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PubMed1975

Therapeutic monitoring of anticonvulsant drugs: gas-chromatographic simultaneous determination of primidone, phenylethylmalonamide, carbamazepine, and diphenylhydantoin.

We describe a sensitive and precise gas-chromatographic method in which benzylmalonate methylester monoamide is used as the internal standard for the simultaneous determination of primidone, phenylethylmalonamide, carbamazepine, and diphenylhydantoin. The trimethylsilyl derivatives of the anticonvulsants are well separated from each other and from normal serum constituents. The lower limit of detection for each drug is 0.5 mg/liter when 1 ml of serum is analyzed. Within-run precision (CV), established by analysis of 10 replicates, was as follows: primidone (5.4 mg/liter), 2.6%; phenylethylmalonamide (5.5 mg/liter), diphenylhydantoin (6.6 mg/liter), 3.8%; and carbamazepine (10.4 mg/liter), 3.2%. Fifty specimens were analyzed for primidone and 35 for diphenylhydantoin by a standard gas-chromatographic method involving on-column methylation and by the procedure we have developed. The mean value observed for primidone with the on-column alkylation procedure was 9.3 mg/liter and with our procedure was 9.6 mg/liter. When values for our assay were regressed against values for the standard method, the slope of the least-squares line was 0.936, the intercept was 1.00 mg/liter, and r was 0.939. The mean values observed for diphenylhydantoin by on-column methylation and with our procedure were both 12.6 mg/liter. When values for our assay were regressed against the standard method, the slope of the least-squares line was 0.944, the intercept was 0.3 mg/liter, and r was 0.988.

Anticonvulsants↗
PubMed2001

[Response of structural plasticity of Tilia amurensis sapling crowns to different light conditions].

This paper studied the crown structure of Tilia amurensis saplings, e.g. the shape of crown, and the distribution of branch and leaf. It is shown that the crown structure of the saplings was modified plastically in response to different light conditions. The differentiation of the first order branches was promoted by strong radiation, due to the bole growth being inhibited under high light condition, whereas the bifurcation density of the first order branches whose growth was inhibited by shading was promoted in under-canopy environment. The quantitative leaf densities of the saplings obviously decreased with the decrease of light level, while their leaves tented to distribute in upper crown. The interception of the saplings was enhanced by the distribution pattern of branches and leaves in crown. Under adequate shade condition, the saplings had the strategy of shade-avoidance of pioneer species in upward growth, and had the strategy of light-forage of moderate shade tolerance in horizontal branch growth. The saplings expressed typically shade-tolerant under weak light condition. Such a change of crown structure was an advantageous adaptation for enhancing light interception.

Analysis of Variance↗
PubMed2001

Rate of cognitive change in Alzheimer's disease: methodological approaches using random effects models.

Subtraction of serial scores, Least Squares Estimators, and Best Linear Unbiased Predictors (BLUPs) were compared for estimating rates of cognitive change for Mini-Mental State Exam (MMSE) and Dementia Rating Scale (DRS) scores for 299 probable Alzheimer's disease patients. The BLUPs provided cleaner group estimates of subjects' intercepts and slopes and are preferred. Regression analysis of the BLUP estimates of rate of change indicated that steeper declines were associated with higher levels of education and older age at onset. These effects were much smaller than those due to estimated initial cognitive test score. Differences in longitudinal metric characteristics of the MMSE and DRS were found, with the DRS yielding more precise change estimates. We discuss modeling these longitudinal data, and discuss use of the estimates of rate of change and intercept as data in their own right.

Aged↗
PubMed2002

Rapid analysis of metanephrine and normetanephrine in urine by gas chromatography-mass spectrometry.

BACKGROUND: Widely used HPLC methods for quantification of metanephrine and normetanephrine in urine often have long analysis times and are frequently plagued by drug interferences. We describe a gas chromatography-mass spectrometry method designed to overcome these limitations. METHODS: Metanephrine and normetanephrine conjugates were converted to unconjugated metanephrine and normetanephrine by acid hydrolysis. To avoid the rapid decomposition of the deuterated internal standards (metanephrine-d(3) and normetanephrine-d(3)) under hydrolysis conditions, the internal standards were added after hydrolysis. Solid-phase extraction was used to isolate the hydrolyzed metanephrines from urine. Samples were concentrated by evaporation, then derivatized simultaneously with N-methyl-N-(trimethylsilyl)trifluoroacetamide and N-methyl-bis-heptafluoro-butryamide at room temperature. RESULTS: The assay was linear from 25 to 7000 microg/L. The intraassay CVs were < 5 % and the interassay CVs < 12%. Comparison with a routine HPLC method (n = 192) by Deming regression yielded a slope of 1.00 +/- 0.02 microg/L, an intercept of -5.8 +/- 7.8 micro/L, and S(y/x) = 50.6 microg/L for metanephrine and a slope of 0.94 +/- 0.03, intercept of 19 +/- 11 microg/L, and S(y/x) = 60 microg/L for normetanephrine. The correlation coefficients (r) were calculated after log transformation of the data and gave r = 0.97 for metanephrine and r = 0.97 for normetanephrine. Interference from common medications or drug metabolites was seen in <1% of samples. The time between sequential injections was < 7 min. CONCLUSIONS: This new gas chromatography-mass spectrometry assay for total fractionated metanephrines is rapid, compares well with a standard HPLC assay, and avoids most drug interferences that commonly affect HPLC assays for urine metanephrines.

Biomarkers, Tumor↗
PubMed2002

Multicenter evaluation of a new immunoassay for intact PTH measurement on the Elecsys System 2010 and 1010.

BACKGROUND AND OBJECTIVE: The determination of parathyroid hormone (PTH) is of great clinical relevance in the assessment of calcium metabolic disorders. Although PTH was one of the first hormones measured by immunoassays, there are still many difficulties in its determination due to the low concentration of the hormone in blood and due to the heterogeneity of PTH resulting from different circulating hormone fragments. The aim of our multicenter-study was to evaluate the technical performance and the clinical validity of a new immunoassay for intact PTH measurement on the Elecsys Systems 2010 and 1010. METHODS AND RESULTS: The multicenter evaluation was performed in 11 clinical laboratories. The Elecsys PTH assay is a one step sandwich electrochemiluminescence immunoassay based upon the streptavidin-biotin technology. Two monoclonal antibodies are used in the assay providing detection of intact PTH. The imprecision study yielded within-run and between-days coefficients of variation of 3.1% - 6.6% and 3.4% - 15.6%, respectively using a three level control (PreciControl Bone, Roche Diagnostics) and human pool sera at two different concentrations (HS-low: 20 - 60 pg/ml, HS-high > 65 pg/ml). The analytical sensitivity calculated as the mean value plus 2 standard deviations of a within-run imprecision was below 2.70 pg/ml using zero calibrator matrix. Dilution linearity was observed up to 4890 pg/ml using zero calibrator matrix or human pool sera. Recoveries ranged between 85% - 115%. Serum, EDTA- and heparin plasma were evaluated for PTH measurement. Due to a better analyte stability (48h at 21 degrees C; 3d at 4 degrees C) EDTA plasma was recommended for PTH measurement. Results of the Elec sys PTH immunoassay correlated well (r = 0.926 - 0.994) with three different immunoradiometric assays (N-tact PTH SP, DiaSorin; Nichols Allegro Intact PTH, Nichols Institute Diagnostics; ELSA-PTH, CISBio International) and two different immunochemiluminometric assays (PTH-Intact-Immulite, DPC Biermann; Nichols Advantage Intact PTH, Nichols Institute Diagnostics) in technical and clinical method comparisons. The Passing/Bablok regression analysis yielded slopes of 0.692 - 1.729 and intercepts of -13.982 - +15.763 pg/ml. Deviations from slope 1.0 and intercept 0.0 were not unexpected due to differences in immunoassay standardization and probably due to the presence of different PTH fragments and a variable affinity of the used antibodies to these PTH fragments. Highly similar PTH concentration pattern of the Elecsys immunoassay and the Quick-Intraoperative Intact PTH immunoassay (Nichols Institute Diagnostics) obtained from specimens taken intraoperatively support the applicability of the Elecsys immunoassay to monitor the success of parathyroid resection. A reference range of 12.3 - 56.0 pg/ml calculated from PTH values of 43 apparently healthy individuals confirms reference limits published in the literature. The partition of collectives according to age showed, that individuals > 50 years have slightly higher PTH concentrations, independently of gender. This shift could be due to age itself or to an increased prevalence of individuals without obvious calcium metabolic disorders in this collective. CONCLUSION: The Elecsys PTH assay is a useful and reliable tool for determination of intact PTH. Our data support the intended use of the assay in clinical applications related to disorders of calcium metabolism.

Adolescent↗
PubMed2002

Mean nuclear volume in cervical intraepithelial neoplasia and carcinoma.

OBJECTIVE: To correlate three-dimensional nuclear size (mean nuclear volume) estimated by the stereologic intercept methodfor objective classification of cervical intraepithelial neoplasia (CIN) and carcinoma. STUDY DESIGN: In this retrospective study a total number of 29 CIN cases (8 cases of CIN 1, 10 cases of CIN 2 and 11 cases of CIN 3) and 10 cervical squamous cell carcinoma cases were selected. Mean nuclear volume (MNV) of all cases was measured with an image cytometer (Leica, Cambridge, England) using Quantimet 600 software (Leica). Nuclear point resection method was adopted to measure nuclear volume. Mean intercepted diameter of at least 50 nuclei was measured randomly. MNV was correlated with the histologic grade and diagnosis. RESULTS: MNV of CIN 1, 2, 3 and carcinoma cases was 291.72, 403.33, 711.45 and 893 microm3, respectively. ANOVA test results showed that MNV of CIN 1 and 2 was significantly lower than that of CIN 3 and invasive carcinoma (P < .000). MNV of CIN 3 was also significantly lower than that of carcinoma cases (P <.05). CONCLUSION: The findings suggest that estimates of MNV on conventional histopathology slides provide objective and useful criteria for relatively subjective histopathologic grading.

Carcinoma, Squamous Cell↗
PubMed2002

Evaluation of a new handheld biosensor for point-of-care testing of whole blood beta-hydroxybutyrate concentration.

OBJECTIVES: To evaluate performance characteristics of the newly available handheld combined glucose and ketone meter for beta-hydroxybutyrate measurement. DESIGN: Laboratory method evaluation. MAIN OUTCOME MEASURES: Accuracy of beta-hydroxybutyrate measurement and effect of acetoacetate interference at clinically important beta-hydroxybutyrate levels. RESULTS: Deming regression analysis of beta-hydroxybutyrate measurements assessed by the ketone sensor and a laboratory enzymatic method revealed a coefficient of determination of 0.989 (P<0.001). Passing-Bablok regression analysis showed a linear relationship between the two methods, ie Y= -0.32+1.13X. The 95% confidence interval of the slope and y-intercept were: slope=1.13 (95% confidence interval, 1.04 to 1.22); intercept= -0.32 (95% confidence interval, -0.59 to -0.06). The Bland-Altman plot showed a small proportional bias between the two methods. The mean bias +/-2 standard deviations was between -0.53 and 0.67 mmol/L. Beta-hydroxybutyrate measurements made by the sensor were linear up to 6 mmol/L. Replicate analysis of two samples spiked with 3.6 mmol/L and 0.8 mmol/L of beta-hydroxybutyrate resulted in coefficients of variation of 3.3% and 13%, respectively. The presence of acetoacetate caused a negative interference in beta-hydroxybutyrate measurement. Beta-hydroxybutyrate recovery was 97.0% and 90.7% when the ketone body ratios were 6:1 and 3:1, respectively. CONCLUSION: The analytical performance of the sensor, when operated according to manufacturer's instructions, could meet the needs of point-of-care beta-hydroxybutyrate measurement. Additional clinical studies are needed to assess the benefits of introducing such an assay in a clinical setting.

3-Hydroxybutyric Acid↗
PubMed2002

[Introduction of international normalized ratio of prothrombin time to evaluate multiple depletions of coagulation factors].

Prothrombin time(PT) is utilized in worldwide as a global coagulation test reflected multiple depletions of coagulation factors in diseases such as severe liver dysfunction and Disseminated Intravascular Coagulation(DIC). However, standardization of regents and result reporting methods are not established yet except International Normalized Ration(INR) for control of oral anticoagulant therapy(OAT). We evaluated whether INR is capable for defect of multiple coagulation factors except OAT, using absorbed plasma and different origins of thromboplastin; human recombinant, human placenta, cultured human cell and rabbit brain. PTs of individual 90 samples(group MC) absorbed with BaSO4 and/or bentnite and 60 samples(group W) from patients with OAT were measured with 20 normal plasmas with respective reagents. Sensitivities of four reagents to plasma of group W and MC were determined respectively against human recombinant thromboplastin(ISI = 1.03). Both of human thromboplastin showed that sensitivity to absorbed plasma was very close to OAT plasma, whereas reductions of sensitivity to 84% and 66% for absorbed plasma were revealed in both of rabbit thromboplastins. Correlations of INRs calculated by two different sensitivities, one is to absorbed plasma and another to OAT plasma, indicated that discrepancy of sensitivities was emphasized as large slopes(1.50 and 2.76) of regression lines and large intercepts in rabbit thromboplastins, although slopes closed to 1.0 with small intercepts in both of human thromboplastins. We concluded that use of human thromboplastin was the first priority to introduce INR system for evaluation of multiple coagulation factors depletions.

Adult↗
PubMedDate not supplied

[Acetylcholinesterase. I. Kinetic aspects of interaction with reversible effectors].

Interaction of an effector M with acetylcholinesterase (EC 3.1.1.7) according to the model of Krupka and Laidler was analysed. Some usual functions of [M] : 1/VM, [(VO/VM)-1]/[M] (where VO and VM are the steady state rates in the absence and in the presence of modifiers, respectively), vertical intercept 1/VM, slope KM/VM and absolute value of reciprocal horizontal intercept KM of Lineweaver-Burk plots are investigated and corresponding plots described. It is particularly shown that if Dixon plots are curves concave downwards, plots of [VO/VM)-1]/[M] and 1/VM against [M] are hyperbolas concave upwards and downwards respectively. If Dixon plots are curves concave upwards, plots of [(VO/VM)-1]/[M] and 1/VM versus [M] are hyperbolas concave downwards and upwards respectively. Moreover plots of KM/VM against [M] are linear. However, this model does not explain some observations, under conditions of high ionic strength (gamma/2 greater than or equal to 0,1), where Dixon plots are curves concave upwards, plots of [VO/VM)-1]/[M] versus [M] strainght lines, the plot of 1/VM against [M] is a straight line or a curve concave upwards of positives slopes and the plot of KM/VM versus [M] a curve of positive slope concave upwards. These experimental data might be interpreted by an extension of the preceding model to a mechanism with two enzymatic binding sites under kinetic conditions that are determined.

Acetylcholinesterase↗
PubMed2003

Measurement of cerebral blood flow in chronic carotid occlusive disease: comparison of dynamic susceptibility contrast perfusion MR imaging with positron emission tomography.

BACKGROUND AND PURPOSE: Our purpose was to evaluate the accuracy of cerebral blood flow (CBF) measurements obtained by using dynamic susceptibility contrast-enhanced MR imaging, including the influence of arterial input function (AIF) selection, compared with those obtained by using [(15)O]-H(2)O positron emission tomography (PET) for patients with chronic carotid occlusion. METHODS: MR images and PET scans were obtained of seven patients with unilateral carotid occlusion and were co-registered for region of interest analysis. PET CBF maps were generated by using the autoradiographic method. MR imaging CBF maps were calculated by deconvolution of the susceptibility time curve with a proximal middle cerebral artery AIF and were converted to absolute flow rates either by assuming a constant contralateral white matter CBF value of 22 mL/100 mL/min or by using individually determined PET white matter CBF values. RESULTS: Although CBF values measured by PET and MR imaging were positively correlated for every patient, the slopes and y intercepts of the regression lines varied widely among patients. The correlation was better when individual white matter CBF values measured by PET were used to scale the white matter CBF values measured by MR imaging (r = 0.84, P <.0001) than when constant contralateral CBF values were assumed (r = 0.54, P <.0001). The choice of AIF ipsilateral or contralateral to the occluded carotid artery made no statistically significant difference (P >.05) to the correlation coefficient, slope, or y intercept of the MR imaging versus PET CBF regressions for six of the seven patients. CONCLUSION: Although linearly correlated with CBF values measured by PET, dynamic susceptibility contrast-enhanced MR imaging was not accurate for measuring absolute CBF values. AIF selection relative to the side of carotid occlusion did not significantly affect calculated MR imaging CBF values for six of the seven patients.

Aged↗
PubMed1992

Human contraception: development of new scientific opportunities.

Our current methods of contraception were largely developed in the 1950s and 1960s. Collectively these methods can limit population growth, although their acceptability at a personal level remains marginal. The number of abortions in the UK has risen progressively, from < 130,000 in 1980 to > 170,000 in 1990, and more people have sought sterilization. In global terms, population continues to increase on a scale unrecorded in human history. More than 800 million people, equal to the current population of North America, Europe and Japan, will be added to the world population of 5400 million by the year 2000, with 95% of the increase located in the economically and environmentally fragile regions of the South. Worldwide, in these 8 years, about 500 million abortions will be performed (> 40% by unsafe methods), about 80 million children under 1 year of age will die, and about 5 million women with be lost from pregnancy-related causes. Over 100 million people, most in Africa, Latin America, India and South-east Asia, will have become infected with human immunodeficiency virus. Religious, commercial and political pressures continue to constrain the development and distribution of contraceptive products, though some changes are in sight. Contraception is now being advanced in the broader context of neonatal and maternal health care. New scientific opportunities are also evident, with the potential to advance contraception in a quantal step. Third generation contraceptive steroids, anti-steroids, steroid-releasing vaginal rings, and injectable steroid preparations for men are all under clinical trial. Developments in the longer term, however, could hinge upon the greater specificity afforded by the manipulation of regulatory peptides. Agonists, antagonists and binding proteins for GnRH and the gonadotrophins are being investigated in an attempt to regulate the pituitary-gonadal axis more precisely. Inhibition of this axis may require the provision of low level steroid replacement, appropriately titrated to provide positive health care in the context of menstrual cyclicity, well-being, breast cancer and osteoporosis. Attempts are being made to identify and intercept the highly specific signals involved in fertilization and the maternal recognition of pregnancy, with the current clinical focus on the immunoneutralization of beta human chorionic gonadotrophin (beta hCG). More specific and more acceptable targets might include peptides involved in sperm-zona adhesion and sperm activation, sperm-oocyte fusion, and sperm-activated oocyte cleavage. The interception of these signals would prevent fertilization, implantation or both, and yet leave the hormonal profile of the menstrual cycle unchanged.(ABSTRACT TRUNCATED AT 400 WORDS)

Contraception↗
PubMed1992

Modification of the Trotter and Gleser female stature estimation formulae.

Stature-estimation formulae in common use are those of Trotter and Gleser. Their formulae for females are based on Terry collection skeletons. These skeletons are from people who died in the early 1990s. Because there has been considerable change in body size since then, it is possible that the Trotter and Gleser formulae are inappropriate for modern forensic-science application. The Trotter and Gleser female formulae are tested using data from the Forensic Data Bank at the University of Tennessee. For whites, the femur and tibia yield stature estimates differing from one another by about 3 cm. Using femur and tibia lengths from modern forensic cases and modern height data from anthropometric surveys, new regression intercepts are calculated for Trotter and Gleser's female formulae. The new intercepts improve the performance of the formulae on modern individuals. The Trotter and Gleser formulae for black females require no adjustment. Both blacks and whites have experienced a secular increase in bone length, but whites have experienced a change in proportions as well.

Anthropology, Physical↗
PubMedDate not supplied

Alternative liquid chromatographic method for determination of the methoxyl and 2-hydroxypropoxyl content in cellulose ether derivatives.

An alternative liquid chromatographic (LC) method was developed and validated for the simultaneous determination of methoxyl and 2-hydroxypropoxyl substituents in hypromellose and hypromellose acetate succinate. The method uses the hydriodic acid cleavage reaction, catalyzed by adipic acid, of the substituted methoxyl and 2-hydroxypropoxyl groups, which are quantitatively converted to iodomethane and 2-iodopropane. The iodomethane and 2-iodopropane are extracted into xylene, the extract is diluted with methanol, and the analytes are separated and assayed by gradient elution using a reversed-phase C18 column. The method is selective and sensitive and has good linearity with values of 0.999 for R2 and 0.25% for the gamma-intercept bias from 1.39 to 5.55 mg/mL for iodomethane, and 0.999 for R2 and 0.52% for the gamma-intercept bias from 0.184 to 0.735 mg/mL for 2-iodopropane. The relative standard precisions for this LC method were found to be +/- 2.3% for determining methoxyl at the 23.1% (w/w) level, and +/- 3.5% for determining 2-hydroxypropoxyl at the 6.7% (w/w) level. Compared with the current gas chromatographic (GC) compendial (JPE) method, the LC assay method has equal or better precision. It was found that both the standard and sample solutions have limited stability (8 h) after preparation. This limited stability has not been reported previously in the literature and may have an impact on the reported accuracy/precision of the literature data for the GC method. The LC method was proven to be robust with respect to variation in derivatization time and temperature, flow rate, and column temperature. It is well suited for the quality control needed in today's fast-paced pharmaceutical laboratories.

Adipates↗
PubMed2003

[Differential diagnosis and treatment strategies for peri-implant diseases].

UNLABELLED: The aim of this article is to discuss the requirements to prevent, intercept and treat the peri-implant diseases at different stages. The ethiology and pathogenesis of peri-implant disease is presented, followed by definition and characteristics of the two main entites: peri-implant mucositis and peri-implantitis. Data and concepts regarding various evaluation parameters, such as pocket probing depth, bleeding on probing, gingival and plaque scores, radiographic and mobility which should be used to assess the clinical status of the peri-implant environment are discussed. The detection and treatment of early pathogenic changes during regular recall maintenance visits can prevent peri-implant soft tissue inflammation and progressive bone loss. The biologic rationale and guidelines for therapeutic procedures aimed to prevent and arrest the Peri-implant Disease according to a maintenance system termed Comulative Interceptive Supportive Therapy (CIST) is presented. The CIST protocol includes as a first sequence mechanical antiseptic and antibiotic treatment to control ongoing infection. Following this, peri-implant bony lesion may be corrected by regenerative or resective surgical techniques. IN CONCLUSION: By continuing diagnosis during maintenance, developing peri-implant infections can be controlled successfully by providing mechanical, antiseptic, antibiotic and surgical supportive therapy, individually or combined.

Alveolar Bone Loss↗
PubMed2004

Mean nuclear volume in ovarian papillary serous cystadenocarcinoma.

OBJECTIVE: To measure mean nuclear volume (MNV), estimated by the stereologic intercept method, in ovarian serous carcinomas and to compare that between omentum-positive cases (cases with omental metastasis) and -negative cases. STUDY DESIGN: This retrospective study consisted of 29 cases (stage I and II = 13 cases, and stage IIIb = 16 cases) of ovarian papillary serous cystadenocarcinoma. MNV of all cases (at primary and metastatic sites) was estimated with an image cytometer. The nuclear point intersection method was used to measure nuclear volume. Mean intercepted diameters of at least 50 nuclei were measured. MNV was correlated with histologic grade, International Federation of Gynecology and Obstetrics (FIGO) staging of ovarian malignancy and primary tumor versus metastatic deposits. RESULTS: MNVs estimated in omentum-negative (FIGO stage I and II) and omentum-positive (FIGO stage IIIb) cases were 1,022.48 +/- 608.45 and 2,152 +/- 1,317.51 microns 3 (P = .05, Student t test), respectively. Significant differences in MNV were also observed among the different grades of tumor. However, no significant difference was observed between MNVs of primary and metastatic tumors in omentum-positive cases. CONCLUSION: Estimates of MNV on conventional histopathology sections may provide objective and useful criteria for relatively subjective histopathology grading and staging (FIGO stage I and II vs. IIIb).

Cell Nucleus↗
PubMed2004

The comprehensive osteoarthritis test: a simple index for measurement of treatment effects in clinical trials.

OBJECTIVE: To assess the measurement properties of a simple index of symptom severity in osteoarthritis (OA) of the hips and knees. METHODS: Both the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the proposed new Comprehensive Osteoarthritis Test (COAT) instrument were completed weekly by 125 subjects in the context of a randomized, 12-week, 3 parallel-arm clinical trial. The reliabilities of the various scales were assessed on a weekly basis by use of Cronbach's alpha coefficients. The validity of the COAT total scale was assessed by correlation with the WOMAC total scale on a weekly basis with correlation coefficients, and in terms of the correlations between subject-level intercepts and slopes over time. The relative responsiveness of the WOMAC and COAT total scales was assessed using a multilevel (longitudinal) multivariate (WOMAC, COAT) linear model. RESULTS: The WOMAC and COAT total scales were highly reliable (mean over weeks: WOMAC alpha = 0.98; COAT alpha = 0.97). The correlations between the WOMAC and COAT scales were very high (mean over weeks = 0.92; subject-level intercepts = 0.91, slopes = 0.88). The COAT total scale was significantly more responsive than the WOMAC total scale in the active treatment (34.8% improvement vs 26.8%; p = 0.002). CONCLUSION: The COAT total scale is simple to administer, reliable, valid, and responsive to treatment effects.

Antirheumatic Agents↗
PubMed2004

Communicable diseases monitored by disease surveillance in Kottayam district, Kerala state, India.

BACKGROUND & OBJECTIVES: A disease surveillance model developed in the North Arcot district, Tamil Nadu, was found to be practical, efficient, inexpensive and useful for public health action to monitor the success of ongoing interventions and to detect and intercept outbreaks. It was centred in the private (voluntary) sector with full co-operation and participation by the government sector. As Kerala state wanted to replicate this model in all districts, one district was chosen to pilot test it centred within the existing district public health system, soliciting participation from the private sector. A two-year (1999-2001) performance of this model is presented. METHODS: After elaborate preparations including the selection of 14 diseases to be reported and training of doctors in the private sector health care institutions and doctors and paramedical staff in all government health centres and hospitals, printed post cards were widely distributed. The business reply system was used so as to avoid handling postage stamps. Cards were received by the nodal officer in the district public health office and checked on a daily basis to detect disease prevalence and evidence of clustering in time and space. Swift action was taken on detecting case clustering. A monthly bulletin containing disease summaries and other useful information was freely distributed to all reporting centres. RESULTS: On an average, just over 100 disease reports were received every month. The most frequently reported diseases were, in the descending order, leptospirosis, acute dysentery, typhoid fever and acute hepatitis. Among vaccine-preventable childhood diseases, only measles was reported, but no diphtheria, tetanus or whooping cough. Several outbreaks were detected early and interventions applied to intercept them. The most striking example was that of cholera, the occurrence of which was detected swiftly for instituting highly successful control measures. INTERPRETATION & CONCLUSION: The district level disease surveillance system centred in the government public health system has been highly successful. Disease surveillance was responsible for the government to obtain information on the prevalence of leptospirosis in the district. The reports enabled the public health officers to detect disease-clustering as the early signals of outbreaks and to take quick remedial measures.

Cluster Analysis↗
PubMed1992

Assessment of body composition in heart transplant patients.

Orthotopic heart transplantation (OHT) recipients often experience increased body weight (BW) following surgery. Using hydrostatic weighing (HW), this study assessed the body density (BD) and body composition of 17 white and seven black male OHT patients. It examined the cross-validity of the Jackson and Pollock seven and three site skinfold (SF) regression equations for predicting BD in these patients. We hypothesized that both prednisone (P) dose and months post-operative (MPO) would be inversely related to BD. The average of the last five of ten HW trials was used in computing BD. BW and % body fat (BF) were 88.5 +/- 17.8 kg (mean +/- SD) and 33.5 +/- 9.4%, respectively. The correlation coefficient between hydrostatically determined BD and BD determined via two of the three intercept revised Jackson and Pollock SF equations was r = 0.89, SE = 0.009. A polynomial regression model for BD using P dose and MPO provided a correlation coefficient of r = 0.71, SE = 0.015. Partial correlation techniques incorporating SF, age, MPO, and P dose indicated that neither P dose or MPO provided any significant additive effect, above SF and age, when predicting BD. We conclude that in OHT patients receiving glucocorticoids, the intercept revised Jackson and Pollock SF regression equations are generally applicable and associated with a SE of +/- 4 BF percentage points. Up to 49 months after OHT, both P dose and MPO are inversely related to BD but provide no additive value above SF for predicting BD.

Adult↗