A unique case of penile necrotizing fasciitis secondary to spontaneous corpus cavernosal abscess.

Corpus cavernosal abscess and necrotizing fasciitis occur rarely, and precipitating factors can usually be elicited with careful history and examination. Whilst both conditions share common risk factors such as diabetes mellitus, this is the first reported case of penile necrotizing fasciitis secondary to spontaneous corpus cavernosal abscess in an otherwise healthy patient. A 32-year-old man presented with 4-day history of swollen, painful penis, with ultrasound confirming corpus cavernosal abscess. Biopsies were taken and the cavity aspirated, but, despite intravenous antibiotics, he developed penile necrotizing fasciitis necessitating open cavernostomy and debridement. The overlying skin defect healed by secondary intention, but the patient experienced persistent postoperative erectile dysfunction, so he was referred for penile prosthesis insertion.

Dynamics of Charge-Transfer Processes with Time-Dependent Density Functional Theory.

We show that whenever an electron transfers between closed-shell molecular fragments, the exact correlation potential of time-dependent density functional theory develops a step and peak structure in the bonding region. This structure has a density dependence that is nonlocal both in space and in time that even the exact adiabatic ground-state exchange-correlation functional fails to capture it. For charge-transfer between open-shell fragments, an initial step and peak vanish as the charge-transfer state is reached. The inability of usual approximations to develop these structures leads to inaccurate charge-transfer dynamics. This is illustrated by the complete lack of Rabi oscillations in the dipole moment under conditions of resonant charge transfer for an exactly solvable model system. The results transcend the model and are applicable to more realistic molecular complexes.

Universal dynamical steps in the exact time-dependent exchange-correlation potential.

We show that the exact exchange-correlation potential of time-dependent density-functional theory displays dynamical step structures that have a spatially nonlocal and time nonlocal dependence on the density. Using one-dimensional two-electron model systems, we illustrate these steps for a range of nonequilibrium dynamical situations relevant for modeling of photochemical or physical processes: field-free evolution of a nonstationary state, resonant local excitation, resonant complete charge transfer, and evolution under an arbitrary field. A lack of these steps in the usual approximations yields inaccurate dynamics, for example, predicting faster dynamics and incomplete charge transfer.

Semiclassical electron correlation in density-matrix time propagation.

Lack of memory (locality in time) is a major limitation of almost all present time-dependent density-functional approximations. By using semiclassical dynamics to compute correlation effects in the time propagation of the density matrix, we incorporate memory, including initial-state dependence, as well as changing occupation numbers, and predict more observables in strong-field applications.

Transvaginal measurement of cervical length in the prediction of successful induction of labour.

A total of 100 women with gestational ages of 34-42 weeks requiring induction of labour were consecutively recruited in a prospective study at the Medical College and Hospital, Baroda, India. The aim of this study was to determine the value of transvaginal measurement of cervical length in the prediction of successful vaginal delivery within 24 h. Induction of labour was carried out with Tab Misoprostol (25 microg). A Bishop's score and sonographic cervical assessment were performed prior to induction. Univariate and logistic regression analyses was used. A pre-induction cervical length measurement on TVS was an independent predictor of successful vaginal delivery. At < or =3 cm cervical length, the probability of a LSCS was <30%, while with 4 cm cervical length, the probability became >75%. One unit increase in cervical length increased the probability of LSCS by 45%. The cervical length measurement by TVS is therefore an independent predictor of successful labour induction and performs better than Bishop's score as a method of pre-induction cervical assessment.

Progestogens in combined oral contraceptives for contraception.

BACKGROUND: The progestogen component of oral contraceptives (OC) has undergone changes since it was first recognised that their chemical structures could influence the spectrum of minor adverse and beneficial effects. The major determinants of OCs are effectiveness, cycle control and common side effects. The rationale of this review is to provide a systematic comparison of OCs containing the progestogens currently in use worldwide. OBJECTIVES: The objective of this review is to compare currently available low-dose OCs containing ethinyl estradiol and different progestogens in terms of contraceptive effectiveness, cycle control, side effects and continuation rates. SEARCH STRATEGY: The Cochrane Controlled Trials Register, MEDLINE and EMBASE databases have been searched systematically. Relevant pharmaceutical companies and the authors of articles included in this review have been contacted for clarification. SELECTION CRITERIA: Randomised trials reporting clinical outcomes were considered for inclusion. We excluded studies comparing mono- with multiphasic pills, and crossover trials with trials in which the difference in total content of ethinyl estradiol between preparations exceeded 105 micro g. DATA COLLECTION AND ANALYSIS: The methodological quality and validity of studies were assessed based on the above-mentioned inclusion criteria. Both application of inclusion criteria and data extraction were performed independently by the reviewers. Results are expressed as relative risk (RR) with 95% confidence interval (CI) using a random-effects model. MAIN RESULTS: Twenty-two trials have been included in this review, thus generating 14 comparisons. Eighteen trials were sponsored by pharmaceutical companies and in only 5 cases had a blind trial been attempted. Most comparisons between different interventions included 1-3 trials. There was less discontinuation with second- compared to first-generation progestogens (RR: 0.79, 95% CI: 0.69-0.91). Cycle control appears to be better when using second- compared to first-generation progestogens for both mono- (RR: 0.69; 95% CI: 0.52-0.91) and triphasic (RR: 0.61; 95% CI: 0.43-0.85) preparations.Contraceptive effectiveness, spotting, breakthrough bleeding and the absence of withdrawal bleeding was similar when using GSD compared to LNG, although there was less intermenstrual bleeding in the GSD group (RR: 0.71, 95% CI: 0.55, 0.91). Drospirenone (DRSP) appeared to be similar to DSG. REVIEWERS' CONCLUSIONS: Based on data from one trial, compared to pills containing LNG, those containing GSD may be associated with less intermenstrual bleeding although they show similar patterns of spotting, breakthrough bleeding and the absence of withdrawal bleeds. GSD is also comparable to DSG. Regarding acceptability, all the indices show that third- and second-generation progestogens are preferred over first-generation preparations. Future research should focus on independently conducted, well-designed randomised trials that compare third- and second-generation progestogens in particular.

Expression of alpha and beta integrins during terminal differentiation of cardiomyocytes.

BACKGROUND: In the myocardium, myocyte cell division is irreversibly blocked shortly after birth. The signal that initiates cell cycle withdrawal is unknown. The purpose of this study was to relate changes in expression of beta1 integrin and its associated alpha subunits to cardiomyocyte cell cycle progression during the fetal-to-neonatal developmental transition in rat. METHODS AND RESULTS: The developmental expression pattern and function of beta 1 integrin and several of its associated alpha subunits were examined using reverse transcription (RT) polymerase chain reaction (PCR) and beta 1 blocking antibodies. During the fetal to neonatal transition, a dramatic shift occurred in the levels of beta1 and alpha isoforms. At the 17-day fetal stage only beta 1A was present, which remained relatively constant until immediately after birth then decreased by 30% at the adult stage. By contrast, beta 1D appeared at fetal day 18, increased at neonatal day 2, and afterwards remained constant. This resulted in a ratio of beta 1A to beta 1D of about 1:1 in the adult heart. The integrin beta 1-associated subunits, alpha 3, alpha 6, and alpha 7, were expressed at extremely low levels in 17-day fetal cardiomyocytes. After birth alpha 3 and alpha 6 transiently increased at the 2-day neonatal stage, while alpha 7 isoforms B, C, and X2 progressively increased to the adult stage. Unlike skeletal muscle cells, fluorescence-activated cell sorting analysis (FACS) showed no down regulation of the alpha 5 beta 1 fibronectin receptor during cell cycle withdrawal. Treatment of cultured cardiomyocytes with beta1 blocking antibody inhibited the cell cycle in fetal but not in neonatal cells. CONCLUSION: These results suggest that progression through the cardiomyocyte cell cycle may be dependent upon cell attachment via integrin beta1 and correlate with changes that occur in beta1 spliced variants and their respective alpha isoforms.

Changes in E2F complexes containing retinoblastoma protein family members and increased cyclin-dependent kinase inhibitor activities during terminal differentiation of cardiomyocytes.

Cardiomyocyte terminal differentiation was examined by studying the interaction of retinoblastoma protein (pRb) family members with E2F during the developmental transition from 17-day fetal to 2-day neonatal. Additionally, the expression pattern of cyclins, cyclin-dependent kinases (CDKs), and CDK inhibitors responsible for modulating the phosphorylation of pRb were studied. p107, pRb, and p130 are regulators of cellular proliferation, differentiation, and cell cycle exit and entry, respectively. The active, underphosphorylated form of these proteins targets the E2F family of transcriptional factors that play a critical role in the control of genes associated with DNA synthesis. Electromobility shift analyses demonstrated E2F complexed with p107 in proliferating fetal cardiomyocytes, whereas in 2-day neonatal cells, E2F was principally associated with p130 and a low level of pRb. At the 2-day neonatal stage, decreased protein levels were observed for cyclins D2, D3, and E, and CDK2 and CDK4. No changes were observed in the mRNA levels of the D-cyclins in neonatal cells; however, the transcripts for cyclins A and E and CDK4 were diminished. In skeletal myoblasts, differentiation is associated with induction of p21, a CDK inhibitor, by a MyoD-dependent pathway. Although heart cells lack MyoD, CDK assays demonstrated that the activity of CDKs 2, 4, and 6 were downregulated in 2-day neonatal cells, and CDC2 was increased. RT-PCR indicated that p21 mRNA was induced 1.4-, 2.0-, and 3.1-fold in the 2-day neonatal, 7-day neonatal, and adult stages, respectively, compared to the 17-day fetal stage. At the protein level, p21 also increased at the 2-day neonatal stage. Kinase inhibitory immunodepletion assays showed that CDK inhibitory activity was markedly increased in the 2-day neonate. Although mRNA levels of the p27 CDK inhibitor were unchanged, its protein level and inhibitory effect on CDK2 and CDK4 were increased. Thus, cardiomyocytes retain the capacity to proliferate until the early neonatal period when a series of changes occur, including a switch in pRb partners, a decrease in CDK levels and induction of CDK inhibitory activity, which is associated with terminal differentiation.

Birth outcomes by birth order and maternal nutritional status.

PIP: Birth weights were studied of infants born to 432 women who delivered at SSG Hospital and Medical College in Baroda, India, in 1993 to determine whether birth order and maternal age have effects on birth weight independent of social disadvantages, as measured by maternal height, weight, and hemoglobin level. The weight-height product index (WHPI) (kg x cm x 100/45 kg x 150 cm) was used as one of the indicators for maternal nutrition. Mean WHPI was 101.83. Mean maternal weight and height were 46.56 kg and 147.49 cm, respectively. The hemoglobin level stood at 9.5 g/dl. Mean gestational age was 38.02 weeks. Even though the birth weight of newborns of women in the C nutritional status group (i.e., WHPI = 101.83) were significantly smaller than those born to mothers in the next higher nutritional status group (WHPI = 133.49) (2283 vs. 2381 g; Z = 1.99), the proportion of low birth weight ( 2.5 k) infants in the C group was not significantly different from those in the B group (54.54% vs. 53.08%). The proportion of low birth weight newborns was higher in the birth order 1 group than higher birth order groups (61.04% vs. 50.23% for birth order 2-3 and 37.7% for birth order =or 4). Yet, there was no significant difference in mean birth weight by birth order. When comparing birth weights within the same age group, mean birth weight was significantly greater after birth order 1 regardless of maternal age. Among 16.5-34.5 year old mothers, the percentage of low birth weight newborns was much higher in birth order 1 than higher birth orders (60.45% vs. 48.79%; p 0.02). Thus, within the same age group, first order births have a lower birth weight and a higher incidence of low birth weight than higher order births.^ieng

Bishop's score and induction of labor in prelabor rupture of membrane.

PIP: At the obstetrics department of SSG Hospital in Baroda, India, data was compared on 79 pregnant women at or near term presenting with prelabor rupture of membranes (PROM) with data on 79 pregnant women presenting with intact membranes to determine whether induction of labor contributes to maternal complications. Women in the study group were observed for 1 hour for uterine contractions and then received oxytocin to induce labor. Women in the control group were observed for spontaneous progress of labor. Operative deliveries (e.g., forceps/vacuum) were more common in the study group than the control group (10-36.58% vs. 5.55-16.22%). The difference in assisted deliveries was significant for Bishop's score categories 4-6 and 6-8 (p 0.05). The lowest Bishop's score (4-6) yielded the highest assisted delivery rates (e.g., among primigravidae, 36.58% for study group and 16.22%). 78.78% of PROM women who crossed the alert line and all of those who crossed the action line required operative delivery compared to 50% and 81.82%, respectively, for the control group. PROM women experienced a longer latent phase of labor than did the control group (12.06 vs. 8.42 hours). The duration of other labor phases was comparable. The likelihood of spontaneous vaginal delivery was greater when the latent period lasted more than 12 hours. Based on these findings, induction should not be done on PROM women with no obvious infection or obstetric hazard. If induction is indicated, it should not be done until the Bishop's score reaches 6-8.^ieng

Adolescent sexuality education and sources of information.

PIP: A survey of 959 young females (ages 10-21 years) from India highlighted the importance of educational attainment to fertility-related behaviors. Respondents represented a spectrum of educational levels: school drop-outs (32%), primary and secondary school attendees (41%), and college students (27%). The mean age at menarche was 13.6 years. School drop-outs were most likely to have obtained information about sexuality from films and other mass media, while students cited friends and neighbors as primary sources. There was an positive association between educational level and both preferred age at marriage and intended interval from marriage to first birth. 42% of adolescents with a secondary or college education planned to marry after 23 years of age and 84% wanted to defer childbearing for at least two years after marriage. The desire for formal sex education was strong in all educational subgroups (about 62%), however. It has been estimated that postponement of the marriage age from 16 years to 20-21 years would result in a 20-30% decrease in the annual number of births in India. School-based sex education represents a feasible mechanism for helping to achieve this goal.^ieng

Postabortal sepsis.

A review of postabortal sepsis following a 2-year study undertaken at the Department of Obstetrics and Gynaecology, SSG Hospital, Baroda is presented here with a view to know the incidence of postabortal sepsis and septic induced abortions and to re-evaluate the effectiveness of the MTP services in reducing its impact on maternal morbidity and mortality, since the implementation of the MTP Act in 1972. It has been observed that postabortal sepsis is a major cause of maternal mortality even now and MCH service is to be improved to reduce the same.

Maternal manifestations of malaria in pregnancy: a review.

PIP: Malaria is a major cause of maternal and fetal morbidity and mortality, and this risk is highest in the areas of unstable malaria transmission. In 1990 and 1991 the Department of Obstetrics and Gynecology of Sir Sayajirao General Hospital in central Gujarat, India, has cared for a total of 445 urban as well as rural patients with malaria in pregnancy: 232 were labor ward admissions and 213 were antenatal ward admissions. Plasmodium falciparum infection affected 97.27% of patients, both primigravidae and multigravidae. Heavy parasitemia was observed in 27.14% of primigravidae and 48.57% in secundigravidae, however, this was not statistically significant. Out of the 260 (58.42.) cases who had various degrees of anaemia, 59 (22.69) had severe anaemia with haemoglobin of less than 6.0 gm O/dl. Within this group, 71.16% women were primigravidae or secundigravidae, the rest were multigravidae. Out of the 6 patients in first trimester, the miscarriage rate was 100%. In the second trimester, out of 52 patients 74.99 pregnancies were discontinued, whereas in the third trimester, the miscarriage rate was 18.17%. This observation was statistically significant (p 0.05). 178 patients who were admitted antenatally were discharged, their pregnancy outcome was not known, and accordingly they were excluded. There were 11 patients in the first trimester, 139 in the second trimester, and 295 in the third trimester. The known pregnancy losses were 54.54% in the first trimester. 28.05% in the second trimester, and 12.88% in the third trimester. 75.59% of those with minor parasitemia and 47.36% with heavy parasitemia had a normal pregnancy outcome. The overall fetal loss was 31.08%, which was almost twice that of the miscarriage rates among the general population. Maternal deaths attributed to malaria in pregnancy were 15, with cerebral malaria accounting for 5 deaths. 46.66% of the deaths occurred in primigravidae and secundigravidae. The other causes of mortality were postpartum hemorrhage, acute pulmonary edema, and hypoglycemia.^ieng

Detection of toxic viral-associated double-stranded RNA (dsRNA) in influenza-infected lung.

While many of the molecular events in viral replication are well studied, the molecular mechanisms by which viral infections trigger such constitutional symptoms as fever and 'malaise' are unknown. The hypothesis that these viral constitutional symptoms can be triggered by the toxic action of dsRNA associated with viral replication was investigated. Total lung RNA from mice acutely infected with PR8 influenza virus, but not from sham-infected mice, was shown to induce fever and altered sleep (excess slow-wave sleep, enhanced amplitudes of electroencephalographic slow waves, and reduced rapid eye movement sleep) when injected into the rabbit brain. Viral-associated dsRNA was shown to be responsible for the rabbit responses by differential nuclease digestion. Influenza viral dsRNA was directly demonstrated in the active lung RNA preparations by reverse transcriptase-polymerase chain reaction techniques. The time course of the responses paralleled those seen in the same model inoculated with nanogram quantities of the synthetic dsRNA polyriboinosinic-polyribocytidylic acid and suggested that they were mediated by induced cytokines. A model for the role of viral-associated dsRNA in eliciting both local cytotoxicity and viral constitutional symptoms is presented.

Determination of semimicro amounts of calcium in the presence of other alkaline-earth metals.

Cyclam tetraacetic acid (CTA) is used to determine semimicro quantities of calcium in the presence of other alkaline-earth metals in natural and synthetic water samples. End-point detection is achieved amperometrically with Zn(en)(2+)(3) as the indicator. Magnesium and barium do not interfere. In the presence of strontium, two distinct end-points are obtained when its concentration is comparable with that of the calcium. If the concentrations are substantially different, calcium and strontium appear to be titrated together.