Perinatal ACTH-naloxone treatment: Effects on physical and behavioral development

Pregnant mice were treated with either ACTH or naloxone, or both, from 2 to 5 days prior to parturition, until 5 days postpartum. Perinatal ACTH caused a retardation of growth, eye opening, and vaginal opening that was blocked by naloxone; perinatal naloxone produced a decrease in open field activity at 32 days of age that was blocked by ACTH; naloxone reduced the threshold for heat at 50 days of age with no interaction with the ACTH treatment. It is proposed that part of the role of ACTH in physical systems may be mediated via naloxone-sensitive receptors. The direct effect of naloxone on another class of receptors may mediate the changes in threshold to heat flinch. Effects of ACTH and naloxone on the mother may have indirectly produced alterations in physical and motor development of the offspring.     

Review: Diagnosis and treatment of dementia: 2. Diagnosis

Background

Dementia can now be accurately diagnosed through clinical evaluation, cognitive screening, basic laboratory evaluation and structural imaging. A large number of ancillary techniques are also available to aid in diagnosis, but their role in the armamentarium of family physicians remains controversial. In this article, we provide physicians with practical guidance on the diagnosis of dementia based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia, held in March 2006.

Methods

We developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2005 that pertained to key diagnostic issues in dementia. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care.

Results

Of the 1591 articles we identified on all aspects of dementia diagnosis, 1095 met our inclusion criteria; 620 were deemed to be of good or fair quality. From a synthesis of the evidence in these studies, we made 32 recommendations related to the diagnosis of dementia. There are clinical criteria for diagnosing most forms of dementia. A standard diagnostic evaluation can be performd by family physicians over multiple visits. It involves a clinical history (from patient and caregiver), a physical examination and brief cognitive testing. A list of core laboratory tests is recommended. Structural imaging with computed tomography or magnetic resonance imaging is recommended in selected cases to rule out treatable causes of dementia or to rule in cerebrovascular disease. There is insufficient evidence to recommend routine functional imaging, measurement of biomarkers or neuropsychologic testing.

Interpretation

The diagnosis of dementia remains clinically integrative based on history, physical examination and brief cognitive testing. A number of core laboratory tests are also recommended. Structural neuroimaging is advised in selected cases. Other diagnostic approaches, including functional neuroimaging, neuropsychological testing and measurement of biomarkers, have shown promise but are not yet recommended for routine use by family physicians.     

Perinatal care in British Columbia: Diagnosis and management of hemolytic disease of the newborn

We undertook to measure standards of perinatal care in British Columbia by studying the management of hemolytic disease of the newborn as the sample situation.Our data show that many isoimmunized pregnant women are delivered in hospitals that have infrequent experience with this problem, and by physicians who have little experience with this disease.The physician referral pattern, in regard to maternal isoimmunization, indicated that the more severely affected patients were managed by specialists, particularly those attached to teaching hospitals. However, 25% of the infants treated by exchange transfusion were managed by nonspecialists in nonteaching hospitals.Hospital record search, used as a method of medical audit and as a source of data for comparison with physician reports, did not result in dependable or complete information. Rates of disagreement between items from two data sources, physician report and hospital record, were frequently very high. Our experience suggests that comparison of these two data sources is not an ideal method of assessment of quality of care.A smaller caseload of isoimmunized pregnant women will result from the present prevention program. Nevertheless, cases will continue to occur. Our work supports the conclusion that a program of continuing education covering the diagnosis and management of hemolytic disease of the newborn is still necessary.     

Chemical genetics: where genetics and pharmacology meet

Genetics and pharmacology can elicit surprisingly different phenotypes despite targeting the same protein. This Essay explores these unexpected differences and their implications for biology and medicine.     

A rational treatment of Mendelian genetics

Background  

The key to a rational treatment of elementary Mendelian genetics, specifically to an understanding of the origin of dominant and recessive traits, lies in the facts that: (1) alleles of genes encode polypeptides; (2) most polypeptides are catalysts, i.e. enzymes or translocators; (3) the molecular components of all traits in all cells are the products of systems of enzymes, i.e. of fluxing metabolic pathways; (4) any flux to the molecular components of a trait responds non-linearly (non-additively) to graded mutations in the activity of any one of the enzymes at a catalytic locus in a metabolic system; (5) as the flux responds to graded changes in the activity of an enzyme, the concentrations of the molecular components of a trait also change.     

Huntington disease: genetics and epidemiology

Huntington disease (HD) is an autosomal dominant disorder in which the major gene expression occurs in the central nervous system. It is characterized by the appearance of progressive chorea and dementia, usually in adult life. One tragic aspect of the disorder, due to its late age of onset and, until recently, lack of a presymptomatic marker, is that transmission of the disease to offspring invariably occurs before symptoms develop in the parent. Although the onset of symptoms and the rate of progression may vary, the prognosis is one of relentless deterioration. The major pathological features of HD are a primary loss of cells in the caudate nucleus and putamen (striatum) but other regions of the basal ganglia, hypothalamus, and brain stem are also involved. Not only is there neuronal loss but there is also a decrease in the level of a number of neurotransmitters and associated enzymes, together with abnormalities in some receptor sites. Martin [1] described the disease as "genetically programmed cell death in the human central nervous system."