Borderzone Infarcts and Recurrent Cerebrovascular Events in Symptomatic Intracranial Arterial Stenosis: A Systematic Review and Meta-Analysis / 대한뇌졸중학회지

Background@#and Purpose Intracranial arterial stenosis (ICAS)-related stroke occurs due to three primary mechanisms with distinct infarct patterns: (1) borderzone infarcts (BZI) due to impaired distal perfusion, (2) territorial infarcts due to distal plaque/thrombus embolization, and (3) plaque progression occluding perforators. The objective of the systematic review is to determine whether BZI secondary to ICAS is associated with a higher risk of recurrent stroke or neurological deterioration. @*Methods@#As part of this registered systematic review (CRD42021265230), a comprehensive search was performed to identify relevant papers and conference abstracts (with ≥20 patients) reporting initial infarct patterns and recurrence rates in patients with symptomatic ICAS. Subgroup analyses were performed for studies including any BZI versus isolated BZI and those excluding posterior circulation stroke. The study outcome included neurological deterioration or recurrent stroke during follow-up. For all outcome events, corresponding risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated. @*Results@#A literature search yielded 4,478 records with 32 selected during the title/abstract triage for full text; 11 met inclusion criteria and 8 studies were included in the analysis (n=1,219 patients; 341 with BZI). The meta-analysis demonstrated that the RR of outcome in the BZI group compared to the no BZI group was 2.10 (95% CI 1.52–2.90). Limiting the analysis to studies including any BZI, the RR was 2.10 (95% CI 1.38–3.18). For isolated BZI, RR was 2.59 (95% CI 1.24–5.41). RR was 2.96 (95% CI 1.71–5.12) for studies only including anterior circulation stroke patients. @*Conclusion@#This systematic review and meta-analysis suggests that the presence of BZI secondary to ICAS may be an imaging biomarker that predicts neurological deterioration and/or stroke recurrence.

Prenatal Exposure to Per- and Polyfluoroalkyl Substances, Maternal Thyroid Dysfunction, and Child Autism Spectrum Disorder

Autism spectrum disorder (ASD), with its high economic and societal costs, is a growing public health concern whose prevalence has risen steadily over the last two decades. Although actual increased incidence versus improved diagnosis remains controversial, the increased prevalence of ASD suggests non-inherited factors as likely contributors. There is increasing epidemiologic evidence that abnormal maternal thyroid function during pregnancy is associated with increased risk of child ASD and other neurodevelopmental disorders. Prenatal exposure to endocrine-disrupting chemicals such as per- and polyfluoroalkyl substances (PFAS) is known to disrupt thyroid function and can affect early brain development; thus, thyroid dysfunction is hypothesized to mediate this relationship. The concept of a potential pathway from prenatal PFAS exposure through thyroid dysfunction to ASD etiology is not new; however, the extant literature on this topic is scant. The aim of this review is to evaluate and summarize reports with regard to potential mechanisms in this pathway.

Child dietary intake of folate and vitamin B12 and their neurodevelopment at 24 and 30 months of age / Ingesta de folato y vitamina B12 en la dieta del niño y su neurodesarrollo a los 24 y 30 meses de edad

Abstract Objective To evaluate whether child dietary intake of folate and vitamin B12, is associated with mental and psychomotor development in Mexican children, respectively, at 24 and 30 months of age. Materials and methods Information about neurodevelopment and dietary intake of folate and vitamin B12 at 24 and 30 months of age among 229 children belonging to a perinatal cohort was analyzed longitudinally. Dietary information was assessed using a semi-quantitative food frequency questionnaire, and neurodevelopment by Bayley Scale of Infant Development II. Results At 30 months of age, dietary folate intake was marginally associated with increased Mental Development Index (MDI) (β=8.33; 95%CI -0.48, 17.14; p=0.06). Non-significant positive associations of vitamin B12 with MDI were found. Psychomotor Development Index (PDI) was not associated with these nutrients. Conclusion Dietary folate intake in early childhood may benefit the mental development of children.

Resumen Objetivo Evaluar si la ingesta dietética infantil de folato y vitamina B12 se asocia con el desarrollo mental y psicomotor en niños mexicanos de 24 y 30 meses de edad. Material y métodos La información del neurodesarrollo y la ingesta dietética de folato y B12 a los 24 y 30 meses de edad de 229 niños pertenecientes a una cohorte perinantal, se analizó longitudinalmente. La información dietética se obtuvo por un cuestionario de frecuencia de alimentos semicuantitativo y el neurodesarrollo mediante la Escala de Desarrollo Infantil de Bayley II. Resultados A los 30 meses de edad, la ingesta dietética de folato se asoció marginalmente con un incremento del Índice de Desarrollo Infantil (IDM) (β=8.33; IC95% -0.48, 17.14; p=0.06). Se observaron asociaciones positivas no significativas entre la B12 y el IDM. El Índice de Desarrollo Psicomotor (IDP) no se asoció con dichos nutrientes. Conclusión La ingesta dietética infantil de folato puede beneficiar el desarrollo mental.

Nursing Home Employee and Resident Satisfaction and Resident Care Outcomes

BACKGROUND: Nursing home resident care is an ongoing topic of public discussion, and there is great interest in improving the quality of resident care. This study investigated the association between nursing home employees' job satisfaction and residents' satisfaction with care and medical outcomes. METHODS: Employee and resident satisfaction were measured by questionnaire in 175 skilled nursing facilities in the eastern United States from 2005 to 2009. Facility-level data on residents' pressure ulcers, medically unexplained weight loss, and falls were obtained from the Centers for Medicare and Medicaid Services Long-Term Care Minimum Data Set. The association between employee satisfaction and resident satisfaction was examined with multiple and multilevel linear regression. Associations between employee satisfaction and the rates of pressure ulcers, weight loss, and falls were examined with simple and multilevel Poisson regression. RESULTS: A 1-point increase in overall employee satisfaction was associated with an increase of 17.4 points (scale 0–100) in the satisfaction of residents and family members (p < 0.0001) and a 19% decrease in the incidence of resident falls, weight loss, and pressure ulcers combined (p < 0.0001), after adjusting for staffing ratio and percentage of resident-days paid by Medicaid. CONCLUSION: Job satisfaction of nursing home employees is associated with lower rates of resident injuries and higher resident satisfaction with care. A supportive work environment may help increase quality of care in the nation's nursing homes.

Paraoxonase 1 (PON1) Q192R genotypes and their interaction with smoking strongly increase atherogenicity and the Framingham risk score

ABSTRACT Objective Paraoxonase 1 (PON1) polymorphisms are associated with an increased susceptibility to cardiovascular disease. PON1 Q192R polymorphism (rs662) partially determine PON1 hydrolytic activity and protect against oxidation of LDL and HDL. This study aimed to delineate the association of PON1 status (functional 192 genotype and plasma activity levels) and atherogenicity in urbans residents aged 40 years or more. Materials and methods Anthropometric data, lipid profiles, the atherogenic index of the plasma (AIP) and Framingham score risk were measured. Three kinetic assays were conducted to assay PON1 status using phenylacetate and 4-(chloromethyl)phenyl acetate as substrates. Results Smoking per se did not significantly impact the AIP but the interaction PON1 genotype by smoking significantly increased the AIP. In subjects with the RR genotype smoking increased the AIP index from (estimated mean ± SEM) -0.038 ± 0.039 to 0.224 ± 0.094. The QR genotype increased the Framingham risk index by around 1.3 points. Smoking by RR genotype carriers significantly increased the Framingham risk score (17.23 ± 2.04) as compared to smoking (13.00 ± 1.06) and non-smoking (7.79 ± 0.70) by QQ+QR genotype carriers. The interaction RR genotype by smoking was a more important predictor (odds ratio = 7.90) of an increased Framingham risk score (> 20) than smoking per se (odds ratio = 2.73). The interaction smoking by RR genotype carriers significantly increased triglycerides and lowered HDL cholesterol. Conclusion Smoking per se has no (AIP) or a mild (Framingham risk score) effect on atherogenicity, while the interaction smoking by PON1 RR genotype has a clinically highly significant impact on atherogenicity.

Need for more targeted measures - only less severe hospital-associated infections declined after introduction of an infection control program

A systematic infection control program is found to be an important tool to reduce hospital-associated infections [HAIs] and surveillance of infection is a significant part of it. The aim of this paper was to present the result from 17 years continuous prevalence studies after implementation of a systematic infection control program, to examine trends of hospital-associated infections and to study possible risk factors for different sites of infection.Data from 61 399 in-patients at Haukeland University Hospital, Norway, from 1994 to 2010 was included in the study. Overall prevalence of HAIs was 7.6%. There was a reduction in HAIs from 8.3% in 1994 to 7.1% in 2010 [relative decrease 14.4%], mostly attributable to a significant reduction in the prevalence of urinary tract infections [UTI]. For surgical site infections [SSI] we found a borderline significant increase [p = 0.05]. Male gender [except for UTI], urinary tract catheter and surgical operation were all strong predictors for HAIs. Higher age was a risk factor for all infection types, except for BSI. In conclusion, repeated prevalence surveys demonstrated a significant reduction in HAIs but no decrease in hospital-associated BSI, LRTI and SSI. There was, however, a rapid decline of UTI and other less severe HAIs

Mild-Tourniquet Induced Ischaemia-reperfusion Injury Results in Changes to Haematological, Haemostatic and Inflammatory Parameters.

Background: Ischaemia-reperfusion injury (IRI) is an underlying condition in cardiovascular disease such as arthrosclerosis and stroke, and occurs during surgery that involves the application of a tourniquet. These clinical conditions are extremely prominent in the United Kingdom. This pilot-study aimed to determine the effects of mild tourniquet induced IRI on specific haematological, haemostatic and inflammatory parameters. Patients and Methods: An In vivo model of mild tourniquet induced IRI was performed on 15 volunteers (n=15). Tourniquet pressure was set between 20-40 mmHg for 10 minutes and rendered the arm temporarily ischaemic. Baseline venous blood samples were taken prior to ischaemia, then following the release of the tourniquet at 7 minutes and 48 hours reperfusion. The parameters investigated included: full blood count, von Willebrand factor (vWF), sE-selectin, prothrombin time (PT), Interleukin-6 (IL-6), IL-8 and IL-10. Results: The results demonstrated a significant increase in vWF following reperfusion (p=0.005), and increasing trends of IL-6, IL-8 and sE-selectin concentrations (p=>0.05). Decreasing PT, white blood cell and platelet counts were observed following IRI but were not significant (p=>0.05). Discussion and Conclusion: The study demonstrated that brief periods of IRI caused changes to haematological, haemostatic and inflammatory parameters. Specifically, a significant increase in vWF concentration was observed following tourniquet induced IRI. This suggests that changes to vascular integrity and that of endothelial activation may be occurring. The results of this pilot-study provide a basis for further exploration of haematological, haemostatic and inflammatory parameters following IRI, which may increase our knowledge and understanding of a subject area that is not fully understood. Ultimately, further studies may highlight areas of therapeutic intervention for the underlying occurrence of IRI in pathological conditions, such as cardiovascular disease (CVD) and surgeries that involve the application of a tourniquet. These predictors, however, need further work to validate reliability in a clinical setting.

Significant fibrosis after radiation therapy in a patient with Marfan syndrome

Marfan syndrome is one of the collagen vascular diseases that theoretically predisposes patients to excessive radiation-induced fibrosis yet there is minimal published literature regarding this clinical scenario. We present a patient with a history of Marfan syndrome requiring radiation for a diagnosis of a right brachial plexus malignant nerve sheath tumor. It has been suggested that plasma transforming growth factor beta 1 (TGF-beta1) can be monitored as a predictor of subsequent fibrosis in this population of high risk patients. We therefore monitored the patient's TGF-beta1 level during and after treatment. Despite maintaining stable levels of plasma TGF-beta1, our patient still developed extensive fibrosis resulting in impaired range of motion. Our case reports presents a review of the literature of patients with Marfan syndrome requiring radiation therapy and the limitations of serum markers on predicting long-term toxicity.

Photosynthesis of seedlings of Otoba novogranatensis (Myristicaceae) and Ruagea glabra (Meliaceae) in abandoned pasture, secondary forest and plantation habitats in Costa Rica / Fotosíntesis de plántulas de Otoba novogranatensis (Myristicaceae) y Ruagea glabra (Meliaceae) en pastizales abandonados, bosques secundarios y hábitats de plantaciones en Costa Rica

Enrichment planting in naturally recovering secondary forests or in tree plantations is increasingly being used as strategy to restore later-successional, large-seeded tropical forest trees. We seeded two tree species (Otoba novogranatensis and Ruagea glabra) in three agricultural sites in Southern Costa Rica: abandoned pastures, eight to ten year old secondary forests and three year old tree plantations (containing two N-fixing of four total tree species). We measured micrometeorological conditions, soil water content, plant water potential, leaf area, foliar C and N, and photosynthesis to better understand mechanistic responses of seedlings to conditions in the different successional habitats. Micrometeorological conditions, soil water content, and plant water potential were generally similar across habitats. Certain aspects of leaves (such as Specific Leaf Area and foliar N content), and photosynthesis (e.g. quantum yield and electron transport rate) were highest in the plantations, intermediate in the secondary forests, and lowest in abandoned pastures. Enhanced rates of photosynthetic biochemistry (such as Vcmax and Jmax) and Photosystem II efficiency (e.g. thermal energy dissipation) occurred in leaves from the plantations compared to the abandoned pastures, which may be related to higher leaf %N content. Results suggest that foliar N may be of greater importance than soil water content and micrometeorological factors in driving differences in photosynthetic processes across planting habitats. Planting seeds of these two species in plantations containing three year old trees (including two N-fixing species) enhances certain aspects of their photosynthesis and growth, compared to seedlings in abandoned pastures with non-native grasses, and thus can help increase forest recovery on abandoned agricultural lands.

El enriquecimiento de bosques secundarios o plantaciones forestales en proceso de regeneración natural por medio de la siembra de plántulas es una práctica cada vez más utilizada para restaurar bosques tropicales en estado de sucesión tardía. Sembramos dos especies de árboles (Otoba novogranatensis y Ruagea glabra) en pastizales abandonados, bosques secundarios de ocho a diez años de edad y plantaciones forestales de tres años de edad (con dos especies fijadoras de Nitrógeno de un total de cuatro especies) en tres sitios agrícolas en el Sur de Costa Rica. Medimos condiciones micrometeorológicas, contenido de agua del suelo, potencial hídrico de las plantas, área foliar, C y N foliar, y fotosíntesis para entender de una mejor manera las respuestas funcionales de las plántulas ante condiciones de distintos estadíos sucesionales. Las condiciones micrometeorológicas, contenido hídrico del suelo y el potencial hídrico de las plantas fueron mayoritariamente similares entre hábitats. Algunos aspectos de las hojas (como Área Foliar Específica y contenido de N foliar) y fotosíntesis (ej.: rendimiento cuántico y tasa de transporte de electrones) presentaron valores mayores en las plantaciones, intermedios en los bosques secundarios y menores en los pastizales abandonados. Se obtuvo un aumento en las tasas fotosintéticas bioquímicas (como Vcmax, Jmax) y la eficiencia del Fotosistema II (ej.: disipación de energía térmica) en hojas provenientes de las plantaciones comparado a las de los pastizales, posiblemente relacionado a un mayor %N foliar. Los resultados sugieren que el N foliar puede ser más importante que el contenido de agua del suelo y que los factores micrometeorológicos para marcar diferencias en los procesos fotosintéticos entre hábitats. Las plántulas de estas dos especies en las plantaciones con árboles de tres años de edad (incluyendo dos fijadoras de N) incrementaron ciertos aspectos de su fotosíntesis y crecimiento comparado a las plántulas en los pastizales abandonados de especies exóticas, por lo tanto, esta práctica puede ayudar a incrementar la recuperación de los bosques en áreas agrícolas abandonadas.

Long-Term Anticoagulation in the Extreme Elderly with the Newer Antithrombotics: Safe or Sorry?

BACKGROUND AND OBJECTIVES: The prevalence of atrial fibrillation (AF) doubles in the extreme elderly and is higher than in the rest of the population. Warfarin therapy to prevent thromboembolic events secondary to AF is often underutilized and under-prescribed in this subgroup, due to the fear of bleeding and other complications. Newer oral anticoagulants such as rivaroxaban and dabigatran offer alternative therapeutic options for the extreme elderly. We review the clinical trial data of these newer agents in the extreme elderly population. SUBJECTS AND METHODS: The primary literature was identified through PubMed, using the following search terms: anticoagulation, rivaroxaban, dabigatran, warfarin, elderly, AF, bleeding, stroke, and aging. Additional references were identified through the review of references from the articles obtained. We included clinical studies evaluating anticoagulation therapies in AF. Selection emphasis was placed on those evaluating anticoagulation in the elderly population. RESULTS: Dabigatran and rivaroxaban have predictable, dose-proportional pharmacokinetic and pharmacodynamic properties, which make them favorable options for the elderly. Fewer monitoring parameters and drug interactions allow for the greater ease of use. A landmark trial shows that the rate of intracranial hemorrhage with dabigatran is lower in this population compared to warfarin. However, the data is based on a small number of subjects enrolled in the clinical trials. As such, the real-world use of these agents may not replicate the published rates of bleeding and thrombosis in the study populations. CONCLUSION: More research is needed in this area, specifically in this population, before newer agents such as rivaroxaban and dabigatran are widely recommended for use in the extreme elderly patients.

Inconsistent Effects of Iron-Folic Acid and/or Zinc Supplementation on the Cognitive Development of Infants.

Despite concerns over the neurocognitive effects of micronutrient deficiencies in infancy, few studies have examined the effects of micronutrient supplementation on specific cognitive indicators. This study investigated, in 2002, the effects of iron-folic acid and/or zinc supplementation on the results of Fagan Test of Infant Intelligence (FTII) and the A-not-B Task of executive functioning among 367 Nepali infants living in Sarlahi district. Infants were enrolled in a cluster-randomized, placebo-controlled clinical trial of daily supplementation with 5 mg of zinc, 6.25 mg of iron with 25 μg of folic acid, or zinc-iron-folic acid, or placebo. These were tested on both the tasks using five indicators of information processing: preference for novelty (FTII), fixation duration (FTII), accelerated performance (≥85% correct; A-not-B), deteriorated performance (<75% correct and >1 error on repeat-following-correct trails; A-not-B), and the A-not-B error (A-not-B). At 39 and 52 weeks, 247 and 333 infants respectively attempted the cognitive tests; 213 made an attempt to solve both the tests. The likelihood of females completing the A-not-B Task was lower compared to males when cluster randomization was controlled [odds ratio=0.67; 95% confidence interval 0.46-0.97; p<0.05]. All of the five cognitive outcomes were modelled in linear and logistic regression. The results were not consistent across either the testing sessions or the information-processing indicators. Neither the combined nor the individual micronutrient supplements improved the performance on the FTII or the A-not-B Task (p>0.05). These findings suggest that broader interventions (both in terms of scope and duration) are needed for infants who face many biological and social stressors.

Restauración ecológica de bosques tropicales en Costa Rica: efecto de varios modelos en la producción, acumulación y descomposición de hojarasca

Tropical forest restoration in Costa Rica: the effect of several strategies on litter production, accumulation and decomposition. Tropical forest restoration strategies have the potential to accelerate the recovery of the nutrient cycles in degraded lands. Litter production and its decomposition represent the main transfer of organic material and nutrients into the soil substrate. We evaluated litter production, accumulation on the forest floor, and its decomposition under three restoration strategies: plantation (entire area planted with trees), island (trees planted in patches of three different sizes) and control (natural regeneration) plots. We also compared restoration strategies to young secondary forest (7-9yr). Restoration treatments were established in 50x50m plots in June 2004 at six sites in Southern Costa Rica. Planted tree species included two native timber species (Terminalia amazonia and Vochysia guatemalensis) interplanted with two N fixers (Erythrina poeppigiana and Inga edulis). Litter was collected every 15 days between September 2008 and August 2009 in 12 0.25m² litter traps distributed within each plot; litter that accumulated on the soil surface was collected at four locations (0.25m² quadrats) within each plot in February and May 2009. Total litter production in plantation (6.3Mg/ha) and secondary forest (7.3Mg/ha) did not differ, but were greater than in islands (3.5Mg/ha) and control (1.4Mg/ha). Plantation had greatest accumulation of litter on the soil surface (10.6Mg/ha) as compared to the other treatments (SF=7.2; I=6.7; C=4.9). Secondary forest was the only treatment with a greater annual production of litter than litter accumulation on the soil surface. Carbon storage in litter was similar between plantation and secondary forest, and significantly greater than the other treatments. No differences were found for carbon concentration and storage in the soil among treatments. There was also high variability in the production and accumulation of litter and carbon among sites. Active restoration treatments accelerated the production of litter and carbon storage in comparison to areas under natural recovery. However, the nutrient cycle has not necessarily been restored under these conditions, as high litter accumulation on the soil surface indicates a low decomposition rate, which slows nutrient return to the soil. Rev. Biol. Trop. 59 (3): 1323-1336. Epub 2011 September 01.

Estrategias de restauración tienen el potencial de acelerar el restablecimiento del ciclo de nutrientes en áreas degradadas. En este estudio, se evaluó la producción de hojarasca, su acumulación y descomposición bajo tres tratamientos: plantación (toda la superficie plantada); islas (árboles sembrados en parches de tres tamaños) y testigo (regeneración natural). También se compararon bosques secundarios jóvenes (7-9 años). Los tratamientos fueron establecidos en parcelas de 50x50m en junio 2004 en seis sitios en el sur de Costa Rica. Las especies introducidas fueron dos maderables (Terminalia amazonia y Vochysia guatemalensis) intercaladas con dos fijadoras de nitrógeno (Erythrina poeppigiana e Inga edulis). La producción total de hojarasca en la plantación y bosque secundario no difirió significativamente, fue mayor que en las islas y el testigo. La plantación presentó mayor acumulación de hojarasca sobre el suelo. Los resultados indican una gran variabilidad entre los sitios. Ambas estrategias de restauración activas aceleraron la producción y acumulación de hojarasca en comparación con la regeneración. No obstante, eso no implica la restauración del ciclo de nutrientes. La elevada acumulación de hojarasca sobre el suelo indica baja tasa de descomposición y de retorno de nutrientes al suelo.

Histones, histone chaperones and nucleosome assembly

Chromatin structure governs a number of cellular processes including DNA replication, transcription, and DNA repair. During DNA replication, chromatin structure including the basic repeating unit of chromatin, the nucleosome, is temporarily disrupted, and then reformed immediately after the passage of the replication fork. This coordinated process of nucleosome assembly during DNA replication is termed replication-coupled nucleosome assembly. Disruption of this process can lead to genome instability, a hallmark of cancer cells. Therefore, addressing how replication-coupled nucleosome assembly is regulated has been of great interest. Here, we review the current status of this growing field of interest, highlighting recent advances in understanding the regulation of this important process by the dynamic interplay of histone chaperones and histone modifications.

Bacterial populations in complementary foods and drinking-water in households with children aged 10-15 months in Zanzibar, Tanzania.

Bacteria were quantified in samples of drinking-water and in two porridges prepared for infant-feeding [fortified instant soy-rice porridge (SRP) and cooked porridge (Lishe bora, LB)] in 54 households. Bacterial numbers were measured again after the porridges had been held at room temperature for four hours (T4). Findings were benchmarked against bacterial numbers in traditional complementary foods sampled from 120 households. Total bacteria, coliform, and Enterobacteriaceae counts were enumerated using Petrifilm. The mean log bacterial numbers were the lowest for LB at TO (2.24 +/- 0.84 cfu/g aerobic counts) and the highest for SRP at T4 (4.63 +/- 0.56 cfu/g aerobic counts). The total bacteria, coliform and Enterobacteriaceae counts were higher at T4 than at T0 for LB (p < or = 0.001); however, only the coliform and Enterobacteriaceae counts were higher at T4 than at T0 for SRP (p<0.001). Drinking-water, SRP0, traditional foods, and SRP4 all had the mean aerobic counts higher than the acceptable cut-off but the total bacterial count in SRP0 was not significantly (p=0.543) different from drinking-water. However, coliform and Enterobacteriaceae counts in SRPO were higher than in drinking-water (p<0.001). Also, although the aerobic counts of SRP4 were not significantly (p>0.999) different from traditional foods, the coliform and Enterobacteriaceae counts were significantly higher in SRP4 than in traditional foods (p<0.001). It is, therefore, recommended that food safety concerns be addressed when improving complementary foods.

Association between anaemia during pregnancy and blood loss at and after delivery among women with vaginal births in Pemba Island, Zanzibar, Tanzania.

The study sought to identify determinants of blood loss at childbirth and 24 hours postpartum. The study was nested in a community-based randomized trial of treatments for anaemia during pregnancy in Wete Town, Pemba Island, Zanzibar, United Republic of Tanzania. Status of anaemia during pregnancy, nutritional information, obstetric history, and socioeconomic status were assessed at enrollment during routine antenatal care. Pregnant women presented for spontaneous vaginal delivery, and nurse-midwives collected information on labour and delivery via partograph. Blood-stained sanitary napkins and pads from childbirth and 24 hours postpartum were quantified using the alkaline hematin method. Moderate-to-severe anaemia (Hb <90 g/L) at enrollment was strongly associated with blood loss at delivery and the immediate postpartum period, after adjusting for maternal covariates and variables of biological relevance to blood loss. Greater blood loss was associated (p<0.10) with duration of the first stage of labour, placental weight, receipt of oxytocin, preterm birth, and grand multiparity. The findings provide unique evidence of a previously-suspected link between maternal anaemia and greater blood loss at childbirth and postpartum. Further research is needed to confirm these findings on a larger sample of women to determine whether women with moderate-to-severe anaemia are more likely to experience postpartum haemorrhage and whether appropriate antenatal or peripartum care can affect the relationships described here.

Research Protocol. A Qualitative Study Investigating Depressive Prodrome in Adolescents / Protocolo de investigación: un estudio cualitativo que investiga los prodromos depresivos en adolescentes

Background: Depression is common, disabling and often has its onset in adolescents. Adolescents with depression are at high risk for persistence and recurrence of depression into adulthood. Subthreshold forms of depression in adolescents are also common. Objective: To retrospectively reconstruct the period leading up to the first episode of major depressive disorder (MDD) in a sample of adolescents. It is hypothesized that it is possible to analyse this period in detail and explore all possible symptoms, syndromes and possible risk factors associated with it. Method: To recruit a series of first episode MDD subjects from the Older Adolescent Service (OAS) of ORYGEN Youth Health. Subjects and informants are to be interviewed about the period leading up to the depressive episode using a combination of unstructured and semi-structured techniques. Analysis: Textual data will be explored and categories generated with the aid of the software package N-VIVO. Discussion: The findings could lay the groundwork for the development of quantitative methodologies for assessing and measuring first depressive phenomena. This has the potential to lead to the early recognition and more accurate prediction of subsequent depression.

Antecedentes: la depresión es común e incapacitante y con frecuencia inicia en la adolescencia. Los adolescentes con depresión presentan alto riesgo para la persistencia y recurrencia de depresión en la vida adulta. Formas subclínicas de depresión también son comunes en la adolescencia. Objetivos: reconstruir retrospectivamente el periodo que conduce al primer episodio de trastorno depresivo mayor (TDM) en un muestra de adolescentes. Se establece la hipótesis de que es posible analizar este periodo en detalle y explorar todos los posibles síntomas, síndromes y factores de riesgo asociados. Método: inscribir una serie de sujetos con primer episodio de TDM provenientes del Servicio del Adolescente Mayor (SAM) de ORYGEN. Los sujetos y los informantes son entrevistados acerca del periodo conducente al episodio depresivo, usando una combinación de técnicas estructuradas y semiestructuradas. Análisis: se exploran los datos textuales y se generan categorías con la ayuda de un programa de software N-VIVO. Discusión: estos hallazgos podrían ser la base en el desarrollo de metodologías cuantitativas para evaluar y medir los primeros fenómenos depresivos. Tienen el potencial para llevar al reconocimiento temprano y a una predicción más acertada de depresión subsecuente.

Ethnic disparities in cancer mortality among residents of Guam.

Cancer mortality data collected by the Guam Cancer Registry for the period 1998 through 2002 were analyzed by cancer site, age, and ethnicity. Ethnicity and site specific age-adjusted cancer mortality rates for Guam were calculated utilizing Guam 2000 census data, the US 2000 standard population and compared to U.S. 2002 age-adjusted cancer mortality rates. Age-adjusted cancer mortality rates for ethnic populations represented on Guam, except those of leukemia and non-Hodgkins lymphoma, were high in relation to other population groups and higher than U.S. averages. Some highlights include: 1. Chamorros had high age-adjusted mortality rates for mouth and pharynx (15.5 vs. 2.7 [corrected] U.S.), nasopharynx (9.1 vs. 0.2 U.S.), lung and bronchus (66.9 vs. 54.9 U.S.), colon-rectum-anus (28.6 vs. 19.7 U.S.), breast (32.0 vs. 28.0 U.S.) and prostate cancer (40.9 vs. 27.9 U.S.); 2. Chamorros (6.4 vs. 2.5 U.S.) and Micronesians (6.3) had high and nearly identical age-adjusted mortality rates for cancer of the mouth and pharynx when nasopharyngeal cancers were excluded; 3. Micronesians had the highest mortality rate for liver cancer over all ethnicities documented (43.5 vs. 4.9 U.S.); 4. Asians had the highest mortality rates for pancreatic (12.5 vs. 10.5 U.S.) and cervical cancer (8.5 vs. 2.6 U.S.); 5. Caucasians had the highest mortality rates for leukemia (19.9 vs. 7.5 U.S.) and Non-Hodgkin's lymphoma (17.6 vs. 7.6 U.S.). Suggestions are made for further research on both explaining and ameliorating cancer mortality disparities among ethnic groups on Guam.

Mesiodens in the primary dentition--a case report.

Supernumerary teeth are among the most significant dental anomalies affecting the primary and the permanent dentitions. Mesiodens is a supernumerary tooth with a cone shaped crown and a short root. Though it occurs frequently in the permanent dentition, it is extremely rare in the primary dentition. The exact etiology is still obscure and not well understood. Supernumerary teeth occur as isolated dental findings or as part of a syndrome. The frequency with which supernumerary teeth occur and the effects they have on development of normal occlusion justify the radiographic examination of preschool children. Early removal of such teeth is recommended if they impede the eruption of adjacent permanent teeth, appear inverted or rudimentary, associated with certain pathologic conditions or are symptomatic.

Bilaterally fused primary mandibular incisors--a case report.

Fusion of teeth results from abnormal events in the embryologic development of teeth. In most cases the clinical and radiological findings allow only a presumptive diagnosis to be established since the specific terminology described refers to the etiology of the process, which often cannot be established. An unusual case of bilateral fusion in primary mandibular incisor region in a four-year-old boy is reported.