Assessing the Knowledge and Perceptions of Medical Students from the Western Cape; South Africa; Regarding the Millennium Development Goals

Background: Health science students are key players in implementing the Millennium Development Goals (MDG). Knowledge and understanding at university level is essential to achieve the goals by 2015. The primary objective of this study was to assess the knowledge and perceptions of fifth-year medical students at Stellenbosch University and the University of Cape Town regarding the MDG. The secondary objectives were to determine the degree to which students are involved in awareness campaigns and implementation of the MDG; and to assess students' perceptions regarding the need for the MDG in South Africa. Method: This observational; descriptive; cross-sectional study collected quantitative data. A census was carried out. All participants completed a self-administered questionnaire. Results: Of the 176 participants; 61.14 said they had previously heard or read about the MDG. Forty per cent had heard about the MDG through awareness campaigns. More than half (54.86) claimed to know what the MDG were; but could not name all of the goals. Participants identified a mean of three out of eight MDG correctly. The majority of students considered MDG implementation in South Africa important but ineffective (69.85); and 85.82 believed that the MDG would not be achieved on time.Conclusion: It was found that fifth-year medical students in the Western Cape were not adequately informed about the MDG and their importance in South Africa. However; their perceptions were positive; in that the majority agreed that the implementation of the MDG in South Africa is important and that more needs to be done in creating awareness about the goals

Association of mortality with high temperatures in a temperate climate: England and Wales.

BACKGROUND: It is well known that high ambient temperatures are associated with increased mortality, even in temperate climates, but some important details are unclear. In particular, how heat-mortality associations (for example, slopes and thresholds) vary by climate has previously been considered only qualitatively. METHODS: An ecological time-series regression analysis of daily counts of all-cause mortality and ambient temperature in summers between 1993 and 2006 in the 10 government regions was carried out, focusing on all-cause mortality and 2-day mean temperature (lags 0 and 1). RESULTS: All regions showed evidence of increased risk on the hottest days, but the specifics, in particular the threshold temperature at which adverse effects started, varied. Thresholds were at about the same centile temperatures (the 93rd, year-round) in all regions-hotter climates had higher threshold temperatures. Mean supra-threshold slope was 2.1%/°C (95% CI 1.6 to 2.6), but regions with higher summer temperatures showed greater slopes, a pattern well characterised by a linear model with mean summer temperature. These climate-based linear-threshold models capture most, but not all, the association; there was evidence for some non-linearity above thresholds, with slope increasing at highest temperatures. CONCLUSION: Effects of high daily summer temperatures on mortality in English regions are quite well approximated by threshold-linear models that can be predicted from the region's climate (93rd centile and mean summer temperature). It remains to be seen whether similar relationships fit other countries and climates or change over time, such as with climate change.

Ischemic hepatitis: clinical presentation and pathogenesis.

BACKGROUND: The pathophysiology of ischemic hepatitis, otherwise known as "shock liver," is poorly understood, although it is believed to be the result of a reduction in systemic blood flow as typically occurs in shock. The aim of this study was to investigate the importance of this phenomenon as well as other clinical features in patients with ischemic hepatitis. METHODS: We identified a cohort of 31 patients (case group) who met the most commonly accepted definition of ischemic hepatitis (an acute reversible elevation in either the serum alanine or aspartate aminotransferase level of at least 20 times the upper limit of normal, excluding known causes of acute hepatitis or hepatocellular injury, in an appropriate clinical setting). We also evaluated the clinical features and serum aminotransferase levels in a cohort (the control group) of 31 previously healthy patients who sustained major nonhepatic trauma at San Francisco General Hospital, a major trauma center. Both groups of patients had documented systolic blood pressures <75 mm Hg for at least 15 minutes. Clinical and hemodynamic (invasive and noninvasive) data were recorded. RESULTS: Despite the marked reduction in blood pressure, no patient in the control group developed ischemic hepatitis. The mean (+/- SD) peak serum aspartate aminotransferase level in the control group was only 78 +/- 72 IU, in contrast with a mean peak of 2,088 +/- 2,165 IU in the case group. All 31 patients with ischemic hepatitis had evidence of underlying organic heart disease, 29 (94%) of whom had right-sided heart failure. CONCLUSIONS: Systemic hypotension or shock alone did not lead to ischemic hepatitis in any patient. The vast majority of patients with ischemic hepatitis had severe underlying cardiac disease that had often led to passive congestion of the liver. These data lead us to propose that right-sided heart failure, with resultant hepatic venous congestion, may predispose the liver to hepatic injury induced by a hypotensive event.

Trimellitic anhydride-sensitive mouse as an animal model for contact urticaria.

The respiratory allergen trimellitic anhydride (TMA) has been shown to induce IgE production and immediate ear swelling in mice sensitized to it. We studied whether TMA sensitivity could be used as an animal model for immunological contact urticaria. BALB/C mice were sensitized to TMA by topical applications. Groups of animals were pretreated on the ears with the glucocorticosteroid (GCS) betamethasone-17,21-dipropionate, the antihistamine (AH) diphenhydramine hydrochloride, the non-steroidal anti-inflammatory drug (NSAID) indomethacin or vehicle (VEH). Ears were challenged with TMA and ear thickness was measured at baseline and 1, 2, 4, 8 and 24 h after challenge. Trimellitic anhydride caused a significant biphasic ear swelling response with an early peak at 1-2 h, a plateau at 4 h and a late peak at 24 h. However, there was also an early swelling by TMA in non-sensitized mice, suggesting that non-immunological as well as immunological mechanisms contribute to early swelling by TMA. Glucocorticosteroid suppressed significantly the early and to some extent the late TMA responses, while AH suppressed only early and NSAID only late TMA responses. Ear swelling in TMA-sensitive BALB/C mice may represent a combination of immunological and non-immunological contact urticaria and allergic contact dermatitis. Mice sensitive to TMA may be helpful in defining pharmacological agents affecting contact urticaria and the model is perhaps suitable for identification of some immunologically mediated contact urticants.

Direct quantitation of biotin-labeled nucleotide analogs in RNA transcripts.

We have developed a method to determine directly the number of biotinylated (Bio) nucleotide analogs incorporated into RNA transcripts. Transcripts synthesized in vitro in the presence of [alpha 32-P]CTP and varying concentrations of Bio-4-UTP were subjected to alkaline hydrolysis and the resulting 2' and 3' nucleoside monophosphates separated by reverse-phase HPLC. The amount of 32P transferred to each monophosphate was indicative of the frequency of their incorporation into the transcript. Transcripts synthesized in the presence of equimolar concentrations of Bio-4-UTP and UTP resulted in 70 out of the 125 possible UTP sites occupied by Bio-4-UMP. This study agrees with kinetic data in suggesting that T7 RNA polymerase does not significantly discriminate between the natural and the biotinylated nucleotide. Therefore, the number of biotinylated residues that are incorporated into a transcript can be controlled by varying the ratio of Bio-4-UTP to UTP in the transcription reaction. We have shown that as few as 10 Bio-4-UMP residues per 486 nucleotide transcript still results in greater than 90% binding efficiency on a streptavidin/biotin-cellulose affinity column.