Patients Presenting to the Emergency Unit with Gynaecological Lower Abdominal Pain, with and without Pathological Clinical Findings - Service Utilisation, Pain History, Implications

Introduction: Few studies have evaluated the utilisation of emergency gynaecological services, although lower abdominal pain (LAP) is one of the most common symptoms prompting emergency presentation. Although such pain may be caused by potentially life-threatening gynaecological diseases, very often no clinical cause is found. The aim of this study was to describe the characteristics of emergency presentations in order to enable quicker identification of real emergencies in routine clinical practice. Materials and Methods: Standardised, so-called first aid cards of 1066 consecutive patients with LAP presenting acutely to one emergency unit were analysed in this retrospective, cross-sectional study. Results: Over one third of cases did not constitute actual medical emergencies on objective criteria, with investigations yielding "no pathological findings". Parameters were identified that more often lead to hospital admission, e.g. palpation of a mass/resistance or at least one pathological ultrasound finding. In addition, it was found that symptoms of longer duration (average 8 days), and not only acute LAP, were also often experienced by patients as emergencies. Conclusion: A diagnosis of "no pathological findings", which was common in our study, suggests a subjective experience of an emergency from the patient's point of view, although the possibility of unrecognised pathology has to be borne in mind. Apart from functional disorders, the origins of symptoms may include psychosomatic causes and psychosocial problems, which cannot be further defined in the emergency care setting. Also, the phenomenon of increased utilisation of emergency services parallel to the assumed opening hours of routine outpatient care facilities must be seen in a critical light.

Differences in the Frequency of Use of Epidural Analgesia between Immigrant Women of Turkish Origin and Non-Immigrant Women in Germany - Explanatory Approaches and Conclusions of a Qualitative Study

Introduction: The starting point of this study was the considerably lower rate of epidural analgesia use among women of Turkish origin in Germany compared to non-immigrant women in the German Research Foundation (DFG)-funded study entitled "Perinatal Health and Migration Berlin". The study aimed to identify possible differences in the women's attitudes towards epidural analgesia. Methods: Exploratory study with semi-structured interviews, interviews lasting 17 minutes on average were conducted with 19 women of Turkish origin and 11 non-immigrant women at a Berlin hospital. The interviews were subjected to a qualitative content analysis. Results: Immigrant women of Turkish origin in Germany more frequently ascribe meaning to the pain associated with vaginal delivery. They more frequently categorically reject the use of epidural analgesia, 1) for fear of long-term complications such as paralysis and back pain and 2) based on the view that vaginal delivery with epidural analgesia is not natural. Information on epidural analgesia is frequently obtained from a variety of sources from their social setting, in particular, by word of mouth. The women in both groups stated that they would take the decision to use epidural analgesia independent of their partner's opinion. Discussion: The differences in epidural analgesia use rates observed correspond to the women's attitudes. For the immigrant women of Turkish origin in Germany, the attitude towards using epidural analgesia is based in part on misinformation. In order to enable the women to make an informed decision, epidural analgesia could receive a stronger focus during childbirth courses.

Risk Factors Associated With Early Invasive Pulmonary Aspergillosis in Kidney Transplant Recipients: Results From a Multinational Matched Case-Control Study

Risk factors for invasive pulmonary aspergillosis (IPA) after kidney transplantation have been poorly explored. We performed a multinational case-control study that included 51 kidney transplant (KT) recipients diagnosed with early (first 180 posttransplant days) IPA at 19 institutions between 2000 and 2013. Control recipients were matched (1:1 ratio) by center and date of transplantation. Overall mortality among cases was 60.8%, and 25.0% of living recipients experienced graft loss. Pretransplant diagnosis of chronic pulmonary obstructive disease (COPD; odds ratio [OR]: 9.96; 95% confidence interval [CI]: 1.09-90.58; p = 0.041) and delayed graft function (OR: 3.40; 95% CI: 1.08-10.73; p = 0.037) were identified as independent risk factors for IPA among those variables already available in the immediate peritransplant period. The development of bloodstream infection (OR: 18.76; 95% CI: 1.04-339.37; p = 0.047) and acute graft rejection (OR: 40.73, 95% CI: 3.63-456.98; p = 0.003) within the 3 mo prior to the diagnosis of IPA acted as risk factors during the subsequent period. In conclusion, pretransplant COPD, impaired graft function and the occurrence of serious posttransplant infections may be useful to identify KT recipients at the highest risk of early IPA. Future studies should explore the potential benefit of antimold prophylaxis in this group.

Biodegradation of flubendiamide by a newly isolated Chryseobacterium sp. strain SSJ1

Flubendiamide, as a new class (Phthalic acid diamide) of pesticide with a wide spectrum of activity against lepidopteran pests extensively used alone or in combination with other insecticides in agriculture system to get protection from insect pests. Due to high specificity and limited approach towards non-target organism, the extensive use of this pesticide as an alternate for organophosphate and organochlorine pesticides, causing an eventual increase in environmental pollution. Five flubendiamide-resistant bacterial strains were isolated during the present study from agriculture soil considering previous history of pesticide application. Minimal inhibitory concentration of all the isolates showed strain SSJ1 was most efficient flubendiamide resistant organism. Biochemical tests and molecular sequencing of 16s rRNA was carried out which confirmed the isolate as Chryseobacterium indologenes strain SSJ1. UV–visible spectrophotometer study revealed that 89.06 % initial pesticide was removed by the isolate at optimum temperature of 35 °C and pH 7.0 with 5 days incubation period and is further confirmed by high-performance liquid chromatography (HPLC) analysis. Results of the present study however, suggest strain SSJ1 is most resistant to flubendiamide and can possibly be applied in the bioremediation of flubendiamide contaminated soils.

Indications and Route of Hysterectomy for Benign Diseases. Guideline of the DGGG, OEGGG and SGGG (S3 Level, AWMF Registry No. 015/070, April 2015)

Background: Official guideline "indications and methods of hysterectomy" to assign indications for the different methods published and coordinated by the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (OEGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). Besides vaginal and abdominal hysterectomy, three additional techniques have been implemented due to the introduction of laparoscopy. Organ-sparing alternatives were also integrated. Methods: The guideline group consisted of 26 experts from Germany, Austria and Switzerland. Recommendations were developed using a structured consensus process and independent moderation. A systematic literature search and quality appraisal of benefits and harms of the therapeutic alternatives for symptomatic fibroids, dysfunctional bleeding and adenomyosis was done through MEDLINE up to 6/2014 focusing on systematic reviews and meta-analysis. Results: All types of hysterectomy led in studies to high rates of patient satisfaction. If possible, vaginal instead of abdominal hysterectomy should preferably be done. If a vaginal hysterectomy is not feasible, the possibility of a laparoscopic hysterectomy should be considered. An abdominal hysterectomy should only be done with a special indication. Organ-sparing interventions also led to high patient satisfaction rates, but contain the risk of symptom recurrence. Conclusion: As an aim, patients should be enabled to choose that therapeutic intervention for their benign disease of the uterus that convenes best to them and their personal life situation.

In vivo studies on hepato-renal impairments in freshwater fish Cyprinus carpio following exposure to sublethal concentrations of sodium cyanide

Reactive oxygen species is an inevitable composite of aerobic systems that could channelize their lethality by imparting oxidative stress under a stressful environment. Cyanide is an important environmental toxicant that could be responsible in the resulting detrimental health issues of aquatic fauna. The present effort investigates the possibilities of hepato-renal damage in freshwater fish Cyprinus carpio following exposure to sublethal concentrations of sodium cyanide (NaCN). Fish were exposed to 0.1 mg/L of NaCN for 10 days (E1) and 20 days (E2) and were further subjected to recovery for 14 days (R) in NaCN-free medium. Liver tissue exhibited a significant decline in activity of catalase, superoxide dismutase, glutathione peroxidase, and glutathione S-transferase enzymes in exposed fish, unlike in control (C). Subsequent levels of lipid peroxidation elevation at 'E1' and 'E2' suggested oxidative damage to hepatocytes. This was further confirmed through a histopathological evaluation which indicated important findings like lymphocytic infiltration and necrosis in liver and tubular and glomerular degeneration in renal organ. The investigation suggests biochemical and histopathological alterations in fish following exposure to NaCN. Nevertheless, fish upon the recovery period were known to exhibit incomplete recuperation which was indicated by partial restoration tendencies under biochemical and histopathological factions. The study clearly implicated the role of NaCN in emphasizing its toxicity to C. carpio, further suggesting lack of recovery transition at a limited tenure of 14 days. The study might contribute in the course of regulatory surveillance and monitoring of aquatic bodies and may also reflect the possibilities of NaCN contamination during aquaculture practices. Graphical Abstract ᅟ.