Fatigue assessment and its predictors in pediatric patients with chronic kidney disease stages III to V

Background

Chronic fatigue is an intense subjective feeling of mental or physical exhaustion. It influences patients’ daily functioning and quality of life, delays recovery, and increases mortality, especially in chronic kidney disease (CKD) patients. The aim of this study is to assess and determine predictors of chronic fatigue in children with ESRD, dialysis, and pre-dialysis stages that can affect the patients’ quality of life (QOL).

Methods

We conducted a cross-sectional study on 114 patients diagnosed with CKD stages III to V, following at the nephrology outpatient clinic and hemodialysis (HD) unit of Cairo University Children’s Hospital during the period September 2020 till April 2021. Demographic and laboratory data of patients were gathered, and dialytic analysis in the form of frequency, duration of dialysis sessions, and adequacy of hemodialysis was calculated. The fatigue severity score (FSS) questionnaire was used to assess fatigue’s effects on daily functions, querying its relationship to motivation, physical activity, work, family, and social life.

Results

The mean age in the current study was (8.8 ± 1.8) years, with 62% being males. The median FSS score was 5.8, with a higher FSS score in stage V CKD patients. High e-GFR, serum sodium, folic acid, and L-carnitine supplementation all reduced the intensity of fatigue, while prolonged HD duration, acidosis, hypertension, and non-compliance to vitamin D replacement increased tiredness severity.

Conclusion

Routine fatigue assessment and measures to reduce it is a fundamental issue in pediatric CKD patients for better QOL.

Medication-Induced Oral Hyperpigmentation: A Systematic Review

BACKGROUND

Medication-induced oral hyperpigmentation is an oral condition that impacts patients' quality of life and has been linked to many systemic therapeutic agents. The exact pathogenesis of tissue pigmentation varies greatly and is not completely known. This systematic review aimed to present data on the causal association between medications and the development of oral/mucosal pigmentation as an adverse drug reaction.

METHODS

A systematic review and analysis of literature were conducted using the following databases: PubMed, Science Direct, ProQuest, Web of Science, and Scopus. The systematic review included original articles written in English and published between January 1982 and June 2020. Following the PRISMA statement, eligible articles were systematically reviewed, and data were extracted from eligible studies and analyzed.

RESULTS

A total of 235 articles were identified, of which 57 met the inclusion criteria and were included in this review. The mean age of included patients was 46.2±16.38 years (range: 10-90 years) with a male to female ratio of 1:1.45. Oral mucosal hyperpigmentation was reported following the use of several classes of medications such as antiviral (eg, zidovudine), antibiotic (eg, minocycline), antimalarial (eg, chloroquine), anti-fungal (eg, ketoconazole), antileprotic (eg, clofazimine), antihypertensive (eg, amlodipine), chemotherapeutic, and antineoplastic drugs. The risk of developing oral pigmentation was significantly higher with antimalarial medications, antibiotics, antineoplastic and chemotherapeutic agents. Medication-induced oral hyperpigmentation was most frequent among women and in the hard palate.

CONCLUSION

Future research is warranted to better understand the pathogenesis and risk factors for medication-induced oral hyperpigmentation in order to reassure patients during prescription and management.

Clinical efficacy of new aloe vera- and myrrh-based oral mucoadhesive gels in the management of minor recurrent aphthous stomatitis: a randomized, double-blind, vehicle-controlled study

OBJECTIVE

To evaluate the clinical efficacy, and safety of newly customized natural oral mucoadhesive gels, containing either aloe vera or myrrh as active ingredients, in the management of minor recurrent aphthous stomatitis (MiRAS).

SUBJECTS AND METHODS

Ninety subjects with MiRAS were recruited from Oral Medicine Clinic, at Faculty of Dentistry, King Abdulaziz University, Saudi Arabia, for this randomized, double-blind, placebo-controlled study. Two new natural gels, containing aloe vera and myrrh, were prepared in a concentration of (0.5% w/w), in addition to a plain mucoadhesive gel used as a placebo. Patients with fresh ulcers (<48-h duration) were instructed to apply either one of the three gels four times a day for a period of 5 days. Clinical efficacy was investigated in the form of changes in ulcer size, pain intensity, erythema, and exudation at days 4 and 6 of study entry. Participants were interviewed for the emergence of any side effects.

RESULTS

76.6% of patients using aloe gel showed complete ulcer healing, 86.7%, and 80% of them revealed subsidence of erythema and exudation, respectively, especially at day 6 visit, whereas 76.7% of myrrh-treated patients revealed almost absence of pain at day 6. No side effects were encountered with the use of any of the three gels.

CONCLUSION

The new formulated aloe- and myrrh-based gels proved to be effective in topical management of MiRAS. Aloe was superior in decreasing ulcer size, erythema, and exudation; whereas myrrh resulted in more pain reduction.

Good practice guide for cervical ultrasound scan and echo-guided techniques in treating differentiated thyroid cancer of vesicular origin

Good practice guide for cervical ultrasound scan and echo-guided techniques in treating differentiated thyroid cancer of vesicular origin. American, European and French Recommendations for the treatment of differentiated vesicular thyroid cancer were recently published. Cervical ultrasound scanning is now considered a key examination in the follow-up of these cancers. This examination is noninvasive, easy to perform and to obtain, is not costly, but remains operator-dependent. To date, there are no recommendations published that assemble all the technical aspects, results, indications and the limits of this examination in the initial medical report and the follow-up of these cancers. In order to standardise the procedure and validate the quality of the examination, a workgroup made up of a panel of experts particularly involved in carrying out ultrasound scans was set up. The aim was to draw up a good practice guide for performing cervical ultrasound scans and echo-guided techniques in treating patients with differentiated thyroid cancer of vesicular origin. The main objectives are to: (a) standardise the procedure and reports, (b) define the criteria for establishing whether lesions identified during a cervical ultrasound scan are malignant or benign, (c) standardise the indications for carrying out cytological tests and an in situ assay of markers, (d) help doctors to select the patients who ought to receive a cervical ultrasound scan and or cytological tests, (e) discuss how frequently the examinations should be carried out depending on the risk of recurrence.

Three-dimensional ultrasound and three-dimensional power Doppler in the assessment of ovarian tumors

OBJECTIVE

To determine preoperative method that predicts nature of ovarian tumors.

METHODS

Fifty patients with complex pelvic masses assessed preoperatively with two-dimensional ultrasound (2DUS), two-dimensional power Doppler (2DPD), three-dimensional ultrasound (3DUS), three-dimensional power Doppler (3DPD), color Doppler.

RESULTS

All patients underwent exploration, 19 (38%) had benign tumors, 31 (62%) had ovarian cancer. 2DUS identified 29 cases suspicious for malignancy giving sensitivity, specificity, PPV and accuracy of 80%, 78%, 86%, and 80%. 2DUS with 2DPD identified 28 suspicious cases giving sensitivity, specificity, PPV and accuracy of 80%, 84%, 89%, and 82%. 3DUS identified 31 suspicious cases including 28 cancers giving sensitivity, specificity, PPV and accuracy of 90%, 84%, 90%, and 88%. 3DUS with 3DPD, identified 34 suspicious cases including all 31 cancers giving sensitivity, specificity, PPV and accuracy of 100%, 84%, 91%, and 94%. Color Doppler RI of 0.48 identified 28 cases of 31 cancers giving sensitivity of 90%.

CONCLUSION

Evaluation by 3DUS with 3DPD improves diagnostic accuracy of ovarian tumors.

[Bilateral and recurrent facial palsy due to lymphoma: a case report]

OBJECTIVE

To discuss about management of facial paralysis reccurence and to highlight the ENT's important role in the diagnosis of systemic diseases.

MATERIAL AND METHODS

This article presents a case report about a controlateral facial palsy recurrence, two months later in a fifty-two year's old woman. This cranial nerves involvement was due to non-Hodgkin lymphoma with neuro-meningeal spreading. The first palsy had completely recovered with steroids. The early recurrence of the palsy and the lymph nodes areas exam lead to the diagnosis. The patient was treated by chemotherapy with good neuromeningeal diffusion. The facial score rapidly improved, according to facial electromyography results.

DISCUSSION

Specific biological and radiological explorations are usually carried out in recurrent facial palsy. Complete clinical examination and cerebrospinal fluid study are useful in this case. Moreover it should be preferable to do these explorations before steroid therapy. A diffuse meningeal enhancement on the MRI can complete sometimes clinical and biological data.

CONCLUSION

Cranial nerves involvement is sometimes one of the first symptoms of neuro-meningeal lymphoma. Facial palsy reccurence has to conduce ENT pratician to do more specific explorations, of which CSF analysis is required.

[Group B streptococcus screening: a retrospective study in 1,674 pregnancies]

OBJECTIVE

To evaluate our clinical practice for Group B streptococcus (GBS) screening during pregnancy and antibiotic therapy during delivery.

MATERIAL AND METHODS

We performed a retrospective evaluation of our SBS screening protocol, by vaginal swab, for a period of two years, including 1,674 asymptotic patients. Intra partum antibiotic prophylaxis was administrated for GBS-positive women.

RESULTS

The rate of GBS carriage was 6.9%. Antibiotics were administrated for 79.3% patients with GBS-positive culture. Of these women only 39% had an interval greater than four hours between antibiotic injection and delivery. In the group of patients with positive GBS culture, no newborn was infected and only 5% were colonised. In the GBS-negative group with 1.3% of the newborns were GBS positive.

CONCLUSION

We were surprised by our low rate of GBS carriage and the non optimal application of antibiotics during labor. We reviewed our results with all our team and a prospective evaluation has been initiated.

Maladies trophoblastiques gestationnelles

BACKGROUND

Trophoblastic diseases correspond to a very heterogeneous group of rare pathology in young women which fertility should be preserved.

PATIENT AND METHODS

We conducted a retrospective study from 1997 to 2003, including all patients with molar pregnancy or trophoblatic tumor in our department of Obstetrics and Gynecology.

RESULTS

Fifteen patients were identified with 9 molar pregnancies, 5 trophoblastic tumors and 1 placental tumor of implantation site. The outcome was favorable for 14, and one patient died from her metastatic disease. For 4 patients we asked our university colleague for the optimal approach.

DISCUSSION

Management of molar pregnancies is well established. Persistent gestational disease is more rare and problematic with potential metastatic dissemination. Multidisciplinary care is often needed.

CONCLUSION

Persistent gestational disease should be managed in a highly specialized centre, as developed in the Lyon University Hospital.

Usefulness of fine needle aspiration cytology in the diagnosis of loco-regional recurrence of differentiated thyroid carcinoma

AIM

The aim of our study was to define the usefulness of fine needle aspiration cytology (FNAC) in the assessment of loco-regional recurrence of differentiated thyroid carcinoma (DTC).

METHODS

Among 1182 consecutive patients treated and followed for DTC from 1992 to 2001, we retrospectively analysed 65 FNAC results of patients presenting a suspicion of loco-regional recurrence. Recurrences were proved at histology in 35 cases and by cervical radioiodine uptake on post-therapeutic WBS (whole body scan) in nine cases.

RESULTS

Among the 44 recurrences, FNAC results were malignant, benign and unsatisfactory in 33, two and nine cases, respectively. For the diagnosis of malignancy, FNAC sensitivity was 94%, specificity 100%, positive predictive value 100% and negative predictive value 87%. In the 35 cases where divergent results between diagnostic WBS (37-111MBq (131)I) and Tg level were observed, FNAC assessed the final status in 22 cases (malignant and benign in 17 and five cases, respectively). Of the 12 non-functioning and non-secreting lesions, FNAC diagnosed malignancy in four of the five malignant cases and ruled out malignancy in all seven benign lesions.

CONCLUSION

These results outline the interest of FNAC in the assessment of loco-regional recurrences of DTC, especially when classical follow-up tools such as WBS and/or Tg level are unable to detect the recurrences.

[Acute carbon monoxide poisoning during pregnancy: 2 cases with different neonatal outcome]

We report two cases of moderate maternal poisoning during the third trimester. They underwent hyperbaric oxygen therapy at 2.5 atmospheres for 90 minutes and were delivered at term. In one case the newborn presented an antenatal ischemic cerebral lesion probably due to monoxide poisoning. Pathophysiology and treatment of such accidents are discussed.

[Ritualistic female genital mutilation. The sentiment of the women]

Female genital mutilation (FGM) is considered as the most dangerous custom still ritually practiced and 2 million girls undergo the ordeal each year. This practice is anchored and fixed firmly in numerous African people's culture and Western countries are confronted to it through African immigrants. In order to understand the justifications and the consequences of FGM we interviewed 14 genitally mutilated African women living in France. Unfortunately and despite the conscious knowledge of consequences and absurd side of such practice, yet it seems to be perpetuated over the descendants. Educational approach is the best solution to fight female genital mutilation fixed firmly in numerous African people's culture.

Optimal frequency of changing intravenous administration sets: is it safe to prolong use beyond 72 hours?

OBJECTIVE

To determine the safety and cost-effectiveness of replacing the intravenous (IV) tubing sets in hospitalized patients at 4- to 7-day intervals instead of every 72 hours.

DESIGN

Prospective, randomized study of infusion-related contamination associated with changing IV tubing sets within 3 days versus within 4 to 7 days of placement.

SETTING

A tertiary university cancer center.

PATIENTS AND METHODS

Cancer patients requiring IV infusion therapy were randomized to have the IV tubing sets replaced within 3 days (280 patients) or within 4 to 7 days of placement (232 patients). Demographic, microbiological, and infusion-related data were collected for all participants. The main outcome measures were infusion- or catheter-related contamination or colonization of IV tubing, determined by quantitative cultures of the infusate, and infusion- or catheter-related bloodstream infection (BSI), determined by quantitative culture of the infusate in association with blood cultures in febrile patients.

RESULTS

The two groups were comparable in terms of patient and catheter characteristics and the agents given through the IV tubing. Intent-to-treat analysis demonstrated a higher level of tubing colonization in the 4- to 7-day group versus the 3-day group (median, 145 vs 50 colony-forming units; P=.02). In addition, there were three episodes of possible infusion-related BSIs, all of which occurred in the 4- to 7-day group (P=.09). However, when the 84 patients who received total parenteral nutrition, blood transfusions, or interleukin-2 through the IV tubing were excluded, the two groups had a comparable rate of colonization (0.4% vs 0.5%), with no catheter- or infusion-related BSIs in either group.

CONCLUSION

In patients at low risk for infection from infusion- or catheter-related infection who are not receiving total parenteral nutrition, blood transfusions, or interleukin-2, delaying the replacement of IV tubing up to 7 days may be safe, as well as cost-effective

Ovarian gastrinoma in multiple endocrine neoplasia type I: a case report

We report a very rare case of ovarian gastrinoma in the context of multiple endocrine neoplasia type I, including primary hyperparathyroidism and Zollinger-Ellison syndrome. Somatostatin receptor scintigraphy revealed the ovarian involvement at an early stage. Oophorectomy led to the final diagnosis and complete healing.

[Amniotic fluid leakage and premature rupture of membranes after amniocentesis. A review of the literature]

BACKGROUND

Amniotic fluid leakage and premature rupture of membranes following amniocentesis is uncommon.

MATERIAL AND METHODS

We reviewed the literature. Thirteen recent studies including 17 186 amniocenteses and 280 cases of amniotic fluid leakage were analyzed.

RESULTS AND DISCUSSION

Risk increases when early amniocentesis is performed prior to 15 weeks gestation and when the needle is inserted far from the placenta. Significant loss of amniotic fluid compromises pregnancy. Conservative management with bed rest seems to give good results. When amniotic leakage persists for more than two weeks, there is little spontaneous resolution. The risk of pursuing the pregnancy should be discussed with the couple in this case. Risks include respiratory disorders, skeletal malformations and premature birth.

CONCLUSION

New techniques such as 'amniopatch' may play an important role in the near future.

Acardiac fetus in a triplet pregnancy: ultrasound pitfalls. A case report

This communication aims at illustrating ultrasound diagnostic difficulties in early pregnancy with acardiac fetus. Our case concerns a spontaneously conceived triplet pregnancy. It was diagnosed as a twin pregnancy at 11 weeks of amenorrhea. One and a half months later the patient was referred to our center for spontaneous premature rupture of membranes with the diagnosis of a fetal demise in a triplet pregnancy. The definite diagnosis of acardia was assessed sonographically by the presence of a reverse blood flow through the umbilical cord, reflex movements, limbs anomalies and discordance between femoral and crown-rump length. Two days after admission, the patient developed chorioamnionitis and the three fetuses were expelled.

An unusual case associating ileal Crohn's disease and diffuse large B-cell lymphoma of an adjacent mesenteric lymph node

Intestinal non-Hodgkin's lymphomas are a rare complication of long-standing Crohn's disease and generally arise in sites of active inflammatory disease. To our knowledge, we report the first case of an unusual association between ileal Crohn's disease and a diffuse large B-cell non-Hodgkin's lymphoma involving an adjacent mesenteric lymph node but not the intestinal tract. A 22-year-old man was seen for intermittent abdominal pain, vomiting, and severe weight loss that were suggestive of intestinal obstruction. A segmental ileocolonic resection was performed. Gross examination revealed a terminal ileal inflammatory stenosis and enlarged mesenteric lymph nodes. Histologically, terminal ileal Crohn's disease was associated with a diffuse large cell lymphoma localized within one mesenteric lymph node without intestinal involvement. Immunophenotyping performed on deparaffinized sections demonstrated the B phenotype of this lymphoma.

AIDS-related primary lymphoma of the pleural cavity. A case report

BACKGROUND

Pleural effusions are common in patients with the acquired immunodeficiency syndrome (AIDS). Their most frequent causes are Kaposi's sarcoma and mycobacterial infections. We report cytologic, immunophenotypic and molecular features of a primary pleural non-Hodgkin's lymphoma (NHL) that represent an uncommon cause of isolated pleural effusion in patients with AIDS.

CASE

A 66-year-old, human immunodeficiency virus-positive male presented with chest pain and dyspnea. He had no history of opportunistic infections or Kaposi's sarcoma. A chest radiography displayed a right-sided pleural effusion. Cytology of pleural fluid revealed lymphomatous cells with markedly irregular nuclei. Their immunophenotype was indeterminate. Computed tomography of the thorax and abdomen did not show any tumor mass. Molecular analysis demonstrated that the lymphomatous cells had a B-cell genotype and contained Kaposi's sarcoma-associated herpesvirus (KSHV) and Epstein-Barr virus (EBV) DNA sequences.

CONCLUSION

This case belongs to a new subgroup of AIDS-related NHL that is characterized by unusual morphology, null immunophenotype, B-cell genotype and association with both KSHV and EBV.

The effects of liver denervation on the regulation of hepatic biliary secretion

Effects of liver denervation on bile formation were studied in eight dogs prepared with chronic biliary fistulas. The animals were studied in the basal state, after feeding, and during infusion of glucagon 50 ng/kg/min, secretin 2 U/kg/hr, or somatostatin 200 ng/kg/min. After this first set of experiments the animals underwent a total hepatic denervation that consisted of section of the hepatic ligaments and a careful dissection of the portal vein, hepatic artery, and common duct with stripping of all the surrounding connective tissue and topical application of phenol. The above experiments were then repeated. Denervation did not modify bile flow, or bile salts, cholesterol, or phospholipid concentration or output. Biliary response to glucagon and secretin was similar before and after denervation. Somatostatin had an anticholerectic effect in both intact and denervated animals, but significantly reduced bile salt output only in the intact dogs. Feeding had a choleretic effect pre- and postdenervation, and the infusion of somatostatin following feeding decreased bile flow to the same degree before and after denervation. In the intact animals the output of all three biliary lipids was reduced by somatostatin after feeding but they were unaffected by somatostatin after denervation. Moreover, cholesterol and phospholipid outputs were stable after feeding in intact animals, but significantly decreased after denervation. 14C-erythritol clearance studies indicated no change in the canalicular component of bile flow with denervation, except again during somatostatin suppression of feeding. These data indicate that basal bile flow is normal after denervation but that innervation may play an important role in the modulation of responses to somatostatin and more complex stimuli such as feeding.

Hemodynamic and catecholamine responses to laryngoscopy with vs. without endotracheal intubation

To study the relationship between the intensity of the stimulus exerted against the base of the tongue during direct laryngoscopy and the magnitude of associated hemodynamic and catecholamine responses, a study was conducted in 40 ASA I or II patients. Laryngoscopy lasting 40 s was performed with a size 3 Macintosh blade connected to a force-displacement transducer. The intensity of the stimulus exerted during laryngoscopy is expressed by the product of its average force (N) and duration (s) and given as impulse in Ns. Highly significant relationships were found between the impulse during laryngoscopy and the maximal hemodynamic and catecholamine responses. Also, when laryngoscopy was followed by orotracheal intubation, significant relationships were found with steeper slopes of the regression lines for systolic blood pressure, heart rate and plasma epinephrine concentrations. A more rapid regression of hemodynamic data was seen in intubated patients, whereas their plasma catecholamine concentrations regressed more slowly. The mechanisms of the responses to laryngoscopy and orotracheal intubation are proposed to be by somato-visceral reflexes. Stimulation of proprioceptors at the base of the tongue during laryngoscopy induces impulse-dependent increases of systemic blood pressure, heart rate and plasma catecholamine concentrations. Subsequent orotracheal intubation recruits additional receptors that elicit augmented hemodynamic and epinephrine responses as well as some vagal inhibition of the heart.

Genetic conditions among Canadian Mennonites: evidence for a founder effect among the old colony (Chortitza) Mennonites

Distinctive disease patterns exist among Canadian Old Colony (Chortitza) Mennonites. This religious and genetic isolate is of 16th century Dutch/German ancestry. The group originated in the Netherlands, then settled in the Vistula delta area of western Prussia for 200 years. A small number of founding families later migrated to Chortitza, the "Old Colony", in the Ukraine in the late 18th/early 19th century, where they remained a distinct genetic isolate. This group has come to Canada over the past 100 years. The more conservative Canadian Mennonites of Chortitza descent practice strict endogamy, have a large family size and live predominantly in rural public health subdistricts in the four western provinces, and in southern Ontario. The world's largest reported familial aggregations of insulin-dependent diabetes mellitus, of autoimmune diseases and of Tourette syndrome were initially ascertained in a small northern Alberta public health subdistrict. Clusterings of malformations, inborn errors of metabolism, and other conditions were also found in the subdistrict, and in group descendents living in other provinces. A founder effect, or genetic drift, accounts for the familial aggregations of autosomal recessive and dominant conditions, some diseases of multifactorial determination, and other inherited conditions in Canadian kinships descending from this ancestral group. The medical literature on genetic conditions among Canadian Mennonites is reviewed and re-evaluated in the light of this information. There is biochemical, serologic, and molecular biologic evidence in favour of genetic homogeneity amongst patients with certain inherited conditions in this special population group. This genetic isolate offers potential for the study of the genetic epidemiology and molecular biology of inherited diseases. A computerized genealogic data base on about 1400 group members, as well as a cryopreserved lymphocyte/DNA bank on over 100 individuals with genetic conditions has been established in this special population group.

Inherited diseases in North American Mennonites: focus on Old Colony (Chortitza) Mennonites

The patterns of migration and the genetic disorders occurring among North American Mennonites are reviewed, and inherited conditions recently recognized in a religious and genetic isolate, the Old Colony (Chortitza) Mennonites, are described. Old Colony Mennonites are of Dutch/German origin and descend from approximately 400 founding families who settled in the Old Colony, Chortitza (the Ukraine, USSR) in the late 1700s, and then migrated to Canada and Central and South America in the past century. We investigated over 6 generations of a Canadian Old Colony kindred in which there was extensive intermarriage, and in whom 28 individuals developed diabetes mellitus. Insulin-dependent diabetes mellitus (IDDM) occurred in 14 affected individuals in 10 closely related sibships; the 11 living IDDM patients were all concordant for the immunogenetic marker HLA-DR4. Fourteen close relatives had other disorders of carbohydrate metabolism, including gestational diabetes and non-insulin-dependent diabetes mellitus. Other close relatives had autoimmune diseases, including rheumatoid arthritis, hyper- and hypothyroidism, multiple sclerosis, and red cell aplasia. Other inherited diseases, including Alport syndrome, congenital defects, and inborn errors of metabolism were also found in the kindred. In the almost exclusively (99%) Old Colony Mennonite public health district in which the kindred was ascertained, there were multiple cases of Tourette syndrome, of malformations (including congenital heart defects and cleft lip +/- palate), and familial clusters of inborn errors of metabolism. We report this Old Colony (Chortitza) Mennonite isolate because 1) there are large familial aggregations of tissue-specific autoimmune diseases, malformations, inborn errors of metabolism, and of some other conditions whose genetic basis is still unknown; 2) there are multiple cases of rare genetic conditions, 3) we have established a computerized genealogic data base on over 1,000 kindred members as well as a cryopreserved lymphocyte/DNA bank on over 100 closely related individuals with various genetic conditions; and 4) this religious isolate, which extends across North, Central, and South America, offers an excellent opportunity for studying the epidemiology and molecular genetics of both common and rare inherited diseases.

Alteration in sialidase and other glycosidase activities in the kidney of spontaneously hypertensive rats: persistence after preventive treatment with hydralazine

Because kidney microangiopathy with capillary basement membrane thickening has been reported in spontaneous hypertension, we have studied the activities of three lysosomal glycosidases able to degrade the carbohydrate moieties of basement membrane constituents in the kidney cortex of 12-week-old spontaneously hypertensive rats (SHR) and age-matched normotensive Wistar Kyoto rats (WKY). These activities were also determined in SHR and WKY treated from 6 to 12 weeks of age with hydralazine (mean dose, 18 mg/kg per day in drinking water). Sialidase specific activity on sialyl-alpha 2-3-[3H]lactitol was markedly decreased in the kidney of untreated SHR, 40% activity remaining relative to that found in untreated age-matched WKY (p less than 0.001). beta-Galactosidase specific activity on p-nitrophenyl-beta-D-galactoside was also decreased, 86% activity remaining relative to that found in untreated WKY (p less than 0.001). Glucosyl-galactosyl-hydroxylysyl glucohydrolase specific activity on glucosyl-galactosyl-hydroxylysine was equally diminished, 74% activity remaining relative to that found in untreated age-matched WKY (p less than 0.001). In contrast, the activities of two control glycosidases inactive on the carbohydrate moieties of basement membrane constituents, alpha-glucosidase assayed with p-nitrophenyl-alpha-D-glucoside as substrate and beta-glucosidase assayed with p-nitrophenyl-beta-D-glucoside as substrate, were significantly increased. All the alterations in enzyme activities observed in the kidney of SHR were also present in the long-term treated normotensive SHR. No effect of the hydralazine treatment on the three enzyme activities investigated could be demonstrated in the WKY. Thus the alterations observed in the kidneys of SHR appear to be independent of blood pressure level.

Unusual clustering of diseases in a Canadian Old Colony (Chortitza) Mennonite kindred and community

We investigated a large Old Colony (Chortitza) Mennonite kindred with branches across Canada. Six generations of the kindred were traced. There was intermarriage among numerous family members. Insulin-dependent diabetes mellitus (IDDM) was identified in 10 members; all 7 living patients were found to carry the immunogenetic marker HLA-DR4. Nine other close relatives had disorders of carbohydrate metabolism, including gestational diabetes mellitus and non-insulin-dependent diabetes mellitus progressing to insulin use. Ten other relatives had autoimmune diseases, including rheumatoid arthritis, hyperthyroidism, hypothyroidism and multiple sclerosis. Cases of Alport's syndrome, congenital malformations, inborn errors of metabolism and unusual malignant diseases were also found in the kindred. In the small Alberta community in which the kindred was ascertained there were people of Old Colony Mennonite descent with genetic conditions such as Gilles de la Tourette's syndrome and congenital malformations, including congenital heart disease. This kindred represents the largest reported familial aggregation of IDDM. This disease and other disorders of carbohydrate metabolism occur in the context of a strong familial predisposition to autoimmune disease. Study of this family may permit empiric testing of proposed models of inheritance of diseases of complex origin such as IDDM. We report this Old Colony (Chortitza) Mennonite community because it is one of the settlements populated by this religious and genetic isolate, which extends across Canada and Central and South America and affords opportunities for the study of both common and rare inherited diseases.

Self-reported assertion of males with and without a physical disability: a cross-cultural study

The purpose of the present study was to compare the level of assertion among four different groups of male subjects: Arab and Jewish Israelis with and without a physical disability. A total of 189 subjects participated in the present study: 42 Israeli Arabs and 40 Israeli Jews with a physical disability and the remaining 107 served as control groups. Subjects filled out the Assertion Inventory (Gambrill and Richey, 1975). A significant interaction between cultural affiliation and physical disability was found. The Arab subjects without a physical disability reported the lowest level os assertion compared to the other three research groups. This finding is discussed on the basis of different cultural demands for social behavior particularly in regard to physical disability.