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Research conducted by a team led by Dr. Miettinen of the University of Kuopio, Finland has shown that clinical proteinuria is a predictor for stroke, as well as for serious coronary heart disease. The team followed 1,375 nondiabetic and 1,056 diabetic men and women for 7 years. The incidence of stroke was 1.6% in nondiabetic subjects without proteinuria - less than 150 mg/L, 3.2% in subjects with borderline proteinuria - 150 to 300 mg/L, and 8.5% in subjects with clinical proteinuria greater than 300 mg/L. Similar findings, for the most part, emerged in the non-insulin-dependent diabetics, for whom the incidence of stroke in those without proteinuria was 7.2%; in those with borderline proteinuria, 11.1%; and in diabetics with clinical proteinuria, 23%. (Source: Stroke November 1996;27:2033-2039)
Millennium Pharmaceuticals Inc., Cambridge, MA has announced that researchers have identified a gene implicated in the development of type II diabetes. Millenium is conducting this research in cooperation with Hoffman-La Roche Inc, U.S.
Research performed at the University of Utah School of Medicine has found that pregnant women who carry the factor V Leiden mutation are at increased risk for severe preeclampsia. They followed 158 pregnant women with severe preeclampsia and 403 normal pregnant women and found that 14 of the 158 women with severe preeclampsia (8.9%) were heterozygous for the Leiden mutation compared with 17 of 403 normotensive gravid controls (4.2%). (Source: American Journal of Obstetrics and Gynecology, November 1996;175:902-905)
A group of physicians in Brescia, Italy, have performed a successful bone-marrow transplant on a 20-week-old fetus. The patient was a woman who had already lost one son with X-linked severe combined and learned that her second child was also affected. The physicians took bone marrow from the father and injected it into the peritoneum of the fetus, with the expectation that the immature fetal immune system would probably not mount a rejection response. The infant was delivered by cesarean section and has remained disease free for three and a half months so far. (Source: The Lancet November 1996;348:1484-1487)
Writing in the November 1 issue of Obstetrics and Gynecology News, Dr. Washington C. Hill, Sarasota Medical Center, Florida, has advised physicians that currently available rapid tests for group B streptococcal infection are not appropriate for screening pregnant women. According to Hill, the rapid tests are very good when there is a heavy colony count, but this does not make them useful for screening. The best way to screen for maternal asymptomatic colonization of group B strep remains a culture.
Incyte Pharmaceuticals, Palo Alto, CA, has announced it will collaborate with Affymetrix, Santa Clara, CA in developing and commercializing disease-specific gene expression databases and services.
Studies conducted at the Boston Children's Hospital have identified 2 routine lab tests that can predict adverse outcome - complete blood count and serum fibrinogen concentration. They reviewed the medical records of 250 patients younger than 19 years of age with invasive meningococcal disease. An absolute neutrophil count of less than 3000 per cubic millimeter, a platelet count less than 150,000 per cubic millimeter and a serum fibrinogen concentration of less than 2.5 gm/L was associated with an 89% risk of adverse outcome - loss of a limb or death. (Source: Journal of Pediatric Medicine, November 1996; 129: 702-710)
Researchers at the University of California San Francisco have devised a method to isolate fetal cells from the mother's blood for prenatal screening by PCR. The new technique involves isolation of erythroblasts, immature fetal red blood cells that contain a nucleus, from maternal cells. Twenty CCs of maternal blood is processed with a magnetic bead separation step that increases the ratio of fetal cells to about one per several thousand maternal cells, rather than one in millions. These cells are placed on a slide and stained with an antibody to fetal or embryonic hemoglobin that turns them bright red stain and visible on the slide. The fetal cells are then transferred to a test tube and tested with PCR for common inherited disease mutations. In the two patients they tested, the fetuses were found not to carry the abnormal gene for sickle cell disease or beta thalassemia. In both fetuses, the results were different from the mothers who were carriers of the abnormal gene. (Source: Nature Genetics, November 1996)
A study conducted at the University of Louvain, Netherlands, to evaluate the sensitivity and positive predictive value of three cervical sampling devices - the Ayre spatula, the Cytobrush and the cotton swab - indicate that, when used alone, all are about equally useful. They are more effective in combination. Each device, used alone generally performed significantly worse than the combination of a spatula and Cytobrush or cotton swab, the extended tip spatula, or the Cervex brush. (Source: The British Medical Journal, November 1996;313:1285-1290)
As part of the European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study, more than 3,000 patients with angina pectoris were followed for two years. The data suggest that TPA antigen levels constitute a biological marker of coronary heart disease, influenced by a variety of pathophysiological pathways, including inflammation. In contrast, plasminogen activator inhibitor levels, which determine fibrinolytic activity and which are dependent mainly on the metabolic status, emerge as a risk factor predictive for the future development of atherothrombosis. (Source: Circulation, November 1996)
Data collected from the files of 531 Mayo Clinic patients with an average age of 63 found that routine check-ups that include urinalysis, complete blood count, thyroid studies and blood chemistry have a very low probability of actually finding something. Blood chemistry had a therapeutic yield of 2.8%, while the urinalysis, thyroid tests and blood counts had less than a 1% yield. (Source: The American Journal of Medicine, November 1996)
Seven hundred and seventy samples from the GUSTO-IIa substudy, were tested for both troponin I and T, and ECG measurements were taken. The data showed that elevated troponin T, ECG categories and elevated troponin I were all associated with a higher 30-day mortality. However, in a regression model of ECG categories with both serum markers and mortality, troponin T added prognostic information after the ECG and troponin I values were included, while this was not the case for troponin I, even using a cutoff at the minimal detectable limit of the method. The study concluded that troponin T is a better prognostic marker than either ECG or troponin I. The study was lead by Dr. E. Magnus Ohman, a cardiologist at the Duke Clinical Research Institute and was printed in the October 31 issue of the New England Journal of Medicine.
Researchers at King's College, London, UK have concluded that postulated that the ratio of of the serum levels of two brain chemicals, the enzymes enolase and carnosinase, appears to be useful in predicting outcome in stroke patients. They found that the ratio of enolase to carnosinase was significantly associated with 90-day outcome in 124 stroke patients. Patients who died during the follow-up period had mean ratios of 0.069, while patients who were discharged home had ratios of 0.038. (Source: Stroke November 1996;27:2064-2068)
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