Immunogold labeling and cerium cytochemistry of the enzyme ecto-5'-nucleotidase in promastigote forms of Leishmania species

We have applied both enzyme cytochemistry and immunological labeling techniques to characterize the enzyme 5'-nucleotidase (5'-Nase), at the ultrastructural level, in promastigote forms of four Leishmania species: Leishmania amazonensis, Leishmania mexicana, Leishmania donovani and Leishmania chagasi. The cerium phosphate staining was localized at the surface of the cell body, the flagellum and the flagellar pocket membranes of all the parasites studied. The immunogold labelling technique confirmed these results. In this report we localized 5'-Nase in L. chagasi and L. amazonensis which have been implicated respectively in visceral and cutaneous forms of leishmaniasis. In addition, we confirmed the localization of this phosphomonoesterase in the other two species studied. The superior quality of the images, obtained with both methodologies, confirms that these parasites possess mechanisms capable of hydrolyzing nucleotide monophosphates, and that the expression of 5'-Nase is associated with the outer surface of the plasma membrane.

Reversible congestive heart failure associated with primary carnitin deficiency: report of a case and review of the literature.

A 5-year-old previously healthy boy was admitted for abdominal pain and vomiting. Physical examination showed tachypnoe (32/min), hepatomegaly and painful palpation of the upper right abdominal quadrant. Laboratory tests were normal except for elevated ammonium (202mcmol/l). Chest X-ray was performed, showing cardiomegaly and interstitial edema. Transthoracic echocardiography revealed dilated left cavities and LV hypertrophy together with a diffuse hypokinesia and LVEF of 30-40%. Diuretics and ACE-inhibitors were introduced. At that time, the differential diagnosis for the DCM included myocarditis, congenital or genetic, metabolic or autoimmune disease. The next day, the boy underwent cardiac magnetic resonance (CMR) examination, showing a severe dilatation of the LV with an end-diastolic diameter of 50mm and a volume of 150ml. LVEF was 20% with diffuse LV hypokinesia (Fig. 1). No late enhancement was present after Gadolinium injection, ruling out myocarditis. Further laboratory metabolic analysis indicated severely decreased total and free carnitin levels and low renal carnitin reabsorption, corroborating the diagnosis of primary carnitin deficiency (PCD). Carnitin substitution was initiated. The clinical condition rapidly improved. No symptoms of heart failure were present anymore. A follow-up CMR performed 9 months later confirmed the recovery. LV end-diastolic volume decreased from 150ml to 66ml, LVEF increased from 20% to 55% (Fig. 2). Late enhancement was absent after Gadolinum injection (Fig. 3).Carnitin is required for the transport of fatty acids from the cytosol into mitochondria during lipid breakdown. 75% of carnitin is obtained from food, 25% is endogenously synthesized. PCD is an autosomal recessive disorder resulting from impairment of a transporter activity, caused by mutation of the SLC22A5 gene. Incidence is about 1 in 40'000 newborns. Diagnosis is usually made at age 1 to 7. Three forms of PCD are described. In the form associated with cardiomyopathy, the disease is progressive and patient die from heart failure if not treated. Substitution of L-Carnitin leads to a dramatic improvement of disease course.This case underlines the crucial role of etiologic diagnostics in this reversible form of DCM. Early diagnostics and therapy are critical for the prognosis of the patient. This is furthermore an example of a role played by CMR in the diagnostic work-up of heart failure and its follow-up under therapy.

The Mental Health Order (Northern Ireland) 1986 - prescribed forms (PDF 169 KB)

The Mental Health Order (Northern Ireland) 1986 - prescribed forms.

GP Appraisal Forms 1-6 Feb 06 (PDF 52 KB)

GP Appraisal Updated Forms 1-6 (February 2006)

Home Accident Prevention Strategy

The overall aim of the strategy is “To reduce the number of accidental deaths and injuries in the home.” OBJECTIVES OF THE STRATEGY The key objectives are: • to reduce home accidents, particularly in those most at risk; • to raise awareness of the causes of home accidents and promote effective preventative measures to reduce such accidents; • to promote and facilitate effective training, skills and knowledge in home accident prevention across all relevant organisations, groups and individuals. These objectives will be met through integrated and effective approaches including: • education and information programmes to promote home safety, and promote a change in public behaviour towards home accident prevention; and • the use of evidence based practice, models of good practice, and by evaluating home accident prevention initiatives. OUTCOMES If successful, implementation of this strategy will lead to a reduction in the number of home accidents and contribute to the outcome “reduction in preventable deaths and diseases and improvement in wellbeing” set out in the Northern Ireland Priorities and Budget 2004-2006.

Home Accident Prevention Strategy

A Healthier Future: A Twenty Year Vision for Health and Wellbeing in Northern Ireland 2005-2025

Regional Advisory Committee on Cancer - Report on Endocrine Cancer (September 2004) (PDF 144 KB)

There is already a good infrastructure for the management of endocrine cancer in Northern Ireland but to develop and strengthen it we recommend the following: • Increasing the already close cooperation between the individual parts of the service for endocrine cancer by use of shared protocols for assessment and follow up: • The main hub of management should remain at the RGH focussed on The Regional Centre for Endocrinology and Diabetes and the Endocrine Surgery department where there has been a long-term interest in the management of these patients. This includes a close working relationship between the endocrinologists and surgeon at the Belfast City Hospital. • This does not suggest that current developments of shared follow-up should not be encouraged. They should but with the provision of adequately resourced registers to allow adequate audit and to ensure adequate assessment of follow-up attendance. The issues regarding informed consent for such registers are currently being discussed for all forms of cancer. In the rarer conditions follow-up should remain central to allow adequate numbers and experience to maintain internationally recognisable outcomes and to allow training of future specialists to continue åÊ

A Five Year Home Accident Prevention Strategy and Action Plan (PDF 124KB)

The Executive in its Programme for Government under the theme “Working for a Healthier People” gave a commitment to promoting public safety by reducing the number of injuries and deaths caused by accidents at home, at work and on the road. An overarching strategy for children and young people is also being developed, which will set out the vision, values and underlying principles, including general safety, for all children and young people and the long-term goals to make that vision a reality. Consultation Document

A Five Year Home Accident Prevention Strategy and Action Plan (Word 34KB)

Questionnaire

Regional Advisory Committee on Cancer - Second Report 2002 (PDF 132 KB)

Regional Advisory Committee on Cancer (RACC) was established in 1997 to carry forward the recommendations of the Campbell Report of 1996 and to provide advice to the Department of Health and Social Services on the future development of cancer services. The Committee meets twice a year and its membership (Appendix I) is an indication of the wide range of interests involved in Cancer Care across the community. This report records some of the key developments in cancer services over the last 3 years. åÊ Significant progress has been made toward developing a high quality and integrated cancer care network. All five Cancer Units are now operational with chemotherapy and outpatient services for the most common forms of cancer are delivered from these locations. Agreement to the start of the new Cancer Centre, at the Belfast City Hospital, currently estimated to cost å£58m, is expected shortly. As a temporary expedient two additional therapy machines will be installed in Belvoir Park Hospital to increase capacity while the building of the new Cancer Centre proceeds. åÊ To deliver high quality cancer care the workforce needs to continue to expand. This requires increasing investment in the training of professional staff in the context of an already difficult HPSS labour market. The development of the five Cancer Units has increased staff mobility in the short-term, drawing skilled staff away from the centre who have been difficult to replace. At the same time increasing numbers of patients are being offered effective therapies at both the Cancer Units and the Centre. åÊ This report contains a review of selected developments in cancer care. The first section introduces the Memorandum of Understanding and the Tripartite Agreement between the National Cancer Institute of the USA and the Health Departments both North and South. This is a unique international partnership, which promises to bring very significant advantages to both the service and research communities across the Island. åÊ åÊ åÊ

Accident and Emergency Nursing (PDF 74KB)

A Contribution to the Future

Alcohol and Injuries in the Accident and Emergency Department:A National Perspective

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