Expanded phenotypic spectrum of neurodevelopmental and neurodegenerative disorder Bryant-Li-Bhoj syndrome with 38 additional individuals

Bryant-Li-Bhoj syndrome (BLBS), which became OMIM-classified in 2022 (OMIM: 619720, 619721), is caused by germline variants in the two genes that encode histone H3.3 (H3-3A/H3F3A and H3-3B/H3F3B) [1-4]. This syndrome is characterized by developmental delay/intellectual disability, craniofacial anomalies, hyper/hypotonia, and abnormal neuroimaging [1, 5]. BLBS was initially categorized as a progressive neurodegenerative syndrome caused by de novo heterozygous variants in either H3-3A or H3-3B [1-4]. Here, we analyze the data of the 58 previously published individuals along 38 unpublished, unrelated individuals. In this larger cohort of 96 people, we identify causative missense, synonymous, and stop-loss variants. We also expand upon the phenotypic characterization by elaborating on the neurodevelopmental component of BLBS. Notably, phenotypic heterogeneity was present even amongst individuals harboring the same variant. To explore the complex phenotypic variation in this expanded cohort, the relationships between syndromic phenotypes with three variables of interest were interrogated: sex, gene containing the causative variant, and variant location in the H3.3 protein. While specific genotype-phenotype correlations have not been conclusively delineated, the results presented here suggest that the location of the variants within the H3.3 protein and the affected gene (H3-3A or H3-3B) contribute more to the severity of distinct phenotypes than sex. Since these variables do not account for all BLBS phenotypic variability, these findings suggest that additional factors may play a role in modifying the phenotypes of affected individuals. Histones are poised at the interface of genetics and epigenetics, highlighting the potential role for gene-environment interactions and the importance of future research.

Magnetic resonance imaging pattern recognition in childhood bilateral basal ganglia disorders

Bilateral basal ganglia abnormalities on MRI are observed in a wide variety of childhood disorders. MRI pattern recognition can enable rationalization of investigations and also complement clinical and molecular findings, particularly confirming genomic findings and also enabling new gene discovery. A pattern recognition approach in children with bilateral basal ganglia abnormalities on brain MRI was undertaken in this international multicentre cohort study. Three hundred and five MRI scans belonging to 201 children with 34 different disorders were rated using a standard radiological scoring proforma. In addition, literature review on MRI patterns was undertaken in these 34 disorders and 59 additional disorders reported with bilateral basal ganglia MRI abnormalities. Cluster analysis on first MRI findings from the study cohort grouped them into four clusters: Cluster 1—T₂-weighted hyperintensities in the putamen; Cluster 2—T₂-weighted hyperintensities or increased MRI susceptibility in the globus pallidus; Cluster 3—T₂-weighted hyperintensities in the globus pallidus, brainstem and cerebellum with diffusion restriction; Cluster 4—T₁-weighted hyperintensities in the basal ganglia. The 34 diagnostic categories included in this study showed dominant clustering in one of the above four clusters. Inflammatory disorders grouped together in Cluster 1. Mitochondrial and other neurometabolic disorders were distributed across clusters 1, 2 and 3, according to lesions dominantly affecting the striatum (Cluster 1: glutaric aciduria type 1, propionic acidaemia, 3-methylglutaconic aciduria with deafness, encephalopathy and Leigh-like syndrome and thiamine responsive basal ganglia disease associated with SLC19A3), pallidum (Cluster 2: methylmalonic acidaemia, Kearns Sayre syndrome, pyruvate dehydrogenase complex deficiency and succinic semialdehyde dehydrogenase deficiency) or pallidum, brainstem and cerebellum (Cluster 3: vigabatrin toxicity, Krabbe disease). The Cluster 4 pattern was exemplified by distinct T₁-weighted hyperintensities in the basal ganglia and other brain regions in genetically determined hypermanganesemia due to SLC39A14 and SLC30A10. Within the clusters, distinctive basal ganglia MRI patterns were noted in acquired disorders such as cerebral palsy due to hypoxic ischaemic encephalopathy in full-term babies, kernicterus and vigabatrin toxicity and in rare genetic disorders such as 3-methylglutaconic aciduria with deafness, encephalopathy and Leigh-like syndrome, thiamine responsive basal ganglia disease, pantothenate kinase-associated neurodegeneration, TUBB4A and hypermanganesemia. Integrated findings from the study cohort and literature review were used to propose a diagnostic algorithm to approach bilateral basal ganglia abnormalities on MRI. After integrating clinical summaries and MRI findings from the literature review, we developed a prototypic decision-making electronic tool to be tested using further cohorts and clinical practice.

Great expectations: virus-mediated gene therapy in neurological disorders

Gene therapy (GT) has tremendous potential for the treatment of neurological disorders to transform patient care. The successful application of virus-mediated GT to treat spinal muscular atrophy is a significant milestone, serving to accelerate similar progress in a spectrum of neurological conditions, with more than 50 clinical trials currently underway, across neurodevelopmental, neurodegenerative, muscular dystrophy, epilepsy, chronic pain and neoplastic diseases. This review provides an overview of the key features of virus-mediated GT, paradigms of delivery and dosing, potential risks and highlights ongoing research to optimise safe and effective delivery of vectors into the nervous system. Examples of the application of GT in various neurological diseases alongside clinical development challenges will be presented. As the development and translation of GTs gain pace, success can only ultimately be realised for patients following implementation in the health system. The challenges and controversies of daunting costs, ethics, early diagnosis and health system readiness will require innovative pricing schemes, regulatory policies, education and organisation of a skilled workforce to deliver of high-quality care in clinical practice as we prepare for advanced therapeutics in neurology.

Surgical management of gastroesophageal reflux disease in the obese patient

BACKGROUND

Gastroesophageal reflux disease (GERD) affects two thirds of the American population. Obesity is also a disease that affects two thirds of the population. The pathophysiology of reflux disease is reasonably understood, however, the degree to which obesity affects this disease remains poorly defined. Therefore the approach to GERD in the obese patient requires special attention and its own algorithm.

METHODS

A literature search was conducted to consolidate the current available literature on GERD and its management in the obese. In addition, the authors reviewed the literature and present expert opinion on controversial topics.

RESULTS

It is well established that GERD is increased in obesity and the pathophysiology is reviewed. Management options for GERD are discussed, with a focus on the obese population. Management strategies including fundoplication and gastric bypass are discussed. In addition, bariatric surgery in the setting of GERD is also reviewed.

CONCLUSIONS

Currently this is an extremely controversial topic and this white paper presents a strong review of the literature to help guide the management of this challenging disease in this population. Expert recommendations are given throughout the paper based upon the current available data.

Functional mRNA analysis reveals aberrant splicing caused by novel intronic mutation in WDR45 in NBIA patient

WDR45 gene-associated neurodegeneration with brain iron accumulation (NBIA), referred to as beta-propeller protein-associated neurodegeneration (BPAN), is a rare disorder that presents with a very nonspecific clinical phenotype in children constituting global developmental delay. This case report illustrates the power of a combination of trio exome sequencing, in silico splicing analysis, and mRNA analysis to provide sufficient evidence for pathogenicity of a relatively intronic variant in WDR45, and in so doing, find a genetic diagnosis for a 6-year-old patient with developmental delay and seizures, a diagnosis which may otherwise have only been found once the characteristic MRI patterns of the disease became more obvious in young adulthood.

Bi-allelic Loss-of-Function CACNA1B Mutations in Progressive Epilepsy-Dyskinesia

The occurrence of non-epileptic hyperkinetic movements in the context of developmental epileptic encephalopathies is an increasingly recognized phenomenon. Identification of causative mutations provides an important insight into common pathogenic mechanisms that cause both seizures and abnormal motor control. We report bi-allelic loss-of-function CACNA1B variants in six children from three unrelated families whose affected members present with a complex and progressive neurological syndrome. All affected individuals presented with epileptic encephalopathy, severe neurodevelopmental delay (often with regression), and a hyperkinetic movement disorder. Additional neurological features included postnatal microcephaly and hypotonia. Five children died in childhood or adolescence (mean age of death: 9 years), mainly as a result of secondary respiratory complications. CACNA1B encodes the pore-forming subunit of the pre-synaptic neuronal voltage-gated calcium channel Ca_v2.2/N-type, crucial for SNARE-mediated neurotransmission, particularly in the early postnatal period. Bi-allelic loss-of-function variants in CACNA1B are predicted to cause disruption of Ca²⁺ influx, leading to impaired synaptic neurotransmission. The resultant effect on neuronal function is likely to be important in the development of involuntary movements and epilepsy. Overall, our findings provide further evidence for the key role of Ca_v2.2 in normal human neurodevelopment.

Surveillance for variant CJD: should more children with neurodegenerative diseases have autopsies?

OBJECTIVES

To report investigations performed in children with progressive neurodegenerative diseases reported to this UK study.

DESIGN

Since 1997 paediatric surveillance for variant Creutzfeldt-Jakob disease (vCJD) has been performed by identifying children aged less than 16 years with progressive intellectual and neurological deterioration (PIND) and searching for vCJD among them.

SETTING

The PIND Study obtains case details from paediatricians who notify via the British Paediatric Surveillance Unit.

PARTICIPANTS

Between May 1997 and October 2017, a total of 2050 cases meeting PIND criteria had been notified and investigated.

RESULTS

Six children had vCJD. 1819 children had other diagnoses, made in 12 cases by antemortem brain biopsy and in 15 by postmortem investigations. 225 children were undiagnosed: only 3 had antemortem brain biopsies and only 14 of the 108 who died were known to have had autopsies; postmortem neuropathological studies were carried out in just 10% (11/108) and only two had prion protein staining of brain tissue. Of the undiagnosed cases 43% were known to come from Asian British families.

CONCLUSIONS

Most of the notified children had a diagnosis other than vCJD to explain their neurological deterioration. None of the undiagnosed cases had the clinical phenotype of vCJD but brain tissue was rarely studied to exclude vCJD. Clinical surveillance via the PIND Study remains the only practical means of searching for vCJD in UK children.

Comprehensive Cancer-Predisposition Gene Testing in an Adult Multiple Primary Tumor Series Shows a Broad Range of Deleterious Variants and Atypical Tumor Phenotypes

Multiple primary tumors (MPTs) affect a substantial proportion of cancer survivors and can result from various causes, including inherited predisposition. Currently, germline genetic testing of MPT-affected individuals for variants in cancer-predisposition genes (CPGs) is mostly targeted by tumor type. We ascertained pre-assessed MPT individuals (with at least two primary tumors by age 60 years or at least three by 70 years) from genetics centers and performed whole-genome sequencing (WGS) on 460 individuals from 440 families. Despite previous negative genetic assessment and molecular investigations, pathogenic variants in moderate- and high-risk CPGs were detected in 67/440 (15.2%) probands. WGS detected variants that would not be (or were not) detected by targeted resequencing strategies, including low-frequency structural variants (6/440 [1.4%] probands). In most individuals with a germline variant assessed as pathogenic or likely pathogenic (P/LP), at least one of their tumor types was characteristic of variants in the relevant CPG. However, in 29 probands (42.2% of those with a P/LP variant), the tumor phenotype appeared discordant. The frequency of individuals with truncating or splice-site CPG variants and at least one discordant tumor type was significantly higher than in a control population (χ2 = 43.642; p ≤ 0.0001). 2/67 (3%) probands with P/LP variants had evidence of multiple inherited neoplasia allele syndrome (MINAS) with deleterious variants in two CPGs. Together with variant detection rates from a previous series of similarly ascertained MPT-affected individuals, the present results suggest that first-line comprehensive CPG analysis in an MPT cohort referred to clinical genetics services would detect a deleterious variant in about a third of individuals.

Chromium-zinc ferrite nanocomposites for the catalytic abatement of toxic environmental pollutants under ambient conditions

Catalytic abatement of 4-chlorophenol, 2,4-dichlorophenol and 2,4-dichlorophenoxy acetic acid in water was investigated by peroxide oxidation over chromium substituted zinc ferrite nanocomposites at ambient conditions. The structural and chemical properties of composites synthesized by sol-gel auto combustion method was studied by X-ray diffraction, Fourier Transform Infra-Red spectroscopy, Transmission Electron Microscopy, surface area, X-ray Fluorescence spectroscopy, Temperature Programmed Reduction and Desorption techniques. Complete removal of 4-CP, DCP and 2,4-D was achieved within 60, 75 and 90min with 96.7/90.5%, 93.88/77.23% and 88.55/62.1% of COD/TOC removal respectively at 298K and 343K. Influence of reaction variables including reaction temperature, oxidant concentration, substrate concentration, catalyst dosage and its composition on the removal efficiency was studied. Kinetic study revealed that wet peroxide oxidation followed a first order kinetic model with rate constant and activation energy of 3.5×10^-2min^-1/10.7kJ/mole, 9.5×10^-3min^-1/12.9kJ/mole and 2.29×10^-2min^-1/17.7kJ/mole respectively for 4-CP, DCP and 2,4-D. The results of five consecutive catalytic runs from X-ray diffraction, Brunauer Emmet Teller surface area and leaching studies from Atomic Absorption Spectrophotometry (AAS) revealed the excellent stability of the catalyst. Scavenging effect of n-butanol on hydroxyl radical indicated a heterogeneous free radical mechanism.

A Randomized, Double Blind Study to Evaluate the Efficacy of Palonosetron with Dexamethasone Versus Palonosetron Alone for Prevention of Post-Operative Nausea and Vomiting in Subjects Undergoing Bariatric Surgeries with High Emetogenic Risk

Introduction:

Postoperative (PONV) and postdischarge (PDNV) nausea and vomiting are common (60-70%) after bariatric surgery. Palonosetron (Pal), a novel 5-HT3 antagonist, is an effective antiemetic with a prolonged duration of action in the setting of PDNV. We hypothesized that combination therapy with Palonosetron (Pal) and dexamethasone (Dex) would improve treatment in comparison to Palonosetron alone in patients at high risk for PONV.

Methods:

In this study, patients undergoing bariatric laparoscopic surgery under general anesthesia, a subgroup of a larger Phase IV clinical trial of patients who had laparoscopic surgery, were randomized to 8 mg Dex + 0.075mg Pal or saline + 0.075mg Pal. Data was collected postoperatively at 2, 6, 24 and 72 hrs. A Functional Living Index-Emesis (QOL-FLIE) test was administered at 96 hrs.

Results:

We enrolled 76 ASA 1-2 patients with at least 3 PONV risk factors. Both randomization groups had a low incidence of vomiting in the PACU (Pal, 0.0%; Pal + Dex, 5.4%) as well as at 72 hours (0.0% both groups). Complete response (no vomiting, no rescue medication) was not different between treatment groups at any time intervals. Cumulative success rates over the entire 72 hrs were 60.4% (Pal alone) vs. 60.0% (Pal + Dex). Nausea scores (4 point ordinal scale) were not different between groups for any time intervals. Cumulative success scores for nausea (score = “none”; 0-72 hrs) were 41.9% for the Pal group, and 55.2% for the Pal+ Dex group. The Pal + Dex group showed a trend toward greater satisfaction on the QOL-FLIE scores with the greatest differences in the “nausea domain”.

Discussion:

The combination therapy (Pal + Dex) did not significantly reduce the incidence of PONV or PDNV when compared with Pal alone although a trend was observed indicating the possible increased efficacy of multi-drug therapy. There was no change in comparative efficacy over 72 hrs, possibly due to the low incidence of PDNV in both groups.

Hydrocarbon uptake by roots of Vicia faba (Fabaceae)

Vicia faba was grown in crude oil polluted soil and its roots were extracted for the detection and estimation of hydrocarbons. Saturated and unsaturated Aliphatic Hydrocarbons (AHs) ranging from C(22) to C(36) were identified in AHs fraction. However, PAHs were not present in the same extract. This could be due to the fact that PAHs being toxic compounds are not accumulated in the plant root extracts of V. faba grown in crude oil polluted soil. Three phytoalexins were identified and estimated by mass spectrometric analysis in the root extracts of V. faba. These three compounds are 2-t-butyl-4-(dimethyl benzyl) phenol, 2, 4-bis (dimethyl benzyl) phenol and 2,4-bis (dimethyl benzyl)-6-butyl phenol. These phenolics in V. faba are being reported for the first time. These compounds are presumably elicited as a direct stress on crude oil hydrocarbons on the roots of this plant.

Multimodality imaging for focus localization in pediatric pharmacoresistant epilepsy

Multiple structural and functional imaging modalities are available to localize the epileptogenic focus. In pre-surgical evaluation of children with pharmacoresistant epilepsy, investigations with the maximum yield should be considered in order to reduce the complexity of the workup.

OBJECTIVE

To determine the extent to which PET, ictal/interictal SPECT and its co-registration with the patient's MRI contributes to correct localization of the epileptogenic focus, surgical intervention and to the post surgical outcome in paediatric patients.

METHODS

The study population included children and adolescents with pharmacoresistant epilepsy (n = 50) who underwent preoperative evaluation, surgery and had postoperative follow-up for at least 12 months. Outcome was measured by postoperative seizure frequency using Engel's classification.

RESULTS

Thirty-nine patients (78%) became completely seizure free after surgical intervention. The likelihood to benefit from surgical treatment was significantly higher if localization with more imaging modalities (MRI, PET, SPECT) were concordant with respect to the resected brain area (p < 0.01). Preoperative PET examination provided better localizing information in patients with extratemporal epilepsy and/or dysplastic lesions, whereas SPECT was found to be superior to PET in patients with temporal lobe epilepsy and/or tumors (p < 0.05). No significant difference was noted in the surgical outcome in younger or older age group, in children with or without special education needs.

CONCLUSION

In paediatric epilepsy pre-surgical evaluation, the combined use of multiple functional imaging modalities for a precise localisation of the epileptogenic focus is worthwhile for both extratemporal and temporal lobe epilepsy, also when EEG and MRI alone are non-contributive, given the potential benefit of complete postoperative seizure control.

Visual failure without headache in idiopathic intracranial hypertension

AIM

To determine the differences in outcome in a group of children with idiopathic intracranial hypertension (IIH) who do not present with headaches.

METHODS

Differences in epidemiological and aetiological factors, clinical presentation, and visual outcome were investigated in children with a diagnosis of IIH presenting with and without headaches to the Paediatric Neurology and Paediatric Ophthalmology Services at Guy's & St Thomas' Hospitals NHS Trust between 1997 and 2002.

RESULTS

Compared to the 29 children with headaches, the 12 children in the non-headache group were younger (7.3 v 9.5 years), presented with more neurological signs (33% v 10%), and were more likely to present with severe visual failure (33% v 4%), with a tenfold increased risk of an enlarged blind spot or field defects (50% v 5%). Permanent visual failure affected a third of all children in the non-headache group, but was rare in children presenting with headaches (33% v 3%), with one patient registered blind and two severely visually impaired.

CONCLUSION

The management of IIH is difficult in the absence of headache. Visual surveillance is vital. These children were treated with an aggressive management programme to reduce cerebrospinal fluid pressure by repeated lumbar puncture, medication, and early surgical intervention if required. Non-invasive monitoring techniques might contribute to a better understanding of the natural history of IIH, improved management, and visual outcome.

Tetanus in developing countries: an update on the Maternal and Neonatal Tetanus Elimination Initiative

Tetanus is a vaccine-preventable disease that yearly causes a total of 309,000 deaths. Of particular concern is maternal and neonatal tetanus (MNT), which can be prevented through immunization of the mother in pregnancy. In 2000, neonatal tetanus alone was responsible for an estimated 200,000 deaths. While the focus is on 57 priority countries, 90% of the neonatal tetanus deaths occur in 27 countries. UNICEF is spearheading the effort to eliminate MNT by the year 2005, with the support of numerous partners. MNT elimination is defined as less than one case of neonatal tetanus per 1000 live births at district level. The main strategies consist of promotion of clean delivery practices, immunization of women with a tetanus toxoid (TT) containing vaccine, and surveillance. Maternal tetanus immunization is, in most developing countries, implemented as part of the routine immunization program. However, large areas remain underserved, due to logistical, cultural, economical or other reasons. In order to achieve the target of MNT elimination by 2005, and to offer protection to women and children otherwise deprived from regular immunization services, countries are encouraged to adopt the "high risk approach". This approach implies that, in addition to routine immunization of pregnant women, all women of child bearing age living in high risk areas are targeted for immunization with three doses of a tetanus toxoid containing vaccine (TT or Td), implemented as "supplemental immunization activities" (SIAs). Through SIAs, about 17 million women have been reached with at least two doses of TT vaccine in the past 3 years, and it is estimated that another 200 million need to be targeted in the years to come. SIAs should substantially reduce the burden of disease. Countries will also have to improve their existing immunization and clean delivery programs to ensure that the elimination of maternal and neonatal tetanus is maintained.

The metabolic and immune response to laparoscopic versus open liver resection

BACKGROUND

Laparoscopic liver surgery is a field in its infancy, and scientific evidence of its benefits over those of traditional open techniques has not been shown. Various applications from wedge resections to formal segmental resections have been reported, but the technical ability does not necessarily translate into improved patient outcomes. There is an abundance of evidence reflecting the benefits of laparoscopic cholecystectomy [9, 12, 23], and some of these benefits have been linked to the decreased metabolic and immune responses involved [24, 27]. There is also accumulating evidence that tumor growth may be slower after laparoscopic surgery than after comparable open surgery, and that this is a result of less immune suppression [1]. It is not known whether laparoscopic liver surgery will convey similar benefits.

METHODS

In this study, 14 pigs were assigned randomly to undergo a liver resection either by a laparoscopic or an open approach. Operative stress was assessed via cortisol, tumor necrosis factor, interleukin-6, C-reactive protein. The immune response was evaluated through delayed-type hypersensitivity skin antigen testing. Adhesion formation also was assessed at 6 weeks.

RESULTS

Immune response as measured by delayed-type hypersensitivity is better preserved after laparoscopic than after open liver resection. The average diameter of induration was 46% greater in the laparoscopic group (20.71 +/- 2.7 mm versus 14.14 +/- 1.5 mm). Interleukin-6 and tumor necrosis factor levels showed a significantly greater rise after open surgery. No difference was observed in the levels of C-reactive protein or cortisol. Adhesion formation was considerably less after laparoscopic resection.

CONCLUSIONS

Laparoscopic liver resection results in a diminished stress response, as compared with that of open resection, which translates into greater preservation of immune function. This finding may well have a beneficial effect on infection and tumor growth.

Anticholinergic drugs for wheeze in children under the age of two years

BACKGROUND

Wheeze in infancy and early childhood is common and appears to be increasing though the magnitude of any increase is unclear. Most wheezing episodes in infancy are precipitated by respiratory viral infections. Treatment of very young children with wheeze remains controversial. Anti-cholinergics are often prescribed but practice varies widely and the efficacy of this form of therapy remains the subject for debate.

OBJECTIVES

Wheeze in infancy and early childhood is common and appears to be increasing. Most wheezing episodes in infancy are a result of viral infection. Bronchodilator medications such as beta2-agonists and anti-cholinergic agents are often used to relieve symptoms, but patterns of use vary. The objective of this review was to assess the effects of anti-cholinergic therapy in the treatment of wheezing infants.

SEARCH STRATEGY

We searched the Cochrane Airways Group trials register and the reference lists of articles. We contacted researchers in the field and industry sources.

SELECTION CRITERIA

Randomised trials that compared anti-cholinergic therapy with placebo or beta2-agonists in wheezing children under two years of age. Children with acute bronchiolitis and chronic lung disease were excluded.

DATA COLLECTION AND ANALYSIS

Eligibility for inclusion and quality of trials were assessed independently by two reviewers.

MAIN RESULTS

Six trials involving 321 infants in three different settings were included. Compared with beta2-agonist alone, the combination of ipratropium bromide and beta2-agonist was associated with a reduced need for additional treatment, but no difference was seen in treatment response, respiratory rate or oxygen saturation improvement in the emergency department. There was no significant difference in length of hospital stay between ipratropium bromide and placebo; or between ipratropium bromide and beta2-agonist combined compared with beta2-agonist alone. However, combined ipratropium bromide and beta2-agonist compared to placebo showed significantly improved clinical scores at 24 hours. Parents preferred ipratropium bromide over nebulised water or placebo for relief of their children's symptoms at home.

REVIEWER'S CONCLUSIONS

There is not enough evidence to support the uncritical use of anti-cholinergic therapy for wheezing infants, although parents using it at home were able to identify benefits.

Occupational open globe injuries

PURPOSE

Occupational ocular trauma is an important cause of acquired monocular blindness in a rapidly industrialising country like India. Knowledge of the epidemiology of occupational eye injuries is essential to formulate viable industrial safety measures.

METHOD

We retrospectively reviewed all patients with occupational open globe injuries between 1994 and 1998. We documented the circumstances of the injuries, their clinical findings and the use of appropriate protective eyewear at the time of the injury. The visual acuity 6 months after the injury was the final outcome measure.

RESULTS

In this study period we examined 43 patients with open globe injuries sustained at the work place. Thirty-four (79.1%) patients were young males. The iron and steel industry accounted for 19 (44.2%) cases while 8 (18.6%) patients each were from the agricultural, mining and other small scale industrial sectors. At the time of the injury, 33 (76.7%) were not wearing the recommended protective eyewear and 6 (13.9%) were under the influence of alcohol. The injuries were mild in 6 (13.9%), moderate in 18 (41.9%) and severe in 19 (44.2%) patients. At the end of 6 months, 2 (4.7%) patients had a visual acuity of 6/12 or better, 4 (9.3%) had a visual acuity of 6/18 to 6/60 and 29 (67.4.%) had a vision of <6/60. Eight (18.6%) patients were not available for follow up.

CONCLUSIONS

Occupational open globe injuries are usually severe and are associated with a poor visual outcome. Mandatory use of protective eyewear and alcohol-free environment at the work place is likely to reduce the incidence of severe occupational open globe injuries.

Methacholine challenge in preschool children: methacholine-induced wheeze versus transcutaneous oximetry

Tracheal/chest auscultation for wheeze and transcutaneous oximetry have both been suggested as measures of outcome in bronchial provocation tests in young children. This study aimed to compare the sensitivity and safety of these two techniques as end-points for methacholine challenge in children aged <4 yrs. Seventy-two methacholine challenges were performed in 39 children aged <4 yrs with recurrent wheeze. Arterial oxygen saturation (Sa,O2) and transcutaneous oxygen pressure tcPO2 continuously, and the test was terminated when wheeze was heard or at Sa,O2 <91%. tcPO2 was not used as an end-point. Wheeze or desaturation occurred at < or =8 mg x mL(-1) methacholine in every test. One child had transient clinical cyanosis, but no other ill-effects were seen. Fifty-six tests (78%) were terminated for wheeze, seven (10%) for fall in Sa,O2 and nine (12%) showed simultaneous responses in both parameters. Twenty-eight tests (39%) contained a fall in tcPO2 >3 kPa but six of these also showed a significant rise. Fifty-three tests (75%) contained a fall in tcPO2 >15%, but 20 of these also showed a significant rise. Tracheal/chest auscultation with Sa,O2 monitoring is a sensitive and relatively safe end-point for bronchial challenges in preschool children. The erratic pattern of transcutaneous oxygen pressure response in some children casts doubt on its reliability as a proxy measure of bronchial obstruction.

The bronchoprotective effect of inhaled salmeterol in preschool children: a dose-ranging study

The optimal dose of salmeterol in infants and preschool children is not known. The aim of this study was to assess the bronchoprotective effect of different doses of salmeterol using methacholine-induced wheeze in children aged <4 yrs. Children <4 yrs old with a history of recurrent wheeze underwent two methacholine challenges within 7 days. One hour before each challenge they were pretreated in double-blind fashion using a metered-dose inhaler and Babyhaler spacer. Placebo was given before one challenge, and either 25, 50 or 100 microg of salmeterol before the other. Both the dose and treatment order were random. The provocative concentration of methacholine causing wheeze (PCwheeze) was measured on each occasion. Studies were terminated when wheeze occurred or arterial oxygen saturation (Sa,o2) fell below 91%. Of the 42 children enrolled, 33 completed the study. Two subjects refused the challenge test, two failed to return and five developed upper respiratory tract infections or wheeze between the two tests. The mean (range) age of the population was 27 (8-46) months. Ratios of PCwheeze between treatment and placebo challenges were calculated for each dosage group. The treatment/placebo ratios (95% confidence intervals) were 1.2 (0.6-2.4) for 25 microg, 2.5 (1.4-4.6) for 50 microg (p<0.01), and 4.0 (2.1-7.4) (p<0.001) for 100 microg doses. In recurrently wheezy children aged <4 yrs a single dose of salmeterol between 25 and 100 microg has a dose-dependent effect on methacholine-induced wheeze, and this is significantly different from placebo at 50 and 100 microg. This study suggests that the Babyhaler effectively delivers salmeterol to children <4 yrs of age and that doses between 50-100 microg are efficacious.

Vicia faba as a bioindicator of oil pollution

In 1990, the Gulf War caused an unprecedented environmental catastrophe. More than 700 oil wells were set on fire, emitting thousands of tons of oxides of nitrogen, sulfur, soot and oil mist at high temperatures. The blazing oil wells and lakes were the major cause of environmental pollution, damaging flora and fauna throughout Kuwait and the surrounding region. We set up this study in order to investigate whether Vicia faba could be used as a bioindicator of oil pollution. Growth parameters of Vicia faba, such as levels of photosynthetic pigments, proteins, free amino acids, phenols, sugars, biomass, moisture and fatty acids, were studied. Levels of total reducible sugars, phenols, proteins, free amino acids and proline were found to be higher in plants grown in hydrocarbon-polluted soil, compared to those grown in control soil. However, biomass, moisture, pheophytin, the 435/415 nm ratio for chlorophylls and the chlorophyll a/carotenoid ratio, were higher in the plants grown in control soil than those grown in polluted soil. Our results indicate that Vicia faba can be used as a bioindicator of pollution and a ratio of the fatty acid C(20:1)/C(18:1) is an important index of environmental oil pollution.

Coping by the carers of dementia sufferers

One hundred and nine of 125 patients from consecutive referrals to a clinical service had an informal carer in contact at least once a week. Thirty-two of the carers had major or minor depression. The active management strategy 'being firm in directing behaviour' was significantly inversely associated with depression amongst carers living with the dementia sufferers, whilst carers who prioritized their daily routines were significantly more likely to be depressed. The active psychological coping strategy 'constructing a larger sense of the illness' was also significantly inversely associated with depression amongst carers living with the patients and 'reduction of expectations' showed a trend in the same direction. There were no significant differences between the coping strategies used by men and women. The type of coping strategy used by carers has an important relationship with depression. Active practical and psychological strategies were of benefit to carers and this has important treatment implications.

A single up-stream element confers responsiveness to 1,25-dihydroxyvitamin D3 and tumor necrosis factor-alpha in the rat osteocalcin gene

Tumor necrosis factor-alpha (TNF alpha) is one of several autocrine/paracrine factors known to exert potent inhibitory effects on bone. We have shown that TNF alpha inhibition of 1,25-dihydroxyvitamin D3 [1,25-(OH)2D3]-stimulated synthesis of the bone-specific protein osteocalcin (OC) occurs by decreasing steady state levels of OC mRNA, suggesting a pretranslational mechanism. In many genes, TNF alpha action is mediated by the transcription factor NF kappa B. Analysis of OC 5'-flanking DNA revealed a sequence structurally homologous to the previously described NF kappa B-binding site and, thus, a potential TNF alpha response element. Deletion analysis was performed to identify the sequences mediating the response to TNF alpha in osteoblastic ROS 17/2.8 cells by transient transfection with reporter constructs containing rat OC 5'-flanking DNA [chloramphenicol acetyltransferase (CAT)] that retained or deleted homologous NF kappa B sites or a previously defined 1,25-(OH)2D3 response element (VDRE). Transfection with all reporter constructs resulted in low basal CAT activity, measured 72 h after transfection. 1,25-(OH)2D3 stimulated CAT activity 2.8- to 4.5-fold in cells transfected with constructs that included the VDRE. TNF alpha inhibited 1,25-(OH)2D3-stimulated, but not basal, CAT activity. Deletion analysis localized the effect of TNF alpha to a sequence between -522 and -306 relative to the OC transcription start site, an area that included the VDRE but deleted a homologous NF kappa B element. Transfection of cells with a heterologous reporter containing one copy of the OC VDRE inserted in correct orientation or two copies in inverse orientation was sufficient to confer a response to TNF alpha. Gel mobility shift analysis of DNA-nuclear protein interaction revealed that 1,25-(OH)2D3 stimulated an increase in binding of nuclear proteins to an OC 32P-VDRE probe. Preincubation of nuclear extract with specific monoclonal antibodies confirmed that the proteins binding the VDRE included the vitamin D receptor and retinoid-X receptor. TNF alpha treatment of cells inhibited the 1,25-(OH)2D3-stimulated increase in nuclear protein binding to the VDRE. These results suggest 1) the VDRE is sufficient to confer a response to the inhibitory effect of TNF alpha on 1,25-(OH)2D3-stimulated rat OC gene transcription; 2) the action of TNF alpha does not require homologous NF kappa B response elements; and 3) the mechanism of TNF alpha inhibition of 1,25-(OH)2D3-stimulated OC gene expression includes modulation of binding of the vitamin D receptor/retinoid-X receptor heterodimer to the VDRE.

Personality characteristics and duration of ATA Taekwondo training

Students in ATA Taekwondo schools were administered the 16 Personality Factor Questionnaire. The students were divided into two groups of 15 persons each based on 0-1.4 yr. vs 1.5 + yr. spent in formal Taekwondo training. From the 16 PF, scores on two second-order and one derived factor were calculated for Anxiety, Independence, and Leadership. The groups having longer Taekwondo training times scored significantly lower on Anxiety and higher on Independence. Although Leadership scores were higher for the longer trained group they were not statistically significant.

Consanguinity and its effect on fetal growth and development: a south Indian study

The effect of consanguinity on fetal growth and development was studied in 3700 consecutive births (live and stillborn); 26% of the total births were to consanguineous couples. Hindus had a higher frequency of consanguineous marriages, uncle-niece unions being the commonest type, whereas Moslems preferred first cousin marriages. The incidence of congenital malformations was 39.1/1000 births with a significantly higher incidence among the consanguineous group (8.01%) as against the nonconsanguineous group (2.42%) (p less than 0.001). The incidence of malformations was higher in the uncle-niece matings (9.34%) compared to the first cousin marriages (6.18%) (p less than 0.01). Malformations of major systems were significantly more frequent among the consanguineous couples, whereas malformations of the eyes, ears, and skin did not show any significant effect of consanguinity. Stillbirth rates were significantly higher in the consanguineous group, irrespective of the mother's socioeconomic status, and were higher in uncle-niece matings compared to first cousin and beyond first cousin unions in both the poor and middle/upper class. A significant decrease in the mean birth weight and head circumference of babies born to consanguineous parents was noted in both the poor and middle/upper socioeconomic class. The mean length was less in babies born to consanguineous parents belonging to the poor social class only.

Genetic heterogeneity in Waardenburg's syndrome

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Oxidant effect of acetylphenylhydrazine: a comparative study with erythrocytes of several animal species

Red cells from several animal species were treated with acetylphenylhydrazine and a comparative study of the oxidation of hemoglobin (Hb) and glutathione (GSH) made. Wide interspecies differences were observed but the oxidation of GSH paralleled that of Hb. Added glucose protected both Hb and GSH from oxidation; GSH by itself exercises a protective effect on Hb. The characteristic rates of oxidation of GSH in the different species can be observed only in the presence of oxyhemoglobin but not carboxyhemoblobin or methemoglobin. The oxidation of Hb appears to be the primary event, the oxidation of GSH being a consequence thereof.