Prediction of spontaneous preterm birth using fetal fibronectin in women with a low-lying placenta

Objective: To determine the effect of a low-lying placenta on the concentration of quantitative fetal fibronectin (qfFN) in the cervicovaginal fluid (CVF), and predictive accuracy for spontaneous preterm birth in asymptomatic high-risk women (18?⁺?⁰–24?⁺?⁰ weeks gestation). Methods: Median concentrations of qfFN were compared in women who had a low-lying placenta, covering the cervical os (n?=?61) to matched controls (n=?61) without a low-lying placenta. Proportions of women with raised qfFN concentrations (>10?ng/ml), and false positive and negative rates (FPR and FNR) for spontaneous preterm delivery were also compared. Results: The median concentration of qfFN in women with low-lying placenta was 5.0?ng/mL, compared with 6.0?ng/mL in controls. Proportion of women with raised levels (>10?ng/mL), positive levels (>50?ng/mL) and very high levels (>200?ng/mL) were similar in both groups (62.3% versus 59.0%, 16.3% versus 22.0% and 6.5% versus 4.9%, p?>?0.05 for all thresholds). The FPR and FNR rate for delivery before 34 and 37 weeks were also comparable (FPR 90.0% versus 85.7% and 80.0% versus 78.6%; FNR 5.8% versus 4.3% and 9.8% versus 8.5%).

Conclusions: CVF qfFN concentrations in asymptomatic high-risk women are not affected by the presence of a low-lying placenta.     

Substance Use by Women Using Domestic Violence Shelters

This study investigated the connections between stressors, substance use, and experience of violence among women (N = 125) who accessed help from domestic violence shelters in British Columbia, Canada between October 2001 and June 2003. Changes in substance use and stressors following a shelter stay were explored, using both qualitative and quantitative methods. Women generally decreased their use of alcohol and stimulants, and this change was found to be integrally connected to social and structural supports made available to them. Future research that augments current stress models of addiction by considering social and structural factors that come into play in women's substance use and domestic violence is suggested. The study's limitations are noted.     

Melioidosis in a returned traveller

Melioidosis is an infection endemic to Southeast Asia and Northern Australia, and is associated with significant morbidity and mortality. The present report describes a case of chronic melioidosis in a returning traveller from the Philippines. Clinical suspicion of this illness is warranted in individuals with a history of travel to endemic regions. Safety in handling clinical specimens is paramount because laboratory transmission has been described.     

Knowledge and self-care practice regarding diabetes among type 2diabetics: experience from a non-profit hospital chain in Bangladesh

Diabetes mellitus (DM) is generally being perceived as a problem of the developed world, but currently, people from developing countries like Bangladesh are suffering from chronic diseases of which diabetes is a major one. The aim of the study was to assess knowledge and self-care practice regarding diabetes among type 2 diabetes mellitus (T2DM) subjects. A cross-sectional study was conducted among 11,917 (age ≥?18 years, 4418 males and 7499 females) T2DM subjects attending the health care centers and hospitals in Dhaka (Capital) and also in the northern part of Bangladesh operated by the local diabetic association. Data were collected through interviewer-administered questionnaire. The levels of knowledge and self-care practice were measured by predefined scores, categorized as poor (<mean – 1 SD), average (mean?±?1 SD), and good (>mean?+?1 SD). Independent samples t test, ANOVA, and Pearson’s correlation were used to determine the association between different variables considering p value <?0.05. The mean (± SD) age (years) of the T2DM was 50?±?12. The proportion of “poor,” “average,” and “good” score for knowledge were 34%, 51%, and 15% and for that practice were 16%, 72%, and 12%, respectively. Knowledge was significantly associated with practice (r?=?0.299, p?=?0.001). The study reveals a difference between knowledge and self-care practice related to T2DM. T2DM health literacy program needs to be developed for better health promotion.     

Use of ceramic water filtration in the prevention of diarrheal disease: a randomized controlled trial in rural South Africa and zimbabwe

To determine the effectiveness of ceramic filters in reducing diarrhea, we conducted a randomized controlled trial in Zimbabwe and South Africa, in which 61 of 115 households received ceramic filters. Incidence of non-bloody and bloody diarrhea was recorded daily over 6 months using pictorial diaries for children 24-36 months of age. Poisson regression was used to compare incidence rates in intervention and control households. Adjusted for source quality, intervention household drinking water showed reduced Escherichia coli counts (relative risk, 0.67; 95% CI, 0.50-0.89). Zero E. coli were obtained for drinking water in 56.9% of intervention households. The incidence rate ratio for bloody diarrhea was 0.20 (95% CI, 0.09-0.43; P < 0.001) and for non-bloody diarrhea was 0.17 (95% CI, 0.08-0.38; P < 0.001), indicating much lower diarrhea incidence among filter users. The results suggest that ceramic filters are effective in reducing diarrheal disease incidence.     

Beta-blockers alprenolol and carvedilol stimulate beta-arrestin-mediated EGFR transactivation

Recent evidence suggests that binding of agonist to its cognate receptor initiates not only classical G protein-mediated signaling, but also beta-arrestin-dependent signaling. One such beta-arrestin-mediated pathway uses the beta(1)-adrenergic receptor (beta(1)AR) to transactivate the EGFR. To determine whether beta-adrenergic ligands that do not activate G protein signaling (i.e., beta-blockers) can stabilize the beta(1)AR in a signaling conformation, we screened 20 beta-blockers for their ability to stimulate beta-arrestin-mediated EGFR transactivation. Here we show that only alprenolol (Alp) and carvedilol (Car) induce beta(1)AR-mediated transactivation of the EGFR and downstream ERK activation. By using mutants of the beta(1)AR lacking G protein-coupled receptor kinase phosphorylation sites and siRNA directed against beta-arrestin, we show that Alp- and Car-stimulated EGFR transactivation requires beta(1)AR phosphorylation at consensus G protein-coupled receptor kinase sites and beta-arrestin recruitment to the ligand-occupied receptor. Moreover, pharmacological inhibition of Src and EGFR blocked Alp- and Car-stimulated EGFR transactivation. Our findings demonstrate that Alp and Car are ligands that not only act as classical receptor antagonists, but can also stimulate signaling pathways in a G protein-independent, beta-arrestin-dependent fashion.     

Acute renal embolism. Forty-four cases of renal infarction in patients with atrial fibrillation

Acute renal embolus is rarely reported in the medical literature; thus, accurate data regarding presentation, laboratory tests, diagnostic techniques, and treatment are lacking. To better define this condition, we examined the medical records of all patients admitted to Kaplan Medical Center and Sheba Medical Center in central Israel from 1984 to 2002 who had a diagnosis of renal infarction and atrial fibrillation. We noted demographic, clinical, and laboratory parameters; method of diagnosis; treatment received; and patient outcome. We identified 44 cases of renal embolus: 23 females and 21 males, with an average age of 69.5 +/- 12.6 years. Thirty (68%) patients had abdominal pain, and 6 (14%) had a previous embolic event. Nine patients were being treated with warfarin on admission, 6 (66%) of whom had an international normalized ratio (INR) < 1.8. Hematuria was present in 21/39 (54%), and 41 (93%) patients had a serum lactate dehydrogenase (LDH) level > 400 U/dL. The mean LDH was 1100 +/- 985 U/dL. Diagnostic techniques included renal isotope scan, which was abnormal in 36/37 cases (97%); contrast-enhanced computed tomography (CT) scan, which was diagnostic in 12/15 cases (80%); and ultrasound, which was positive in only 3/27 cases (11%). Angiography was positive in 10/10 cases (100%). Twenty-three (61%) of 38 patients had normal renal function on follow-up. The 30-day mortality was 11.4%. Renal embolus was diagnosed mainly in patients aged more than 60 years, some of whom had a previous embolic event. Most of those receiving anticoagulant therapy had a subtherapeutic INR. Abdominal pain was common, as well as hematuria and an elevated LDH. These patients are at risk of subsequent embolic events to other organs. The most sensitive diagnostic technique in this population is a renal isotope scan, but contrast-enhanced CT scan requires further assessment.