Knowledge of cancer symptoms and risk factors: A cross-sectional study from a developing country.

The delayed presentation of cancer patients to healthcare facilities for diagnosis is a pressing issue, as late-stage cancer cases are often more challenging to treat effectively. In low-resource settings, such as those with limited access to healthcare facilities, the impact of inadequate awareness of cancer signs and symptoms can be particularly severe. Therefore, this study aimed to evaluate public knowledge of cancer signs and symptoms and risk factors in the context of Jordan. This cross-sectional study was conducted among participants from all settings. Data was obtained from an Arabic version of the cancer awareness measure (CAM), which was answered online. It described demographic data and knowledge of cancer prevalence, age-related risk, signs, symptoms, and risk factors in recall and recognition-type questions. Participants (n = 1998) completed the questionnaire with a Median age of 35 and an interquartile range of 24. About half (n = 1070) thought that cancer is unrelated to age. Most participants identified breast cancer as the most common cancer among women (81%). Awareness of cancer signs/symptoms significantly differed in the level of knowledge in favor of females. The symptom "unexplained weight loss" was most commonly recognized (66.3%) and "persistent difficulty swallowing" the least (42.6%). As for risk factors, "smoking" was the most identified (76.9%) and "eating less than 5 portions of fruits and vegetables a day" was the least (19%), and "doing <30 minutes of moderate physical activity 5 times a week" as a close second least (19.95%). Females identified "smoking," "passive smoking," "HPV infection," and "having a close relative with cancer" as risk factors significantly more than males. Those with good economic status were more aware that smoking is a cancer risk factor by 1.51 times compared to those with poor economic status. To enhance early diagnosis and presentation in Jordan, there is a need for increased public awareness of the signs, symptoms, and risk factors of cancer. One effective strategy to achieve this goal is to conduct targeted public campaigns that cater to different population groups, such as the youth, to improve their understanding and ensure that the message resonates.

Artificial endometrial preparation for oocyte donation using synthetic estrogen and progestogen.

OBJECTIVE: To evaluate the outcome of an oocyte donation program using synthetic estrogen and progestational agents for uterine preparation. METHODS: Conjugated estrogen, 1.25 mg per day at increasing doses and dydrogesterone, a synthetic progestogen, 30 mg per day were used for uterine priming. All embryo transfers were done on day 2 of progestogen supplementation. RESULTS: The pregnancy rates were 38% per embryo transfer. The ongoing pregnancy rate was 31% with an abortion rate of 20%. CONCLUSION: Endometrial preparation in an oocyte donation program using orally administered synthetic estrogen and progestogen gives pregnancy rates comparable to those reported with natural products.

Is there a safe anticoagulation protocol for pregnant women with prosthetic valves?

We studied the outcome of 41 pregnancies in an attempt to identify an appropriate and safe anticoagulant regimen for pregnant women with cardiac valve prosthesis. The cumulative number of events: (neonatal death, premature deliveries, intrauterine fetal death and spontaneous abortion) was 66.6%, 20%, 12.5% and 20% in the Coumadin, Fraxiparine, Heparin and porcine valve groups, respectively. We conclude that in pregnant women with mechanical heart valves, low molecular weight heparin therapy is a superior strategy compared to warfarin.

Successful pregnancy outcome following Tompkins metroplasty done early in pregnancy.

A hysterosalpingogram revealed a septate uterus in a 29 year old nulliparous woman with a history of recurrent pregnancy loss. The patient underwent Tompkins metroplasty in the proliferative phase of the menstrual cycle. One month after the operation she presented with a delay in her menses and a positive pregnancy test. Ultrasound revealed a viable fetus commensurate with 10 weeks gestation, making the gestation period 5 weeks at the time of surgery. After reviewing the patient's menstrual history it was found that the period the patient had before surgery was on time but with unusually minimal bleeding. A repeat ultrasound scan for anomaly done 7 weeks later was commensurate with 17 weeks gestation. The patient carried her pregnancy for the first time until approximately 37 weeks when she delivered by Caesarean section a healthy female baby weighing 3700 g.

Anaphylactic shock during hysteroscopy using Hyskon solution: case report and review of adverse reactions and their treatment.

Dextran 70 (Hyskon) solution, as many other substances, is in current use as distension medium during hysteroscopy. The advantages of Hyskon solution are its nonconductivity and immiscibility with blood, allowing good visibility during operative hysteroscopy. Adverse reactions to Hyskon are mainly attributable to the drug's antigenic properties and include severe anaphylactic reactions and fatalities. We report a case of anaphylactic shock during hysteroscopy using Hyskon solution as the distension medium, review the adverse reactions of Hyskon and summarize the treatment modalities used to decrease the incidence of the rare but serious adverse reactions with its use.

Reproductive outcome following abdominal metroplasty.

OBJECTIVE: To evaluate pregnancy outcome following uterine unification procedures in patients with uterine anomalies. METHODS: A retrospective survey included all abdominal metroplasty procedures performed on 43 patients at the American University of Beirut Medical Center between January 1, 1974 and December 31, 1991. Age at metroplasty, type of anomaly and surgical procedures, as well as preoperative and postoperative reproductive performance were all recorded. RESULTS: Forty (93%) out of 43 patients who underwent metroplasty had postoperative live births compared with five (12%) prior to surgery. The fetal wastage rate dropped from 93% pre- to 16% postoperatively. All seven patients with a history of primary infertility conceived and had live births. CONCLUSION: Our data suggest a remarkable improvement following abdominal metroplasty in patients with both typical and uncharacteristic preoperative reproductive performance.

Labial edema in pregnancy. A case report.

Edema is a frequently encountered medical sign in pregnancy. Edema confined strictly to the labia, however, is not as common. This report describes severe labial edema in a patient with a twin gestation while on intravenous magnesium sulfate tocolysis. The tocolysis could have initiated the process of labial swelling in the presence of other, predisposing factors.

Ear length: a potential sonographic marker for Down syndrome.

OBJECTIVES: The purpose of this study was to determine if antenatal sonographic determination of fetal ear length is a useful screening method for identification of fetuses with Down syndrome. METHODS: Ear length measurements were recorded in 418 fetuses undergoing ultrasound scanning between 20 and 28 weeks of gestation. Four trisomy 21 and six trisomy 18 fetuses were identified by karyotyping. The relationship between ear length and gestational age in the normal population was determined by linear regression analysis: expected ear length = -6.000 + 1.075 gestational age. The ability of measured-to-expected ear length cut-off ratios to discriminate between affected and non-affected fetuses was assessed. RESULTS: The mean ear length and measured-to-expected ear length ratios were significantly lower in the affected group as compared to the normal one. A measured-to-expected ear length ratio of less than 0.8 was 75.0% sensitive and 98.8% specific in detecting Down syndrome fetuses, and resulted in an 8.5% positive predictive value in the general population. CONCLUSIONS: This preliminary study suggests that antenatal ear length measurements might be a promising sonographic screening method for the detection of Down syndrome in the second trimester of pregnancy.

Postmortem cesarean section following maternal blast injury: case report.

We report a postmortem cesarean section resulting in fetal survival, performed 25 minutes after maternal blast injury. The time interval between cardiopulmonary arrest and delivery, prior maternal health status, and continued cardiopulmonary resuscitation represent important determinants of fetal survival. Improvement in maternal hemodynamic condition may potentially occur following the procedure. Postmortem cesarean section is advised in the event of fatal maternal trauma since it may result in fetal salvage.

High-velocity penetrating wounds of the gravid uterus: review of 16 years of civil war.

OBJECTIVE: To evaluate the value of selective laparotomy in pregnant women with penetrating abdominal injuries. METHODS: A retrospective survey was carried out at our center over 16 years of civil war, extending from 1975 to 1991. Fourteen pregnant women had uterine injuries secondary to high-velocity abdominal penetrating trauma. The corresponding management was evaluated carefully with respect to maternal and fetal outcomes. RESULTS: Two maternal deaths occurred, neither resulting solely from intra-abdominal injuries. Visceral injuries were present when the entrance of the missile was in either the upper abdomen or the back. When the entry site was anterior and below the uterine fundus, visceral injuries were absent in all six women upon surgical exploration. Perinatal deaths occurred in half of the cases and were due to maternal shock or uteroplacental or direct fetal injury. Immediate cesarean delivery was performed because of either limited surgical field exposure, fetal injury, or distress. Three patients explored were managed by delaying delivery. All later delivered vaginally with successful fetal outcomes in all three. CONCLUSION: Selective laparotomy may be considered in pregnant women with anterior penetrating abdominal trauma, as the likelihood of intra-abdominal injuries may be predicted based on the location of the penetrating wound.

Imperforate hymen: report of an unusual familial occurrence.

BACKGROUND: Although imperforate hymen occurs in approximately 0.1% of female newborns, familial occurrence of imperforate hymen has been reported only once. CASES: We report two families in which imperforate hymen was diagnosed in three siblings of each family. One family is described in detail; the patients were two postmenarchal young women and one premenarchal girl. CONCLUSION: Imperforate hymen usually occurs sporadically but can be familial. We advise screening all female newborns and children for vaginal patency, especially family members of an affected child. Identification of other families with a similar problem might point to a specific mode of inheritance.

Preoxygenation of pregnant and nonpregnant women in the head-up versus supine position.

The influence of preoxygenation in the supine (n = 10) versus the 45 degrees head-up (n = 10) position on the duration of apnea leading to a decrease in arterial oxygen saturation to 95%, as monitored by pulse oximetry, was investigated in 20 women undergoing elective cesarean section at term of pregnancy. The results were compared with those obtained in a control group of 20 nonpregnant women. In the supine position, the average time to desaturation to 95% was significantly shorter in the pregnant group (173 +/- 4.8 s [mean +/- SD]) than in the control group of nonpregnant women (243 +/- 7.4 s). Using the head-up position resulted in an increase in the desaturation time in the nonpregnant group (331 +/- 7.2 s) but had no significant effect in the pregnant group (156 +/- 2.8 s). We conclude that pregnant women desaturate their arterial blood of oxygen more rapidly than do nonpregnant women. Furthermore, the head-up position extends the duration of apnea that can take place before desaturation occurs in nonpregnant patients.

Onset of vecuronium neuromuscular block is more rapid in patients undergoing caesarean section.

This investigation was carried out in ten patients undergoing elective Caesarean section and the results were compared with those of a control group of ten nonpregnant females of the same age group. The study investigated the onset of vecuronium neuromuscular block and the conditions of tracheal intubation when ketamine (1.5 mg.kg-1)-vecuronium 100 micrograms.kg-1) sequence was used for rapid-sequence induction of anaesthesia. The ulnar nerve was stimulated supra-maximally at the wrist with train-of-four stimuli every 20 sec, and the electromyographic response of the adductor pollicis muscle was displayed. The onset of 50% neuromuscular block as monitored by electromyography was shorter in the Caesarean group (80 +/- 30 sec) than in the control group (144 +/- 43 sec). The conditions of intubation at 50% block were adequate in both groups. Also, the onset of 90% block was shorter in the Caesarean group. The time of recovery to T1/control ratio of 25% was longer in the Caesarean group (46 +/- 10 min) than in the control patients (28 +/- 10 min). The results show that administration of vecuronium according to body weight results in a more rapid onset and delayed recovery of neuromuscular block in pregnant women undergoing Caesarean section than in the nonpregnant control patients.

Gonadotropin secreting pituitary microadenoma.

FSH and LH secreting pituitary adenomas may not be as rare as has been previously thought. Women in their reproductive years with a normal estrogenic state and hypergonadotropic amenorrhea should be suspected to harbor a pituitary microadenoma secreting gonadotropins. A computerized tomogram of the pituitary confirms the diagnosis. Two such cases who underwent transphenoidal resection of their adenomas are presented. Pituitary dynamic testing is normal in both. Laparoscopic directed ovarian biopsies show primordial follicles in one and a corpus luteum in the other. Transphenoidal resection, with the risk of permanent hypopituitarism, should be weighed against expectant management, with periodic evaluation of pituitary functions, until the natural history of these adenomas is uncovered.

Puerperal uterine inversion.

Puerperal uterine inversion, a life threatening condition, is a true obstetrical emergency. Quick reanimation measures coupled with manual or surgical correction are the key to success in managing this rare condition.

Uterine unification procedures: post-operative obstetrical outcome.

Seventeen patients with different uterine anomalies underwent unification procedures for various indications. Preoperative obstetrical performance segregated them into three main groups: seven patients had only first trimester abortion (group A), seven patients had second trimester abortion with or without first trimester abortion (group B) and three patients were infertile (group C). Postoperatively, all seven patients in group A became pregnant with 100% viable pregnancy rate. Six patients in group B became pregnant (85.7%) and five (57%) had living children. All three patients with primary infertility (group C) became pregnant and two had living babies. The overall pregnancy rate was 94.1% and the viable pregnancy rate was 76.5%. Uterine unification procedures are recommended for patients with repeated first trimester abortions as well as for selected patients with infertility.