Pseudohypoparathyroidism--another monogenic obesity syndrome

Obesity is a common feature of pseudohypoparathyroidism (PHP) type 1a, but is usually associated with short stature. We describe two children referred because of hyperphagia and excessive weight gain from early infancy. Tall stature in both children initially confounded the diagnosis of PHP, but on follow-up both children developed the typical hormonal abnormalities and Case 2 developed typical skeletal features of Albright hereditary osteodystrophy. PHP type 1a is caused by germline loss of function mutations in the alpha subunit of GS, the ubiquitously expressed G protein that couples many hormone receptors to the adenylate cyclase second messenger system. Recent evidence suggest that the hypothalamic GS protein coupled melanocortin-4 receptor (MC4R) may mediate the central effects of leptin on inhibition of satiety. Similar patterns of infancy onset hyperphagia, excessive weight gain and tall stature are seen in subjects with congenital leptin deficiency and in subjects with MC4R mutations. We suggest that the genetic mutations in GSalpha which underlie PHP type 1a may also directly result in severe obesity. This diagnosis should be considered in any child with a history of hyperphagia and early onset morbid obesity.

Perianal Paget's disease

Perianal Paget's disease is rare. Unlike Paget's disease of the nipple, which is always associated with a subjacent breast adenocarcinoma, perianal Paget's disease is not always associated with a subjacent or visceral malignancy. The treatment recommendation in nearly all reported cases has been surgical excision. Radiation therapy is seldom used as a curative treatment. A case of perianal Paget's disease is described in whom radiation therapy was used with a curative intent after four unsuccessful surgical resections.

Non-Hodgkin's lymphoma complicating chronic pyothorax

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Intramedullary spinal metastasis from carcinoma of the cervix

Intramedullary spinal metastases are rare and prior to the availability of MRI were seldom diagnosed antemortem. Lung and breast carcinoma are the most common primary sources. Cervical carcinoma is the least likely source of intramedullary spinal metastases. A case of intramedullary spinal metastases is described in a 29-year-old woman with squamous cell carcinoma of the cervix.

Contraceptive use and desire for more children in two rural districts of Sierra Leone

Data from a 1993 household survey in rural Sierra Leone revealed that, among women aged 12-49 with at least one child younger than 5, about 13% were using a contraceptive method and about 67% wanted more children. These rates differ from those reported for the 1980s and 1970s, when the contraceptive use rate was around 6% and more than 85% of women desired more children, suggesting a trend towards fertility limitation over the years. Logistic regression analysis showed that contraceptive use was positively associated with age, number of living children, age at marriage, education, and economic status, and negatively associated with Islamic and traditional religious affiliations. Government and other health clinics, hospital, and government paramedical personnel were the major sources of contraceptive supplies. The lower desire for more children might relate to demographic pressure from the recent improved child survival rate compounded by recent economic hardship.

Perianal Paget's disease

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Effect of aqueous extract of Commiphora opobalsamum on blood pressure and heart rate in rats

The cardiovascular effects of aqueous extracts from the branches of Commiphora opobalsamum tree were investigated. The intravenous administration of 4 mg/kg of the aqueous extract depressed systemic arterial blood pressure by 20% (P < 0.01) and reduced heart rate of anaesthetised rats by 14% (P < 0.05). The hypotensive and the bradycardiac effects were immediate and in a dose related manner. The hypotensive effect of C. opobalsamum was inhibited by the pretreatment with atropine sulfate (1-4 mg/kg). These results suggest that the hypotensive effect of C. opobalsamum is due to the activation of muscarinic cholinergic receptors.

An aldose reductase inhibitor and aminoguanidine prevent vascular endothelial growth factor expression in rats with long-term galactosemia

OBJECTIVE

To study the effects of an aldose reductase inhibitor (ARI-509, Wyeth-Ayerst, Princeton, NJ) and aminoguanidine (AMG), agents that have been reported to prevent or delay diabetic retinopathy, on retinal vascular abnormalities and the immunocytochemical expression in the retina of vascular endothelial growth factor (VEGF) in rats maintained for up to 2 years on a 50% galactose diet.

METHODS

Albino rats were placed on a control diet, a diet containing 50% galactose, or the 50% galactose diet containing either ARI-509 or AMG. Treatment with ARI-509 or AMG was initiated at the beginning of the experiment or after 12 months of galactose feeding. After 22 to 24 months, the rats were killed and the retinal vasculature from half of one eye was isolated by trypsin-elastase digestion for semiquantitative evaluation of retinal vascular lesions. The other half of the retina was prepared for immunocytochemistry and stained for the presence of VEGF, factor VIII, vimentin, and glial fibrillary acidic protein. Red blood cells, sciatic nerves, and a portion of the retina from the second eye were assayed for glucose, galactose, fructose, sorbitol, galactitol, and myo-inositol. Red blood cells were also assayed for galactosylated hemoglobin.

RESULTS

Galactose-fed animals developed a vascular retinopathy characterized by severe cellular loss in the retinal capillaries and intensification of periodic acid-Schiff staining of the vascular basement membranes. Some animals also displayed dilation and hypercellularity of vessels in the posterior retina. These changes were substantially reduced in animals receiving ARI-509 from the beginning of the galactose diet, but were unaffected in all of the other treatment groups. None of the rats receiving ARI-509 or AMG treatment, whether initiated from the onset or after 12 months of galactosemia, demonstrated VEGF immunoreactivity. With the exception of the animals receiving ARI-509 from the beginning of the experiment, all of the galactose-fed animals developed dense cataracts within 6 weeks of the beginning of the galactose diet. Galactitol levels in animals receiving ARI-509 were 86% to 93% lower in red blood cells, retina, and sciatic nerve than those in the other galactose-fed groups.

CONCLUSIONS

Although ARI-509 and AMG have different abilities to delay or prevent the diabetic-like retinopathy in galactosemic rats, even when substantial retinal microvascular acellularity occurs, both drugs prevent the immunocytochemical expression of VEGF. These results suggest that factors other than hypoxia may be responsible for VEGF expression in the retina, and that aldose reductase inhibitors and AMG have potential roles in preventing such expression and, thus, perhaps preventing retinal neovascularization.

NGO-promoted women's credit program, immunization coverage, and child mortality in rural Bangladesh

A growing number of non-governmental organizations (NGOs) are adopting the collateral-free credit programs by anchoring them with their social development programs aimed at improved program effectiveness and sustainability. Drawing upon a sample of 3,564 targeted poor households covered by five small NGOs in rural Bangladesh, this study finds that the NGO credit-members as well as those who reside in the NGO program area are higher adopters of child immunization than those in the non-program area. Similarly, the study found that infant and child mortality is lower among the NGO credit members than among the non-members and that under five-year deaths of children progressively decline with the increase in the doses of vaccines. Implications of these findings are discussed in the study.

Hypoglycemic effect of copper(II) acetate imidazole complexes

The effect of copper(II) complexes on glucose metabolism was studied in normal and streptozotocin-induced diabetic rats. The copper(II) complexes used were bis(acetato)tetrakis(imidazole) copper (II), [Cu(OAc)2(Im)4], bis(acetato)bis(2-methylimidazole) copper(II), [Cu(OAc)2(2mIm)2], bis(acetato)bis(1,2-dimethylimidazole) copper(II), [Cu(OAc)2(1,2dmIm)2], and bis(acetato)bis(mu-acetato)tetrakis(N-methylimidazole) copper(II) hexaaquo, [Cu2(OAc)4-(NmIm)4].6H2O. Intramuscular administration of various doses of Cu(OAc)2(Im)4 ranging from 10 to 100 mg/kg body mass to overnight fasted rats decreased blood glucose levels in a dose-dependent manner. Maximum hypoglycemic effect was observed 3 h after administration and lasted for at least 6 h. Treatment with 100 mg/kg body mass of Cu(OAc)2(Im)4 caused hypoglycemic shock, which was irreversible and even lethal. Blood insulin levels were reduced sharply during this hypoglycemic shock. Similar changes in blood glucose level were achieved using Cu(OAc)2(2mIm)2. The same pattern of hypoglycemia, although less pronounced, was observed for Cu2(OAc)4(NmIm)4.6H2O and Cu(OAc)2(1,2dmIm)2. Binary copper(II) acetate complex, the ligand imidazole, and the inorganic form of copper, such as copper(II) chloride, had no significant effect on blood glucose level. These results indicate that the hypoglycemic activity of these complexes varies with the imidazole ligand and structure of the complex.

Immunization coverage and child mortality in two rural districts of Sierra Leone

The study, which is based on data from a household level health survey conducted in early 1993 in the rural areas of the districts of Western Area and Port Loko of Sierra Leone, examines the coverage of an Expanded Program on Immunization (EPI), infant and child mortality, and disease symptoms in children who died under age five in the study area. The results of the study indicated that the infant and child mortality rate per thousand live births declined from about 162 in the mid 1980s to about 77 in 1993. This decline was associated with immunization coverage which considerably increased by 1993, reaching as high as above 60% of the eligible children. The study further reveals that the major symptoms of disease at the time of death of an infant or a child were fever, cough, troubled breathing, and diarrhea in that order. While fever and cough could reflect the persistence of malaria and pneumonia-two major causes of infant and child deaths not covered by existing EPI-the study also revealed that many children failed to take full doses of immunization. Similarly, inadequate coverage of domiciliary oral rehydration therapy (ORT) might have been the reason of high incidence of diarrhea-related deaths. Simple medical technologies to eliminate many of the existing major causes of infant and child mortality in rural Sierra Leone are now available. Perhaps, a strengthened primary health care service, including an extensive rural health care network, aimed at eliminating these diseases, would go a long way in reducing infant and child mortality to irreducible minimum.

Relationship between survival status of first child and subsequent child death

This paper examines the association between infant mortality of the first born and subsequent children using data from rural Bangladesh collected during the period 1971-82. It shows that birth spacing and age of mother at the time of the second birth are important predictors of the survival status of the first child. The findings are discussed in terms of policy implications.

Pharmacokinetics, bioavailability, and safety of montelukast sodium (MK-0476) in healthy males and females

PURPOSE

The safety, tolerability, and pharmacokinetics of intravenous *i.v.) montelukast sodium (Singulair, MK-0476), and the oral bioavailability of montelukast sodium in healthy males and healthy females were studied.

METHODS

This was a two-part study. Part I was a four-period study in males of rising i.v. doses of montelukast sodium (3, 9, and 18 mg) administered as 15-minute constant-rate i.v. infusions (Periods 1-3), followed by a 10-mg oral tablet dose of montelukast sodium (Period 4) under fasting conditions. Part II was a four-period study in females of i.v. montelukast sodium (9 mg) infused over 15 and 5 minutes (Periods 5 and 6, respectively) or injected as a bolus over 2 minutes (Period 7), followed by a 10-mg oral tablet dose of montelukast sodium (Period 8). Plasma samples were collected and analyzed by HPLC.

RESULTS

In males (N = 6), as the i.v. dose of montelukast sodium increased from 3 to 18 mg, the area under the plasma concentration-time curve of montelukast sodium from time 0 to infinity (AUC) increased proportionately. The mean values of plasma clearance (CL), steady-state volume of distribution (Vss), plasma terminal half-life (t1/12), and mean residence time in the body (MRTi.v.) of montelukast sodium were 45.5 ml/min, 10.5 1, 5.1 hr, and 3.9 hr, respectively, and remained essentially constant over the i.v. dosage range. Following oral administration of a 10-mg tablet of montelukast sodium, the AUC, maximum plasma concentration (Cmax), time when Cmax occurred (Tmax), apparent t1/12, mean absorption time (MAT), and bioavailability (F) of montelukast sodium averaged 2441 ng.hr/ml, 385 ng/ml. 3.7 hr, 4.9 hr, 3.4 hr, and 66%, respectively. Following i.v. administration of 9 mg of montelukast sodium to females (N = 6), the values of CL, Vss, t1/2, and MRT i.v. averaged 47.6 ml/min, 9.6 1, 4.5 hr, and 3.6 hr, respectively. Following oral administration of a 10-mg tablet to females, the mean AUC, Cmax, Tmax, apparent t1/2, MAT and F were 2270 ng.hr/ml, 350 ng/ml, 3.3 hr, 4.4 hr, 2.6 hr, and 58%, respectively. These parameter values were similar to or slightly smaller than those in healthy males receiving the same i.v. and oral doses.

CONCLUSIONS

The disposition kinetics of montelukast sodium were linear. Gender had little or no effect on the kinetics of montelukast sodium. Safety results from this study indicate that intravenous doses of montelukast sodium from 3 to 18 mg and a 10-mg oral dose are well tolerated.

Case report: primary non-Hodgkin's lymphoma of the bladder

Primary lymphoma of the bladder is uncommon. Less than 75 cases have been reported so far in the literature. Two further cases are reported here and relevant literature is reviewed.

Case report: malignant fibrous histiocytoma following radiation therapy of fibrous dysplasia

Malignant fibrous histiocytoma commonly occurs spontaneously. In some cases it follows previous therapeutic or incidental irradiation, or miscellaneous pre-existing osseous conditions. Recently, it has been associated with total hip arthroplasty. We report a case of malignant fibrous histiocytoma following radiation therapy of fibrous dysplasia and review the relevant literature.

Single dose pharmacokinetics, safety and tolerability of MK-0476, a new leukotriene D4-receptor antagonist, in healthy volunteers

MK-4076 or sodium 1-(1(R)-(3-(2-(7-chloro-2-quinolinyl)-(E)- ethenyl)phenyl) 3-(1-hydroxy-1-methylethyl)phenyl)propyl)thio)methyl) cycloproprane) acetate is a novel, potent, and specific LTD4-receptor antagonist. The safety, tolerability and plasma drug profiles of single oral doses of MK-0476 (capsules) were evaluated in 18 healthy male volunteers assigned to one of the two parallel 9-subject panels. Under fasting conditions, increasing single doses of 20 to 800 mg were administered in a first part of the study and in a second part, 200 mg MK-0476 was given either as a solution, under fasting conditions, or as capsules, after a standard breakfast. All volunteers completed the study. Side effects, reported by the investigator to be related to study drug, were mild and transient. No laboratory abnormalities were noted. In the evaluated dose range of MK-0476 (20 to 800 mg) the median value of tmax ranged from 2 to 4 h, while the apparent t1/2 value averaged 4 to 5 h. The median tmax value of the 200 mg capsule dose was not significantly different from the median tmax of the 200 mg oral solution dose indicating that neither disintegration nor dissolution is a rate-limiting step for the absorption of MK-0476 from capsules. There was a statistically significant increase in the AUC (geometric mean ratio of fed/fast was 2.52 with 95% confidence interval of 1.25, 5.06) and in Cmax (geometric mean ratio of fed/fast was 1.36 with 95% confidence interval of 0.60, 3.04) when MK-0476 was given together with a breakfast, suggesting an increase in bioavailability.(ABSTRACT TRUNCATED AT 250 WORDS)

Case report: malignant mesothelioma of the tunica vaginalis testis--an indolent course

Malignant mesothelioma of the tunica vaginalis testis is an extremely rare tumour. So far less than 50 cases have been reported in the literature. Radical inguinal orchiectomy appears to be the optimal treatment. Upon recurrence, treatment remains unsatisfactory. A further case is reported here, where the disease ran an indolent course despite several recurrences after initial treatment.

Poor Women's Participation in Credit-based Self-employment: The Impact on their Empowerment, Fertility, Contraceptive Use, and Fertility Desire in Rural Bangladesh

By analysing a 1992 national level household sample survey data collected from the female recipients of collateral-free loans of three relatively large rural development agencies in Bangladesh-GB, BRAC, and BRDB-the present study shows that the participation in income-generating projects by poor rural women had been associated with their increased level of contraceptive use, decreased level of fertility, elevated level of desire for no more children, and enhanced level of empowerment. Some of these effects were much higher than those of the corresponding levels for Bangladesh as a whole, indicating the possible additional effect of income-generating projects as well as the effects of their population-education components. The implications of these findings for an integrated development strategy m Bangladesh are discussed.

Infant and child mortality levels and trends in Bangladesh

Infant and child mortality levels and trends in Bangladesh are examined using data from the 1989 Bangladesh Fertility Survey. Both infant and child mortality declined from the mid 1970s but infant mortality declined more quickly. The level of infant mortality in 1989 was around 100 per 1000 live births while child mortality (5q0) was 200 per 1000 live births. Life table analysis confirms the change in infant and child mortality. The decline in infant mortality is attributed to the introduction of improved public health measures and access to maternal and child health services.

Replication-deficient adenovirus induces expression of interleukin-8 by airway epithelial cells in vitro

Preclinical studies with first-generation adenovirus (Ad) vectors administered in vivo to the respiratory tract have demonstrated a nonspecific host response consisting, in part, of parenchymal neutrophil accumulation followed by mononuclear cell and macrophage accumulation. We hypothesized that the mechanism for this host response might be the elaboration of interleukin-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) from the airway epithelium following the exposure to Ad. To evaluate this hypothesis, we infected A549 cells (a human-derived lung epithelial cell line) in vitro with an adenovirus type 5 (Ad5)-based vector expressing a nuclear targeted beta-galactosidase enzyme (Av1LacZ4). We found that cellular transduction was efficient, resulting in gene delivery to 85.5% +/- 3.9% of the cell monolayer after 96 hr. Importantly, IL-8 mRNA transcript levels in Av1LacZ4-transduced cells were significantly higher than uninfected controls by 24 hr and remained elevated for 96 hr. IL-8 protein secretion from Av1LacZ4-transduced cells was increased for the same period. The Av1LacZ4-transduced A549 cells also showed a neutrophil chemoattractant activity higher than control cells, measurable at 24 hr, and persisting for 96 hr. The chemoattractant activity could be neutralized by a specific monoclonal antibody to IL-8. Whereas Av1LacZ4 transduction induced IL-8 gene expression, there was a lack of expression of MCP-1 by A549 cells. These observations demonstrate that the gene delivery to the airway epithelium using the Ad5-based expression vector results in IL-8 gene activation in these cells, which may contribute to the described inflammatory host response.

Growth factor localization in choroidal neovascular membranes of age-related macular degeneration

PURPOSE

Because several polypeptide growth factors are known to influence capillary endothelial cell mitogenesis, the authors investigated the presence of some of these molecules in choroidal neovascular membranes (CNVMs) removed surgically from human subjects with age-related macular degeneration (ARMD).

METHODS

The authors performed immunoelectron microscopic studies on surgically removed submacular CNVMs from nine subjects with ARMD and from one subject with ARMD whose eye was studied after death. These were compared with retinal pigment epithelial (RPE) and choroidal tissue from eight normal subjects whose eyes were received after death and one received after massive trauma.

RESULTS

RPE cells from the CNVMs were strongly immunoreactive for acidic and basic fibroblast growth factor (aFGF and bFGF) and for transforming growth factor beta (TGF beta). Some of the immunoreactivity was intracytoplasmic, but most was intralysosomal. In addition, some choriocapillary endothelial cells located close to the RPE layer in these CNVMs were immunopositive for bFGF and for FGF receptor. Reaction product for these two substances was located at regular intervals along the endothelial plasma membrane on both the anteluminal and the luminal side of the cells, suggesting a physiological reaction between the growth factor and its receptor. Choriocapillary endothelial cells deeper within the stroma were unreactive to bFGF and FGF receptor antibodies. There was little immunoreactivity for the growth factors in RPE or choriocapillary endothelial cells from normal eyes. The aFGF and bFGF immunoreactivity was highly specific because aFGF positivity was abolished when the antibody was incubated with 10(-6) M aFGF but not a with the same concentration of bFGF, whereas bFGF immunoreactivity was abolished by incubation of the antibody with bFGF but not with aFGF. RPE cells from normal eyes and from eyes affected by ARMD showed strong cytoplasmic immunoreactivity to antibodies for cytoplasmic retinaldehyde-binding protein and superoxide dismutase and weak reactivity to antibodies for vimentin.

CONCLUSIONS

These results are consistent with the hypothesis that one or both FGFs are causally related to the development of choroidal neovascularization. The authors have reported similar observations in experimental choroidal neovascularization in pigmented rats after red krypton laser photocoagulation. TGF beta may serve to modulate the effects of these mitogens. The authors suggest that growth factor production is induced in RPE cells after physical or chemical damage. Because of the damage to these cells, FGF molecules can be released from the cells despite the absence of a "signal sequence" in the DNA coding for FGF production.

Factors affecting desired family size in Bangladesh

Factors affecting desired family size in rural Bangladesh are examined using data from contraceptive prevalence surveys conducted between 1983 and 1991. The analysis suggests that mothers having two sons and one daughter are more inclined to perceive their family as complete than those having three sons and no daughter. Logistic regression analysis indicates that important determinants of desire for more children are age of woman, current contraceptive use status, work status, and family planning worker's visit. The policy implications of these findings are discussed.

Recent evidence on trends and differentials in Bangladesh fertility: an update

A comparison of contraceptive and fertility data for 1985-91 with data for 1983 shows that fertility has continued to decline in Bangladesh, in all segments of society. The magnitude of decline varied according to educational level, region and urban-rural locality. The percentage decline in total marital fertility rate was somewhat higher among urban than rural residents; educated women showed greater declines than uneducated, increasing the overall educational differences in total fertility by 1991. Factors contributing to the recent decline in fertility are discussed.

Factors influencing child mortality in Bangladesh and their implications for the national health programme

"This study attempts to estimate by indirect estimation technique the levels of infant and child mortality in Bangladesh using the 1989 Bangladesh Fertility Survey (BFS). The levels of infant and child mortality obtained from the 1989 BFS indicate substantial improvements in child survival, although the fall in infant mortality has been faster than the fall in child mortality."

Immunization coverage, infant morbidity and infant mortality in Freetown, Sierra Leone

The study, which is based on data from a household level health survey conducted in 1990 in Freetown, Sierra Leone, examines the coverage of an Expanded Program on Immunization (EPI), infant mortality, and infant morbidity among children in Greater Freetown, capital of Sierra Leone. The results of the study indicate that there was a decline in infant mortality in the recent period of the survey, 1988-89, compared to earlier periods. This decline seemed to have been the result of immunization coverage, which considerably increased by 1989-90, reaching above 70% of the children under age 5. The study further reveals that the increased immunization coverage of children and their mothers might have considerably reduced the incidence of tetanus. While reduction of tetanus might have played the leading role in the latest reduction in infant mortality, the incidence of diarrhea, measles, and malaria continued to be high, suggesting that the increase in the quality and quantity of basic immunizations, oral therapy for diarrheal disease, and provision of chloroquine and improved drugs for malaria disease could further reduce most of the deaths from these prevailing diseases among children under age 5.

Role of D-1 and D-2 receptors in apomorphine-induced pecking in chicks

The possible involvement of subtypes of dopamine (DA) receptors in pecking induced by apomorphine (APO) in chicks was studied. D-1/D-2 agonist APO dose-dependently induced pecking in chicks. The APO response was decreased in animals pretreated with either the D-2 receptor antagonist sulpiride or the D-1 receptor antagonist SCH 23390. The inhibitory effects of both antagonists were also dose dependent. The pecking induced by APO was completely inhibited in animals pretreated with a combination of SCH 23390 and sulpiride and was potentiated with reserpine. Single administration of D-2 agonist quinpirole or D-1 agonist SKF 38393 did not induced pecking, although quinpirole, but not SKF 38393 caused considerable response in reserpine or reserpine + alpha-methyl-p-tyrosine (AMPT)-treated animals. When quinpirole was administered with SKF 38393, a slight pecking response was shown. This was also potentiated in reserpine or reserpine + AMPT-treated chicks. The results may indicate that both D-1 and D-2 DA receptors are involved in pecking induced by APO, and reserpine treatment caused the sensitization of the D-2 receptors for the induction of pecking in chicks.

Recent evidence on trends and differentials in Bangladesh fertility

Recent data from Bangladesh reveal evidence of some fertility decline. Although fertility increased among younger age groups between 1975 and 1983, it was offset by a decrease in fertility in the older age groups, resulting in a slight overall decrease in total fertility in 1983. Fertility was lower among urban residents, educated mothers and contraceptive users than among rural residents, uneducated mothers and contraceptive non-users, respectively, particularly in 1983.

Menstrual regulation training and service programs in Bangladesh: results from a national survey

Using nationally representative sample survey data collected in 1986, this study evaluates the training and service programs for menstrual regulation (MR), and estimates the number of MR procedures performed during 1986, in Bangladesh. The results show that most of the MR providers, who received either formal or informal training, were physicians and family welfare visitors (paramedics) employed by the government. They were trained in various aspects of MR performance, including contraindications and complications associated with MR, the techniques of MR performance and follow-up procedures, and maintenance and sterilization of MR equipment. Averages of 20.5 and 13.0 MR procedures were performed by formally and informally trained physicians, respectively, in the three-month period preceding the date of interview. The corresponding average numbers for formally and informally trained family welfare visitors were 11.6 and 9.1, respectively. A total of 241,442 MR cases were estimated to have been performed between August 1985 and July 1986.

Characteristics of traditional midwives and their beliefs and practices in rural Bangladesh

This study has analyzed the characteristics, beliefs and practices of midwives in rural Bangladesh. The midwives were mainly above age 30, married or widowed, and illiterate. Most of them learned their midwifery from informal sources such as female relatives or neighbours. Often, during pregnancy, childbirth, and post-partum period, midwives imposed dietary restriction on the mothers. Similarly, devices used in the cutting of the umbilical cord and placenta were not properly sterilized and potentially dangerous substances were applied at the navel after cutting the umbilical cord or placenta. There was a practice of withholding breast-feeding up to 3 days after the birth of a child. However, there were also some beliefs or practices among the midwives that could be regarded as based on scientific understanding such as the practice of cutting the umbilical cord by boiled razor blade or the belief that child death could occur from tetanus caused by the unsterilized device used in the cutting of the umbilical cord.

Community health services and health care utilization in rural Bangladesh

The study, which is based on data from two household level health surveys conducted in 1976 and 1987 in the Companiganj area of rural Bangladesh, examines the premise that the utilization of public health care services can be increased by increasing the availability and accessibility of effective medicines to the public and by improving the disease recognition and management by the health practitioners. The results of the study suggest that the availability and accessability of modern effective medicines through the provision of decentralized community-based rural health services, by a well-trained and well-managed field personnel structure, had an incremental impact on the utilization of modern health care from a rural health center and its subcenters. The study further reveals that, in 1976 as well as in 1987, the overwhelming majority of the rural Bangladesh population were using modern Western medical practitioners, although most of these practitioners were informally trained or self-trained without any formal medical degrees or training. It is concluded that the persons responsible for health program planning and health program implementation need to ensure that the access to basic public health care services be made broad enough to cover the majority of the rural population through a system of decentralized curative and preventive services, as well as through a system of adequate training and deployment of health professionals, including training programs to improve the quality of medical services offered by the informal and self-trained practitioners of modern medicines.

Menstrual regulation in Bangladesh: an evaluation of training and service programs

This article evaluates the performance of three urban menstrual regulation (MR) training and service programs in Bangladesh. Virtually all of the MR providers including physicians and paramedics in the three centers received training in various MR procedures by means of demonstration or class lectures. However, a significant proportion of the trained MR providers were unable to render proper MR services due to the lack of clinical facilities and lack of equipment. Analysis of follow-up data for MR clients revealed that those women who utilized MR procedures offered through the centers had an average of about three live births. Physician providers were more likely to serve clients from a higher socioeconomic strata, while paramedical providers were more likely to serve MR clients from lower socioeconomic strata or agricultural background. Most of the clients receiving MR services were ever and current users of contraceptives and developed fewer complications from MR procedures than those served by untrained traditional herbalists, healers or birth attendants.

Infant and child mortality in Bangladesh

Socioeconomic differences and trends in infant and child mortality in Bangladesh are examined using data from the 1975 World Fertility Survey and 1979 Contraceptive Prevalence Survey. There is evidence of some recent decline in infant and child mortality. Logit analysis of infant and child mortality indicates that sociodemographic variables such as mother's education, recent period, or higher birth orders, had significant independent effects upon the reduction of infant and child mortality. Other variables such as fetal loss, father's education, or land ownership had no consistent significant effect of upon infant and child mortality. On the other hand, the effect of urban residence on infant and child mortality was positive after the control of the sociodemographic variables. Mere concentration on the supply of modern medical services may bring limited returns unless they are reinforced by appropriate social changes, in particular those affecting the socioeconomic status of women.

Trends and Differentials in Knowledge, Ever Use, Current Use, and Future Intended Use of Contraceptives in Rural Bangladesh: Evidence from Three Surveys

The study examines the trends and differentials in knowledge, ever .use, current use, and future intended use of contraceptives in rural Bangladesh. Using data from three national-level surveys between 1968 and 1977, the study finds that there had been an increase in contraceptive knowledge, ever use, current use, and future intended use over the years. Although estimated logit regression models indicated that more educated women and women having higher parity were significantly more likely to adopt or to intend to adopt contraceptives in the future, other socio-economic indicators such as regional development or non-agricultural occupations did not lead to higher contraceptive use or future intended use of contraceptives. Somewhat similar levels of differences in ever, current, and future intended use of contraceptives among socio-economic groups persisted over the years. Implications of these findings are discussed in the paper.

Son preference in Bangladesh: an emerging barrier to fertility regulation

This study investigates the effect of son preference on contraceptive use and desire for additional children using national level survey data from Bangladesh for the years 1969 and 1979. Son preference had a negative effect on contraceptive use and a positive effect on the desire for additional children regardless of socioeconomic and demographic characteristics. This adverse effect of son preference on fertility regulation seemed to have persisted over the years. Relevant socioeconomic conditions in Bangladesh are described.

Non-Hodgkin's lymphoma following successful treatment of Hodgkin's disease

Two cases of non-Hodgkin's lymphoma complicating the successful treatment of Hodgkin's disease are presented. A review of the literature reveals that it is a relatively uncommon but significant complication of therapy for Hodgkin's disease.