Correlates of unintended pregnancy among currently pregnant married women in Nepal

Background  

Women living in every country, irrespective of its development status, have been facing the problem of unintended pregnancy. Unintended pregnancy is an important public health issue in both developing and developed countries because of its negative association with the social and health outcomes for both mothers and children. This study aims to determine the prevalence and the factors influencing unintended pregnancy among currently pregnant married women in Nepal.     

Rapp-Hodgkin syndrome with palmoplantar keratoderma,glossy tongue,congenital absence of lingual frenum and of sublingual caruncles: Newly recognized findings

We report on a boy with Rapp-Hodgkin syndrome (RHS) or Rapp-Hodgkin ectodermal dysplasia. He had sparse, wiry, slow growing and uncombable hair, but no pili torti or pili canaliculi characteristic of RHS. He also had sparse eyelashes and eyebrows, and obstructed lacrimal puncta and epiphora. Bilateral bony external auditory canal stenosis led to hearing loss. The mouth was small with repaired bilateral cleft lip and palate. Oral manifestations included hypodontia, microdontia, unerupted mandibular premolars with well formed roots, large dental pulp spaces, enamel hypoplasia, multiple caries, glossy tongue, and congenital absence of lingual frenum and of sublingual caruncles including submandibular and sublingual salivary duct openings. Palmoplantar keratoderma, unerupted premolars, congenital absence of lingual frenum, sublingual caruncles, glossy tongue, and pili canaliculi seen in the patient are newly recognized findings of this syndrome. Overlapping findings of RHS ectrodactyly–ectodermal dysplasia–clefting syndrome (EEC), and ankyloblepharon–ectodermal defects–cleft lip and palate syndrome (AEC) are discussed. Am. J. Med. Genet 79:343–346, 1998. © 1998 Wiley-Liss, Inc.     

Appropriateness of patients transferred with orthopedic injuries: experience of a level I trauma center

Background

Trauma patients are frequently transferred to a higher level of care for specialized orthopedic care. Many of these transfers are not necessary and waste valuable resources. The purpose of this study was to quantify our own experience and to assess the appropriateness of orthopedic transfers to a level I trauma center emergency department.

Methods

A retrospective review of orthopedic emergency department transfers to a level I trauma center was performed. Data collected included time of transfer, injury severity score (ISS), age, gender, race, orthopedic coverage at transfer institution, and insurance status. Two orthopedic trauma surgeons graded the appropriateness of transfer. A weighted logistic regression model was used to compare dependent and independent variables.

Results

A total of 324 patient transfers were reviewed; 65 (20.1%) of them were graded as inappropriate. There was no statistically significant relationship between appropriateness of transfer and age, availability of orthopedic coverage, night/weekend transfer, or insurance status. Regression analysis showed that only ISS (OR 1.130, p = .008) and “polytrauma” (OR 25.39, p < .0001) designation were associated with increased odds ratio of appropriate transfer. The kappa coefficient for inter-rater reliability between the two raters was 0.505 (95% CI, 0.388–0.623) reflecting moderate agreement.

Conclusion

Inappropriate transfers create a significant medical burden to our health care system using valuable resources. Our study found similar results of inappropriate transfers compared to previous studies. However, we did not find a relationship between insurance status or nights/weekends and transfer appropriateness.

     

Proteomics analysis and evaluation of biomarkers for detection of cholangiocarcinoma

Cholangiocarcinoma (CCA) is a rare but devastating neoplasm that accounts for about 3% of all gastrointestinal cancers and about 15% of all primary liver cancers worldwide. The lack of early detection and limited therapeutic options are major problems in controlling CCA. The current study attempted to identify novel serum markers which can substitute the carbohydrate antigen CA19-9, or can improve, when measured together, the diagnostic accuracy of CA19-9. Differentially expressed proteins in pooled and individual plasma samples obtained from patients with CCA and control subjects (10 each) were identified by using two-dimensional gel electrophoresis (2-DE) and mass spectrometry (MALDI-TOF). Out of a total of 21 protein spots separated and identified, five spots were found to be up-regulated in plasma from CCA patients. The up-regulation of α1-antitrypsin (AP1) was observed in all of the ten samples from CCA patients with protein intensity significantly higher than control subjects. Based on results of binary logistic regression analysis of the three serum biomarkers (CA19-9, AP1 and α-fetoprotein: AFP), serum levels of at least CA19-9 together with AP1 were the minimum requirement to obtain prediction accuracy of greater than 80% in a battery test for diagnosis of CCA. However, in order to obtain high predictability of 100% or approaching, an addition of at least one of the three liver function enzymes (alkaline phosphatase: ALP; aspartase transaminase: AST; alanine trasaminase: ALT) is required. Serum biomarkers may be a useful diagnostic or prognostic monitoring tool for CCA. Further evaluation of larger number samples is needed to support their applicability in a clinical setting as diagnostic and prognostic tools. Determination of clinical utility of these marker models in early diagnosis of CCA requires study in animal models with disease progression.     

Chronological observations of intestinal histopathology in rats (Rattus norvegicus) infected with Centrocestus caninus

Intestinal pathological enzyme activity changes were studied chronologically in rats after Centrocestus caninus infection. A single inoculation of 300 metacercariae isolated from the gills of goldfish (Carassius auratus), was orally administered to male rats (n = 15). Uninfected animals were used as controls (n = 5). At days 3, 7, 14, 21, and 28 post-infection (PI), three infected rats, and one from each control group, were sacrificed. The duodenum, jejunum, and ileum were removed separately and fixed in 10% formalin and 10% cold formal calcium solution for histopathological and alkaline phosphatase activity investigations, respectively. The worms were found intruded into the intervillous space of the mucosa and the mucosa showed villous atrophy, crypt hyperplasia and stromal inflammation with inflammatory cell accumulations. Alkaline phosphatase (ALP) activity also showed retardation. However, it seemed that these phenomena would return to normal at the end of the experiment. It can be concluded, from our data, that C. caninus could cause mild histopathological alterations and reduce ALP activity in the small intestines.     

A workplace intervention program and the increase in HIV knowledge,perceived accessibility and use of condoms among young factory workers in Thailand

Vulnerability to Human Immunodeficiency Virus (HIV) infection among factory workers is a global problem. This study investigated the effectiveness of an intervention to increase AIDS knowledge, perceived accessibility to condoms and condom use among young factory workers in Thailand. The intervention was a workplace program designed to engage the private sector in HIV prevention. A cross-sectional survey conducted in 2008 to measure program outcomes in factories in Thailand was used in this study. The workplace intervention included the development of policies for management of HIV-positive employees, training sessions for managers and workers, and distribution of educational materials and condoms. A multi-level analysis was used to investigate the effect of HIV/AIDS prevention program components at the workplace on HIV/AIDS knowledge, perceived accessibility to condoms and condom use with regular sexual partners among 699 young factory workers (aged 18–24 years), controlling for their individual socio-demographic characteristics. Interventions related to the management and services component including workplace AIDS policy formulation, condom services programs and behavioral change campaigns were found to be significantly related to increased AIDS knowledge, perceived accessibility to condoms and condom use with regular partners. The effect of the HIV/AIDS training for managers, peer leaders and workers was positive but not statistically significant. With some revision of program components, scaling up of workplace interventions and the engagement of the private sector in HIV prevention should be seriously considered.     

Effects of the etonogestrel-releasing implant Implanon and a nonmedicated intrauterine device on the growth of breast-fed infants

The study objectives were to compare the effects of an etonogestrel-releasing implant (Implanon) and a nonmedicated intrauterine device (IUD) on parameters of lactation in breast-feeding women and on the growth of their breast-fed infants over a 3-year period. Healthy lactating women (28-56 days postpartum) chose either the implant (n=42) or the IUD (n=38). Infant growth during a 3-year follow-up period is reported here. Total duration of breast-feeding coinciding with the mothers' treatment was 421.0 and 423.4 days in the Implanon and IUD groups, respectively. There were no differences between the infant groups in terms of body length, biparietal head circumference and body weight. No abnormalities were reported in psychomotor development or during physical examination. No treatment-related side effects were observed in either group. In conclusion, there were no differences in the growth of breast-fed infants of women treated with Implanon or a nonmedicated IUD. Implanon, therefore, appears to be a safe contraceptive option for breast-feeding women and their infants.     

Rapid identification of Penicillium marneffei by PCR-based detection of specific sequences on the rRNA gene

An emerging pathogenic dimorphic fungus, Penicillium marneffei, is one of the major causes of morbidity in patients with human immunodeficiency virus infection in Southeast Asia. A PCR-hybridization assay has been developed to identify this pathogen. This study describes the use of single and nested PCR methods for the rapid identification of P. marneffei. Two sets of oligonucleotide primers were derived from the sequence of 18S rRNA genes of P. marneffei. The outer primers (RRF1 and RRH1) were fungus specific. The inner primers (Pm1 and Pm2) were specific for P. marneffei and were used in nested or single PCR. The specific fragment of approximately 400-bp was amplified from both mold and yeast forms of 13 P. marneffei human isolates, 12 bamboo rat isolates, and 1 soil isolate, but not from other fungi, bacteria, and human DNA. The amplified products were analyzed by agarose gel electrophoresis followed by ethidium bromide staining. The sensitivities of the single PCR and nested PCR were 1.0 pg/microl and 1.8 fg/microl, respectively. The assay is useful for rapid identification of P. marneffei cultures. Very young culture of P. marneffei (2-day-old filamentous colony, 2 mm in diameter) could be performed by this assay. The species was identified within 7 h (single PCR) or 10 h (nested PCR), compared to 4 to 7 days for confirmation of dimorphism. The application of these PCR methods for early diagnosis of the disease needs to be studied further.