Relationship of myoma cell size and menopausal status in small uterine leiomyomas

CONTEXT: Although myomas shrink after menopause, the cellular mechanism for this phenomenon has received little attention. It was recently demonstrated that fibrous degeneration is significantly associated with postmenopausal status in both small and large myomas. OBJECTIVE: The purpose of the present study was to evaluate whether reduction in myoma cell size is also associated with postmenopausal status in small myomas. DESIGN: Tumor size and patient age have also been related to fibrous degeneration in small (<1 cm) myomas. Therefore, in the present study, 10 pairs of premenopausal and postmenopausal small myomas were matched within 3 years for patient age, within 1 mm for size, and within 1 grade for degree of fibrous degeneration. Most of the women were in their 50s, the decade during which postmenopausal fibrous degeneration in small myomas is most prevalent. Myoma cell size was derived by morphometric evaluation of relative myoma cell area (correcting for percentage of stroma, as measured by point counting) and by direct counting of the number of myoma cells per unit area in trichrome-stained sections. RESULTS: Small myomas from postmenopausal women had significantly (P <.05) smaller cell sizes than did size-matched myomas from age-matched premenopausal women. Myoma cell sizes and nucleus-cell (N/C) ratios were highly variable, especially in premenopausal myomas. CONCLUSIONS: Reduction in myoma cell size is significantly associated with postmenopausal status in small uterine leiomyomas and may be an important mechanism for postmenopausal shrinkage of myomas. In addition, the high variability of myoma cell size and N/C ratio may further support the somatic mutation theory (ie, the theory that diverse mutations may account not only for variations in the growth potential of uterine myomas, but also for variations in their cellular details).     

NEUROCYSTICERCOSIS IN CHILDREN PRESENTING WITH AFEBRILE SEIZURE: CLINICAL PROFILE,IMAGING AND SERODIAGNOSIS

Neurocysticercosis (NCC) is one of the major causes of childhood seizures in developing countries including India and Latin America. In this study neurological pediatric cases presenting with afebrile seizures were screened for anti-Cysticercus antibodies (IgG) in their sera in order to estimate the possible burden of cysticercal etiology. The study included a total of 61 pediatric afebrile seizure subjects (aged one to 15 years old); there was a male predominance. All the sera were tested using a pre-evaluated commercially procured IgG-ELISA kit (UB-Magiwell Cysticercosis Kit ^™). Anti-Cysticercus antibody in serum was positive in 23 of 61 (37.7%) cases. The majority of cases with a positive ELISA test presented with generalized seizure (52.17%), followed by complex partial seizure (26.08%), and simple partial seizure (21.73%). Headaches were the major complaint (73.91%). Other presentations were vomiting (47.82%), pallor (34.78%), altered sensorium (26.08%), and muscle weakness (13.04%). There was one hemiparesis case diagnosed to be NCC. In this study one child without any significant findings on imaging was also found to be positive by serology. There was a statistically significant association found between the cases with multiple lesions on the brain and the ELISA-positivity (p = 0.017). Overall positivity of the ELISA showed a potential cysticercal etiology. Hence, neurocysticercosis should be suspected in every child presenting with afebrile seizure especially with a radio-imaging supportive diagnosis in tropical developing countries or areas endemic for taeniasis/cysticercosis.     

The impact of religiously tailored and ethically balanced education on intention for living organ donation among Muslim Americans

We tested the efficacy of religiously tailored and ethically balanced education upon living kidney organ donation intent among Muslim Americans. Pre-post changes in participant stage of change, preparedness, and likelihood judged efficacy. Among 137 participants, mean stage of change toward donation appeared to improve (0.59; SD ± 1.07, P < .0001), as did the group's preparedness to make a donation decision (0.55; SD ± 0.86, P < .0001), and likelihood to donate a kidney (0.39; SD ± 0.85, P < .0001). Mean change in likelihood to encourage a loved one, a co-worker, or a mosque community member with ESRD to seek a living donor also increased (0.22; SD ± 0.84, P = .0035, 0.23; SD ± 0.82, P = .0021, 0.33; SD ± 0.79, P < .0001 respectively). Multivariate ordered logistic regression models revealed that gains in biomedical knowledge regarding organ donation increased odds for positive change in preparedness (OR = 1.20; 95% CI 1.01-1.41, P = .03), while increasing age associated with lower odds of positive change in stage of change (OR = 0.98, 95% CI 0.96-0.998, P = .03), and prior registration as an organ donor lowered odds for an increase in likelihood to donate a kidney (OR = 0.22; 95% CI 0.08-0.60, P = .003). Our intervention appears to enhance living kidney donation-related intent among Muslim Americans [Clinicaltrials.gov number: NCT04443114].     

Outcome of partial hepatectomy for large (> 10 cm) hepatocellular carcinoma

BACKGROUND: Surgical resection for large (> 10 cm) hepatocellular carcinoma (HCC) is believed by many to be ineffective. The objective of the current study was to review the outcome of partial hepatectomy in patients with large HCC. METHODS: Between 1985 and 2002, 193 consecutive patients who underwent partial hepatectomy for HCC were identified from a prospective database. The 82 patients with tumors > 10 cm were compared with the remaining 111 patients with < or = 10 cm tumors. Clinicopathologic features were analyzed and prognostic factors were evaluated by univariate and multivariate analysis. RESULTS: The 5-year overall survival for patients with large HCC was 33% with a median of 32 months. Patients with < or = 10 cm tumors had similar survival. Furthermore, there was no significant difference between the groups in operative mortality (2% in large HCC vs. 6%) or recurrence rate. In patients with large HCC, vascular invasion by tumor and intraoperative blood loss > 2 liters predicted overall survival on multivariate analysis. CONCLUSIONS: Partial hepatectomy is safe for patients with large HCC. In selected patients with large tumors, resection achieves similar overall survival and recurrence-free survival to that of patients with smaller tumors. Minimizing intraoperative blood loss appears to be critical for favorable long-term outcome in patients with large HCC.     

The ethics of organ donation,donation after circulatory determination of death,and xenotransplantation from an Islamic perspective

Donation after circulatory determination of death (DCDD) and xenotransplantation are advanced as possible solutions to the growing gap between the number of individuals in need of organ transplantation and the pool of donors. Investigating how various publics, including religious leaders, might view these “therapies” is essential for broad public and professional support and will be needed in order to make these solutions viable. This study, therefore, presents normative Islamic bioethical perspectives on donation after circulatory determination of death and xenotransplantation. First, we will discuss foundational Islamic ethico‐legal debates regarding organ donation. These debates can be grouped into three broad positions, those who consider organ donation categorically impermissible as a violation of human dignity (?urma and karāma ), those who agree that organ donation is impermissible in principle, but allow it conditionally on the basis of dire necessity (?arūra ), and those who permit organ donation based on notions of public interest (ma?la?a ). Next, we will reflect upon the additional ethical dimensions DCDD and xenotransplantation add to these debates. We contend that the condition of minimal harm to the donor and the definition of death need to be accounted for within Islamic perspectives on DCDD. Xenotransplantation, on the other hand, highlights concerns about using pigs for therapeutic purposes. We conclude by commenting on additional questions that remain to be addressed in the Islamic bioethical debate over these practices and with recommendations for further research.     

Islamic perspectives on clinical intervention near the end-of-life: We can but must we?

The ever-increasing technological advances of modern medicine have increased physicians’ capacity to carry out a wide array of clinical interventions near the end-of-life. These new procedures have resulted in new “types” of living where a patient’s cognitive functions are severely diminished although many physiological functions remain active. In this biomedical context, patients, surrogate decision-makers, and clinicians all struggle with decisions about what clinical interventions to pursue and when therapeutic intent should be replaced with palliative goals of care. For some patients and clinicians, religious teachings about the duty to seek medical care and the care of the dying offer ethical guidance when faced with such choices. Accordingly, this paper argues that traditional Sunni Islamic ethico-legal views on the obligation to seek medical care and Islamic theological concepts of human dignity (karāmah) and inviolability (?urmah) provide the ethical grounds for non-intervention at the end-of-life and can help calibrate goals of care discussions for Muslim patients. In closing the paper highlights the pressing need to develop a holistic ethics of healthcare of the dying from an Islamic perspective that brings together multiple genres of the Islamic intellectual tradition so that it can meet the needs of the patients, clinicians and Muslim religious leaders interacting with the healthcare system.     

A critical role for fibroblast growth factor-7 during early alveolar formation in the neonatal rat

Mesenchymal cell-derived FGF-7 (fibroblast growth factor-7) induces proliferation in both epithelial and endothelial cells. We found FGF-7 to be expressed in the lungs of neonatal rats from birth to d 14 of age. A role for FGF-7 in early postnatal lung growth and alveolar formation, by an action on type II pneumocytes, has been excluded by the work of others. However, a role through an action of FGF-7 on other cell types has not been excluded. We used intraperitoneal injections of neutralizing antibodies on d 3, 4, and 5 of life to inhibit binding of FGF-7 to its receptors, and assessed alveolar formation on d 6 of life. This intervention inhibited DNA synthesis in, and number of, alveoli-forming secondary crests, resulting in a significantly reduced alveolar number. This failure of alveolar formation was associated with a reduction in the number of small blood vessels in the lung periphery. We conclude that FGF-7, most likely through its effect on the vascular bed, is required for normal early postnatal alveolar formation from secondary crests.     

The Association of Perceived Abuse and Discrimination After September 11, 2001, With Psychological Distress, Level of Happiness, and Health Status Among Arab Americans

Objectives. We assessed the prevalence of perceived abuse and discrimination among Arab American adults after September 11, 2001, and associations between abuse or discrimination and psychological distress, level of happiness, and health status.Methods. We gathered data from a face-to-face survey administered in 2003 to a representative, population-based sample of Arab American adults residing in the greater Detroit area.Results. Overall, 25% of the respondents reported post–September 11 personal or familial abuse, and 15% reported that they personally had a bad experience related to their ethnicity, with higher rates among Muslims than Christians. After adjustment for socioeconomic and demographic factors, perceived post–September 11 abuse was associated with higher levels of psychological distress, lower levels of happiness, and worse health status. Personal bad experiences related to ethnicity were associated with increased psychological distress and reduced happiness. Perceptions of not being respected within US society and greater reported effects of September 11 with respect to personal security and safety were associated with higher levels of psychological distress.Conclusions. Perceived post–September 11 abuse and discrimination were associated with increased psychological distress, reduced levels of happiness, and worse health status in our sample. Community-based, culturally sensitive partnerships should be established to assess and meet the health needs of Arab Americans.The events of September 11, 2001, adversely affected Americans both near and far from the destruction, with different psychological consequences across different demographic lines. Studies have shown that Hispanics,¹ women,^2,3 younger individuals,³ and those with a history of anxiety or depression² have experienced greater psychological distress and have been more at risk for adverse health outcomes. To date, however, there has been no representative, population-based investigation of the psychological impact of September 11 and its aftermath on Arabs or Muslims living in the United States.In the United States, prejudice, discrimination, and violence against Muslims and Arabs have increased since September 11.⁴ Estimates of the American Muslim population vary widely but average 5.4 million,^5–9 consisting of equivalent numbers of African Americans, South Asians, and Arabs.⁹ In addition, up to 2.5 million non-Muslim Arabs reside in the United States.¹⁰ The Federal Bureau of Investigation (FBI) reported a 1600% increase in hate crimes against these populations in the year after the events of September 11.^10–13 Similarly, in a population-based survey of Middle Eastern Arabic-speaking adults in the United States, approximately 30% of Arabs and 50% of Muslims reported discrimination in the 8 months after September 11.¹⁴ Mosques and Muslim-owned business were vandalized, and individuals Muslim in appearance were verbally abused, physically assaulted, and, in some cases, murdered.¹² Anti-Muslim and anti-Arab hate crimes continue to be at higher levels than before September 11.^15,16US governmental policies have also targeted Muslims and Arabs and their community organizations. Muslim civic and religious organizations have been raided by the FBI,^17,18 Muslim charities have had their assets frozen,¹⁹ and racial profiling has occurred at airports and on the streets.²⁰ Further coloring the social environment are the US-led wars in Afghanistan and Iraq. These wars may create increased tension between the general American population and people of Afghani and Iraqi ancestry residing in the United States, in addition to increasing psychological distress among the US-based relatives of Iraqis and Afghanis.An important but largely unanswered question is how this climate has affected the health of American Arab and Muslim populations. Racial and ethnic discrimination is associated with increased psychological distress^21,22 and anxiety,²³ increased risk for adverse mental health outcomes,^22,23 and poorer health status.^21,24,25 Moreover, immigrants who perceive increased discrimination in their new country are more likely to have high levels of psychological distress and decreased levels of trust in society, potentially leading to underuse of mental health services by those in need.²⁶ However, research within US Arab or Muslim communities in the post–September 11 environment is scant. To date, only a handful of small studies have been conducted, and these investigations have involved convenience samples.^27,28To address the lack of representative surveys of Arab Americans, we examined the psychological and health effects of perceived discrimination and abuse approximately 2 years after September 11, 2001, in a representative sample of Arab American adults residing in greater Detroit. The Detroit-area Arab community is the largest such community outside of the Middle East; a result of its size, affluence, and long history in the United States, it possesses arguably greater social capital than other US-based Arab communities.²⁹Our research questions were as follows: How prevalent is reported abuse and discrimination in our study population? How are reports of abuse or discrimination associated with self-reported psychological distress, level of happiness, and health status? What role do sociodemographic factors play in reported abuse or discrimination? We examined these questions among individuals who took part in the 2003 Detroit Arab American Survey (DAAS).³⁰     

Emergency Medical Practice: Advancing Cultural Competence and Reducing Health Care Disparities

In an increasingly diverse patient population, language differences, socioeconomic circumstances, religious values, and cultural practices may present barriers to the delivery of quality care. These obstacles contribute to the health care disparities observed in all areas of medical care. Increasing cultural competence has been cited as part of the solution to reduce disparities. The emergency department (ED) is an environment where cultural sensitivity is particularly needed, as it is often a primary source of health care for the underserved and ethnic and racial minorities and a place where high patient volume and acuity place the provider under demanding time pressures, yet the emergency medicine (EM) literature on health care disparities and cultural competence is limited.
The authors present three clinical scenarios highlighting challenges in providing equitable emergency care to minority populations. Using these cases as illustrations, three processes are proposed that may improve the quality of care delivered to minority populations: 1) increase cultural awareness and reduce provider biases, enabling providers to interact more effectively with different patient populations; 2) accommodate patient preferences and needs in medical settings through practice adjustments and cultural modifications; and 3) increase provider diversity to raise levels of tolerance, awareness, and understanding for other cultures and create more racially and/or ethnically concordant patient–physician relationships.