Polycystic ovary syndrome: infertility, cardiovascular, metabolic and obstetrical risks, laboratory and clinical outcomes -- the PICOLO Study

OBJECTIVES

The primary objective of this multicenter study is to evaluate the relative impact of insulin resistance (IR) and body mass index (BMI) in women with polycystic ovary syndrome (PCOS) on (1) Key hemodynamic/thrombogenic variables, (2) Oocyte quality and early embryo development, (3) Fetal growth, placental function and adverse obstetric outcome.

SECONDARY OBJECTIVE

To establish a PCOS database and biobank facilitating future basic and interventional research related to PCOS.

DESIGN

A cross-sectional and longitudinal cohort study at four University Hospitals in Denmark. POPULATION INCLUSION: About 200 women fulfilling the Rotterdam Criteria and 100 women without PCOS recruited from 2010 to 2012.

METHODS

The impact of PCOS, as well as the impact of IR and BMI on the hormonal, metabolic and hemostatic key variables will be analyzed combining conventional, molecular techniques and selected gene analysis. Oocytes will be characterized by gene expression of granulosa and cumulus cells and the early embryo development will be followed by time lapse microscopy. Fetal growth will be assessed by repeated ultrasound measurements, and the pregnancy outcome compared to maternal and fetal biochemical markers of growth and inflammation and clinical pregnancy complications.

MAIN OUTCOME MEASURES

Metabolic and hemostatic risk-biomarkers, oocyte and embryo quality, adverse pregnancy outcome, fetal growth and placental function in women with PCOS.

Clinical evaluation of the Levitan Optical Stylet

A Levitan Optical Stylet with a modified curve was used in the operating theatre for 301 timed tracheal intubations. Jaw lift was provided manually instead of with a direct laryngoscope. All tracheas except one were intubated successfully (99.7%). Mean (SD) intubation times were 23 (24) s. Three patients (1%) suffered minor trauma. The modified Levitan Optical Stylet can be used without direct laryngoscopy as an effective, rapid and relatively atraumatic tool for intubation, even in difficult airways. It may be appropriate as an alternative or primary intubation technique instead of direct laryngoscopy.

Beneficial effects of cathepsin inhibition to prevent chemotherapy-induced intestinal mucositis

One of the main secondary toxic side effects of anti-mitotic agents used to treat cancer patients is intestinal mucositis. Previous data showed that cathepsin D activity, contributing to the proteolytic lysosomal pathway, is up-regulated during intestinal mucositis in rats. At the same time, cathepsin inhibition limits intestinal damage in animal models of inflammatory bowel diseases. The aim of this study was to evaluate the effects of cathepsin inhibition on methotrexate-induced mucositis in rats. Male Sprague-Dawley rats received saline solution subcutaneously as the control group or 2·5 mg/kg of methotrexate for 3 days (D0-D2). From D0 to D3 methotrexate-treated rats also received intraperitoneal injections of pepstatin A, a specific inhibitor of cathepsin D or E64, an inhibitor of cathepsins B, H and L, or vehicle. Rats were euthanized at D4 and jejunal samples were collected. Body weight and food intake were partially preserved in rats receiving E64 compared with rats receiving vehicle or pepstatin A. Cathepsin D activity, used as a marker of lysosomal pathway, was reduced both in E64 and pepstatin-treated rats. However, villus atrophy and intestinal damage observed in methotrexate-treated rats were restored in rats receiving E64 but not in rats receiving pepstatin A. The intramucosal concentration of proinflammatory cytokines, interleukin-1β and cytokine-induced neutrophil chemoattractant (CINC)-2, was markedly increased in methotrexate-treated rats receiving vehicle or pepstatin A but not after E64 treatment. In conclusion, a large broad inhibition of cathepsins could represent a new potential target to limit the severity of chemotherapy-induced mucositis as opposed to the inhibition of cathepsin D alone.

Antibacterial effect of NSAIDS on clinical isolates of urinary tract infection and diabetic foot infection

Non Steroidal Anti-inflammatory Drugs (NSAIDS) are a group of chemically dissimilar agents that have primary effect of inhibition of prostaglandin's synthesis. Aspirin (Acetyl Salicylic Acid) is used as an analgesic, anti pyretic, anti-inflammatory agent and also have an anticoagulant effect. Tylenol (acetaminophen) is used as pain reliever. The objective of this study was to determine the effect of Aspirin and Tylenol against clinical isolates of urinary tract infection (UTI) and diabetic foot infections. A total of 100 clinical isolates were analyzed. Out of these 50 were urine samples from diabetic patients with UTI and 50 pus samples from diabetic foot infection. Bacteriological study was done by inoculating urine samples on Cysteine Lactose Electrolyte deficient (CLED) media. Pus samples were inoculated on Blood agar and MacConkey's agar. Identification was done by colony characteristics, gram staining and standard biochemical tests and Quick Test Strip (QTS-20) DESTO Laboratories, Karachi. Antibacterial effect of Aspirin and Tylenol were tested against 100 clinical isolates by Replica plate method, Agar well diffusion method and tube dilution method. Concentrations of Aspirin and Tylenol (10 microg, 50 microg, 100 microg, 500 microg, 1000 microg) were made in Muller Hinton media. Bacteria isolated from urine samples were Escherichia coli 30%, Staphylococcus aureus 20%, Enterococcus faecalis 10%, S. saprophyticus 10%, Proteus spp. 6%, Pseudomonas spp. 6%, S. pyogenes 6%, S. agalactiae 6%, S. epidermidis 4%, and Klebsiella spp. 2%. Bacteria isolated from pus samples were S. aureus 30%, Pseudomonas aeruginosa 18%, S. epidermidis 14%, Klebsiella pneumonia 12%, Proteus mirabilis 12%, E. coli 10%, P. vulgaris 4%. Aspirin was effective at 100-500 microg concentration against all isolates. Tylenol has marked effect on pathogens at 100 microg concentration. Aspirin and Tylenol along with analgesic, anti-pyretic, anti-inflammatory properties also have marked anti bacterial effect on isolates from UTI and Diabetic foot infections and inhibits the growth of both gram negative and gram positive bacteria, and both can be used synergistically with antibiotics for effective treatment.

Adsorption of U(VI) from dilute aqueous solutions onto peat moss

The adsorption of U(VI) onto peat moss has been studied as a function of uranium concentration, pH, shaking time and ionic strength. The pH and ionic strength of the solution markedly affect the extent of removal. The attainment of equilibrium is fast and the equilibrium data fit well the Freundlich, Langmuir and Dubinin-Radushkevich equations. A probable mechanism of uptake is discussed. Further studies demonstrate that under optimum conditions peat moss can be used for the treatment of waste solutions containing low concentrations of uranium.

External quality control of Mycobacterium tuberculosis drug susceptibility testing: results of two rounds in endemic countries

SETTING

Quality assurance for the World Health Organization (WHO)/International Union Against Tuberculosis and Lung Disease (The Union) global tuberculosis (TB) drug resistance surveillance programme.

OBJECTIVE

To monitor the quality of drug susceptibility testing (DST) in different countries.

METHODS

In 2002-2003 and 2005-2006, 20 Mycobacterium tuberculosis strains were sent by the WHO/Union Supranational Reference Laboratory of Rome to TB reference laboratories in Albania, Bahrain, Kosovo, Mozambique, Oman, Qatar and Turkey for external quality control (EQC).

RESULTS

In 2002-2003, the specificity, sensitivity, efficiency, reproducibility and predictive values for resistance/susceptibility were >or=90% for streptomycin (SM), isoniazid (INH) and ethambutol (EMB). In 2005-2006, all statistical values were >or=96% for SM, INH, rifampicin and EMB.

CONCLUSION

EQC improved the quality of M. tuberculosis DST in the participating countries.

Expression patterns and predictive value of phosphorylated AKT in early-stage breast cancer

BACKGROUND

AKT phosphorylation is a critical step in the activation of growth factor receptors and can mediate tumor resistance to anthracyclines. We evaluated the expression patterns and predictive value of phosphorylated AKT (pAKT) in breast cancer tissues.

PATIENTS AND METHODS

pAKT expression was assessed by immunohistochemistry in 823 tumors from patients with early breast cancer enrolled in two randomized trials. The distribution of pAKT expression was correlated with HER2 and epidermal growth factor receptor (EGFR) expression. The predictive value of pAKT for the efficacy of adjuvant chemotherapy was determined by test for interaction.

RESULTS

pAKT, EGFR, and HER2 were expressed in 119 of 781 (15%), 118 of 758 (16%), and 99 of 775 (13%) assessable tumors. Staining was positive for pAKT in 28 of 99 (28%) and 90 of 676 (13%) HER2+ and HER2- tumors (P < 0.001). pAKT was expressed in 15 of 94 (16%) and 75 of 563 (13%) HER2-/EGFR+ and HER2-/EGFR- tumors, respectively (P = 0.49). A positive staining for pAKT did not correlate with prognosis (P = 0.94), and did not predict the resistance to anthracyclines (test for interaction, P = 0.70).

CONCLUSIONS

AKT phosphorylation is associated with HER2 expression but not EGFR expression in patients with early breast cancer. pAKT is not predictive for the efficacy of anthracycline-based adjuvant chemotherapy.

Use of a standardised checklist to assess peripheral sputum smear microscopy laboratories for tuberculosis diagnosis in Uganda

SETTING

TB diagnostic units in Uganda.

OBJECTIVES

To assess and improve the supervision and performance of sputum smear microscopy in the peripheral diagnostic units in Uganda using a standardised laboratory checklist.

DESIGN

A standardised checklist was developed and used during the quarterly supervisory visits of the District TB and Leprosy Supervisors for five quarters from the fourth quarter of 1997 until the last quarter of 1998. Individual peripheral laboratory performance was monitored during the study period.

RESULTS

Forty-eight of 304 TB diagnostic units in six of the 45 Ugandan Districts were supervised using the checklist. A total of 208 checklists were analysed. The situational analysis of the peripheral diagnostic units at the beginning and at the end of the study showed a marked improvement in laboratory performance in all aspects related to sputum smear microscopy. Individual laboratory performance was monitored over five quarters, and timely response to shortcomings was provided.

CONCLUSION

The systematic use of a standardised laboratory checklist can be considered an important step forward in improving the performance of the peripheral laboratories in Uganda through on-the-spot correction of any identified shortcomings.

ECT and mental retardation: a review and case reports

Electroconvulsive therapy (ECT) in patients with mental retardation has received limited study and is a subject of controversy. Specific difficulties in using ECT for this patient population include diagnostic dilemmas, difficulties with measuring outcome and monitoring side effects, and problems with professional attitudes. We report our experience with two cases in which ECT was applied to treat severe psychotic and catatonic symptoms. In case 1, a 22-year-old male patient with a history of moderate mental retardation, bipolar disorder, and neuroleptic malignant syndrome was admitted to manage his disruptive behavior and psychotic symptoms. The patient responded well to six bilateral ECTs with diminution of his psychotic symptoms and behavioral disturbances. In Case 2, a 39-year-old female patient with a history of mental retardation, schizoaffective disorder, and catatonic symptoms successfully responded to 11 bilateral ECTs. We conclude that ECT can be used safely and effectively in patients with mental retardation and severe or refractory psychotic symptoms.

Notification of occupational and work-related diseases and poisonings in Malaysia, 1997-1998

In 1997, the Ministry of Health Malaysia introduced a surveillance programme for occupational and work-related diseases including poisonings for cases seen in government health facilities. Between June 1997 and November 1998, there were 36 cases of respiratory disease and 95 cases of poisoning by chemicals and pesticides notified while skin diseases were 108 cases. Respiratory diseases reported were predominantly occupational asthma (25%), pneumoconiosis (17%) and infections (39%). The commonest reported skin disease was contact dermatitis (87%). The commonest causes of occupational poisonings were paraquat (19%), organo-phosphates (16%), agro-chemicals excluding pesticides (15%) and gases (10%). The number of cases reported is still relatively few compared to data from other countries, suggesting that there is still considerable under reporting.