Potential alcohol use disorder (AUD) among men who have sex with men (MSM) in Ireland

Background

Alcohol consumption is a major public health concern in Ireland. Alcohol use disorder (AUD) appears to disproportionately affect men who have sex with men (MSM). However, little is known about the prevalence of AUD in this group in Ireland specifically, and the characteristics of MSM who may struggle with this.

Methods

The European MSM Internet Survey 2017 was an online, self-completed, anonymous questionnaire among MSM residing in Ireland. Standardised questions were used to explore a variety of topics. The validated CAGE-4 questionnaire was used to screen for potential AUD, defined as a CAGE-4 score of ≥ 2 out of 4. Multivariable-adjusted logistic regression analysis was used to identify factors associated with potential AUD.

Results

In total, 1,793 MSM met inclusion criteria, and 31% screened positive for AUD. We observed higher odds of possible AUD among MSM who were bisexual (vs. gay/homosexual) (aOR 1.48 95%CI 1.01-2.18), native to Ireland (vs. non-native) (aOR 1.49 95%CI 1.12-1.96), unemployed (vs. employed) (aOR 1.80 95%CI 1.02-3.16), had used illicit drugs in the previous year (vs. none) (cannabis only, aOR 1.74 95%CI 1.14-2.63) (other illicit drugs, aOR 2.28 95%CI 1.67-3.09), reported anxiety/depression (vs. none) (aOR 1.73 95%CI 1.12-2.66), and MSM who experienced homophobic abuse (vs. never) (aOR 1.55 95%CI 1.09-2.22). Student MSM were less likely to screen positive for AUD (vs. employed) (aOR 0.65 95%CI 0.46-0.93).

Conclusions

The prevalence of AUD appears to be higher in the MSM population compared to the general male population in Ireland. Targeted interventions may be warranted to reduce the burden of AUD among MSM.

Key messages

The prevalence of AUD appears to be higher in the MSM population compared to the general male population in Ireland. Targeted interventions may be warranted to reduce the burden of AUD among MSM.

Drug use among men who have sex with men in Ireland: Prevalence and associated factors from a national online survey

BACKGROUND

Little is known about the prevalence and determinants of drug use among men who have sex with men (MSM) in Ireland. The aims of this study were to measure the prevalence of recreational drug use among MSM in a national sample, and to identify sub-groups of MSM who may benefit from targeted preventive interventions.

METHODS

The MSM Internet Survey Ireland (MISI) 2015 was a community-recruited, nationally-promoted, self-completed online survey for MSM. MISI 2015 included standardised questions on recreational drugs, poppers, and drugs associated with chemsex (i.e. crystal methamphetamine, GBL/GHB, mephedrone, ketamine). Multivariable-adjusted logistic regression was used to identify factors associated with use of these substances.

RESULTS

In the previous year, 36% of MSM used recreational drugs, 33% used poppers, and 7% used drugs associated with chemsex. Five percent were diagnosed HIV-positive. Recreational drug users were significantly younger than non-users (median = 27 vs. 32 years; p < 0.001); popper users were significantly older than non-users (median = 34 vs. 28 years; p < 0.001). The odds of recreational drug use were higher among MSM diagnosed HIV-positive (vs. never tested; AOR 2.27, 95%CI 1.39-3.70). Use of poppers, and use of drugs associated with chemsex, were also higher among MSM diagnosed HIV-positive (vs. never tested; AOR 3.77, 95%CI 2.41-5.90, and AOR 5.87, 95%CI 3.08-11.18 respectively).

CONCLUSIONS

The prevalence of recreational drug use is higher among MSM than in the general population in Ireland, and it is particularly high among MSM diagnosed HIV-positive. Targeted harm reduction messages and preventive interventions are warranted to complement population-based approaches to reducing drug use in this population.

Inequalities in HIV testing uptake and needs among men who have sex with men living in Ireland: findings from an internet survey

OBJECTIVES

HIV disproportionately affects men who have sex with men (MSM) in Ireland. The aim of this study was to improve understanding of HIV testing among MSM living in Ireland to inform prevention and testing initiatives.

METHODS

We used data from the MSM Internet Survey Ireland 2015 (MISI 2015), a cross-sectional survey of MSM living in Ireland. We identified factors associated with never having tested for HIV using univariable and multivariable logistic regression. We identified preferred sites for future tests and examined the relationships between unmet HIV testing needs and socio-demographic groups.

RESULTS

More than one-third (n = 1006; 36%) of MSM had never tested for HIV. Multivariable logistic regression showed that untested men were more likely to be aged 18-24 years, live outside Dublin, have a lower level of education, be born in Ireland, identify as bisexual, be out to fewer people, and not have had sex with a man in the previous 12 months. The same groups of men also had the least knowledge about HIV and were least confident in accessing an HIV test. Men who had never tested for HIV were more likely to prefer testing by their general practitioner (GP) or using home sampling HIV kits and less likely to prefer testing in a sexual health clinic.

CONCLUSIONS

HIV prevention and testing programmes for MSM should be targeted towards younger men, those living outside Dublin and those with lower levels of education. We recommend increased promotion and availability of free HIV testing services in a range of clinical and nonclinical settings (including self-sampling and home testing).

Polyacrylic Acid Gel in Patients with Dry Eyes: A Randomised Comparison with Polyvinyl Alcohol

Purpose

To compare the safety and efficacy of polyacrylic acid 0.2% (PAA) gel and polyvinylalcohol 1.4% (PVA) in the treatment of patients with dry eyes.

Methods

Eighty-nine patients with dry eyes were randomly allocated to treatment with either PAA (48) or PVA (41) in a prospective, investigator-masked study in two centres. The parameters assessed were daily frequency of instillation of the study medications, ocular signs and symptoms, tear film break up time, Schirmer's test values, local tolerance and global assessment of the improvement following treatment.

Results

The two groups were similar in patient demographics and study parameters at baseline. The total score of symptoms (gritty or foreign body sensation, burning sensation, dry eye sensation, photophobia, others) and signs (conjunctival hyperaemia, ciliary injection, corneal and conjunctival epithelial staining) was reduced significantly more by treatment with PAA than with PVA at both three and six weeks (p<0.0001). The daily frequency of instillation of PAA was significantly less than that PVA on 38 of the 41 (93%) study days. Both PAA and PVA were safe and equally well-tolerated except for blurred vision, usually mild and transient, on PAA. On global assessment of the improvement in their dry eye condition, significantly more PAA patients felt better on treatment at six (p=0.02) weeks compared with those on PVA.

Conclusions

Polyacrylic acid gel was as safe as and more effective than polyvinylalcohol in the treatment of patients with dry eyes.

The impact of a structured clinical training course on interns' self-reported confidence with core clinical urology skills

BACKGROUND

Undergraduate training in core urology skills is lacking in many Irish training programmes.

AIMS

Our aim was to assess newly qualified doctors' experience and confidence with core urological competencies.

METHODS

A questionnaire survey covering exposure to urology and confidence with core clinical skills was circulated to all candidates. The group then attended a skills course covering male/female catheterisation, insertion of three-way catheters, bladder irrigation and management of long-term suprapubic catheters. The groups were re-surveyed following the course.

RESULTS

Forty-five interns completed the pre-course questionnaire (group 1) and 27 interns completed the post-course questionnaire (group 2). 24/45 (53%) had no experience of catheter insertion on a patient during their undergraduate training. 26/45 (58%) were unsupervised during their first catheter insertion. 12/45 (27%) had inserted a female catheter. 18/45 (40%) had inserted a three-way catheter. 12/45 (27%) had changed a suprapubic catheter. 40/45 (89%) in group 1 reported 'good' or 'excellent' confidence with male urinary catheterisation, compared to 25/27 (92.5%) in group 2. 18/45 (40%) in group 1 reported 'none' or 'poor' confidence with female catheterisation, compared to 7/27 (26%) in group 2. 22/45 (49%) in group 1 reported 'none' or 'poor' confidence with insertion of three-way catheters, compared to 2/27 (7%) in group 2. 32/45 (71%) in group 1 reported 'none' or 'poor' confidence in changing long-term suprapubic catheters, falling to 3/27 (11%) in group 2.

CONCLUSION

This study raises concerns about newly qualified doctors' practical experience in urology. We suggest that this course improves knowledge and confidence with practical urology skills and should be incorporated into intern induction.

HPV vaccine acceptability in HIV-infected and HIV negative men who have sex with men (MSM) in Ireland

Background Men who have sex with men (MSM), particularly HIV-infected MSM are disproportionately affected by HPV infection and associated disease. The HPV vaccine has potential to greatly reduce the burden of HPV-associated disease including anal cancer in MSM. The efficacy of the HPV vaccine is dependent on high levels of vaccine uptake. The aim of this study was to examine HPV vaccine acceptability and factors influencing vaccine acceptability in MSM in Ireland. Methods A self-administered survey was distributed to HIV-infected and HIV negative MSM examining HPV vaccine acceptability and factors associated with vaccine acceptability. Logistic regression was used to identify key variables and predictors of HPV vaccine acceptability. Results 302 MSM participated in the study. Acceptability of HPV vaccine was 31% (unconditional), 51% (conditional on stated efficacy and a cost of €300), 65% (conditional on stated efficacy and a cost of €100) and 78% (conditional on stated efficacy and no cost). Cost was negatively associated with HPV vaccine acceptability (p<0.01) while knowledge of HPV vaccine efficacy was significantly associated with vaccine acceptability, even in the context of associated cost (p<0.01). Conclusions Acceptability of HPV vaccine in MSM in Ireland is high based on no cost vaccine and on stated vaccine efficacy (78%). Cost is negatively associated with vaccine acceptability. Understanding levels of knowledge of HPV infection, HPV associated disease and attitudes toward HPV vaccination are important as they will contribute to HPV vaccine acceptability among MSM and will help guide effective preventive programs.

70,489 primary care encounters: retrospective analysis of morbidity at a primary care centre in Ireland

BACKGROUND

While considerable changes are happening in primary care in Ireland and considerable potential exists in intelligence derived from practice-based data to inform these changes, relatively few large-scale general morbidity surveys have been published.

AIMS

To examine the most common reasons why people attend primary care, specifically 'reasons for encounter' (RFEs) among the general practice population and among specific demographic groups (i.e., young children and older adults).

METHODS

We retrospectively examined clinical encounters (which had a diagnostic code) over a 4-year time period. Descriptive analyses were conducted on anonymised data.

RESULTS

70,489 RFEs consultations were recorded (mean 13.53 recorded RFEs per person per annum) and consultations involving multiple RFEs were common. RFE categories for which codes were most commonly recorded were: 'general/unspecified' (31.6 %), 'respiratory' (15.4 %) and 'musculoskeletal' (12.6 %). Most commonly recorded codes were: 'medication renewal' (6.8 %), 'cough' (6.6 %), and 'health maintenance/prevention' (5.8 %). There was considerable variation in the number of RFEs recorded per age group. 6239 RFEs (8.9 %) were recorded by children under 6 years and 15,295 RFEs (21.7 %) were recorded by adults aged over 70. RFEs recorded per calendar month increased consistently through the study period and there was a marked seasonal and temporal variation in the number of RFEs recorded.

CONCLUSIONS

Practice databases can generate intelligence on morbidity and health service utilisation in the community. Future research to optimise diagnostic coding at a practice level and to promote this activity in a more representative sample of practices is a priority.

Where would you turn for help? Older adults' awareness of community support services

Previous findings on older adults' awareness of community support services (CSSs) have been inconsistent and marred by acquiescence or over-claiming bias. To address this issue, this study used a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In telephone interviews, 1,152 adults aged 50 years and over were read a series of vignettes and asked if they were able to identify a community organization or agency that they may turn to in that situation. They were also asked about their most important sources of information about CSSs. The findings show that, using a vignette methodology, awareness of CSSs is much lower than previously thought. The most important sources of information about CSSs included information and referral sources, the telephone book, doctors' offices, and word of mouth.

Primary extrasac orbital lymphoma presenting as nasolacrimal obstruction

Primary orbital lymphoma is an unusual cause of epiphora in the elderly population. Lymphomas that give rise to nasolacrimal duct obstruction usually arise from within the lacrimal sac. Epiphora is a common presenting complaint that may be easily disregarded as a minor debilitating symptom. This case describes a 58-year-old Caucasian man presenting with epiphora due to primary extrasac orbital lymphoma, causing external mechanical compression on the nasolacrimal duct system. Although a rare presentation, it highlights the need for a thorough examination in patients presenting with epiphora. Nasolacrimal duct obstruction could well be the initial manifestation that leads to the diagnosis of a more serious underlying systemic disease, and lymphoma needs to be included in the differential diagnosis of secondary nasolacrimal duct obstruction.

Transanal endoscopic microsurgical repair of iatrogenic recto-urethral fistula

BACKGROUND

Recto-urethral fistula formation following radical prostatectomy is an uncommon but potentially devastating event. Traditional surgery for such fistulae is technically demanding, jeopardizes continence and usually necessitates a diverting colostomy. We present the case of an iatrogenic fistula treated by a transanal endoscopic microsurgical approach, without recourse to a stoma.

METHOD

A 71-year-old man had recently undergone a radical prostatectomy, complicated by significant intra-operative haemorrhage. He subsequently developed a recto-urethral fistula, confirmed clinically and endoscopically. Due to his bleeding diathesis, he was considered for, and underwent, a transanal endoscopic microsurgical (TEMS) repair.

CONCLUSION

TEMS is a safe and reliable minimally-invasive surgical technique for the treatment of this difficult condition.

The global expansion of precarious employment, work disorganization, and consequences for occupational health: placing the debate in a comparative historical context

Mounting research evidence suggests that the shift to contingent work arrangements in industrialized countries is having serious adverse effects on the health of workers, both directly and indirectly (by undermining regulatory and other protections). The authors place this research, and the issues surrounding it, in a comparative historical context. Extensive use of precarious employment is not essentially new. It was a characteristic feature of most if not all industrialized societies in the 19th and early 20th centuries. Though the two phases are not identical, historical comparisons are instructive for understanding recent experiences and ways of addressing them. The authors also make comparisons with the developing world, where the informal sector typically accounts for over half the workforce. Such comparisons are instructive in indicating the consequences of a shift to more precarious patterns of employment and disorganized work settings. There is also good evidence that precarious employment is expanding in the developing world. The growing precarious employment in both industrialized and developing countries is interconnected, and the authors identify a number of the mechanisms affecting workers' health.

The global expansion of precarious employment, work disorganization, and consequences for occupational health: a review of recent research

In this review of a range of studies on the health and safety effects of precarious employment in industrialized societies published since 1984, the authors examine the overall findings and methodological issues and identify areas in need of further research. Of the 93 published journal articles and monographs/book chapters reviewed, 76 studies found precarious employment was associated with a deterioration in occupational health and safety (OHS) in terms of injury rates, disease risk, hazard exposures, or worker (and manager) knowledge of OHS and regulatory responsibilities. Of the more than 25 studies each on outsourcing and organizational restructuring/downsizing, well over 90 percent find a negative association with OHS. The evidence is fairly persuasive for temporary workers, with 14 of 24 studies finding a negative association with OHS. The evidence is less strong for small business, and a handful of studies on part-time workers found no clear association with negative OHS outcomes (in some cases the reverse). Further research is needed to more clearly link health effects to particular business practices and neoliberal policies and to explore the regulatory implications of the growth of precarious employment. The authors suggest some ways to conceptualize the association between precarious employment and occupational health.

The effects of outsourcing on occupational health and safety: a comparative study of factory-based workers and outworkers in the Australian clothing industry

Outsourcing has become increasingly widespread throughout industrialized societies over the past 20 years. Accompanying this has been a renewed growth in home-based work, sometimes using new technologies (telework) but also entailing a re-emergence of old forms, such as clothing outwork, used extensively 100 years ago. A growing body of research indicates that changes to work organization associated with outsourcing adversely affect occupational health and safety (OHS), both for outsourced workers and for those working alongside them. This study assessed the OHS implications of the shift to home-based workers in the Australian clothing industry by systematically comparing the OHS experiences of 100 factory-based workers and 100 outworkers. The level of self-reported injury was over three times higher among outworkers than factory-based workers undertaking similar tasks. The most significant factor explaining this difference was the payment system. All outworkers were paid solely by the piece, whereas factory workers were paid either under a time plus production bonus system or solely on a time basis. While the incidence of injury was far higher among outworkers, factory-based workers paid under an incentive system reported more injuries than those paid solely on a time basis. Increasing injury was correlated with piecework payment systems.

Phacoemulsification versus extracapsular cataract extraction: a comparative study of cell survival and growth on the human capsular bag in vitro

AIMS/BACKGROUND

Phacoemulsification is rapidly replacing conventional extracapsular cataract extraction (ECCE) as the method of choice for cataract surgery in the Western world. However, posterior capsule opacification (PCO) still remains the major postoperative complication, affecting 20-50% of patients, and results from persistent cell growth of epithelial cells remaining after surgery. This study aimed to compare cell survival and growth on capsular bags following ECCE and phacoemulsification surgery using an established human capsular bag culture system.

METHODS

Sham ECCE and phacoemulsification cataract operations were performed on pairs of human donor eyes. Capsular bags were dissected free, pinned flat on a petri dish, and incubated with Eagle's minimum essential medium (EMEM) alone or EMEM supplemented with 10% fetal calf serum (FCS). Ongoing observations were made using phase contrast microscopy.

RESULTS

Cell growth was observed across the posterior capsule of all preparations studied. It was found that there was no significant difference in the rate of cell growth on the posterior capsule with the two extraction methods, such that 50% confluency was achieved in 7.0 (SD 1.8) (n = 7) days for ECCE and 7.43 (2.1) (n = 7) days for phacoemulsification surgery. The physical changes to the capsule as a result of cell growth, such as wrinkling and capsular tensioning, were also seen in both groups.

CONCLUSIONS

Cell survival and growth is dependent on the donor, rather than the surgical technique performed. There is no significant difference between phacoemulsification and ECCE surgery on the rate and nature of cell growth on the posterior capsule in vitro.

[Immigration and labor: Australia and Canada compared]

"Australia and Canada share...a common colonial history and many similarities in geography, economy, demography, etc., as well as a substantial anti-non anglo-celtic immigrant tradition, in spite of their being immigration countries. Those similarities and differences are analyzed here, as far as labor migration and relationships between immigrant and local labor are concerned. The arrival of European labor first, Asian later, was perceived similarly by both Australia and Canada, combining racial prejudice and unions' hostility towards contract labor migration as well as towards assisted migration. The evolution of those difficult relations through the 19th and 20th centuries is analyzed here." (SUMMARY IN ENG)

Acid-base status and spiracular control during discontinuous ventilation in grasshoppers

Many insects ventilate discontinuously when quiescent, exhibiting prolonged periods during which little or no gas exchange occurs. We investigated the consequences of discontinuous ventilation (DV) on haemolymph acid&shy;base status and tested whether spiracular opening during DV is due to changes in internal gas tensions in the western lubber grasshopper Taeniopoda eques. At 15 &deg;C, resting T. eques exhibited interburst periods of about 40 min. During the interburst period, haemolymph PCO2 rose from 1.8 to 2.26 kPa, with minimal acidification of haemolymph. Animals in atmospheres in which PCO2 was 2 kPa or below continued to exhibit DV, while atmospheres in which PCO2 was 2.9 kPa or above caused cessation of DV. These data indicate that accumulation of internal CO2 to threshold levels between 2 and 2.9 kPa induces spiracular opening in grasshoppers. In contrast to the situation in lepidopteran pupae, variation in atmospheric PO2 had no effect on interburst duration. Relative to lepidopteran pupae, the internal PCO2 of grasshoppers during DV is threefold lower, the PCO2 required for triggering spiracular opening is also threefold lower, and the open phase spiracular conductance is at least tenfold higher, demonstrating that considerable diversity exists in these aspects of insect respiratory physiology.

Double-blind, controlled trial of short-term prednisone therapy in immunoglobulin A glomerulonephritis

Twenty children and adolescents with IgA glomerulonephritis were enrolled in a crossover trial. Each received 12 weeks of prednisone therapy and 12 weeks of placebo dosing. Urinary protein and erythrocyte excretion were monitored during both courses. There was no evidence that, under the conditions of the study, corticosteroid therapy was effective in IgA nephropathy.

Major histocompatibility complex extended haplotypes in systemic lupus erythematosus

In a study of 32 white patients with systemic lupus erythematosus from 28 families, 60 unique chromosome 6 haplotypes were defined. The MHC extended haplotype HLA-B8, -DR3, SC01, GL02 was strongly disease-associated (0.09 patients, 0.02 controls, RR = 4.5, C.I. = 1.6-12.4, P less than 0.05), while the corresponding haplotype with the GL01 specificity was not increased in frequency (0.05 in both patients and controls). In the present data, the increase in the haplotype bearing GL02 accounted entirely for the association between HLA-DR3 and SLE. Furthermore, the phenotype of complete C4A deficiency was also strongly disease-associated (patients 0.14, controls 0.02, RR = 8.5, C.I. = 1.8-37.0, P less than 0.05). The only other MHC association in these patients was an increased occurrence of the HLA-B17, -DR7, SC61 haplotype (patients 0.07, controls 0.01, RR = 6.0, C.I. = 1.8-20.6, P corr. less than 0.05). The relationship between MHC markers and autoimmune disease appears to be a result of an association with MHC extended haplotypes and complete complement component deficiencies rather than with individual alleles. It is important that future studies include family members so that such haplotypes can be defined.

Minoxidil for control of acute blood pressure elevation in chronically hypertensive children

Twenty-three episodes of acute elevation of BP related to renal disease in 13 chronically hypertensive children 2 to 18 years of age were treated with a single oral dose of minoxidil. All except one patient were receiving a diuretic and all but one a beta-blocking agent at the time of minoxidil treatment. The goal of lowering BP to or below the 95th percentile for age within four hours of minoxidil administration was achieved in 14 of 23 treatment episodes. The goal was achieved in nine of 11 (82%) when the dose of minoxidil was greater than or equal to 0.2 mg/kg and in five of 12 (42%) when the dose was less than 0.2 mg/kg (P less than .05). In patients treated with greater than or equal to 0.2 mg/kg of minoxidil, mean systolic and diastolic BP decreased significantly from pretreatment values within one hour. In patients receiving less than 0.2 mg/kg, mean systolic BP was never significantly reduced and mean diastolic BP did not change significantly for two hours. Adverse effects were minimal. The results indicate that minoxidil in a dose of 0.2 mg/kg in combination with a diuretic and beta-blocking agent will lower BP to safe levels in most patients with severe hypertension related to renal disease within four hours with minimal side effects.

Thyroid function and the incidence of breast cancer in Hawaiian, British and Japanese women

Serum-free thyroxine (FT4) concentrations are lower in Hawaiian and Hawaiian Caucasian women than in Hawaiian Japanese, Hawaiian Filipino, Hawaiian Chinese, and English and Japanese mainland women. There is a high inverse correlation between FT4 and risk of breast cancer in these ethnic groups. Thyroid-stimulating hormone (TSH) concentrations, which are inversely correlated with FT4, generally show the same relationship.

Abnormal phosphorylation of the microtubule-associated protein tau (tau) in Alzheimer cytoskeletal pathology

A monoclonal antibody to the microtubule-associated protein tau (tau) labeled some neurofibrillary tangles and plaque neurites, the two major locations of paired-helical filaments (PHF), in Alzheimer disease brain. The antibody also labeled isolated PHF that had been repeatedly washed with NaDodSO4. Dephosphorylation of the tissue sections with alkaline phosphatase prior to immunolabeling dramatically increased the number of tangles and plaques recognized by the antibody. The plaque core amyloid was not stained in either dephosphorylated or nondephosphorylated tissue sections. On immunoblots PHF polypeptides were labeled readily only when dephosphorylated. In contrast, a commercially available monoclonal antibody to a phosphorylated epitope of neurofilaments that labeled the tangles and the plaque neurites in tissue did not label any PHF polypeptides on immunoblots. The PHF polypeptides, labeled with the monoclonal antibody to tau, electrophoresed with those polypeptides recognized by antibodies to isolated PHF. The antibody to tau-labeled microtubules from normal human brains assembled in vitro but identically treated Alzheimer brain preparations had to be dephosphorylated to be completely recognized by this antibody. These findings suggest that tau in Alzheimer brain is an abnormally phosphorylated protein component of PHF.

Major-histocompatibility-complex extended haplotypes in membranoproliferative glomerulonephritis

Membranoproliferative glomerulonephritis is often associated with evidence of immune derangement, especially hypocomplementemia. We studied genetic markers for membranoproliferative glomerulonephritis within the major histocompatibility complex in 34 patients and their families and in 29 normal families. We examined the frequencies of extended haplotypes (combinations of alleles that tend to occur together) in patients and controls. The extended haplotype HLA-B8,DR3,SC01,GLO2(glyoxalase I 2) was observed in 9 of 68 disease-associated haplotypes (13 percent), but in only 3 of 205 controls (1 percent) (relative risk, 14.79; P less than 0.001). An extended haplotype similar except for a different glyoxalase allotype (B8,DR3,SC01,GLO1) did not occur with increased frequency, nor did any other extended haplotypes. Patients with the extended haplotype B8,DR3,SC01,GLO2 had a higher incidence of renal insufficiency than those without it (P less than 0.01). The data support the hypothesis that a specific extended haplotype of the major histocompatibility complex is associated with susceptibility to membranoproliferative glomerulonephritis, and that patients with glomerulonephritis who have this extended haplotype have a poorer prognosis for kidney survival than those without the haplotype.

Microtubule-associated protein tau. A component of Alzheimer paired helical filaments

Microtubule-associated protein tau was purified from bovine brain microtubules by either (1) phosphocellulose chromatography, (2) heat treatment at pH 6.4, (3) heat treatment at pH 2.7, (4) heat treatment at pH 2.7 followed by extraction with perchloric acid and precipitation with glycerol, or (5) by precipitation with ammonium sulfate followed by extraction with perchloric acid. All of these tau preparations reacted specifically with antibodies to Alzheimer paired helical filaments. Affinity purified antibodies to tau labeled both Alzheimer neurofibrillary tangles and plaque neurites but not amyloid in Alzheimer brain tissue sections and labeled paired helical filament polypeptides on Western blots. Human brain tau and paired helical filament polypeptides co-migrated on sodium dodecyl sulfate-polyacrylamide gels. These results suggest that tau is a major component of Alzheimer paired helical filaments.

Improved growth of three uremic children by nocturnal nasogastric feedings

Three children with high-output renal insufficiency (estimated creatinine clearance, 20 to 25 mL/min/1.73 sq m) and linear and ponderal growth retardation were administered nocturnal nasogastric (NG) feedings at home by trained parents. The NG feedings were initiated at 50 kcal/kg/night and increased as needed to establish and maintain weight gain. Nocturnal feedings were continued for 13.5, 16, and 11 months, respectively. Improved caloric intake reestablished the velocity of weight gain from less than 5% to greater than 95% in each patient. Linear growth velocity improved from less than 5% in two patients and 40% in one patient to greater than 95% in two patients and 80% in the third patient. No change was observed in serum creatinine, electrolyte, calcium, or phosphorus levels. The serum urea nitrogen level remained below 100 mg/dl. Ensuring adequate caloric intake by nocturnal NG feedings, in addition to standard therapy, improved both ponderal and linear growth velocity.

A sensitive human thyroglobulin RIA to define clearly the presence or absence of functioning thyroid tissue

This paper describes a practical procedure to establish a sensitive radioimmunoassay for the measurement of human thyroglobulin (HTg) in serum. The assay enables a clear distinction to be made between levels of HTg indicating the presence or absence of functioning thyroid tissue. It compares the use of HTg serum levels with the conventional I-131 scintigram as a marker for recurrent thyroid cancer. In addition, a simple and sensitive radioimmunologic assay is described for the determination of serum antithyroglobulin autoantibodies, the presence of which may give falsely elevated HTg levels.

Emergency discharges: their outcome

This paper compares the short-term outcome of a group of seven patients released from an inpatient facility during an employee strike and a group of eight released at the optimal time according to the treating physicians. There was no difference in the outcome of the two groups, only two fifth of the entire cohort could be considered as doing well. The reasons for the findings are explored.