Chlamydia trachomatis among sexually active teenage girls: influence of sampling location and clinical signs on the detection rate.

A total of 707 cultures for Chlamydia trachomatis were obtained from healthy teenage girls attending an adolescence clinic for family planning. Apart from sampling from the endocervix, specimens were also obtained from outside the squamocolumnar junction and from the posterior fornix and cultured separately in order to study whether it was possible to improve the detection rate of C trachomatis by sampling from outside the endocervix. In 91 (12.8%) of the girls a positive culture was found. Of the chlamydia positive samples, 83.5% were obtained from the endocervix and 95% from outside the squamocolumnar junction of the portio. Of the 91 positive cultures, 15 (16.5%) were positive only in the sample obtained from the portio surface. The results indicate that the detection rate of C trachomatis could be improved by extended specimen collection. C trachomatis was isolated significantly more often when there was an ectopy, irrespective of whether the specimens had been collected from the endocervix or from outside the squamocolumnar junction. C trachomatis was particularly common if there was an ectopy and a bleeding at specimen collection. If there was no bleeding at sampling, C trachomatis was equally common in women with as in those without an ectopy.     

Site and mechanism of the action of diuretics

Abstract: The mechanism of action of diuretics can be established by studying the molecular mechanism of action, the site of action within the nephron, and the relationship between the pharmacokinetics of the diuretic and its effect. The molecular mechanism of action is known for diuretic agents such as acetazolamide (carbonic anhydrase), theophylline (phosphodiesterase), digitalis glucosides (Na-K-ATPase), spironolactone (aldosterone antagonism) and dopamine (specific receptors?). The “receptor” for the clinically most important diuretics, i.e. loop diuretics, thiazides, and other potassium-sparing diuretics is, however, unknown. It appears from recent studies of the ion transport in the dilating segment that there probably is a sodium-chloride co-transport in this segment and that loop diuretics specificly inhibit the active chloride transport. The main site of diuretic action is well established for the different groups of diuretics: carbonic anhydrase inhibitors act on the proximal tubulus, loop diuretics on the diluting segment, thiazides on the cortical diluting segment/distal tubulus, and potassium-sparing agents on distal tubulus/collecting ducts. Moreover, some diuretics have additional tubular sites of action. It is also important to realize that other effects of diuretics, e.g. inhibition of the tubuloglomerular feedback mechanism or renal and extrarenal hemodynamic effects, can modify the tubular diuretic effect. Finally, the renal handling of diuretics is of importance to the diuretic effect by determining the concentration of the drug at the “receptor” sit (s). It is emphasized that knowledge of the different aspects of the mechanisms of action of diuretics is a prerequisite for rational use of diuretics, clinically as well as experimentally.     

SEITO - Stockholm Eastman Index of Treatment Outcome

To obtain high quality in orthodontics; it is important to evaluate the treatment. There are many indices for evaluation of treatment outcome however all of them compare treatment outcome with ideal occlusion. Therefore Stockholm Eastman Index of Treatment Outcome (SEITO) was invented. This index relates the treatment outcome to the treatment goal. SEITO is a morphological index based on criteria from the records including study casts, and/or intra oral photos. METHOD: The outcome of treatment is related to the treatment goal as stated in the records. Pre-treatment goals are divided into subgroups; overjet, vertical relation anterior/lateral), anterior cross bite, transverse relations, impacted teeth and space crowding/ spacing. Each subgroup is scored; the points are 0, 1, 3 or 5 depending on the severity of the malocclusion. The points for each subgroup are added to give a total sum of treatment goal points. Each post-treatment subgroup above is evaluated. If the treatment goal is fulfilled, the treatment outcome points are equal to the treatment goal points. If not - there is a reduction in the outcome points. Finally the outcome points are expressed as a percentage of the treatment goal points and form a measure of the success of treatment. CONCLUSION: SEITO index is a simple and quick way to obtain a picture of the quality of treatment outcome, and the only orthodontic index that relates the treatment outcome to the treatment goal.     

A prospective study of infections in burn patients

In a 3-year prospective study, all infections presenting in the burns unit of a university hospital were registered in a specially designed database. Two-hundred and thirty adult patients were included. Eighty-three patients had in all 176 infections, giving an infection rate of 48 per 1000 patient days including both nosocomial and community-acquired infections. Thirty-five blood-stream infections (BSI) occurred in 22 patients; most common micro-organisms were coagulase-negative staphylococci and methicillin-sensitive Staphylococcus aureus. The device-specific BSI rate was 6 per 1000 central venous catheter days, which is low compared to other burn units. The pneumonia rate was 41 per 1000 ventilator days. Seventy-two patients had 107 burn wound infections. Antibiotics were given to only 50% of the burn patients, including 96% of the patients with infection and 26% of those without infection. Most frequently used antimicrobials were cloxacillin, penicillin and gentamicin. The antibiotic resistance rates were low, and multi-resistant bacteria or fungi were rare. The database can be used to evaluate the effects of changes in burn treatment, staffing and design of burn units, and antimicrobial resistance development in relation to antibiotic usage.     

School stressors, psychological complaints and psychosomatic pain

BACKGROUND: The proportion of Scandinavian school children reporting psychosomatic pain and psychological complaints have increased in recent decades. In this study we investigated these symptoms in relation to potential stressors in the school environment. METHODS: A cross-sectional study was conducted based on child interviews linked to nationally representative household surveys in Sweden during 2002-2003 covering a sample of 2588 children aged 10-18 years. The main outcome variable of psychosomatic pain signified suffering from headache as well as recurrent abdominal pain on a weekly basis. RESULTS: School stressors, such as harassment by peers, schoolwork pressure and being treated poorly by teachers, were associated with psychosomatic pain as well as psychological complaints such as sadness, irritability, feeling unsafe and nervous. Harassment was identified as a particularly important determinant with adjusted odds ratios (ORs) ranging from 3.1 to 8.6 for psychosomatic pain. All psychological complaints were associated with psychosomatic pain with adjusted ORs ranging from 2.2 to 3.7, and mediated most of the association of harassment to psychosomatic pain. CONCLUSIONS: School stressors are strongly associated with psychosomatic pain and psychological complaints in school children. Psychological complaints seem to function as mediators in the association of school stressors to psychosomatic pain symptoms to a great extent.     

Acceptability of a nonsurgical method to terminate very early pregnancy in comparison to vacuum aspiration.

Seventy-seven patients applying for abortion during early pregnancy consented to be treated by prostaglandin vaginal suppositories or vacuum aspiration by Kahrman catheter in a random design. They also consented to participate in an acceptability study of the two procedures. Attitude and preference measures were obtained by interviewing and rating scales on three occasions: before assignment to abortion procedure, immediately after treatment, and two weeks later. The first 30 patients with complete abortion by either procedure participated in the acceptability study. Both treatments were positively evaluated but perceived to have very different characteristics. The preference for the method used for own treatment increased in both groups. Before treatment 1/3 of the patients in each group had a positive attitude to a self-administered method to induce abortion outside clinics. This proportion increased significantly after treatment but only in the group that received prostaglandin by the vaginal route.     

Popliteal Pterygium Syndrome in a 74-Year-Old Woman

The case of a 74-year-old woman with the rare popliteal pterygium syndrome is presented. This syndrome is inherited as an autosomal dominant trait with incomplete penetrance and varying expression and consists of cleft lip and palate, lip pits, genital anomalies, popliteal pterygium, and malformations of the extremities. The various treatments our patient underwent over the years are reported. Treatment of popliteal pterygium involves special problems when removing the skin fold because the nerve and vascular cords lie immediately anterior to the posterior fibrous cord. in the present case there are widespread arthrotic changes, both in the extremity joints and in the spine. These patients are short in stature. This, together with the general arthropathy, suggests a hereditary metabolic disturbance in the cartilaginous tissue.