Symptomatology and health status in patients with chronic obstructive pulmonary disease.

Chronic Obstructive Pulmonary Disease (COPD) is a growing health problem worldwide and in Malaysia. Until recently, research on COPD has been slow and difficult, partly due to the huge heterogeneity of this disease, and its variable and imprecise definitions. To perform a descriptive study on a convenient sample of local patients with COPD treated in a state hospital in Malaysia. Fifty-two patients [mean (95% CI) age: 67 (63-70) years; 86% male: 38% Malays, 36% Chinese, 25% Indians; mean (95% CI) PEFR: 45 (40-51) % predicted normal] were interviewed. Clinico-demographic data was collected using a structured questionnaire and health-related quality of life was scored using St George's Respiratory Questionnaire (SGRQ). For analysis, patients were also divided into moderate (n=17) [PEFR 50% to 80%] and severe (n=35) [PEFR < 50%] disease groups. Except for education and total family income, demographic and comorbidity variables were comparable between the two groups of COPD severity. All except 9% of patients were current or ex-smokers. Breathlessness, not chronic bronchitis (i.e. cough and sputum), was the first ranking respiratory symptom in over 70% of the patients, whether currently or at early disease manifestation. Between 5 and 15% of the patients denied any symptom of chronic bronchitis as current or early stage symptoms. Duration of symptoms prior to the diagnosis varied considerably with about 9% having symptoms for over 10 years. Over 80% of the patients smoked for over 15 years before the onset of symptoms. Quality of life in patients with COPI) was generally poor and similar between both COPD severity groups. About one fifth of the patients had exacerbations more than 12 times a year. While many features described in our local patients are well recognized in COPD, the finding that 'chronic bronchitis' is not a prominent symptom in the current or past history may have important implications in the diagnosis of at risk individuals and patients with early disease requiring attention. More research is required to confirm and to understand this.

A secure Web-based interface to maternity records with decision support.

The recent developments in Web technology now make it easy to create user-friendly interfaces to databases and link them to the Internet or to local Intranets. With the acceptance of this new approach one can take advantage of the opportunity to use this development to incorporate additional knowledge into the interface. Not only can this provide a more supportive interface, but it can also create the opportunity for sharing and comparing such knowledge in the future. This paper describes how this has been used to develop an interface to a database of maternity case records which incorporates a knowledge base of rules relating to care plan protocols and uses this to provide decision support to the carer. The issue of security is a serious problem and some aspects of the measures taken are discussed.

Parameters influencing the expression of mature glial-cell-line-derived neurotrophic factor in Escherichia coli.

Factors governing expression in Escherichia coli, namely promoters, fusion partners, targeting signals, host strains, growth temperature of cultures and inducer concentrations, were investigated to elucidate their influence on the accumulation of mature glial-cell line-derived neurotrophic factor (GDNF). The present study provided evidence indicating that translational and/or post-translational events were more important in determining overall accumulation of the target protein than was transcription. Under the control of the strong inducible tac or T7 promoter, no direct correlation between transcript abundance and final yield of recombinant protein was observed. GDNF was also recalcitrant to being produced in a soluble form in E. coli. Direct expression resulted in the exclusive localization of GDNF in inclusion bodies, regardless of whether the protein was produced in the cytoplasm or targeted to the periplasm. The fusion approach was found to be the most efficient method, as it resulted not only in the highest level of GDNF produced, albeit primarily in inclusion bodies, but also in the accumulation of small amounts of soluble proteins. Using different host strains, low inducer concentration or sub-optimal growth temperature did not result in any detectable shift towards solubility. Persistent localization in inclusion bodies, low levels of expression as a native protein and in vivo proteolysis of soluble fusion forms appeared to be influenced by structural features located at the N-terminus of GDNF. Deletion of this region was found to result in substantial alleviation of these problems.