Significant Decrease In Cases Research Articles

Medico-Legal Cases in Breast Imaging in Canada: A Trend Analysis.

Purpose: Breast imaging accounts for a large proportion of medico-legal cases involving radiologists in several countries and may be a disincentive to breast imaging. As this has not been well studied in Canada, we evaluated the key medico-legal issues of breast imaging in Canada and their implications for health care providers and patient safety. Methods: In collaboration with Canadian Medical Protective Association (CMPA), we obtained information from the medico-legal repository, including civil-legal, medical regulatory authority (College) and hospital complaints occurring between 2002-2021. Canadian Classification of Health Interventions (CCI) codes were used for breast imaging and biopsy. Trend analysis was done comparing cases involving breast imaging/biopsy to all cases where a radiologist was named. Results: Radiologists were named in 3108 medico-legal cases, 188 (6%, 188/3108) of which were CCI coded for breast imaging or biopsy. Factors related to radiologists were most frequent (64%, 120/188), followed by team (23.4%, 44/188) and system (6.9%, 13/188). Equal representation of male and female radiologists was found (IRR = 1.22; 95% CI: .89, 1.56). In a 10-year test window from 2006 - 2015 we identified an increasing trend for all cases involving radiologists (P = 0,0128) but a decreasing trend for cases coded with breast imaging or biopsy (P = 0,0099). Conclusions: A significant decrease in cases involving breast imaging were found from 2006-2015, accounting for 6% of the medico-legal cases. The lower risk of breast imaging medico-legal issues may encourage more radiologists in breast imaging.

10 Year Analysis of Pediatric Surgery Fellowship Match and Operative Experience: Concerning Trends?

This paper aims to evaluate the pediatric surgery training pipeline vis-à-vis the pediatric surgery match and operative experience of pediatric surgery fellows. Pediatric surgery remains a competitive surgical subspecialty. However, there is concern that operative experience for pediatric surgery fellows is changing. This paper examines the selectivity of the pediatric surgery match, along with the operative experience of pediatric surgery fellows to characterize the state of pediatric surgery training. The pediatric surgery fellowship match was analyzed from the National Resident Matching Program data from 2010 to 2019. Selectivity among fellowships was compared using analysis of variance with Dunnett test. Operative log data for pediatric fellows was analyzed using the Accreditation Council for Graduate Medical Education case logs from 2009 to 2019. Linear regression analysis was used to evaluate trends in operative volume over time. Pediatric surgery had the highest proportion of unmatched applicants (47.2% ± 5.3%) and lowest proportion of unfilled positions (1.4% ± 1.6%) when compared to other National Resident Matching Program surgical fellowships. Accreditation Council for Graduate Medical Education case log analysis revealed a statistically significant decrease in cases for graduating fellows (-5.3 cases/year, P < 0.05). Total index cases decreased (-4.7 cases/year, P < 0.01, R 2 = 0.83) such that graduates in 2019 completed 59 fewer index operations than graduates in 2009. Although pediatric surgery fellowship remains highly selective there has been a decline in the operative experience for graduating fellows. This highlights the need for evaluation of training paradigms and operative exposure in pediatric surgery to ensure the training of competent pediatric surgeons.

The paraoxonase 1 activity and lipid levels in umbilical cord blood and maternal venous blood, and their relations according to birth weight

Objectives: Aim of this study is to find out the clinical relevance of estimating paraoxonase activity of PON1 enzyme, triglyceride (TG), total cholesterol, HDL, and LDL levels in maternal serum and umbilical cord blood according to birth weight. Methods: Venous blood samples were taken from mothers just before birth. Babies were divided into four groups: normal-weight babies, premature babies, low birth weight babies, and postmature babies. The weight of the newborns was measured and cord blood was taken. The samples were looked at HDL, LDL, total cholesterol, triglyceride levels and PON1 activities. We have investigated the paraoxonase activity of the PON1 enzyme. Enzyme activity assay was obtained spectrophotometrically measurement of p‐nitrophenol at 412 nm. Results: Maternal PON1 paraoxonase activity levels in Pre-Term show a significant decrease in cases as compared to other groups. Baby PON1 paraoxonase activity levels are also found to be significantly decreased in cases concerning the Term and Post-Term groups. There was a significant difference in all values the such as baby's weight, TG, Total cholesterol, HDL, LDL and PON1.belonging to babies (p &amp;lt; 0.05). Conclusions: Decreased paraoxonase activity in maternal serum may be considered as an additional risk factor for the development of low birth weight. It appears that PON1 activity plays an important role in infant development and affects birth weight. We think that the paraoxonase activity of the PON1 enzyme in mothers may be a marker in predicting the babies who are at risk in terms of birth weight.

SOSIALISASI TENTANG PENERAPAN PROTOKOL KESEHATAN PENCEGAHAN COVID-19 DI KABUPATEN BATU BARA PROVINSI SUMATERA UTARA

The COVID-19 pandemic has become a world health problem since the end of 2019, this case is increasing and spreading rapidly throughout the world, including Indonesia. Batu Bara Regency is one of the districts experiencing an increase in confirmed cases of COVID-19. The purpose of this paper is to provide socialization about the implementation of the COVID-19 prevention health protocol in Batu Bara Regency, North Sumatra Province. The method of implementing the activity is in the form of observation and socialization about the implementation of the COVID-19 prevention health protocol in the community. Based on the results of the activities that have been carried out, the community has a better understanding of health protocols in prevention efforts, it is hoped that it will have an impact on changing people's behavior to better comply with and implement the COVID-19 prevention health protocol so that there will be a significant decrease in cases.

Orthopedic Department of Education Center and Service Provide During Coronavirus Disease-2019 Pandemic: An Experience from Single-Center Hospital

BACKGROUND: In the global pandemic of the 2019 coronavirus disease (COVID-19), many countries have reported a decrease in visits to hospitals, and health-care systems around the world are reshaping health protocols. Health service and education in orthopedics are also affected although not at the frontline in dealing COVID-19. METHODS: The data from this study collected from several official databases, including the Indonesian Ministry of Health, Central Java provincial government, general hospital, and orthopedic surgery cases. RESULTS: Pandemic COVID-19 started in March 2020 in Indonesia. Surakarta has become one of the epicenters. Health services in the orthopedic department also experienced a decrease cases on all divisions (outpatient clinics, emergency rooms, and inpatients). Mann–Whitney non-parametric comparative test showed significance result in p value operation of orthopedic cases and inpatients (p = 0.016 and p = 0.016; p &lt; 0.05), meanwhile, outpatient visits did not show significance result with p = 0.0509 (p &gt; 0.05). The decrease in the number of cases being treated in the orthopedic service also has an impact on education and training programs. The digital era is one of the choices in the field of education. However, digital resources cannot substitute for direct patient exposure. CONCLUSION: The average number of orthopedic patients during the pandemic period from January to December 2020 decreased compared to visits in the same period in 2019 so that orthopedic services at tertiary and academic referral hospitals experienced a significant decrease in cases. The education and services department must adapt to the policy on educational activities for residents and medical students. The education department and hospital institutions restructured and reorganized resident doctors to continue providing services. The digital era is an option that supports the education process during a pandemic.

Ventricular Assessment by Echocardiography in Children with Bronchial Asthma

Background: Bronchial asthma is a chronic inflammatory condition of the airways characterized by hyperresponsiveness of the airways arising from a combination of genetic and environmental factors. The aim of this work is to evaluate the effect of bronchial asthma with different grades of severity and medical control on the ventricular function of the heart using echocardiography. Methods: This case-control study was carried out at pulmonology and cardiology units, pediatric department, in Zagazig University hospitals during the period from December 2016 to January 2018. Included 120 age and sex matched children; 60 of them asthmatic and 60 healthy children. All children were assessed clinically, radiologically, and investigated by Electrocardiography (ECG), pulmonary function tests and by conventional and tissue echocardiography. Results: Echocardiographic data of the left ventricle Demonstrated statistically important variations between cases and controls as regard LV systolic function as Ejection Fraction (EF) showed significant decrease in cases when compared to controls. Right ventricle wall thickness by conventional echocardiography was significantly thicker in asthmatics than control with highly significant difference between cases and controls as regard IVRT, IVCT, ET of right ventricle, lateral tricuspid E and E/A ratio. Also, significant correlations between findings on TDE and pulmonary function tests in asthmatic patients were found Conclusion: TDE can be used for early detection of impairment of cardiac function in asthmatic children at a stage when conventional echocardiographic indices are still normal, diastolic function of right ventricle is more affected by asthma than systolic function detected by TDE.

Evaluation of serum levels of interleukin-10 and transforming growth factor-β1 among Egyptian children with wheezy asthma phenotype

Background Asthma is known to be a heterogeneous disease that forms a problem in asthma management. Symptom-based asthma phenotyping with endotyping of the proposed phenotype is a trial to solve this problem. Asthma phenotypes and endotypes facilitate research, establish genetic associations, identify biomarkers, and test for new lines of treatment. Aim To clarify the cytokine profile of wheezy asthma phenotype which could pave the way to personalize asthma medicines according to symptom-based asthma phenotypes. Patients and methods A case–control study was conducted in 50 asthmatic patients presented solely with wheezes with a mean±SD of age of 9.54±2.81 years and 50 healthy controls, with a mean±SD of age of 8.98±2.79 years. The studied cases and controls underwent assessment of serum levels of interleukin-10 (IL-10), transforming growth factor-β1 (TGF-β1), total serum immunoglobulin E (IgE), peripheral eosinophilic percent, and pulmonary function tests. Results Wheezy asthma phenotype showed significant increase in parental smoking, positive family history, total serum IgE, peripheral eosinophilic percent, and TGF-β1 compared with controls. However, serum IL-10 showed significant decrease in cases versus controls. Asthmatics with allergic rhinitis showed significant increase in total serum IgE and peripheral eosinophilic percent compared with non-allergic rhinitis asthmatics. Conclusion Wheezy asthma phenotype showed significant increase of serum TGF-β1 as a promoting effect of airway remodeling, significant decrease in serum IL-10, and significant increase of both total serum IgE and eosinophilic percent. This throws a light on the importance of asthma phenotyping according to symptomatology, as a trial toward tailoring asthma medications.

Prognosticating the Spread of Covid-19 Pandemic Based on Optimal Arima Estimators.

COVID-19 cases have been reported as a global threat and several studies are being conducted using various modelling techniques to evaluate patterns of disease dispersion in the upcoming weeks. Here we propose a simple statistical model that could be used to predict the epidemiological extent of community spread of COVID-19 from the explicit data based on optimal ARIMA model estimators. Raw data was retrieved on confirmed cases of COVID-19 from Johns Hopkins University (https://github.com/CSSEGISandData/COVID-19) and the Auto-Regressive Integrated Moving Average (ARIMA) model was fitted based on cumulative daily figures of confirmed cases aggregated globally for ten major countries to predict their incidence trend. Statistical analysis was completed by using R 3.5.3 software. The optimal ARIMA model having the lowest Akaike information criterion (AIC) value for US (0,2,0); Spain (1,2,0); France (0,2,1); Germany (3,2,2); Iran (1,2,1); China (0,2,1); Russia (3,2,1); India (2,2,2); Australia (1,2,0) and South Africa (0,2,2) imparted the nowcasting of trends for the upcoming weeks. These parameters are (p, d, q) where p refers to the number of autoregressive terms, d refers to the number of times the series has to be differenced before it becomes stationary, and q refers to the number of moving average terms. Results obtained from the ARIMA model showed a significant decrease in cases in Australia; a stable case for China and rising cases have been observed in other countries. This study predicted the possible proliferate of COVID-19, although spreading significantly depends upon the various control and measurement policy taken by each country.

Novel assay based on diluted prothrombin time reflects anticoagulant effects of direct oral factor Xa inhibitors: Results of multicenter study in Japan

BackgroundDirect oral anticoagulants targeting factor Xa (DXaIs) are administered as prophylaxis for various venothrombotic diseases without routine monitoring required. However, assessment of their anticoagulant effects is necessary to prevent severe events, including major bleeding and/or refractory thrombosis. ObjectivesWe examined the correlation of ratio of inhibited thrombin generation (RITG), determined using a novel assay based on dilute prothrombin time (dPT), with coagulant markers and laboratory test results to show drug effects. In addition, RITG usefulness as a confirmation test for DXaI therapy was investigated. MethodsCitrated plasma samples were obtained from patients treated with rivaroxaban (n = 882), apixaban (n = 1214), or edoxaban (n = 820) at 4 different institutions in Japan. Laboratory tests, including prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and plasma concentrations of DXaIs, were conducted, with drug concentrations divided into peak and trough groups, within and after 5 h of administration. ResultsIn each DXaI group, RITG was positively correlated with PT, APTT, and drug concentration, and negatively with D-dimer. RITG fluctuation during the peak and trough periods reflected the anticoagulant activity characteristic of each DXaI, which was different from blood concentration fluctuations. RITG showed a significant decrease in cases with thrombosis, while that was increased in those with hemorrhage. ConclusionWe developed RITG, a novel measurement method based on dPT. RITG represents residual coagulation ability in plasma samples, and is useful for assessment of bleeding and thrombotic tendencies in DXaI patients. RITG can be utilized to confirm the effectiveness of oral anticoagulation therapy with DXaI agents.

Predictive Value of both Serum Placental protein 13 Level and Uterine Artery Doppler for Prediction of Pre-Eclampsia

Background: Preeclampsia [PE] is one of the commonest medical emergencies. It had high morbidity for the mother and her infant. Early diagnosis could reduce such morbidity. Aim of the work: To evaluate the role of maternal serum placental protein [PP13] levels and uterine artery Doppler in early prediction and prognosis of preeclampsia.Patients and Methods: The study included 60 pregnant women in their first and early second trimester with high risk for preeclampsia. Patients were divided into three groups: control, mild and sever preeclampsia. All were subjected to proper history taking, clinical and obstetrical examination, laboratory investigations and ultrasound examination.Results: Cesarean delivery was significantly increased in preeclampsia compared to controls [55% of mild and 20% of severe disease compared to 15% of controls]. Both uterine artery resistance index [RI] and pulsatility index [PI] were significantly increased in PE when compared to control and in severe when compared to mild PE groups. Finally, PP13 was significantly decreased in patients with severe PE [171.7±35.9] when compared to mild PE [213.1±41.8] or control group [254.8±51.1]. In addition, there was significant decrease in cases with mild PE when compared to control group. Finally, there was inverse [negative], moderate and statistically significant correlation between PP-13 from one side and each of systolic BP, diastolic BP, uterine artery RI and PI. In addition, both RI and PI were proportionally correlated with PI and RI.Conclusion: The present study showed that PP13 combined with PI or RI can predict PE with a good sensitivity and specificity.

Decreased Level of Nitric Oxide in Preeclamptic Pregnancy: A Relationship with PON1 Arylesterase Activity

Aims: The aim of the study was to evaluate the status and diagnostic utility of PON1. (Paraoxonase-1) Arylesterase and nitric oxide as indicator of antioxidant status in preeclampsia.&#x0D; Study Design: Analytical case control study.&#x0D; Place and Duration of Study: Sample: Department of obstretics and gynecology Department, G. M. C. Ambajogai, between July 2010 and July 2012.&#x0D; Methodology: We conducted a case-control study of 57 women with preeclampsia and 57 women with uncomplicated deliveries. We measured PON1 Arylesterase activity, Nitric oxide and lipid profile.&#x0D; Results: Serum levels of LDLc (low density lipoprotein cholesterol) are higher in cases than in controls and are statistically significant (p=0.023). However serum HDLc (high density lipoprotein cholesterol) levels are decreased significantly (p = 0.017). Serum PON1 Arylesterase showed significant decrease in cases152.68 KU/L versus controls 180.89 KU/L, p value=0.002. Serum nitric oxide also showed significant decrease in cases 22.77 ± 4.792 umol/L versus controls 25.127 umol/L, p=0.010. PON1 Arylesterase activity is found to be positively correlated with serum HDL cholesterol (r = 0.449, p value&lt; 0.001). Multivariate logistic regression analysis was done.&#x0D; Conclusion: Our observed results show decrease in the antioxidant PON1 Arylesterase activity point towards their role in the pathogenesis of Preeclampsia.

СТАТЕВІ ТА ВІКОВІ ОСОБЛИВОСТІ РЕМОДЕЛЮВАННЯ ЛІВИХ КАМЕР СЕРЦЯ У ХВОРИХ НА АРТЕРІАЛЬНУ ГІПЕРТЕНЗІЮ

This article determines gender- and age-specific peculiarities of left heart changes in patients with stage II hypertension regardless of degree. For this purpose, a complete examination of 160 male and female patients was conducted. The examined cohort was divided into 4 subgroups: the 1st – young men aged 18 to 44 years (n = 40), the 2nd – young women (n = 40), the 3rd – middle-aged men from 45 to 60 years (n = 40) and the 4th – middle-aged women (n = 40). All groups were comparable to age and gender. Verification of the diagnosis was carried out on the basis of existing criteria. All persons who were included in the study underwent general clinical and instrumental methods of examination, which included echocardiography (Echo-CG) conducted by means of ultrasound diagnostic scanner “HI VISION AVINS” (“NITASNI”, Japan) in a one-dimensional (M-mode), two-dimensional (B-mode), by means of Doppler echocardiography and tissue scanning mode according to the generally accepted methodology. The obtained results showed that a significant increase in LA dimensions/volumes and their indices, aortic diameter value, LV, RV, myocardial thickness and its mass, diastolic and systolic stress levels was recorded in young men as compared to women of the same age. The average age of the examined persons, that formed the main group, was marked only by an increase in the absolute/relative dimensions of LA. The most important differences in morphological and functional parameters and the increase in dimensions of LA, LV, aortic diameter, RV, myocardial thickness and its mass, diastolic and systolic stress levels were reported exactly in middle-aged women, as opposed to young women. Of the calculated indices of LP and mass of myocardium of left ventricle, the strongest association with age was shown by the indices calculated for recalculation in grade 2.7. Fundamental differences in the nature of LV structural remodeling were determined in middle-aged men as compared to middle-aged women. A decrease in cases of LV normal geometry and an increase in cases with LV concentric remodeling were recorded. The conducted analysis of the nature of LV structural remodeling with respect to age showed fundamental differences in middle-aged women, as opposed to young women. A significant decrease in cases with concentric remodeling and an increase in cases with concentric hypertrophy was observed.

Aryl hydrocarbon receptor (AhR) rs2066853 gene polymorphism association with infertile oligoasthenoteratozoospermic men and seminal oxidative stress.

This study aimed to assess the association between aryl hydrocarbon receptor (AhR) rs2066853 gene polymorphism with infertile oligoasthenoteratozoospermic (OAT) men and seminal oxidative stress (OS). A total of 170 Egyptian men were allocated according to their semen analysis into fertile normozoospermic controls (n=50) and infertile OAT men (n=120). They were subjected to history taking, clinical examination, semen analysis, estimation of seminal glutathione peroxidase (GPx), and malondialdehyde (MDA). AhR rs2066853 gene polymorphism was identified in the blood by PCR-RFLP. Comparing infertile OAT men with fertile controls, AhR rs2066853 genotypes showed decreased prevalence for wild homozygous genotype GG (35.8 vs 56%) and for heterozygous genotype GA (17.5 vs 30%) and an increased prevalence for homozygous genotype AA (46.7 vs 14%). Distribution of alleles of AhR rs2066853 among OAT men compared with fertile men showed decreased prevalence of G allele (44.6 vs 71%) and an increased prevalence of A allele (55.4 vs 29%). Seminal MDA demonstrated significant increase whereas seminal GPx demonstrated significant decrease in cases with AA and GA/AA genotypes compared to cases with GG genotype. It is concluded that there is a significant association between AhR rs2066853 genotype polymorphism with decreased sperm parameters as well as increased seminal oxidative stress in infertile OAT men.

The Paraoxonase 1 Arylesterase Activity, Total Oxidative Stress, Nitric Oxide and Vitamin C Levels in Maternal Serum, and Their Relation to Birth Weight of Newborn.

Aim of this study is to find out clinical relevance of estimating PON1 arylesterase activity, total oxidative stress (TOS), nitric oxide (NO), and vitamin C levels in maternal serum for prediction of birth weight of newborn. We have investigated the PON1 arylesterase activity, TOS, NO, vitamin C, total protein, and albumin levels in 56 postnatal clinic patients having newborn weighing <2500gm (low birth weight) and compared with 56 postnatal clinic patients having newborn weighing >2500gm. Samples were collected immediately after delivery. PON1 arylesterase activity levels show significant decrease in cases as compared to controls (93.27±13.76kU/l vs. 112.77±9.42kU/l). Nitric oxide (nitrate+nitrite) levels are also found to be significantly decreased in cases with respect to controls (22.89±2.65 umol/l vs. 24.73±3.80 umol/l). Total oxidative stress is significantly increased in cases than in control subjects (23.34±2.64μmol H2O2 equiv./l vs.±21.43±2.47μmol H2O2 equiv/l). Vitamin C levels are also significantly decreased in cases as compared to controls (1.23±0.25mg/dl vs. 1.34±0.28mg/dl). Positive correlation between neonatal birth weight and maternal serum PON1 arylesterase activity (r=0.682, p<0.05) while negative correlation is obtained between neonatal birth weight and maternal serum oxidative stress (r=-0.478, p<0.05). Logistic regression analysis is applied for assessing predictive utility which demonstrated a significant association of birth weight with PON1 arylesterase activity (AUC=0.960, Naglekerke's R (2)=0.793, p<0.05). Decreased arylesterase activity and antioxidant vitamin C levels with increased total oxidative stress in maternal serum may be considered as the additional risk factors for the development of low birth weight newborn.

English

OBJECTIVE: Pre-eclampsia and atherosclerosis are both endothelial diseases with an involvement of lipid-mediated oxidative damage. The intracellular antioxidant enzyme paraoxonase 2 (PON2) may have a protective function in the prevention of atherogenesis. Oxidative stress have important role in the pathogenesis of pre-eclampsia. Study was designed to investigate monocytic paraoxonase 2 activity in pre-eclampsia. DESIGN AND METHOD: Study group was case-control study of 60 with preeclampsia and 60 uncomplicated term-deliveries. Paraoxonase2 activity done using substrate Dihydrocoumarin (DHC). RESULTS: Monocytic Paraoxonase2 activity was significantly lower in women with preeclampsia v/s controls (1.22U/mg versus1.67U/mg protein, p =0.002) Serum levels of T. chol, LDLc and VLDLc are higher in cases than in controls and are statistically significant. Serum nitric oxide also showed significant decrease in cases 22.92umol/L versus 25.12umol/L, p=0.015. In multivariate regression analysis PON2 (OR 2.393, p=0.002) and for nitric oxide (OR 1.091, p=0.030). Multivariate logistic regression analysis after adjustment of other risk factors demonstrates decreased PON2 lactonase activity is associated with greatest risk for preeclampsia. Model 1:, total cholesterol, HDL-C, LDL-C, nitric oxide ( R2=0.137, p= 0.011) , model 2 All parameters in Model I + PON2 lactonase activity. (R2=0.243, p<0.001). ROC plots demonstrated a high diagnostic accuracy for model 2 (area under ROC curve = 0.745) than model1 (area under ROC curve=0.686) CONCLUSION: decreased PON2 lactonase activity, abnormal lipid profile and decreased nitric oxide (nitrate+ nitrite) may have role in pathogenesis of pre-eclampsia and also gives valuable information regarding the risk prediction of pre-eclampsia.

Inhibin/activin betaE-subunit in uterine endometrioid adenocarcinoma and endometrial cancer cell lines: From immunohistochemistry to clinical testing?

Objective Inhibins and activins are important regulators of the female reproductive system and have also been described to be involved in gynecologic cancer development. A new inhibin/activin subunit betaE has been identified, but only limited data on its expression in human uterine adenocarcinomas and endometrial cancer cell lines exist. Methods A series of 223 uterine endometrial adenocarcinomas were immunohistochemically analyzed with a specific antibody against the inhibin betaE-subunit. In addition, established endometrial cancer cell lines were analyzed for the synthesis of the inhibin betaE subunit by immunofluorescence and RT-PCR analysis. Results In this analysis, the inhibin betaE staining intensity was associated with histological grading along with a significant decrease in cases with ovarian invasion. However, inhibin-betaE did not affect patient survival nor did it constitute an independent prognostic parameter in endometrial adenocarcinoma patients. Additionally, the inhibin/activin betaE-subunit was found to be expressed in the human endometrial carcinoma cell lines HEC1a, HEC1b, Ishikawa, and RL95-2, although the level of expression was found to be highly differing among the cancer cell lines tested. Conclusion The isolated analysis of the inhibin betaE subunit might be of minor prognostic value in identifying high-risk patients. However, its differential expression in cancer of different histological differentiation and ovarian metastasis suggests a putative but yet undefined role in endometrial carcinogenesis. Whether this novel and not well studied inhibin subunit has a substantial function in the pathogenesis and malignant transformation of human endometrium is still under investigation.

Lipid Peroxidation and Antioxidant Status in Preeclampsia

Preeclampsia is characterized by increased lipid peroxidation and diminished antioxidant capacity; however, there is no consensus as to the extent of these conditions. To assess the association of lipid peroxidation and antioxidant status with preeclampsia quantitatively using meta-analysis. Systematic review and meta-analysis. Studies were identified by performing an extensive search using BIOSIS (1986-2007), EMBASE (1986-2007), Medline (1986-2007), and the Cochrane database. Standardized mean differences (SMD) with 95% confidence intervals (CI) were used in the meta-analysis and sources of heterogeneity were examined. In the included studies, the overall SMD was a 1.21 nmol/mL increase in serum malondialdehyde in preeclampsia cases compared to controls (95% CI: 0.76, 1.66). Overall, total serum thiobarbituric acid-reactive substances SMD were 1.62 nmol/mL greater in cases than in controls (95% CI: 0.27, 2.96). The overall estimate SMD for serum vitamin E was 1.12 nmol/mL less in cases than controls (95% CI: -1.77, -0.48) and vitamin C SMD overall estimate was -0.53 (95%CI: -1.03, -0.02), significantly lower in cases compared with controls. The overall SMD for erythrocyte superoxide dismutase was -2.37 (95% CI: -4.76, 0.03), a marginally significant decrease in cases versus controls. Established preeclampsia is associated with increased concentrations of oxidative stress markers including lipid peroxidation products, and a reduction in antioxidant concentrations. Obstetricians & Gynecologists, Family Physicians. After completion of this educational activity, the participant should be better able to describe the pattern of oxidative stress markers associated with preeclampsia, and interpret the available literature as it relates to oxidative stress and preeclampsia.

Epidemiología de la enfermedad meningocócica en Cataluña antes y después de la vacunación frente al serogrupo C

Meningococcal disease remains a serious public health problem worldwide. In Catalonia, after implementing the vaccination program, there has been a significant decrease in cases caused by meningococcus C. Reported cases of meningococcal disease between 1997 and 2008 were analyzed to determine the evolution after the introduction of a conjugated vaccine in Catalonia. In < 6 years, the incidence rate of serogroup C fell from 7.6 to 0.6 per 100,000 persons/year in the periods before (1997-2000) and after (2001-2007) the introduction of the conjugate vaccine. In serogroup B, the reduction was from 15.4 to 11.1. In < 20 years case-fatality-rate increased only in serogroup B (3% and 7.4%). Serosubtype P1.15was the most frequent in serogroup B (31%), mainly associated with serotype 4 (80%), and in serogroup C subtype P1.5 (36%), with serotype 2a (86%). During 2008, 5 apparently unrelated cases of B:2a:P1.5 were identified in the same geographic area, with a case-fatality-rate of 80%. Exhaustive surveillance of circulating meningococcal strains is essential.

Geographic and Seasonal Variation in Mycobacterium avium Bacteremia Among North American Patients With AIDS

AbstractAnalysis of geographic risk was performed for Mycobacterium avium complex (MAC) bacteremia among North American patients with AIDS. Monthly mycobacterial blood cultures were taken from patients who were placebo recipients in a prospective evaluation of MAC prophylaxis. Of 571 patients, 102 (17.9%) acquired MAC bacteremia during an average follow-up of 256 days. The area with the highest risk for MAC was the South Central region (27.9%; P <0.02), whereas the area with the lowest risk was Canada (11.3%; P = 0.12). When the southern states were combined and compared with the northern states and Canada, the incidence of MAC bacteremia was higher in the southern states (21.6% versus 14.0%, P < 0.03). Proportional hazards analysis was performed for the difference between the North and South and controlled for baseline CD4 cell count. In this analysis, time to MAC was significantly longer in the North (hazard ratio = 0.587,95% confidence interval 0.390 to 0.883, P = 0.01). Although overall variation in seasonality was not marked, there was a significant decrease in cases in the North during the summer months (P < 0.01). We conclude that geographic location is a risk factor for MAC bacteremia in patients with advanced AIDS, with decreased risk in northern North America.

Bacterial adhesion and disease activity in Helicobacter associated chronic gastritis.

Ultrastructural examination of biopsies showing Helicobacter pylori associated chronic gastritis reveals close attachment between gastric surface epithelial cells and the organism. The finding of 'adhesion pedestals', which represents a cellular response to the presence of the organism, is analogous to the response of intestinal cells to enteropathogenic E coli. Thus the development of bacterial attachment sites in H pylori associated gastritis might be an indication of pathogenicity. We have therefore explored the relationship between the proportion of organisms forming attachment sites and histological indices of disease 'activity'. Antral biopsies from 40 patients with H pylori positive gastritis were examined histologically and ultrastructurally, and the percentage of attached organisms compared with subjective assessments of epithelial degeneration, mucin depletion, polymorphonuclear and chronic inflammatory cell infiltration. We found a significant increase in the proportion of attached bacteria in cases showing histological epithelial degeneration, and a significant decrease in cases showing intraepithelial polymorph infiltration. The direct relationship between bacterial attachment and cellular degeneration lends further support to a pathogenic effect. Reduced attachment in the face of polymorph infiltration might indirectly reflect aspects of the immune response--namely, blocking of adhesion by IgA, with complement activation and generation of leucotactic factors.