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In the past ten years, almost every mode of inheritance, including sex-linked dominant, has been proposed for the Noonan syndrome. The occurrence of the phenotype in father and son reported in this and two other communications makes X-linked dominant hypothesis untenable. It appears that the inheritance of the Noonan syndrome could best be explained by an autosomal dominant gene with variable expressivity. The proband, in the present communication, had truncus arteriosis type 4, not previously described in this syndrome.

Although information exists on the morphological aspects of the immature and adult monkey testis (van Wagenen & Simpson, 1965; Baker, 1972) and peripheral plasma testosterone levels in the adult monkey (Goodman, Hotchkiss, Karsch & Knobil, 1974; Michael, Setchell & Plant, 1974), little consideration has been given to the functional postnatal differentiation of the testis in nonhuman primates. In the present study, therefore, we describe the histological changes and corresponding changes in testicular and plasma testosterone levels in the testis of young rhesus monkeys treated with HCG.

A 5½-year-old boy had triphalangy of thumbs and great toes with the terminal phalanges of other digits being either absent or hypoplastic. Associated conditions included hypoplasia of nails and teeth, deafmutism, convulsive disorder, mental retardation, and dermatoglyphic abnormalities.

Dermatoglyphics of 19 girls and 15 boys with congenital virilizing adrenal hyperplasia (CVAH) were compared with the population controls. Only the female patients had significantly higher total digital ridge count, summed a-b ridge count, and more whorls among digital and hallucal patterns than the controls. Larger pattern size in girls with CVAH may be a result of increased growth from the third month of intrauterine life, since these infants also had significantly higher birth weight.

Introduction:Risk-standardized survival rate (RSSR) for in-hospital cardiac arrest (IHCA) has emerged as an important metric to measure and incentivize resuscitation quality at a hospital-level. We examined whether hospital performance on the RSSR metric was generally stable year-over-year.Methods:We used data from 81,795 adult patients with an IHCA from 163 hospitals with continuous participation in Get With The Guidelines-Resuscitation from 2012 to 2017. A two-level hierarchical regression model was used to compute RSSRs for 2 time intervals (baseline: 2012-13; follow-up: 2014-17). Hospitals were classified as top-, middle- and bottom-performing if they ranked in the top 25%, middle 50%, and bottom 25% on the RSSR metric during 2012-2013. We examined the trajectory of top, middle, and bottom-performing hospitals? RSSR during 2014-2017 (follow-up).Results:During 2012-2013, 41 hospitals were identified as top-performing (median RSSR 31.9%), 81 as middle-performing (median RSSR 24.9%) and 41 as bottom-performing (median RSSR 18.5%). During 2014-2017, more than 3/4th(75.6%) of top-performing hospitals remained in the top 50% and 53.7% remained in the top 25% (Table). In contrast, most (81.5%) bottom-performing hospitals ranked in the bottom 50%, and 56.1% remained in the bottom 25% during 2014-2017. Performance of middle-performing hospitals on the RSSR metric was variable. Importantly, rankings improved by at least 1 quartile (>25 percentile points) at 26.8% and by at least 2 quartiles (>50 percentile points) at 12.2% bottom-performing hospitals (Table). Likewise, rankings at 31.7% and 19.5% of top-performing hospitals worsened by at least 25 and 50 percentile points during 2014-2017, respectively.Conclusion:Hospital performance on RSSR during a baseline period was generally consistent with their performance during follow up. However, percentile rankings changed markedly over time at a small proportion of top- and bottom-performing hospitals.

The article offers information on the terrorists attack made on the students of the Army Public School in Peshawar, Pakistan by militants from Tehreek-e-Taliban Pakistan (TTP). Topics discussed include Pakistan's crisis of urban violence, weaknesses in intelligence apparatus and need of strengthening counterterrorism capabilities.

The article focuses on Sultan Qaboos bin Said Al Said of Oman who addressed his nation via a video message from Germany where he is allegedly receiving treatment for colon cancer as of December 2014. Topics discussed include the ailing health of the sultan and its impact on the future of Oman and the leadership transition, the economic growth of Oman under the sultanate of Qaboos, and the challenges and threats to the country's stability.

The article reports on the two anti-government marches which plunged Pakistan's fragile democracy into another period of turbulence on the eve of its 68th Independence Day. The marches were led by Imran Khan and his Pakistan Tehrik-e-Insaaf (PTI), and by Tahir-ul Qadri and his Pakistan Awami Tehrik (PAT). PTI claimed that elections were not free and demanded Prime Minister Nawaz Sharif's resignation, while PATcalled for the dissolution of the national parliament and provincial assemblies.

The article reports on the survival of journalist Hamid Mir from an attempted assassination in April 2014, which he claimed was committed by the Pakistani military's Inter-Services Intelligence Directorate (ISI). Topics discussed include the apology made by Mir's employer, Geo to its accusations against ISI, tye protests held by the religious groups against Geo's allegations, and the challenges brought by the onslaught for Geo.

The article reports on the promotion of public-private partnerships by the U.S. Agency for International Development (USAID) in high-risk markets. USAID programs funded by private capital are mentioned including Private Capital Group for Africa, African Agricultural Capital Fund and two private equity funds via the Pakistan Private Investment Initiative. It discusses factors driving USAID to support such partnerships which include tight budgets and decline in overseas development assistance.

The article discusses the legacy of reform to be left behind by Pakistan's army chief General Ashfaq Parvez Kayani when he retires on November 29, 2013. These include transforming the army to better cope with emerging security threats, distancing it from politics after ten years of military rule and proclaiming homegrown militancy as Pakistan's biggest security risk. It also discusses the possibilities that these policies will continue under his successor, Lieutenant General Raheel Sharif.

The article reports that the composite index indicates overall poor readiness of South Asia to cope with change. The index assesses and ranks countries depending on their scores across sub-indexes to measure their ability to respond to social changes. It mentions that India ranked 65th, Pakistan 69th and Nepal 82nd in the international ranking of 90 nations.

The article examines the first 100 days of Nawaz Sharif as prime minister of the Pakistan Muslim League-Nawaz (PML-N) after being elected in May 2013. It recalls the major promises made by Sharif during the campaign which covered the economy, energy shortages, U.S. drone strikes, terrorism and positive international relations. It notes that the economy saw both negative and positive developments during the period. It discusses the foreign policy of Sharif towards India, China and Afghanistan.

The article cites political developments in November 2012 that indicate new cooperative efforts by Pakistan, Afghanistan and the U.S. to bring the Taliban leadership into the negotiation process. The countries agreed on a list of at least 20 Taliban leaders to be taken off the United Nations (UN) sanctions list and Pakistan released 13 Taliban members. A commission also met to discuss the transition of security and border control before the foreign troops' withdrawal in Afghanistan in 2014.

The article examines the role of the regional element, particularly Pakisan, in achieving sustainable peace in Afghanistan. It highlights the invitation of Pakistani President Asif Ali Zardari to participate in the North Atlantic Treaty Organization (NATO) summit to discuss the re-opening of NATO supply lines in Pakistan. The author suggests that U.S. diplomatic efforts should focus on encouraging compliance of regional countries to a policy of noninterference.

The article focuses on how the strategic depth strategy of Pakistan in Afghanistan has changed from its 1990s version. Pakistan wants a coalition government in which the Taliban and other Pashtun groups are represented instead of allowing the Taliban to rule Afghanistan. Pakistan's own goals in Afghanistan have changed from creating instability in an effort to impose a client regime, to seeking stability in both Afghanistan and Pakistan's own northern territory.

To ascertain the efficacy of Trimethoprim (TMP) as a single therapeutic agent in the treatment of UTI in children, a prospective study was designed to compare TMP against sulfamethoxazole (sulfa), trimethoprim-sulfamethoxazole (TMP-sulfa) and ampicillin. Eighty children with 100,000 colonies of the same organism grown in 2-3 consecutive clean catch specimens were randomly assigned to each treatment group for 10 days therapy in following doses: TMP 10 mg/kg; sulfa 150 mg/kg; TMP-sulfa 8AO mg/kg; and ampicillin 100 mg/kg.Also, TMP produced 67% cure rate in another 9 children who had either failures or relapses from other treatments. Two patients developed skin rashes, one each in ampicillin and TMP-sulfa groups. Two other patients had diarrhea with ampicillin treatment, one of which was severe enough to discontinue ampicillin. None of the patients treated with TMP had skin rashes or diarrhea.Above results indicate that TMP is a safe, efficacious alternative to TMP-sulfa, sulfa, and ampicillin in the treatment of UTI.

Dermatoglyphic patterns were studied in 32 black female patients with SLE and compared to 100 black female controls. The digital pattern frequencies are shown below.Patients with SLE, compared to the controls had a significantly increased frequency (p<0.005) of ulnar loops and decreased frequency (p<0.005) of whorls. No significant differences were found in pattern frequencies in hypothenar, thenar, third and fourth interdigital areas and summed atd angles. The abnormal dermatoglyphic pattern frequencies noted in the present study is not sufficient to aid in the diagnosis of SLE but the association may represent a prematal and/or genetic characteristic which may contribute to the understanding of SLE.

Patients with King syndrome are known to suffer from a non-specific myopathy. By using C-T scan in one case we have found focal myopathy involving only a certain group of muscles.The proband was a nine year old Mexican boy referred for evaluation of a neuromuscular disease. He tired easily while walking and had much difficulty climbing stairs. At six years of age, while undergoing an operation for undescended testes, he developed muscular rigidity, tachycardia, and acidosis during induction of anesthesia. His other physical features consisting of short stature, micrognathia, pectus carinatum, dorsal kyphoscoliosis, and lumbar lordosis were compatible with the diagnosis of King syndrome.Neurological examination showed mild facial weakness, lordotic gait, equivocal Gower's sign, and proximally diminished DTRs. A needle EMG of selected proximal and distal muscles, and a muscle biopsy of vastus lateralis showed a chronic, morphologically non-specific, but severe myopathy. Fiber type differentiation was indefinite. A C-T scan at various levels through the extremities revealed a patchy involvement of certain muscle groups (e.g. vastus medialis, intermedius, and lateralis) with muscle degeneration and fatty infiltration, while others (e.g. rectus femoris and muscles of the posterior compartment) appeared well preserved. We conclude that myopathy in King syndrome is focal and can be demonstrated by a relatively non-invasive procedure.

We have evaluated 30 children with HIV infection ranging in age from 4-1/2 months to 8-1/2 years, and 30 controls matched for age, sex, and race/ethnicity for growth, head size, craniofacial dysmorphism, dermatoglyphics and other physical features. All patients and their mothers were serologically positive for HIV-antibody.Aside from growth failure and microcephaly (which are attributable to chronic infections and central nervous system lesions in AIDS patients) there were no significant differences in clinical findings (including dermatoglyphics) between patients and controls. A previous report describing craniofacial dysmorphism in children with AIDS noticeably lacked in comparison with normal controls. We conclude that although there is evidence for intrauterine transmission of HIV infection causing immunological impairment, there is no evidence for “embroypathy”.

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The proposed test is based on observations that lead, in vitro and in vivo, increases the osmotic resistance of erythrocytes.Blood samples were collected in heparinized lead-free tubes from 32 patients admitted to the hospital with lead poisoning (blood lead level of 0.06 mg/100 ml, or higher). Samples obtained from 30 blood donors, 27 children without lead poisoning and 10 children with iron deficiency anemia served as controls. A hemoglobin pipetteful of blood is added to each of two tubes, one containing 5 ml of 0.4% buffered sodium chloride solution and the other, 5 ml of double distilled water. After 20 minutes, the tubes are centrifuged and the optical density (OD) of the supernatants determined at 540 mµ. The results are calculated and expressed as follows:(OD in 0.4% saline ÷ OD in water) × 100 = % hemolysisThe results show that the mean hemolysis in children with lead poisoning (49.9, SD 18.7) was distinctly lower (P < .01) than that in blood donors (95.2, SD 5.2), in unaffected children (92.2, SD 6.0) and in children with iron deficiency anemia (87.1, SD 9.2). The test identified 28 of 32 children with blood lead levels of 0.06 mg/100 ml, or higher, and each of ten children with blood lead levels of 0.09 mg/100 ml, or more.Further data, derived from continued use of the test, will be presented.