Complement upregulation and activation on motor neurons and neuromuscular junction in the SOD1 G93A mouse model of familial amyotrophic lateral sclerosis

Complement activation products are elevated in cerebrospinal fluid, spinal cord and motor cortex of patients with amyotrophic lateral sclerosis (ALS) but are untested in models. We determined complement expression and activation in the SOD1 G93A mouse model of familial ALS (fALS). At 126days, C3 mRNA was upregulated in spinal cord and C3 protein accumulated in astrocytes and motor neurons. C3 activation products C3b/iC3b were localized exclusively on motor neurons. At the neuromuscular junction, deposits of C3b/iC3b and C1q were detected at day 47, before the appearance of clinical symptoms, and remained detectable at symptomatic stage (126days). Our findings implicate complement in the denervation of the muscle endplate by day 47 and destruction of the neuromuscular junction and spinal neuron loss by day 126 in the SOD1 G93A mouse model of fALS.     

Defibulation to treat female genital cutting: effect on symptoms and sexual function

OBJECTIVE: Women who have undergone type III female genital cutting may suffer long-term complications. Defibulation (reconstructive surgery of the infibulated scar) can alleviate some of these complications. We studied the physical and sexual outcomes after defibulation and evaluated both patient and husband satisfaction. METHODS: The medical records of 40 consecutive women with a history of type III female genital cutting who underwent defibulation between 1995 and 2003 were reviewed. Data collected included demographics, indications for the procedure, closure type, intraoperative and postoperative complications. Telephone surveys were conducted between 6 months and 2 years postprocedure to evaluate the long-term health and sexual satisfaction outcomes. RESULTS: Of 40 women identified as having undergone defibulation, 95% were Somali, 65% were married, and 73% were between the ages of 19 and 30. Primary indications for defibulation were being pregnant (30%), dysmenorrhea (30%), apareunia (20%), and dyspareunia (15%). Secondary indications were apareunia (20%), difficulty urinating (12.5%), and dyspareunia (10%). Sixty-five percent had a subcuticular repair. Forty-eight percent had an intact clitoris buried beneath the scar. None had intraoperative or postoperative complications. Of the 32 patients reached by telephone, 94% stated they would highly recommend it to others. One hundred percent of patients and their husbands were satisfied with the results, felt their appearance had improved, and were sexually satisfied. CONCLUSION: Defibulation is recommended for all infibulated women who suffer long-term complications. The complication rates are minimal, with high satisfaction rates among patients and their husbands. LEVEL OF EVIDENCE: II-3.     

Preparing for Global Women’s Health Work

Interest in global maternal health has steadily increased over the past decade. Medical schools are offering courses on this subject, residencies are incorporating international elective rotations into their practices, and retiring practitioners are opting to spend a year or two in low-resource settings. Although interest is growing, sometimes wellmeaning health practitioners are not entirely prepared for their new experience. Prior to departure, a multistep process is necessary to prepare physicians for living and practicing overseas.Key words: Global women’s health, Overseas practice managementMany low-resource countries suffer from maternal health problems, including obstetric fistula, infectious disease, cervical cancer, and maternal death. There is a great need for better clinics and hospitals that are supplied with medication and functioning equipment and that are staffed by well-rained health practitioners. The United Nations Millennium Development Goals have led to a greater focus on the health needs in these nations. In the United States, the American Congress of Obstetricians and Gynecologists (ACOG) has issued a policy statement that acknowledged women’s health and rights around the world.¹ There is a genuine desire to become involved in global women’s health, but recognizing the best way to help can be challenging.     

Obesity in resource-poor nations

Obesity is increasing in resource-poor nations at an alarming rate. Obesity is a risk factor for noncommunicable diseases such as diabetes, cardiovascular disease, cancer, and high-risk pregnancy. The combination of obesity and its concomitant diseases affects more women than men. Obesity places a large burden on an already thinly stretched health system that creates a public health challenge. Given faster population growth, increased urbanization, and lifestyle changes, an epidemic of obesity is expected in resource-poor nations within the next decade. Diet, exercise, medication, and weight-loss surgery are methods of weight reduction, but cultural and public health considerations must be assessed when implementing these various methods of weight loss.     

HIV and Pregnancy in Resource-Poor Settings

There are 33.4 million people living with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome. Globally, HIV/AIDS is the leading cause of death among women of reproductive age. In the United States and other developed countries, aggressive efforts to treat HIV-positive pregnant women with highly active antiretroviral therapy have decreased the maternal-to-child transmission (MTCT) from over 20% to less than 2%. However, in resource-poor settings, access to antiretroviral therapy (ART) is not readily available, and perinatal transmission rates remain as high as 45%. Women are at greater risk of heterosexual transmission of HIV, which is compounded by lack of condom use, imbalance of social power, and the high fertility rate. Prevention programs are needed to empower and educate women and engender community awareness for condom use. Prenatal screening and treatment, intrapartum ART, and postpartum prophylaxis must be made available to all women and children to prevent MTCT.Key Words: Human immunodeficiency virus, AIDS, Antiretroviral therapy, Pregnancy, Perinatal transmissionHuman immunodeficiency virus (HIV) and AIDS are recognized as major contributors to maternal mortality worldwide. Of the 33.4 million people affected with HIV/AIDS, 22.4 million live in sub-Saharan Africa, 3.8 million live in Southeast Asia, and 2 million live in Latin America (Figure 1). Almost 16 million (47%) are women, and 2.7 million (6.2%) are children.¹ According to the World Health Organization (WHO), approximately 60,000 fewer maternal deaths would have occurred in 2008 in the absence of HIV, and the maternal mortality rate from 1980 to 2008 would have dropped much more significantly if it had not been for the introduction of the HIV epidemic.²Open in a separate windowFigure 1Adults and children estimated to be living with human immunodeficiency virus (2008). Reproduced with permission from UNAIDS/World Health Organization.¹ © UNAIDS.     

Schistosomiasis: Health Effects on Women

Schistosomiasis is a parasitic infection endemic in 74 resource-poor nations that affects approximately 200 million people. Schistosomes are water-borne flatworms or blood flukes that enter the human body through the skin. Some symptoms of schistosomiasis include fever, arthralgias, abdominal pain, bloody diarrhea, and hematuria. Ultimately, patients develop heptosplenomegaly, ascites, and lymphadenopathy. Schistosomiasis is a neglected tropical disease, and its global health impact is grossly underestimated. Women suffer considerably from female genital schistosomiasis that causes infertility, preterm labor, anemia, menstrual disorders, and dyspareunia. More effort is needed to prevent schistosomiasis. Treating pregnant and lactating women decreases the disease burden and improves maternal and fetal outcome.Key words: Schistosomiasis, Praziquantel, Female genital schistosomiasisSchistosomiasis, also known as, bilharzia, bilharziasis, or snail fever, affects approximately 200 million people worldwide. Theodor Bilharz, a German surgeon who worked in Cairo, discovered schistosomiasis in 1851. Today, 120 million people are symptomatic.¹ Over 80% of the disease is currently found in sub-Saharan Africa (Figure 1). According to the World Health Organization (WHO), approximately 652 million people are at risk with an estimated 200,000 deaths occurring annually. Forty million women of childbearing age are infected.² WHO has placed schistosomiasis as the third most devastating tropical disease, following malaria and intestinal helminthiasis.³Open in a separate windowFigure 1Countries and areas at risk for schistosomiasis (2008). Available at http://gamapserver.who.int/mapLibrary/Files/Maps/Global_ShistoPrevalence_ITHRiskMap.png. Reprinted with permission.There are 5 species of schistosomiasis. These water-borne flatworms or blood flukes are schistosomes. The most common are Schistosoma mansoni, S japonicum, and S haematobium. The rarer forms are S intercalatum and S mekongi. S mansoni occurs in Africa, the Caribbean, South America, and the Eastern Mediterranean. S japonicum and S mekongi are found in Southeast Asia and the Western Pacific. S intercalatum is endemic in central Africa and S haematobium occurs throughout Africa and the Eastern Mediterranean. S haematobium affects both the urinary and reproductive tract systems, whereas the 4 other species impact the hepatic and gastrointestinal systems.⁴