Self-rated health and social capital in transitional countries: Multilevel analysis of comparative surveys in Armenia, Azerbaijan, and Georgia

The objective of this study is to analyze the effect of social capital on self-rated health in transitional countries of the South Caucasus region. The study is based on recent, 2009, cross-sectional nationally-representative surveys of 2082 respondents in Armenia, 2014 in Azerbaijan, and 1837 in Georgia with response rate of 78-80%. Two-level random-coefficient ordered logistic regression, modeling individual and community variations in subjective health was estimated to account for the hierarchical structure of the data set which includes individuals nested within communities. The results allow several interesting conclusions to be drawn. First, a proportion of the total variation in self-rated health explained at the community level is 0.23 for Azerbaijan, 0.10 for Georgia, and 0.08 for Armenia. These findings highlight the importance of more decentralized community-based healthcare interventions in the region. Second, human capital covariates remained significant predictors of health status even after controlling for social capital both at individual and community levels. Likewise, social capital variables are significant predictors of health status when used alone and when they are controlled by human capital covariates. These findings suggest that human capital and social capital influence health status independently of each other. Finally, this study sheds light on whether social capital collectively benefits members of a community in transitional countries beyond the individual benefits. In Armenia and Azerbaijan, community level differences in health status are rooted in "compositional" differences between social capital of individuals in the communities rather than at the community "contextual" level. In Georgia, by contrast, the beneficial effect of social capital can be simultaneously observed at the individual "compositional", and community "contextual" levels. These findings suggest that neither "compositional" nor "contextual" models of the social capital effect of health status can apply to all transitional societies universally.     

Severe influence of early pregnancy on newly reconstructed breast

Since mastectomy may have a devastative effect on the patient's appearance, body image and psychology, especially in young women, immediate breast reconstruction is widely preferred to avoid the unpleasant results caused by the defect of mastectomy. Presented here is the case of a 33-year-old patient. Considering her fibrocystic mastopathy, atypical ductal hyperplasia and a history of familial breast cancer, subcutaneous mastectomy and breast reconstruction using an implant was planned with skin reduction and repositioning of the areola-nipple complex. During her postoperative follow-up examinations which were conducted periodically, it was expected that the formation of the breasts in relation to the prosthesis would take place in the healing time. In contrast, an increase in the skin thickness and breast fullness, massive filling in the submammary fold, a vertical suture depression and consolidation were observed. These unexpected deformities were based on a pregnancy beginning just after the last operation. Later, the breast findings were followed both clinically and photographically. After termination of the pregnancy, reduction in the skin thickness, involution of the glandular tissue and changes in the shape of the breasts were observed to continue for 6 months. The end result was the development of an unacceptable breast appearance which required a major revisional surgery. Early pregnancy after subcutaneous mastectomy with reconstruction severely affects development leading to distortions in the shape of the breast during pregnancy. Additionally, involution after delivery is not also good enough to provide acceptable outcomes.     

Prospective analysis of risk factors and distribution of venous thromboembolism in the population-based Malmö Thrombophilia Study (MATS)

Background

Despite venous thromboembolism (VTE) being a major cause of morbidity and mortality, there is still limited information on its prevalence and incidence in the general population.

Objective

To evaluate risk factors, distribution and epidemiology of VTE in the Malmö area with 280 000 inhabitants.

Methods

Patients diagnosed with VTE at Malmö University Hospital in 1998–2006 were invited to a prospective population-based study. Blood sampling and a questionnaire study could be performed in 70% of patients. Remaining 30% were excluded due to language problems, dementia, other severe disease, or unwillingness to participate.

Results

During 1998–2006 1140 VTE patients (559 men [49%, age 62 ± 16 years] and 581 women [51%, age 61 ± 20 years]) were included. Deep venous thrombosis (DVT) occurred in 882 (77%), pulmonary embolism (PE) in 330 (29%), and both DVT and PE in 72 (6%). The most common acquired risk factors among VTE patients were hormone therapy (24% of female DVT patients and 19% of female PE patients), immobilisation (17% of DVT patients and 18% of PE patients), previous surgery (13% of DVT patients and 19% of PE patients), and concomitant malignant disease (12% of DVT patients and 11% of PE patients). A positive family history for VTE was obtained from 25% of DVT patients and 22% of PE patients.Yearly incidences of VTE, DVT and PE in Malmö were 66, 51, and 19/100.000, respectively.

Conclusion

Hormone therapy, immobilisation, previous surgery and concomitant malignancy were the most common acquired risk factors among VTE patients in this population-based study. The VTE-incidence was lower than in earlier epidemiological studies.     

SP-D polymorphisms and the risk of COPD

Introduction: There are limited data linking serum levels of surfactant protein D, its genetic polymorphisms to the risk of Chronic Obstructive Pulmonary Disease (COPD). Objectives: We sought to investigate these relationships using a case control study design. Methods: Post bronchodilator values of FEV1/FVC < 0.7 were used to diagnose COPD patients (n=115). Controls were healthy subjects with normal spirometry (n=106) Single nucleotide polymorphisms (rs721917, rs2243639, rs3088308) were genotyped using polymerase chain reaction (PCR) and restriction analysis. Serum SP-D levels were measured using a specific immunoassay. Results: Allele 'A' at rs3088308 (p < 0.00, B= -0.41) and 'C' allele at rs721917 (p=0.03; B= -0.30) were associated with reduced serum SP-D levels. Genotype 'T/T' at rs721917 was significantly associated with risk of COPD (p=0.01). Patients with repeat exacerbations had significantly higher serum SP-D even after adjusting for genetic factors. Conclusions: We report for the first time that rs3088308 is an important factor influencing systemic SP-D levels and confirm the previous association of rs721917 to the risk of COPD and serum SP-D levels.     

Retrieval of a detached resectoscope sheath beak during a TURP

The detachment of a resectoscope beak during transurethral resection is a rare and unpleasant event. Published techniques for its retrieval are not practical to the majority of urologists. The authors outline a novel approach for the retrieval of a detached continuous-flow resectoscope plastic beak that is quick, safe, and effective. The plastic beak is extracted at the time of detachment using standard continuous-flow resectoscope equipment. This has increased patient safety as no further loss of time and blood resulted from the delay associated with the more conventional approaches.     

Linburg-Comstock anomaly in musicians.

Anomalous tendon connections from the flexor pollicis longus to the index finger flexor digitorum profundus cause lack of independent excursion of the flexor pollicis longus, first described in 1979 by Linburg-Comstock. This anatomical variation is potentially problematic for musicians. The purpose of this study was to evaluate the incidence of this anomaly in musicians and to operate on the symptomatic patients with a limited incision with the help of magnetic resonance imaging. We studied the incidence of the anomaly among 136 musician volunteers. A lower incidence rate of the anomaly was determined in this study. One of the symptomatic musicians was operated on and the tendinous connection was excised. Clinical examination of 136 volunteers suggested that the anomaly was present in 13% of the volunteers; unilateral in 9% and bilateral in 4%. Follow-up of the patient who was operated on revealed full pain-free function without any complaint. Surgical treatment although rarely necessary, is simple and effective.     

A potential determinant of enhanced crystallization of HbC: spectroscopic and functional evidence of an alteration in the central cavity of oxyHbC

The structural basis of the crystallizing tendencies of oxyHbC (β6Glu → Lys), that produces haemolytic anaemia in homozygotes, is unknown. Using a fluorescent organic phosphate analogue (8-hydroxy-1,3,6-pyrenetrisulphonate), and conventional oxygen equilibrium studies, data suggest that the binding of inositolhexaphosphate (IHP) to oxyHbC differs from HbA, indicating perturbations of the oxyHbC central cavity, which was predicted from our earlier spectroscopic findings. To define the relationship between this conformational change in oxyHbC and its tendency to crystallize, the effect of four central cavity ligands on the crystallization rate was studied: a peptide containing 11 residues from the N-terminal portion of band 3, the full cytoplasmic domain of band 3, 2,3-diphosphoglycerate and IHP. OxyHbC crystallization was accelerated by all these central cavity ligands and not by the appropriate controls. These central cavity changes become an excellent candidate for the dramatic increase in the crystallization rate of oxyHbC.     

Pitfalls of Coronary Angiography in Aortic Dissection—A Case Report

A pitfall of coronary angiography is described in a patient with acute type A aortic dissection. Initially, the coronary arteries could not be engaged because of the guidewire crossing into the false lumen from the true lumen via the distal dissection flap.