Homocysteine and Mild Cognitive Impairment: Are These the Tools for Early Intervention in the Dementia Spectrum?

Dementia, being a neurodegenerative disease, has devastating consequences not just for the ailing but also for the carers as it has a tremendous negative impact on the quality of life. The pathophysiology of dementia commences far earlier than its diagnosis. Mild cognitive impairment (MCI) is a stage prior to definite dementia. The progression from MCI to dementia is insidious with no definite demarcation, thus making diagnosis clinically difficult at an early stage. This paper attempts to throw light on the epidemiology, risk factors and the aetiopathogenesis of MCI. It further attempts to elaborate on the rate of conversion of MCI to definite dementia and the factors influencing the same. Many established as well as probable, modifiable as well as non-modifiable risk factors influence the progress of MCI to definite dementia. Homocysteine, a sulphur containing amino-acid has been identified as a probable risk factor for the dementia spectrum. Various existing clinical evidences and biological plausibility towards probable link between homocysteine and dementia are discussed in this paper. B vitamin mediated homocysteine reduction and cognitive outcomes demonstrate mixed results. This review attempts to evaluate hyperhomocysteinaemia and MCI as a brain risk marker and assess their potential for future research with a view to attempt early intervention.

Vitamin D replacement therapy in patients with cardiac syndrome X

AIMS

The aim of present study was to assess whether vitamin D, with proven beneficial effects on the cardiovascular system, has any effect on angina and exercise-induced ischemia in patients with cardiac syndrome X and low serum vitamin D.

METHODS

Patients with cardiac syndrome X and low serum vitamin D3 were studied before and after treatment with an intramuscular injection of vitamin D3 (300,000 units, every other week for 2 months). We determined the angina episode (per day) and several indices of exercise capacity.

RESULTS

At the end of the treatment course (75±6 day), a significant increase of serum vitamin D3 occurred and was within the normal range (45±8 ng/ml) and the frequency of angina improved significantly (p=0.003). Exercise duration and maximal work capacity increased significantly (p<0.001). Maximal ST-segment depression (mm) decreased significantly (p=0.001). The calculated Duck treadmill score improved significantly (p=0.001).

CONCLUSIONS

Our findings show that vitamin D replacement therapy in patients with cardiac syndrome X and vitamin D deficiency dramatically improves symptoms and signs of ischemia.

Evaluation of dietary stevioside supplementation on anti-human serum albumin immunoglobulin G, Alpha-1-glycoprotein, body weight and thyroid hormones in broiler chickens

Sixty male broiler chickens fed a diet supplemented with 130 mg/kg stevioside (S group) or an unsupplemented diet (C group) from day 1 of age onwards. On day 21 of age, ten birds from either the S (SH) or C (CH) group were injected subcutaneously with 100 μg human serum albumin (HSA) and ten others from either S (SP) or C (CP) group injected with 100 μl phosphate-buffered saline (PBS) in the same way. There were no significant effect of supplementation nor interaction with age on average body weights, T(3) and T(4) concentrations of non-injected chickens. After the primary immunization, α(1) -glycoprotein concentrations increased in all treatment groups except the CP group, and were significantly higher in the CH group in relation to the other groups. Fourteen and 18 days after the primary immunization, HSA injected chickens of both dietary treatments had significantly higher anti-HSA immunoglobulin G (IgG) levels than their PBS injected controls. No effect of stevioside supplementation was observed for IgG level. In conclusion, dietary stevioside inclusion can attenuate the pro-inflammatory response after stimulation of the innate immune response in broiler chickens.

Femtosecond powder diffraction with a laser-driven hard X-ray source

X-ray powder diffraction with a femtosecond time resolution is introduced to map ultrafast structural dynamics of polycrystalline condensed matter. Our pump-probe approach is based on photoexcitation of a powder sample with a femtosecond optical pulse and probing changes of its structure by diffracting a hard X-ray pulse generated in a laser-driven plasma source. We discuss the key aspects of this scheme including an analysis of detection sensitivity and angular resolution. Applying this technique to the prototype molecular material ammonium sulfate, up to 20 powder diffraction rings are recorded simultaneously with a time resolution of 100 fs. We describe how to derive transient charge density maps of the material from the extensive set of diffraction data in a quantitative way.

Enhancing global capacity in the surveillance, prevention, and control of chronic diseases: seven themes to consider and build upon

BACKGROUND

Chronic diseases are now a major health problem in developing countries as well as in the developed world. Although chronic diseases cannot be communicated from person to person, their risk factors (for example, smoking, inactivity, dietary habits) are readily transferred around the world. With increasing human progress and technological advance, the pandemic of chronic diseases will become an even bigger threat to global health.

METHODS

Based on our experiences and publications as well as review of the literature, we contribute ideas and working examples that might help enhance global capacity in the surveillance of chronic diseases and their prevention and control. Innovative ideas and solutions were actively sought.

RESULTS

Ideas and working examples to help enhance global capacity were grouped under seven themes, concisely summarised by the acronym "SCIENCE": Strategy, Collaboration, Information, Education, Novelty, Communication and Evaluation.

CONCLUSION

Building a basis for action using the seven themes articulated, especially by incorporating innovative ideas, we presented here, can help enhance global capacity in chronic disease surveillance, prevention and control. Informed initiatives can help achieve the new World Health Organization global goal of reducing chronic disease death rates by 2% annually, generate new ideas for effective interventions and ultimately bring global chronic diseases under greater control.

Hormonal profiles and biochemical indices of bone turnover in Indian women

The study establishes Indian referent database for bone turnover markers. The levels of markers decreased across the four quartiles of BMD showing a negative correlation with BMD. The study depicts that levels of hormones and bone turnover makers can aid in identifying women at risk for osteoporosis.

INTRODUCTION

Biochemical markers of bone turnover reflect changes in bone metabolism earlier and aid in the management of osteoporosis. Since a referent database for Indian women is lacking, the study was initiated to establish the same and suggest that hormonal profiles and markers of bone turnover can aid in identifying women at risk for osteoporosis.

METHODS

Osteocalcin (OC), bone specific alkaline phosphatase ((BSAP), C-terminal crosslinking telopeptide of type-I collagen (CTX-I), deoxypyridinoline (DPD), follicle-stimulating hormone (FSH) and estrone glucuronide (E(1)G) were measured in 365 Indian women (20-70 years) and correlated with BMD measurements by dual energy absorptiometry (DXA) using one way analysis of variance (ANOVA).

RESULTS

The mean levels of bone resorption markers; CTX-I and DPD increased significantly across the age showing a negative correlation with BMD. The increase in levels of CTX-I and DPD was significantly higher (p < 0.0001) as compared to the femoral and spinal BMD, which dropped only 30-36%. The levels of bone turnover markers and FSH decreased across the four quartiles of spinal and femoral BMD showing a negative correlation whereas E(1)G levels increased across the four quartiles.

CONCLUSION

The bone turnover markers were comparatively low in cohort of Indian women studied.

Ecotoxicological effect of grounded MV River Princess on the intertidal benthic organisms off Goa

The ecotoxicological effects of oil spill from the grounded vessel MV River Princess on the intertidal benthic organisms of Sinquerim-Candolim beach at Goa were investigated. An intertidal expanse of 1 km on either side of the grounded vessel was selected to evaluate the concentration of total petroleum hydrocarbon (TPH) in the sediment and its effects on the composition, abundance and diversity of micro-, meio- and macrobenthos. TPH in the intertidal sediment ranged from 7.8 to 89 microg g(-1) (mean 35.44+/-26.35 SD). Microbenthos comprised of microalgae, protozoans and juvenile forms of meiobenthos. Apart from juvenile nematodes, which were abundant, Coscinodiscus spp., Navicula spp., and Nitzschia spp. representing microalgae were also observed in microbenthic samples. Meiobenthos was represented by 13 taxa and their total density ranged between 92 and 1057 nos. 10 cm(-2). Maximum meiobenthic abundance of 1057 nos. 10 cm(-2) was observed at Sinquerim. Nematodes were the dominant meiobenthic taxa followed by turbellarians and harpacticoid copepods. The macrobenthos was numerically dominated by polychaetes, followed by crustaceans whereas bivalve molluscs were less represented. There was substantial increase in the petroleum concentration in the beach sediment compared to the previously reported values and highest TPH (89 microg g(-1) sediment) values were in the vicinity of the grounded vessel. The polychaete/amphipod ratio and cumulative and partial dominance abundance-biomass curves showed significant negative impact of TPH on macrofauna. The benthic community structure also showed measurable changes, as there was significant decrease (60%) in the number of species. Given that the microalgal counts were low in sediment, it is assumed that the intertidal meiofauna was possibly using oil-degrading bacteria as alternate food source. In conclusion, the results reported here suggest that the grounded ore carrier is not only detrimental to the beach community, that may take longer time for recovery, but also affects the beach morphology which may have long-term impact on local fishery.

Single-shot measurement of revival structures in femtosecond laser-induced alignment of molecules

We present a single-shot detection technique for field-free molecular alignment. The method is based on probing the time-varying birefringence of an aligned sample by use of a chirped probe pulse, thus encoding the dependence of the alignment on time onto the spectral domain. The technique is applied to alignment of O2. The recorded signals are well described by an analytical formula.

Small Area Analysis of Diabetes Complications: Opportunities for Targeting Public Health and Health Services Interventions

The objective of this paper is to present small area analyses of diabetes complications in Victoria, Australia, and to illustrate their importance for targeting public health and health services interventions. Local government areas in Victoria were aggregated into 32 Primary Care Partnerships (PCP), which are voluntary alliances of primary care providers. The 32 PCP areas were used as the basic geographic units for small area analyses. Admission rates for diabetes complications were age and sex standardised using the direct method and the 1996 Victorian population as the reference. Admission rate ratios were calculated using the Victorian admission rates as the reference. The 95 per cent confidence intervals for the standardised admission rate ratios were based on the Poisson distribution. There was a wide variation (almost fivefold) in admission rates for diabetes complications across the PCP catchments, with the lowest standardised rate ratio of 0.37 and the highest of 1.75. There were 11 PCPs (seven metropolitan, four rural) with admission rate ratios significantly higher than the Victorian average. The seven metropolitan PCPs contributed more than 43% of all admissions and bed days for diabetes complications in Victoria. Small area analyses of diabetes complications are an exciting new development aimed at stimulating an evidence-based dialogue between local area health service providers, planners and policy-makers. The purpose is to provide opportunities to target public health and health services interventions at the local level to improve the management of diabetes complications in the community.

Trends and geographic variations in hospital admissions for asthma in Victoria. Opportunities for targeted interventions

OBJECTIVE

To describe variations in rates of hospital admissions for asthma in Victoria as health indicators of quality of primary care services and access.

DESIGN

Routine analyses of age and sex standardised admission rates of asthma in rural and metropolitan Victoria from 1993-1994 to 1999-2000.

RESULTS

There were 10,079 admissions for asthma, with an average of 2.71 bed days in 1999-2000. The admission rate for asthma decreased from 3.1/1000 (95% CI: 3.1-3.2) in 1993-1994 to 2.2/1000 (2.1-2.2) in 1999-2000, with a 37% reduction in rural regions and 26% in metropolitan regions. Sixteen primary care partnerships (small areas), 13 of them rural, had significantly higher admission rates than the Victorian average.

CONCLUSION

Although asthma hospital admission rates are falling faster in rural than metropolitan areas, rural areas still have higher admission rates with significant variation between small areas.

Elimination of beam walk-off in low-coherence off-axis photorefractive holography

Whole-field photorefractive holography can be combined with low-coherence interferometry for three-dimensional imaging and other applications, including imaging through turbid media, but the off-axis holographic recording geometry results in a limited field of view when light of low temporal coherence is used. We show that tilting the energy fronts with respect to the wave fronts by use of prisms can eliminate this problem and point out that this approach will be useful for many linear and nonlinear wave-mixing experiments.

Priority setting in public health and health services research

Models for strategic priority setting in public health and health services research typically lack coherence or omit key considerations. We propose a new model, the Seven 'I's, with seven components: innovation, identification, inequalities, incorporation, importance, influences, and interventions. It tests the 'relevance' of research, while 'excellence' will be evaluated using existing criteria for peer review. It should be used to set research priorities primarily on the basis of expected health benefits, with adjustments for other non-health benefits as necessary. We discuss each component and compare our approach to other models. We argue that our model helps ensure resource allocation is transparent and accountable, and encourages the link to population health gains. It is flexible, and is applicable to both commissioned and investigator-driven research. It may be applied to assess existing proposals, or to generate research ideas.

Nitric oxide production is enhanced in patients with heat stroke

OBJECTIVE

To determine whether nitric oxide (NO) production is increased in heat stroke (HS) patients.

DESIGN

A prospective analysis of nitrite and nitrate (NO2*/NO3) levels in ten HS patients was performed at the HS center in Makkah, Saudi Arabia.

METHODS

Plasma (NO2*/NO3) levels were determined spectrophotometrically before cooling (0 time), and at 6, 12, and 24 h post-cooling.

RESULTS

The mean level of NO in the ten HS victims before cooling was significantly higher than in eight control patients (35.6+/-37.0 vs. 3.0+/-4.2 micromol/l; p<0.01). The levels were higher in non-survivors than in survivors. NO also correlated positively with the Acute Physiology and Chronic Health Evaluation II score (r = 0.72, p<0.018). There was no correlation between the NO level before cooling and blood pressure, rectal temperature, or cooling time.

CONCLUSION

HS is associated with excessive NO production, the magnitude of which is proportional to the severity of illness. NO may be an important mediator and integral part of the pathophysiological processes resulting in HS and may be a central factor linking the neurological and cardiovascular abnormalities observed in HS.

Central venous pressure from common iliac vein reflects right atrial pressure

PURPOSE

To determine whether central venous pressure at the common iliac vein reflects right atrial pressure in adult patients.

METHODS

In this prospective, non-blinded study 26 mechanically-ventilated adult patients were studied. Simultaneous pressure readings were obtained from the right atrium (TCVP) and the common iliac vein (ACVP).

RESULTS

There was a correlation between TCVP and ACVP (r = 0.987; P < 0.0001). The mean difference between TCVP and ACVP was 0.93 mm Hg. And the limits of agreement were: -1.93 to 1.77 mm Hg.

CONCLUSION

Venous pressure recorded from the common iliac vein reflects that in the right atrium. Adopting a femoral route for central venous pressure measurement may avoid some of the complications associated with the subclavian route.

Effect of gamma-irradiation on the survival and development of the infective larvae of the hookworm, Gaigeria pachyscelis

Irradiation of the infective larvae of Gaigeria pachyscelis Railliet and Henry, 1910 with gamma rays upto 160 Kr had no significant effect on the in vitro survival of these larvae for a period of 49 days, maintained either at room temperature (32.2--39.4 degrees C) or at 4 degrees C. However, the behaviour of the irradiated larvae in the lamb host was much changed, as shown by a marked reduction in the worm establishment and the development of stunted and sterile worms from these larvae. As the level of irradiation increased, there was a corresponding decrease in the subsequent worm establishment. It was found that male larvae are more sensitive to the effects of irradiation than female ones, particularly at higher levels.

The use of gamma-radiation-attenuated larvae of Gaigeria pachyscelis Railliet and Henry, 1910, for vaccination in lambs

The results of vaccination trial in lambs with gamma-irradiated infective larvae of Gaigeria pachyscelis are described. A single percutaneous (P/C) vaccination of lambs with 2000 infective larvae irradiated at 40 Kr induced the development of resistance. The vaccinated lambs successfully resisted a lethal challenge infection of 5000 non-irradiated larvae 3 months later. In the vaccinated lambs, the manifestations of resistance were shown by marked reduction in the worm establishment, development of retarded and functionally sterile worms and absence of clinical signs of hookworm disease after the challenge infection.

Acute renal failure due to radio-contrast agents

Over a 2-year period, acute renal failure following radio-contrast studies was observed in 25 patients after intravenous urography in 13, angiography in 10, oral cholecystography in 1, and cholangiography in 1. 20 had impaired renal function prior to the study. Renal failure, oliguric in 16 patients, occurred within 24 h. Serum creatinines reached levels of 5.3-13.3 mg% in 3-10 days. Recovery occurred in 20 patients within 5-37 days. Among the 5 patients in whom renal failure function was not restored, 1 died of progressive underlying renal disease and 4 of other causes while still in acute renal failure. These observations demonstrate the not infrequent occurrence of severe oliguric renal failure following radio-contrast study in patients with preexisting renal disease.