Incidence of community-acquired meticillin resistant Staphylococcus aureus hand infections in Tayside, Scotland: a guide to appropriate antimicrobial prescribing

The prevalence of community-acquired meticillin resistant Staphylococcus aureus (ca-MRSA) as an important cause of hand infections has gained much recognition. The clinical impact of this is less well documented in the United Kingdom. This study looks at the incidence of hand infections in an urban Scottish teaching hospital over a 12 month period.

Strain experienced by caregivers of stroke survivors in the Western Cape

Recovery  after  stroke  is  often  incomplete  and  many  stroke  survivors depend on family caregivers. The demands of caring can negatively impact quality  of  life  of  these  carers.  This  study  explores  levels  of strain experienced  by  caregivers  and  the  variables  that  impact  on their strain. A  concurrent,  mixed  method,  descriptive  design  was  utilized. Fifty-seven caregivers  of  stroke  survivors  who  received  rehabilitation at the  Western  Cape  Rehabilitation  Centre  participated  in  the  study.  The Barthel  Index  and Caregiver  Strain  Index  were  utilised  to  collect quantitative  data,  which  was statistically analysed (p <0.05). Qualitative data was collected through semi-structured interviews and thematically analysed.Fifty eight percent of caregivers were experiencing high levels of strain. The following variables significantly impacted on strain namely, caregiver loss of employment (0.04), emotional pressure (0.01), patient residual cognitive and perceptual impairments (0.01), personality changes (0.01) and physical dependency (0.0012).   According to the qualitative data the burden was aggravated by financial problems, patient perceptual problems and patient personality changes. The findings indicate the need for support after discharge, ongoing community support and respite care to enable time off for caregivers.

Compression neuropathy of the common peroneal nerve secondary to a ganglion cyst

There are various causes of the common peroneal nerve palsy. However, common peroneal nerve palsy caused by ganglia are uncommon. We hereby present a case of a 55-year-old man with a 1 week history of foot drop and swelling in the region of the right leg. Physical examination and nerve conduction study studies confirmed a diagnosis of common peroneal nerve palsy. Magnetic resonance imaging (MRI) revealed a lobulated, elongated cystic-appearing mass anterior to the head of fibula. Surgical decompression of the nerve with removal of the mass was performed. Surgical pathology reports confirmed the diagnosis of a ganglion cyst. Findings on physical examination, nerve conduction study and MRI results of this interesting case are being discussed. We wish to highlight that even a tumour which is benign and within the nerve sheath can cause compression.

Abstract P4-09-09: Serum SDF-1: Biomarker of Bone Relapse in the NCIC MA.14 Adjuvant Breast Cancer Trial

Background: Massague et al have shown that breast cancer cell line subpopulations with elevated bone metastatic activity overexpress chemokine receptor 4 (CXCR4), interleukin 11 (IL11), osteopontin (OPN) and connective tissue growth factor (CTGF) (Cancer Cell 3:537, 2003). CXCR4 overexpression results in bone-homing and extravasation of tumor cells in bone. In MA.14, we found that serum β-CTx was associated with bone-only relapse while Basik et.al showed that higher serum stromal cell-derived factor 1 (SDF-1) (ligand for CXCR-4) levels were associated with worse overall event-free survival (EFS) (ASCO 2010). In this study, we examined concurrently the association of both β-CTx and serum SDF-1 with bone relapse.

Methods: Serum β-CTx (Serum CrossLaps, Nordic Biosciences, Copenhagen, DN) was determined in pretreatment sera from 621 of 667 NCIC CTG MA.14 patients. SDF-1 (CXCL12) (R&D Systems, Minneapolis, MN) levels were successfully determined in the 4 month post-treatment serum (SDF-1) for 508 (76%) of the patients. Trial stratification was by administration of adjuvant chemotherapy, axillary lymph node status, and ER and/or PR status. Recurrence-free survival (RFS) was defined as the time from randomization to the time of recurrence of the primary disease. Adjusted and unadjusted Cox step-wise forward multivariate analyses were used to assess the effects of β-CTx, SDF-1, trial therapy and baseline patient characteristics on non-bone, all bone and bone-only RFS; a factor was added if p&lt;=0.05.

Results: Joint assessment of β-CTx and SDF-1 was possible for 493 (74%) of the 667 patients. Imbalances in who was, or was not, included in this subset led to the trial arm of Tamoxifen + Octreotide LAR having a significant longer unadjusted ITT non-bone RFS (p=0.03-0.06). There was shorter time to bone metastasis of any type with higher lymph node involvement (p=0.001), larger T (p=0.02), and higher log SDF-1 (p=0.03). Meanwhile, high categorical and continuous β-CTx was associated multivariately with shorter bone-only RFS (p=0.04 and 0.01, respectively); higher log SDF-1 was only associated with shorter bone-only RFS (p=0.02) when the number of strata were reduced to 2 categories per factor.

Conclusions: Higher serum SDF-1 level may be associated with bone metastasis, although there is less evidence of its relevance in bone-only relapse than there is for the biomarker β-CTx. Serum SDF-1 deserves further study as a promising predictive factor of bone relapse in breast cancer.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-09-09.

Observation of postsoliton expansion following laser propagation through an underdense plasma

The expansion of electromagnetic postsolitons emerging from the interaction of a 30 ps, 3×10¹⁸ W cm⁻² laser pulse with an underdense deuterium plasma has been observed up to 100 ps after the pulse propagation, when large numbers of postsolitons were seen to remain in the plasma. The temporal evolution of the postsolitons has been accurately characterized with a high spatial and temporal resolution. The observed expansion is compared to analytical models and three-dimensional particle-in-cell results, revealing a polarization dependence of the postsoliton dynamics.

Association of the ENPP1 rs997509 polymorphism with obesity in South African mixed ancestry learners

BACKGROUND

The Ectonucleotide Pyrophosphatase Phosphodiesterasel (ENPP1) polymorphisms have been associated with metabolic traits. There is no data on the effect of ENPP1 in South African children or adults.

OBJECTIVE

To investigate the role of K121Q (rs1044498), rs997509 and rs9402349 in obesity and other components of the metabolic syndrome.

DESIGN

A case-control study.

SUBJECTS

Sixty four obese and 64 lean mixed ancestry learners.

SETTING

Western Cape, South Africa.

MAIN OUTCOME MEASURE

The ENPP1 rs997509T allele is independently associated with obesity in children of mixed ancestry from South Africa.

RESULTS

The T allele frequency of the rs997509 differed significantly between obese and controls, p=0.0100 and increased the risk of being obese, p = 0.0238. Furthermore, the estimated effect of the T allele was an increase of 8.6 cm in waist circumference, 10.2 kg in weight and a corresponding 4.9 kg/m2 in BMI. Individuals carrying both the 121Q and the T allele of rs997509 were more associated with obesity (odds ratio = 3.85, 95% CI: 1.13 to 13.09) whilst those carrying the C allele of rs997509 in the presence of 121Q were likely to be lean with odds ratio of obesity 0.41 (95% CI: 0.19 to 0.87).

CONCLUSION

Our findings suggest that ENPP1 polymorphisms may contribute to different metabolic characteristics, all of which are associated with insulin resistance in mixed ancestry children of South Africa. However, a larger study is required to confirm findings of this study.

Broad reactive monoclonal antibodies for rapid identification of enteroviruses show cross-reactivity with chikungunya virus infected cells

In the past decade, enterovirus 71 (EV71) and chikungunya (CHIK) virus have re-emerged periodically causing serious public health problems in Malaysia, since their first emergence in 1997 and 1998 respectively. This study demonstrates that CHIK virus causes similar patterns of cytopathic effect in cultured Vero cells as some enteroviruses. They also show positive cross-reaction on direct immunofluorescence staining using monoclonal antibodies meant for typing enteroviruses. Without adequate clinical and epidemiological information for correlation, CHIK virus isolated from patients with acute febrile rash can be wrongly reported as untypeable enterovirus due to its cross-reactivity with commercial pan-enterovirus monoclonal antibodies. This is due to the diagnostic laboratory being unaware of such cross-reactions as it has not been reported previously. Final identification of the virus could be determined with specific antibodies or molecular typing using specific oligonucleotide primers for the CHIK virus.

Does conventional HRT protect from urogenital atrophy? A prospective study

Urogenital atrophy is a poorly defined entity. This prospective study looked at the effect of conventional HRT on urogenital atrophy. One hundred and sixty-three women were studied in a 12-month period. The incidence of urinary symptoms and clinical evidence of urogenital atrophy was found to be similar in both the 'HRT group' and the 'no HRT group'. This can be explained by the new oestrogen receptor theory. Conventional HRT does not seem to protect women from urogenital atrophy and receptor specific oestrogen therapy may be required to address the problem of urogenital atrophy and postmenopausal urinary symptoms.

Early oral intake after caesarean section performed under general anaesthesia

This study assesses the outcome and benefits of initiation of oral intake 4 hours after caesarean section done under general anaesthesia. After uncomplicated sections, 207 healthy women were alternately assigned either to start oral intake 4 hours after operation, with concurrent stoppage of infusions (n = 106) or to receive 'standard'postoperative care (n = 101). Early oral intake was not associated with increase in gastrointestinal morbidity. Compared with the control group the early intake group had a shorter mean time to first flatus and to first bowel evacuation; initiated breast feeding earlier; ambulated more and were more satisfied. Both groups had similar urine output in the first 24 hours. The nurse's work load decreased when they looked after the early intake group. It is concluded that post-caesarean mothers could be adequately hydrated orally after discontinuing infusions in the early postoperative period without apparent harm and with benefit.

A study on the usefulness of Techlab Entamoeba histolytica II antigen detection ELISA in the diagnosis of amoebic liver abscess (ALA) at Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia

Amoebic serodiagnosis at Hospital Universiti Sains Malaysia (HUSM), Kelantan employs an indirect haemagglutination assay (IHA) which detects anti-Entamoeba histolytica antibodies in patients' serum samples. In an amoebiasis endemic area such as Kelantan, interpretation of a positive IHA result can be problematic due to the high background antibody levels. The TechLab E. histolytica II ELISA is a commercial kit for detection of specific Gal/GalNAc lectin antigen in stool samples, and has been reported to be able to detect the antigen in serum samples from patients with amoebic liver abscess (ALA). Thus in this study we investigated the usefulness of TechLab E. histolytica II ELISA for diagnosis of ALA by comparing it with IHA. This is a cross sectional study involving 58 suspected ALA patients who were admitted to the surgical ward, HUSM, Kelantan. The diagnosis of ALA was established based on clinical symptoms and signs, ultrasound and/or CT scan results. The serum specimens obtained from the patients were tested with IHA (Dade Behring Diagnostics, Marburg, Germany) and TechLab E. histolytica II ELISA (Techlab, Blacksburg, Virginia, USA) according to the manufacturers' instructions. Of the 58 patients, 72.4% (42) were positive by IHA and only 8.6% (5) were positive by the TechLab E. histolytica II ELISA. Agreement between the IHA and ELISA was poor (kappa value 0.019, p=0.691). There was also no correlation between ELISA results and IHA antibody titers. The TechLab E. histolytica II ELISA was not sensitive in detecting amoebic antigen in samples from ALA patients. In addition the results of the test did not correlate with the IHA anti-E. histolytica antibody titres. Therefore, the TechLab E. histolytica II ELISA was found not to be useful for serological diagnosis of ALA at HUSM.

Anterior abdominal wall hydatid cyst; an unusual presentation

BACKGROUND

Hydatid disease is common in sheep rearing communities, often presenting with hepatic cysts in a majority of cases. Musculo-skeletal involvement as occurred in our patient is an unusual manifestation. Hydatid disease should be considered a differential of superficial and soft tissue swellings in our environment.

METHOD

A 27-year-old HIV positive widow on antiretroviral therapy, who presented with intramuscular hydatid cyst in the right lower quadrant of the anterior abdominal wall is presented.

RESULT

Following total excision and chemotherapy with albendazole, the patient did well and remained symptom free two years later.

CONCLUSION

Though a rarity, hydatid cyst does occur in the musculo-skeletal system, presenting as a superficial swelling. Correct surgical management, including the intra-operative avoidance of spillage of cyst fluid demands pre-operative diagnosis or at least a high index of suspicion. Hydatid cyst should therefore be kept in mind in the differential diagnosis of superficial swellings of musculo-skeletal origin in sheep rearing communities such as ours.

Massive lingual teratoma in a neonate

Teratoma of the tongue is a rare entity. We present a male newborn with massive lingual teratoma and cleft palate, which surprisingly did not cause immediate airway obstruction. This case illustrates a huge mass in the oral cavity, which was missed on antenatal ultrasonography because it did not present with polyhydramnios. The mass was excised under general anaesthesia. Histopathologically, it consisted of all three layers of embryonic elements with predominantly glial tissue. Postoperatively, the patient developed hypoglossal nerve palsy, and no recurrence was detected after four years.

Adenoid mast cells and their role in the pathogenesis of otitis media with effusion

INTRODUCTION

Otitis media with effusion (OME) is an inflammation of the middle ear in which a collection of liquid is present in the middle-ear space while the tympanic membrane is intact. The association between adenoid inflammation and OME has long been noted but the exact mechanism is still much debated. We studied the role of adenoid mast cells in the causation of OME.

OBJECTIVE

To study the distribution and role of adenoid mast cells in the causation of OME.

METHODOLOGY

A cross-sectional, prospective study was carried out in the otorhinolaryngologic clinic, department of otorhinolaryngology (ORL), Science University of Malaysia, from June 1999 to September 2001. A total number of 50 cases were studied. Twenty-five of these patients underwent adenoidectomy, while another 25 patients underwent adenoidectomy and myringotomy with ventilation tube insertion. The adenoid specimens from all patients were examined for the number of adenoid mast cells present, using light microscopy and toluidine blue as the staining agent. The results were analysed using SPSS version 10.0 computer software.

RESULT

The population of adenoid mast cells in children with OME was significantly greater than that in children without OME (p=0.000).

CONCLUSION

The increased number of adenoid mast cells in patients with OME suggests that inflammation may play a role in this condition.

The use of high-dimensional biology (genomics, transcriptomics, proteomics, and metabolomics) to understand the preterm parturition syndrome

High-dimensional biology (HDB) refers to the simultaneous study of the genetic variants (DNA variation), transcription (messenger RNA [mRNA]), peptides and proteins, and metabolites of an organ, tissue, or an organism in health and disease. The fundamental premise is that the evolutionary complexity of biological systems renders them difficult to comprehensively understand using only a reductionist approach. Such complexity can become tractable with the use of "omics" research. This term refers to the study of entities in aggregate. The current nomenclature of "omics" sciences includes genomics for DNA variants, transcriptomics for mRNA, proteomics for proteins, and metabolomics for intermediate products of metabolism. Another discipline relevant to medicine is pharmacogenomics. The two major advances that have made HDB possible are technological breakthroughs that allow simultaneous examination of thousands of genes, transcripts, and proteins, etc., with high-throughput techniques and analytical tools to extract information. What is conventionally considered hypothesis-driven research and discovery-driven research (through "omic" methodologies) are complementary and synergistic. Here we review data which have been derived from: 1) genomics to examine predisposing factors for preterm birth; 2) transcriptomics to determine changes in mRNA in reproductive tissues associated with preterm labour and preterm prelabour rupture of membranes; 3) proteomics to identify differentially expressed proteins in amniotic fluid of women with preterm labour; and 4) metabolomics to identify the metabolic footprints of women with preterm labour likely to deliver preterm and those who will deliver at term. The complementary nature of discovery science and HDB is emphasised.

The preterm parturition syndrome

The implicit paradigm that has governed the study and clinical management of preterm labour is that term and preterm parturition are the same processes, except for the gestational age at which they occur. Indeed, both share a common pathway composed of uterine contractility, cervical dilatation and activation of the membranes/decidua. This review explores the concept that while term labour results from physiological activation of the components of the common pathway, preterm labour arises from pathological signalling and activation of one or more components of the common pathway of parturition. The term "great obstetrical syndromes" has been coined to reframe the concept of obstetrical disease. Such syndromes are characterised by: (1) multiple aetiology; (2) long preclinical stage; (3) frequent fetal involvement; (4) clinical manifestations that are often adaptive in nature; and (5) gene-environment interactions that may predispose to the syndromes. This article reviews the evidence indicating that the pathological processes implicated in the preterm parturition syndrome include: (1) intrauterine infection/inflammation; (2) uterine ischaemia; (3) uterine overdistension; (4) abnormal allograft reaction; (5) allergy; (6) cervical insufficiency; and (7) hormonal disorders (progesterone related and corticotrophin-releasing factor related). The implications of this conceptual framework for the prevention, diagnosis, and treatment of preterm labour are discussed.

Appendicitis at Kenyatta National Hospital, Nairobi

BACKGROUND

Appendicitis still remains a diagnostic challenge particularly in women and extremes of age. The incidence of appendicectomy for suspected appendicitis is higher but declining in the developed countries in contrast with a low but increasing incidence in Africa.

OBJECTIVE

To describe the characteristics of appendicitis at Kenyatta National Hospital, with emphasis on epidemiological oddities.

DESIGN

A prospective descriptive study.

SETTING

Kenyatta National Hospital, a 2000 bed teaching and referral hospital in Nairobi, Kenya

SUBJECTS

One hundred and eighty nine patients managed for suspected acute appendicitis between July 2000 and June 2001.

RESULTS

There were 116 males and 73 females. The peak incidence was in the third decade. Sixty four percent of patients were below 30 years of age. The elderly (< 60 years of age) accounted for 1.6% of cases. The rate of false appendicectomy was 18.0%. This rate of negative appendicectomies was 12.9% for males and 30.1% for females. The rate of perforation/gangrene was 29.7%. Hospital stay averaged 6.4 days. Overall morbidity was 12.3%. It was 19.4% in perforated appendicitis and 7.6% in non-perforated appendicitis. There was no mortality.

CONCLUSION

The incidence of appendicitis has increased at Kenyatta National Hospital over the last 30 years. The disease is common in men in their third decade. These odd characteristics warrant further investigations.

Underlay myringoplasty: comparison of human amniotic membrane to temporalis fascia graft

Human amniotic membrane as a homograft material was compared to temporalis fascia to close tympanic membrane perforations in 50 patients with chronic otitis media. Human amniotic membrane was used in 20 patients while temporalis fascia was used in the remaining 30. Anatomical closure of the perforation and reduction of the air-bone gap was measured. The graft uptake showed a 65% success rate for the amniotic membrane and 56.7% for the temporalis fascia at 3 months post-operatively. Significant closure of air-bone gap was observed in the human amniotic group. These results indicate comparable outcomes between human amniotic membrane and the temporalis fascia graft.

Self reported alcohol use in an urban traffic trauma population in Kenya

BACKGROUND

Kenya has a soaring rate of road traffic fatalities. Available evidence suggests significant alcohol-relatedness to trauma. We know little about the prevalence of alcohol-related injuries in Nairobi.

OBJECTIVE

To determine the extent and pattern of alcohol use in subjects admitted following road traffic accident.

DESIGN

A descriptive hospital based survey.

SETTING

Kenyatta National Hospital (KNH)- a university affiliated hospital in Nairobi, Kenya.

RESULTS

The overall incidence of alcohol use was 26.3%. This was higher in males (29.6%) than females (9.1%). Use was 24.4%, 31.0%, 28.6% and 13.6% in the 16-25, 26-35, 36-45 and 46-55 age groups respectively. The mean ages, pre-hospital times and ISS were similar for the AUG and NAUG. The incidence of males, weekend injuries, night collisions, and pedestrian involvement was 94.4%, 69.4%, 41.7%, 77.8% in the AUG and 83.2%, 35.6%, 19.8% and 61.4% in the NAUG respectively. The incidence of head and extremity injuries in AUG was 27.8% and 50% respectively compared to 11.9% and 66.3% in the NAUG. Treatment costs were higher for the NAUG.

CONCLUSIONS

The results suggest a high incidence and potential alcohol-relatedness to road trauma in Nairobi. The study calls for objective evaluation of the extent, interactions and effects of this modifiable trauma factor.

The prevalence and clinical significance of amniotic fluid 'sludge' in patients with preterm labor and intact membranes

OBJECTIVE

To determine the prevalence and clinical significance of amniotic fluid (AF) 'sludge' observed during transvaginal ultrasound examination of the cervix in patients with preterm labor and intact membranes, and in those with uncomplicated pregnancies.

METHODS

This retrospective study included patients with preterm labor and intact membranes (n = 84) and those with uncomplicated term pregnancies (n = 298). The outcome variables included the occurrence of documented microbial invasion of the amniotic cavity (MIAC), histological chorioamnionitis, examination-to-delivery interval, admission to the neonatal intensive care unit (NICU), a composite neonatal morbidity, perinatal death, and delivery within 48 h, 7 days, and < 35 weeks and < 32 weeks. Statistical analysis included Chi-square test, stepwise logistic regression analysis and survival analysis.

RESULTS

The prevalence of AF 'sludge' was 1% (3/298) in patients with uncomplicated term pregnancies and 22.6% (19/84) in those with preterm labor and intact membranes. Among patients with preterm labor and intact membranes: (1) cervical length < or = 15 mm was present in 58.3% (49/84) of the patients; (2) the prevalence of MIAC and histological chorioamnionitis was 12.1% (7/58) and 32.9% (25/76), respectively; (3) the rate of spontaneous preterm delivery within 48 h, 7 days, and < 32 weeks and < 35 weeks of gestation was 13.6% (8/59), 28.8% (17/59), 39.5% (17/43) and 50.8% (30/59), respectively; (4) patients with AF 'sludge' had a higher frequency of positive AF cultures [33.3% (6/18) vs. 2.5% (1/40), P = 0.003] and histological chorioamnionitis [77.8% (14/18) vs. 19% (11/58), P < 0.001] than those without AF 'sludge'; (5) a higher proportion of neonates born to patients with AF 'sludge' was admitted to the NICU [64.3% (9/14) vs. 12.9% (8/62), P < 0.01], had a composite neonatal morbidity [36.8% (7/19) vs. 13.8% (9/65), P = 0.04] and died in the perinatal period [36.8% (7/19) vs. 4.6% (3/65), P = 0.001] than those born to women without 'sludge'; (6) a higher proportion of patients with AF 'sludge' had spontaneous delivery within 48 h [42.9% (6/14) vs. 4.4% (2/45), P = 0.001], within 7 days [71.4% (10/14) vs. 15.6% (7/45), P < 0.001], < 32 weeks [75% (9/12) vs. 25.8% (8/31), P = 0.005] and < 35 weeks [92.9% (13/14) vs. 37.8% (17/45), P < 0.001] than those without AF 'sludge'; and (7) patients with AF 'sludge' had a shorter examination-to-delivery interval than those without AF 'sludge' [AF 'sludge' median, 1 (IQR, 1-5) days vs. no AF 'sludge' median, 33 (IQR, 18-58) days; P < 0.001].

CONCLUSION

The presence of AF 'sludge' in patients with preterm labor and intact membranes is a risk factor for MIAC, histological chorioamnionitis and impending preterm delivery.

Primary breast sarcoma: case report

Primary breast sarcoma is a rare entity occurring in 0.5% of women with breast malignancy. Like in breast carcinoma, delay in its diagnosis has important clinical and treatment implications. The subject of this report presented at our breast unit with advanced breast lesion months after she noticed a small lump in her right breast. She had no clear diagnosis despite several consultations, in-patient treatments at two facilities in the city, breast ultrasonography, breast mammography and three fine needle aspiration cytology (FNAC) examinations. The patient needed multiple blood transfusions. A final FNAC showed ductal carcinoma. Histology following wide excision confirmed high-grade primary stromal breast sarcoma. She required adjuvant combination chemotherapy. A combination of diagnostic failures and patient fault caused delay in subject's treatment. Lesion progression during delay which influenced the pattern of physical morbidity, tumour prognosis and need for adjuvant treatment. Embracing the concept of breast care in dedicated breast units may minimise such treatment delays.

Indirect immunofluorescence test: role in seroepidemiology and serodiagnosis of herpes simplex viral infections

A study was carried out to find out a) the seroprevalence of herpes simplex viral infections (HSV) in and around Chandigarh city, North India and the probable age of acquisition of infection; b) the usefulness of salivary antibody detection in seroprevalence studies; c) role of HSV immunofluorescence antibodies in the sero-diagnosis of herpes simplex encephalitis (HSE) patients. Single blood samples from 306 and paired blood and saliva samples from 48 apparently healthy individuals as well as paired blood and C.S.F. samples from 50 clinically suspected patients of HSE were included in the study proper. The subjects belonged to <6 months to > 30 years age group. Serum, saliva and C.S.F. samples were subjected to in house standardized indirect immunofluorescence test for the detection of HSV antibody. The overall seropositivity was 59.3%, which increased from 37.5% in children less than 10-years of age to 88.9% in individuals above 30 years of age (p<0.001). The maximum titer in less than 10 years children and above 10 years subjects were found to be 40 and 160 respectively. The difference in percentage positivity of HSV antibody in these groups was statistically significant (p<0.001). No difference in the seroprevalence rate was observed between different socio-economic groups and sex. Saliva in comparison to serum showed a sensitivity of 44% and specificity of 100% for the detection of HSV antibodies. Among the suspected HSE patients 4 (8%) could be serologically confirmed. This study indicated the endemicity of HSV infection in this locality. Indirect immunofluorescence test could detect intrathecal HSV antibodies in 8% of suspected HSE patients proving it to be a very useful rapid serodiagnostic tool. However, saliva testing showed limited sensitivity in HSV sero surveys.

Maternal and fetal inflammatory responses in unexplained fetal death

OBJECTIVE

The role of intra-amniotic infection in the etiology of fetal death has been proposed. This study was conducted to determine the prevalence of microbial invasion of the amniotic cavity (MIAC) and the frequency of maternal and/or fetal inflammation in patients presenting with a fetal death.

METHODS

A prospective study was conducted in patients with a fetal death. Amniocenteses were performed for clinical indications (karyotype), as well as to assess the microbiological and cytological state of the amniotic cavity. Fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas. An amniotic fluid white blood cell count and glucose determinations were also performed. Histological examination of the placenta was conducted to identify a maternal inflammatory response (acute chorioamnionitis) or a fetal inflammatory response (funisitis).

RESULTS

This study included 44 patients with intrauterine fetal death. The median gestational age at diagnosis was 30.1 weeks (range 16.3-40.4 weeks). One patient had documented MIAC (1/44). Acute histological chorioamnionitis was found in 20.9% (9/43), but a fetal inflammatory response was observed in only 2.3% (1/43) of cases. One patient had a positive amniotic fluid culture for Streptococcus agalactiae (group B streptococcus).

CONCLUSION

Histological chorioamnionitis was present in 20.9% of cases, but MIAC could be demonstrated with conventional microbiological techniques in only one case. A fetal inflammatory response was nine times less frequent than a maternal inflammatory response (maternal 20.9% vs. fetal 2.3%, p = 0.008) in cases of fetal death.

Mature cystic teratoma: unusual presentation as anterior neck swelling

The unusual presentation of a mature mediastinal cystic teratoma as an anterior neck swelling in a 29-year-old Malay woman is reported.

Cervical changes associated with progestagen-only contraceptives: a team approach

OBJECTIVES

To report clinical, cytologic and colposcopic findings among women using progestagen-only contraceptives for more than 3 years as compared to nonhormonal contraceptives; and to assess the role of nursing in increasing the women's knowledge about Pap test and risk factors for cervical cancer in a developing country set-up.

DESIGN

A prospective cross-sectional comparative study.

SETTING

Family-planning clinic of a tertiary care university hospital.

SUBJECTS

A total of 325 current users of contraceptive methods for more than 3 years.

INTERVENTIONS

Patients were divided into two groups. Group A included 200 patients using progestagen-only contraceptives. While group B comprised 125 patients wearing intrauterine devices. In both groups, the patient was asked about the risk factors and her knowledge about cancer cervix. Clinical and cytologic evaluations of the cervix were done. For each patient, two cervical smears were taken using Ayre's spatula and the endocervical brush.

MAIN OUTCOME MEASURES

Clinical, cytologic and histopathologic cervical abnormalities after prolonged use, and the effect of health education or counseling on the patient's knowledge about preinvasive or invasive cervical cancer.

RESULTS

Initial naked eye assessment of the cervix revealed statistically significant difference between both groups (p < 0.000). However, cytologic examinations revealed positive cases of low- and high-grade squamous intraepithelial lesions (SIL) in 38 (19%) and 22 (17.6%) in the study and control groups, respectively, without any statistically significant difference. There were no statistically significant differences in both groups regarding the frequency of positive cases whether using Ayre's spatula or the endocervical brush. Women's knowledge was compared in the first and last interviews by the nursing staff involved in health education or counseling. It increased in the counseling group; however, the difference was statistically insignificant.

CONCLUSIONS

Prolonged use of progestagen-only contraceptives is not associated with increased risk of abnormal cytologic findings. There was a marked lack of women's knowledge as regards Pap test and cervical cancer with some statistically insignificant improvement after interview and counseling. Extended training of the nursing staff on the procedure of Pap smear would help establish screening programs in the developing countries.