Endocrinology: Pure and highly purified follicle-stimulating hormone alone or in combination with human menopausal gonadotrophin for ovarian stimulation after pituitary suppression in in-vitro fertilization

The use of pure follicle stimulating hormone (pFSH) and highlypurified FSH (FSH-HP) versus the combinations pFSH/human menopausalgonadotrophin (HMG) and FSH-HP/HMG, respectively, was comparedfor stimulating follicular development after gonadotrophin-releasinghormone agonist (GnRHa) suppression in women undergoing in-vitrofertilization (TVF)—embryo transfer. Two consecutive prospective,randomized studies were carried out at the Assisted ReproductionUnit of the Hospital Clínic i Provincial in Barcelona,a tertiary care setting. Two groups of 188 (study 1) and 252(study 2) consecutive infertile patients respectively, scheduledfor IVF-embryo transfer were included. Pretreatment with leuprolideacetate (long protocol) was followed by gonadotrophin treatmentin all patients. In study 1, 92 patients received i.m. pFSHalone (group pFSH) and 96 were treated with the combinationof i.m. pFSH and i.m. HMG (group HMG-1). In study 2, 123 patientsreceived s.c. FSH-HP alone (group FSH-HP) and 129 patients weregiven the combination of s.c FSH-HP and i.m. HMG (group HMG-2).Main outcome measures included follicular development, oocyteretrieval, fertilized oocytes, duration and dose of gonadotrophintherapy, and clinical pregnancy. There were no significant differencesbetween pFSH and pFSH/HMG nor between FSH-HP and FSH-HP/HMGcycles with regard to the number of ampoules of medication used,day of human chorionic gonadotrophin (HCG) administration, meanpeak serum oestradiol concentrations, number of follicles punctured,and number of oocytes aspirated, embryos transferred, or pregnancies.We conclude that urinary FSH (either purified of highly purified)alone is as effective as the conventional combination of urinaryFSH/HMG for ovarian stimulation under pituitary suppressionin IVF cycles. Therefore, they can be used interchangeably inFVF programmes.     

Head louse infestations: epidemiologic survey and treatment evaluation in Argentinian schoolchildren

Background Our aim was to demonstrate that the treatment of individual cases is effective, but not sufficient, to control endemic Pediculus capitis, and that eradication of the epidemiologic school focus may lower significantly the prevalence of infestation. Statistical data on the degree of infestation relating to socio-economic and cultural variables were also updated. Therapeutic effects and educational impact were evaluated. Methods An educational and motivational program was designed for pupils, parents, and teachers: 326 children and 15 adults were subjected to clinical and parasitologic evaluation. The recorded parameters included the age, sex, hair style and length, presence of other dermatologic diseases, degree of infestation, clinical remission, parasitologic remission, dwelling type and features, need to share a bed with co-dwellers, availability of home tap water supply, level of family income, and periodic medical controls. The entire population received treatment with neutral shampoo and rinsing cream containing 1% permethrin. Exclusion criteria were the presence of acute scalp inflammation and a history of pyrethrin and/or pyrethroid sensitivity. Statistical analysis was performed as required on data expressed as frequencies, percentages, means, and standard deviations by chi-square and Fisher exact tests. Results The overall infestation prevalence rate was 81.5%, the highest values corresponding to children from 6 to 11 years of age, with a slight predominance in males (55.4% vs. 44.6%). A significantly greater rate of clinical remission was observed in subjects enjoying home tap water supplies (p<0.01). Conclusions The model of research plus action adopted allows the following conclusions to be drawn; (i) individual and isolated treatments for pediculosis are useful, but will not by themselves allow for the epidemiologic control of this parasitosis; (ii) massive, complete, and simultaneous treatments lead to a significant decrease in infestation prevalence; (iii) educational measures tending to foster collective awareness enable greater epidemiologic surveillance to be achieved; (iv) careful inspection of the entire scalp is essential with the use of a powerful light source and lenses with high magnification, as the parasite has no predilection for any given area; (iv) socio-economic and cultural conditions are not relevant for infestation, although a good home tap water supply is essential for treatment.     

Analytical quality specifications for common reference intervals.

Interpretation of laboratory test results requires comparison to some type of reference value or reference interval. These comparisons can be cross-sectional (population-based reference interval and cut-off values) or longitudinal (reference change value). Quality specifications for cross-sectional comparison have been established by determining the influence of analytical bias and imprecision on the percentage of the healthy population falling outside the reference limits, when sharing population-based reference intervals in a Gaussian distribution of results. Quality specifications for longitudinal comparisons are equally important and are often overlooked, since less work has been done in this area. Some criteria suggest that a difference between consecutive results designates a true change in a patient health status when the difference is higher than the within-subject biological variation plus the within-laboratory analytical variation. In this chapter we discuss the clinical considerations and laboratory-related factors that must be considered when quality specifications are applied to sharing reference comparisons. Real life experience shows that different analytical methods can produce comparable results when common quality goals are established, and quality can be achieved through a willingness to work together. Within the existing organization, the current specifications for analytical quality and a dedication to quality health care makes it possible to achieve transferability between laboratories within a geographic area.     

Factors associated with edentulousness in an elderly population in Valencia (Spain)

Objective

To determine the prevalence of edentulism and its association with various socioeconomic factors and oral health habits in the population aged 65-74 years old in the region of Valencia.

Methods

A cross sectional study was designed. Thirty-four primary health centers and five nursing homes were chosen at random in the region of Valencia (10-15 voluntary participants per sampling point). Clinical examinations were carried out by three calibrated dentists (kappa > 0.85) in the same centers. The total sample consisted of 531 individuals (235 men and 296 women).

Results

The percentage of toothlessness was 20.7% and the mean number of natural teeth present was 14.92. The prevalence of edentulism was significantly higher (p <0.05) in men, institutionalized persons, those with no schooling, those with poor oral hygiene, those who visited the dentist regularly and those living in peri-urban/rural areas. In a multivariate logistic regression model with edentulism as the dependent variable, the following factors were identified as significant independent variables: institutionalization (odds ratio [OR] = 2.88), poor oral hygiene (OR = 2.35), regular visits to the dentist (OR = 2.34) and age (OR = 1.19).

Conclusion

Edentulousness is a complex phenomenon that involves distinct social and economic factors.     

In vitro study of transporters involved in intestinal absorption of inorganic arsenic

Inorganic arsenic (iAs) [As(III)+As(V)] is a drinking water contaminant, and human exposure to these arsenic species has been linked with a wide range of health effects. The main path of exposure is the oral route, and the intestinal epithelium is the first physiological barrier that iAs must cross in order to be absorbed. However, there is a lack of information about intestinal iAs absorption. The aim of this study was to evaluate the participation of certain transporters [glucose transporters (GLUT and SGLT), organic anion transporting polypeptides (OATPs), aquaporins (AQPs), and phosphate transporters (NaPi and PiT)] in intestinal absorption of As(V) and As(III), using the Caco-2 cell line as a model of the intestinal epithelium. For this purpose, the effects of chemical inhibition and gene silencing of the transporters of interest on iAs uptake were evaluated, and also the differential expression of these transporters after treatment with iAs. The results show that chemical inhibition using rifamycin SV (OATP inhibitor), phloridzin (SGLT inhibitor), phloretin (GLUT and AQP inhibitor), and copper sulfate (AQP inhibitor) leads to a significant reduction in the apparent permeability and cellular retention of As(III). RT-qPCR indicates up-regulation of GLUT2, GLUT5, OATPB, AQP3, and AQP10 after exposure to As(III), while exposure to As(V) increases the expression of sodium-dependent phosphate transporters, especially NaPiIIb. Gene silencing of OATPB, AQP10, and GLUT5 for As(III) and NaPiIIb for As(V) significantly reduces uptake of the inorganic forms. These results indicate that these transporters may be involved in intestinal absorption of iAs.     

Screening for domestic violence during pregnancy

This experimental study was conducted to determine the specific problems experienced by couples participating in assisted reproductive techniques (ART) and to assess couples’ counseling needs. It was also intended to determine the effects of the counseling service model, developed and implemented by the researcher, on the success rate of ART, and to assess the couples’ anxiety, depression and life satisfaction levels.

Thirty couples for the experimental group and 30 couples for the control group were included in the study. The couples in the control group experienced the routine procedures that the treatment currently includes. Couples in the experimental group took part in the counseling service model, and were informed and supported throughout the steps of the ART. A guide developed for the couples and education material developed for the counseling service model were used during the study. Three psychological tests were given to the couples before (pretest) and after (post-test) each procedure. These tests included anxiety, depression and life satisfaction inventories. The difference means test and Student's t test were used for statistical analysis.

The results of the study showed that couples in the experimental group had lower anxiety and depression scores than the couples in the control group. Life satisfaction scores and pregnancy rates were higher for couples in the experimental group than for the couples in the control group. Statistical evaluation showed that the difference between the experimental group and the control group was significant (p < 0. 05).

This study demonstrates the importance of the counseling role of the nurse, and the development and application of counseling services in ART centers, in lowering the anxiety and depression levels of couples and ensuring success of the treatment