Health-seeking behavior of Karachi women with reproductive tract infections

To explore the contextual factors influencing health-seeking behavior of women in Karachi regarding reproductive tract infections, 18 women with reproductive tract infections from different clinics and community settings were identified and in-depth interviews were conducted. Physicians in our study diagnosed a woman to have lower reproductive tract infection if she complained of malodorous vaginal discharge with or without perineal itching; and to have pelvic inflammatory disease or upper reproductive tract infection if she had any two of the following complaints: malodorous vaginal discharge, menstrual irregularities, lower abdominal pain or dyspareunia. Women consulted a variety of healthcare providers in their pursuit for treatment, mainly allopathic doctors and hakims. The different treatments prescribed to women ranged from oral and intravaginal medications to various home remedies including refraining from specific foods. Causes of reproductive tract infections reported were "melting bones", consuming foods with perceived hot composition, poor personal hygiene and procedures like dilatation and curettage, delivery and induced abortions. None reported sexually transmitted diseases as the perceived cause of their problem. Interference with religious activities, sexual relationships or socializing was reported as consequences of reproductive tract infections, in addition to lower abdominal pain, menstrual irregularities, backache and kamzori (weakness). Pakistani women seek care for reproductive tract infections and visit a variety of providers, though causes and treatments offered are usually not related to sexually transmitted diseases. We therefore suggest training of healthcare providers for appropriate counseling and that treatment management protocols be advocated.     

Acrokeratosis Verruciformis of Hopf: a localized variant

Acrokeratosis Verruciformis of Hopf (AKV) is a rare autosomal dominant genodermatosis. It usually develops during early childhood affecting both sexes equally. Typically, the lesions are warty to convex, brownish to skin-colored papules on the dorsa of the hands and feet, forearms and legs. A possible relationship with Darier disease has long been postulated on a clinical basis mainly. But recently, evidence has suggested that AKV and Darier disease are allelic disorders. I am reporting these two unrelated cases as a unilateral localized variant of AKV.     

The role of stainless steel wire mesh and cement in bone allograft incorporation in impaction grafting technique: an experimental study in rabbits

Cages of flexible stainless steel wire mesh were filled with impacted morcellized cancellous allograft. Bone defects were created in both tibial metaphyseal regions of 10 adult white New Zealand rabbits. The base of both defects was plugged with a small amount of bone cement. The cages were implanted in the right tibia while the left tibia was filled with impacted bone allograft. Histologic and histomorphometric evaluation of the retrieved specimens at 3 months showed a statistically significant difference in active bone formation parameters between the 2 groups. Active bone formation was more prominent away from the bone cement. The biological process of bone graft incorporation in the "impaction grafting" technique seems to be adversely affected by stainless steel wire mesh and in areas adjacent to bone cement.     

Erythrokeratoderma variabilis

Erythrokeratoderma variabilis is a rare autosomal dominant genodermatosis of variable expressivity. In this report, we describe the clinical features and microscopic findings in one of our patients born to unaffected parents. We also briefly review the literature on this disorder.     

Demographic,maternal, and infant health correlates of post‐partum depression in Jordan

This cross‐sectional correlational study examined post‐partum depression and its relationship with demographic, maternal, and infant health problems in urban Jordanian women. Participants (n = 315) were selected from five maternal child healthcare centers and one major hospital in Amman, Jordan. Patient Health Questionnaire‐9 was used to measure post‐partum depression within 12 weeks of birth. A number of socio‐demographic and health problems were examined for an association with post‐partum depression. Results showed that 25% of post‐partum women suffered moderate to severe depression and 50% of the sample had mild depression. None of the socio‐demographic variables (age, education, employment, income) were significantly related to post‐partum depression; however, two obstetric/infant variables (mode of birth and breastfeeding), were significantly associated with post‐partum depression. There was a significant association between post‐partum depression and 15 health problems of obstetric, gynecologic (i.e. episiotomy pain, infection), and general health conditions (i.e. fatigue, headache). Nurses and midwives need to emphasize post‐partum depression screening, follow‐up, and proper management of maternal and infant health factors predisposing to post‐partum depression rather than merely focusing on women's inherent demographic factors.     

Reduction of catheter-related colonisation by the use of a silver zeolite-impregnated central vascular catheter in adult critical care

Central vascular catheters (CVC) are used extensively in critical care for monitoring and therapy. They can become colonised with viable micro-organisms within 24 h of insertion, which can rapidly form biofilm. This colonisation is a precursor of catheter-related bloodstream infections (CR-BSI), which are associated with substantial morbidity, mortality, prolonged hospital stay and increased cost. Antimicrobials have been incorporated into the bulk material of CVC or applied to their surfaces as a coating in an attempt to reduce the incidence of CVC colonisation and infection. This study examines the effect of a silver zeolite-impregnated catheter on catheter-related colonisation and infection in adult critical care patients. The study was conducted in adult Intensive Care Units (ICU) at three acute hospitals over 14 months and involved 246 CVC insertions (122 silver-impregnated and 124 non-impregnated). CVC tip colonisation was detected by the Maki Roll culture and CR-BSI by differential time-to-positivity of blood cultures. Overall colonisation rate was significantly lower in the silver zeolite-impregnated CVC tips (58%) as compared with the control CVC tips (73%) (p<0.025). In addition, there was a lower rate (34%) of tip colonisation by coagulase negative staphylococci in the silver zeolite-impregnated CVC tips as compared with the control CVC tips (47%) (p<0.05). Four episodes of CR-BSI were detected in each arm by differential time-to-positivity in a subset of patients. This study indicates that the silver zeolite-impregnated catheter is superior to non-impregnated catheter in reducing the rate of CVC colonisation but it showed no difference in the rates of CR-BSI in the two arms. Larger prospective randomised control studies are required to evaluate its role in the prevention of CR-BSI.