Motivation for giving birth after breast cancer

BACKGROUND: Breast cancer at a young age threatens the natural developmental tasks that characterize this phase in life including parenthood. The dilemma of whether to give birth arises due to the potential medical, psychological and social implications of pregnancy, birth and child rearing after breast cancer. The purpose of this study was to investigate the positive and negative motivations toward childbirth of breast cancer survivors and their husbands. METHOD: Thirty breast cancer survivors and 13 husbands were compared to 29 healthy women and 15 husbands. The study included qualitative questions and quantitative measures including: a demographic and medical questionnaire, the Parenthood Motivation Questionnaire--Revised, the ENRICH Marital Satisfaction Scale, the Brief Symptom Inventory, the Impact of Events Scale, and the Mental Adjustment to Cancer Questionnaire. RESULTS: The experience of having breast cancer did not hinder overall positive motivations toward childbirth, nor did it increase overall negative motivations toward childbirth, among women and their husbands. However, there were several differences between the groups, which may reflect the illness experience. For example, breast cancer survivors and their husbands reported more negative motivations toward childbirth due to health concerns than did healthy women and their husbands.     

The 1100delAT BRCA1 and the 8765delAG BRCA2 Mutations: Occurrence in High-Risk Non-Ashkenazi Jews and Haplotype Comparison of Jewish and Non-Jewish Carriers

Few mutations have been described in BRCA1 and BRCA2 in high-risk non-Ashkenazi Jews. In a Libyan family the 1100delAT BRCA1 mutation was detected and the 8765delAG BRCA2 mutation was previously described in two Jewish-Yemenite-families. In this study, the rate of these mutations in high-risk Jews of North African and Yemenite origin was assessed, and the BRCA1 -linked haplotype of Jewish and non-Jewish 1100delAT mutation carriers were compared. Genotyping included 64 high-risk Yemenite women (tested only for the BRCA 2 mutation) and 147 high-risk North African women, tested for both mutations. PCR amplification was followed by either restriction enzyme digestion or DGGE or dHPLC analyses and direct sequencing. For haplotyping, 5 BRCA1 -linked markers were used. Neither the 1100delAT BRCA1 nor the 8765delAG BRCA2 mutations were detected in any non-Ashkenazi individual. The haplotype of the non-Jewish 1100delAG mutation carrier differed from that of the Jewish-Libyan mutation carriers. We conclude that both1100delAT BRCA1 and 8765delAG BRCA2 mutations occur rarely in high-risk non-Ashkenazi Jews, and while the latter seems to be a founder mutation in some populations, the former occurs on a different background in ethnically diverse families.     

Mediterranean spotted fever during pregnancy: case presentation and literature review

Mediterranean spotted fever (MSF) is caused by Rickettsia conorii, an obligate intracellular parasite of eukaryotic cells. Although, usually this disease has a benign course, a rapidly fatal outcome can occur even in young healthy adults. We describe a case of a 40-year-old Bedouin woman gravida 11, para 10, who was admitted at 36 weeks gestation with this rickettsial disease. During pregnancy, the treatment of choice for Mediterranean spotted fever is chloramphenicol, but it seems that Azithromycin could be another possible option.     

Mechanisms of matrix metalloproteinase-9 and matrix metalloproteinase-2 inhibition by N-acetylcysteine in the human term decidua and fetal membranes

OBJECTIVE: The purpose of this study was to evaluate the effect of N-acetylcysteine on the activity and secretion of the matrix metalloproteinases in the decidua, amnion, and chorion and the secretion of the tissue inhibitor of matrix metalloproteinase-1. STUDY DESIGN: Samples from eight nonlaboring women were taken at elective cesarean section and incubated in an in vitro organ culture in the absence or presence of N-acetylcysteine. Matrix metalloproteinase-2 and matrix metalloproteinase-9 activity was measured with the use of gel zymography. Western blot analysis was used to measure matrix metalloproteinase and tissue inhibitor of matrix metalloproteinase-1 secretion. Data were analyzed with the paired Student t test. RESULTS: N-acetylcysteine had a direct inhibitory effect on matrix metalloproteinase-2 and matrix metalloproteinase-9 activity, regardless of tissue origin, starting at 1.0 mmol/L. In cultured media, 20 mmol/L N-acetylcysteine inhibited matrix metalloproteinase-2 and matrix metalloproteinase-9 activity in all three tissues. A differential response was demonstrated for matrix metalloproteinase-2 secretion, depending on the tissue that was studied. Its secretion was decreased in decidua at 10 mmol/L and 20 mmol/L; in amnion, the secretion was inhibited at 0.1 mmol/L and not affected at all in chorion. Matrix metalloproteinase-9 secretion was not affected in a statistically significant manner in any tissue. In the chorion, matrix metalloproteinase-9 showed a trend toward increased secretion. Tissue inhibitor of matrix metalloproteinase-1 secretion significantly decreased in the decidua at 20 mmol/L. CONCLUSION: N-acetylcysteine, at higher concentrations, has an inhibitory effect on matrix metalloproteinase-2 and matrix metalloproteinase-9 activity, regardless of the tissue origin and the differential effect on secretion depending on the tissue and N-acetylcysteine concentration.     

Amelioration of sulfur mustard skin injury following a topical treatment with a mixture of a steroid and a NSAID

The ability to ameliorate sulfur mustard (HD)-induced oedema by treatment with anti-inflammatory drugs was reported previously after screening four steroids and four non-steroidal anti-inflammatory drugs (NSAIDs) using the mouse ear vesicant model. Following the screening study, one steroid and one NSAID (Adexone and Voltaren) were selected as the most effective, and a mixture of the two was chosen for the present more extensive research. The effect of the combined treatment on clinical, biochemical and histopathological parameters following HD insult was studied. Mice ears were exposed to 0.2 micro l of HD for 10 min to produce a moderate skin injury. Oedema development peaked ca. 48 h following exposure, as determined by weighing ear biopsies. Histological observations at that time exhibited damage to the epidermis and dermis. An increase in prostaglandin E (PGE) was measured in skin homogenates, starting 8 h following exposure and lasting at least up to 48 h post-exposure. A topical treatment using the above anti-inflammatory mixture significantly reduced inflammatory parameters when applied up to 4 h following exposure. These parameters included extent of oedema, levels of PGE, area of clinical damage and extent of cytotoxic injury (vesications and damaged epithelial cells). Thus, a combination of a steroid and NSAID was found to be effective in reducing the intensity of HD skin injury and possibly shortening the time to full recovery. The treatment, however, did not prevent completely the ensuing cytotoxic processes in the epithelial layer.     

The role of the family physician in eating disorders

The steady increase in Eating Disorders (ED) during the last three decades has raised increasing concern over the early diagnosis and treatment of this disease. Due to the multi-factorial etiology of ED, treatment is complex, prolonged, and demands a team approach. Family physicians are often approached first for consultation following the patient's initial physical complaints. For this reason, the general practitioner can play a critical role in the early diagnosis and treatment of these disorders. By asking the appropriate questions and providing relevant information, the family physician (FP) may be able to refer the patient to treatment necessary for recovery, as well as assist in this process. Because the family physician typically has previous acquaintance with the patient and her family, he or she may be of considerable import to creating a therapeutic liaison and support framework with the professional team. This article will discuss the potential involvement and significance of the family physician in the successful diagnosis, prevention, and treatment of ED. The importance of the FP in the decision for hospitalization, referral, and follow-up is emphasized, as well as the pivotal role of the FP as a multi-disciplinary team coordinator.     

Intra-observer and inter-observer reliability and reproducibility of slit-lamp-adapted optical coherence tomography for evaluation of anterior chamber depth and central corneal thickness

BACKGROUND AND OBJECTIVE:To evaluate the intra-observer and inter-observer reproducibility of anterior chamber depth (ACD) and central corneal thickness (CCT) measurements taken by slit-lamp-adapted optical coherence tomography (SL-OCT) and to evaluate concordance of CCT and ACD values obtained by SL-OCT with gold standard devices. PATIENTS AND METHODS: Three images of each eye were taken by two different operators using SL-OCT. ACD and CCT values obtained by each operator were determined and compared to one another and to ultrasonic pachymetry (CCT) and axial OCT biometry (ACD) values obtained by a third, masked operator. Intra-observer and inter-operator reproducibility was assessed using the intraclass correlation coefficient (ICC). RESULTS: Forty-one eyes of healthy subjects were enrolled. Mean CCT was 0.556 +/- 0.020, 0.557 +/- 0.019, and 0.532 +/- 0.032 and mean ACD was 3.12 +/- 0.36, 3.13 +/- 0.38, and 3.50 +/- 0.44 for operators 1, 2, and 3, respectively (P < .001, for both CCT and ACD). Intra-operator reproducibility for CCT (ICC of 0.948 to 0.995) and ACD (ICC of 0.972 to 0.987) was excellent. CONCLUSION: SL-OCT provides highly reproducible measures for both CCT and ACD. SL-OCT yields higher values for CCT compared to ultrasonic pachymetry and lower values for ACD compared to axial OCT biometry. Caution should be taken when extrapolating these data into clinical practice until the differences between SL-OCT, axial OCT biometry, and ultrasonic pachymetry can be further elucidated.