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Glycosylated haemoglobin, HbA1c, is used in patients with diabetes to evaluate long term control of the disease. HbA1c is the result of non-enzymatic addition of a glucose residue to one or both N-terminal valines of the haemoglobin B chains. This is commonly measured by ion exchange HPLC and expressed as a percentage of total haemoglobin. In this report we describe how the presence of abnormal haemoglobin variants haemoglobinopathies ; can produce erroneous results. A 30 year old female with a history of diabetes presented for routine testing. HbA1c assay with the Bio-Rad Variant II HPLC method revealed an unknown peak in the pre-A area. Review of the patient's results showed a consistently high haemoglobin, MCV and PCV, suggesting the possibility of a high affinity haemoglobin variant. Further HPLC analysis showed a peak poorly resolved from A but not identifiable. Electrophoresis suggested Hb J Calabria. Sequencing of the beta globin gene revealed a single base change at nucleotide 324 g324G A ; that results in a Glycine to Aspartic acid substitution at codon 64. This result confirmed the abnormal haemoglobin to be Hb J-Calabria. The increased use of HbA1c measurement has resulted in the identification of an increasing number of individuals with haemoglobinopathies, many of which are haematologically silent. The principle clinical problem in these cases is the invalidation of the HbA1c result if recognised ; and difficulty in managing the patient using the DCCT guidelines.
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Bylund, J. Tahmatzopoulos, A. and Kyprianou, N. Growth Factor Signaling Pathways Regulating Prostate Growth in "Prostate Cancer: Principles and Practice" Editors, Partin, A. Kirby, R., et al ; 2006, Taylor and Francis, Oxford, pp 91-101. Zhu, B. and Kyprianou, N. Transforming growth factor- and cancer; in the "Molecular and Cellular Basis of Cancer"; The Cancer Textbook, Editor, Alison, M.R. ; 2007, Ch. 22, pp257-271.
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316: 1336-134 view this article via: crossref pubmed scott et al 200 a genome-wide association study of type 2 diabetes in finns detects multiple susceptibility variants.
Derikx PJ, Simons FH, OP Den Camp HJ, et al. 1991. Evolution of volatile sulfur compounds during laboratory-scale incubations and indoor preparation of compost used as a substrate in mushroom cultivation. Appl Environ Microbial 57 2 ; : 563-567. * DeRouck A, DeLaey JJ, Van Hoorne M, et al. 1986. Chronic carbon disulfide poisoning: A 4-year follow-up study of the ophthalmological signs. Int Ophthalmol 9: 17-28. * Dietzmann K, Laass W. 1977. Histological and histochemical studies on the rat brain under conditions of carbon disulfide intoxication. Exp Pathol 13: 320-327. * Djerassi LS, Lumbroso R. 1968. Carbon disulphide poisoning with increased ethereal sulphate excretion. Br J Ind Med 25: 220-222. * Djuric D. 1967. Determination of carbon disulphide and its metabolites in biological material. In: Brieger H, Teisinger J, eds. Toxicology of Carbon Disulfide. Amsterdam, The Netherlands: Excerpta Medica Foundation, 52-61. * Djuric D. 1971. Antabuse, carbon disulfide, and ethyl alcohol metabolism. Arh Hig Rada Toksikol 22: 171-177. Djuric D. 1991. Predisposition in exposure to carbon disulfide. In: "Ecogenetics: Genetic predisposition to the toxic effects of chemicals, " Grandjean P, ed. Chapman & Hall, Regional Office for Europe 193-203. * Djuric D, Postic-Grujin A, Graovac-Leposavic L, et al. 1973. Antabues as an indicator of human susceptibility to carbon disulfide: Excretion of diethyldithiocarbamate sodium in the urine of workers exposed to CS2 after oral administration of disulfiram. Arch Environ Health 26: 287-289. Djuric D, Stojadinovic LZ, Bojovic V, et al. 1967. Excretion of zinc in the urine of persons exposed to carbon disulfide. In: Brieger H, Teisinger J, eds. Toxicology of Carbon Disulfide. Amsterdam, The Netherlands: Excerpta Medica Foundation, 118-221. DOC. 1973. Selected specific rates of reactions of transients from water in aqueous solution: 1. Hydrated electron. U.S. Department of Commerce, National Bureau of Standards. NSRDS-NBS 43. DOC. 1977. Reaction rate and photochemical data for atmospheric chemistry-1977. Hampson RF Jr, Garvin D, eds. U.S. Department of Commerce, National Bureau of Standards, National Measurement Laboratory, Washington, DC, 107. * DOD. 1991. Comparison of headspace gas chromatography with EPA SW-846 method 8240 for determination of volatile organic compounds in soil. Aberdeen Proving Ground, MD: U.S. Army Toxic and Hazardous Materials Agency. U.S. Department of the Army. CETHA-TE-CR-91009. * Dormer M, Falck K, Hemminiki K, et al. 1981. Carbon disulfide is not mutagenic is bacteria or drosophila. Mutat Res 9 1: 163-166 and zerit.
Our study has several important limitations that should be recognized. 1 ; The study population is predominantly an older group of male veterans and might not be representative of other populations. For example, previous reports of ACE inhibitor cough have emphasized a striking female predomi nance. 9'12-15'16 The reasons for this female predomi nance are not well explained, but may represent an unwillingness of males spontaneously to report symp toms to their physicians. 2 ; Our information was based strictly on patient self-reporting of both the presence or absence of cough and whether the patient's physician had previously diagnosed a confounding condition such as COPD or congestive heart failure. Our study methods might explain the higher preva lence of cough when our results are compared with those of previously published reports. 3 ; Because this is a cross-sectional survey, no inferences can be made about the relationship between starting medication and the development of cough. Data on the resolution of cough symptoms with discontinuation of medication and recurrence on re-challenge is not available from our questionnaire. Other reports have shown that this relationship exists.9'13'18-21-22 IMPORTANCE For several reasons, it is important for clinicians to recognize that a patient's cough may be a side effect of ACE inhibitors. First, failure to recognize the possible relationship between a patient's respiratory symptoms and ACE inhibitor use may lead to unnec essary investigations. The patients described in pub lished case reports and case series have had various combinations of diagnostic tests: chest x-ray films, sputum cultures, pulmonary function tests including bronchoprovocation with methacholine, allergy eval uations, ENT consultation, and in one case fiberoptic bronchoscopy. Second, empiric treatments such as antitussives, bronchodilators and antibiotics are inef fective; patients may obtain relief from their cough only if its relationship to the offending drug is recog nized and the ACE inhibitor is discontinued. Third, in patients with congestive heart failure, cough may be misinterpreted as a sign of worsening failure. It may be particularly difficult to determine the exact etiology of cough in these patients. If the cough is related to use of the medication, then increasing the dose of ACE inhibitors will not help the cough and might increase the chance of other dose-related side effects. On the other hand, stopping these afterload.
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Susceptible to modulation by specific drugs. Additionally, it has been recently demonstrated that administration of the relatively selective copper chelator iV, N-diethyldithiocarbamate or its disulfide dimer, disulfiram Antabue ; , produces a dose-dependent increase in glycine-extended immature forms of Lu-melanocyte-stimulating hormone and of joining peptide in the intermediate pituitary and in cultured mouse corticotrophic tumor cells, via inhibition of peptidylglycine cy-amidating monooxygenase activity 12 ; . However, the effects of inhibitors of amidation on neuropeptide expression within the CNS have not been previously reported. The analysis of COOH-terminal extended immature forms of SP may serve as a sensitive indicator of biosynthetic and posttranslational processing events in SP-containing neural systems. Previous work from this laboratory has provided an immunochemical and chromatographic characterization of the unamidated immediate precursor form to SP, i.e. SP-GLI, by combined RIA-HPLC analyses of rodent nervous tissues, utilizing highly specific and sensitive anti-SP-G sera 5, 13 ; . In the present study, we have examined the effects of disulfiram administration on several neurochemical parameters in mouse CNS, including levels of SP-LI, SP-G-LI.
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UNDERSTANDING INSOMNIA FROM THE PATIENT'S PERSPECTIVE: A VIEW FROM MEDICAL ANTHROPOLOGY Rosenthal L, 2 Henry D, 1 Dedrick D, 3 McClellen D, 1 Gosdin M1 1 ; Anthropology, University of North Texas, Denton, TX, USA, 2 ; Sleep Medical Associates of Texas, Dallas, TX, USA, 3 ; St. Charles High Desert Sleep Disorders Clinic, Bend, OR, USA Introduction : The elicitation of patient "explanatory models" for chronic illnesses has revealed important insight into socially constructed patient beliefs about illness etiology, expected course, and patient compliance with medically prescribed treatment. Such consideration has not heretofore been given, however, to insomnia. We will present data from a qualitative, exploratory anthropological study of a cross-sectional cohort of insomnia patients. Methods : Patients clinically presenting with chronic insomnia were recruited by physicians at two different locations and offered participation in the study. A medical anthropologist then arranged in-depth, semi-structured, qualitative interviews in the patient homes, in order to make observation of the sleeping environment n 24 ; . Interviews were recorded, transcribed, and coded with the qualitative software package Atlas Ti. Content analysis followed standard inductive strategies, allowing emic patterns to emerge from the data independent of predetermined analytical approaches in order to provide an understanding of how participants identify and organize factors related to their insomnia. A content coding system was developed in which words or themes are coded according to their contextual significance. Relationships between categories were examined, as were trends that emerged across sub-groups. Results : Only 30% of chronic insomniacs interviewed understood the!
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Miller, P.M., and Hersen, M. "Modification of Marital Interaction Patterns Between an Alcoholic and His Wife." Jackson, MS: University of Mississippi Medical Center, 1975. National Academy of Sciences; Institute of Medicine. Broadening the Base of Treatment for Alcohol Problems. Washington, DC: National Academy Press, 1990. National Institute on Alcohol Abuse and Alcoholism. Alcohol and Health. Seventh Special Report to the U.S. Congress. DHHS Publication No. ADM ; 90-1656. Washington, DC: Supt. of Docs., U.S. Govt. Print Off., 1990. O'Farrell, T.J. A behavioral marital therapy couples group program for alcoholics and their spouses. In: O'Farrell, T.J., ed. Treating Alcohol Problems: Marital and Family Interventions. New York: Guilford Press, 1993a. O'Farrell, T.J., ed. Treating Alcohol Problems: Marital and Family Interventions. New York: Guilford, 1993b. O'Farrell, T.J., and Bayog, R.D. Antabyse contracts for married alcoholics and their spouses: A method to insure Antabuse taking and decrease conflict about alcohol. J Subst Abuse Treat 3: 1-8, 1986. O'Farrell, T.J.; Choquette, K.A.; Cutter, H.S.G.; Brown, E.D.; and McCourt, W.F. Behavioral marital therapy with and without additional relapse prevention sessions for alcoholics and their wives. J Stud Alcohol 54: 652-666, 1993. O'Farrell, T.J.; Cutter, H.S.G.; Choquette, K.A.; Floyd, F.J.; and Bayog, R.D. Behavioral marital therapy for male alcoholics: Marital and drinking adjustment during the two years after treatment. Behav Ther 23: 529-549, 1992. O'Farrell, T.J.; Cutter, H.S.G.; and Floyd, F.J. Evaluating behavioral marital therapy for male alcoholics: Effects on marital adjustment and communication from before to after therapy. Behav Ther 16: 147-167, 1985. Robichaud, C.; Strickler, D.; Bigelow, G.; and Liebson, I. Disulfiram maintenance employee alcoholism treatment: A three-phase evaluation. Behav Res Ther 17: 618-621, 1979. Sereny, G.; Sharma, V., Holt, J.; and Gordis, E. Mandatory supervised Antabuse therapy in an outpatient alcoholism program: A pilot study. Alcohol Clin Exp Res 10: 290-292, 1986. Wilson, A.; Blanchard, R.; Davidson, W.; McRae, L.; and Maini, K. Disulfiram implantation: A dose response trial. J Clin Psychiatry 45: 242-247, 1984. World Health Organization: Alcohol-Related Disabilities. WHO Offset Publication No. 32. Geneva: World Health Organization, 1977.
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Due deliberation, it is my determination that the individual's access authorization should not be restored since I unable to conclude that such restoration would not endanger the common defense and security and would be clearly consistent with the national interest. 10 C.F.R. 710.27 d ; . The specific findings that I make in support of this determination are discussed below. A. Criteria H & J; Mental Condition Alcohol Use 1. Derogatory Information In his report to DOE, the DOE Psychiatrist diagnosed the individual with Alcohol-Related Disorder, Not Otherwise Specified NOS ; under criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition DSM-IV ; .3 In explaining his diagnosis, the DOE Psychiatrist states in his report: "[The individual] does have a history of alcohol abuse, and there have been some remissions from this [The individual] continues to use alcohol despite a history of problems affecting his dealings with others, and having had problems with the law. He also continued to drink notwithstanding the risk of jeopardizing his security clearance. [The individual] is particularly vulnerable to decompensations with alcohol. In the past, when faced with stressors, his drinking has materially increased." Exh. 10 at 6-7. The DOE Psychiatrist further opined that the individual "has a significant defect in judgment by continuing to drink notwithstanding the difficulties he has had in the past." Id. at 7. These past difficulties include two arrests for DUI, in 1985 and 1992, incidents of domestic violence in 1994, and the individual resorting to Antabuse in 1998-99 to control his binge drinking. The DOE Psychiatrist further elaborated at the hearing that at the time the individual sought treatment in 1994, he clearly met the DSM-IV criteria for Alcohol Abuse. Tr. at 58. The DOE Psychiatrist believes that the individual "achieved rehabilitation and reformation at least to an extent" during the nearly three-year period, from 1994 to 1997, when the individual underwent group counseling and remained abstinent. Tr. at 60. However, the DOE Psychiatrist observed that upon resuming drinking in 1997, the individual relapsed into habitual binge drinking when under stress, leading the individualto resort to Antabuse in 1998. Tr. at 190. Thus the DOE Psychiatrist explained that the individual's decision to resume drinking in 1999 reflected poor judgment: "It's like having developed allergic reactions to a certain substance. And subsequently, common sense and logic dictate that you don't expose yourself to that substance anymore. And in the case of [the individual], he is putting himself at risk by getting exposed to a substance that has caused him problems in the past." Tr. at and kytril.
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Can elderly with psychological problems still change meaningfully? With this important question this symposium deals. The answer is a clear "yes". In fact, cognitivebehavioral therapy is a powerful asset for this purpose. As a result of this therapy, elderly will start to think, feel and act differently. This doesn't apply only to the well-educated "young-elderly", but also to very old, frail elderly with cognitive deficits. This form of therapy is widely applicable, well teachable, and suitable for use by different disciplines, amongst which nursing staff and caregivers. In this symposium, different aspects of cognitive-behavioral therapy will be presented by four psychologists, three cognitive-behavioral therapists and one clinical neuropsychologist. This will be done in four separate presentations. Mrs. I. J. C. Ingrid ; Weijnen, drs.: "It must be "C". Individual cognitive-behavioral therapy. How does individual support and treatment work? Mrs. A. C. G. Corry ; Linssen, Ph. D.: Learning with peers. Group therapy. In which way is cognitive-behavioral therapy applicable to groups of elderly? R. W. H. Rudolf ; Ponds, PhD: Psychological treatment of age-related memory problems. Psychoeducation for functional memory complaints and phobia about forgetting. Research and clinical implications. A. F. M. Teun ; Hamer, drs.: Nursing staff behavioral training. What are the possibilities to influence behavior through the "nursing-environment" Focus will be on the way nurses and caregivers can be involved in treatment. This symposium will clarify the application of current possibilities in clinical practice. The contributions will cover most domains of psychogeriatric care.
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