Cent CI Research Articles

Sonographically Thick Placenta: a Marker for Increased Perinatal Risk—a Prospective Cross-sectional Study

The aim of this study was to determine placental thickness by ultrasound examination throughout pregnancy and establish the correlation of sonographically thick placenta with perinatal mortality and morbidity.Placental thickness was determined by routine sonographic examination throughout pregnancy in 561 normal singleton pregnancies. Thick placenta was determined as placenta that was above the 90th percentile. Gravidae between 20–22 weeks' gestation (n=193) and 32–34 weeks (n=73) were then divided into two groups according to placental thickness. The study group consisted of 44 gravidae with thick placenta. The control group included 151 gravidae with placental thickness between the 10th and 90th percentile. A comparison of perinatal mortality and morbidity rates as well as the incidence of small and large for gestational age neonates was conducted.A linear increase of placental thickness was found to correlate with gestational age throughout pregnancy. No statistical differences were observed between the two groups with regard to obstetrical variables such as maternal age, parity and gestational age at delivery. No correlation was found between placental thickness and maternal age or parity. The incidence of perinatal mortality was significantly higher among gravidae with thick placentae (6.82% versus 0.66 per cent, P=0.037, 95 per cent confidence interval 1.71–70.29). Birthweight at term was found to be above 4000g in 20.45 per cent of the thick-placenta group as compared to 5.3 per cent in the control group (P=0.001, 95 per cent CI 2.08–13.85), and birthweight of less than 2500g was found in 15.9 per cent of the thick-placenta group as compared to 7.3 per cent in the control group (P=0.03, 95 per cent CI 1.11–8.14). The incidence of fetal anomalies was 9.1 per cent in the thick-placenta group and 3.97 per cent in the control group (not significant).Sonographically thick placenta is associated with increased perinatal risk with increased mortality related to fetal anomalies and higher rates of both small for gestational age and large for gestational age infants at term.

The role of expressed breastmilk and continuous positive airway pressure as predictors of survival in extremely low birthweight infants.

A case-control study was carried out on 152 extremely low birthweight (ELBW, < 1000 g) infants born consecutively in a large Malaysian maternity hospital during a 21-month period to determine the significant predictors associated with survival at discharge. Forty-nine (32.2 per cent) of these infants survived and 103 (67.8 per cent) died. The survivors weighed significantly heavier (mean = 888 g, SD = 99) than infants who died (mean = 763 g, SD = 131; p < 0.0001). They were also of higher gestational age (mean = 28.7 weeks, SD = 2.2) than those who died (mean = 26.7 weeks, SD = 2.5; p < 0.0001). Logistic regression analysis showed that, after controlling for various confounders, only three factors were significantly associated with the survival of these infants. These were: (1) increasing birthweight of the infants (with every gram increase in birthweight, adjusted odds ratio of survival was: 1.009; 95 per cent CI 1.004, 1.015; p = 0.0006); (2) given nasal continuous positive airway pressure for treatment of respiratory distress syndrome (adjusted odds ratio of survival: 4.2; 95 per cent CI 1.2, 14.0; p = 0.02); and (3) given expressed breastmilk (adjusted odds ratio of survival: 57.5; 95 per cent CI: 7, 474; p = 0.0002). Maternal illness, intrapartum problems, ethnicity, gestational age, use of antenatal steroid, modes of delivery, Apgar scores, congenital anomalies, respiratory distress syndrome, persistent ductus arteriosus, septicemia, necrotising enterocolitis, chronic lung disease, oxygen therapy, intermittent positive pressure ventilation, surfactant therapy, and blood transfusion were not significant factors associated with increased survival.

Dental caries experience in Mexican schoolchildren from rural and urban communities

To compare dental caries experience in Mexican rural and urban settings. Cross-sectional samples of schoolchildren. A school in Mexico City and a rural school in a remote area of the Oaxaca State in Southern Mexico. A total of 347, 9- to 10-year-old schoolchildren (rural area, 131 children; urban, 216) was examined by two standardised dentists using the WHO 1987 criteria. Data were analysed in terms of central tendency measures and 95 per cent confidence intervals. Caries prevalence was 91.6 per cent in the urban area, and 54.4 per cent in the rural area (P < 0.05). DMFT in 10-year olds was 1.93 (sd 1.72) and 0.40 (sd 0.76) in urban and rural areas respectively (95 per cent CI 1.16-1.89). The entire DMFT/dmft indices in the rural group were made up of the decayed component. There is a large difference in the prevalence and distribution of dental caries between rural and urban Mexican children. Dental treatment background also differs markedly. Findings highlight the need to establish distinct preventative and rehabilitative treatment strategies tailored to meet the specific needs of different population groups.

Inherited sensorineural low-frequency hearing impairment: some aspects of phenotype and epidemiology.

This contribution forms part of the HEAR project. It describes some phenotypes of inherited low-frequency sensorineural hearing impairment (LFSHI) and estimates the prevalence of this inherited hearing impairment (HI) based on a clinical series. During a 10-year period (1987-1996), 418 subjects (134 males and 284 females), with a median age of 68 years (range 4-98), had been examined with LFSHI, defined as hearing loss most pronounced in the low frequencies (i.e., 250 and 500 Hz > 20 dB HL with better hearing, i.e., > or =15-dB difference at 1 and/or 2 and/or 4 kHz with an air-bone gap <15 dB for the average of 0.5, 1, and 2 kHz). The 418 subjects comprising 0.6 per cent of the total number of subjects examined (N=69,309) were subdivided into four categories: category I positive genetic subjects (N=69); category II, probably genetic (N=339); category III, uncertain genetic (N=6); and category IV, subjects with contradictory audiological findings (N=4). The phenotype in category I demonstrated a symmetrical LFSHI, with a pattern of progression showing a slow deterioration in the high frequencies (i.e., 2, 4, and 8 kHz as a function of age)--the progression comprising 40-45 dB. In the low frequencies (i.e., 250, 500, and 1,000 Hz), a deterioration of 15-25 dB could be demonstrated from the youngest to the oldest age group. In category II, a symmetrical LFSHI was found in 179 subjects, showing the same pattern of progression as in category I. However, in the age group 20-39 years, a significantly poorer hearing was found in the low frequencies compared to category I, implying that several phenotypes may be present in LFSHI. A subgroup (A) in category II exhibited normal hearing in one ear with LFSHI in the opposite ear with the same pattern of progression as in category I. Three other subgroups with LFSHI and flat/sloping audiogram in the opposite ear and asymmetrical LFSHI also showed the same type of progression in the ear with LFSHI as in category I. A prevalence of 0.18/1,000 (95 per cent CI 0.13-0.22) of LFSHI was estimated based on the background population with a fairly constant prevalence throughout life. It is concluded that inherited nonsyndromal LFSHI is a rare disease and that the many different phenotypes of LFSHI probably are associated with pronounced genetic heterogeneity.

Folic Acid and Homocyst(e)ine Metabolic Defects and the Risk of Placental Abruption, Pre-eclampsia and Spontaneous Pregnancy Loss: A Systematic Review

Placental infarction or abruption, recurrent pregnancy loss and pre-eclampsia are thought to arise due to defects within the placental vascular bed. Deficiencies of vitamin B12 and folate, or other abnormalities within the methionine-homocyst(e)ine pathway have been implicated in the development of such placental diseases. We conducted a systematic literature review to quantify the risk of placental disease in the presence of these metabolic defects.Studies were identified through OVID Medline between 1966 and February 1999. Terms relating to the measurement of vitamin B12, folic acid, methylenetetrahydrofolate reductase or homocyst(e)ine were combined with those of pre-eclampsia, placental abruption/infarction or spontaneous and habitual abortion. Human studies comprising both cases and controls and published in the English language were accepted. Their references were explored for other publications.Data were abstracted on the matching of cases with controls, the mean levels of folate, B12 or homocyst(e)ine in each group or the frequency of the homozygous state for the thermolabile variant of methylenetetrahydrofolate reductase. The definition of ‘abnormal’ for each exposure was noted and the presence or absence of the exposure of interest for each outcome was calculated as an absolute rate with a 95 per cent confidence interval. The crude odds ratios were calculated for each study and then pooled using a random effects model.Eighteen studies were finally included. Eight studies examined the risk of placental abruption/infarction in the presence of vitamin B12 or folate deficiency, or hyperhomocyst(e)inaemia. Folate deficiency was a prominent risk factor for placental abruption/infarction among four studies, though not statistically significant (pooled odds ratio 25.9, 95 per cent CI 0.9–736.3). Hyperhomocyst(e)inaemia was also associated with placental abruption/infarction both without (pooled odds ratio 5.3, 95 per cent CI 1.8–15.9) and with methionine loading (pooled odds ratio 4.2, 95 per cent CI 1.2–15.0), as was the homozygous state for methylenetetrahydrofolate reductase (pooled odds ratio 2.3, 95 per cent CI 1.1–4.9). Vitamin B12 deficiency was not a demonstrable risk factor.Eight studies examined blood levels among women with spontaneous abortion or recurrent pregnancy loss. The pooled odds ratios were 3.4 (95 per cent CI 1.2–9.9) for folate deficiency, 3.7 (95 per cent CI 0.96–16.5) for hyperhomocyst(e)inaemia following methionine challenge, and 3.3 (95 per cent CI 1.2–9.2) for the methylenetetrahydrofolate reductase mutation.Five case-control studies examined the relationship between pre-eclampsia and abnormal levels of vitamin B12, folate, homocyst(e)ine or methylenetetrahydrofolate reductase. Folate deficiency was not an associated risk factor (odds ratio 1.2, 95 per cent CI 0.5–2.7), but hyper-homocyst(e)inaemia was (pooled odds ratio 20.9, 95 per cent CI 3.6–121.6). Similarly, homozygosity for the methylenetetrahydrofolate reductase thermolabile variant was associated with a moderate risk of preeclampsia (odds ratio 2.6, 95 per cent CI 1.4–5.1). Some pooled data were associated with significant statistical heterogeneity, however.There is a general agreement among several observational studies that folate deficiency, hyperhomocyst(e)inaemia and homozygosity for the methylenetetrahydrofolate reductase thermolabile variant are probable risk factors for placenta-mediated diseases, such as pre-eclampsia, spontaneous abortion and placental abruption. Vitamin B12 deficiency is less well defined as an important risk factor. Due to the limited quality of these data, including insufficient matching of cases with controls, and possible laboratory measurement bias relating to pregnancy, prospective studies are needed to confirm these findings and guide future preventative and therapeutic research.

Diagnosis of bovine brucellosis by skin test: conditions for the test and evaluation of its performance

Brucellergene OCB (Rhône-Mérieux) was used as an allergen to define the intrinsic parameters of a skin test and to compare its properties with serology for the diagnosis of bovine brucellosis....

Predictors of breastfeeding in very low birthweight infants at the time of discharge from hospital.

In a case-control study carried out in the Kuala Lumpur Maternity Hospital between 1st July 1995 and 31st January 1996 the objectives were (1) to determine the rate of breastfeeding in surviving very low birthweight (VLBW, < or = 1500 g) Malaysian infants following the introduction of the Baby Friendly Hospital Concept, and (2) to identify significant predictors associated with successful breastfeeding in these infants. During the study period, 201 (1.24 per cent) of live-born infants were VLBW infants, 192 (95.5 per cent) were Malaysians, and 141 (73.4 per cent) of them survived to go home. The breastfeeding rate among all surviving VLBW Malaysian infants at the time of discharge was 40.2 per cent (57/141). The mothers of 126 (89.4 per cent) VLBW Malaysian infants were interviewed before discharge. Logistic regression analysis showed that, after controlling for various confounders, the significant predictors associated with successful breastfeeding were: (a) Malay mothers (odds ratio: 6.0; 95 per cent CI: 1.9, 19.4), (b) mothers with educational levels of between 7 and 9 years (odds ratio: 3.6; 95 per cent CI: 1.0, 12.2), and (c) earlier age of commencement of enteral feeds in the VLBW infants (for each additional day delay in commencement of feeding, odds ratio of breastfeeding was 0.5; 95 per cent CI: 0.4, 0.8).

Congenital anterior abdominal wall defects in the north of England, 1986-1996: occurrence and outcome.

The aim was to describe trends in prevalence, maternal age-specific prevalence, associated anomalies, clinical outcomes and the sensitivity of antenatal diagnosis of congenital anterior abdominal wall defects (in particular gastroschisis and exomphalos). Data were identified from a population-based register of major congenital abnormalities in the Northern health region of England, the Northern Congenital Abnormality Survey (NorCAS), between 1986 and 1996. 296 cases were notified; there were 133 cases of gastroschisis, 98 exomphalos, 30 limb-body wall defects and 23 other anterior abdominal wall defects. 12 cases could not be classified. In 19 (6 per cent) the initial diagnosis was changed following case review. 30 (30.6 per cent) cases of exomphalos were associated with a chromosomal anomaly compared with 1 (0.8 per cent) case of gastroschisis. The total prevalence for the 11 years was 6.33 (95 per cent CI=5.57-7.08) per 10 000 live births, still births and terminations of pregnancy, and the overall birth prevalence was 4.30 (95 per cent CI=3.68-4.93) per 10 000 live births and still births. For gastroschisis, there was a significant increase over the study period in both the total prevalence (1.48 in 1986 to 5.29 per 10 000 in 1996; chi(2)=8.41, p=0.00433) and the birth prevalence (1.48 in 1986 to 4.72 per 10 000 in 1996; chi(2)=7.42, p=0.00644), but there was no such significant increase for exomphalos (total prevalence chi(2)=2.29, p=0.13055; birth prevalence chi(2)=0.16, p=0.69348). The maternal age-specific prevalence was highest in the 11-19 year age group for gastroschisis but in the 35-39 year age group for exomphalos. Fewer pregnancies with gastroschisis resulted in a termination and a greater proportion of cases were alive at one year compared with exomphalos. The sensitivity of abnormality detection by ultrasonography was 75 per cent and 77.3 per cent for gastroschisis and exomphalos, respectively. Antenatal diagnosis improved from 47.4 per cent during 1986-91 to 80 per cent between 1992-96 for gastroschisis (chi(2)=5.7, p=0.00169), and from 55.6 per cent to 68.8 per cent for isolated exomphalos, although this increase was not significant. Total and birth prevalence of gastroschisis increased in the Northern region between 1986 and 1996. For exomphalos, there was a trend towards an increase in total prevalence and towards a decrease in birth prevalence. This decreasing trend has been accompanied by improvements in antenatal detection and subsequent termination of cases of exomphalos associated with other anomalies.

A study of cardiovascular disease, depression and antidepressants on a computerised general practice database

Previous evidence suggests there is an association between cardiovascular disease and depression. Tricyclic antidepressants (TCAs) are contraindicated in patients with a recent history of cardiovascular disease. 5678 patients between the ages of 50 and 79 years and with a new acute cardiac event were selected from a computerised general practice database and followed up for one year. ‘New episodes’ of diagnosed depression were identified and treatment with antidepressants was investigated. 183 656 patients aged 50–79 years without a cardiac event were used for comparison. A significant association was found between cardiovascular disease and a new diagnosis of depression (adjusted OR=2.23, 95 per cent CI 1.90–2.62). Patients who had suffered a recent cardiac event were less likely to be prescribed a TCA than an SSRI (adjusted OR=0.59, 95 per cent CI 0.41–0.85). However, 35 per cent of patients with a recent cardiac event were initially prescribed a TCA. The findings indicate that general practitioners recognise the dangers of prescribing TCAs to patients with a recent history of cardiovascular disease. However, a substantial minority of cardiac patients were prescribed TCAs where they may not have been the optimal choice. Copyright © 1999 John Wiley & Sons, Ltd.

Is the AIDS incubation time changing? A back-calculation approach.

Contradictory literature was recently published on possible changes in AIDS incubation time over the period 1978-1994. The purpose of this work was to test if a change in incubation time (shortening or lengthening) was observed in France, either globally or in specific transmission groups (homosexual-bisexual men, heterosexual subjects), using a back-calculation approach. An age dependent TSI model (time since infection), which took into account a temporary treatment effect and allowed us to test for a change in the incubation time, was applied to the French AIDS cases (Réseau National de Santé Publique). The EM algorithm was used to maximize the likelihood and the best model was selected on the basis of the likelihood ratio statistic. The analysis on all AIDS cases indicated a shortening of the AIDS incubation time estimated to begin in 1983 (95 per cent CI 1982-1984). This shortening of incubation time was also apparent when analysis was restricted to homosexual-bisexual men and to heterosexual subjects. This shortening corresponded to a median incubation time of 9.6 years (95 per cent CI 8.1-10.5) for people infected at 30 years of age in 1983, versus 12.7 years for people infected at 30 years of age before the change.

Impact of prematurity on admissions to the neonatal nursery of a rural South African district hospital.

The objectives of this study were to determine causes of admission to a district hospital neonatal nursery; to describe outcomes; and to determine risk factors for these outcomes. The study was based at the neonatal nursery of Hlabisa hospital, KwaZulu/Natal; 149 consecutive admissions to the nursery between May and November 1995 were audited. The main outcome measures were diagnosis, gestational age, birthweight, critical event during admission (sepsis, severe vomiting, diarrhoea, jaundice, fits, apnoea), and outcome (discharged alive, death, discharged with deficit). Most admitted neonates (73; 54 per cent) were aged less than 37 weeks at birth, and 123 (84 per cent) weighed less than 2.5 kg. Prematurity and low birthweight accounted for 114 (81 per cent) admissions. In all, 58 (39 per cent) neonates experienced a total of 72 critical events, the most frequent being sepsis (39; 54 per cent). Although most (114; 77 per cent) were discharged well, 20 (15 per cent) died and three (3 per cent) were discharged with a significant deficit. Sepsis and apnoea were most frequent among the lightest and most immature babies, while fits were more frequent among heavier, mature babies. In a multivariate model, experiencing any critical event (odds ratio [OR] 15.6; 95 per cent CI 3.0-82.6, p = 0.001) was the only significant independent risk factor for mortality, although birthweight (p = 0.068) and gestational age (26-30 vs. > or = 37 weeks; OR 5.6, 95 per cent confidence internal [CI] 0.3-95.7, p = 0.23), further contributed to risk of death. We conclude that a substantial proportion (around 27 per cent) of district perinatal mortality occurs in the neonatal nursery. Several simple and effective interventions exist to minimize neonatal loss in district hospitals in South Africa.

Fetal loss in Down syndrome pregnancies

It is recognized that pregnancies with Down syndrome are liable to end in spontaneous fetal loss. It is important to determine the magnitude of this effect so that it can be taken into account when assessing the results of antenatal screening programmes for Down syndrome. Failure to do so will tend to overestimate the detection rate in intervention studies in which the screening results are used to identify women for a diagnostic test and the offer of a termination of pregnancy if indicated. We present new data on the spontaneous fetal loss in Down syndrome pregnancies from the National Down Syndrome Cytogenetic Register (1989-1996). We compare our results with published results of other studies on the subject to obtain a summary estimate. We exclude one study from the meta analysis due to incorrect methodology resulting in an overestimate of fetal loss. Based on the combined data (i) between the time of chorionic villus sampling and term an estimated 43 per cent (95 per cent CI: 31-54 per cent) of pregnancies ended in a miscarriage or still birth, (ii) between the time of amniocentesis and term an estimated 23 per cent (95 per cent CI: 19 28 per cent) of pregnancies ended in a miscarriage or still birth, and (iii) 12 per cent (95 per cent CI: 2-23 per cent) of births were stillborn or resulted in a neonatal death.

Results of non-selective adrenocorticolysis by O,p'-DDD in 129 dogs with pituitary-dependent hyperadrenocorticism

One hundred and twenty-nine dogs with pituitary-dependent hyperadrenocorticism were treated according to a protocol aimed at the complete destruction of the adrenal cortices by the administration of O,p'-DDD (mitotane) at...

Assaying the granulocyte-macrophage colony-stimulating factor (GM-CSF) as a mitogen of immature cells in fetal blood cultures

Based on the presence of immature cells in fetal blood, and in an attempt to shorten the cytogenetic reporting time, three simultaneous one-day culture regimes were established in 23 fetal blood samples: (a) the standard phytohemagglutinin (PHA)-stimulated lymphocytes culture, (b) a culture using the granulocyte-macrophage colony-stimulating factor (GM-CSF) as an alternative mitogen, and (c) an unstimulated culture. Diagnostic success rates achieved by these three methods were as follows: 43 per cent (95 per cent CI: 23-64) (GM-CSF), 30 per cent (95 per cent CI: 12-49) (PHA) and 9 per cent (unstimulated). These three regimes were also assayed in three-day cultures giving 100 per cent diagnostic success rate for the PHA and GM-CSF, and 62 per cent (95 per cent CI: 41-83) for the unstimulated. A moderate correlation was found between the initial concentration of cultured erythroblasts and the metaphase count in one-day GM-CSF-stimulated (r=0.43, p=0.01) and unstimulated (r=0.35, p=0.05) cultures, suggesting that erythroblasts may be in part responsible for the mitotic index observed in these two regime cultures. In conclusion, our experience suggests that immature cells in fetal blood may be successfully cultured for diagnostic purposes.

Assaying the granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) as a mitogen of immature cells in fetal blood cultures

Based on the presence of immature cells in fetal blood, and in an attempt to shorten the cytogenetic reporting time, three simultaneous one-day culture regimes were established in 23 fetal blood samples: (a) the standard phytohemagglutinin (PHA)-stimulated lymphocytes culture, (b) a culture using the granulocyte-macrophage colony-stimulating factor (GM-CSF) as an alternative mitogen, and (c) an unstimulated culture. Diagnostic success rates achieved by these three methods were as follows: 43 per cent (95 per cent CI: 23–64) (GM-CSF), 30 per cent (95 per cent CI: 12–49) (PHA) and 9 per cent (unstimulated). These three regimes were also assayed in three-day cultures giving 100 per cent diagnostic success rate for the PHA and GM-CSF, and 62 per cent (95 per cent CI: 41–83) for the unstimulated. A moderate correlation was found between the initial concentration of cultured erythroblasts and the metaphase count in one-day GM-CSF-stimulated (r=0·43, p=0·01) and unstimulated (r=0·35, p=0·05) cultures, suggesting that erythroblasts may be in part responsible for the mitotic index observed in these two regime cultures. In conclusion, our experience suggests that immature cells in fetal blood may be successfully cultured for diagnostic purposes. Copyright © 1999 John Wiley & Sons, Ltd.

Secular changes in rates of respiratory complications and diarrhoea among measles cases

It has been observed that the occurrence of respiratory complications and diarrhoea among measles cases has changed over time but this change has not been quantified. A study was carried out in the city of Gweru, Zimbabwe, to quantify these changes. Rates of respiratory complications and diarrhoea among measles cases were determined in each year for the period 1968-89. It was found that mean rates of respiratory complications and diarrhoea during 1968-78 were 17.2 per cent (95 per cent CI = 11.6-22.8) and 5.2 per cent (95 per cent CI = 0-11) respectively while during 1979-89, mean rates of respiratory complications and diarrhoea were 6.5 per cent (95 per cent CI = 1-12.1) and 16.4 per cent (95 per cent CI = 10.1-22.0) respectively. Analysis of variance (ANOVA) to determine the main effects and the interaction showed that the main effects were not statistically significant (F = 0.01, d.f.1,2 = 1,40, p = 0.935; and F = 0.13, d.f.1,2 = 1,40, p = 0.725 respectively) Meanwhile the interaction term of complications and period was statistically significant (F = 15.7, d.f.1,2 = 1,40, p < 0.001). It was concluded that a change in rates of respiratory complications and diarrhoea had occurred among measles cases. It is suggested that the increase in vaccination coverage in 1979-89 and the shift in age at infection to older age groups in the same period may have brought about this change through selective suppression of respiratory complications among measles cases.

Epidemiologic consequences of moderate coverage levels of measles vaccine in a district headquarter town (Alwar) in India, 1996.

This paper describes the epidemiology of measles in a medium size town (population 240,000) in India where vaccine coverage levels have remained constant at around 70 per cent in the past 7 years. A retrospective community survey covering 4023 children under 10 years old detected 252 cases of measles in the previous year. This gave an annual incidence of 6.3 per cent (95 per cent CI 5.5-7). About half of the cases occurred in vaccinated children. Only 5 per cent of the cases occurred in children below 9 months of age. This age is appropriate for routine measles immunization. Despite modest coverage levels with only 54 per cent effective vaccine (estimated by a screening method), there was a modest upward shift in the age distribution of measles cases; the median age was more than 48 months.

Iodine deficiency disorders among school children in upper Egypt: an epidemiologic study

Iodine deficiency disorders (IDD) are the world's single most significant cause of preventable brain damage and mental retardation. Data regarding IDD in upper Egypt are scarce and even lacking. The aim of the present work was to study the prevalence of IDD and some potential risk factors in upper Egypt. Using a two-stage cluster sampling technique, 6750 school children aged 8-10 years were screened for IDD through clinical examination of the thyroid gland and determination of urinary iodine, from three governorates in upper Egypt, namely Al-Minya (population of 3.3 million), Assyut (population of 2.9 million), and Suhag (population of 3.1 million). Iodine was determined in samples of soil and drinking water. Overall, the prevalence rate of goitre was 34.6 per cent. The median urinary iodine level for children with goitre was 5.04 micrograms/dl compared to 14.81 micrograms/dl among children free of goitre. Multiple logistic regression analysis showed that certain groups of school children were much more likely to develop goitre. They included females (OR = 3.07, 95 per cent CI = 2.78-3.39), children in households where drinking water had an iodine content of less than 0.5 microgram/100 ml (OR = 3.44, 95 per cent CI = 3.09-3.89), and children living in places where soil content of iodine was less than 0.2 microgram/100 g (OR = 2.67, 95 per cent CI = 2.30-3.10). We conclude that IDD is a severe public health problem in upper Egypt. The present situation in upper Egypt necessitates an urgent intervention programme.

Treatment of indolent lymphoma with fludarabine/mitoxantrone combination: a phase II trial

In an effort to reduce the risk of opportunistic infections, 25 patients with advanced indolent lymphoma (age range: 30–77 years) were treated, using a combination of fludarabine and mitoxantrone, without corticosteroids. Fludarabine was given at 25 mg/m2 for three daily doses, and mitoxantrone at 10 mg/m2. Cycles were repeated every four weeks for up to maximum response, and for no more than six months. Eight patients had follicular lymphoma, and 11 had CLL/SLL. Objective response was observed in 11 of 12 previously untreated patients, including five complete remissions, and in 10 of 13 previously treated patients, including three complete remissions. Only two relapsed patients failed to respond, whereas two patients were not evaluable. Hence, the overall response rate based on the intention-to-treat analysis was 84 per cent (95 per cent CI: 70–98 per cent). The median survival has not been reached after a 22-month follow-up. Median time to progression was 15 months. One patient on corticosteroids developed pneumocystis carinii pneumonia, and an elderly patient succumbed to neutropenic sepsis. Apart from granulocytopenia, the treatment was well tolerated. Omission of corticosteroids reduces the risk of opportunistic infections, while the activity of the combination against indolent lymphoma and CLL is maintained. Copyright © 1998 John Wiley & Sons, Ltd.

Eating disorder and type 1 diabetes: overview and summing-up

The subject of concurrent eating disorder (ED) and insulin-dependent diabetes mellitus (IDDM) has attracted considerable attention for more than a decade. This paper is the first attempt at a quantitative summary of this field. Uncontrolled studies and anecdotal reports suggest an increase of ED in IDDM patients, and also an increase of IDDM in ED patients. Reviews and case reports underscore the difficulty of treating patients with both disorders, the early occurrence of neurovascular complications in these patients and the need for controlled studies. Meta-analysis of five controlled studies do not support an hypothesis of increased risk of ED in female IDDM patients for any type of ED: (anorexia nervosa, AN; bulimia nervosa, BN; unspecified or subclinical ED, ED-NOS). Findings from register studies do not support an hypothesis of increased occurrence of IDDM in female AN-patients. An hypothesis of increased risk of retinopathy is supported by two controlled studies. The interest in concurrent ED and IDDM is thus not justified by any increase in concurrence, but in the early occurrence of clinically significant retinopathy (OR 8·04; 95 per cent CI 4·0–16·1), and other diabetic complications. The existing studies do not seem to have taken full advantage of existing diabetes-specific knowledge, whereas knowledge related to the eating disorders are fully incorporated. Future epidemiological studies should be cause-seeking rather than merely descriptive. These studies should try to relate risk factors, protective factors and specific risk behaviours with health outcome i.e. complications and mortality. © 1998 John Wiley & Sons, Ltd and Eating Disorders Association.