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On the Connection between the RMS Charge Radii and E1σb for Trinucleons

Silver Jubilee Commemoration Medal Lecture, 1982

Triton Binding Energy in UPA with Hard-Core Spin-Dependent Potentials

Objectives: The occurrence of aplastic anemia following topical administration of ophthalmic chloramphenicol is controversial and debated internationally. We have determined the influence of such debate on the utilization of ophthalmic chloramphenicol in Bahrain, through studying the utilization patterns of ophthalmic antimicrobial preparations by the Ministry of Health, with an emphasis on chloramphenicol, between 1993 and 2000. Cost-implications of these patterns are examined. Material and methods: Information on the annual purchase of ophthalmic antimicrobial drug preparations and their unit price was obtained from the Directorate of Materials Management, Ministry of Health, and analyzed. Results: In 1993, the 3 most commonly purchased ophthalmic antibacterial preparations were oxytetracycline 1% eye ointment (40.1%); sulfacetamide 10% and 20% eye drops (25.3%); and chloramphenicol 0.5% eye drops and 1% eye ointment (10.8%). In 2000, oxytetracycline remained the most frequently purchased preparation (33%), followed by chloramphenicol (21.2%), Between 1993 and 1999, chloramphenicol purchases fluctuated between 10% to 16.4% with a remarkable increase to 21.2%, in 2000. Chloramphenicol accounted for 8.6% and 15.1% of cost of total ophthalmic preparations purchased in 1993 and 2000, respectively. Conclusion: Despite continued concerns of potential risks of ophthalmic chloramphenicol, this preparation is extensively utilized in Bahrain. We are of the opinion that for minor infections, chloramphenicol ophthalmic preparations should be replaced by safer alternatives. Further, we recommend that their use be reserved for ocular infections that are resistant to other antimicrobials, and that ophthalmologists, at the secondary care level, should supervise such treatment.

Purpose To determine whether primary care physicians take into consideration age, gender and diabetes mellitus as risk factors for sexual dysfunction (SD) when prescribing antihypertensives. Methods A prescribing survey on hyperternsive patients with or without diabetes mellitus in primary care setting of Bahrain was carried out. Results In 5301 hypertensive patients, we found that a β-blocker (atenolol) was the most commonly prescribed drug and was significantly more often prescribed for young male hypertensives (

OBJECTIVE: To determine drug prescription patterns and the extent of conformity with World Health Organization/International Society of Hypertension (WHO/ISH) guidelines in diabetic hypertension. DESIGN: Retrospective prescription-based survey. SETTING: Seven primary-care health centers, comprising approximately one-third of primary-care health centers in Bahrain. PATIENTS: Patients with type 2 diabetes and hypertension. MAIN OUTCOME MEASURE: The prescribing pattern of antihypertensive and antidiabetic drugs. RESULTS: Among a study sample of 1463 patients with type 2 diabetes and hypertension, antidiabetic agents were prescribed as monotherapy in the following descending order: glyburide, gliclazide, insulin, and metformin. As combinations, sulfonylureas plus metformin was most popular, followed by metformin plus insulin, and sulfonylureas plus insulin. Sulfonylurea and metformin with insulin was rarely used. There was no significant difference in prescribing of glyburide and metformin between the elderly and young middle-aged diabetic patients; many patients older than 65 years were treated with a β-blocker along with a long-acting sulfonylurea. Both as monotherapy and in overall use, β-blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium-channel blockers were most often prescribed. Among 35.5% patients treated with antihypertensive combinations, various two- and three-drug combinations of β-blockers, ACE inhibitors, calcium-channel blockers, and diuretics were often used. The proportion of patients taking atenolol 100 mg/d was higher with combination regimens. Hydrochlorothiazide 25 mg or equivalent thiazide diuretics were extensively used. CONCLUSIONS: The prescribing pattern of antihypertensives in diabetic hypertension differs in many instances from WHO/ISH guidelines, especially regarding the choice of antihypertensive drugs and their combinations. The appropriateness of antidiabetic drug choice is questionable in relation to the antihypertensive used.

OBJECTIVES To determine in older people with uncomplicated hypertension: (a) the pattern of prescribing of antihypertensives; (b) the extent of physicians' adherence to recommendations on dosage for antihypertensive combinations; (c) whether prescribing practice conforms with recommended therapeutic guidelines; and (d) the frequency of prescribing of other drugs which have the potential to alter the efficacy of antihypertensive agents. METHODS A survey of prescribing in older patients with uncomplicated hypertension in primary care setting of Bahrain was conducted. RESULTS Of the 432 (56.5%) patients on monotherapy, 192 (44.4%) were treated with beta-blockers, 87 (20.1%) with calcium channel blockers (CCBs), 53 (12.3%) with alpha-methyldopa, 47 (10.9%) with diuretics, 46 (10.6%) with angiotensin converting enzyme (ACE) inhibitors, and 7 (1.6%) with hydralazine. Of the 1146 patients on mono- or combination therapies, 434 (56.8%) were treated with beta-blockers, 244 (31.9%) with diuretics, 211 (27.6%) with CCBs, 139 (18.2%) with ACE inhibitors, 103 (13.5%) with alpha-methyldopa 8 (1.0%) with brinerdine and 7 (0.9%) with hydralazine. In the 332 (43.5%) patients on combination therapy, 15 different two- and three-antihypertensive drug combinations were prescribed: a diuretic with a beta-blocker (37.2%) and a beta-blocker with either a CCB (20.9%) or an ACE inhibitor (12.4%) were the most popular two-drug regimens. The most commonly prescribed triple drug regimens were a diuretic and a beta-blocker plus either a CCB (26.1%) or an ACE inhibitor (17.4%) and diuretic plus an ACE inhibitor and a CCB (15.2%). Daily dosage of beta-blockers, ACE inhibitors and alpha-methyldopa were somewhat high in a considerable proportion of patients on both mono- and combined therapies. A substantial proportion (9.7%) of patients on monotherapy were treated with immediate release nifedipine. CONCLUSION The pharmacotherapy of hypertension in elderly patients was found in some instances not to conform to recommended guidelines. For certain classes of antihypertensive agent such as beta-blockers, ACE inhibitors and alpha-methyldopa, neither the principles of geriatric pharmacology nor of antihypertensive combination therapy, and in particular, the need to reduce daily dosage, were followed. The use of immediate release nifedipine in the elderly is irrational, and instead, the use of long-acting dihydropyridine CCBs should be considered. The results of long-term randomized clinical trials published during the last decade have had a minimal impact on clinical practice of primary care physicians in Bahrain.

Purpose To determine the antihypertensive drug prescribing pattern by primary care physicians in patients with uncomplicated essential hypertension; to identify whether such pattern of prescription is appropriate and in accordance with international guidelines for pharmacotherapy of hypertension; and to estimate the impact of such prescriptions on cost of treatment. Methods A prescription-based survey among patients with uncomplicated essential hypertension was conducted in seven out of a total of 18 health centres in Bahrain. The relevant data for our study was collected using cards, designed for chronically-ill patients. Results A total of 1019 male and 1395 female (62.9%) out of 3838 of the study population were on monotherapy, whereas 596 male and 828 female (37.1%) were on antihypertensive combination therapy. Among the monotherapy category, the various antihypertensive drugs used were as follows: beta-blockers (58.8%), angiotensin converting enzyme (ACE) inhibitors (14.2%), calcium channel blockers (11.1%), diuretics (8.1%) and α-methyldopa (7.0%). With respect to overall utilization pattern, beta-blockers were the most frequently prescribed (65.5%), diuretics ranked second (27.4%), followed by ACE inhibitors (20.6%), calcium channel blockers (19.9%) and α-methyldopa (8.5%). Within each class of antihypertensives used, the most frequently used individual agents were as follows: (a) among beta-blockers 97.7% used atenolol; (b) among the diuretics, indapamide (35.4%), hydrochlorothiazide (HCTZ) (32.7%), HCTZ in combination with triamterene (25.7%), and chlorthalidone (4.6%); (c) among the ACE inhibitors, captopril (44.9%), enalapril (29.7%), and lisinopril (19.0%); (d) among the calcium channel blockers, nifedipine (98.2%). Significant age- and gender-related differences in prescribing patterns were seen. Short-acting nifedipine monotherapy was inappropriately prescribed in a significant number of patients above the age of 50 years. ACE inhibitors accounted for approximately two-thirds of the total antihypertensive drug expenditure, although these drugs represent only one-fifth of overall antihypertensives used. There is a trend towards excessive use of expensive thiazide-like diuretics such as indapamide which seems to be unjustifiable practice, particularly in a study population free from diabetic hypertensive patients. Conclusions The general pattern of antihypertensive utilization appears to be in accordance with the guidelines of WHO and the Joint National Committee issued in the 1990s. The trends of prescribing of antihypertensives were in favour of conventional ones such as the beta blockers and diuretics, and the introduction of newer classes of antihypertensives had a generally minimal impact on the prescribing profile. Almost two-thirds of the patients were treated with monotherapy. A disproportionately large percentage of antihypertensive drug cost was due to overt use of ACE inhibitors, and indapamide, instead of thiazide diuretics. The use of short-acting calcium channel blockers especially in the elderly is unjustifiable. Copyright © 2001 John Wiley & Sons, Ltd.

OBJECTIVES To explore the prescribing pattern and rationale of antihypertensive combination drug therapy at the level of primary health care centers; and to analyze the extent of physicians' adherence to dosage range of antihypertensives in combination regimens as recommended by Guidelines Subcommittee of WHO/ISH 1999. SUBJECTS, MATERIAL AND METHODS A prescribing survey of antihypertensive combination regimens among patients with uncomplicated essential hypertension was conducted in 7 out of a total of 18 health centers in Bahrain. The relevant data for our study was collected using cards designed for chronically ill patients. RESULTS A total of 2414 hypertensive patients (62.9%), of a 3838 study population, were on monotherapy, whereas 1414 (37.1%) were on antihypertensive combination therapy. Among those who were treated with drug combinations, 85.1% (n = 1212) received two-drug, 14.2% (n = 202) received three-drug and four- and five-drug regimens were used by 0.6% and 0.07%, respectively. Prescription analysis revealed that 17 different two- and three-antihypertensive drug combinations were prescribed for each category. The four major two-drug regimens were ranked in the following order: a beta-blocker with a diuretic (40.4%) used more frequently in females than in males (p < 0.0001), a beta-blocker with a calcium channel blocker (19.7%), a beta-blocker with an ACE inhibitor (12.8%) and a diuretic with an ACE inhibitor (7.3%) - used more frequently in males than in females (p = 0.001, 0.01, and 0.028, respectively). The most frequently prescribed three-drug regimens were diuretic and a beta-blocker plus either an ACE inhibitor (30.7%) or a calcium channel blocker (22.3%), beta-blocker plus an ACE inhibitor and a calcium channel blocker (16.3%), and a diuretic plus an ACE inhibitor and a calcium channel blocker (11.4%). There was no gender-related difference among triple-drug regimens. There was a trend towards using high doses of the beta-blocker atenolol, ACE inhibitors and methyldopa. CONCLUSION The prescribing patterns of some practising physicians were analyzed in terms of conformity with guidelines of combination of drugs and dosages. The use of antihypertensive combination therapy and the doses of individual drugs in combination regimens seem to be partly non-compliant with guidelines issued by WHO recommendations; this is illustrated by excessive prescription of some irrational combinations, as well as limited prescription of some rational combinations. In addition, a tendency to use high doses of certain classes of antihypertensive combinations was observed.

A comparison of the adverse effects of the depot preparations of flupenthixol decanoate (Depixol®) and fluphenazine decanoate (Modecate®) was conducted in 100 chronic schizophrenic patients attending the outpatient department at the Psychiatric Hospital, Bahrain.

Objectives To determine: (i) the gender-based differences of physicians in prescribing antihypertensive drugs in the management of hypertension; (ii) the influence of patient comorbidity such as diabetes mellitus on the gender-based pattern of antihypertensive prescription, and (iii) gender-based prescription patterns among family physicians (FPs) and general practitioners (GPs). Methods A survey study was carried out at 15 out of 20 health centres in Bahrain during May and June 2000. A total of 3971 prescriptions, issued to 2705 patients with uncomplicated hypertension and 1266 patients with diabetic hypertension by 77 FPs (female = 54, male = 23) and 41 GPs (female = 11, male = 30), were analysed. Results As monotherapy, female physicians preferred ACE inhibitors (OR: 0.82, CI: 0.68–0.98, P = 0.033). In terms of overall drug utilization (monotherapy + combination therapy): (i) male physicians preferred beta blockers (OR: 1.17, CI: 1.03–1.31, P = 0.014) and diuretics (OR: 1.15, CI: 1.00–1.32, P = 0.047), while female physicians preferred methyldopa (OR: 0.73, CI: 0.56–0.94, P = 0.019); (ii) in uncomplicated hypertension, female physicians preferred calcium channel blockers (OR: 0.83, CI: 0.69–0.99, P = 0.038) and methyldopa (OR: 0.69, CI: 0.49–0.98, P = 0.042), and (iii) in diabetic hypertension, male physicians preferred beta blockers (OR: 1.26, CI: 1.00–1.57, P = 0.047). While female FPs prescribed methyldopa more extensively (OR: 0.66, CI: 0.47–0.92, P = 0.018), male GPs prescribed beta blockers (OR: 1.28, CI: 1.00–1.62, P = 0.046). Conclusions Within the same practice setting, gender-based differences in the prescription of antihypertensive drugs were seen. Such preference for a particular class of antihypertensives was also influenced by the presence of comorbidity in patients and, to a limited extent, by the training level of primary care physicians.

Radiocontrast-induced nephropathy develops in approximately 10% to 20% of patients following administration of iodine-based dye and is one of the most prognostically detrimental complications that invasive cardiologists and radiologists encounter. Preexisting renal dysfunction and diabetes mellitus are two of the most powerful predictors of the likelihood of developing acute renal insufficiency after contrast delivery. To date, only adequate preprocedural hydration and postprocedural hydration to offset dehydration from contrast-induced diuresis have been shown to be effective in preventing this condition. Fenoldopam mesylate, a systemic vasodilator currently FDA-approved for short-term, in-hospital management of severe hypertension, has been shown to increase renal plasma flow in patients with and without chronic renal insufficiency. As a selective agonist of the dopamine-1 receptor, fenoldopam may preserve outer medullary renal blood flow and thereby attenuate radiocontrast-induced nephropathy. Small studies with fenoldopam prior to iodine-based dye administration have demonstrated low rates of radiocontrast nephropathy, and a larger, randomized trial has found that renal blood flow 1 hour after angiography rose in the fenoldopam group compared to a decline in the placebo group. The CONTRAST study has been designed to determine whether fenoldopam is indeed effective in diminishing the occurrence of radiocontrast-induced nephropathy.

There are no proven therapeutic agents for the prevention or treatment of acute renal failure. Radiocontrast agents induce intense vasoconstriction in the renal medulla, which is hypoxic even in normal physiologic states, thereby aggravating the imbalance of medullary oxygen supply and demand. Fenoldopam specifically increases blood flow to the renal medulla through selective agonism of dopamine-1 receptors and has been found to prevent radiocontrast nephropathy in several investigations, including one randomized, double-blind, placebo-controlled trial.

The issue of cardiovascular safety of calcium channel blockers (CCBs) has been widely debated in view of reflex increase in sympathetic activity induced by immediate release (IR) / short acting formulations. It is generally agreed that such CCBs should not be used alone in the management of hypertension.We have determined the extent to which primary care physicians prescribe CCBs as monotherapy, especially the immediate release formulations, in the management of uncomplicated hypertension and diabetic hypertension - with an emphasis upon the age of the patients. SETTING, DESIGN AND METHODS: A retrospective prescription-based study was carried out in seven out of 18 Health Centres in Bahrain. The study involved a registered population of 229,300 representing 46% of registered individuals, and 35 physicians representing 43% of all primary care physicians. The data was collected between November 1998 and January 1999 using chronic dispensing cards.In all categories CCBs were the third commonly prescribed antihypertensive as monotherapy, with a prescription rate of 11.1% in uncomplicated hypertension, 18% in diabetic hypertension and 20.1% in elderly patients above 65 years of age. Nifedipine formulations were the most extensively prescribed CCBs. Almost half of the CCB-treated patients were on IR-nifedipine, whereas IR-diltiazem and IR-verapamil, and amlodipine were infrequently prescribed.Prescription of IR-formulations of CCBs as monotherapy by primary care physicians does not conform with recommended guidelines. In view of concerns about the safety of such practice, measures to change the prescribing pattern are required.

The aim was to determine whether there are differences among family physicians (FPs) and general practitioners (GPs) in terms of their preference for different classes of antihypertensives, either alone or in combinations, in uncomplicated cases of hypertension and to determine the extent of adherence to WHO/ISH guidelines. We have analysed prescribing of antihypertensives by qualified family physicians (FPs) (n=77) and compared this with that of general practitioners (GPs) (n =41) by auditing 1791 prescriptions of FPs and 914 prescriptions of GPs, issued to patients with uncomplicated hypertension, at 15 out of 20 health centres in Bahrain. The choice of antihypertensive(s) by FPs and GPs was comparable and conformed with the WHO/ISH guidelines as regards preference for: (i) beta-blockers, angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers (CCBs) as monotherapy; (ii) two-drug combinations (diuretic-beta-blocker; beta-blocker-CCB); (iii) three-drug combinations (diuretic-beta-blocker-CCB; diuretic-beta-blocker-ACE inhibitor; beta-blocker- ACE inhibitor-CCBs), and (iv) choice of drug used for the elderly either alone (CCBs) or as combinations (diuretic-beta-blocker; beta-blocker-CCB and diuretic-beta-blocker-ACE inhibitor; diuretic-beta-blocker-CCB). In several instances prescribing by both FPs and GPs was not in accordance with the WHO/ISH guidelines: reluctance to prescribe diuretics as monotherapy; use of suboptimal combinations (beta-blocker-ACE inhibitor); and extensive use of beta-blockers and irrational use of immediate-release nifedipine in elderly. A statistically significant prescribing difference between FPs and GPs was evident in the following: beta-blockers as monotherapy (P =0.01), diuretic-CCB (P=0.046), and diuretic-CCB-methyldopa (P=0.01) combination, and immediate-release nifedipine monotherapy in the elderly (P=0.027), were prescribed more often by the GPs. However, beta-blocker-ACE inhibitor-CCB combination was more often prescribed by FPs (P=0.046). Remarkable differences in prescribing pattern of antihypertensives between the FPs and GPs were evident. Although the general pattern supported a superior prescribing profile of the FPs as expected, there is a need for improved prescribing by both GPs and FPs. Educational programmes, both graduate and residency training, and continuing professional education, should specifically address these deficiencies in order to assure quality primary health care.

Internal mammary arteries are the grafts of choice for coronary artery bypass because they are generally free of atherosclerosis and they have high patency rates as grafts. There are, however, increasing reports of graft failure due to diffuse or distal narrowing, known as the string phenomenon. From June 1999 to October 1999, we prospectively reviewed all cases of internal mammary artery angiography at our institution. Twenty-eight cases of internal mammary artery graft failure were identified (M:F, 15:13; mean age, 62 years) out of 261 patients who had undergone internal mammary artery grafting at any institution, including ours. The mean interval between coronary artery bypass and re-angiography was 35 months. There was evidence of competitive flow in 81% (22 of 27) of patients whose internal mammary grafts had developed the string sign. This observational study supports the hypothesis that competitive flow predisposes internal mammary grafts to the string phenomenon. Given the high frequency of competitive flow situations amongst patients with internal mammary artery graft failure, caution should be exercised in the anastomosis of the internal mammary artery to recipient vessels that are less than severely stenosed.

A 46-year-old man underwent two coronary bypass operations and three percutaneous interventions over a period of 18 years. A non-functioning internal mammary artery (IMA) graft, was observed shortly after the second surgery. This graft was anastomosed to the left anterior descending (LAD) that had adequate flow from an older vein graft placed during the first surgery. Over the ensuing 8 years, the IMA graft regained patency after progressive occlusive disease in the competing vein graft.

Stenosis of vessels proximal to the renal artery is an unusual cause of allograft ischemia. We report four patients who had such 'suprarenal' arterial stenoses leading to graft dysfunction that was reversed with revascularization. We additionally review the existing literature on this entity, outline the etiologies of such stenoses, as well as discuss the surgical and non-surgical therapeutic options in patients with this uncommon cause of allograft dysfunction.

We present two case reports of renal polyomavirus infection leading to renal allograft dysfunction, review the literature of this entity, and discuss the role of specific immunosupressives. Histologically, the virus caused an interstitial infiltrate composed of plasma cells and lymphocytes, interstitial fibrosis, and tubular atrophy. Viral inclusions were seen within tubular cells on light microscopy. Electron microscopy showed viral particles of 40 to 50 nm in a characteristic paracrystalline array. Both patients had been on FK-506-based immunosuppression. In both patients, the virus appeared to clear histologically and renal function stabilized when the patients were converted to cyclosporine-based immunosuppression. Contrary to prior reports, our patients have not lost their grafts and continue to have stable, albeit reduced, graft function at 2.5 years and 4.5 years following the initial diagnosis of renal polyomavirus infection.

In this paper an ongoing programme on rational selection of drugs and prescription writing at the College of Medicine and Medical Sciences (CMMS), Bahrain is described. The CMMS follows the integrated curriculum of problem-based, learner directed learning where all the basic and clinical sciences are presented through simulated patient problems. The six year curriculum is divided into three phases — the Premedicai, Unit and the Clerkship phase. In this programme the student acquires not only knowledge but skills, values and attitudes which go a long way in moulding him to be a good physician. Exercises on rational selection of drugs and prescribing skills are introduced in the unit system at an early stage in unit I. In this unit the student learns about the prescription order and its components, common abbreviations used, household measures and the skill to use the Formularies and the Pharmacopoeia. This is followed by exercises on prescription writing contained in a work book. During the subsequent units the student makes a regular visit to the skill laboratory where they get a new set of exercises centered around the problems in a work book containing objectives, instructions, relevant text and pages from the British National Formulary and clinico-therapeutic exercises. The exercises are aimed on rational selection of a drug, preparing personal formulary, critical appraisal of current literature and writing of chart orders and prescriptions. So far five such exercises out of the planned eight have been completed. The preliminary evaluation based on the results of the responses in work book 4 and the formative assessment have shown very encouraging results.

A survey of the prescribing of psychotropic drugs was carried out at the Psychiatric Hospital of Bahrain. This retrospective study on 60 inpatients of the Long Stay Ward revealed a man:woman ratio of 2.7. 91% of the men and 88% of the women were over 40 years old. 44 of the 60 patients had a diagnosis of schizophrenia, the rest had dementia, depression, schizoaffective disorders, drug-induced psychosis, general paralysis or Huntington's chorea. 95% of patients received antipsychotic drugs. Thioridazine was the most common drug followed by chlorpromazine. The mean number of drugs/patient was 1.7, with 41.7% of patients receiving only 1 drug. Tardive dyskinesia was observed in 11 patients and 9 experienced varying degrees of tremor. The findings confirm that psychiatric illness treated by psychiatrists need not lead to polypharmacy. As a consequence, its treatment may be less likely to result in adverse reactions than when patients are treated by general practitioners.

Fifty otherwise healthy patients with diabetes mellitus (37 males, 13 females; mean age: 53 +/- 10 years) of more than five year duration were compared with twenty six healthy age and sex matched controls. Detailed echocardiographic evaluation was done in all and systolic time intervals (STI) were measured. In diabetics, metabolic control and presence of microangiopathy were evaluated. PEP Index (patients: 146.23 +/- 17.04; controls: 121.99 +/- 5.15; p less than 0.001), PEP/LVET ratio (patients: 0.38 +/- 0.07; controls: 0.32 +/- 0.02; p less than 0.001), LVEF% (patients: 54.1 +/- 10.56; controls: 64.71 +/- 6.33; p less than 0.001), all were significantly altered in diabetics suggesting left ventricular dysfunction. The left ventricular posterior wall thickness (patients: 0.96 +/- 0.23 cm; controls: 0.85 +/- 0.12 cm; p less than 0.01) and interventricular septal thickness (patients: 1.2 +/- 0.24 cm; controls: 0.87 +/- 0.25 cm; p less than 0.001) in diastole were increased in diabetics. The PEPI correlated with day-to-day control but not with chronic glycemic control of diabetes mellitus. The PEP/LVET was significantly increased in patients with severe, as compared to those with none or mild microangiopathy (p less than 0.05). Thus, significant left ventricular dysfunction is evident in asymptomatic, otherwise healthy diabetics. Both metabolic control and microangiopathy may be responsible for the abnormalities.

136 lactating women 42 Controls and 94 oral contraceptive (OCs) users were studied prospectively to determine the effect of combination OCs (Primovlar and Minovlar) and low-dose progestins (norgestrel) on production and composition of human breast milk. Mean milk yield per feed was 100.18+ or -27.29 gm. in controls and no significant difference was shown when compared to the 3 study groups before therapy. In controls milk production reduced by 13 18 and 28% respectively at 10 14 and 18 weeks postpartum; these results are similar to the effects of the low-dose norgestrel preparation (13 20 and 30% reduction in milk yield respectively). In the Primovlar and Minovlar groups the reduction of milk yield was about 2 times greater (25 39 and 57% and 18 38 54% respectively for the 2 formulations). The Primovlar group showed significant reduction in milk yield during the first cycle (P < .05) whereas the other 2 study groups did not. Both Primovlar and Minovlar showed significant reductions in milk yield (P < .01) in the second and third cycles. There was no significant change in parameters used to evaluate the quality of milk in any group after starting the OC; however in terms of yield control and norgestrel groups required more than 4 feedings only 7% of the time whereas infants fed more than 4 times 26 and 30% of the time in Primovlar and Minovlar groups respectively.

(6Li,d) reactions, involving the transfer of an alpha cluster on the nuclei 12C and 16O have been studied in the framework of the three-body model. The relevant three-body equations have been solved for a system of three particles, namely alpha , d and 12C (or 16O), to calculate the on-shell amplitudes of the various rearrangement processes using the bound-state approximation (BSA). To see whether such calculations have a bearing on reactions involving the transfer of an alpha cluster, the calculated absolute values of the differential cross sections of the (6Li,d) and (6Li, alpha ) reactions on 12C and 16O have been compared with the corresponding experimental results.

Exact analytic expressions for the S-wave phase shifts and half-shell functions have been obtained in the case of exponential potentials with and without hard core. The same quantities have also been computed in the unitary pole approximation to the same potential. A comparison of the exact and unitary pole approximation values shows that the unitary pole approximation is a fairly good approximation at positive energies too, particularly when the potential has an infinitely repulsive core.

Three indices of drug metabolism, antipyrine clearance in vivo, and aminopyrine N-demethylase and bilirubin UDP-glucuronyl transferase activity in liver biopsies, were studied in fifteen patients with amoebic liver abscess (with and without jaundice). The mean (+/- S.E.) antipyrine half-life in patients with jaundice was 21.64 (+/- 1.52) h and in patients without jaundice was 19.36 (+/- 0.93) h. It was significantly prolonged in both groups of patients as compared to controls (11.63 +/- 0.86 h). It showed a good correlation with serum albumin (p less than 0.01), prothrombin time index (p less than 0.01), and aminopyrine N-demethylase (p less than 0.05). Aminopyrine N-demethylase was found to be decreased in patients without jaundice but no significant change could be observed in patients with jaundice. Bilirubin UDP-glucuronyl transferase showed no significant change in either of the groups.

The form factor of a separable interaction between a pair of particles is an important input in a three-body calculation for a transfer reaction. To construct the same, a method based on the work of Bolsterli and Mackanzie is tried for a simple case viz. α-d pair, the inputs in this calculation being the phase shift of α-d elastic scattering and the α-d separation energy of 6 Li. Finally the wave function of the relative motion of α-d clusters in the ground state of 6 Li, as derived from the calculated form factor, is compared with the available information on it from the experimental data on the 6 Li(π - , nn) 4 He reaction.

A total of 1,275 elderly patients (70 years and older) underwent coronary artery bypass alone from 1970 to 1981. The percent of elderly patients who underwent coronary bypass surgery alone increased from 2.04% in 1971 to 8.2% in 1981. Most of the patients had severe, disabling or unstable angina pectoris. The overall early mortality rate was 5.8%. The early mortality rate was 13.9% in the first group (1970 to 1975) of 158 patients compared with 4.7% in the second group (1976 to 1981) of 1,117 patients. An average of 3.1 bypass grafts per patient were implanted. On follow-up examination, angina was relieved or decreased in 89% of the patients. The 5 year survival rate was 80,6% and the 10 year survival rate was 44.1%, with an average attrition of 3.9 and 5.6%/year, respectively. It is concluded that elderly patients are high risk surgical candidates, yet the risk has decreased progressively because of improved techniques of medical and surgical management and myocardial preservation. This decreasing operative mortality rate provides evidence that when medical management of the elderly patient with severe angina fails, coronary artery bypass becomes a successful alternative.

A simple dynamical model is used to calculate the partial rate for various decay modes of charmed pseudoscalar and vector mesons. Our results together with the presently available data lend support to the hypothesis that the lowest-lying charmed particles are vector mesons. It is suggested that the multiparticle state K/sup -/..pi../sup +/..pi../sup -/..pi../sup +/ should be produced fairly copiously in charmed-vector-meson decays, which could offer a fruitful way of identifying charm. (AIP)

The problem of superconductivity is studied within the framework of partial-wave dispersion relations in. theN/D form. The B.C.S. results are obtained at zero as well as finite temperatures. An attempt is made to interpret the instability of the vacuum in terms of the energy gap.

1. Placentas from normal women and from those with pre-eclamptic toxaemia, taken immediately after labour, were examined for oxytocinase activity and analysed morphometrically. 2. Both enzyme activity and volume of syncytiotrophoblast were significantly reduced in placentas from patients with toxaemia. 3. There was a positive correlation between the enzyme activity and the proportion of trophoblast in the placenta. When the activity was expressed per unit volume trophoblast, there was very little difference between placentas, whether from normal subjects or from patients with toxaemia. 4. It is concluded that human placental oxytocinase is located in the syncytiotrophoblast.

Using equal-time commutation relations of the axial-vector "charges" with the isoscalar and isovector electromagnetic current densities, the magnetic moments of the strange members of the baryon octet and the ${\ensuremath{\Sigma}}^{0}\ensuremath{-}\ensuremath{\Lambda}$ transition moment have been calculated in terms of the pseudoscalar-meson photoproduction amplitudes, which are evaluated using low-lying baryon resonant states. The results agree very well with the experimental values available for the ${\ensuremath{\Sigma}}^{+}$ and the $\ensuremath{\Lambda}$ magnetic moments. A comparison is also made with the results of the $\mathrm{SU}(3)$ symmetry.

The Veneziano amplitude, Adler's self-consistency condition, and universality of the ρ-coupling are shown to determine theS-wave scattering lengths for the process πA→πA. A discussion is presented with reference to the current algebra result.

In an attempt to clarify the roles of the δI = 1/2 rule and the δS=δQ rule in semi-leptonic weak interactions, the decay Ω-→ n + e-+Ν is considered. The characteristics of this decay mode are calculated and compared with those of the leptonic decay of Ω- to ξ0.