Echis ocellatus Venom-Induced Reproductive Pathologies in Rat Model; Roles of Oxidative Stress and Pro-Inflammatory Cytokines

This study reported reproductive pathologies associated with Echis ocellatus venom in animal model. Twenty male Wistar rats with body weight between 180 and 220 g were selected randomly into two groups (n = 10). Rats in group 1 served as the control while rats in group 2 were envenomed with a single intraperitoneal injection of 0.055 mg/kg⁻¹ (LD_6.25) of E. ocellatus venom on the first day and a repeated dose on the twenty fifth day. Both control and envenomed rats were monitored for fifty consecutive days. The venom caused a significant (p < 0.05) reduction in sperm motility, count, and volume, with increased sperm anomalies in envenomed rats compared to the control. Likewise, serum concentrations of male reproductive hormones were significantly (p < 0.05) higher in envenomed rats. Increased levels of malondialdehyde were accompanied by a significant (p < 0.05) decrease in reduced glutathione and catalase activity in the epididymis and testis tissues of envenomed rats. The venom enhanced the release of epididymal and testicular tumor necrosis factor-alpha and interleukin1-beta compared to the control. Furthermore, severe pathological defects were noticed in tissues of the testis and epididymis of envenomed rats. This study demonstrated that E. ocellatus venom toxins can induce reproductive dysfunction in male victims of snake envenoming.     

A comprehensive Laboratory Services Survey of State Public Health Laboratories.

In November 2004, the Association of Public Health Laboratories (APHL) conducted a Comprehensive Laboratory Services Survey of State Public Health Laboratories (SPHLs) in order to establish the baseline data necessary for Healthy People 2010 Objective 23-13. This objective aims to measure the increase in the proportion of health agencies that provide or assure access to comprehensive laboratory services to support essential public health services. This assessment addressed only SPHLs and served as a baseline to periodically evaluate the level of improvement in the provision of laboratory services over the decade ending 2010. The 2004 survey used selected questions that were identified as key indicators of provision of comprehensive laboratory services. The survey was developed in consultation with the Centers for Disease Control and Prevention National Center for Health Statistics, based on newly developed data sources. Forty-seven states and one territory responded to the survey. The survey was based on the 11 core functions of SPHLs as previously defined by APHL. The range of performance among individual laboratories for the 11 core functions (subobjectives) reflects the challenging issues that have confronted SPHLs in the first half of this decade. APHL is now working on a coordinated effort with other stakeholders to create seamless state and national systems for the provision of laboratory services in support of public health programs. These services are necessary to help face the threats raised by the specter of terrorism, emerging infections, and natural disasters.     

The Role of Minimally Invasive Gynecologic Surgery in Sub Saharan Africa

Purpose of Review

Minimally invasive gynecologic surgery (MIGS) is now firmly established in developed countries where there has been a trend away from traditional open surgery towards laparoscopy given proven benefits of faster recovery time and better cosmesis for patients. However, this same trend has not been observed in regions like sub Saharan Africa (SSA) where resources are limited. Lack of human and material resources, need for technological support, and challenges with training have been postulated as major limitations for wide spread introduction and expansion of MIGS in SSA. Nonetheless, a few institutions in sub Saharan Africa have been able to surmount these challenges to develop MIGS in SSA. This paper reviews the current state of minimally invasive surgery in sub Saharan Africa. We review the role and benefits of expanding minimally invasive surgery in sub Saharan Africa with a focus on management of gynecologic conditions. Finally, we review the challenges associated with MIGS in SSA and provide recommendations on the way forward.

Recent Findings

There are several published studies on the successful development of minimally invasive surgery in sub -Saharan Africa with similar benefits of shorter hospital stay, quicker recovery, and better cosmesis for patients. These studies also report the challenges with human and material resources and training.

Summary

There is a large role and need for expansion of minimally invasive surgery in sub Saharan Africa. The challenges of lack of resources, personnel, and training can be surmountable through ingenuity, modeling based on experiences from other low to middle income countries and commitment to the advancement of MIGS for the benefit of women’s health globally.

     

Surgical site infection after cesarean delivery: incidence and risk factors at a US academic institution

Purpose: To identify the rate of surgical site infection (SSI) after Cesarean delivery (CD) and determine risk factors predictive for infection at a large academic institution.

Methods: This was a retrospective cohort study in women undergoing CD during 2013. SSIs were defined by Centers for Disease Control (CDC) criteria. Chi square and t-tests were used for bivariate analysis and multivariate logistic regression was used to identify SSI risk factors.

Results: In 2419 patients, the rate of SSI was 5.5% (n?=?133) with cellulitis in 4.9% (n?=?118), deep incisional infection in 0.6% (n?=?15) and intra-abdominal infection in 0.3% (n?=?7). On multivariate analysis, SSI was higher among CD for labor arrest (OR 2.4; 95%CI 1.6–3.5; p?<.001). Preterm labor (OR 2.8; 95%CI 1.3–6.0; p?=?.01) and general anesthesia (OR 4.4; 95%CI 2.0–9.8; p?=?.003) were predictive for SSI. Increasing BMI (OR 1.1; 95%CI 1.05–1.09; p?=?.02), asthma (OR 1.9; 95%CI 1.1–3.2; p?=?.02) and smoking (OR 1.9; 95%CI 1.1–3.2; p?=?.02) were associated with increased SSI.

Conclusions: Several patient and surgical variables are associated with increased rate of SSI after CD. Identification of risk factors for SSI after CD is important for targeted implementation of quality improvement measures and infection control interventions.     

A model to predict risk of postpartum infection after Caesarean delivery

Purpose: The purpose of this study is to build and validate a statistical model to predict infection after caesarean delivery (CD).

Methods: Patient and surgical variables within 30 d of CD were collected on 2419 women. Postpartum infection included surgical site infection, urinary tract infection, endomyometritis and pneumonia. The data were split into model development and internal validation (1 January–31 August; N?=?1641) and temporal validation subsets (1 September–31 December; N?=?778). Logistic regression models were fit to the data with concordance index and calibration curves used to assess accuracy. Internal validation was performed with bootstrapping correcting for bias.

Results: Postoperative infection occurred in 8% (95% CI 7.3–9.9), with 5% meeting CDC criteria for surgical site infections (SSI) (95% CI 4.1–5.8). Eight variables were predictive for infection: increasing BMI, higher number of prior Caesarean deliveries, emergent Caesarean delivery, Caesarean for failure to progress, skin closure using stainless steel staples, chorioamnionitis, maternal asthma and lower gestational age. The model discriminated between women with and without infection on internal validation (concordance index?=?0.71 95% CI 0.67–0.76) and temporal validation (concordance index?=?0.70, 95% CI 0.62, 0.78).

Conclusions: Our model accurately predicts risk of infection after CD. Identification of patients at risk for postoperative infection allows for individualized patient care and counseling.     

Glucokinase inhibitor glucosamine stimulates feeding and activates hypothalamic neuropeptide Y and orexin neurons

Maintaining glucose levels within the appropriate physiological range is necessary for survival. The identification of specific neuronal populations, within discreet brain regions, sensitive to changes in glucose concentration has led to the hypothesis of a central glucose-sensing system capable of directly modulating feeding behaviour. Glucokinase (GK) has been identified as a glucose-sensor responsible for detecting such changes both within the brain and the periphery. We previously reported that antagonism of centrally expressed GK by administration of glucosamine (GSN) was sufficient to induce protective glucoprivic feeding in rats. Here we examine a neurochemical mechanism underlying this effect and report that GSN stimulated food intake is highly correlated with the induction of the neuronal activation marker cFOS within two nuclei with a demonstrated role in central glucose sensing and appetite, the arcuate nucleus of the hypothalamus (ARC) and lateral hypothalamic area (LHA). Furthermore, GSN stimulated cFOS within the ARC was observed in orexigenic neurons expressing the endogenous melanocortin receptor antagonist agouti-related peptide (AgRP) and neuropeptide Y (NPY), but not those expressing the anorectic endogenous melanocortin receptor agonist alpha-melanocyte stimulating hormone (α-MSH). In the LHA, GSN stimulated cFOS was found within arousal and feeding associated orexin/hypocretin (ORX), but not orexigenic melanin-concentrating hormone (MCH) expressing neurons. Our data suggest that GK within these specific feeding and arousal related populations of AgRP/NPY and ORX neurons may play a modulatory role in the sensing of and appetitive response to hypoglycaemia.     

Access to root canal treatment in a Nigerian sub-population: assessment of the effect of dental health insurance

BackgroundThe final pathway of tooth mortality lies between tooth extraction, and the more expensive and less accessible root canal treatment (RCT).AimTo determine the extent to which individuals'' financial resources as measured by socioeconomic status and dental insurance coverage affects their access to RCT.MethodsA hospital-based study that used a 15-item questionnaire to collect data among patients scheduled for RCT. All scheduled subjects (N = 291) over a one-year period constituted the sample for the study. Using the SPSS software, associations between the subjects'' variables, and the dental insurance status were carried out with Chi square and independent t test respectively at 95% confidence interval.ResultsTwo hundred and ninety-one subjects were to have 353 RCTs within the study period. A high proportion (79.7%, p < 0.001) of the subjects had dental health insurance, majority (95.3%) of which was government funded. 20.9% of those with previous tooth loss was due to inability to afford cost of RCT. The lowest socioeconomic group had the highest proportion (90%, p = 0.421) of insured that visited for RCT.ConclusionDental insurance increased access to RCT. Socioeconomic status did not affect dental insurance status and dental visit for RCT.