Hepatitis A virus knowledge and immunization attitudes and practices in the United Arab Emirates community.

Annually, 1.5 million cases of hepatitis A infection occur worldwide. The United Arab Emirates (U.A.E.) has seen a decrease in infection rates and seroprevalence coupled with an increase in the average age of infection. This study aimed to assess the U.A.E. society's hepatitis A knowledge, and attitudes and vaccination practices, with the applicability of its introduction into the local immunization schedule. A self-administered, 50-item questionnaire was used to collect data from the four most populous cities in the U.A.E., between January and March 2020. A total of 458 responses were collected and analysed using IBM-SPSS-26, R-4.0.0 and Matplotlib-v3.2.1. Females had better attitudes (P = 0.036), practices (P < 0.0005), immunization schedule knowledge (AOR = 3.019; CI 1.482-6.678), and appreciation of the immunization schedule (AOR = 2.141; CI 1.310-3.499). A higher level of perceived knowledge was associated with an actual better knowledge (P < 0.0005), better practices (P = 0.011), and increased willingness to get vaccinated (AOR = 1.988; CI 1.032-3.828). Respondents were more likely to vaccinate their children against HAV if the vaccine were introduced into the National Immunization Program (P < 0.0005). Overall, disease knowledge was lacking but with positive attitudes and poor practices. There is high trust in the National Immunization Program and a potential for improving poor practices through local awareness campaigns.

Bundling unbundled charges: a case study in an academic obstetrical practice.

In the practice of obstetrics, the non-stress test (NST) and the biophysical profile (BPP) are used to assess fetal well-being. Failure to bundle the NST with the ultrasound BPP will result in a rejected claim if both procedures are performed at the same visit. We implemented a quality improvement program to reduce the number of charge tickets that were coded incorrectly because same-day NST and ultrasound BPP were not bundled. The effectiveness of quality improvement interventions was monitored using statistical process control techniques. The hospital outpatient clinic and department billing processes were in statistical control before any changes were made, but quality was poor: > 40% of same-day NSTs and ultrasound BPPs were coded incorrectly. After clinic processes were changed, the number of incorrectly coded charge tickets decreased over a 9-week period to less than 5% of the total number of BPPs performed each week. This analysis demonstrates that continuous quality improvement is possible in an academic practice operating within a relatively inflexible university outpatient clinic environment.

A major QTL for acute ethanol sensitivity in the alcohol tolerant and non-tolerant selected rat lines.

The Alcohol Tolerant and Alcohol Non-Tolerant rats (AT, ANT) were selectively bred for ethanol-induced ataxia as measured on the inclined plane. Here we report on a quantitative trait locus (QTL) study in an F(2) intercross population derived from inbred AT and ANT (IAT, IANT) and a follow-up study of congenics that were bred to examine one of the mapped QTLs. Over 1200 F(2) offspring were tested for inclined plane sensitivity, acute tolerance on the inclined plane, duration of the loss of righting reflex (LORR) and blood ethanol at regain of the righting reflex (BECRR). F(2) rats that were in the upper and lower 20% for inclined plane sensitivity were genotyped with 78 SSLP markers. Significant QTLs for inclined plane sensitivity were mapped on chromosomes 8 and 20; suggestive QTLs were mapped on chromosomes 1, 2 and 3. Highly significant QTLs for LORR duration (LOD = 12.4) and BECRR (LOD = 5.7) were mapped to the same locus on chromosome 1. Breeding and testing of reciprocal congenic lines confirmed the chromosome 1 LORR/BECRR QTL. A series of recombinant congenic sub-lines were bred to fine-map this QTL. Current results have narrowed the QTL to an interval of between 5 and 20 Mb. We expect to be able to narrow the interval to less than 5 Mb with additional genotyping and continued breeding of recombinant sub-congenic lines.

Metformin does not enhance ovulation induction in clomiphene resistant polycystic ovary syndrome in clinical practice.

AIMS: To determine whether metformin pretreatment has beneficial effects in clomiphene resistant infertile women with polycystic ovary syndrome (PCOS) in an infertility clinic. METHODS: This was a randomized placebo controlled double-blind crossover study of 3 months metformin (1500 mg day-1)/placebo, followed by 3 months metformin/placebo together with clomiphene (50-100 mg for 5 days) for three cycles in clomiphene resistant women with PCOS. The primary outcomes were restoration of spontaneous menses, ovulation induction (spontaneous or clomiphene induced) and pregnancy. Secondary endpoints were changes in biochemical parameters related to androgens and insulin. RESULTS: Twelve women completed the metformin arm and 14 the placebo arm. Spontaneous menstruation resumed in five metformin treated patients and in six placebo treated women, P=0.63. No women given metformin spontaneously ovulated, although one patient given placebo did, P=0.30. There was no difference in the efficacy of clomiphene between the two groups with ovulation being induced in five (out of 12) metformin treated women and four (out of 14) placebo treated women, P=0.63. Pregnancy occurred in three (out of 12) women given metformin and two (out of 14) women given placebo, P=0.59. CONCLUSIONS: Metformin is not always beneficial when given to clomiphene resistant infertile women with PCOS in clinical practice.

Analysis of 44,279 blood glucose estimations in relation to outcomes in 80 pregnant diabetic women.

A retrospective study was conducted to assess glycaemic control in relation to pregnancy outcomes in pre-existing and gestational diabetics. Computerised blood glucose records from 47 pre-existing diabetic patients and 33 gestational diabetics were collected prospectively and then analysed retrospectively in relation to pregnancy outcomes. There were two spontaneous miscarriages from the pre-existing diabetic cohort. A total of 44,279 individual blood glucose estimations were made. The mean fasting glucose for pre-existing diabetic patients fell significantly throughout pregnancy, being 7.7+/-2.1, 7.2+/-3.1 and 6.5+/-2.4 mmol/l, respectively, for trimesters 1,2 and 3 (P<0.01). The mean post-prandial glucose for each trimester were 8.9+/-2.0, 8.6+/-1.6 and 8.2+/-1.2 mmol/l (P<0.01). The HbAlc for pre-existing diabetic patients for each trimester was 7.5+/-1.4%, 6.1+/-1.0% and 5.9+/-0.7%, respectively. Gestational diabetic patients had a mean fasting glucose of 5.6+/-1.5 mmol/l and a mean post-prandial glucose of 8.0+/-2.1 mmol/l during trimester 3. Home glucose monitoring correlated reasonably well with first trimester HbA1c (r2=0.43, P<0.001), but this relationship became less valid as pregnancy progressed. The mean gestation at delivery was 37 weeks, although 30% of women were delivered between 34 and 37 weeks and 8% delivered before 34 weeks. Labour was induced in 49% of patients and the overall caesarean section rate was 58%. The mean birth weight for pre-existing diabetic patients was 3479 g (1410-5000 g) and for women with gestational diabetes was 3605 g (1890-5920 g). For pre-existing diabetic patients HbA1c did not correlate with birth weight; however, home blood glucose data from trimester 2 did correlate (r2=0.15, P <0.005) and there appeared to be stronger relationship with trimester 3 data (r2=0.24, P <0.005). There was no association between trimester 3 glucose data and birth weight in the gestational cohort. The babies born to pre-existing diabetic mothers had a high incidence of admission to a neonatal unit and over 50% of the babies had proven hypoglycaemia. Our present computerised system for home blood glucose monitoring has shown that for pre-existing diabetes patients but not gestational diabetic patients, glycaemic control in the second and third trimester influences birth weight. The current degree of glycaemic control in the mothers did not prevent a high rate of neonatal hypoglycaemia.

Out-patient hysteroscopy in asymptomatic postmenopausal women.

OBJECTIVE: To determine the prevalence of uterine and endometrial abnormalities in normal postmenopausal women and assess the accuracy of subjective hysteroscopic appearances and endometrial histology following 12 weeks of hormonal treatment. DESIGN: A multicentered randomized double-blind placebo-controlled trial in which the volunteers received conjugated equine estrogen 0.625 mg, selective estrogen receptor modulator (in one of two doses) or placebo. SETTING: Out-patient endoscopy unit in a large teaching hospital. METHODS: Out-patient hysteroscopy and endometrial biopsy. RESULTS: Forty-eight women had a hysteroscopy and endometrial biopsy: eight (16.6%; 95% confidence interval, CI 6-27%) women had intrauterine polyps and 38 (79.2%) women had normal hysteroscopies. Thirty-five women had a repeat endometrial assessment with hysteroscopy and, for the detection of proliferative endometrium (prevalence 22.8%), a sensitivity of 87.5%, a specificity of 74%, a negative predictive value of 95% and a positive predictive value of 50% were observed. There was a good proportion of agreement, 0.77 (95% CI 0.63-0.91), but a kappa score of 0.486 revealed only a moderate level of agreement. The likelihood ratios for proliferative endometrium were: LHR+ = 3.38 (fair), and LHR- = 0.17 (moderate). CONCLUSIONS: Hysteroscopic assessment of the uterine cavity is efficient in the detection of pathological intrauterine lesions, but is only moderately successful in determining physiological changes in the endometrium. This study defines a standard of observational statistics for out-patient hysteroscopy in relation to normal endometrial histology in postmenopausal women who may have been ingesting exogenous estrogens.

Effect of pasteurization on long chain polyunsaturated fatty acid levels and enzyme activities of human milk.

Milk fatty acids, including the polyunsaturated long chain fatty acids essential for retinal function and brain development, are not affected by pasteurization (62.5 degrees C for 30 min). Milk lipases are completely destroyed by pasteurization, whereas amylase lost only 15% of initial activity. Thus, certain bioactive components are stable to pasteurization of donor milk and can benefit the recipient infants.

Managing STIs identified after testing outside genitourinary medicine departments: one model of care.

OBJECTIVES: To develop a local strategy for managing cases of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) which have been identified in the departments of obstetrics and gynaecology (O&G). METHODS: Weekly notification from the local microbiology laboratory to genitourinary medicine (GUM) departments of all positive CT and GC results generated by tests performed in the two local O&G departments. Direct contact made by GUM departments to index patients identified and "fast track" appointments made. Data recorded for future audit include numbers attending, details of health adviser input, and success of contact tracing. RESULTS: Over 18 months, 294 women were identified and 231 (78%) attended GUM departments; 142 (48%) had received antibiotics before attending GUM departments and of these, 58 (41%) had risked reinfection by an untreated partner and 48 (20%) were found on screening to have a previously undiagnosed genital infection. Over 90% were interviewed by a health adviser. Appropriate follow up was achieved in 87% of index cases. Of the contacts, 194 were treated--150 in the local GUM department. Of these 150 men, 99 (66%) had an identifiable genital infection and 84% of those with CT/non-gonococcal urethritis were asymptomatic. There have been no complaints either formal or informal, by women managed by this system. CONCLUSIONS: GUM clinics are the ideal setting to achieve successful treatment of patients with sexually acquired infections, which must include notification and treatment of their partners if reinfection is to be avoided. For patients with infections diagnosed on other settings, such as O&G, a system of direct notification of results to GUM departments by an agreed protocol can be highly successful. For such a system to work, close cooperation and trust between departments is essential.

Is macrosomia associated with poor glycaemic control in diabetic pregnancy?

The study aimed to determine the influence of glucose control during pregnancy on the incidence of macrosomia in the infants of mothers with insulin-dependent diabetes. The prevalence of macrosomia was determined in pregnancies of all such women attending the City Hospital Nottingham, between July 1987 and July 1993, where it is policy for diabetic patients to aim during pregnancy for preprandial capillary glucose levels of less than 6.0 mmol I-1, and postprandial glucose levels of less than 8.0 mmol I-1. Macrosomia was defined as a birthweight greater than 90th centile using a computer model which takes into account all the major determinants of birthweight. Twelve of 29 infants were macrosomic, which is greater than expected (p < 0.01). During pregnancy there was no difference in mean seven point glucose profiles between those mothers with normal weight babies and those with macrosomia, but fructosamine levels at booking were significantly higher in the latter 2.5 (1.9-2.9) vs 2.2 (1.2-3.0); p < 0.05. These data confirm other studies and suggest that the incidence of macrosomia may be reduced by tighter control of diabetes at conception and in the first trimester, but to a lesser extent during later pregnancy.

[Hematic pseudocysts of the adrenal gland. Apropos of a case]. / Les pseudokystes hématiques de la surrénale. A propos d'une observation.

We report an adrenal pseudocyst fortuitously discovered in a 30-year-old young woman. Diagnostic of this uncommon pathology is characterized by absence of specific clinical signs and the importance of recent radiologic examinations, echography and NMR. Percutaneous aspiration appears to be warranted prior to or instead of surgery in patients with symptomatic cysts or cystic lesions that do not fulfill the imaging criteria for simple cysts. Treatment is based on adrenal gland resection owing to the seriousness of the potential complications.

Behavioral effects and pharmacokinetics of propofol in rats selected for differential ethanol sensitivity.

High- and low-alcohol sensitivity (HAS and LAS) rats have been selected for their differences in ethanol-induced sleep time. The rats also differ in sensitivity to pentobarbital, halothane, isoflurane, and enflurane. To determine if this sensitivity extended to propofol, the anesthetic requirements were measured. In this study, the sleep time and the tissue levels of propofol at awakening, as well as the pharmacokinetics, were evaluated. Propofol was administered intravenously. For one group of rats, sleep times were measured; blood and brain samples were taken at awakening. Blood samples were collected in another group of rats at frequent intervals from 0 to 90 min after injection. Propofol concentration of the samples was determined by gas chromatography. The pharmacokinetic analysis was performed using a nonlinear least-squares regression program. Sleep time was not different; however, blood and brain propofol levels at awakening showed a small, but significant difference between HAS and LAS rats. Propofol blood concentration-time curve data were fitted to a three-compartment model. Pharmacokinetic parameters were also not different between the rat lines. However, sleep time was 50% longer in female rats than male rats in both strains (p < 0.0001). The rates of propofol clearance were slower in female rats, because of different rates of disappearance from the second compartment. The observations suggest that the genetic selection for ethanol sensitivity selection for propofol sensitivity was not nearly as intense and presumably involves some different genes. These two central nervous system depressants would seem to differ significantly in their mechanism of action.(ABSTRACT TRUNCATED AT 250 WORDS)

[Paraganglioma of the organ of Zuckerkandl]. / Paragangliomes de l'organe de Zuckerkandl.

From the study of one case of non secreting paraganglioma of the organ of Zuckerkandl, the authors have surveyed the existing literature gathering 95 cases from 1902 to 1992. It is an exceptional tumor of the paraganglioma and it often a secreting one. When it is not it looks like a malignant retroperitoneal tumor. The surgical resection is often performed without the operating diagnosis. Asserting the malignancy of these tumors only depends on the presents of metastasis appearing lately. There fore a long continued control of the patients who have been operated upon is a must all the more as 30% of the paraganglioma of Zuckerkandl prove to be malignants.

Prevalence screening for ovarian cancer in postmenopausal women by CA 125 measurement and ultrasonography.

OBJECTIVE: To assess the performance of the sequential combination of serum CA 125 measurement and ultrasonography in screening for ovarian cancer. DESIGN: The serum CA 125 concentration of each subject was determined and those with a concentration > or = 30 U/ml were recalled for abdominal ultrasonography. If ultrasonography gave abnormal results surgical investigation was arranged. Volunteers were followed up by annual postal questionnaire. SETTING: General practice, occupational health departments, ovarian cancer screening clinic. SUBJECTS: 22,000 women volunteers who were postmenopausal and aged over 45 years. MAIN OUTCOME MEASURES: Apparent sensitivity, specificity, positive predictive value, years of cancer detected. RESULTS: 41 women had a positive screening result and were investigated surgically. 11 had ovarian cancer (true positive result) and 30 had other disorders or no abnormality (false positive result). Of the 21,959 volunteers with a negative screening result, eight subsequently presented clinically with ovarian cancer (false negative result) and 21,951 had not developed ovarian cancer during follow up (apparent true negative result). The screening protocol achieved a specificity of 99.9%, a positive predictive value of 26.8%, and an apparent sensitivity of 78.6% and 57.9% at one year and two year follow up respectively. The estimated number of years of cancer detected by the prevalence screen was 1.4 years. CONCLUSIONS: This screening protocol is highly specific for ovarian cancer and can detect a substantial proportion of cases at a preclinical stage. Further investigation is required to determine the effect of the screening protocol on the ratio of early to late stage disease detected and on mortality from ovarian cancer.

Hearing and neurodevelopmental outcome in survivors of persistent pulmonary hypertension of the newborn.

Thirty-four infants who had a diagnosis of severe persistent pulmonary hypertension of the newborn at birth (alveolar-arterial oxygen difference greater than 600) were treated without paralysis or hyperventilation to induce alkalosis. All survived. Twenty-seven of these 34 eligible infants (79%) underwent neurologic, intelligence, and audiologic testing between 10 months and 6 years of age. Children who were younger than 1 year of age at the initial hearing test were retested after they reached 2 years of age. The average IQ was within the normal range (mean = 96.23). None had sensorineural hearing loss. Severe neurologic abnormalities were seen in 4 children, 3 of whom had been severely asphyxiated at birth (determined by biochemical criteria). Mild neurologic abnormalities were observed in 5 children. Two infants had bronchopulmonary dysplasia because they required supplemental oxygen for 29 and 66 days, respectively, and had abnormal chest roentgenograms; 1 patient takes intermittent doses of albuterol (Ventolin) and neither currently requires supplemental oxygen. This study of 27 infants with severe persistent pulmonary hypertension of the newborn suggests that conservative management without induced alkalosis or respiratory paralysis is accompanied by no sensorineural hearing loss and a good neurologic outcome.

Human endometrial peptides: a review of their potential role in implantation and placentation.

This paper reviews human endometrial peptide synthesis and discusses the biological function of these peptides in relation to implantation and placentation. Despite the substantial literature on quantitative and qualitative peptide synthesis by the endometrium, it has not been possible to define the function of most of these substances. Various aspects of endometrial morphology, especially the endometrial leukocytes, are discussed in an attempt to relate cellular structure and function. A number of serum proteins are produced by the endometrial glandular epithelium and may play a role in early embryo development. Extracellular matrix proteins produced by stromal cells are important for endometrial structure and integrity but also provide a site for trophoblast attachment. Several hormones and binding proteins are also produced by stromal cells and probably influence endometrial metabolism. Complement factors and secretory component may have a role in maintaining a sterile intrauterine environment. Many other endometrial proteins have been less well characterized and their role in endometrial physiology at present remains uncertain. Perhaps the most exciting advance has been the realization that a number of peptide regulatory factors (cytokines and growth factors) are not only produced by the endometrium but play an integral part in the mediation of oestrogen-induced growth and differentiation of the endometrium and with the local metabolic and physiological processes.

A biochemical test for the direct assessment of endometrial function: measurement of the major secretory endometrial protein PP14 in serum during menstruation in relation to ovulation and luteal function.

Circulating PP14 was measured by radioimmunoassay in ovulating (n = 12) and anovulatory (n = 3) women throughout the menstrual cycle, the highest levels of serum PP14 being seen during menstruation and in the late luteal phase in ovulating women. Mean serum PP14 levels on days 1-7 and 24-28 of the menstrual cycle were significantly higher than those observed from days 8 to 23 (P less than 0.0005 and P = 0.005 respectively). There was no difference in mean PP14 levels observed in the menstrual and luteal phase. By contrast, serum PP14 was rarely detected in anovulatory cycles. During the luteal phase, mean serum PP14 levels were apparently not related to serum progesterone levels. However, mean PP14 levels during the menstrual phase were significantly higher in the group of women with the highest progesterone production (Pmax greater than 39 nmol/l) (P less than 0.002) in comparison with levels seen in ovulating women with lower progesterone production (Pmax less than 32 nmol/l). These findings suggest that the synthesis and secretion of PP14 is influenced by ovulation and luteal function. Serum PP14 measurements may provide useful information about the endometrium in relation to fertility, and that these measurements during the menstrual cycle may distinguish between ovulatory and anovulatory cycles.

De novo synthesis of placental protein-14 (PP14) and not PP12 by monolayer cultures of glandular epithelium of gestational endometrium.

Nine monolayer cell cultures of glandular epithelium from gestational endometrium were established from six apparently healthy women undergoing elective termination of pregnancy (7-11 weeks gestation). Radiolabel incorporation studies showed increasing incorporation of [35S]methionine into proteins present in supernatant and cytosol fractions over 48 h. The secreted proteins represented approximately 20% of the total incorporation of methionine into cytosolic proteins. De novo synthesis and secretion of placental protein-14 (PP14) and not PP12 was identified by a novel combination of line immunoelectrophoresis and autoradiography. All monolayer cultures demonstrated the presence of radiolabeled PP14, but not PP12, in the culture supernatants. These observations suggest that the glandular epithelial cells are the major site of synthesis and secretion of PP14 in human gestational endometrium.