Post-Traumatic Stress Disorder and severe maternal morbidity: is there an association?

OBJECTIVE: To evaluate the occurrence of Post-Traumatic Stress Disorder among women experiencing a severe maternal morbidity event and associated factors in comparison with those without maternal morbidity. METHODS: In a retrospective cohort study, 803 women with or without severe maternal morbidity were evaluated at 6 months to 5 years postpartum for the presence of Post-Traumatic Stress Disorder. Interviews were conducted by telephone and electronic data was stored. Data analysis was carried out by using χ2, Fisher's Exact test, and logistic regression analysis. RESULTS: There was no significant change in the prevalence of Post-Traumatic Stress Disorder related to a previous severe maternal morbidity experience. There were also no differences in diagnostic criteria for severe maternal morbidity (hypertensive syndromes, hemorrhage, surgical intervention or intensive care unit admission required, among other management criteria). Low parity (2.5-fold risk) and increasing age were factors associated with Post-Traumatic Stress Disorder. CONCLUSIONS: A severe maternal morbidity episode is not associated with Post-Traumatic Stress Disorder symptoms within five years of the severe maternal morbidity event and birth. However, a more advanced maternal age and primiparity increased the risk of Post-Traumatic Stress Disorder. This does not imply that women who had experienced a severe maternal morbidity event did not suffer or need differentiated care.

Chemical constituents from Bauhinia acuruana and their cytotoxicity

ABSTRACT Phytochemical investigation of Bauhinia acuruana Moric., Fabaceae, resulted in the isolation of sixteen constituents, including two new compounds 2'-hydroxy-2,3,5-trimethoxybibenzyl (1), (2R,3S)-2-(3,4'-dihydroxyphenyl)-5-methoxy-6-methylchroman-3,7-diol (2), together with fourteen known ones (3-16). The structures of the compounds were established by spectroscopic analysis including HR-ESI-MS, 1D and 2D NMR data, followed by comparison with previously reported data from the literature. Compounds 1, 2, 6, 7, 8 and 9 were evaluated for their cytotoxicity, which turned out to be marginal in a panel of six human cancer cell lines.

Predictors of bone mineral density among asian indians in northern mississippi: a pilot study

Background: Osteoporosis is a systemic skeletal disorder characterized by low bone mineral density [BMD] that leads to an increase in bone fragility, causing an individual to be at an increased risk for fractures. Asian-Indians are at an increased risk for developing Osteoporosis. Considering the number of Asian-Indians in the US is rapidly growing, they likely could be an underappreciated population at risk for bone fractures. The aim of this study was to investigate bone health and determine the factors affecting BMD in Asian-Indians living in the US

Methods: Asian-Indians residing in Northern Mississippi [n = 87] were enrolled in this cross-sectional study from June 2013 to August 2014. Eligible participants completed a self-administered Osteoporosis Risk Factor Assessment questionnaire. BMD and body composition were measured using a dual energy x-ray absorptiometry scan [DXA]

Results: Eight-seven Asian-Indians [male: 62.1%] participated, with the average age being 28.49 yr old [SD = +/-6.62]. Overall, 31.0% and 48.3% had low femoral neck BMD and spinal BMD, respectively. Multiple regression analysis revealed that age, percent body fat, and body mass index [BMI] significantly predicted BMD at femur neck [P<0.05]. Additionally, percent body fat, BMI, childhood milk consumption, and gender were statistically significant predictors of spinal BMD [P<0.05]

Conclusions: The findings from this study should be beneficial to healthcare providers that work with Asian-Indian population groups. Health promotion programs focusing on Osteoporosis prevention are needed among Asian-Indians to prevent the risk of fractures

Unappreciated Cognitive Dysfunction is Common among Patients Hospitalized with Cardiovascular Disease.

Background: Better understanding of the prevalence of unappreciated cognitive dysfunction among patients with cardiovascular disease during hospitalization is integral to patient-centered care. We tested the hypothesis that there is a substantial prevalence of debilitating cognitive dysfunction in cardiac patients which health care providers do not appreciate. Methods: This observational prospective study evaluated 51 patients on admission to a cardiac intensive care unit (CICU) who did not have a history of conditions known to adversely affect cognition and appeared cognitively intact to treating physicians and nursing staff. Patients underwent neuropsychological testing to assess the domains of global cognition, attention, memory, and executive function at important points during hospitalization. Results: Twenty-six percent of participants were impaired globally based upon the Modified Mini Mental Status Examination. Of the study’s participants, 46% were impaired in memory on short recall and 40% were impaired on long recall based upon Rey Auditory Verbal Learning, while 49% were impaired based upon Digit Span. Further, 38% of participants were impaired in attention based upon Trail Making Test Part A. Twenty-five percent of participants were impaired in executive function based upon Trail Making Test Part B, and 18% were impaired based upon Frontal Assessment Battery. Conclusions: In patients hospitalized with cardiovascular disease, unappreciated cognitive dysfunction is common. The dysfunction involves multiple domains and likely impedes patient participation in longitudinal care and their comprehension of health education which ultimately hinders the transition from hospital to home care. This process creates a setting of poor self-management with significantly increased potential for rehospitalizations.

Urotensin II as a novel marker for portal hypertension and bleeding varices: an Egyptian survey

Background and aim: Urotensin II [U-II], a somatostatin-like cyclic peptide, was recently identified as the most potent human vasoconstrictor peptide. We investigated whether serum U-II could be considered a marker for portal hypertension [PHT] and its complications in patients with hepatitis C virus [HCV]-related cirrhosis

Patients and methods: After clinical, ultrasonographic, and endoscopic assessments and exclusion of patients with hypertension or diabetes and cardiac or renal comorbidities, 75 patients with HCV-related cirrhosis were classified into three equal groups. Group A included 25 patients with PHT presenting with bleeding esophageal varices [EV]. Group B included 25 patients with PHT with no history of bleeding EV. Group C included 25 patients without PHT or EV. In addition, 25 apparently healthy volunteers were included as controls [group D]. All participants were investigated for liver tests, Child-Pugh scoring, and serum U-II

Results: Serum U-II was significantly higher in cirrhotic patients with PHT with and without bleeding EV compared with the other groups; also, it correlated with the severity of liver disease [P<0.0001]. U-II, at a cutoff value of 2.07 ng/ml or more, could predict the presence of PHT with 98% sensitivity and 100% specificity [P<0.05], whereas at a cutoff value of 2.51 ng/ml or more, it could predict the presence of bleeding EV with 96% sensitivity and 93.3% specificity [P<0.05]

Conclusion: Serum U-II in HCV-related cirrhosis could be a simple and easy predictor of the presence of PHT and bleeding episodes in patients with EV

Effectiveness of Scaling up the ‘Three Pillars’ Approach to Accelerating MDG 4 Progress in Ethiopia.

This paper describes the integrated approach taken by the Government of Ethiopia with support from the Essential Services for Health in Ethiopia (ESHE) Project and assesses its effect on the coverage of six child health practices associated with reducing child mortality. The ESHE Project was designed to contribute to reducing high child mortality rates at scale among 14.5 million people through the ‘three pillars’ approach. This approach aimed to (i) strengthen health systems, (ii) improve health workers’ performance, and (iii) engage the community. The intervention was designed with national and subnational stakeholders’ input. To measure the Project’s effect on the coverage of child health practices, we used a quasi-experimental design, with representative household survey data from the three most populous regions of Ethiopia, collected at the 2003-2004 baseline and 2008 endline surveys of the Project. A difference-in-differences analysis model detected an absolute effect of the ESHE intervention of 8.4% points for DTP3 coverage (p=0.007), 12.9% points for measles vaccination coverage (p<0.001), 12.6% points for latrines (p=0.002), and 9.8% points for vitamin A supplementation (p<0.001) across the ESHE-intervention districts (woredas) compared to all non-ESHE districts of the same three regions. Improvements in the use of modern family planning methods and exclusive breastfeeding were not significant. Important regional variations are discussed. ESHE was one of several partners of the Ministry of Health whose combined efforts led to accelerated progress in the coverage of child health practices

Caracterización de los mecanismos de resistencia a azoles en aislados clínicos chilenos de Candida albicans / Characterization of azole resistance mechanisms in Chilean clinical isolates of Candida albicans

Introduction: The commensal yeast Candida albicans, can cause superficial or systemic candidiasis in susceptible hosts. In Chile, azole antifungals are the most widely used drugs in the treatment of candidiasis. In a previous study performed at our center, 2.1 and 1.6% of clinical isolates of C. albicans were found to be resistant to fluconazole and voriconazole, respectively. Objective: To characterize the resistance mechanisms involved in azoles resistance in Chilean clinical isolates. Methodology: Eight resistant, nine susceptible-dose dependent (SDD) and 10 susceptible strains (n: 27) were selected according to the Clinical Laboratory Standards Institute (CLSI) M27-S3 criteria, from vaginal and urine samples. Mutations in the 408-488 region of the ERG11 gene were studied by sequencing, and the relative expression of ERG11 gene and efflux pump genes CDR1, CDR2 and MDR1, was evaluated by quantitative real-time PCR (q-PCR). Results: No mutations were detected in the ERG11 gene and its overexpression was found only in 12.5% of the resistant strains (1/8). The most prevalent mechanism of resistance was the over-expression of efflux pumps (62.5%; 5/8). Conclusion: The study of the expression of efflux pumps by q-PCR could be a useful diagnostic tool for early detection of azole resistance in C. albicans.

Introducción: Candida albicans es una levadura comensal capaz de causar una infección oportunista en hospederos susceptibles denominada candidiasis, que puede ser superficial o sistémica. En Chile, los antifúngicos más utilizados para el tratamiento de las candidiasis son los azoles. En un estudio previo en nuestro centro, se detectó que 2,1 y 1,6% de cepas clínicas de C. albicans fueron resistentes a fluconazol y voriconazol, respectivamente. Objetivo: Caracterizar los mecanismos de resistencia involucrados en la resistencia a azoles en cepas clínicas chilenas. Metodología: Según los criterios del Clinical Laboratory Standards Institute (CLSI) M27-S3, se seleccionaron ocho cepas resistentes, nueve cepas susceptibles dosis dependiente (SDD) y 10 cepas sensibles (n: 27), aisladas de flujo vaginal y orina. Se evaluó la presencia de mutaciones en la región 408-488 del gen ERG11 por secuenciación y la expresión relativa del gen ERG11 y de los genes de bombas de eflujo CDR1, CDR2 y MDR1 por RPC en tiempo real cuantitativa (q-PCR). Resultados: No se encontraron mutaciones en el gen ERG11 y la sobre-expresión de éste sólo se presentó en 12,5% de las cepas resistentes (1/8). El mecanismo prevalente en la cepas resistentes fue la sobre-expresión de bombas de eflujo encontrándose en 62,5% de las cepas resistentes (5/8). Conclusión: El estudio de la expresión bombas de eflujo por q-PCR podría ser una herramienta diagnóstica útil para la detección temprana de resistencia a azoles en C. albicans.

Detección ecográfica de anomalías congénitas en 76.155 nacimientos en Bogotá y Cali, 2011-2012 / Ultrasound detection of congenital anomalies in 76,155 births in the cities of Bogotá and Cali, 2011-2012

Introducción. Las anomalías congénitas afectan de 2 a 3 % de los nacidos vivos en Colombia y, actualmente, son la principal causa de mortalidad en menores de un año en Bogotá y la tercera causa de mortalidad en menores de un año en Cali; en el mundo son causa importante de mortalidad y morbilidad fetal e infantil. Algunas anomalías congénitas pueden detectarse por la ecografía obstétrica, lo que permite establecer su manejo. Objetivo. Determinar la tasa de detección de anomalías congénitas mediante ecografía obstétrica y la tasa de falsos positivos, comparando poblaciones de Bogotá y Cali atendidas en servicios de salud de diferentes niveles de complejidad. Materiales y métodos. Se vigilaron 76.155 nacimientos en las ciudades de Cali y Bogotá en la modalidad de caso control basada en la metodología del Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), durante el periodo de enero de 2011 a diciembre de 2012. Resultados. Se encontró una tasa de infantes malformados de 2,08 %. La tasa de detección de anomalías congénitas diagnosticables fue de 31,45 % en los casos sobre los que se tenía información de control prenatal. La tasa encontrada fue menor a las reportadas en la literatura científica. Las anomalías congénitas más detectadas fueron las del sistema nervioso central y las urogenitales. Conclusiones. La baja tasa de detección evidencia la necesidad de mejorar la calidad de la ecografía para tener mayor sensibilidad y un diagnóstico prenatal adecuado que contribuya a la disminución de la morbilidad y la mortalidad, y a brindar una mejor atención al recién nacido con malformaciones.

Introduction: Congenital anomalies affect 2 to 3% of live births in Colombia and they are currently the leading cause of death in children under 1 year of age in Bogotá, and the third cause of death in children under 1 year of age in Cali. Congenital anomalies are a major factor contributing to fetal and infant mortality and morbidity in the world. Some congenital anomalies can be detected by obstetric ultrasonography, thus helping to decide on the best way to manage them. Objective: To determine the rate of detection of congenital anomalies by obstetric ultrasound and the false positive rate comparing infants born with birth defects in Bogota and Cali treated at health care facilities of different levels of complexity. Materials and methods: We monitored 76,155 births in the cities of Cali and Bogotá based on a case-control model following the methodology of the Latin American Collaborative Study of Congenital Malformations (ECLAMC) from January 2011 to December 2012. Results: The rate of malformed infants was 2.08%. The detection rate of diagnosable congenital anomalies was 31.45% among cases that had information about prenatal care. This rate is lower than that reported in the literature. Most of the congenital anomalies detected were of the central nervous system and of the genitourinary system. Conclusions: The low detection rate highlights the need to improve the quality of ultrasound to have greater sensitivity for adequate prenatal diagnosis that will contribute to the reduction of morbidity and mortality and allow for better care of newborns with malformations.

Actividad antifúngica de melanina en cepas clínicas de Candida spp / Antifungal activity of melanin in clinical isolates of Candida spp

Background: Melanocytes are cells located in epidermis and mucous membranes that synthesize melanin and cytokines. It is known that melanin has antimicrobial activity and that melanocytes are melanized in presence of microbial molecules. Objective: To study the antifungal activity of melanin on Candida spp. Methodology: The minimum inhibitory concentration (MIC) to melanin was determined in 4 Candida ATCC strains (C. albicans SC5314, C. parapsilosis 22019, C. glabrata 2001, C. krusei 6258) and 56 clinical isolates of Candida spp. (33 C. albicans, 12 C. glabrata, 3 C. famata, 3 C. krusei, 3 C. parapsilosis, 2 C. tropicalis) using a broth microdilution method. In addition, the antifungal activity of melanocytes and mice melanoma cells was tested against C. albicans. Results: Melanin inhibited the tested isolates, including the susceptible dose-dependent and fluconazole-resistant strains; MIC range and MIC50 were 0.09-50 μg/mL and 6.25 μg/mL, respectively. Pigmented cells lysates inhibited C. albicans. Conclusions: Melanin is able to inhibit clinical isolates of Candida spp. Melanization could be an important protective mechanism of melanocytes.

Introducción: Los melanocitos son células presentes en piel y en mucosas que sintetizan melanina, además de citoquinas. Es sabido que melanina presenta actividad antimicrobiana y que los melanocitos se melanizan al ser expuestos a moléculas microbianas. Objetivo: Estudiar la actividad antifúngica de melanina en cepas clínicas de Candida spp. Metodología: Se midió la concentración inhibitoria mínima (CIM) a melanina, de 4 cepas de Candida ATCC (C. albicans SC5314, C. parapsilosis 22019, C. glabrata 2001 y C. krusei 6258) y 56 aislados clínicos de Candida spp. (33 C. albicans, 12 C. glabrata, 3 C. famata, 3 C. krusei, 3 C. parapsilosis, 2 C. tropicalis) mediante un método de microdilución en caldo. Además se estudió el efecto antifúngico de lisados de melanocitos y células de melanoma de ratón en C. albicans. Resultados: Melanina inhibió las cepas analizadas, incluso cepas susceptibles dosis-dependiente y resistentes a fluconazol, siendo los rangos de CIM y CIM50 de 0,09-50 μg/mL y 6,25 μg/ mL, respectivamente. Los lisados de células pigmentadas inhibieron C. albicans. Conclusiones: Melanina es capaz de inhibir cepas clínicas de Candida spp. La melanización podría ser un importante mecanismo protector de los melanocitos.

Cross Talk between Oxidative Stress, PPAR- γ and RAS System in Diabetic Rat Heart Exposed to Ischemia / Reperfusion Injury.

The present study aimed at clarifying the cross talk between peroxisome proliferator-activated receptor-gamma (PPAR- γ), cardiac reactive Oxygen species (ROS) and Renin-Angiotensin System (RAS). Methods: A total of 90 male albino rats were used. The rats were divided into: Group 1: Control group, Group 2: Type 2 diabetic rats, Group 3: PPARγ agonist protected type 2 diabetic rats. Group 4: Antioxidant protected type2 diabetic rats, Group 5: Metformin treated type 2 diabetic rats. Blood samples were collected for measurement of FBS and fasting insulin. Half the number of each group was sacrificed and the heart excised and perfused, from the rest of the group small piece from the heart was taken for estimation of malondialdehyde (MDA), Angiotensin 2 Receptor (AT2R) and Angiotensin Converting Enzyme 2 (ACE2) gene expression. Results: Treatment with pioglitazone and Vitamin E significantly lowered blood glucose, insulin levels and Homeostasis Model Assessment Insulin Resistance (HOMA IR). However, values did not return to control values. Pioglitazone and Vitamin E improved myocardial performance and percentage recovery following ischemia reperfusion. The cardioprotective effect was more pronounced in the pioglitazone group. This positively correlated with decreased MDA levels and increased AT2R and ACE2 expression in cardiac tissue. Conclusion: Pioglitazone and Vitamin E in type 2 DM significantly offered cardioprotection through improving the diabetic condition and / or decreasing MDA levels.

Isolation, structural identification and cytotoxic activity of hexanic extract, cyperenoic acid, and jatrophone terpenes from Jatropha ribifolia roots

The cytotoxicity of a hexanic fraction produced from the ethanolic crude extract, obtained from Jatropha ribifolia (Pohl) Baill, Euphorbiaceae, roots was evaluated against ten human cancer cell lines (MCF-7, NCI-ADR/RES, OVCAR-3, PC-3, HT-29, NCI-H460,786-O, UACC-62, K-562, U251) compared with doxorrubicine as positive control. Compounds jatrophone and cyperenoic acid were isolated from the hexanic extract and characterized by spectroscopic techniques (NMR of ¹H, 13C and IR). The in vitro antiproliferative activity of jatrophone showed selectivity in a concentration dependent way with Total Inhibition growth of: glioma 0.57 µg mL-1 (U251), breast cancer 9.2 µg mL-1 (MCF-7), adriamycin-resistant ovarian cancer 0.96 µg mL-1 (NCI-ADR/RES), kidney 4.2 µg mL-1 (786-0), prostate cancer 8.4 µg mL-1 (PC-3), colon cancer 16.1 µg mL-1 (HT29) and leukemia 0.21 µg mL-1 (K-562).

Distribución de especies y perfil de susceptibilidad de aislados de Candida spp: la importancia de vigilar también cepas de la comunidad / Species distribution and susceptibility pattern of Candida spp.: the importance to survey also strains isolated from the community

Background: The most of the surveillance studies has been conducted in hospitalized patients with invasive infections. Recently, new clinical breakpoints (CBPs) have been proposed for antifungal susceptibility testing and epidemiological cutoffs (ECVs). Aim: To evaluate species distribution and susceptibility pattern of Candida spp. obtained from in and outpatients in a period of 6 months. Material and Methods: The isolates (n=223) came from vaginal discharge (51.6%), lower respiratory tract (24.7%), urine (20.2%), wounds (1.8%), blood (0.9%), peritoneal fluid (0.4%) and nails (0.4%). Results: The species distribution was C. albicans 84.8% (n: 189), C. glabrata 7.6% (n: 17), C. tropicalis 2.7% (n: 6), C. parapsilosis 2.2% (n: 5), C. kefyr 0.9% (n: 2) and others 1.8% (C. krusei, C. lusitanie, C. guilliermondii, C. intermedia) (n: 4). The susceptibility dose dependence (SDD) and resistance were 3.2% for fluconazole and 2.2% for voriconazole. The most of SDD and resistant strains were isolated from ambulatory patients. Also, a higher percentage of MICs over the new CBPs and ECVs were found in strains from ambulatory patients and especially in C. glabrata isolates to caspofungin. Conclusion: Taking into consideration that most of the invasive infections are caused by strains from the endogenous microbiota, and that there is a resistant population of Candida spp. in the community, should be important to include in surveillance studies strains isolated from ambulatory patients.

Introducción: Los estudios de vigilancia de Candida spp. en general, no incluyen cepas de la comunidad. Recientemente, se han propuesto nuevos puntos de corte clínicos (CBPs) para interpretar la susceptibilidad y puntos de corte epidemiológicos (ECVs), para detectar cepas silvestres o con algún tipo de resistencia. Objetivo: Ainalizar la distribución y perfil de susceptibilidad Candida spp. de pacientes hospitalizados y ambulatorios durante seis meses. Material y Métodos: Las cepas (n: 223) provenían desde flujo vaginal (51,6%), tracto respiratorio bajo (24,7%), orina (20,2%), heridas (1,8%), sangre (0,9%), líquido peritoneal (0,4%) y uñas (0,4%). Resultados: La distribución de especies fue C. albicans 84,8% (n: 189), C. glabrata 7,6% (n: 17), C. tropicalis 2,7% (n: 6), C. parapsilosis 2,2% (n: 5), C. kefyr 0,9% (n: 2) y otras 1,8% (C. krusei, C. lusitanie, C. guilliermondii, C. intermedia) (n: 4). La susceptibilidad dosis dependiente (SDD) y resistencia fueron de 3,2% para fluconazol y 2,2% para voriconazol. La mayoría de las cepas SDD resistentes y fueron ambulatorias. Además, en este grupo, se encontró un alto porcentaje de cepas con CIMs sobre los nuevos CPBs y ECVs, especialmente en aislados C. glabrata para caspofungina. Conclusión: Dado que la mayoría de las infecciones invasoras son causadas por cepas endógenas, y que hay cepas con algún grado de resistencia en la comunidad, estas últimas debieran vigilarse.

Histological study on conjunctival and corneal reactions in rabbits induced by chronic topical application of latanoprost and travoprost

Chronic topical glaucoma therapy was reported to cause deleterious changes to the ocular surface epithelial layer. The aim of this study was to compare the histological changes in the cornea after chronic exposure to latanoprost preserved with 0.02% benzalkonium chloride [BAK] eye drops, travoprost preserved with sofZia eye drops and preservative-free artificial tears. Fifteen white rabbits were randomized into three groups [five animals each]. They received once-daily topical application of one of the three treatments for 30 days. The first group [the control group] received preservative-free artificial tears [Refresh Plus]. The second group received travoprost preserved with SofZia [Travatan Z]. The third group received latanoprost preserved with 0.02% BAK [Xalatan]. Enucleation was performed at the end of the experiment. Corneal samples were processed for light and transmission electron microscopic studies and conjunctival samples for light microscopic study. The mean epithelial height of the corneal epithelium, the mean number of goblet cells in the conjuctival epithelium and the mean area% of PAS-positive goblet cells were measured using an image analyzer. These results were statistically analysed using analysis of variance and the Hest. Latanoprost eye drops preserved in BAK produced toxic changes in the form of degeneration and desquamation of the superficial epithelial cells in the cornea, separation of Descemet's membrane and degeneration of endothelial cells, in addition to decreased number of goblet cells in the conjunctiva. Travoprost eye drops preserved in sofZia were safer and produced slight changes on the rabbit's ocular surface compared with latanoprost eye drops preserved in BAK. It was concluded that antiglaucomatous drugs preserved with sofZia produced less corneal and conjunctival changes than those preserved with BAK

Potency and persistence of the bacterial mosquitocide bacillus sphaericus against culicine mosquitoes under field conditions

The biopesticide Bacillus sphaericus represents one of the important tools used in the control of mosquito larvae after chemical insecticides. The present study was conducted to investigate the efficacy B. sphaericus 2362 [VectoLex] in two different technical powders, ABG-6232 and ABG-6491 against larvae of two mosquitoes, Culex pipiens and Aedes caspius in El-Arish city, North Sinai, Egypt. The mosquito larvae were collected from polluted and fresh water [Cx. Pipiens] and saline water [Ae. Caspius]. The physicochemical characteristics of larval breeding water sites were measured as salinity, conductivity, pH values and temperature. Susceptibility bioassays showed that Cx. pipiens larvae from polluted water sites have high susceptibility to B. sphaericus 2362 formulation ABG-6232 [LC[50] 0.15-0.33 ppm, LC[90]: 0.73-9.68 ppm]. In case of ABG-6491 formulation, the values were LC[50]: 0.15-0.33 ppm and LC[90]: 1.73-9.83 ppm. Cx. pipiens larvae collected from fresh water habitat in El-Qusiema, outside El-Arish city, susceptibility to B. sphaericus 2362 ABG-6232 had LC[50] values ranging between 0.12 and 0.28 ppm, while LC[90] ranged between 1.59 and 4.13 ppm. In case of ABG-6491, the LC[50] values ranged between 0.13 and 0.28 ppm, while LC[90] values ranged between 1.46 and 8.93 ppm. For Ae. caspius larvae from saline water and treated with B. sphaericus 2362 ABG-6232, LC[50] values ranged between 0.31 and 1.36 ppm, while LC[90] ranged between 1.92 and 9.75 ppm. In case of ABG- 6491, the LC[5o] values ranged between 0.34 and 0.59 ppm, while LC[90] values ranged between 1.79 and 11.56 ppm

The Efficacy of Steroid Injection in the Treatment of Trigger Finger

BACKGROUND: Trigger finger is one of the most common reasons for referral to a hand specialist clinic. The purpose of this study is to investigate the efficacy of steroid injections for treating trigger digits. METHODS: Ninety digits were investigated with at least a year follow up. The study mainly focused on the efficacy of the injections, as well as co-morbidities, presence of a nodule, actual digit injected and the severity at presentation using Green's classification. RESULTS: The study found that 66% of trigger digits were effectively treated using steroid injections. There was a difference between the efficacy of the injection in the different digits, with a statistical significance between the thumb and the fingers. The results also showed that there was no statistical relationship between the severity of the condition, the presence of a nodule or co-morbidities and the efficacy of the steroid injections. CONCLUSIONS: The study found that steroid injections are an effective first-line intervention for the treatment of trigger digit. It also found an increased efficacy for treating the thumb compared to other digits. Both the severity of the condition at presentation and the presence of a nodule had no significant impact on the efficacy of the injections.

Implementation and progress of an inclusive primary health care model in Guatemala: coverage, quality, and utilization / Ejecución y avance de un modelo inclusivo de atención primaria de salud en Guatemala: cobertura, calidad y utilización

OBJECTIVE: To describe a primary health care model designed specifically for Guatemala that has been implemented in two demonstration sites since 2004 and present results of a process evaluation of utilization, service coverage, and quality of care from 2005 to 2009. METHODS: Coverage, utilization, and quality were assessed by using an automated database linking census and clinical records and were reported over time. Key maternal and child health coverage measures were compared with national-level measures. RESULTS: The postnatal coverage achieved by the Modelo Incluyente de Salud of nearly 100.0 percent at both sites contrasts with the national average of 25.6 percent. Vaccination coverage for children aged 12-23 months in the Modelo Incluyente de Salud reached 95.6 percent at site 1 (Bocacosta, Sololá) and 92.7 percent at site 2 (San Juan Ostuncalco), compared with the national average of 71.2 percent. Adherence to national treatment guidelines increased significantly at both sites with a marked increase between 2006 and 2007. Utilization increased significantly at both sites, with only 7.5 percent of families at site 1 and 11.2 percent of families at site 2 not using services by the end of the 5-year period. CONCLUSIONS: Coverage, quality of care, and utilization measures increased significantly during the 5-year period when the service delivery model was implemented. This finding suggests a strong possibility that the model may have a benefit for health outcomes as well as for process measures. The Modelo Incluyente de Salud will be financially sustained by the Ministry of Health and extended to at least three additional sites. The model provides important lessons for primary care programs internationally.

OBJETIVO: Describir un modelo de atención primaria de salud diseñado específicamente para Guatemala que se ha ejecutado en dos sitios piloto desde 2004 y presentar los resultados de una evaluación de la utilización, la cobertura de servicios y la calidad de la atención entre 2005 y 2009. MÉTODOS: Se evaluaron la cobertura, la utilización y la calidad mediante una base de datos automatizada que relaciona los datos obtenidos a partir de un censo con los registros clínicos, y su evolución se informó a lo largo del tiempo. Se compararon las medidas clave de cobertura de la salud maternoinfantil con las medidas obtenidas en el nivel nacional. RESULTADOS: La cobertura posnatal lograda por el Modelo Incluyente de Salud, de casi 100,0 por ciento en ambos sitios, contrasta con el promedio nacional de 25,6 por ciento. La cobertura de vacunación de los niños de 12 a 23 meses de edad en dicho modelo alcanzó 95,6 por ciento en el sitio 1 (Bocacosta, Sololá) y 92,7 por ciento en el sitio 2 (San Juan Ostuncalco), en comparación con el promedio nacional de 71,2 por ciento. El cumplimiento de las directrices nacionales de tratamiento aumentó significativamente en los dos sitios, con un aumento acentuado entre 2006 y 2007. La utilización aumentó significativamente en ambos sitios; al finalizar el período de 5 años no usaban los servicios solo 7,5 por ciento de las familias en el sitio 1 y 11,2 por ciento de las familias en el sitio 2. CONCLUSIONES: Las medidas de cobertura, calidad de la atención y utilización aumentaron significativamente durante el período de 5 años durante el cual se ejecutó el modelo de prestación de servicios. Estos datos indican firmemente que el modelo puede mejorar tanto los resultados relacionados con la salud como las medidas de proceso. El Modelo Incluyente de Salud será mantenido económicamente por el Ministerio de Salud Pública y Asistencia Social y se extenderá, al menos, a tres sitios más. El modelo proporciona enseñanzas importantes para los programas de atención primaria de otros países.

Subsequent reproductive outcome in women who have experienced a potentially life-threatening condition or a maternal near-miss during pregnancy

OBJECTIVE: To evaluate the long-term reproductive consequences that affect women who have experienced potentially life-threatening or life-threatening (near-miss) maternal complications. INTRODUCTION: Although advances have been made in reducing maternal death, few studies have investigated the long-term repercussions of significant events such as severe maternal morbidity and maternal near-misses. These repercussions may be long-lasting and negatively affect quality of life. METHODS: A total of 382 women who had experienced a potentially life-threatening pregnancy-related condition within the last five years were analyzed in this retrospective cohort study. A control group of 188 women who gave birth without complications was also included. Trained interviewers contacted the subjects by telephone and completed a pre-coded, structured questionnaire on reproductive health. Data were analyzed using odds ratios adjusted for age. The main outcome measures were occurrence and outcome of subsequent pregnancies. RESULTS: The estimated risk of becoming infertile as a result of tubal ligation or hysterectomy was 3.5 times higher in women who experienced a maternal near-miss or severe maternal morbidity during the index pregnancy as compared to controls. Likewise, the risk of complications in subsequent pregnancies was five times greater in women who had experienced severe maternal morbidity. However, no differences were found in the occurrence or number of subsequent pregnancies or perinatal outcome. CONCLUSION: The occurrence of a life-threatening or potentially life-threatening maternal condition reduces future reproductive potential and increases the risk of complications in subsequent pregnancies.

Disseminated protothecosis.

Here is presented, a rare case of disseminated protothecosis in a 10-year-old boy with combined immunodeficiency, hitherto unreported from India. Even though it is difficult to diagnose clinically,observation of the sporangiospores within the sporangium in culture gives the accurate laboratory identification of Prototheca spp. In this patient, failure to eradicate the infection with amphotericin B and recurrence with olecranon bursitis along with skin lesions and splenomegaly was observed. Disseminated protothecosis in a child with combined immunodeficiency and failure to eradicate the infection with amphotericin B is reported.

Expression analyses of human cleft palate tissue suggest a role for osteopontin and immune related factors in palatal development

Cleft lip and/or palate (CL/P) is a common congenital malformation with a complex etiology which is not fully elucidated yet. Epidemiological studies point to different etiologies in the cleft lip and palate subgroups, isolated cleft lip (CL), isolated cleft palate (CP) and combined cleft lip and palate (CLP). In order to understand the biological basis in these cleft lip and palate subgroups better we studied the expression profiles in human tissue from patients with CL/P. In each of the CL/P subgroups, samples were obtained from three patients and gene expression analysis was performed. Moreover, selected differentially expressed genes were analyzed by quantitative RT-PCR, and by immunohistochemical staining of craniofacial tissue from human embryos. Osteopontin (SPP1) and other immune related genes were significantly higher expressed in palate tissue from patients with CLP compared to CP and immunostaining in palatal shelves against SPP1, chemokine receptor 4 (CXCR4) and serglycin (PRG1) in human embryonic craniofacial tissue were positive, supporting a role for these genes in palatal development. However, gene expression profiles are subject to variations during growth and therefore we recommend that future gene expression in CL/P studies should use tissue from the correct embryonic time and place if possible, to overcome the biases in the presented study.