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PubMed1997

Calcium and osteoporosis.

Osteoporosis is a crippling disease that emerges as an important public health problem both in developed and developing countries including Brazil. The clinical condition is characterized mainly by loss of bone mineral mass in later life as the net result of complex physiological and environmental interacting factors during lifetime. Calcium intake appears as an obvious nutritional factor in the prevention of osteoporosis but its contribution is still not well established particularly when populations with different habitual levels of calcium intake are compared. In this section, we examine the role of calcium intake as affecting bone mineral density at different stages of development and with aging, with special attention to the possible stress on bone mass due to pregnancy and lactation. Nutritional studies demonstrate that, in general, adequate calcium intake during lifetime contributes to decrease the risk of osteoporosis. However, the long term effects on bone health of sub-adequate, but not very low, habitual calcium intakes during highly demanding physiological periods such as adolescence, pregnancy and lactation, are still largely unknown. Sub-adequate calcium intakes are probably common in Brazil.

Aged↗

PubMed1998

The mad cow problem in the UK: risk perceptions, risk management, and health policy development.

Mad cow disease or bovine spongiform encephalopathy (BSE) is a fatal neurological disease of cattle first recognized in the United Kingdom (UK) in 1986. Until recently, the UK government considered the chance of a human becoming infected with the BSE agent to be extremely remote. As a result of new developments, alarmist media attention, bureaucratic mishandling of the issues, scientific uncertainty, bickering among technical experts, and a dearth of easily assimilated and balanced information on the problem, widespread fears that affected cattle could enter the human food supply and transmit the disease to humans have periodically erupted, causing social, economic, and political consequences of tremendous magnitude. Better management of the mad cow problem could have minimized the magnitude of the epidemic among cattle, the risk to humans, and the public outrage. Trust in the British government was seriously eroded, an entire industry crippled, and international relations severely tried. Although the scientific data concerning BSE and its transmissibility to humans are still not conclusive, a growing body of (still largely circumstantial) evidence suggests that BSE may be transmissible to humans. Unfortunately, policy decisions cannot wait for a final scientific answer. Therefore, high-stakes decisions must be made in the face of this uncertainty. Such decisions should be made with the primary purpose of protecting the public, and not preferentially the economics of an industry, political alliances, or other considerations. Given that the risk to humans from BSE was (and still is) unknown and may be high, and that the perceived risk among the British public was (and still is) extraordinarily high, policies should support more aggressive interventions. Of necessity, such interventions will be preventive, as there is presently no available treatment. Such policies should be modified as necessary as the developing scientific data warrants.

Animals↗

PubMed1998

[Inguinal pain caused by iliopsoas bursitis].

Four patients, three men aged 69, 55 and 45 years and one woman aged 72 years, complained of pain in and around the inguinal region without clear cause. The crippling symptoms were of a few days' to 8 years' standing. Passive hip movements were not restricted. Presence of pain after pressure on or stretching of the bursal wall during provocation tests and absence of other disorders resulted in a probability diagnosis of iliopectineal bursitis. This diagnosis was confirmed by marked abatement of the pain after an injection of lidocaine into the bursa. Inflammation of the iliopectineal bursa may occur after injury or overstrain and cause various kinds of complaints. The diagnosis injection of lidocaine as a rule constitutes an adequate treatment as well.

Aged↗

PubMed1998

Are osteoporotic fractures due to osteoporosis? Impacts of a frailty pandemic in an aging world.

Osteoporosis is a major risk factor for fractures in the elderly. Osteoporotic (hip, forearm, and vertebral) fractures today strike hard on Western populations, with a lifetime risk in women similar to the risk for cardiovascular disease. The risk of dying from hip fracture equals breast cancer mortality. Osteoporotic fractures are associated with pain, crippling and social dependency; annual costs in the United States are between $7 to $20 billion, and the contribution from hip fractures is above 60%. Of all hospital beds in Europe, 1 to 1.5% are occupied by osteoporotic patients, a figure expected to more than double during the next fifty years. Whereas vertebral fractures mainly seem to be caused by osteoporosis alone, hip fractures are heavily affected by an age-dependent contributory risk factor, frailty. Frailty might act as an involutionary phenomenon or as comorbidity, particularly neurological; it affects fracture risk along several causal paths, but the increasing frequency and severity of falls are essential. Results of attempts to prevent falls are discouragingly poor. Nevertheless, identification of risk possessors, particularly demented elderly living in institutions, is substantial for directing preventive and treatment programs, mainly acting on general health and on osteoporosis. Frailty of populations increases with longevity. Consequently, projections of fracture occurrence are too conservative. The annual hip fracture incidence in Asia in 2050 might pass 10 million, rather than the hitherto forecasted 3.2 million, thus shifting tomorrow's burden of age-related fractures from the wealthier to the poorer countries. There is an immediate call for vigorous global actions to reallocate resources, to reorganize health care, and to institute high-risk prevention programs.

Aged↗

PubMed1998

[Substitution urethroplasties with free graft buccal mucosa].

OBJECTIVE: To present our experience with free graft buccal mucosa substitution urethroplasties. METHODS: Between June, 1992 and December, 1997, we performed 18 urethroplasties with buccal mucosa in 17 patients (double urethroplasty in the same stage in one): 8 for the repair of urethral strictures, 9 for the repair of hypospadias cripples and one for epispadias repair, in an exstrophic boy. Only 3 patients had not undergone previous reconstructive operations. The mean age was 26.2 years (range 10-69). In 8 cases we harvested the graft from the inner cheek and in another 8 cases from the inner lower lip; in two cases we combined mucosa from the cheek and from the lip. In 14 patients we managed to preserve the urethral roof and the buccal mucosa was grafted as an onlay patch; 4 patients underwent full circumference tube replacement. The median follow-up of the series was 17.8 months, ranging from 1 month to 5.5 years. RESULTS: In 15 out of 18 repairs (83.3%) the final outcome was satisfactory, while in three cases the graft failed and reoperation was necessary. In 10 of the 15 successful urethroplasties the end result was excellent: first intention healing no complications or sequelae; in the other 5, although the end result was good, fistulae requiring surgery for closure developed in 2 and meatal stenosis requiring autodilations in three patients. The best results were obtained in strictures of the bulbar urethra secondary to trauma with 100% success rate. In hypospadias the success rate was 77.7%. Onlay patch grafts never failed, with 10 out of 14 excellent results. Three out of 4 tubed grafts failed. CONCLUSIONS: At short and medium term, the free grafts of buccal mucosa yield results comparable to those of other epitheliums in use for urethral repair, thus increasing the choice of techniques at our disposal for one-stage repairs. We consider that it is best suited for long strictures of the bulbar urethra.

Adolescent↗

PubMed1976

Legislation relevant to perinatal care.

The legislative process is one route to follow in the attempt to change and improve perinatal care. Payment by the State Crippled Children's Service for medical care of certain costly high-risk neonatal conditions, only to qualified specialists and in centers meeting acceptable standards has had a snowball effect on upgrading neonatal care in this state. Not only has a large network of neonatal care centers and infant transport systems been developed, but there has been a rush especially on the part of nurses, to get special training in neonatal care. This has included not only the care of the sick neonate, but a look at newborn evaluation and resuscitation in the delivery and newborn areas. It is expected that this same center development and education and training process will now be extended to obstetrical care, as there is renewed interest in special care for high-risk mothers because of Assembly Bill 1326. The new hospital perinatal regulations mandate improvement of care in community hospitals where the majority of deliveries take place. The emphasis is on a larger and better educated staff, more concern with patients rights, and provision of a more humanistic family centered care as well as continual evaluation of maternal and neonatal outcome. The greatest limitation has been lack of Health Department staff to provide adequate consultation and surveillance of these services for compliance with the new laws. There has been an approximate 10 per cent reduction in the number of hospitals with maternity services- from 416 in 1968 to 369 today. While much of this consolidation may have been due to the fall in birth rate, these regulations have also contributed to the process. Most important of all, these laws have kept perinatal care constantly in the consciousness of California health care providers and consumers.

California↗

PubMed1999

Road rash with a rotten odor.

As military physicians, our mission is to support the fighting force and keep our soldiers mission capable. One group of disorders that can quickly cripple a fighting force is disorders of the foot. A complete survey of dematologic conditions of the foot is quite extensive, but only one comes with its own distinctive odor. This foul rash is pitted keratolysis.

Adult↗

PubMed1999

Structure and genomic organization of a second cluster of immunoglobulin heavy chain gene segments in the channel catfish.

The structure, organization, and partial sequence of a 25-kb genomic region containing a second cluster of H chain gene segments in the channel catfish (Ictalurus punctatus) has been determined. Multiple VH gene segments, representing different VH families, are located upstream of a germline-joined VDJ. The VDJ segment has a split leader sequence and a single open reading consistent with that expressed in members of the VH1 family. Downstream of the germline-joined VDJ is a single JH segment and two pseudogene exons structurally similar to the Cmu1 and Cmu2 exons of the functional gene. Both pseudogene exons are multiply crippled with RNA splice sites destroyed, and open reading frames are interrupted by termination codons, insertions, and/or deletions. Sequence alignment of a 10.8-kb region within the second H chain cluster with the genomic sequence of the nine JH segments and the functional Cmu within the first H chain gene cluster indicates that the second H chain gene cluster probably arose by a massive duplication event. The JH region of the VDJ, the coding and flanking regions of the single JH segment, and the pseudogene Cmu exons were readily aligned with homologous segments in the first gene cluster. This duplication event may have extended to include the upstream VH segments. A member of the Tc1 mariner family of transposable elements is located downstream of the pseudogene Cmu2, which suggests that the transposition may have contributed to the evolution of the duplicated Cmu.

Amino Acid Sequence↗

PubMed1998

[Ronald Ross: a century of the transfer of malaria by mosquitoes].

Ronald Ross is a brilliant and polyvalent mind. When orientated towards medicine he took the training amateurishly and ended up with a limited qualification. After 2 years as a ship doctor, he attended the compulsory complementary training in order to be admissible in the IMS, the garrison life left him with plenty of time to engage in his hobby's: painting for a short while, writing, poetry and mathematics. By the end of his first term he questioned the sense of his medical activities and decided, with a view to his career, to acquire a Public Health diploma and some complementary bacteriology. During his second term the malaria problem drew his attention. As he was unable to detect the parasite of Laveran in the blood of patients with malarial fevers he concluded that the parasite had been some lucky microscopic finding without any value and turned this parasite into ridicule. During his leave in 1894 he met Manson, who showed him the technique to put the parasite in evidence and convinced him to search for its vector which, to his opinion, should be a mosquito. Ross decided to follow this lead. With his minimal parasitological knowledge and an entomological background limited to the external appearance of mosquitoes he endeavoured to establish the life cycle of the malarial parasites. Notwithstanding some service bounded transfers, he followed the fate of the filaments of the crescents and discovered the parasite on the stomachwall of dapled-winged mosquitoes. During his special mission in Calcutta and in the absence of suitable malaria infections in man he shifted to bird proteosoma (now P. relictum) with a grey mosquito (culex) as vector. He demonstrated the complete life-cycle ending in the salivary glands of the mosquitoes and succeeded in transmitting this infection by mosquito-bites in healthy birds. This climax in his research was crowned by the attribution in 1902 of the Nobel Prize for Medicine. In the mean time he resigned from the IMS and was appointed as "Lecturer on Tropical Diseases" at the Liverpool School. He reoriented his activities to the prevention of malaria by control of the vector in its aquatic larval stage, which he tried out and promoted during his journeys to the West African Coast and other countries. His current were variegated but without salient details. Through the survey of the parasite index and the assessment of the spleen rate in children he founded the malariometry as a epidemiological tool, focussed attention on the relation of malaria and the community and on the complexity of the transmission dynamics. By handing in his resignation at the Liverpool School and moving to London he hampered further his scientific productivity. The tardy foundation of the Ross Institute did not stimulate a new impetus. He suffered a stroke which left him partially crippled an he died in his Institute.

Animals↗

PubMed1953