Bemiparin for thromboprophylaxis after benign gynecologic surgery: a randomized clinical trial.

BACKGROUND: Venous thromboembolism (VTE) is the leading cause of mortality and morbidity in women following gynecologic surgery. OBJECTIVES: To determine the efficacy of a second-generation low molecular weight heparin (bemiparin) for thromboprophylaxis after benign gynecologic surgery. METHODS: We performed a single-blind randomized controlled trial including women in the moderate-risk, high-risk and highest-risk groups for developing VTE after benign gynecologic surgery. Participants were randomized at a 1 : 1 ratio into parallel groups to receive either seven daily doses of 3500 IU of subcutaneous bemiparin or to a non-intervention group receiving standard rehydration and advice on ambulation. Participants were followed up for 7 days and 30 days postoperatively for symptomatic VTE, which was confirmed by compression Doppler ultrasound, magnetic resonance imaging, or computed tomographic pulmonary angiography, according to the type of VTE. RESULTS: In total, 387 participants were randomized to the bemiparin group and 387 to the non-intervention group. The incidence of symptomatic VTE (deep vein thrombosis and pulmonary embolism) events was lower (0/377) in participants who received bemiparin than in those who received no pharmacologic intervention (12/380, 3.2%; 95% confidence interval [CI] 0.002-0.6). Logistic regression analysis showed significant associations between VTE and immobility (odds ratio [OR] 7.1; 95% CI 1.3-36.2), varicose veins (OR 16.8; 95% CI 3.1-76.2), and thrombophilia (OR 39.3; 95% CI 1.5-1006.7). There were no major bleeding events or side effects related to the use of bemiparin. CONCLUSIONS: Bemiparin was an effective thromboprophylactic agent for preventing venous thrombosis after benign gynecologic surgery.

Association between UTI and urinary tract abnormalities: a case-control study in Erbil City/Iraq.

OBJECTIVE: To determine the proportion of ultrasound abnormalities of the urinary system between two groups of children: affected with urinary tract infection (UTI) and unaffected (control). Further, to determine the most common microorganisms causing UTI in those children with urinary tract abnormalities. METHODS: A case-control study was carried out in Erbil, Iraq between September and December 2012. Ultrasound examinations were carried out on 64 children affected with UTI and on 64 unaffected with UTI (control) in order to detect differences, in the presence of abnormalities, in the urinary tract between the two groups. RESULTS: A majority (59.4%) of children affected with UTI had ultrasound abnormalities, compared with 26.6% of the control group (P<0.001). Escherichia coli was the most common microorganism in both groups, although the difference was not statistically significant. More than one half (75%) of patients with UTI were female, compared with 25% who were male (P<0.001). CONCLUSION: More than one half of the children in the present study who presented with UTI were found to have ultrasound abnormalities. E. coli was the most common causative pathogen for children with or without ultrasound abnormalities.

Demographic transition and potential for development: the case of Iraqi Kurdistan.

The effect of population growth and demographic transitionon economic developmenthas been well documented. The population growth in Iraqi Kurdistan is passing through a critical stage of demographic transition. It is, in fact, extremely likely that the region will fail to efficiently move through the demographic transition and will experience a long period in the demographic trap, i.e. the population will grow steadily and rapidly owing to the high fertility and low mortality rates. With correct government policies in terms of promoting family planning programmes, should the political context allow, demographic transition can pass smoothly through this critical stage. Furthermore, if demographic transition in Kurdistan moves to the next stage, it will provide an important window of opportunity for economic development. Proper exploitation of this demographic window through investment in education, on-the-job training and health services, in addition to proper and appropriate exploitation of economic resources and suitable and productive use of the labour force, will result in significant economic development over the next few decades.

Demographic transition and potential for development: the case of Iraqi Kurdistan

The effect of population growth and demographic transition on economic development has been well documented. The population growth in Iraqi Kurdistan is passing through a critical stage of demographic transition. It is, in fact, extremely likely that the region will fail to efficiently move through the demographic transition and will experience a long period in the demographic trap, i.e. the population will grow steadily and rapidly owing to the high fertility and low mortality rates. With correct government policies in terms of promoting family planning programmes, should the political context allow, demographic transition can pass smoothly through this critical stage. Furthermore, if demographic transition in Kurdistan moves to the next stage, it will provide an important window of opportunity for economic development. Proper exploitation of this demographic window through investment in education, on-the-job training and health services, in addition to proper and appropriate exploitation of economic resources and suitable and productive use of the labour force, will result in significant economic development over the next few decades

Prevalence of and factors associated with overweight and obesity among a group of Iraqi women.

We studied the prevalence and factors associated with overweight and obesity among 200 non-pregnant Iraqi women (> 18 years) attending 2 outpatient clinics in Baghdad. The women were interviewed using a questionnaire and had their body mass index (BMI) and waist-to-hip ratio (WHR) calculated. Only 24% of the women were normal weight: 39%, 25% and 12% were overweight (BMI 25-29.9 kg/m2), obese (> or =30 kg/m2) and morbidly obese (> or = 40 kg/m2) respectively. While the mean WHR was normal, the mean waist circumference was higher than normal. Factors significantly associated with overweight and obesity were older age, history of previous laparotomy and type of clothing worn (gown) inside the home.

Prevalence of and factors associated with overweight and obesity among a group of Iraqi women

We studied the prevalence and factors associated with overweight and obesity among 200 non- pregnant Iraqi women [> 18 years] attending 2 outpatient clinics in Baghdad. The women were interviewed using a questionnaire and had their body mass index [BMI] and waist- to- hip ratio [WHR] calculated. Only 24% of the women were normal weight: 39%, 25% and 12% were overweight [BMI 25- 29.9 kg/ m 2], obese [>/= 30 kg/ m 2] and morbidly obese [>/= 40 kg/ m 2] respectively. While the mean WHR was normal, the mean waist circumference was higher than normal. Factors significantly associated with overweight and obesity were older age, history of previous laparotomy and type of clothing worn [gown] inside the home

Lymphocyte transformation test in adult patients with minimal change nephrotic syndrome.

The lymphocyte transformation test was used to evaluate the cellular immune response in 31 adult patients with MCNS in comparison with 30 normal control and 49 patient (CRF, FSGN, MGN) control groups. The results showed that the stimulation indices of the lymphocytes in MCNS group were significantly lower than those of the normal control and patient control groups with the exception of CRF group. In cross studies, lymphocytes obtained from normal individuals were incubated in homologous serum obtained from MCNS patients in relapse, and lymphocytes from MCNS patients in relapse were incubated in normal homologous AB serum. In both circumstances there was a depressed lymphocyte function which indicates that there is a defect in lymphocyte itself as well as a serum inhibitory factor(s) during the active stage of the MCNS. This depressed cellular immune response returned to normal level during remission of the patients with MCNS.

Virological and immunological studies in patients with acute viral hepatitis.

One hundred and seven patients with acute viral hepatitis (AVH) were studied prospectively regarding the viral aetiological agent HAV, HBV and NANB (by exclusion) using radioimmunoassay. Acute HAV infection occurred in 43 patients, and acute HBV infection in 34 patients, while HDS occurred in two patients only. Acute, presumably NANB, infection occurred in 28 patients. Ten out of 28 sera of patients with AHBV infection were positive for smooth muscle antibody by immunofluorescence. Important findings include: (1) presence of delta superinfection in the absence of HBsAg; (2) HBsAg as the only marker in two patients with AHBV infection; (3) concurrent presence of HBsAg and anti-HBsAg in three patients with AHBV infection.

Metal allergy in cashiers. An in vitro and in vivo study for the presence of metal allergy.

Thirty healthy cashiers continuously exposed to nickel in coins were tested in vivo and in vitro for the presence of metal contact allergy. A traditional epicutaneous test and lymphocyte transformation test were used. We tested for nickel, cobalt and chromium sensitivity. Seven of the 30 cashiers were patch test positive and 3 were in vitro positive to nickel sulphate. Two were in vivo positive to cobalt and only one in vitro positive. None was chromium allergic. There was no correlation between the exposure time and the lymphocyte response towards nickel. The presence of pierced and non-pierced ear lobes was noted with and without eczema in conjunction with the wearing of ear-rings containing nickel. The lymphocyte reactivity showed no significant difference between these groups. Only 5 out of the 12 with ear lobe dermatitis were patch test positive towards nickel. The data suggest that nickel as test substance or released from nickel-containing jewellery can evoke a cutaneous response which is not always associated with allergy.

T and B lymphocytes in patients with nickel sensitivity.

Peripheral blood mononuclear cells from altogether 45 nickel-sensitive patients and 37 controls were assayed for various T and B cell variables. All the patients, but none of the controls, fulfilled our in vitro criteria for a positive response to nickel sulphate (NiSO4). We report normal T and B lymphocyte counts, normal spontaneous plaque-forming cell (PFC) numbers, normal serum immunoglobulin levels, and no demonstrable specific cytotoxic T lymphocyte activity associated with nickel sensitivity. We could detect only a slight increase in the number of PFC and in the number of cytoplasmic immunoglobulin positive (cIg+) cells following stimulation of the patients' cells with NiSO4 for 6 days in culture. Apart from a transient increase in the [3H]thymidine uptake by patients' cells stimulated with NiSO4 in vitro, and a transient drop in the OKT4/OKT8 ratio, there were no major differences in the values of the above variables before and after in vivo challenge of 3 patients with NiSO4. Blood from only 2 of the latter 3 patients was tested in the DNA synthesis test. We conclude that apart from the DNA synthesis test, none of these tests is of any use as an aid to diagnosis in patients with nickel sensitivity. A careful attitude towards patch testing should be maintained.

HLA-class II restriction of the proliferative T lymphocyte responses to nickel, cobalt and chromium compounds.

Peripheral blood mononuclear cells from nickel and/or cobalt or chromium sensitive patients were stimulated with the appropriate metal compound for 7 days in culture. The transformed blasts were separated from non-transformed small cells on Percoll density gradients. The blasts, maintained in interleukin-2 containing medium and enriched for T cells, were both antigen specific and devoid of alloreactivity. The metal compound primed T cell blasts from all patients showed a good proliferative response on restimulation with the priming compound in the presence of autologous adherent cells (AC). Analysis of HLA class II phenotypes of allogeneic AC that could serve as antigen presenting cells indicated that responsiveness of T cell blasts from most but not all patients could be explained on the basis of HLA-DR as a restricting element. We conclude that products of other class II loci (HLA-DQ and/or HLA-DP) might also serve as restricting elements for a secondary in vitro proliferative response to these metal compounds.

Correlation between quantitative in vivo and in vitro responses in nickel-allergic patients.

Forty-three nickel-allergic patients (40 females and 3 males) participated in this study which was designed to elucidate the correlation between quantitative in vivo and in vitro responses. All were patch-tested with various concentrations of nickel-sulphate serial-diluted in water. The lowest concentration eliciting a cutaneous reaction (indicating the severity of the allergy) was recorded for each individual and compared with the in vitro lymphocyte response, using the lymphocyte transformation test. The best correlation coefficients obtained were 0.42 and 0.46, tested for linear and logarithmic correlation respectively. However, there were individuals who showed a weak cutaneous response and high lymphocyte reactivity. The converse situation was also found, however, indicating that other mechanisms than those mediated via lymphocytes may be of significance in the patch test response.

In vitro testing for cobalt sensitivity: an aid to diagnosis.

Peripheral blood lymphocytes from 45 patients with a positive patch test to cobalt chloride (CoCl2) and 37 controls were stimulated with various concentrations of CoCl2 and/or cobalt sulphate (CoSO4) or cobalt nitrate (Co(NO3)2) or cobalt acetate [CH3COO)2Co) for various days in culture. Lymphocytes from 35 of these patients showed a significantly greater response than that of the controls. The response occurred in the T enriched population and was monocyte dependent. The strength of the in vivo serial dilution test results did not correlate well with the height of in vitro responses. Lymphocytes from 3 nickel and/or chromium sensitive patients failed to respond to stimulation with cobalt compounds thus confirming the specificity of the reaction. The DNA synthesis test seems to be a reliable in vitro method to aid in the diagnosis of cobalt sensitivity.

Lymphocyte stimulation by trivalent and hexavalent chromium compounds in patients with chromium sensitivity. An aid to diagnosis.

Peripheral blood lymphocytes from 31 patients with a positive patch test to potassium dichromate (K2Cr2O7) and from 24 healthy controls were stimulated with various concentrations of chromium chloride (CrCl3) and/or chromium basic sulphate (Cr4(SO4)5(OH)2), sodium chromate (Na2CrO4) or K2Cr2O7 on various days of culture. Both trivalent and hexavalent chromium compounds could induce lymphocyte transformation, as measured by increased DNA synthesis. The response occurred in the T-enriched population and was monocyte dependent. Lymphocytes from 11 of these patients could not be stimulated with the chromium compounds in vitro, whereas the in vivo serial dilution test (SDT) was positive in 4 and negative in 7 of them. Lymphocytes from 2 patients with a negative in vivo SDT showed a positive response in vitro. The strength of the in vivo SDT results did not correlate well with the height of in vitro responses. The DNA synthesis test seems to be a reliable in vitro method to aid in the diagnosis of chromium sensitivity.

Lymphocyte transformation test in patients with nickel sensitivity: an aid to diagnosis.

Peripheral blood lymphocytes from 16 patients with a positive patch test to 2.5% nickel sulphate (NiSO4) and 18 healthy controls were tested by the lymphocyte transformation technique where NiSO4 in six different concentrations was used and tested after various days of culture. Lymphocytes from all except one of the patients showed a significantly greater response than that of the controls. Lymphocyte transformation as measured by increased DNA synthesis seems to be a valuable tool for investigating the problems arising from false-positive or false-negative patch tests. With these data we have defined certain criteria for in vitro reactivity that should be fulfilled. Lymphocytes from controls responded non-specifically to high concentrations of NiSO4. Cord blood lymphocytes from 4 newborn infants could also be activated by NiSO4, thus confirming the assumption that NiSO4 is a weak mitogen.

Study of the immunological status of patients with pulmonary tuberculosis.

Most patients with pulmonary tuberculosis have impaired T-lymphocyte function as measured by dinitrochlorobenzene (DNCB) sensitization and response to tetanus toxoid. The humoral immune response as gauged by the ability to respond to typhoid vaccine was not affected. Tuberculous patients had higher immunoglobulin levels than normal controls. The relative proportions of T lymphocytes in patients were lower than in controls while those of B lymphocytes were normal. By these criteria, rifampin treatment did not seem to cause immunosuppression.