Factors affecting the recruitment and retention of pharmacists to practice sites in rural and remote areas of New South Wales: a qualitative study

OBJECTIVE: To explore factors affecting recruitment and retention of pharmacists in rural/remote areas of New South Wales (NSW). DESIGN: Qualitative semistructured in-depth interviews. SETTING: Primary care--rural/remote community pharmacies. PARTICIPANTS: Purposive sample of 12 community pharmacists. MAIN OUTCOME MEASURES: Factors affecting recruitment and retention of pharmacists in rural/remote areas of NSW. RESULTS: Respondents reported a variety of personal and professional reasons for taking up rural practice, including previous rural experience and a preference for working in rural over metropolitan areas. The main factor affecting retention in rural areas was the high level of professional satisfaction and interprofessional rapport. Perceived reasons for the current under-supply of pharmacists to rural/remote areas of NSW included changing demographics of the pharmacy undergraduate degree programs and pharmacy workforce, and negative perceptions of rural pharmacy practice and rural lifestyle. CONCLUSIONS: This study identified factors believed to affect recruitment and retention of pharmacists in rural/remote areas. There appears to be considerable overlap between the factors, with different weightings of importance for different individuals. The lack of consensus for a proposed method of resolving this problem highlights its complexity and the need for further studies in this area.     

Antisense-mediated melanoma inhibitor of apoptosis protein downregulation sensitizes G361 melanoma cells to cisplatin

Malignant melanoma is an aggressive form of skin cancer that is highly resistant to conventional therapies. The melanoma inhibitor of apoptosis protein is a potent inhibitor of apoptosis and is overexpressed in melanoma cells, but undetectable in most normal tissues including melanocytes. We designed 20-mer phosphorothioate antisense oligonucleotides complementary to five putatively single-stranded sites on the melanoma inhibitor of apoptosis protein mRNA and investigated their ability to sensitize G361 melanoma cells to cisplatin. Inhibition of melanoma inhibitor of apoptosis protein mRNA and protein expression were measured by real-time polymerase chain reaction and immunoblotting. Cell viability and apoptosis were quantitated by colorimetric viability assays and by annexin V staining, respectively. Oligonucleotide M706 was identified as the most efficient antisense sequence which downregulated melanoma inhibitor of apoptosis protein mRNA and protein levels in G361 cells by 68 and 78%, respectively. The specificity of target downregulation was confirmed using scrambled sequence control oligonucleotides that only marginally decreased melanoma inhibitor of apoptosis protein expression. Whereas downregulation of melanoma inhibitor of apoptosis protein moderately inhibited cell growth by 26%, in combination with cisplatin, this resulted in a supra-additive effect with almost 57% reduction in G361 cell viability compared with cisplatin alone (17%) (P<0.05). Cell death was mainly due to apoptosis as demonstrated by a 3- to 4-fold increase in annexin V-positive cells and typical morphological changes compared with controls. In summary, we describe a new antisense oligonucleotide that efficiently downregulates melanoma inhibitor of apoptosis protein expression and sensitizes melanoma cells to cisplatin.     

Nodular Adenomyosis of the Uterus Causing Severe Groin Pain

Objectives:

To determine the cause of severe, disabling, groin pain.

Methods:

We describe in this case report 2 patients with severe groin pain. Two myoma-like masses were found on the uterus near the right round ligament. Both masses were excised via laparoscopy.

Results:

The pathology report of these 2 cases indicated adenomyosis. Both patients were asymptomatic after the procedure. Adenomyosis usually propagates in the myometrium, and the nodular shape of this pathology is rare. In patients with severe groin pain (menstrual or continuous), the gynecologist should think about both endometriosis of the round ligament and adenomyosis near the round ligament.

Conclusion:

Severe groin pain is rare but disabling. Endometriosis of the external part of the round ligament is described as a cause. In this case report, we explain that nodular adenomyosis can also be a cause.     

Influence of B cells in liver fibrosis associated with hepatitis B virus harboring basal core promoter mutations

The development of the liver disease in chronic hepatitis B with common viral variants can be determined through the interaction between the virus and the host immune response. B cells constitute half of the intrahepatic lymphocyte population with an impact on fibrosis. A proliferation‐inducing ligand (APRIL) has been shown to have a co‐stimulatory activity on B cells. For this study HBV DNA was amplified and then sequenced to show the presence of the basal core promoter (BCP) mutations in the serum from 57 patients with chronic hepatitis B. The range of IgD‐positive B cells was detected by immunohistochemistry in liver biopsies; and patients serum was assayed for APRIL levels by enzyme immunoassay. Twenty‐seven patients (47.4%) harbored the A1762T‐G1764A BCP mutations. Coefficients of logistic regression showed that the effect of increasing IgD‐positive B cells in rising odds of the liver disease is the same in the patients with BCP mutation A1762T‐G1764A and in the patients without mutation, nevertheless the effect of APRIL is not similar in these two groups of patients. Logistic regression in patients with BCP A1762T‐G1764A mutations demonstrated that increasing one score of APRIL decreased the odds of fibrosis stage about 8%. These results suggest that in infection with viral variants of hepatitis B virus, the population of IgD‐positive B cells may play a decisive role in later stages of the liver disease which is reduced by APRIL in chronic hepatitis patients with BCP mutations. J. Med. Virol. 84:1889–1896, 2012. © 2012 Wiley Periodicals, Inc.     

Hepatitis B and C among women with illegal social behavior in Isfahan, Iran: Seroprevalence and associated factors

Background

In Iran, there is limited evidence on the prevalence of hepatitis B and C viruses (HBV and HCV) among females who engage in illegal sexual behavior.

Objectives

To determine the prevalence of HBV and HCV infections and their associated factors in this population in Isfahan-Iran.

Patients and Methods

In this cross-sectional study, 100 females who engaged in illegal sexual behavior during 2009-2010 in Isfahan were recruited from welfare to the DIC for women, and referrals were made among those who knew others who engaged in prostitution. Markers for HBV and HCV-Ab were measured by ELISA, and recombinant immunoblot assay was used for confirmation of HCV infection. Also, a questionnaire on demographics and prostitution-associated risk data in a face-to-face interview was completed for each participant. Chi-square and multivariate logistic regression models were used for data analysis.

Results

Of the 100 samples collected, 91 were sufficient for testing. The mean age and time spent in sex work were 30.84 ± 9.34 years and 36 ± 28.5 months, respectively. HBsAg was detected in 1 (1.1%), anti-HBc in 4 (4.4%), anti-HBs in 60 (65.9%), and HCV Ab in 9 (9.9%) subjects. The evidence of vaccination was seen in 54 subjects (59.3%). There were no significant differences in the prevalence of HBV or HCV infection by estimated risk factors, and there was no independent risk factor for these infections.

Conclusions

The high prevalence of HCV infection in this study indicates the need to implement preventive interventions for female sex workers and, perhaps more importantly, to involve their male clients.     

Invasive fungal infections in renal transplant recipients

Invasive fungal infections are a significant and often lethal problem in transplant patients. Infections caused by geographically limited endemic fungi are infrequent, and Aspergillus species, Mucorales species, Candida species, and Cryptococcus neoformans are the opportunistic fungi responsible for most such infections. The symptoms of systemic fungal infections are nonspecific, particularly in their early stages. The high rates of mortality and graft loss owing to fungal infections render early diagnosis and treatment imperative in immunosuppressed patients. Current methods for the diagnosis of systemic fungal infections include imaging procedures, endoscopic methods and biopsies, microscopic and culture techniques, antibody and antigen-based serologic testing, and the detection (via polymerase chain reaction) of fungal deoxyribonucleic acid in blood or bronchoalveolar lavage fluid, as well as the careful analysis of signs and symptoms. Antifungal therapy should be initiated early in patients with a suspected fungal infection (even before laboratory findings have confirmed that diagnosis) and should be administered with appropriate adjustment of immunosuppressive regimens. To manage fungal infections in patients with renal failure, optimizing the pharmacokinetics of antifungal drugs to reduce the risk of nephrotoxicity is crucial.     

A 10-year review of assault-related open-globe injuries at an urban hospital

Background

To describe the demographics and outcomes of assault-related open-globe injuries (OGI) at University Hospital (UH), Newark, New Jersey over a ten-year period.

Methods

The medical records of all subjects presenting to a single university referral center with an OGI were retrospectively analyzed to identify prognostic factors for enucleation and final visual acuity (VA) of no light perception (NLP).

Results

One hundred and forty-eight eyes of 147 patients presented to UH with assault-related OGI. Eighty-two percent of patients were male, and the mean age was 35.9 years. The anatomic site of the wound was zone 3 in the majority (54.1 %) of eyes. Most common type of injury noted was rupture (57.4 %), followed by penetrating injury (35.1 %). Mean initial presenting and final VA in LogMAR were 2.38?±?0.12 and 2.18?±?0.16 respectively. Initial Snellen VA was no light perception (NLP) in 57 eyes (38.5 %); four eyes had an initial VA of ≥20/40 (2.7 %). Final VA was NLP in 68 eyes (45.9 %) of which 46 were enucleated (31.1 %); 18 eyes (12.2 %) had a final VA of ≥20/40. Fifty eyes (33.8 %) underwent pars plana vitrectomy (PPV). Significant risk factors of final VA of NLP or enucleation included initial VA of NLP, perforating or rupture type of OGI, and zone 3 injury. Eyes that sustained penetrating injuries were less likely to have final VA of NLP or require enucleation.

Conclusions

Assault-related OGIs carry an extremely poor visual prognosis and a high rate of enucleations. Only eighteen eyes (12.2 %) recovered VA ≥20/40. We found initial VA of NLP and zone 3 injury to be significant predictors of final VA of NLP or undergoing enucleation. Penetrating injuries were less likely to have a final VA of NLP or an enucleation.