and "used prescribed medication before current visit" for health-seeking behaviour. RESULTS: More than one-third of patients believed that URTI resolved on its own. Subjects who believed that URTI resolved on its own were not significantly different in terms of gender, ethnic group, educational status, age, knowledge of germs as causal, and number of days sick before attendance. However, such patients were 1.68 times (confidence interval [CI] 1.17, 2.41) more likely to agree that, nowadays, antibiotics are used unnecessarily for "flu", and 2.07 times (CI 1.32, 3.24) more likely to self-medicate. They were 0.51 (CI 0.35, 0.76) times more likely to be dependant on prescribed medication. CONCLUSION: Knowledge that URTI resolves on its own is associated with more appropriate antibiotic cognition and health-seeking behaviour.

Further treatment with MPTP does not produce parkinsonism in marmosets showing behavioural recovery from motor deficits induced by an earlier exposure to the toxin.

1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), or 0.9% saline, was administered to a group of common marmosets initially treated with the toxin 12-18 months previously. Initial treatment had consisted of a cumulative dose of 6-22 mg/kg (i.p.) which caused marked parkinsonism. Subsequently, the animals gradually recovered normal motor function. Further treatment consisted of a cumulative dose of MPTP of 78-83 mg/kg (i.p.) but this produced only modest akinesia. At 12-18 months after the initial treatment with MPTP, the content of dopamine, HVA and DOPAC in the caudate and putamen was markedly reduced. However, levels of dopamine, HVA and DOPAC in the nucleus accumbens were normal. Three months after the second treatment with MPTP there was no further decrease in the content of dopamine in the caudate-putamen. However, in the nucleus accumbens the content of dopamine, HVA and DOPAC was now reduced. The initial treatment with MPTP substantially decreased the binding of [3H]mazindol in the caudate-putamen but less so in the nucleus accumbens. Only a small additional decrease occurred upon further treatment with MPTP. The density of tyrosine hydroxylase (TH) immunoreactive cells in substantia nigra was reduced after the initial treatment with MPTP. However, the cell loss was far less marked than the decrease in terminal density, assessed by the binding of [3H]mazindol. Subsequent treatment with MPTP caused a small further loss of tyrosine hydroxylase-positive cells. Initial treatment with MPTP may kill the majority of MPTP-sensitive dopamine cells in the nigra. Compensation by the remaining nigrostriatal neurones may account for the behavioural recovery observed.(ABSTRACT TRUNCATED AT 250 WORDS)

The D-1 dopamine receptor partial agonist, CY 208-243, exhibits antiparkinsonian activity in the MPTP-treated marmoset.

Administration of L-DOPA plus carbidopa, or the D-2 agonist (+)-PHNO, to MPTP-treated common marmosets caused motor hyperactivity and a reversal of the parkinsonian syndrome. In contrast, administration of the putative D-1 agonist SKF 38393 was without effect on movement or motor disability. The subsequent administration of another putative selective D-1 partial agonist CY 208-243 produced a dose-related improvement in motor activity and reversal of parkinsonian motor deficits in MPTP-treated animals. The effect of CY 208-243 was inhibited by pretreatment with the D-1 antagonist SCH 23390 and, to a lesser extent, by the D-2 antagonist sulpiride. In another group of normal drug naive marmosets, the administration of CY 208-243 produced only a small increase in motor activity. Following treatment with MPTP and without other drug administration, administration of CY 208-243 produced a marked reversal of motor deficits and locomotor hyperactivity. Thus, CY 208-243, suggested to be a partial D-1 agonist exhibits antiparkinsonian activity in MPTP-treated marmosets which does not require prior or concurrent exposure to D-2 agonists.

Stereoselective reversal of MPTP-induced parkinsonism in the marmoset after dermal application of N-0437.

The selective dopamine D-2 receptor agonist N-0437 produced a rapid and dose-dependent reversal of motor deficits lasting 90-120 min following i.p. or oral administration of the racemate to MPTP-treated common marmosets. In contrast, topical application of (+/-)-, (+)- or (-)-N-0437 to the skin of MPTP-treated animals did not alter locomotor activity in the initial 4 h although other motor disabilities were reduced. However, 24 h following application of the racemate or the (-) enantiomer both locomotor activity and the other motor deficits induced by MPTP were improved. The increase in locomotor activity returned to basal values by 48-52 h following application of the racemate to the skin and by 72-76 h following administration of (-)-N-0437; the other motor deficits induced by MPTP were reduced for up to 72-76 h by both (+/-)- and (-)-N-0437. Application to skin of the (+) enantiomer produced no behavioural improvement or stimulation of locomotor activity. Transdermal administration of the active enantiomer of N-0437 may be of value in producing a prolonged reversal of parkinsonian motor deficits in man.

Reduced hypothalamic blood flow after radiation treatment of nasopharyngeal cancer: SPECT studies in 34 patients.

To determine the effect of cranial irradiation on hypothalamic blood flow, we performed 44 regional cerebral blood flow studies with 99mTc hexamethyl propyleneamine oxime (HMPAO) single-photon emission CT (SPECT) on four normal volunteers and 34 patients with pathologically proved nasopharyngeal cancer. Twenty-three men and 15 women, 30-65 years old, were divided into four study groups: group 1 served as a control and consisted of four normal volunteers and six patients studied prior to cranial irradiation; group 2 patients had cranial irradiation half a year before the SPECT study (n = 12, one from group 1); group 3 patients were irradiated 1 year before the study (n = 13, three from group 1 and two from group 2); and group 4 patients were irradiated at least 5 years before SPECT imaging (n = 9). Six patients were studied twice. Quantification of the 99mTc-HMPAO brain SPECT studies was done separately by three radiologists to obtain the hypothalamus/occipital (H/O) and hypothalamus/parasagittal (H/P) ratios. Endocrinologic studies were performed in all cases and the hypothalamus-thyrotroph-thyroid, hypothalamus-gonadotroph-testis (ovary), hypothalamus-lactotroph, hypothalamus-somatotroph, and hypothalamus-corticotroph-adrenal axes were evaluated separately. We determined that regional hypothalamic blood flow was reduced after cranial irradiation in patients with nasopharyngeal cancer. The H/O ratio of groups 3 and 4 did not differ from that of group 2 (one-half year after cranial irradiation). The H/O ratio was significantly reduced 6 months and 1 year after cranial irradiation; mean +/- SD = 0.5801 +/- 0.0829 (p less than .025), 0.5725 +/- 0.0791 (p less than .01) versus 0.6477 +/- 0.0458 before cranial irradiation, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Low-dose bromocriptine therapy in severe Parkinson's disease.

We present an interim report of an ongoing, single-blind study of the effectiveness and safety of bromocriptine mesylate (Parlodel) in 15 patients, 14 of whom had severe idiopathic Parkinson's disease (Stages 4 and 5 on the Hoehn and Yahr Scale). The patients had never received levodopa, amantadine, or bromocriptine. Gradually increasing doses of bromocriptine were assessed: Initial daily dosage was 1.25 mg, with weekly increments of 1.25 mg/day until either the clinical response was satisfactory or a maximum of 15 mg/day was reached. The patients were on no other antiparkinsonian agents, except trihexyphenidyl HCl (Artane). Response to treatment was scored on the Columbia Scale. The patients discussed in this report had been in the study for varying times, ranging from 1 month to 3 years. Only one patient who entered this study dropped out because his response to bromocriptine was unsatisfactory; he had taken the drug for 2 weeks. No serious adverse reactions were noted with the gradually increasing dosage regimen. Response on the whole was very satisfactory; patients improved by at least two stages on the Hoehn and Yahr Scale. Improvement began within 48 h of onset of treatment with 1.25 mg daily. The preliminary results of this study indicate that low-dose bromocriptine as a first-line drug in severe Parkinson's disease is definitely warranted.

Botulinum toxin in the treatment of hemifacial spasm.

Thirteen patients with disabling idiopathic hemifacial spasm received botulinum toxin A injections to the affected muscles. Previous treatments, including one posterior fossa decompression, had no sustained benefit. There was excellent response in all the patients with improvement in social disability. Local side effects were mild and transient and include mild facial weakness. One patient had mild diplopia. The benefit lasted more than three months. Reinjection resulted in identical efficacy. Botulinum toxin A injection is a useful therapy for Hemifacial spasm.

Acute hemiparesis with hemichorea and crossed hemiparesis; unusual presentation for myasthenia gravis.

Myasthenia gravis is an autoimmune disease mediated by antibodies directed against the acetylcholine receptor. Patients typically present with weakness and fatiguability involving predominantly ocular and bulbar muscles. We describe 2 patients with acute weakness, one with a left hemiparetic pattern and chorea, and the other with crossed left hemiparesis and right facial weakness. More typical features of generalised myasthenia developed with time and both had thymic follicular hyperplasia on thymic histopathology. Clinical improvement occurred in both following thymectomy and immunosuppression. These cases exemplify the fact that markedly asymmetric limb weakness can be an early feature of generalised myasthenia gravis.

Choreoacanthocytosis in a Chinese patient--a case report.

A 50-year old Chinese woman with the rare neurological disorder of Choreoacanthocytosis is described. Her illness is characterised by seizures, buccolingual dyskinesia, choreiform movements, arreflexia and mild sensorimotor polyneuropathy. Acanthocytes were present in her peripheral blood in large numbers but the serum lipid profile was normal. Her features are consistent with those so far described in Caucasian and Japanese patients. The disease differs from Huntington's chorea in that there are acanthocytes, peripheral neuropathy, and metal function remains relatively intact.

Progressive hemifacial atrophy--a report of 2 cases.

Idiopathic hemifacial atrophy (Parry-Romberg Syndrome) is characterised by progressive wasting or loss of subcutaneous tissue in half of the face, starting usually in childhood, and often associated with skin changes. Two adult onset cases are described. They did not demonstrate skin changes but one had complicated hemiplegic migraine with headaches always ipsilateral to the facial wasting.

Knowledge and practice of breast cancer screening amongst public health nurses in Singapore.

AIM OF STUDY: The study aimed to examine the knowledge and practice of breast cancer screening amongst Public Health nurses who are patient educators. METHOD: A self-administered questionnaire was sent to all 447 nurses in the Public Health Service to assess their knowledge and practice of breast cancer screening. Response rate was 96.4%. Knowledge scores ranged from 0-17 with one point given to a correct knowledge question, zero for wrong answer. RESULTS: Median knowledge score was nine and 58.3% of nurses scored > or = 9. Statistically significant factors influencing knowledge scores were related to the nursing profession, namely nursing qualifications, current nursing post and current workplace. 76.2% of Nursing Officers/Higher Nursing Officers and 74.5% of midwives had knowledge scores > or = 9 compared with 57.3% of staff nurses and 40.8% of assistant nurses (p < 0.01). 60.1% of nurses who were taught breast-self examination scored > or = 9 (p < 0.05). As for practice, 93.7% of nurses did breast-self-examination, 54.1% had clinical breast examination in the past one year and 50.2% had mammogram done. On multivariate analysis, significant factors affecting practice of clinical breast examination were marital status (Prevalence Rate Ratio 1.94, 95% Confidence Interval 1.20-3.15), doctor's gender (PRR 1.35, CI 1.04-1.75) and those affecting mammogram were age group (PRR 1.78, CI 1.27-2.48), marital status (PRR 1.63, CI 1.03-2.59), history of breast disease (PRR 1.51, CI 1.06-2.16). CONCLUSIONS: The majority of nurses had certain misconceptions in the knowledge of breast cancer and breast cancer screening. A higher proportion of nurses in the Family Health Service had higher knowledge scores than other nurses in the Public Health Service. Most of the nurses did breast-self-examination. Having ever married and the availability of a female doctor influenced the nurses attending clinical breast examination. Nurses who were > or = 50 years old, ever married and those with a positive history of breast disease were more likely to have mammography done.

Headache characteristics in university undergraduates presenting to medical attention.

A 78-point self-administered questionnaire relating to headaches was completed by 1208 undergraduates of the National University of Singapore. The management and characteristics of the study population that had sought medical consultation for their headaches was studied. The lifetime prevalence of headaches in the study population was 98.1%. One hundred and six (8.8%) had visited a doctor for their headache. These had more severe symptoms and required more pharmacotherapy. They also tended to have migraines rather than tension headaches. Malays were more likely than non-Malays to seek medical attention. No significant gender predisposition was found. Eight of the 106 (7.5%) had been given prophylactic/interval therapy. A significant proportion of the study population responds well to non-prescription medication, suggesting that the purpose of many medical consultations may be to relieve anxieties regarding the diagnosis rather than to obtain symptomatic relief.

An index case of adrenomyeloneuropathy in a Chinese man.

X-linked adrenomyeloneuropathy (AMN) is a phenotypic variant of adrenoleukodystrophy (ADL) presenting in early adult life with progressive ataxia and spasticity, and on occasion with adrenal insufficiency. We describe a 26-year-old Chinese man with a 2-year history of gait difficulty due to spasticity, absent pattern shift visual evoked (VER) responses and posterior white matter lesions on T2 weighted brain magnetic resonance images. His parents are clinically normal and his 24-year-old brother has hyperreflexia in the legs but normal VER latencies. The patient's ACTH levels were elevated and the serum cortisol did not rise with either Synacthen or corticotropin releasing hormone. Assay of his plasma confirmed elevation of very long chain fatty acids (VLCFA) consistent with a defect in peroxisomal VLCFA metabolism. This is the first local report of a patient with AMN.

Drug treatment of Parkinson's disease: current concepts.

The cause of Parkinson's Disease remains unknown although environmental toxin/s and ageing are likely to play a significant role. Experimental 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine induced parkinsonism can be prevented by monoamine oxidase B inhibitors. Monoamine oxidase B inhibitors have been shown to delay disease progression in early Parkinson's Disease and improve mortality. Symptomatic therapy remains the cornerstone of drug treatment, and should include levodopa replacement with concomitant dopamine agonist therapy in order to achieve maximum efficacy, and reduce side effects. Complicated Parkinson's Disease could be managed by better delivery systems like slow release preparations and parenteral infusions. Brain tissue transplants may offer hope of restoring the damaged nigrostriatal system.

Botulinum toxin in the treatment of facial dyskinesias.

Patients with hemifacial spasm (N = 25), blepharospasm (n = 8), and benign eyelid fasciculation (n = 2) were treated with botulinum toxin injections (PHLS, Porton Down, England). All patients reported substantial symptomatic relief. Marked improvement was seen in fifteen patients with hemifacial spasm and six patients with blepharospasm. Benign eyelid fasciculation was completely abolished. Beneficial effects was evident two to three days after injections, became maximum at one week, and remained effective for up to six months. Side effects were transitory and mild. They included periorbital edema, mild diplopia, ptosis and facial weakness. Only in two patients was ptosis unacceptable. Severity of side effects was dose-related. Reinjections had similar efficacy. Botulinum toxin therapy is a safe and effective treatment for these facial dyskinesias and should be considered a viable alternative to surgical procedures.

Disability, rehabilitation and after-care of stroke patients after discharge from hospital, Singapore 1983-84.

135 new onset stroke patients admitted over a nine-month period to a medical unit in Singapore were studied with emphasis on their rehabilitation and community care after discharge. Follow-up visits were made to 79 survivors at third month after onset. 16.7% of the patients made apparently complete recoveries, 20.3% remained slightly disabled, 21.5% moderately disabled, and the remaining 41.8% severely disabled. Sixty-five patients were staying in private households at third month follow-up. The main care-givers were usually female relatives. These informal carers assisted a large proportion of patients in various activities of living: 62.0% in dressing, 54.4% in walking and toileting, 30.4% in feeding, and 22.8% in turning in bed. The study establishes the need to develop and strengthen supportive services to enable disabled stroke patients to be cared for in their own homes. These include the home nursing service, elderly day care service, home help service, and meals-on-wheel service.

The bulbocavernosus reflex in the assessment of neurogenic impotence in diabetic and non-diabetic men.

The results of a 6-year review of bulbocavernosus reflex (BCR) latencies in 300 men are presented. The relationship of BCR latency to potency, diabetic status and age was examined. The mean BCR latency in 32 normal men aged 22 to 78 years (x = 44.9 +/- 14.4) was 40.6 +/- 8.9 ms. A significant trend towards increasing BCR latency with age was evident. BCR latency was not found to be significantly associated with potency, the mean measurable BCR latency in impotent men being 43.0 +/- 11.6 ms. Diabetic men were more likely to have a prolonged measurable BCR latency (x = 46.2 +/- 11.2) and impotence, but even in this subset no significant correlation between BCR latency and impotence was detectable. Our results suggest that detectable pudendal neuropathy is unrelated to impotence in non-diabetic and diabetic men and does not usefully distinguish between neurologic and non-neurologic causes of impotence. With the advent of newer objective techniques to assess organic impotence, the value of BCR latency in the routine assessment of impotent subjects is questionable.

Acetylcholine receptor antibody assay kit: establishment of controls in normals and non-myasthenics and evaluation of sera from patients with thyroid disease.

Immunoprecipitation assays for antibodies to the nicotinic acetylcholine receptor are a specific test for the diagnosis of myasthenia gravis. However, testing has largely been confined to reference laboratories because the preparation of the reagents is laborious, making it less accessible to practising clinicians locally. We recently acquired a test kit produced by RSR Ltd (Avenue Park, Pentwyn, Cardiff) which makes testing of serum samples practicable in smaller centres. We describe our experience in establishing normal and control values in 30 separate samples. We also assayed the sera of ten patients with thyroid disease, some of whom had ophthalmopathy and/or weakness due to periodic paralysis, and none of these tested positive. Three additional patients with thyroid disease and concurrent myasthenia gravis were also inadvertently included in the latter assay and two had high titres and one had equivocal titres. The assay is now run regularly every quarter of the year.

Calcium Intake, Vitamin D and Bone Health Status of Post-menopausal Chinese Women in Kuala Lumpur.

Bone health status was investigated in 178 free-living Chinese post-menopausal women in Kuala Lumpur. Body mass index (BMI), body composition (using whole body DXA), calcium intake and serum 25-OH vitamin D status were measured along with biochemical markers of bone turnover, that is, pro-collagen Type 1 N-terminal peptide (P1NP), osteocalcin (OC) and C-telopeptide ß cross link of Type 1 collagen (CTX- ß). Bone mineral density (BMD) was measured using DXA (Hologic, USA) at the lumbar spine, femoral neck and total hip. Results showed that osteopenia was present in 50% of the subjects at the spine and 57.9% at the femoral neck. Osteoporosis was diagnosed in 10% of the subjects at both the femoral neck and spine. A total of 29.3% of the subjects had high levels of CTX- ß. Mean serum level of 25-OH vitamin D was 60.4+15.6 nmol/L and 50.6% of the subjects had hypovitaminosis D (defined as < 50 nmol/l). Mean total calcium intake of the subjects was 497 + 233 mg, of which only 14% met the RNI for calcium with the additional intake of calcium supplements. Body fat was also significantly correlated (r=0.181, p< 0.05) with BMD at the spine but not BMD at the femoral neck. Lean body mass was positively correlated with BMD at the spine (r=0.289, p< 0.001) and femoral neck (r=0.295, p< 0.001). CTX-ß was negatively correlated with BMD at the spine (r= -0.235, p< 0.001), whereas P1NP (r=-0.215, p< 0.001) and osteocalcin (r=-0.265, p< 0.001) were both negatively correlated with BMD at the femoral neck. Generally, the study found that women with osteopenia had higher levels of bone turnover markers, less lean body mass and lower calcium intake than women with normal BMD. In conclusion, this study demonstrated that the majority of free living Chinese post-menopausal women in Kuala Lumpur have low calcium intake, low 25-OH vitamin D status and low bone mass and elevated biochemical markers of bone turnover.