Network connectivity underlying episodic memory in children: Application of a pediatric brain tumor survivor injury model.

Episodic memory involves personal experiences paired with their context. The Medial Temporal, Posterior Medial, Anterior Temporal, and Medial Prefrontal networks have been found to support the hippocampus in episodic memory in adults. However, there lacks a model that captures how the structural and functional connections of these networks interact to support episodic memory processing in children. Using diffusion-weighted imaging, magnetoencephalography, and memory tests, we quantified differences in white matter microstructure, neural communication, and episodic memory performance, respectively, of healthy children (n = 23) and children with reduced memory performance. Pediatric brain tumor survivors (PBTS; n = 24) were used as a model, as they exhibit reduced episodic memory and perturbations in white matter and neural communication. We observed that PBTS, compared to healthy controls, showed significantly (p < 0.05) (1) disrupted white matter microstructure between these episodic memory networks through lower fractional anisotropy and higher mean and axial diffusivity, (2) perturbed theta band (4-7 Hz) oscillatory synchronization in these same networks through higher weighted phase lag indices (wPLI), and (3) lower episodic memory performance in the Transverse Patterning and Children's Memory Scale (CMS) tasks. Using partial-least squares path modeling, we found that brain tumor treatment predicted network white matter damage, which predicted inter-network theta hypersynchrony and lower verbal learning (directly) and lower verbal recall (indirectly via theta hypersynchrony). Novel to the literature, our findings suggest that white matter modulates episodic memory through effect on oscillatory synchronization within relevant brain networks. RESEARCH HIGHLIGHTS: Investigates the relationship between structural and functional connectivity of episodic memory networks in healthy children and pediatric brain tumor survivors Pediatric brain tumor survivors demonstrate disrupted episodic memory, white matter microstructure and theta oscillatory synchronization compared to healthy children Findings suggest white matter microstructure modulates episodic memory through effects on oscillatory synchronization within relevant episodic memory networks.

Dissociating executive function and ADHD influences on reading ability in children with dyslexia.

Developmental dyslexia (DD) and attention-deficit/hyperactivity disorder (ADHD) are two of the most common neurodevelopmental disorders among school-age children. These disorders frequently co-occur, with up to 40-50% of children with one diagnosis meeting criteria for the other, and similar percentages of children with either DD or ADHD exhibiting impaired executive functions (EF). Although both ADHD and EF deficits are common in dyslexia, there is little evidence about how ADHD and EF deficits specifically influence the brain basis of reading difficulty in dyslexia, and whether the influences of ADHD and EF on dyslexia can be disentangled. The goal of the current study was to investigate, at both behavioral and brain levels, whether reading performance in individuals with dyslexia is more strongly associated with EF or with diagnostic status of comorbid ADHD. We examined reading abilities and EF in children (8-13 years old) with typical reading ability, DD only, or both DD + ADHD. Across both groups with dyslexia, impaired EF was associated with greater impairment on measures loading onto a reading fluency, but not a reading accuracy, factor. There were no significant differences between the DD and DD + ADHD groups on measures of reading fluency or reading accuracy. During functional magnetic resonance imaging (fMRI) while performing a rhyme-matching reading task requiring phonological awareness, typically developing readers showed greater left-hemisphere reading network activation than children with DD or DD + ADHD. Children with DD and DD + ADHD did not show differential activation, but DD children with unimpaired EF showed greater activation than those with impaired EF in reading-related areas. Thus, ADHD status alone had no measurable influence on reading performance or brain activation. Impaired EF in dyslexia, independent of ADHD status, was associated with greater deficits in reading fluency and greater reductions of activation in response to print in the typical left-hemisphere reading network.

Cross-translational models of late-onset cognitive sequelae and their treatment in pediatric brain tumor survivors.

Pediatric brain tumor treatments have a high success rate, but survivors are at risk of cognitive sequelae that impact long-term quality of life. We summarize recent clinical and animal model research addressing pathogenesis or evaluating candidate interventions for treatment-induced cognitive sequelae. Assayed interventions encompass a broad range of approaches, including modifications to radiotherapy, modulation of immune response, prevention of treatment-induced cell loss or promotion of cell renewal, manipulation of neuronal signaling, and lifestyle/environmental adjustments. We further emphasize the potential of neuroimaging as a key component of cross-translation to contextualize laboratory research within broader clinical findings. This cross-translational approach has the potential to accelerate discovery to improve pediatric cancer survivors' long-term quality of life.

Agent-Based Medical Health Monitoring System.

One of the leading healthcare concerns worldwide is the aging population. Aged patients require more significant healthcare resources because they are more likely to have chronic diseases that result in higher healthcare expenses. The design and implementation of e-health solutions, which offer patients mobile services to assist and enhance their treatment based on monitoring specific physiological data, is one of the key achievements in medical information technology. In the last few decades, there have been tremendous advancements in healthcare technology regarding mobility, size, speed, and communication. However, the critical drawback of today's e-Health monitoring systems is that patients are confined to smart rooms and beds with monitoring gadgets. Such tracking is not widespread due to chronic patients' mobility, privacy, and flexibility issues. Further, health monitoring devices that are fastened to a patient's body do not give any analysis or advice. To improve the health monitoring process, a multi-agent-based system for health monitoring is provided in this study, which entails a group of intelligent agents that gather patient data, reason together, and propose actions to patients and medical professionals in a mobile context. A multi-agent-based framework presented in this study is evaluated through a case study. The results show that the proposed system provides an efficient health monitoring system for chronic, aged, and remote patients. Further, the proposed approach outperforms the existing mHealth system, allowing for timely health facilities for remote patients using 5G technology.

Clinical practice guidelines in multisystem inflammatory syndrome (MIS-C) related to COVID-19: a critical review and recommendations.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) is a serious health condition that develops from and is linked to coronavirus disease 2019. MIS-C is considered a multi-organ dysfunction involving cardiac, renal, respiratory, hematologic, gastrointestinal and neurological symptoms and groups of signs and symptoms such as rash or bilateral non-purulent conjunctivitis, hypotension or shock and acute gastrointestinal problems, which require immediate therapeutic intervention to prevent the aggravation of the patient's health condition. MIS-C is relatively new in the field of evidence-based medicine; however, there are several clinical guidelines for good clinical practice. For every disorder, the guidelines have different suggestions. Hence, based on the current status of the evidence, recommendations have been combined to form a unified guideline for therapeutic management. METHODS: This paper compares and evaluates the current MIS-C-specific clinical practice guidelines (namely, American Academy of Pediatrics, American College of Rheumatology, Helen DeVos Children's Hospital Foundation, Children's Hospital of The King's Daughters, and the Infectious Diseases Society of America). The compiled literature was then assessed by the authors separately, and an algorithm was proposed for each disorder, taking into consideration the various guidelines proposed for the management of the disorder. RESULTS: The features of MIS-C patients are unified; this is very helpful in managing its symptoms and decreasing mortality rates. In addition, recommendations for pharmacological treatment for MIS-C symptoms are formulated after cross-comparison across five different guidelines. CONCLUSIONS: This study provides a general interpretation of the results in the context of other evidence and implications for future research. It proposes a unified guideline based on the current evidence, with the best potential to maintain suitable clinical standards in the Saudi Arabian Ministry of Health.

Anxiety, Motivation, and Competence in Mathematics and Reading for Children With and Without Learning Difficulties.

Knowledge of the relations among learners' socio-emotional characteristics and competencies as they engage in mathematics and reading is limited, especially for children with academic difficulties. This study examined the relations between anxiety, motivation, and competence in mathematics and reading, within and across domains, in an academically-diverse set of 8-13-year-old learners (n = 146). To measure anxiety and motivation across domains, we paired existing measures of math anxiety and reading motivation with researcher-developed analogs for reading anxiety and math motivation. Participants completed standardized assessments of mathematics and reading, anxiety and motivation surveys for math and reading, and a measure of nonverbal cognitive ability. Results showed high internal consistency for all anxiety and motivation scales (Cronbach's alpha = 0.76-0.91). Pearson correlations showed that within and across domains, participants with higher competence had lower anxiety and higher motivation. Higher anxiety was also associated with lower motivation. Regression analyses showed that for both math and reading, within-domain motivation was a stronger predictor of competence than anxiety. There was a unidirectional across-domain relation: socio-emotional characteristics for reading predicted math competence, after accounting for nonverbal cognitive ability, age, gender, and within-domain anxiety and motivation. Results contribute to knowledge of the socio-emotional characteristics of children with and without learning difficulties in association with reading and math activities. Implications of a unidirectional socio-emotional link between the two domains can advance research and theory of the relations among socio-emotional characteristics and competence for academically-diverse learners.

The impact of thyroid tumor features on lymph node metastasis in papillary thyroid carcinoma patients in head and neck department at KAMC: A retrospective cross-sectional study.

Papillary thyroid carcinoma (PTC) is the most prevalent type of thyroid cancer. It is one of the most common types of malignancy of the thyroid that spreads to cervical lymph nodes. Lymph node metastasis (LNM) is an important factor when determining recurrence risk, and determining the extent of lymph node involvement can guide treatment. Our main objective is to evaluate the association between the size of the tumor and the number of lymph node metastases in patients with PTC. METHODS: We conducted an electronic retrospective chart review of 125 patients with PTC followed in the Head and Neck Department at KAMC from 2009 to 2020. Twenty-two patients included in our study were pathologically and clinically diagnosed and confirmed to have LNM of PTC. RESULTS: The study included 22 PTC patients who had undergone lymph node dissections. Patients had a median age of 38.8 years (IQR = 32.2-54.5), and the median tumor size was 20.5 mm. The most commonly affected level of the neck was IV (76.2%). Distant metastasis M1 was seen in only two patients (9.1%). Tumors sizes >30mm (75%) had ≥5 LNM. Most cases were the classic subtype PTC. For the site of the tumor, the site had a significant impact on the number of LNM (p = 0.004). Multifocality had a high impact on LNM (p = 0.019). CONCLUSIONS: This study showed no association between the size of PTC and the number of LNMs. The bilaterality of PTC was significantly associated with a high number of LNMs.

Understanding the biological basis of dyslexia at a neural systems level.

We examined the naming speed performance of 18 typically achieving and 16 dyslexic adults while simultaneously recording eye movements, articulations and fMRI data. Naming speed tasks, which require participants to name a list of letters or objects, have been proposed as a proxy for reading and are thought to recruit similar reading networks in the left hemisphere of the brain as more complex reading tasks. We employed letter and object naming speed tasks, with task manipulations to make the stimuli more or less phonologically and/or visually similar. Compared to typically achieving readers, readers with dyslexia had a poorer behavioural naming speed task performance, longer fixation durations, more regressions and increased activation in areas of the reading network in the left-hemisphere. Whereas increased network activation was positively associated with performance in dyslexics, it was negatively related to performance in typically achieving readers. Readers with dyslexia had greater bilateral activation and recruited additional regions involved with memory, namely the amygdala and hippocampus; in contrast, the typically achieving readers additionally activated the dorsolateral prefrontal cortex. Areas within the reading network were differentially activated by stimulus manipulations to the naming speed tasks. There was less efficient naming speed behavioural performance, longer fixation durations, more regressions and increased neural activity when letter stimuli were both phonologically and visually similar. Discussion focuses on the differences in activation within the reading network, how they are related to behavioural task differences, and how progress in furthering the understanding of the relationship between behavioural performance and brain activity can change the overall trajectories of children with reading difficulties by contributing to both early identification and remediation processes.

Developmental Trends of Visual Processing of Letters and Objects Using Naming Speed Tasks.

Studying the typical development of reading is key to understanding the precise deficits that underlie reading disabilities. An important correlate of efficient reading is the speed of naming arrays of simple stimuli such as letters and pictures. In this cross-sectional study, we examined developmental changes in visual processing that occurs during letter and object naming from childhood to early adulthood in terms of behavioral task efficiency, associated articulation and eye movement parameters, and the coordination between them, as measured by eye-voice span in both the spatial and temporal domains. We used naming speed (NS) tasks, in which participants were required to name sets of letters or simple objects as quickly and as accurately as possible. Single stimulus manipulations were made to these tasks to make the stimuli either more visually and/or phonologically similar to one another in order to examine how these manipulations affected task performance and the coordination between speech and eye movements. Across development there was an increased efficiency in speech and eye movement performance and their coordination in both the spatial and temporal domains. Furthermore, manipulations to the phonological and visual similarity of specific letter and object stimuli revealed that orthographic processing played a greater role than phonological processing in performance, with the contribution of phonological processing diminishing across development. This comprehensive typical developmental trajectory provides a benchmark for clinical populations to elucidate the nature of the cognitive dysfunction underlying reading difficulties.

Examining the neural and cognitive processes that underlie reading through naming speed tasks.

We combined fMRI with eye tracking and speech recording to examine the neural and cognitive mechanisms that underlie reading. To simplify the study of the complex processes involved during reading, we used naming speed (NS) tasks (also known as rapid automatized naming or RAN) as a focus for this study, in which average reading right-handed adults named sets of stimuli (letters or objects) as quickly and accurately as possible. Due to the possibility of spoken output during fMRI studies creating motion artifacts, we employed both an overt session and a covert session. When comparing the two sessions, there were no significant differences in behavioral performance, sensorimotor activation (except for regions involved in the motor aspects of speech production) or activation in regions within the left-hemisphere-dominant neural reading network. This established that differences found between the tasks within the reading network were not attributed to speech production motion artifacts or sensorimotor processes. Both behavioral and neuroimaging measures showed that letter naming was a more automatic and efficient task than object naming. Furthermore, specific manipulations to the NS tasks to make the stimuli more visually and/or phonologically similar differentially activated the reading network in the left hemisphere associated with phonological, orthographic and orthographic-to-phonological processing, but not articulatory/motor processing related to speech production. These findings further our understanding of the underlying neural processes that support reading by examining how activation within the reading network differs with both task performance and task characteristics.

Potentials and Pitfalls of Cross-Translational Models of Cognitive Impairment.

A number of clinical disorders that are either neurodevelopmental or neurodegenerative exhibit significant cognitive impairments that require some form of intervention. However, the current paucity of pro-cognitive treatments that are available, due to the lack of knowledge of biological targets and symptomologies, impedes the treatment of individuals with cognitive impairments. In this review article, we explore three critical steps that need to be established in order to lead to the development of effective and appropriate treatments for cognitive impairments. The first step specifically involves the ability to efficiently reproduce and standardize current animal models of disease. The second step involves establishing well-controlled and standardized animal models across different species, such as rodents and monkeys, that link to human disease conditions. The third step involves building these animal models from both a translational and a reverse translational perspective in order to gain critical insight into the etiologies of specific cognitive impairments and the development of their early physiological and behavioral biomarkers. This bidirectional translational approach is important to improve the investigation of disease biomarkers, the underlying mechanisms of novel therapeutics on cognition, and to validate preclinical findings of drug discovery. Overall, even though animal models play an important role in investigating the pathophysiological processes and mechanisms associated with typical and atypical behavior, we discuss the ongoing challenges associated with these three critical steps of cross-translational research that has led to the current lack of success of developing effective new compounds for potential treatments and suggest approaches to stimulate advances in the field.

Are liquid biopsies a surrogate for tissue EGFR testing?

Molecular profiling has changed the treatment landscape in advanced non-small-cell lung cancer. Accurately identifying the tumours that harbour sensitizing EGFR mutations, the most common targetable molecular alteration, as well as those with acquired resistance mutations (e.g. T790M) on treatment is a high clinical priority. The current clinical gold standard is genotyping of tumour specimens. However, the practical utility of this approach is limited by the lack of available tissue and the potential complications associated with biopsies. With the advent of newer sequencing assays, it has become feasible to assess tumour genomics via a blood sample, termed a 'liquid biopsy'. In this review, we summarize the available techniques for liquid biopsies and their applicability for detecting sensitizing and resistance EGFR mutations and how these results may be used for making treatment decisions.

Eye Movements and Articulations During a Letter Naming Speed Task.

Naming speed (NS) refers to how quickly and accurately participants name a set of familiar stimuli (e.g., letters). NS is an established predictor of reading ability, but controversy remains over why it is related to reading. We used three techniques (stimulus manipulations to emphasize phonological and/or visual aspects, decomposition of NS times into pause and articulation components, and analysis of eye movements during task performance) with three groups of participants (children with dyslexia, ages 9-10; chronological-age [CA] controls, ages 9-10; reading-level [RL] controls, ages 6-7) to examine NS and the NS-reading relationship. Results indicated (a) for all groups, increasing visual similarity of the letters decreased letter naming efficiency and increased naming errors, saccades, regressions (rapid eye movements back to letters already fixated), pause times, and fixation durations; (b) children with dyslexia performed like RL controls and were less efficient, had longer articulation times, pause times, fixation durations, and made more errors and regressions than CA controls; and (c) pause time and fixation duration were the most powerful predictors of reading. We conclude that NS is related to reading via fixation durations and pause times: Longer fixation durations and pause times reflect the greater amount of time needed to acquire visual/orthographic information from stimuli and prepare the correct response.

Bubbles in the Heart: A Case of Venous Air Thromboembolism.

INTRODUCTION: Venous air embolism (VAE) due to central venous catheter (CVC) placement is a rare but preventable complication which is potentially fatal. We describe a case highlighting unique patient characteristics which increase the risk of developing VAE. CASE DESCRIPTION: A sixty-year-old gentleman was admitted to the hospital with dyspnea and altered mental status. His comorbidities include cancer of the neck and tongue, currently in remission, and schizophrenia. On presentation, he was found to be in acute respiratory failure, due to pneumonia, and required mechanical ventilation. Following extubation, his CVC was removed from the right internal jugular vein. While ambulating around the unit, he experienced a coughing fit and dizziness. He rapidly developed cardiopulmonary collapse requiring re-intubation and vasopressor support. Chest x-ray demonstrated a radiolucent column along the lateral aspect of the right neck. Due to concern for VAE, an echocardiogram was performed, revealing multiple air-bubbles in the right and left chambers of the heart. DISCUSSION: Our patient was predisposed to developing VAE due to the extensive radiation induced skin changes, from his cancer treatment, on the neck and upper thorax. This resulted in loss of underlying subcutaneous tissue and decreased skin pliability. He had a large, open puncture wound at the catheter site on his neck, probably resulting in air entry. Anxiety and agitation, due to schizophrenia, made it difficult to maintain our patient in a supine or Trendelenburg position following CVC removal. This case highlights the importance of recognizing patient factors that may increase the risk of VAE.

Expression, purification, and evaluation of recombinant LecA as a candidate for an amebic colitis vaccine.

Entamoeba histolytica, which causes amebic colitis and liver abscess, is considered a major enteric pathogen in residents and travelers to developing countries where the disease is endemic. Interaction of this protozoan parasite with the intestine is mediated through the binding of the trophozoite stage to intestinal mucin and epithelium via a galactose and N-acetyl-d-galactosamine (Gal/GalNAc) lectin comprised of a disulfide linked heavy (ca. 180 kDa) and light chain (ca. 35 kDa) and a noncovalently bound intermediate subunit (ca. 150 kDa). Our efforts to develop a vaccine against this pathogen have focused on an internal 578 amino acid fragment, designated LecA, located within the cysteine-rich region of the heavy chain subunit because: (i) it is a major target of adherence-blocking antibodies of seropositive individuals and (ii) vaccination with his-tagged LecA provides protection in animal models. We developed a purification process for preparing highly purified non-tagged LecA using a codon-optimized gene expressed in Escherichia coli. The process consisted of: (i) cell lysis, collection and washing of inclusion bodies; (ii) solubilization and refolding of denatured LecA; and (iii) a polishing gel filtration step. The purified fragment existed primarily as a random coil with ß-sheet structure, contained low endotoxin and nucleic acid, was highly immunoreactive, and elicited antibodies that recognized native lectin and that inhibited in vitro adherence of trophozoites to CHO cells. Immunization of CBA mice with LecA resulted in significant protection against cecal colitis. Our procedure yields sufficient amounts of highly purified LecA for future studies on stability, immunogenicity, and protection with protein-adjuvant formulations.

Labor outcome of primigravidae in Mymensingh Medical College Hospital.

This cross sectional study was done in the department of Obstetrics and Gynae, Mymensingh Medical College Hospital, during the period 1st January to 30th June 2000 to evaluate the labor outcome in primigrvidae women. Total 1250 cases were delivered in this period. Among all 500(40%) were primigravidae. All the primigravidae were included and labor was monitored and managed by close observation. Condition of the baby was determined by applying APGAR (Appearance, Pulse, Grimace, Activity and Respiration) score. Maximum (66.6%) of patients were belonged to 21-29 years age group. Only few 28.2% had regular antenatal check-up. Risk factors were present in 32% cases. Common risk factors were PET (Pre-eclamptic toxemia) and eclampsia. Mode of deliveries were normal vaginal delivery (NVD) in (51.6%) cases, Lower Uterine Caesarean section (LUCS) in 43.8% cases, Ventouse in 2.8% cases, Forceps in 9(1.8%) cases and craniotomy was required in 2(0.4%) cases. Complications during labor were prolonged labor, postpartum hemorrhage, obstructed labor and perineal tear. PET was common (29.62%) in age group 30-36 years and eclampsia was more common (15%) in age group 16-20 years. NVD were more (55.85%) in 21-29 years group than other age group. The duration of labor pain was short in the age group of 21-29 years and was prolonged in the age group 30-36 years. Maternal mortality was 1.6% (8) cases. Causes of death were septic shock, renal failure and Cerebrovascullar accident. Morbidities after delivery were hypertension, wound infection, puerperal psychosis, acute renal failure, vesicovaginal fistula, hypertensive retinopathy, chronic ill health and retention of urine. Among 500 cases 92.6% were live born and 7.4% were still born. Among total cases 81.6% babies were healthy, 6.8% were asphyxiated, 71.2% had normal birth weight 21.4% had low birth weight, 18% were premature and 7.4% were IUGR. This study shows the safest and easiest delivery age group of primigravidae is between 21-29 years. Maternal mortality and early neonatal death are still holding high rate.

Vermiremoval of heavy metal in sewage sludge by utilising Lumbricus rubellus.

Experiments were conducted to remove heavy metals (Cr, Cd, Pb, Cu and Zn) from urban sewage sludge (SS) amended with spent mushroom compost (SMC) using worms, Lumbricus rubellus, for 105 days, after 21 days of pre-composting. Five combinations of SS/SMC treatments were prepared in triplicate along with a control for each treatment in microcosms. Analysis of the earthworms' multiplication and growth and laboratory analysis were conducted during the tenth and fifteenth week of vermicomposting. Our result showed that the final biomass of earthworms (mg) and final number of earthworms showed significant differences between treatments i.e. F=554.70, P=0.00 and F=729.10, P=0.00 respectively. The heavy metals Cr, Cd and Pb contained in vermicompost were lower than initial concentrations, with 90-98.7 percent removal on week ten. However, concentrations of Cu and Zn, that are considered as micronutrients, were higher than initial concentrations, but they were 10-200-fold lower than the EU and USA biosolid compost limits and Malaysian Recommended Site Screening Levels for Contaminated Land (SSLs). An increment of heavy metals were recorded in vermicompost for all treatments on week fifteen compared to week ten, while concentration of heavy metals in earthworms' tissue were lower compared to vermicompost. Hence, it is suggested that earthworms begin to discharge heavy metals into their surroundings and it was evident that the earthworms' heavy metals excretion period was within the interval of ten to fifteen weeks.

Waste recycling: utilization of coffee grounds and kitchen waste in vermicomposting.

Vermicomposting using Lumbricus rubellus for 49 days was conducted after 21 days of pre-composting. Three different combination of treatments were prepared with eight replicates for each treatment namely cow dung: kitchen waste in 30:70 ratio (T(1)), cow dung: coffee grounds in 30:70 ratio (T(2)), and cow dung: kitchen waste: coffee grounds in 30:35:35 ratio (T(3)). The multiplication of earthworms in terms of numbers and weight were measured at the end of vermicomposting. Consequently, only T(2) showed significant increase (from it initial stage) compared to other treatments. The presence of coffee grounds in T(2) and T(3) showed higher percentage of nutrient elements in vermicompost produced. The data reveal that coffee grounds can be decomposed through vermicomposting and help to enhance the quality of vermicompost produced rather than sole use of kitchen waste in vermicomposting.

Histopathological analysis of hysterectomy specimens.

The objective of this study was to explore the histopathological findings and the rate of removal of ovaries in hysterectomy specimens. This study took into account 328 hysterectomy specimens examined in the Department of Pathology, Mymensingh Medical College and in one private Pathology Laboratory in Mymensingh town from March to August, 2005. Formalin fixed paraffin embedded tissue sections stained with haematoxylin and eosin were examined under light microscope. Patients' age, parts of uterus examined and their histopathological findings were retrieved from laboratory records. The common histopathological findings were: chronic cervicitis (87.80%), leiomyoma (17.07%), uterine prolapse (16.72%), adenomyosis (3.96), non-specific endometritis (3.35%), squamous cell carcinoma of cervix (2.44%), endometrial polyp (2.44%), serous cystadenoma of ovary (2.44%) and endometrial hyperplasia (1.83%). Some of the specimens show more than one lesions in the body of uterus, of which coexistence of adenomyosis and leiomyoma was the most common. Neoplastic lesions in cervix were 4.27%, in body 16.92% and in ovaries 5.06%. Malignant neoplasms were found in cervix 71.43%, in uterine corpus 3.03% and in ovaries 25%. Ovaries of both sides were removed in 48.17% of total cases. Their median age was 45 years, lowest age 23 years and maximum age was 82. The rate of removal of both ovaries was found to be increasing with the increase of age. Only one case was found to be subtotal hysterectomy and others were total hysterectomy. The present study revealed that the most common histopathological cause of hysterectomy is chronic cervicitis. Most common neoplastic cause of hysterectomy is leiomyoma. The rationalities and the possible after effect of hysterectomy in sexual functions and other physiological impairment should be followed up.

"Discovery to treatment" window in patients with smear-positive pulmonary tuberculosis.

Delay in commencing treatment in patients diagnosed with smear-positive pulmonary tuberculosis (PTB) may promote the spread of PTB in the community. Socio-demographic and clinical data from 169 patients (119 retrospectively and 50 prospectively collected) treated for smear-positive PTB in our hospital Chest Clinic from June 2002 to February 2003 were analysed. One hundred and fifty eight (93.5%) patients were started on treatment in less than 7 days from the time when the report first became available while 11 (6.5%) patients had their treatment started > or = 7 days. The median 'discovery to treatment' window was 1 day (range, 0 to 24 days). Of the factors studied, longevity of symptoms, absence of fever or night sweats and having sought traditional medicine were associated with delay in treatment commencement. The urgency and importance of anti-TB treatment should be emphasized especially to patients who are inclined towards treatment with traditional medicine.