Disruption of microbial cell morphology by Buxus macowanii.

BACKGROUND: Microbial infections are one of the major causes of death globally. This is attributed to the rising costs of primary healthcare and its inaccessibility especially in developing countries. Moreover, there has been an increase in microbial strains that have reduced susceptibility to antimicrobial drugs. Research on the antimicrobial properties of medicinal plants, which could address these problems, has become more important as they present fewer side effects when compared to the antibiotics currently in use. This study evaluated the antimicrobial properties of a methanolic extract from Buxus macowanii in order to assess its potential in the development of novel antimicrobial drugs. METHODS: Antimicrobial activity of the extract was evaluated using the broth microdilution method. The effects of B. macowanii on the morphology of B. cereus were observed using Scanning and Transmission electron microscopy. Chemical profiling of the plant extract was performed using the GCMS. RESULTS: The extract showed antimicrobial activity against all the microbial species used. Microscopic examination of the cells of B. cereus cells treated with Buxus macowanii showed some changes in morphology such as damage of the cell wall, swelling of the cells and incomplete cell division that eventually resulted in cell death. Neophytadiene, an antimicrobial compound was detected in the extract using GCMS. CONCLUSION: The morphological disruptions of the cell wall of Bacillus cereus explain the antimicrobial properties of B. macowanii and indicate its possible application in the development of natural antimicrobial drugs.

Space maintainers in the primary and mixed dentition - a clinical guide.

This paper describes different types of space maintainers and the clinical situations where they may be useful, for example, when primary teeth have been lost prematurely. It serves as a clinical guide for practitioners on the best types of space maintainers to use and on the clinical uses of space maintainers in preventing undesirable tooth movements and resulting loss of arch length.

Rats with altered behaviour following nerve injury show evidence of centrally altered thyroid regulation.

The co-morbidity of mood disturbance, in a proportion of patients, is now described across a wide range of chronic disease states. Similarly, a 'Low Thyroid Syndrome' is also reported in a proportion of individuals with chronic diseases. Here, we report on central changes in an animal model of inflammatory stress in which altered social behaviour, representing social disability, persists in a sub-group of rats following injury. We showed in an earlier study that rats with social disability following injury have significantly decreased peripheral thyroid hormones, with no increase in Thyroid Stimulating Hormone (TSH). Only rats identified by behavioural change showed changes in hypothalamic gene expression. In whole hypothalamus extracted RNA, relative expression of mRNA for Thyrotrophin-releasing hormone (TRH) was significantly down-regulated in disabled rats (p=0.039) and deiodinase 3 up-regulated (p=0.006) compared to controls. Specifically in the paraventricular nucleus (PVN), numbers of immunoreactive cells for deiodinase 3-like and thyroid hormone receptor beta-like proteins were decreased in the sub-group with disability compared to the control group (p=0.031 and p=0.011 respectively). In rats with behavioural change post-injury, down-regulation of TRH provides an explanation for the failure of the hypothalamo-pituitary-thyroid (HPT) axis to respond to the post-injury decrease in thyroxine. Decreased local expression of deiodinase 3 protein, resulting in a local increase in T3, offers an explanation for down regulation of TRH in the hypophysiotrophic TRH neurons. It is possible that, in a sub-group of animals identified behaviourally, a mechanism resulting in hypothalamic down-regulation of the HPT axis persists following inflammatory injury.

Altered thyroid hormones and behavioural change in a sub-population of rats following chronic constriction injury.

Hypothyroidism is associated with a disturbance of behaviour and mood. There are also individuals, not classified as hypothyroid, with low to 'low normal' thyroid hormone levels and normal thyroid-stimulating hormone (TSH) levels who have mood and behavioural changes. As the peripheral thyroid hormones decrease, TSH is expected to increase. However, there are a number of physiological mechanisms known to suppress TSH. In the present study, we report on thyroid hormone regulation in a rat model of neuropathic pain and altered social behaviour that is usually transient, but is persistent in a sub-group of the population. Following ligation of the sciatic nerve, male Sprague-Dawley rats were assessed for social dominance towards an intruder: 20% showed persistently decreased social dominance. Plasma levels of thyroid hormones, TSH and corticosterone were measured before and on days 2, 3, 4, 5 and 6 after injury in 21 rats. The mean plasma thyroxine (T4), free thyroxine (fT4) and triiodothyronine (T3) levels decreased significantly post-injury in rats with persistently changed behaviour compared to rats with unchanged behaviour (P < or = 0.002). There was no significant difference between groups for mean change in free triiodothyronine (fT3) or TSH. There was a correlation between decreased dominance behaviour and decrease in both T4 (r = 0.62, P = 0.009) and fT4 (r = 0.71, P = 0.001), but no correlation with TSH. In a sub-population of rats, decreased thyroid hormones did not result in the expected increased levels of TSH to restore pre-injury levels, nor did they show increased hypothalamic thyrotrophin-releasing hormone mRNA expression, indicating altered hypothalamic-pituitary-thyroid axis regulation. Because T3 availability to the brain is dependent on both circulating T3 and T4, decreased peripheral thyroid hormones may result in changed neural function, as expressed in altered complex behaviours in this sub-population of rats.

Bovine viral diarrhoea virus infection of alpacas (Vicugna pacos) in the UK.

Three alpacas (Vicugna pacos) aged two to 22 months with a history of illthrift and diarrhoea were examined postmortem, and tissues were collected for histology, including immunohistochemical labelling for pestivirus antigen, virus isolation and TaqMan reverse transcriptase-pcr assay. Blood samples from two clinical cases and the remaining herd members were tested for bovine viral diarrhoea virus (bvdv) antibody by serum neutralisation, antigen detection and pcr assay. The three affected alpacas were positive for bvdv by pcr of splenic tissue and/or heparinised blood. Non-cytopathic bvdv was isolated from several tissues and plasma of two of the alpacas. dna sequencing and phylogenetic analysis of the viral genome from the pcr product showed that the bvdv was of subgenotype 1b. Immunohistochemical examination of brain tissue was positive in two cases, consistent with a persistent infection. bvdv antibodies were detected in 16 of 25 clinically unaffected alpacas. There was no evidence of persistent infection in the in-contact animals. The source of the infection was not determined.

The experience of dysphagia and its effect on the quality of life of patients with oesophageal cancer.

This qualitative study was designed to explore the experience of dysphagia in oesophageal cancer and how this impacts on quality of life. The aim of the study was to add to the knowledge and comprehension of this poorly understood symptom. Data was collected through in-depth interview and administration of the EORTC QLQ-C30 and EORTC QLQ-OES24 quality of life tools with six people with incurable oesophageal cancer who had dysphagia. The interviews were tape-recorded and then transcribed verbatim for each participant. Through a thematic analysis of the interview data and a descriptive analysis of the questionnaires a detailed description of the experience of dysphagia and its impact on quality of life was obtained. Five basic themes emerged from the participant's accounts and these were recognizing dysphagia, the physical experience, the emotions evoked, the impact on social life and dysphagia and treatment. In conclusion dysphagia is a troublesome symptom which affects all aspects of quality of life.

Randomized clinical trial comparing self-expanding metallic stents with plastic endoprostheses in the palliation of oesophageal cancer.

BACKGROUND: There is little evidence of the clinical and cost effectiveness of self-expanding metallic stents in the palliation of oesophageal cancer. The aims of this randomized trial were to evaluate the immediate and medium-term clinical outcomes following palliative intubation, examine patient quality of life, and evaluate costs and benefits from the perspective of the health service. METHODS: Fifty patients with inoperable oesophageal cancer were randomly allocated a metallic stent (n = 25) or plastic endoprosthesis (n = 25). Patients were followed up monthly until death. RESULTS: There was no significant difference in procedure-related complications or mortality rate between the two groups. There was a trend towards significance in favour of metallic stents with respect to quality of life and survival (median survival 62 versus 107 days for plastic prosthesis and metallic stent respectively). The cost of the initial placement of metallic stents was significantly higher than that of plastic endoprostheses ( pound 983 versus pound 296). After 4 weeks, cost differences were no longer significant. CONCLUSION: Metallic stents may contribute to improved survival and quality of life in patients with oesophageal cancer. Although initially more expensive, this cost difference does not last beyond 4 weeks. A larger trial involving approximately 300 patients would be required to detect a quality of life benefit of the magnitude observed in this trial.

Purification and identification of active antibacterial components in Carpobrotus edulis L.

Very little is known about the chemical composition of Carpobrotus edulis, also known as Hotnotsfig or sourfig. However, some claims have been made in the past by traditional healers, regarding its usage as a medicinal plant. In this investigation it was initially illustrated that a crude methanolic extract of the plant exhibits strong anti-bacterial activity. Subsequently, the crude extract was fractionated by means of liquid-liquid chromatography, tannins removed by means of LH20 column chromatography and bioactive fractions with antibacterial properties isolated by means of preparative thin layer chromatography. Five bioactive compounds, individually or collectively responsible for the antibacterial property of C. edulis, were purified from an active ethyl acetate fraction. These compounds were initially identified as flavanoids using standard fingerprinting methods and eventually identified as rutin, neohesperidin, hyperoside, cactichin and ferulic acid using flavanoid standards. A sixth flavanoid with antibacterial activity was also purified but could not be identified in this way. The latter is currently isolated in larger volume for identification through nuclear magnetic resonance spectroscopy.

Time of day urinary catheters are removed: a study of current practices.

Nursing abounds with rituals and routines that guide every day clinical practice, including nursing practices concerned with the timing of urinary catheter removal in adult acute care patients. Many of the underlying assumptions regarding the time of day that urinary catheters are removed are questionable and indicate a need for further study. An understanding of current practices has the potential to contribute to establishing scientific principles on which rational nursing care can be based.

The earlier the better: an evaluation of changes to teaching Year 1 nuclear medicine.

OBJECTIVE: In 1996 changes were made to the nuclear medicine content and mode of delivery in the Year 1 degree program at The University of Sydney, Australia. The aim was to evaluate whether changes made to the program raised the clinical abilities of students entering their clinical placement in Year 2. METHODS: Questionnaires to assess the students' perception of how well Year 1 had prepared them for their clinical Year 2 were distributed to both the 1995 and 1996 students. The clinical supervisors also were surveyed to determine if the 1996 students demonstrated any difference in their understanding and application of nuclear medicine technology principles. RESULTS: The 1996 students were more positive about their clinical readiness and the clinical supervisors observed an increased level of understanding and application by the 1996 students. CONCLUSION: Changes in the Year 1 curriculum provided students with a higher level of clinical readiness at the commencement of their Year 2 clinical placement.

An exploration of the way in which the concept of patient advocacy is perceived by registered nurses working in an acute care hospital.

The purpose of this study was to provide a beginning exploration of the way in which registered general nurses perceived the concept of patient advocacy. A qualitative approach was taken using the techniques of the grounded theory method. A volunteer sample of eight registered nurses working in an adult acute care ward of a major metropolitan hospital were interviewed using an semi-structured format. Areas explored during the interviews included personal definitions of patient advocacy, elements of the advocate role, and the rationale for the nurse acting as patient advocate. Data analysis commenced during the data collection phase, where initial interviews were transcribed, coded and beginning categories were identified. The findings indicate that for the participants, advocacy is based on respect for the person, and acknowledgement of human rights. The quality of the relationship between the nurse and the patient appears to be the basis for the advocate role. Three initial categories emerged that describe the major elements of the participant's conceptualization of patient advocacy. These are, informing, supporting and representing.

A biostatistical study into the efficiency of individualism using nonisotopic chemiluminescent-enhanced NICE multilocus DNA probes.

The efficiency of individualisation using nonisotopic chemiluminescent- enhanced probes (NICE) was investigated by analysing DNA fingerprints obtained from 190 unrelated Caucasians. Novel analysis of the scoring procedure enabled us to include the comparison of 585 pairs of samples for each of two probes. When the results of NICE probes 33.6 and 33.15 were combined, the mean percentage band share between two unrelated individuals was 16.8% and the mean number of bands identified in an individual DNA fingerprint was 54.8. Results were compared with those obtained using isotopically labelled probes and suggest that the two labelling systems gave similar efficiencies for differentiating between individuals. Analysis of DNA fingerprints from 37 family trios (mother, child and father groups) gave a mutation rate of 0.10% when using NICE probes. The two labelling systems compared were equally efficient in establishing family relationships.

DNA fingerprinting provides evidence of discriminate suckling and non-random mating in little brown bats Myotis lucifugus.

Recent advances in DNA extraction and fingerprinting techniques allowed examination of genetic similarity of groups of Myotis lucifugus at maternity roosts. Mean percentage band-sharing between young was significantly higher than between mothers, suggesting fertilization success skewed for individual males or male lineages. Mean percentage band-sharing between presumed mothers and young was significantly higher than band-sharing between all other groups, suggesting that Myotis lucifugus preferentially suckle their own young.

Clomiphene treatment for women with unexplained infertility: placebo-controlled study of hormonal responses and conception rates.

One hundred and eighteen patients with unexplained infertility were treated with clomiphene (Clomid, Merrell) in a randomized placebo-controlled cross-over study lasting up to 3 months with each preparation. Compared with placebo, clomiphene led overall to a 66% increase in mid-luteal serum progesterone levels (from mean 43 nmol/l to 71 nmol/l, p less than 0.001) and a 53% rise in the 3-month cumulative conception rate (from 14.6% to 22.33%, p less than 0.05). The greatest relative increase in conception rates with clomiphene was in women with infertility lasting more than 3 years (3-month rates from 2.9% to 14.4%, p less than 0.05). Differences in conception rates were not related to the rises in progesterone, and there was no carryover effect of clomiphene into the following placebo cycles in terms of progesterone levels or conceptions. The findings suggest that couples with unexplained infertility of less than 3 years duration are essentially normal, but with more than 3 years duration there is often a subtle disorder of ovulation that is corrected by clomiphene therapy.

The value of artificial insemination with husband's semen in infertility due to failure of postcoital sperm-mucus penetration--controlled trial of treatment.

Artificial insemination with husband's semen into the cervical canal and uterine cavity (high AIH) was assessed by a randomized controlled prospective study in 46 couples whose infertility was due to failure of sperm mucus penetration, as defined by negative postcoital tests, after excluding all interfering female factors and men with sperm density less than 1 x 10(6)/ml. Seminal analysis was abnormal in 18 of the 46 men and sperm antibodies in semen were detected in 19 of the remaining 28 with normal seminal analysis. Overall, the cumulative conception rate after 6 months with AIH was 4.7 (SE 3.8)% and without treatment was 6.6 (SE 3.9)%. The results were unaffected by the findings on seminal analysis or by the presence or absence of sperm antibodies in semen. AIH appeared to be of no benefit.

Psychologic predictors of compliance in children with recent onset of diabetes mellitus.

A group of 57 children with recent onset of insulin-dependent diabetes mellitus was studied over 18 months. Compliance with the prescribed diabetic treatment deteriorated over this period. Adolescents (aged 13 to 15 years) were less compliant than preadolescents (aged 9 to 12 years). Initial patient reports of self-esteem, perceived competence, social functioning, behavioral symptoms, and their adjustment to diabetes predicted subsequent compliance behaviors. The findings highlight the linkage of child personality and adjustment with self-care of diabetes, and suggest that psychosocial assessment soon after diabetes is diagnosed may help identify patients at risk for later compliance problems.

Population study of causes, treatment, and outcome of infertility.

Specialist infertility practice was studied in a group of 708 couples within a population of residents of a single health district in England. They represented an annual incidence of 1.2 couples for every 1000 of the population. At least one in six couples needed specialist help at some time in their lives because of an average of infertility of 21/2 years, 71% of whom were trying for their first baby. Those attending gynaecology clinics made up 10% of new and 22% of all attendances. Failure of ovulation (amenorrhoea or oligomenorrhoea) occurred in 21% of cases and was successfully treated (two year conception rates of 96% and 78%). Tubal damage (14%) had a poor outlook (19%) despite surgery. Endometriosis accounted for infertility in 6%, although seldom because of tubal damage, cervical mucus defects or dysfunction in 3%, and coital failure in up to 6%. Sperm defects or dysfunction were the commonest defined cause of infertility (24%) and led to a poor chance of pregnancy (0-27%) without donor insemination. Obstructive azoospermia or primary spermatogenic failure was uncommon (2%) and hormonal causes of male infertility rare. Infertility was unexplained in 28% and the chance of pregnancy (overall 72%) was mainly determined by duration of infertility. In vitro fertilisation could benefit 80% of cases of tubal damage and 25% of unexplained infertility--that is, 18% of all cases, representing up to 216 new cases each year per million of the total population.

Comparative functional and physiologic status of active and dropout coronary bypass patients of a rehabilitation program.

To assess the benefits of regular participation in a medically supervised cardiac rehabilitation program, 22 patients who had undergone coronary artery bypass (2 groups of 11 each) were studied retrospectively. Group I (mean age 53 years) was currently enrolled in the rehabilitation program. Group II (mean age 56 years) had begun but had discontinued the program. The stated reasons for discontinuation were not medical. There was no difference in entry exercise tests, and presurgical catheterization data in both groups were comparable. Mean peak oxygen consumption (VO2) by modified Douglas bag technique, heart rate X systolic blood pressure product, and treadmill duration time were recorded in a single testing period. Results revealed that Group I had higher peak VO2 (30 ml/kg/min) than Group II (24) (p less than 0.005) and greater treadmill time (11 minutes) than Group II (8) (p less than 0.01). Nine of 11 subjects in Group I were fully employed, versus 4 of 11 in Group II (p less than 0.01). One of 11 subjects in Group I had been rehospitalized versus 5 in Group II. None in Group I but 4 of 11 subjects in Group II smoked. Thus, based on the sampling and methodology of this study, it is concluded that coronary artery bypass patients in rehabilitation programs have greater peak VO2 and treadmill test time, smoke less, are less often rehospitalized, and are more often fully employed than those who are not in such programs.