Cadmium uptake by onions, lettuce and spinach in New Zealand: Implications for management to meet regulatory limits.

Paired soil and plant samples collected from the main commercial growing areas for onions (Allium cepa), lettuce (Lactuca sativa) and spinach (Spinacia olearacea) in New Zealand were used to assess the influence of plant and soil factors on cadmium (Cd) uptake in these crops. Differences in Cd concentration between eight lettuce sub-types were not consistent across sites, nor were differences in Cd concentrations in three crisphead cultivars assessed at two sites. Similarly, differences in Cd concentrations between four onion cultivars were inconsistent across sites. Mean lettuce Cd concentrations in eight lettuce varieties (range 0.005-0.034 mg∙kg-1 (fresh weight, FW) were markedly lower than those in baby leaf and bunching spinach, (range 0.005-0.19 mg∙kg-1 FW). Significant regional variation was observed in Cd concentrations in one onion cultivar (mean range 0.007-0.05 mg∙kg-1 FW). Soil Cd concentration, pH and region were statistically significant predictors of onion Cd concentration, explaining low (38% for soil Cd and pH) to moderate (50% for all three parameters) percentage of the variation. Soil Cd concentration and exchangeable magnesium or total carbon were statistically significant predictors of Cd concentration in baby leaf and bunching spinach, respectively, explaining a moderate percentage (49% and 42%) of the variation in Cd concentration. Increasing pH and soil carbon may assist in minimising Cd uptake in onion and bunching spinach, respectively. The low to moderate proportion of explained variation is partly attributable to the narrow range in some measured soil properties and indicates factors other than those assessed are influencing plant uptake. This highlights a challenge in using these relationships to develop risk-based soil guideline values to support compliance with food standards. Similarly, the inconsistency in Cd concentrations in different cultivars across sites highlights the need for multi-site assessments to confirm the low Cd accumulation status of different cultivars.

Challenging behaviours at early adulthood in autism spectrum disorders: topography, risk factors and evolution.

BACKGROUND: Challenging behaviours are highly prevalent in children and adolescents with autism spectrum disorders (ASD), but little is known about the prevalence and course of these behaviours during adulthood. The aims of this study were to describe the topography of challenging behaviours in a cohort of 106 young adults with ASD and to identify the risk factors for challenging behaviours. Our secondary objective was to study the changes in challenging behaviours from adolescence to early adult years. METHOD: The present study uses data from the EpiTED prospective follow-up study in France. The presence of challenging behaviours was assessed by the Aberrant Behaviour Checklist (ABC) completed by parent informants. Several dimensions of behaviour were studied: irritability, stereotypy, lethargy, hyperactivity and self-injury. Clinical variables were collected on ASD symptom severity, cognitive and language levels, adaptive behaviours and comorbid medical disorders. RESULTS: The presence of challenging behaviours at early adulthood was related to the young adult's cognitive and language level, ASD symptom severity and comorbid gastrointestinal and sleep disorders. The main risk factor for challenging behaviours was ASD symptom severity. The level of language impairment was a significant predictor of self-injury. Gastrointestinal disorders were a significant predictor of stereotypy. The change in behaviour topography from adolescence to early adult years corresponded with decreased parent report of hyperactivity, but no significant decrease in parent reports of irritability, stereotypy, lethargy and self-injurious behaviours. CONCLUSIONS: The challenging behaviours in individuals with ASD persist in early adulthood and are related to core symptom severity, levels of cognitive and language impairments and medical comorbidity. The results emphasise the importance of early interventions for children with ASD to target cognitive and language abilities and to alleviate the severity of ASD symptoms. They also underscore the need to enhance opportunities for individuals with ASD to better communicate discomforts and pain in the context of medical illness.

Structured integration of family planning curriculum: comparative assessment of knowledge and skills among new medical graduates in Ethiopia.

OBJECTIVE: The objective was to assess if structured integration of a comprehensive family planning (FP) training into a medical school curriculum improves FP knowledge and skill scores of medical interns. STUDY DESIGN: We compared mean contraception knowledge scores of interns in a medical school with the integrated FP curriculum [intervention school] (n=56) to interns at four conventional medical curriculum schools without structured reinforcement of FP content [control schools] (n=161) in Ethiopia. A survey with 19 multiple choice contraception questions was administered. We also compared the mean contraception skills scores of the two groups at four Objective Structured Clinical Examination stations. The survey included self-reported number of contraception procedures and self-assessed competencies on a Likert scale. RESULTS: A total of 217 interns who have completed an Obstetrics and Gynecology rotation participated in the study. Interns from the intervention school reported performing substantially higher numbers of contraception procedures and rated themselves as being competent/highly competent across all procedures compared to the control schools (p<.001 for both). The mean knowledge score was significantly higher in the intervention school [13.1 vs. 8.7, difference 4.5, 95% CI: (3.7-5.2), p<.001]. The mean contraceptive implant insertion skill score was twofold higher for interns in the intervention school [22 points vs. 11, difference 10.7, 95% CI: (8.6-12.8), p<.001 out of a maximum possible point of 30]. Statistically significant differences in skill scores were also observed for intrauterine device IUD insertion [15 vs. 12, p<.01] and implant removal [11 vs. 9, p=.01]. CONCLUSION: A structured integration of family planning curriculum was associated with higher scores in knowledge, clinical skills and self-assessed competencies. IMPLICATIONS: Integrating comprehensive family planning training in medical curriculum can lead to graduating physicians who are more competent to offer the full range of FP options.

[Anxiety in women undergoing surgical treatment of breast cancer]. / Trevoga u zhenshchin, prokhodiashchikh khirurgicheskoe lechenie raka molochnoi zhelezy.

AIM: To assess anxiety level and factors contributing to its development in patients undergoing surgical treatment for breast cancer. MATERIAL AND METHODS: The subjects of the study were 72 women, aged 20-80 years, with the diagnosis of primary breast cancer. The Basic Psycho-Oncological Documentation Scale (PO-BADO), the European Organization for Research, and the Treatment of Cancer Quality of Life Questionnaire and its Breast Cancer Module (EORTC QLQ-C30; BR-23), the Hospital Anxiety and Depression Scale (HADS) were used. RESULTS AND CONCLUSION: The anxiety score showed negative correlation with EORTC QLQ-C30 'physical functioning', 'cognitive functioning', 'emotional functioning', 'global health status/quality of life' subscales (p≤0,002). Anxiety is a highly prevalent in women with breast cancer and has a marked negative impact, in particular on younger patients.

REALIZATION OF INFORMED CONSENT AS ONE OF PATIENT'S RIGHTS: CURRENT SITUATION IN AZERBAIJAN.

Azerbaijan is a country in which the law is based on democratic principles. The mentioned principles underlie the national health care law. Democratic values, such as respect for human rights and freedoms, human dignity, as well as universal bioethical principles that are widely implemented in the national law, create conditions for the implementation of the patient's rights. The basic law governing the doctor-patient relationship, Law on Protection of Health of Population in Azerbaijan, reflects the basic patients' rights and obligations of doctors and medical institutions. Informed consent, which is a key component of patient rights, is also reflected, however, to date, a significant drawback of the Azerbaijan medical legislation is described in the article in this field. For example, at the moment there is no single standardized informed consent form in the country's different medical institutions. Due to the absence of any legally approved standards for informed consent forms, public and private health care institutions individually develop such forms, which sometimes can differ significantly. At the moment, one of the important directions in the field of healthcare is its improvement in accordance with international standards. The research made it possible to make conclusions about the necessary measures to improve and unify the informed consent form. The authors also analyzed the main provisions of the medical law of Azerbaijan and identified the main trends of its further development.

A review of dopamine agonist therapy in type 2 diabetes and effects on cardio-metabolic parameters.

Dopamine action appears to play a role in changes that are seen in obesity, metabolic syndrome and type 2 diabetes mellitus. Bromocriptine-QR (Quick Release), a dopamine agonist, is approved for use in treatment of type 2 diabetes. It has demonstrated modest improvement in glycemic parameters, cholesterol and weight in certain cohorts. Limited data using cabergoline, a long-acting dopamine agonist, also demonstrate glycemic efficacy. Additionally, bromocriptine-QR appears to have a favorable cardiovascular risk reduction. The direct mechanism by which bromocriptine-QR, or central dopamine agonism, achieves modest glycemic control and favorable cardio-metabolic profile is unclear. This relationship appears to be more complex than the historical explanation of "resetting" the circadian clock and may further be elucidated using data in individuals with hyperprolactinemia and prolactinoma.

Recognition of Autism Spectrum Disorder (ASD) symptoms and knowledge about some other aspects of ASD among final year medical students in Nigeria, Sub-Saharan Africa.

BACKGROUND: Earlier studies suggest that knowledge about Autism Spectrum Disorder (ASD) among healthcare workers in Nigeria is low. This present study assessed the knowledge of Nigerian final year medical students about symptoms of ASD and some other aspects of ASD. This is a cross sectional descriptive study that drew a total of seven hundred and fifty-seven (757) final year medical students from ten (10) randomly selected fully accredited medical schools out of a total of twenty-seven (27) fully accredited medical schools in Nigeria. Sociodemographic and Knowledge about Childhood Autism among Health Workers (KCAHW) questionnaires were used to assess knowledge of final year medical students about ASD and obtain demographic information. RESULTS: Only few, 218 (28.8 %) of the 757 final year medical students had seen and participated in evaluation and management of at least a child with ASD during their clinical postings in pediatrics and psychiatry. Knowledge and recognition of symptoms of ASD is observed to be better among this group of final year medical students as shown by higher mean scores in the four domains of KCAHW questionnaire. Knowledge about ASD varies across gender and regions. Misconceptions about ASD were also observed among the final year medical students. CONCLUSIONS: More focus needs to be given to ASD in the curriculum of Nigerian undergraduate medical students, especially during their psychiatry and pediatric clinical postings.

Autism spectrum disorders (ASD) in Africa: a perspective.

BACKGROUND: The universal occurrence of autism spectrum disorders (ASD) was queried about twenty-six years ago. It was thought to occur only in western industrialized countries with high technological development. Over the last decade, knowledge about ASD and its prevalence has been documented as being on the rise in different regions of the world, with most literature coming from the western world -- the situation in Africa on aspects of ASD remain unclear. METHODS: Literature cited in Pubmed over the last decade on aspects of epidemiology, diagnosis, aetiology and knowledge of ASD in the African context were assessed. KEYWORDS: autism, diagnosis, aetiology, knowledge and Africa were variously combined in the literature search. RESULTS: No study specifically addressed the epidemiology of ASD in Africa. One of the two studies that were relevant addressed epidemiology of ASD in Arab countries, though included two Northern African countries. A higher proportion of non-verbal cases of ASD compared to verbal cases was documented in literature coming from Africa. Associated co-morbid disorders included intellectual disability, epilepsy and oculo-cutaneous albinism. Aetiological factors postulated included post-encephalitic infection, genetic and auto-immune factors, and vitamin D deficiency. Knowledge about ASD in Africa was noted to be low. CONCLUSION: There is a need for epidemiological studies in Africa to define the magnitude of the problem of ASD and the characteristics of children affected by ASD in this region. This would help in planning and might be helpful in answering the question of aetiology of ASD. Policy making needs to be directed at issues of childhood developmental disorders in Africa.

Dietary arginine stimulates humoral and cell-mediated immunity in chickens vaccinated and challenged against hydropericardium syndrome virus.

The effects of dietary supplement of arginine on protective humoral and cell-mediated immune responses of broiler chicks vaccinated and challenged against hydropericardium syndrome virus (HPSV) were investigated and compared with those of 2 reference drugs (cyclophosphamide and cyclosporine). Percentage ratios of lymphoid organs (bursa, spleen, and thymus) to BW, postvaccination and challenge serum antibody responses to HPSV, cutaneous basophil hypersensitivity reaction, peripheral lymphoproliferation, postchallenge detection of HPSV in the tissues of infected birds, and ability of chicks to resist virulent HPSV challenge were the parameters utilized to determine the effects of arginine on protective immune responses of chicks. A total of 600 chicks were used in this study. Arginine-supplemented chicks showed significant (P < 0.05) stimulation of lymphoproliferation and cutaneous basophil hypersensitivity reactions compared with untreated control chicks. Similarly, significantly higher body and lymphoid organ weights were (P < 0.05) recorded in arginine-supplemented chicks compared with untreated control chicks. The highest survival rate was recorded in arginine-supplemented HPS-vaccinated chicks compared with immune-suppressed (cyclophosphamide- and cyclosporine-treated and HPS-vaccinated chicks) and untreated unvaccinated control chicks after virulent HPSV challenges. Postchallenge tissue samples from arginine-supplemented and HPS-vaccinated chicks yielded negligible HPSV detections by virus isolation in cell culture or PCR method, or both, compared with untreated control chicks. Thus, it was concluded that dietary supplementation of arginine had beneficial effects on humoral and cell-mediated immune responses of broiler chicks against HPSV.

Effects of salinomycin on cell-mediated immunity of broiler chickens against hydropericardium syndrome and Newcastle disease viruses.

The effects of salinomycin (SAL) on protective cell-mediated immune (CMI) responses of vaccinated and challenged broiler chicks against hydropericardium syndrome virus (HPSV) and Newcastle disease (NDV) were investigated while comparing 3 reference drugs [levamisole, cyclophosphamide (CYP), and cyclosporine (CYS)]. Peripheral lymphoproliferation, skin hypersensitivity reactions, and the ability of chicks to resist virulent HPSV and virulent NDV challenges were used to determine the effects of drugs on CMI responses in chicks. Salinomycin-medicated chicks showed significant (P < 0.05) stimulation of lymphoproliferation and nonsignificant (P > 0.05) stimulation of skin hypersensitivity reactions compared with untreated control chicks. However, skin thickness and lymphoproliferation of SAL-medicated chicks were significantly greater (P < 0.05) than those of CYP- and CYS-treated chicks. The greatest survival rate was recorded in SAL-medicated chicks compared with immune-suppressed (CYP- and CYS-treated) and untreated control chicks after virulent NDV and virulent HPSV challenges. Thus, it was concluded that SAL had beneficial effects on the CMI responses of broiler chicks against HPSV and NDV.

Proton MR spectroscopy: higher right anterior cingulate N-acetylaspartate/choline ratio in Asperger syndrome compared with healthy controls.

BACKGROUND AND PURPOSE: One former study reported higher prefrontal N-acetylaspartate (NAA) levels in patients with Asperger syndrome (AS). The objective of the current study was to test the hypothesis that patients with AS would have higher dorsolateral prefrontal and anterior cingulate cortex NAA/creatine (Cr) and that NAA/Cr would be correlated with symptom severity. MATERIALS AND METHODS: NAA/choline (Cho), NAA/Cr, and Cho/Cr values revealed by (1)H-MR spectroscopy in 14 right-handed male patients with AS (6 medicated with risperidone), 17-38 years of age, diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were compared with those of 21 right-handed male controls frequency-matched by age and intelligence quotient scores. RESULTS: Patients with AS had significantly higher anterior cingulate NAA/Cho levels (z = -2.18, P = .028); there was a statistical trend for higher anterior cingulate NAA/Cr (z = -1.81, P = .069) that was significant when only the unmedicated patients with AS were taken into account (z = -1.95, P = .050). There were no significant differences in dorsolateral prefrontal MR spectroscopy values. CONCLUSIONS: Our findings show that individuals with AS had higher NAA/Cho levels in the right anterior cingulate compared with healthy controls and that higher anterior cingulate NAA/Cho levels were correlated with higher Yale-Brown Obsessive Compulsive Scale total scores.

Effects of polyether ionophores on the protective immune responses of broiler chickens against Angara disease and Newcastle disease viruses.

Immunization against Angara disease virus (ADV), a serotype 4 avian adenovirus, and Newcastle disease virus (NDV), an avian paramyxovirus serotype 1, is the mainstay of a broiler vaccination programme, while polyether ionophores usually form an essential component of a broiler medication programme in most parts of India and Pakistan. The role of polyether ionophores in the protective immune responses of broiler chickens vaccinated and challenged with ADV and NDV was investigated. A total of 1600 birds were divided into eight groups of 200 birds each. First four groups were vaccinated against NDV and ADV, while the remaining four served as unvaccinated controls. The first 3 groups of birds were administered salinomycin, monensin and cyclophosphamide (CYP), respectively. The last group served as an untreated control. The same treatment schedule was also followed for the next four unvaccinated groups. The post-vaccination and post-challenge serological responses to NDV and ADV, body and lymphoid organ weight gains, post-challenge survival rate and detection of NDV and ADV in the tissues of infected birds were evaluated. Birds administered salinomycin showed a significant stimulation of protective immune responses against both NDV and ADV as compared to the untreated and CYP-treated birds. Monensin also enhanced the protective immune responses against both viruses but the effect was not statistically significant. Thus, it is concluded that monensin and salinomycin augment the anti-NDV and anti-ADV immune responses in broiler chickens, which supports their use in poultry flocks.

Massive gastric dilatation after a single binge in an anorectic woman.

OBJECTIVE: Massive gastric dilatation is a very serious condition that is extremely rare in patients with no history of gastrointestinal disease. Several cases have been reported in patients with eating disorders, particularly after a binge. We report here the case of a young woman who developed severe gastric dilatation after a single binge. METHODS: A computed tomographic (CT) scan of the abdomen was done and a psychiatric evaluation was performed. RESULTS: The diagnosis of acute gastric dilatation was confirmed and superior mesenteric artery syndrome was excluded. The patient responded to nasogastric drainage and bowel rest. She was also found to have situational anxiety and depressive symptoms as well as a nonspecified eating disorder. CONCLUSION: This case illustrates the serious sequel of even a single binge in any patient with abnormal dietary habits, and demonstrates the useful role of the CT scan in the diagnosis.

Transjugular intrahepatic cavoportal shunt for Budd-Chiari syndrome.

Budd-Chiari syndrome (BCS) is characterized by obstruction of the hepatic venous outflow tract. Therapeutic options for BCS are limited. We report a case of a 21-year-old woman with protein S and C deficiency with gross ascites. Treatment with transjugular intrahepatic portosystemic shunt (TIPS) was attempted, which revealed occluded hepatic veins, so transcaval TIPS was performed. No serious procedure-related complication occurred. After successful shunt creation, the patient's symptoms subsided and she was discharged and followed up for 6 months.

Lack of clopidogrel-CYP3A4 statin interaction in patients with acute coronary syndrome.

OBJECTIVE: To assess a clinically significant interaction between cytochrome P450 3A4 (CYP3A4) metabolised statin and clopidogrel. DESIGN: Prospective single centre cohort study. SETTING: Academic teaching hospital in the USA. PATIENTS: 1651 patients presenting with acute coronary syndromes between January 1999 and February 2003 were studied. Data on baseline demographics, co-morbidities, and in-hospital management were collected. MAIN OUTCOME MEASURE: Association of CYP3A4 metabolised statin and clopidogrel use with in-hospital and six month mortality. The impact of the combined use of a CYP3A4 statin and clopidogrel on six month mortality and major adverse cardiac events was analysed by a risk adjusted logistic regression model. RESULTS: The odds ratios for six month mortality were: for CYP3A4 statin, 0.43 (95% confidence interval (CI) 0.27 to 0.71, p = 0.0009); for CYP3A4 statin plus clopidogrel, 0.36 (95% CI 0.23 to 0.60, p < 0.001); for non-CYP3A4 statin, 0.22 (95% CI 0.08 to 0.59, p = 0.002); and for non-CYP3A4 statin plus clopidogrel, 0.22 (95% CI 0.06 to 0.75, p = 0.016). CONCLUSIONS: Use of a combination of a CYP3A4 statin plus clopidogrel was associated with lower six month mortality and morbidity in patients with acute coronary syndromes. There was no significant difference in clinical benefit between a CYP3A4 statin and a non-CYP3A4 statin when used in conjunction with clopidogrel. This suggests that the proposed interaction is probably an ex vivo phenomenon and may not be clinically relevant.

The evaluation of hepatocellular carcinoma with biphasic contrast enhanced helical CT scan.

OBJECTIVE: To evaluate the role of biphasic contrast-enhanced helical CT including Hepatic Arterial Phase (HAP) imaging with Portal Venous Phase (PVP) imaging, in the detection and characterization of hepatocellular carcinomas. METHODS: The study included 40 patients (M = 26, F = 14) with histopathologically proven HCC. Age range was between 30-85 years (mean = 55) by following consecutive patients with cirrhosis in whom Hepatocellular carcinoma was diagnosed or suspected either by raised serum a (alpha)-fetoprotein level or Ultrasound. RESULTS: Biphasic contrast-enhanced examination revealed a total of 85 lesions in these 40 patients, out of which 13 were unifocal, 12 showed a dominant mass with satellite lesions, 2 showed cluster of contiguous nodules and 13 were multifocal HCCs. Mean diameter was 3.1 cm, ranging from 0.8 to 14 cm. On HAP imaging 85% were detected. (hyperattenuating = 69, hypoattenuating = 3) while on PVP imaging detectibility was only 48% (hyperattenuating = 2, hypoattenuating = 39). Hence detectibility was significantly (p = 0.008) superior in HAP as compared to PVP imaging. In 7 patients (17%) tumor was visible only on HAP images. Venous invasion was present in 12 patients (30%) while arterio-portal shunting was seen in 5 patients (13%). CONCLUSION: Biphasic contrast enhanced helical CT is a useful method in detection and characterization of HCC.

The role of magnetic resonance cholangiopancreatography (MRCP) in obstructive jaundice.

OBJECTIVE: To evaluate the diagnostic value of MRCP in studying the sites and cause of obstructive jaundice in comparison with other imaging modalities at the Department of Radiology, Aga Khan University Hospital, from January 1999 to May 2001. METHODS: Forty nine consecutive patients included 19 men and 30 women, suspected of obstructive jaundice. Patients underwent ultrasound (n = 49), CT (n = 11), ERCP (n = 25) and biliary surgery (n = 17). Final diagnosis was established by surgical exploration, endoscopic sphincterectomy, cytology and clinical follow up. RESULTS: Of the 49 patients 17 had choledocholithiasis. Twenty five patients had malignant strictures, out of which 11 had non-specific malignant strictures, 7 had pancreatic carcinoma, 3 had Klatskin tumors, 3 had periampullary carcinoma and 1 had gallbladder carcinoma. Six patients had benign strictures and 1 patient had choledochal cyst. Overall, MRCP was sensitive (88%) and specific (96.8%) in detecting choledocholithiasis. MRCP sensitivity and specificity in detecting benign main bile duct stricture was equal to 83.3% and 97.6% respectively, and 92% and 100% for malignant stricture. CONCLUSION: Our prospective study confirms that MRCP, a noninvasive and well tolerated imaging technique is of value in the diagnosis of obstructive jaundice.