Serum CA 125 concentrations in women with endometriosis or uterine fibroids treated with gonadotrophin-releasing hormone agonist analogues

We assessed the possible role of CA 125 in the monitoring of gonadotrophin-releasing hormone (GnRH) agonist analogue therapy in women with endometriosis and uterine fibroids. Serum concentrations of this cell surface antigen did not correlate with uterine volume and appeared to have no value in the assessment of shrinkage of uterine fibroids during GnRH agonist treatment. While CA 125 levels were not always elevated in subjects with endometriosis, they fell during treatment in all patients. The change accurately reflected therapeutic progress in these women and was of particular value in those patients who had commenced therapy with elevated levels. It is suggested that CA 125 may be useful in the monitoring of therapeutic progress in selected patients with endometriosis treated with GnRH agonists; the need for surgical follow-up may be obviated

Serum CA 125 concentrations in women with endometriosis or uterine fibroids treated with gonadotrophin-releasing hormone agonist analogues

We assessed the possible role of CA 125 in the monitoring of gonadotrophin-releasing hormone (GnRH) agonist analogue therapy in women with endometriosis and uterine fibroids. Serum concentrations of this cell surface antigen did not correlate with uterine volume and appeared to have no value in the assessment of shrinkage of uterine fibroids during GnRH agonist treatment. While CA 125 levels were not always elevated in subjects with endometriosis, they fell during treatment in all patients. The change accurately reflected therapeutic progress in these women and was of particular value in those patients who had commenced therapy with elevated levels. It is suggested that CA 125 may be useful in the monitoring of therapeutic progress in selected patients with endometriosis treated with GnRH agonists; the need for surgical follow-up may be obviated

A prospective study of paediatric preoperative fasting times at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa

Background. Fasting for liquids and solids is recommended prior to procedures requiring anaesthesia, to reduce the risk of pulmonary aspiration. Children often experience excessive fasting, which is associated with negative physiological and behavioural consequences, and patient discomfort. The duration of preoperative fasting in children in South Africa (SA) is unknown.Objectives. To determine compliance with fasting guidelines and fasting times of children prior to elective procedures performed under anaesthesia at a paediatric hospital in Cape Town, SA. The primary focus was fasting for clear liquid. We also intended to identify the most common reasons for prolonged clear liquid fasting.Methods. Over a 7-week period, we prospectively captured fasting times of consecutive patients undergoing elective surgical, medical and radiological procedures at Red Cross War Memorial Children’s Hospital. Measurement outcomes were defined as the period from the last clear liquid, milk or solid feed to the start of anaesthesia. For analysis of compliance with preoperative fasting guidelines, institutional preoperative fasting target limits were established based on the standard 6-4-2-hour guideline.Results. The study included 721 elective paediatric cases. The mean (standard deviation (SD)) fasting time for clear liquids (n=585) was 8.0 (4.8) hours, with an adherence rate of 25.5% (95% confidence interval 22 - 29) to the institutional target of 2 - 4 hours. The mean (SD) fasting times for breastmilk (n=92), formula milk (n=116) and solid feeds (n=560) were 7.1 (2.8), 8.8 (2.8) and 13.9 (3.6) hours, respectively. The factors associated with clear liquid fasting >4 hours were inadequate fasting instructions, poor adherence to fasting orders, procedural delays and fasting to promote theatre flexibility.Conclusions. This study demonstrates that children in an SA hospital experience excessive fasting times prior to elective procedures. To reduce fasting durations and improve the quality of perioperative care, quality improvement interventions are required to create an adaptable fasting system that allows individualised fasting. Improving preoperative fasting times in children is the responsibility of all healthcare professionals in the multidisciplinary management team

The inherited blindness protein AIPL1 regulates the ubiquitin-like FAT10 pathway

Mutations in AIPL1 cause the inherited blindness Leber congenital amaurosis (LCA). AIPL1 has previously been shown to interact with NUB1, which facilitates the proteasomal degradation of proteins modified with the ubiquitin-like protein FAT10. Here we report that AIPL1 binds non-covalently to free FAT10 and FAT10ylated proteins and can form a ternary complex with FAT10 and NUB1. In addition, AIPL1 antagonised the NUB1-mediated degradation of the model FAT10 conjugate, FAT10-DHFR, and pathogenic mutations of AIPL1 were defective in inhibiting this degradation. While all AIPL1 mutants tested still bound FAT10-DHFR, there was a close correlation between the ability of the mutants to interact with NUB1 and their ability to prevent NUB1-mediated degradation. Interestingly, AIPL1 also co-immunoprecipitated the E1 activating enzyme for FAT10, UBA6, suggesting AIPL1 may have a role in directly regulating the FAT10 conjugation machinery. These studies are the first to implicate FAT10 in retinal cell biology and LCA pathogenesis, and reveal a new role of AIPL1 in regulating the FAT10 pathway

Antibodies to Chlamydia trachomatis in patients presenting with ectopic pregnancy at Groote Schuur hospital

Objectives. To detennine the prevalence of antibodies to Chlamydia trachomatis in women presenting with ectopic pregnancies to Groote Schuur Hospital.Methods. C. trachomatis antibody titres were measured using a modified micro-immunofluorescence test in women presenting with ectopic pregnancy. Control subjects were drawn from women with term pregnancies and an uneventful reproductive history.Results. Seventy-four patients and controls were studied. Demographic variables were controlled for at time of entry into the study. A significant association between the number of lifetime sexual partners and exposure to C. trachomatis was noted (P = 0.001). Patients with ectopic pregnancies had significantly higher antibody titres than control subjects (P = 0.001), and in both groups the prevalence of background antichlamydial antibody was high (ectopic pregnancies 59%, pregnant controls 32%).Conclusions. While the role of C. trachomatis infection in women who develop ectopic pregnancies needs to be explored further, it seems wise to treat them all with empirical antibiotics at the time of presentation

Books

Brain work Brain Work and Mental Activity: Quantitative Studies with Radioactive Tracers. Ed. by N. A. Lassen, D. H. Ingvar, M. E. RaicWe and L. Friberg. Pp. 446. Illustrated. Copenhagen: Munksgaard. 1991.Neuroanatomy Neuroanatomy for Medical Students. 2nd ed. By ]. L. Wilkinson. pp. x + 307. illustrated. Oxford: Butterworth Heinemann. 1992.Atherosclerosis Molecular Biology of Atherosclerosis: Proceedings of the 57th European Atherosclerosis Society Meeting. Ed. by M. J. Halpern. Pp. xv + 662. Illustrated. £45. London: John libbey. 1992.Antibiotics Antibiotic Guidelines. By H. J. Koomhof and L. D. Liebowitz. pp. 122. Pretoria: JL van Schaik. 1991.Reproductive medicine Reproduction, Growth and Development. By A. Negro-Vilar and G. perez-Palacios. Pp. xv + 440. illustrated. $162,50. New York: Raven Press. 1991.Obesity research Progress in Obesity Research 1990. Ed. by Y. Oomura, S. Tarui, S. Inoue and T. Shimazu. Pp. xiii + 688. illustrated. £17,50. London: John Libbey. 1991.Epidemiology Fetal and Infant Origins of Adult Disease. Ed. by D.}. P. Barker. Pp. xv + 343. £30. London: BM}. 1992

Tuberculosis research in South Africa over the past 30 years: From bench to bedside

The South African Medical Research Council Centre for Tuberculosis Research has a rich history of high-impact research that has influenced our understating of this hyper-epidemic which is further exacerbated by the emergence and spread of drug-resistant forms of the disease. This review aims to summarise the past 30 years of research conducted in the Centre which has influenced the way that tuberculosis (TB) is diagnosed and treated. The review includes the development of new technologies for rapid screening of people with probable TB and the repurposing of human diagnostics for wildlife conservation

The leber congenital amaurosis protein AIPL1 and EB proteins co-localize at the photoreceptor cilium

Purpose: The aim of this study was to investigate the interaction and co-localization of novel interacting proteins with the Leber congenital amaurosis (LCA) associated protein aryl hydrocarbon receptor interacting protein-like 1 (AIPL1). Methods: The CytoTrapXR yeast two-hybrid system was used to screen a bovine retinal cDNA library. A novel interaction between AIPL1 and members of the family of EB proteins was confirmed by directed yeast two-hybrid analysis and co-immunoprecipitation assays. The localization of AIPL1 and the EB proteins in cultured cells and in retinal cryosections was examined by immunofluorescence microscopy and cryo-immunogold electron microscopy. Results: Yeast two-hybrid (Y2H) analysis identified the interaction between AIPL1 and the EB proteins, EB1 and EB3. EB1 and EB3 were specifically co-immunoprecipitated with AIPL1 from SK-N-SH neuroblastoma cells. In directed 1:1 Y2H analysis, the interaction of EB1 with AIPL1 harbouring the LCA-causing mutations A197P, C239R and W278X was severely compromised. Immunofluorescent confocal microscopy revealed that AIPL1 did not co-localize with endogenous EB1 at the tips of microtubules, endogenous EB1 at the microtu-bule organising centre following disruption of the microtubule network, or with endogenous β-tubulin. Moreover, AIPL1 did not localize to primary cilia in ARPE-19 cells, whereas EB1 co-localized with the centrosomal marker pericentrin at the base of primary cilia. However, both AIPL1 and the EB proteins, EB1 and EB3, co-localized with centrin-3 in the connecting cilium of photoreceptor cells. Cryo-immunogold electron microscopy confirmed the co-localization of AIPL1 and EB1 in the connecting cilia in human retinal photoreceptors. Conclusions: AIPL1 and the EB proteins, EB1 and EB3, localize at the connecting cilia of retinal photore-ceptor cells, but do not co-localize in the cellular microtubule network or in primary cilia in non-retinal cells. These findings suggest that AIPL1 function in these cells is not related to the role of EB proteins in microtubule dynamics or primary ciliogenesis, but that their association may be related to a specific role in the specialized cilia apparatus of retinal photoreceptors

A multicentre crosssectional study investigating the prevalence of hypertensive disease in patients presenting for elective surgery in the Western Cape Province South Africa

Background. Hypertension is common, affecting over one billion people worldwide. In sub-Saharan Africa, hypertensive disease not only affects the older population but is becoming increasingly prevalent in younger individuals. In South Africa (SA), >30% of the adult population has hypertension, making it the single most common cardiovascular risk factor and the predominant contributor to cardiovascular disease and mortality. Elevated blood pressure is the most common perioperative comorbidity encountered in non-cardiac surgical patients, with an overall prevalence of 20 - 25%, and it remains poorly controlled in low- and middle-income countries. Hypertension in the perioperative setting may adversely affect patient outcome. It therefore not only flags possible perioperative challenges to anaesthesiologists, but also identifies patients at risk of long-term morbidity and mortality.Objectives. To determine the prevalence and severity of hypertension in elective adult surgical patients in the Western Cape Province, SA.Results. The study population included all elective surgical patients from seven hospitals in the Western Cape during a 1-week period. Hypertension, defined as having had a previous diagnosis of hypertension or meeting the blood pressure criteria of >140/90 mmHg, was identified in 51.8% of patients during preoperative assessment. Significantly, newly diagnosed hypertension was present in 9.9% of all patients presenting for elective surgery. Although 98.1% of the known hypertensive patients were on antihypertensive therapy, 36.9% were inadequately controlled. There are numerous reasons for this, but notably 32.1% of patients admitted to forgetting to take their medication, making patient factors the most common reason for treatment non-compliance.Conclusions. The perioperative period may be an important opportunity to identify undiagnosed hypertensive patients. The perioperative encounter may have a significant public health implication in facilitating appropriate referral and treatment of patients with hypertension to decrease long-term cardiovascular complications in SA.Â