Sex and Gender Influence Urinary Symptoms and Management in Multiple System Atrophy

Objective@# Multiple system atrophy (MSA) is characterized by urinary dysfunction, yet the influence of sex and gender on urinary symptoms and treatment is unclear. We sought to characterize sex and gender differences in the symptomatology, evaluation, and management of urinary dysfunction in patients with MSA. @*Methods@# Patients with MSA evaluated at our institution were reviewed and stratified by sex. @*Results@# While the prevalence of urinary symptoms was similar in male and female patients, incontinence was more common in females. Despite this, males and females underwent postvoid residual (PVR) measurement at similar rates. While catheterization rates were similar when PVR was measured, males were more than twice as likely to be catheterized than females in the absence of PVR measurement. @*Conclusion@# Urinary symptoms are common in MSA, but their presentation differs between males and females. The difference in catheterization rates may be driven by a gender disparity in referrals for PVR, which can guide treatment.

Assessing the Changing Rationale of the Fisher Youth in Climate Change Hotspots of Kerala

The Indian fisheries and aquaculture statistics seems fail largely to capture the youth and children working in the sector. A detailed study in the area related to the rising interest of fishermen, especially the younger generation to move out of fisheries in search of new opportunities in other fields and the reasons for the same has not been carried out. Taking this into consideration, to throw insights into the changing rationale of fisher youth, and their preferences in the context of climate change and depletion in fish catch over the years, a study was conducted in three coastal villages of Ernakulam district with the objectives of assessing the socio-economic profile of the fishermen community, younger generations interest in choosing fisheries as a livelihood option, generational shift in fishing operations and reasons for the disinterest of the younger generation in choosing fisheries as an occupation. Low status job, low profit and income, poor working conditions, high capital investment and operating cost and seasonal nature of occupation was reported as the five major reasons because of which the younger generation is not interested in choosing fisheries as an occupation and a considerable generational shift in social, economic and professional status was observed.

Assessing the Alternative Livelihood Options for Climate Change Vulnerable Coastal Fishing Villages in Kerala, India

Fisheries and allied sectors provide means of livelihood to millions of people around the world. In India more than 14.5 million individuals depend on fisheries for their livelihood, with Gujarat, Tamil Nadu and Kerala being the main three marine fish producing states of the country. The social and economic contribution of fisheries as a sector cannot be ignored or go unnoticed. Similarly the impact of climate change on fisheries and its resultant impact on the livelihood of fisheries dependent communities cannot be ignored. To address these pertinent issues, we first need to understand the impact of climate change on fisheries and the need of alternative livelihood options from the perspective of the direct stakeholders i.e. fishermen. This study is an endeavour to look at the need of Alternative livelihood options (ALOs) because of climate change among the coastal communities in Poonthura and Elamkunnapuzha villages of Thiruvananthapuram and Ernakulum respectively. Among the 222 marine fishing villages of Kerala, Poonthura and Elamkunnapuzha are the major fishing villages from the South West hotspot locales of India. The examination investigated different socioeconomic aspects, for example, fishing activity, basic household data, economic as well as historic and cultural dependence on fishing, employment and occupational structure, income distribution and assets, physical capital, financial capital, social capital, and exposure and awareness of the fishermen families to climate change by interviewing 1259 fishermen from Poonthura and Elamkunnapuzha. The study conducted in the most climate change vulnerable marine hotspots of Kerala (Elamkunnapuzha and Poonthura) explains the problems and prospects of the inhabitants in the sector and the importance of Alternative Livelihood Options (ALOs) in climate change adaptation.

Impact of Single Dose Praziquantel Treatment on Schistosoma haematobium Infection among School Children in an Endemic Nigerian Community

Schistosomiasis is prevalent in Nigeria, and the foremost pathogen is Schistosoma haematobium, which affects about 29 million people. Single dose of the drug praziquantel is often recommended for treatment but the efficacy has not been documented in certain regions. Therefore, this study was designed to assess the impact of single dose praziquantel treatment on S. haematobium infection among school children in an endemic community of South-Western Nigeria. Urine samples were collected from 434 school children and 10 ml was filtered through Nucleopore filter paper before examination for egg outputs by microscopy. The prevalence was 24.9% at pre-treatment. There was no statistically significant difference for the prevalence of infection between males (14.7%) and females (10.2%), although the mean egg count for the females (9.87) was significantly more (P < 0.05) than the males (6.06). At 6 and 12 months post-treatment there was 74.4% and 86.4% reduction in the mean egg count, respectively. Interestingly, an increased prevalence of infection from 2.1% at 6 months to 7.7% at 12 months post-treatment was observed, nonetheless the mean egg count was reduced to 0.27 at 12th month from 1.98 at 6 months post-treatment. Resurgence in the prevalence rate between 6 and 12 months post-treatment with praziquantel is herein reported and the need for a follow-up treatment in endemic areas for adequate impact on schistosomiasis control is discussed.

Diffusion tensor imaging of brain white matter in Huntington gene mutation individuals / Imagem por tensor de difusão em indivíduos com mutação do gene da doença de Huntington

ABSTRACT Objective To evaluate the role of the involvement of white matter tracts in huntingtin gene mutation patients as a potential biomarker of the progression of the disease. Methods We evaluated 34 participants (11 symptomatic huntingtin gene mutation, 12 presymptomatic huntingtin gene mutation, and 11 controls). We performed brain magnetic resonance imaging to assess white matter integrity using diffusion tensor imaging, with measurement of fractional anisotropy. Results We observed a significant decrease of fractional anisotropy in the cortical spinal tracts, corona radiate, corpus callosum, external capsule, thalamic radiations, superior and inferior longitudinal fasciculus, and inferior frontal-occipital fasciculus in the Huntington disease group compared to the control and presymptomatic groups. Reduction of fractional anisotropy is indicative of a degenerative process and axonal loss. There was no statistically significant difference between the presymptomatic and control groups. Conclusion White matter integrity is affected in huntingtin gene mutation symptomatic individuals, but other studies with larger samples are required to assess its usefulness in the progression of the neurodegenerative process.

RESUMO Objetivo Avaliar o envolvimento da substância branca (SB) cerebral em indivíduos com mutação do gene da huntingtina. Métodos Foram avaliados 34 indivíduos: 11 com mutação do gene da huntingtina sintomática, 12 assintomáticos com mutação do gene da huntingtina e 11 indivíduos controles. Realizamos ressonância magnética cerebral para avaliar a integridade da SB usando o tensor de difusão (DTI), com medição da anisotrofia fracionada (FA). Resultados Observamos uma diminuição da FA no trato corticoespinhal, coroa radiada, corpo caloso (joelho, corpo e esplênio), cápsula externa, radiações talâmicas, fascículo longitudinal superior e inferior, e fascículo frontal-occipital inferior no grupo dos indivíduos com mutação sintomática. A redução da FA é indicativa de processo degenerativo e perda axonal. Não houve diferença estatística entre os grupos controle e pré-sintomático. Conclusão Houve comprometimento da integridade da SB em indivíduos com mutação no gene da Huntingtina sintomática, mas outros estudos são necessários para avaliar a sua utilidade na progressão do processo neurodegenerativo.

Perceived Socio-Cultural and Economic Factors Influencing Maternal and Child Health: Qualitative Insights from Mwingi District, Kenya.

Background: Reducing child mortality rates and improving maternal health are Millennium Develop-ment Goals (MDGs) that Kenya is striving to realize by next year, 2015. One way of achieving the MDGs is through identifying and addressing the factors influencing Maternal and Child Health (MCH). The aim of this study was to explore expert opinions on social –cultural and economic factors influencing MCH in Mwingi District, Kitui County in Kenya. Methods: This was a qualitative study which was conducted as part of a larger mixed method study. Data was conducted using Focus Group Discussions (FGDs) and in-depth interviews. Three FGDs were conducted with each having 8 respondents (N=24) and nine in-depth interviews were conducted with 9 key informants (N=9). Purposive sampling was used to sample participants in the FGDs while maximum variation sampling was used to select key informants for the in-depth interviews. Framework analysis and quasi statistics were used in data analysis. NVivo software was used in data man-agement and analysis. Results: Social-cultural and economic factors influencing MCH in the district include; 1.Various cultural and religious factors, 2. Various deficiencies in health care service provision, 3. Unreliable transport infrastructure, 4. Poverty, 5. Illiteracy, and 7. Food insecurity. Conclusion and recommendations: Efforts to improve MCH in the district should: address cultural and religious influence on MCH, address deficiencies in health care service delivery, alleviate poverty, improve transport infrastructure, reduce illit-eracy, and improve food security.

Perceived Socio-Cultural and Economic Factors Influencing Maternal and Child Health: Qualitative Insights from Mwingi District, Kenya.

Background: Reducing child mortality rates and improving maternal health are Millennium Develop-ment Goals (MDGs) that Kenya is striving to realize by next year, 2015. One way of achieving the MDGs is through identifying and addressing the factors influencing Maternal and Child Health (MCH). The aim of this study was to explore expert opinions on social –cultural and economic factors influencing MCH in Mwingi District, Kitui County in Kenya. Methods: This was a qualitative study which was conducted as part of a larger mixed method study. Data was conducted using Focus Group Discussions (FGDs) and in-depth interviews. Three FGDs were conducted with each having 8 respondents (N=24) and nine in-depth interviews were conducted with 9 key informants (N=9). Purposive sampling was used to sample participants in the FGDs while maximum variation sampling was used to select key informants for the in-depth interviews. Framework analysis and quasi statistics were used in data analysis. NVivo software was used in data man-agement and analysis. Results: Social-cultural and economic factors influencing MCH in the district include; 1.Various cultural and religious factors, 2. Various deficiencies in health care service provision, 3. Unreliable transport infrastructure, 4. Poverty, 5. Illiteracy, and 7. Food insecurity. Conclusion and recommendations: Efforts to improve MCH in the district should: address cultural and religious influence on MCH, address deficiencies in health care service delivery, alleviate poverty, improve transport infrastructure, reduce illit-eracy, and improve food security.

Mycotic aortic aneurysm due to intravesical BCG immunotherapy: Clinical manifestations and diagnostic challenges

A live, attenuated form of Mycobacterium bovis, bacillus Calmette-Guerin[BCG], is commonly used as intravesical immunotherapy for non-invasive urothelial bladder carcinoma. While complications are rare, dissemination can occur. A case of mycotic aortic aneurysm following BCG administration with recovery of Mycobacterium bovis in culture is reported. A review of the published experience with this problem is also presented.

Risk Management in the Clinical Laboratory

Clinical laboratory tests play an integral role in medical decision-making and as such must be reliable and accurate. Unfortunately, no laboratory tests or devices are foolproof and errors can occur at pre-analytical, analytical and post-analytical phases of testing. Evaluating possible conditions that could lead to errors and outlining the necessary steps to detect and prevent errors before they cause patient harm is therefore an important part of laboratory testing. This can be achieved through the practice of risk management. EP23-A is a new guideline from the CLSI that introduces risk management principles to the clinical laboratory. This guideline borrows concepts from the manufacturing industry and encourages laboratories to develop risk management plans that address the specific risks inherent to each lab. Once the risks have been identified, the laboratory must implement control processes and continuously monitor and modify them to make certain that risk is maintained at a clinically acceptable level. This review summarizes the principles of risk management in the clinical laboratory and describes various quality control activities employed by the laboratory to achieve the goal of reporting valid, accurate and reliable test results.

La autoridad personal en el sistema familiar: adaptación y validación a la población mexicana / Adaptation and validation of the Mexican Spanish version of Personal Authority in Family System Questionnaire

El propósito este estudio fue el obtener un instrumento estandarizado de autoridad personal para la población mexicana. Se utilizó el Cuestionario de Autoridad Personal en el Sistema Familiar y se examinó su estructura factorial. Los participantes fueron 600 personas voluntarias, mayores de edad, casadas o en unión libre residentes del Distrito Federal y área metropolitana con número de hijos y ocupaciones variables. Las dimensiones propuestas en el cuestionario original fueron distintas para la población mexicana. Los resultados sugieren una solución de 16 factores para explicar el fenómeno y uno adicional correspondiente a un estudio exploratorio preliminar. Entre las diferencias, se encontraron factores por separado para el padre y la madre relacionados con la intimidad e intimidación intergeneracional en lugar de dimensiones unificadas. También se observaron factores exclusivos para describir la importancia de las expectativas de la madre hacia los hijos resaltando el impacto de la estructura de la familia mexicana en la obtención de los resultados. El análisis factorial de segundo orden muestra la conformación de cinco dimensiones que subyacen a la autoridad personal.

The aim of this study was to propose a standardized measure that assessed personal authority in Mexican population. The Personal Authority in Family System Questionnaire (PAFS-Q) was used. The sample consisted of 600 adult volunteers who were married or who lived with a formal partner at the time of the research. They were Mexico City's or metropolitan area residents with different occupations and from different age groups. The PAFS-Q factor structure was examined. Findings suggest a sixteen-factor solution plus a one-factor preliminary exploratory study with important differences from those reported when the PAFS-Q was developed and standardized for Americans. The main differences were that this study found separate Father and Mother Intimacy and Intimidation factors instead of single Intergenerational Intimacy and Intergenerational Intimidation dimensions. By the way, there were also found two additional factors for describing Mother's expectations that should be fulfilled by her adult children. This might be explained by the impact of Mexican culture in traditional family structure. A second- order factor analysis provided a further explanation of Personal Authority dimensions.

A novel, minimally-invasive technique of cartilage repair in the human knee using arthroscopic microfracture and injections of mesenchymal stem cells and hyaluronic acid--a prospective comparative study on safety and short-term efficacy

<p><b>INTRODUCTION</b>Most current cell-based cartilage repair techniques require some form of scaffolds and 2 separate surgical procedures. We propose a novel, scaffold-less technique of cartilage repair in the human knee that combines arthroscopic microfracture and outpatient intra-articular injections of autologous bone marrow-derived mesenchymal stem cells (MSCs) and hyaluronic acid (HA).</p><p><b>MATERIALS AND METHODS</b>Seventy matched (age, sex, lesion size) knees with symptomatic cartilage defects underwent cartilage repair with the proposed technique (n = 35) or an open technique (n = 35) in which the MSCs were implanted beneath a sutured periosteal patch over the defect. Prospective evaluation of both groups were performed using the International Cartilage Repair Society (ICRS) Cartilage Injury Evaluation Package, which included questions from the Short-Form (SF-36) Health Survey, International Knee Documentation Committee (IKDC) subjective knee evaluation form, Lysholm knee scale, and Tegner activity level scale. Postoperative magnetic resonance imaging (MRI) evaluation was also performed at 1 year for most patients.</p><p><b>RESULTS</b>There were no clinically significant adverse events reported through the course of our study. At the fi nal follow-up (mean = 24.5 months), there was significant improvement in mean IKDC, Lysholm, SF-36 physical component score and visual analogue pain scores in both treatment groups.</p><p><b>CONCLUSION</b>In the short term, the results of this novel technique are comparable to the open procedure with the added advantages of being minimally invasive and requiring only a single operation under general anaesthesia. Its safety has been validated and its efficacy is currently being evaluated in an ongoing randomised controlled trial.</p>

Schistosome serine protease inhibitors: parasite defense or homeostasis?

Serpins are a structurally conserved family of macromolecular inhibitors found in numerous biological systems. The completion and annotation of the genomes of Schistosoma mansoni and Schistosoma japonicum has enabled the identification by phylogenetic analysis of two major serpin clades. S. mansoni shows a greater multiplicity of serpin genes, perhaps reflecting adaptation to infection of a human host. Putative targets of schistosome serpins can be predicted from the sequence of the reactive center loop (RCL). Schistosome serpins may play important roles in both post-translational regulation of schistosome-derived proteases, as well as parasite defense mechanisms against the action of host proteases.

Serpinas são uma família de inibidores macromoleculares estruturalmente conservados encontrados em inúmeros sistemas biológicos. O término e a anotação dos genomas de Schistosoma mansoni e de Schistosoma japonicum permitiram a identificação por análise filogenética de dois principais clados de serpinas. S. mansoni mostra uma multiplicidade maior de genes de serpinas, talvez refletindo uma adaptação à infecção de um hospedeiro humano. Alvos putativos das serpinas de esquistossomos podem ser preditos a partir da sequência do "loop" do centro reativo. Serpinas de esquistossomos podem ter importantes papeis tanto na regulação pós-traducional de proteases derivadas do esquistossoma, quanto nos mecanismos de defesa contra a ação de proteases do hospedeiro.

Laboratory quality control based on risk management

Risk management is the systematic application of management policies, procedures, and practices to the tasks of analyzing, evaluating, controlling and monitoring risk [the effect of uncertainty on objectives]. Clinical laboratories conduct a number of activities that could be considered risk management including verification of performance of new tests, troubleshooting instrument problems and responding to physician complaints. Development of a quality control plan for a laboratory test requires a process map of the testing process with consideration for weak steps in the preanalytic, analytic and postanalytic phases of testing where there is an increased probability of errors. Control processes that either prevent or improve the detection of errors can be implemented at these weak points in the testing process to enhance the overall quality of the test result. This manuscript is based on a presentation at the 2nd International Symposium on Point of Care Testing held at King Faisal Specialist Hospital in Riyadh, Saudi Arabia on October 12-13, 2010. Risk management principles will be reviewed and progress towards adopting a new Clinical and Laboratory Standards Institute Guideline for developing laboratory quality control plans based on risk management will be discussed

The Helminthic Eosinophilic Meningitides: Emerging Zoonotic Parasitic Diseases Worldwide

The helminthic infections that can cause eosinophilic meningitis (EM) share many of the characteristics of emerging infectious diseases, such as the influences of international trade and travel on pathogen dissemination in a warming ecosystem. In order to assess the evolving epidemiology of EM worldwide, define the case diagnosis of EM based on cerebrospinal fluid (CSF) microscopy, and stratify the causes of EM as infectious versus non-infectious; this review analyzes scientific articles selected by MEDLINE search, 1966-2009. In addition, this review compares the clinical manifestations, management, and outcomes of the most common causes of helminthic EM worldwide in order to alert clinicians to populations at increased risk of helminthic EM as a result of age, ethnicity, lifestyle, food choices, location of permanent residence, or recent travel. The most common helminthic causes of EM worldwide are angiostrongyliasis and gnathostomiasis. Angiostrongyliasis, a rodent zoonosis endemic in Southeast Asia, was imported to North and South America and the Caribbean following the embarkation of infected rodents from cargo ships. Gnathostomiasis, a zoonosis of wild carnivores in Southeast Asia and Latin America, has been recently recognized as an emerging cause of EM in travelers returning to England and the United States (US). Baylisascariasis, a North American raccoon zoonosis, is an additional, although unusual, emerging cause of EM, that has extended distribution range across the US since the 1980s, and was exported to Japan by the exotic pet trade. Although EM occurs worldwide, its differential diagnosis is limited to infectious and non-infectious etiologies with non-infectious etiologies, such as intracranial hardware and malignancies, causing more cases, especially in regions that are not endemic for the most common causative parasites. Most cases of helminthic EM can be prevented by public health education, human behavior modification, and proper food preparation.

11th Yahya Cohen Memorial Lecture: An in vivo comparative study of the ability of derived mesenchymal stem cells in the treatment of partial growth arrest

Few in vivo studies had previously been attempted in reaffirming the in vitro data in current literature. This study evaluated the ability of mesenchymal stem cells (MSCs) isolated from bone marrow, periosteum and fat to treat partial growth arrest in immature New Zealand white (NZW) rabbits. A physeal arrest model in an immature rabbit was created. The bony bridge was excised 3 weeks later, and MSCs from various sources were transferred into the physeal defect of different rabbits. Group I consisted of bone marrow-derived MSCs, Group II: periosteumderived MSCs, Group III: fat-derived MSCs. Contra-lateral tibiae, without undergoing operation, served as self-control. The animals were subsequently sacrificed, with radiological and histological analyses performed. All MSCs demonstrated chondrogenic and osteogenic differentiation potentials in vitro. In correction of varus angulation groups I and II exhibited superior results when compared to group III (P <0.05). The length discrepancies between operated and normal tibiae in groups I, II and III were significantly corrected when compared to the control group (P <0.01). In conclusion, bone marrow and periosteum derived stem cells provided better correction of physeal arrest in rabbits. The source of MSCs itself could influence the success in the treatment of growth arrest.

Health Risks and Benefits of Seafood Consumption

Seafood is an important source of dietary protein worldwide, especially for coastal and island dwellers who now comprise 70% of the world’s population. Besides being high in protein and providing 40% of the world’s protein intake, seafood is low in cholesterol and saturated fatty acids and contains unique long-chain omega-3 polyunsaturated fatty acids (PUFAs). Two seafood PUFAs, eicosapentanoic acid (EPA) and docosahexanoic acid (DHA) inhibit platelet aggregation and reduce mortality from myocardial infarction (MI) and ischemic stroke. Although the United States (U.S.) scientific community has recommended a Mediterranean-type diet, based on beneficial PUFAs in seafood, the European scientific community has cautioned that the increasing methylmercury levels in seafood may counteract any cardioprotective effects of PUFAs and actually increase risks of MI. This review describes the health benefits of seafood consumption and makes recommendations for the safe selection and preparation of seafood. In addition, this review describes the burden of seafood-borne diseases, separates seafood-borne toxic, heavy metal, and pesticide poisonings from seafood-borne infectious diseases; and makes recommendations for the management and prevention of seafood-borne illnesses. With the exception of some of the toxic seafood-borne illnesses, most seafood-borne infectious diseases, heavy metal poisonings, and pesticide poisonings can be prevented by careful selection and preparation of fresh seafood and adherence to weekly seafood consumption advisories, especially for those at highest risk of methylmercury poisoning, such as women who are pregnant, breastfeeding, or of child-bearing age, and children age seven and younger. A balanced diet combining protein from a variety of sources, including carefully selected and prepared seafood, along with natural antioxidants from fruits and vegetables is recommended to prevent seafood-borne diseases and to promote health and longevity.

Recurrent patellar dislocation: reappraising our approach to surgery

<p><b>INTRODUCTION</b>The management of recurrent traumatic patellar dislocation includes surgical realignment. There is no clear distinction whether proximal soft tissue or distal procedures produce superior results. However, distal realignment procedures are commonly associated with greater morbidity. We advocate a distal procedure only for cases which are more severe, such as the presence of patellar maltracking.</p><p><b>MATERIALS AND METHODS</b>Between January 2002 and June 2007, all patients who had a history of traumatic patellar dislocation with recurrent symptoms and failed conservative management underwent surgical realignment. Patients who had evidence of lateral patellar subluxation on computed tomography (CT) scan were offered a distal realignment procedure using the Elmslie-Trillat or Roux Goldthwaite procedure. All other patients underwent proximal soft tissue medial patellofemoral ligament (MPFL) reconstruction. Pre and postoperative functional International Knee Documentation Committee (IKDC), Lysholm and Tegner score assessments were performed for a minimum follow-up period of 6 months. The mean scores for each group were analysed using the Wilcoxon Matched-Pairs Signed-Ranks test and the Mann-Whitney U test was used to evaluate the difference between the groups.</p><p><b>RESULTS</b>A total of 23 patients underwent surgery for patellar realignment. Of whom, 14 patients had a distal realignment procedure while 9 patients had a proximal procedure of MPFL reconstruction. There was greater morbidity reported with distal realignment procedures. Pre and postoperative IKDC, Lysholm and Tegner scores showed significant improvement for both treatment arms. However, there was no significant difference between the improvement scores for both groups.</p><p><b>CONCLUSION</b>Patients with significant patellar maltracking following traumatic patellar dislocation would benefit from distal realignment using the Elmslie-Trillat or Roux Goldthwaite procedure. Otherwise, a proximal soft tissue procedure involving MPFL reconstruction would be adequate. A management algorithm is proposed for clinical use.</p>