A comparative monitoring of maternal and cord serum polychlorinated biphenyls levels from Iranian pregnant women between industrial and urban areas

The aim of this study was to compare maternal and fetal exposure to PCBs in pregnant women from a petrochemical and gas area (PGA) and an urban area (UA), by the analyses of serum samples from mother (MS) and cord (CS). After liquid-liquid extracting, samples were analyzed for 12 PCBs congeners by gas chromatography mass spectrometer. Adjusted multiple linear regression models showed the mean levels (μg/L) of total PCBs in the MS and CS samples from the PGA (1.70 ± 0.81 and 1.19 ± 0.43) were significantly higher than those from UA (1.64 ± 0.75 and 1.07 ± 0.38). PCB 44 was predominant in both MS and CS serum samples, and in both PGA (0.80 ± 0.70 and 0.76 ± 0.67) and UA (0.79 ± 0.39 and 0.67 ± 0.34). A negative correlation was found for PCB 52 as one-unit increase in the cord serum levels was associated with 0.024 g decrease in newborn weight. Similarly, one-unit increase in the maternal serum PCB 18 concentrations were associated with 0.09 and 0.086 cm decrease in newborn height and head circumference. The serum levels of PCB 18 and 52 in the mothers who consumed meat and milk at least 1 meal/week were higher than these who consumed meat and milk never or less than 1 meal/month. The findings in this study indicated that higher maternal exposure to PCBs, as result of living in an industrialized area, leads to higher PCBs accumulation in cord blood, which consequently passes to the developing fetus. These events may cause harmful effects on both them in-utero and afterbirth growth and development.

A descriptive analysis of pharmacological management of aggression and/or agitation in patients with traumatic brain injury in a Southwest Virginia inpatient population

WHAT IS KNOWN AND OBJECTIVE

Traumatic brain injury (TBI) is a major cause of disability, and it has been associated with agitation and aggression. In a previous study, we reviewed the literature to identify evidence-based pharmacological agents for treatment of agitation in TBI. Based on the results of our previous study that summarizes the findings of several systematic reviews, the use of haloperidol and benzodiazepines is not supported by the available evidence while the use of amantadine, beta blockers, antiepileptics and methylphenidate is supported by the limited available evidence. In this study, we describe the psycho-pharmacological agents that were administered to patients with agitation and/or aggression in the context of TBI in inpatient facilities of a private, non-profit health care system in southwest Virginia. We will also compare the psycho-pharmacological agents ordered before and after psychiatric consultation.

METHODS

Adult patients who were admitted to Carilion Clinic's inpatient facilities from March 30, 2013, to March 30, 2018, had a diagnosis of TBI, and received psychiatric consultation for agitation and/or aggression were enrolled in this study. A retrospective review of electronic medical records was conducted by researchers and data were collected on the following measures: ordered psycho-pharmacological agents, frequency, dosing and duration of orders, whether each administered psycho-pharmacological agent was started before or after psychiatric consultation, and psycho-pharmacological agents prescribed upon discharge.

RESULTS AND DISCUSSION

About 68% of patients were started on benzodiazepines and/or typical antipsychotics and 23% of patients were subsequently discharged on these medication categories. Only 23% of patients were ordered to receive medications supported by the evidence such as amantadine, beta blockers or antiepileptics. The percentage of patient-days with an order to receive typical antipsychotics significantly decreased following psychiatric consultation (p = 0.0056), but the percentage of patient-days with an order to receive benzodiazepines significantly increased following psychiatric consultation (p = 0.0001). This finding remained statistically significant after excluding patients with active or unclear alcohol/benzodiazepine withdrawal (p < 0.0001).

WHAT IS NEW AND CONCLUSION

This study demonstrates the widespread use of typical antipsychotics and benzodiazepines in the management of agitation in TBI and the importance of multidisciplinary collaboration, research and education of providers to improve patient care.

Maternal and fetal exposure to metal (loid)s, maternal nutrition status, and impact on prenatal growth in an energy rich zone and an urban area along the Persian Gulf

The main purposes of the study were to determine whether maternal and cord blood (MB and CB) levels of metal (loid)s (MLs) are different between industrial and urban areas. Subjects were derived from the petrochemical and gas area (PGA) of Asaluyeh County and the urban area (UA) of Bushehr County in Iran. Adjusted models revealed significant differences between the PGA and UA for maternal Fe, Cu, Mg, Cd, Zn, Ni, V and Pb levels, likewise cord Cu, V, Pb and Ni levels, which were higher in the PGA. Unadjusted models revealed there were decreases in neonatal weight and head circumference by 16.550 g and 0.059 cm, respectively for each Ln unit increase in maternal Cr levels. The mean blood levels of MLs significantly associated with food consumption frequency. The MLs were detected at higher levels in the body's fetuses and their mothers who resided in the PGA than those from the UA. So, the fetuses of mothers living in an industrial areas may be at higher risk from anthropometric measures. The impact of prenatal exposure to MLs on prenatal growth should be considered for better understanding in the further studies.

Cross-tissue immune cell analysis reveals tissue-specific features in humans

Despite their crucial role in health and disease, our knowledge of immune cells within human tissues remains limited. We surveyed the immune compartment of 16 tissues from 12 adult donors by single-cell RNA sequencing and VDJ sequencing generating a dataset of ~360,000 cells. To systematically resolve immune cell heterogeneity across tissues, we developed CellTypist, a machine learning tool for rapid and precise cell type annotation. Using this approach, combined with detailed curation, we determined the tissue distribution of finely phenotyped immune cell types, revealing hitherto unappreciated tissue-specific features and clonal architecture of T and B cells. Our multitissue approach lays the foundation for identifying highly resolved immune cell types by leveraging a common reference dataset, tissue-integrated expression analysis, and antigen receptor sequencing.

Pharmacological Treatment of Agitation and/or Aggression in Patients With Traumatic Brain Injury: A Systematic Review of Reviews

OBJECTIVE

To systematically review the available literature on the pharmacological management of agitation and/or aggression in patients with traumatic brain injury (TBI), synthesize the available data, and provide guidelines.

DESIGN

Systematic review of systematic reviews.

MAIN MEASURES

A literature review of the following websites was performed looking for systematic reviews on the treatment of agitation and/or aggression among patients with TBI: PubMed, CINAHL, DynaMed, Health Business Elite, and EBSCO (Psychology and behavioral sciences collection). Two researchers independently assessed articles for meeting inclusion/exclusion criteria. Data were extracted on year of publication, reviewed databases, dates of coverage, search limitations, pharmacological agents of interest, and a list of all controlled studies included. The included controlled studies were then examined to determine potential reasons for any difference in recommendations.

RESULTS

The literature review led to 187 citations and 67 unique publications after removing the duplicates. Following review of the title/abstracts and full texts, a total of 11 systematic reviews were included. The systematic reviews evaluated the evidence for safety and efficacy of the following medications: amantadine, amphetamines, methylphenidate, antiepileptics, atypical and typical antipsychotics, benzodiazepines, β-blockers, and sertraline.

CONCLUSIONS

On the basis of the results of this literature review, the authors recommend avoiding benzodiazepines and haloperidol for treating agitation and/or aggression in the context of TBI. Atypical antipsychotics (olanzapine in particular) can be considered as practical alternatives for the as-needed management of agitation and/or aggression in lieu of benzodiazepines and haloperidol. Amantadine, β-blockers (propranolol and pindolol), antiepileptics, and methylphenidate can be considered for scheduled treatment of agitation and/or aggression in patients with TBI.

Diet, exposure to polycyclic aromatic hydrocarbons during pregnancy, and fetal growth: A comparative study of mothers and their fetuses in industrial and urban areas in Southwest Iran

The presence of polycyclic aromatic hydrocarbons (PAHs) in the fetal environment is a high-priority concern due to the fetus being more sensitive than adults to these ubiquitous xenobiotics. The aim of the present study was to compare the maternal and fetal serum levels of ΣPAHs and their effects on fetal growth in an industrial and an urban area in Southwest Iran. The industrial area was the petrochemical and gas area (PGA) of the Central District of Asaluyeh County and the urban area (UA) was the Central District of Bushehr County, Ninety-nine maternal serum (MS) and 99 cord serum (CS) samples from the PGA and 100 MS and 100 CS samples from the UA were collected during May 2018 to February 2019. The mean concentrations of ΣPAHs were significantly (p < 0.05) higher in the PGA than the UA in both MS (157.71 vs. 93.56 μg/L) and CS (155.28 vs. 93.19 μg/L) samples. Naphthalene (NAP) was the predominant PAH detected in all the studied samples. Significant negative associations were found between birth weight and anthracene (ANT) level in MS (β = -22.917, p = 0.032; weight decrement = 22.917 g for a 1 μg/L increase in ANT); head circumference and chrysene (CHR) level in MS (β = -0.206, p = 0.023; head circumference decrement = 0.206 cm for a 1 μg/L increase in CHR); and birth height and NAP level in CS (β = -0.20, p = 0.005; height decrement = 0.20 cm for a 1 μg/L increase in NAP). Maternal diet had a significant effect on the serum levels of PAHs. The results of this study showed that transmission of PAHs from mother to fetus through the cord blood is an important issue and mothers who live in industrial areas and consume PAH-containing foodstuffs, and their fetuses, are more at risk than those living in a non-industrial urban area.

Effect of Adding Human Chorionic Gonadotropin to The Endometrial Preparation Protocol in Frozen Embryo Transfer Cycles

In this article which was published in Int J Fertil Steril , Vol 6, No 3, Oct-Dec 2012, on Pages: 175-178, the authors found that Four sam ples from the control group were incorrectly included in the study. 4 cases were removed from the data and the data were re-analyzed. The results in Tables 1-3 are corrected. The authors would like to apologies for any inconvenience caused.

A Systematic Review of Durum Wheat: Enhancing Production Systems by Exploring Genotype, Environment, and Management (G × E × M) Synergies

According to the UN-FAO, agricultural production must increase by 50% by 2050 to meet global demand for food. This goal can be accomplished, in part, by the development of improved cultivars coupled with modern best management practices. Overall, wheat production on farms will have to increase significantly to meet future demand, and in the face of a changing climate that poses risk to even current rates of production. Durum wheat [Triticum turgidum L. ssp. durum (Desf.)] is used largely for pasta, couscous and bulgur production. Durum producers face a range of factors spanning abiotic (frost damage, drought, and sprouting) and biotic (weed, disease, and insect pests) stresses that impact yields and quality specifications desired by export market end-users. Serious biotic threats include Fusarium head blight (FHB) and weed pest pressures, which have increased as a result of herbicide resistance. While genetic progress for yield and quality is on pace with common wheat (Triticum aestivum L.), development of resistant durum cultivars to FHB is still lagging. Thus, successful biotic and abiotic threat mitigation are ideal case studies in Genotype (G) × Environment (E) × Management (M) interactions where superior cultivars (G) are grown in at-risk regions (E) and require unique approaches to management (M) for sustainable durum production. Transformational approaches to research are needed in order for agronomists, breeders and durum producers to overcome production constraints. Designing robust agronomic systems for durum demands scientific creativity and foresight based on a deep understanding of constitutive components and their innumerable interactions with each other and the environment. This encompasses development of durum production systems that suit specific agro-ecozones and close the yield gap between genetic potential and on-farm achieved yield. Advances in individual technologies (e.g., genetic improvements, new pesticides, seeding technologies) are of little benefit until they are melded into resilient G × E × M systems that will flourish in the field under unpredictable conditions of prairie farmlands. We explore how recent genetic progress and selected management innovations can lead to a resilient and transformative durum production system.

Effect of low-dose aspirin on the development of ovarian hyperstimulation syndrome and outcomes of assisted reproductive techniques in the women with PCOS, a randomized double-blinded clinical trial

OBJECTIVE

Ovarian hyperstimulation syndrome (OHSS) is a major complication of assisted reproductive technologies (ART). Polycystic ovary syndrome (PCOS) is a risk factor for OHSS. The aim of this randomized clinical trial (RCT) was to study the effect of low-dose aspirin (LDA) on the development of OHSS and ART outcomes in PCOS during ART.

MATERIALS AND METHODS

This double-blinded placebo controlled RCT was performed on 232 PCOS infertile women in their first ART cycles during 2010-2016. LDA and placebo capsules were prepared, packed and specified by code numbers in similar shapes. One package was given to every woman and asked to take one capsule/day since the 21st day of her cycle prior to the gonadotropin stimulation. Gonadotropin releasing hormone agonist long protocol and triggering by human chorionic gonadotropin were used. Development of moderate to severe OHSS and their ART outcomes were documented then the codes were broken and data analyzed. Chi-square and Mann-Whitney U tests were used for the statistical analyses.

RESULTS

Eighteen cases that did not follow the study design were excluded. 214 cycles remained for the final analyses with 109 cases in LDA and 105 in the placebo group. Rate of the moderate to severe OHSS in LDA group was 34.9% compared to 30.5% in placebo group (P = 0.494). Fertilization rate was 71.8% vs 65.1% (P = <0.001) and the mean number of grade III embryos were 3.28 ± 3.53 vs 1.46 ± 1.42 (P = 0.014) in LDA and placebo groups, respectively. The mean number of the oocytes in different grades, total and frozen embryos also implantation and clinical pregnancy rates were not different between the groups.

CONCLUSION

Moderate to Severe OHSS was not decreased but fertilization rate and the mean number of poor quality embryos were increased in LDA arm.

REGISTRATION NUMBER

IRCT 201105216541N1.

Early childhood investment impacts social decision-making four decades later

Early childhood educational investment produces positive effects on cognitive and non-cognitive skills, health, and socio-economic success. However, the effects of such interventions on social decision-making later in life are unknown. We recalled participants from one of the oldest randomized controlled studies of early childhood investment-the Abecedarian Project (ABC)-to participate in well-validated interactive economic games that probe social norm enforcement and planning. We show that in a repeated-play ultimatum game, ABC participants who received high-quality early interventions strongly reject unequal division of money across players (disadvantageous or advantageous) even at significant cost to themselves. Using a multi-round trust game and computational modeling of social exchange, we show that the same intervention participants also plan further into the future. These findings suggest that high quality early childhood investment can result in long-term changes in social decision-making and promote social norm enforcement in order to reap future benefits.

Serum Levels of Angiopoietin-Like Protein 2 and Obestatin in Iranian Women with Polycystic Ovary Syndrome and Normal Body Mass Index

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disease in women of reproduction age and a major cause of anovulatory infertility. Insulin resistance plays an important role in the development and durability of this disorder. ANGPTL2 is known as an inflammatory mediator derived from adipose tissue that links obesity to systemic insulin resistance, and obestatin has been identified as a hormone associated with insulin resistance that suppresses food reabsorption, inhibits gastric emptying and decreases weight gain. The aim of this study was to evaluate serum levels of ANGPTL2 and obestatin in PCOS women with normal body mass index (BMI). Methods: In this case-control study, 26 PCOS women based on the Rotterdam 2003 diagnostic criteria as the case group and 26 women with normal menstrual cycles as the control group were enrolled. Serum levels of ANGPTL2, obestatin, insulin and other hormone factors related with PCOS were measured by ELISA method and biochemical parameters were measured by an autoanalyzer. Data were analyzed by independent samples-T test, Chi Square, Correlation and a single sample Kolmogrov–Smirnov test using SPSS software, version 16. Results: There were no significant variations in the amount of ANGPTL2, obestatin, cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein, cholesterol, creatinine and dehydroepiandrosterone-sulfate between the two groups. There were significant increases in serum levels of fasting blood sugar (p = 0.01), insulin (p = 0.04), homeostasis model assessments of insulin resistance (p = 0.04), testosterone (p = 0.02), luteinizing hormone (p = 0.004), luteinizing hormone/follicle stimulating hormone (p = 0.006) and prolactin (p = 0.04) in case group compared to the control group. A significant positive correlation was observed between ANGPTL2 and insulin (p = 0.02), HOMA-IR (p = 0.01) and, on the other hand, a significant negative correlation was observed between obestatin and insulin (p = 0.01), HOMA-IR (p = 0.008) in PCOS group. Conclusions: In this study, no significant variations were observed in serum levels of ANGPTL2 and obestatin in PCOS women with normal BMI.

Effect of vitamin D and omega-3 on nocturnal enuresis of 7-15-year-old children

INTRODUCTION

Nocturnal enuresis is known to be a common urinary bladder complication in children. Recent studies have associated vitamin D and omega-3 insufficiency with nocturnal enuresis.

AIM

This was a 2-month randomized, placebo-controlled, double-blind trial to measure the effects of vitamin D, omega-3 supplements, and their combination on nocturnal enuresis among 7-15-year-old children.

MATERIALS AND METHODS

Participants (180 children with nocturnal enuresis) were selected from children referred to the Pediatric ward of Imam Reza Clinic in Shiraz, Iran. Demographic information and anthropometric measures were taken. Fasting blood and urine samples were also collected, and serum vitamin D and urine prostaglandin E2 were measured before and after intervention. Enuretic children were randomly assigned to four groups: Group A, vitamin D (1000 IU/day); Group B, omega-3 (1000 mg/day); Group C, both omega-3 (1000 mg/day) and vitamin D (1000 IU/day); and Group D, placebo.

RESULTS

The results suggested that the study groups were not significantly different regarding demographic and anthropometric measures at baseline. Comparison of different groups revealed that 44.4% of participants in Group A, 28.2% of Group B and 45% of Group C were cured from enuresis (P = 0.03). Serum 25(OH) D was significantly increased in Group A, but urine prostaglandin E2 was not significantly decreased in response to supplementation. Although supplementation with both Group A and Group B were found to be effective, the combined intervention did not increase the effect of each intervention solely.

CONCLUSIONS

The results showed that supplementation with vitamin D and omega-3 could reduce the number of wet nights among 7-15-year-old children with nocturnal enuresis.

The effects of synbiotic supplementation on hormonal status, biomarkers of inflammation and oxidative stress in subjects with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial

BACKGROUND

To our knowledge, no reports are available indicating the effects of synbiotic supplementation on hormonal status, biomarkers of inflammation and oxidative stress in subjects with polycystic ovary syndrome (PCOS). This research was done to assess the effects of synbiotic supplementation on hormonal status, biomarkers of inflammation and oxidative stress in subjects with PCOS.

METHODS

This randomized double-blind, placebo-controlled trial was conducted on 60 subjects diagnosed with PCOS according to the Rotterdam criteria. Subjects were randomly assigned into two groups to take either synbiotic (n = 30) or placebo (n = 30) for 12 weeks. Endocrine, inflammation and oxidative stress biomarkers were quantified at baseline and after the 12-week intervention.

RESULTS

After the 12-week intervention, compared with the placebo, synbiotic supplementation significantly increased serum sex hormone-binding globulin (SHBG) (changes from baseline in synbiotic group: + 19.8 ± 47.3 vs. in placebo group: + 0.5 ± 5.4 nmol/L, p = 0.01), plasma nitric oxide (NO) (changes from baseline in synbiotic group: + 5.5 ± 4.8 vs. in placebo group: + 0.3 ± 9.1 μmol/L, p = 0.006), and decreased modified Ferriman Gallwey (mF-G) scores (changes from baseline in synbiotic group: - 1.3 ± 2.5 vs. in placebo group: - 0.1 ± 0.5, p = 0.01) and serum high-sensitivity C-reactive protein (hs-CRP) (changes from baseline in synbiotic group: - 950.0 ± 2246.6 vs. in placebo group: + 335.3 ± 2466.9 ng/mL, p = 0.02). We did not observe any significant effect of synbiotic supplementation on other hormonal status and biomarkers of oxidative stress.

CONCLUSIONS

Overall, synbiotic supplementation for 12 weeks in PCOS women had beneficial effects on SHBG, mFG scores, hs-CRP and NO levels, but did not affect other hormonal status and biomarkers of oxidative stress.

TRIAL REGISTRATION

This study was retrospectively registered in the Iranian website ( www.irct.ir ) for registration of clinical trials ( IRCT201509115623N53 ), on 2015-09-27.

The effects of coenzyme Q10 supplementation on gene expression related to insulin, lipid and inflammation in patients with polycystic ovary syndrome

OBJECTIVE

This research was conducted to assess the effects of coenzyme Q10 (CoQ10) intake on gene expression related to insulin, lipid and inflammation in subjects with polycystic ovary syndrome (PCOS).

METHODS

This randomized double-blind, placebo-controlled trial was conducted on 40 subjects diagnosed with PCOS. Subjects were randomly allocated into two groups to intake either 100 mg CoQ10 (n = 20) or placebo (n = 20) per day for 12 weeks. Gene expression related to insulin, lipid and inflammation were quantified in blood samples of PCOS women with RT-PCR method.

RESULTS

Results of RT-PCR shown that compared with the placebo, CoQ10 intake downregulated gene expression of oxidized low-density lipoprotein receptor 1 (LDLR) (p < 0.001) and upregulated gene expression of peroxisome proliferator-activated receptor gamma (PPAR-γ) (p = 0.01) in peripheral blood mononuclear cells of subjects with PCOS. In addition, compared to the placebo group, CoQ10 supplementation downregulated gene expression of interleukin-1 (IL-1) (p = 0.03), interleukin-8 (IL-8) (p = 0.001) and tumor necrosis factor alpha (TNF-α) (p < 0.001) in peripheral blood mononuclear cells of subjects with PCOS.

CONCLUSIONS

Overall, CoQ10 intake for 12 weeks in PCOS women significantly improved gene expression of LDLR, PPAR-γ, IL-1, IL-8 and TNF-α.

The effects of fish oil on gene expression in patients with polycystic ovary syndrome

BACKGROUND

This study was conducted to determine the effects of fish oil administration on gene expression related to insulin, lipid and inflammation in women with polycystic ovary syndrome (PCOS).

MATERIALS AND METHODS

This randomized, double-blind, placebo-controlled trial was conducted among 40 subjects with PCOS, aged 18-40 years. Subjects were randomly allocated into two groups to take either 1000 mg omega-3 fatty acids from fish oil (n = 20) or placebo (n = 20) twice a day for 12 weeks. Gene expression related to insulin, lipid and inflammation was quantified in peripheral blood mononuclear cells (PBMC) of PCOS women with RT-PCR method.

RESULTS

Our study demonstrated that after the 12-week intervention, compared with the placebo, fish oil supplementation upregulated gene expression of peroxisome proliferator-activated receptor gamma (PPAR-γ) (P < .001) in PBMC of subjects with PCOS. In addition, compared to the placebo, taking fish oil supplements downregulated gene expression of interleukin-1 (IL-1) (P = .02) and interleukin-8 (IL-8) (P = .01) in PBMC of subjects with PCOS. We did not observe any significant effect of fish oil supplementation on gene expression of lipoprotein(a) [LP(a)], low-density lipoprotein receptor (LDLR), glucose transporter 1 (GLUT-1), tumour necrosis factor alpha (TNF-α) and transforming growth factor beta (TGF-β) in PBMC of subjects with PCOS.

CONCLUSIONS

Overall, fish oil supplementation for 12 weeks to subjects with PCOS significantly improved gene expression of PPAR-γ, IL-1 and IL-8, but did not influence gene expression of LP(a), LDLR, GLUT-1, TNF-α and TGF-β.

CXC Ligand 5 cytokine serum level in women with polycystic ovary syndrome and normal body mass index: A case-control study

BACKGROUND

Polycystic ovary syndrome (PCOS) is the most common endocrine disease and associated with insulin resistance. CXC Ligand 5 (CXCL5) is a new cytokine which is secreted from white adipose tissue during obesity and by blocking insulin signaling pathway inhibits the activity of insulin and promotes insulin resistance.

OBJECTIVE

The aim of this study was to assess serum level of CXCL5 in PCOS women with normal body mass index.

MATERIALS AND METHODS

In this case-control study, 30 PCOS women with normal body mass index as the case group and 30 non-PCOS women as the controls were enrolled. Serum levels of CXCL5, insulin and other hormones factors related with PCOS were measured by ELISA method, also the biochemical parameters were measured by autoanalyzer.

RESULTS

Significant increases in serum insulin concentration, homeostasis model assessments of insulin resistance, luteinizing hormone, luteinizing hormone/follicle-stimulating hormone, fasting blood sugar, testosterone, and prolactin were observed in the case group compared to the controls. were in the serum level of CXCL5, cholesterol, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol,dehydroepiandrosterone-sulfate, creatinine, and homeostasis model assessment of beta cell function between these two groups.

CONCLUSION

In this study, no significant change was observed in serum concentrations of CXCL5 in PCOS women with normal BMI.

The Effects of Omega-3 Fatty Acids and Vitamin E Co-Supplementation on Indices of Insulin Resistance and Hormonal Parameters in Patients with Polycystic Ovary Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial

This study was conducted to determine the effects of omega-3 fatty acids and vitamin E co-supplementation on indices of insulin resistance and hormonal parameters in women with polycystic ovary syndrome (PCOS). This randomized double-blind, placebo-controlled trial was done on 68 women diagnosed with PCOS according to the Rotterdam criteria aged 18-40 years old. Participants were randomly assigned into 2 groups to receive either 1 000 mg omega-3 fatty acids from flaxseed oil containing 400 mg α-Linolenic acid plus 400 IU vitamin E supplements (n=34) or placebo (n=34) for 12 weeks. Hormonal parameters were quantified at the beginning of the study and after 12-week intervention. After 12 weeks of intervention, compared to the placebo, omega-3 fatty acids and vitamin E co-supplementation resulted in a significant decrease in insulin (-1.0±3.5 vs. +2.7±6.6 µIU/mL, P=0.004), homeostasis model of assessment-estimated insulin resistance (-0.2±0.8 vs. +0.6±1.5, P=0.005), homeostasis model of assessment-estimated B cell function (-4.3±14.3 vs. +10.5±24.5, P=0.004) and a significant increase in quantitative insulin sensitivity check index (+0.006±0.02 vs. -0.01±0.04, P=0.008). Supplementation with omega-3 fatty acids plus vitamin E led to significant reductions in serum total testosterone (-0.5±0.7 vs. -0.1±0.5 ng/mL, P=0.008) and free testosterone (-1.2±2.1 vs. -0.2±1.7, P=0.04) compared to the placebo group. We did not observe any significant effect of omega-3 fatty acids and vitamin E co-supplementation on fasting plasma glucose and other hormonal profiles. Omega-3 fatty acids and vitamin E co-supplementation for 12 weeks in PCOS women significantly improved indices of insulin resistance, total and free testosterone.

The effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in gestational diabetes

OBJECTIVE

This study was designed to evaluate the effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes among subjects with gestational diabetes (GDM).

METHODS

This randomized, double-blind, placebo-controlled clinical trial was done among 60 subjects with GDM who were not on oral hypoglycemic agents. Patients were randomly allocated to intake either probiotic capsule containing Lactobacillus acidophilus, Lactobacillus casei and Bifidobacterium bifidum (2 × 10⁹ CFU/g each) (n = 30) or placebo (n = 30) for six weeks.

RESULTS

Compared with the placebo, probiotic supplementation resulted in significant decreases in fasting plasma glucose (FPG) (-5.3 ± 6.7 vs. +0.03 ± 9.0 mg/dL, p = .01), serum high-sensitivity C-reactive protein (hs-CRP) (-2.2 ± 2.7 vs. +0.5 ± 2.4 μg/mL, p < .001), plasma malondialdehyde (MDA) concentrations (-0.1 ± 0.8 vs. +0.5 ± 1.5 μmol/L, p = .03) and MDA/TAC ratio (-0.0003 ± 0.0008 vs. +0.0009 ± 0.002, p = .004), and a significant increase in total antioxidant capacity (TAC) levels (+65.4 ± 103.3 vs. -37.2 ± 143.7 mmol/L, p = .002). Probiotic supplementation did not affect pregnancy outcomes.

CONCLUSIONS

Overall, probiotic supplementation among women with GDM for six weeks had beneficial effects on FPG, serum hs-CRP, plasma TAC, MDA and oxidative stress index, but did not affect pregnancy outcomes.

The effects of omega-3 fatty acids and vitamin E co-supplementation on gene expression of lipoprotein(a) and oxidized low-density lipoprotein, lipid profiles and biomarkers of oxidative stress in patients with polycystic ovary syndrome

This study was conducted to determine the effects of omega-3 fatty acids and vitamin E co-supplementation on gene expression of lipoprotein(a) (Lp[a]) and oxidized low-density lipoprotein (Ox-LDL), lipid profiles and biomarkers of oxidative stress in women with polycystic ovary syndrome (PCOS). This randomized double-blind, placebo-controlled trial was done on 68 women diagnosed with PCOS according to the Rotterdam criteria aged 18-40 years old. Participants were randomly assigned into two groups to receive either 1000 mg omega-3 fatty acids from flaxseed oil containing 400 mg α-Linolenic acid plus 400 IU vitamin E supplements (n = 34) or placebo (n = 34) for 12 weeks. Lp(a) and Ox-LDL mRNA levels were quantified in peripheral blood mononuclear cells of PCOS women with RT-PCR method. Lipid profiles and biomarkers of oxidative stress were quantified at the beginning of the study and after 12-week intervention. Quantitative results of RT-PCR demonstrated that compared with the placebo, omega-3 fatty acids and vitamin E co-supplementation downregulated expressed levels of Lp(a) mRNA (P < 0.001) and Ox-LDL mRNA (P < 0.001) in peripheral blood mononuclear cells of women with PCOS. In addition, compared to the placebo group, omega-3 fatty acids and vitamin E co-supplementation resulted in a significant decrease in serum triglycerides (-22.1 ± 22.3 vs. +7.7 ± 23.6 mg/dL, P < 0.001), VLDL- (-4.4 ± 4.5 vs. +1.5 ± 4.7 mg/dL, P < 0.001), total- (-20.3 ± 16.6 vs. +12.2 ± 26.1 mg/dL, P < 0.001), LDL- (-16.7 ± 15.3 vs. +11.9 ± 26.1 mg/dL, P < 0.001) and total-/HDL-cholesterol (-0.5 ± 0.6 vs. +0.4 ± 0.8, P < 0.001). There were a significant increase in plasma total antioxidant capacity (+89.4 ± 108.9 vs. +5.9 ± 116.2 mmol/L, P = 0.003) and a significant decrease in malondialdehyde levels (-0.3 ± 0.4 vs. -0.008 ± 0.6 μmol/L, P = 0.01) by combined omega-3 fatty acids and vitamin E intake compared with the placebo group. Overall, omega-3 fatty acids and vitamin E co-supplementation for 12 weeks in PCOS women significantly improved gene expression of Lp(a) and Ox-LDL, lipid profiles and biomarkers of oxidative stress.

Gender Comparison in Referrals and Treatment Completion to Residential and Outpatient Alcohol Treatment

BACKGROUND

Residential treatment for alcoholism is associated with high completion rates for clients, yet there appear to be gender disparities in patient referrals and treatment completion rates. We studied whether (A) gender is associated with differential patient placement to outpatient vs. residential treatment facilities and (B) completion rates differ by gender.

METHODS

In this cross-sectional study, we analyzed the admission and discharge data from 185 publicly funded substance abuse treatment facilities across Los Angeles County between 2005 and 2010.

RESULTS

Among the 33,745 studied cases, women were referred to residential treatment facilities less frequently than men (75% vs. 66%). The adjusted results derived from logistic regression models confirmed that females were more likely to be referred to outpatient treatment than to residential treatment facilities (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.05–1.26). In addition, we observed that compared to White/Caucasian patients, all other races were associated with more referral to outpatient facilities (ie, less referral to residential facilities), indicating a racial disparity on the top of the observed gender disparity. However, there was no significant link between gender and treatment completion rates (OR: 0.93, 95% CI: 0.86–1.00).

CONCLUSIONS

Women seem to have treatment completion rates comparable to men, yet they are less likely to be referred to residential treatment facilities. Hence, there still remains a gender disparity in alcoholic patient referrals. Further studies should delineate which specific therapeutic aspects and programmatic components of women-focused treatments are essential to augment positive treatment outcomes.

Applying Least Absolute Shrinkage Selection Operator and Akaike Information Criterion Analysis to Find the Best Multiple Linear Regression Models between Climate Indices and Components of Cow's Milk

This study focuses on multiple linear regression models relating six climate indices (temperature humidity THI, environmental stress ESI, equivalent temperature index ETI, heat load HLI, modified HLI (HLI new), and respiratory rate predictor RRP) with three main components of cow's milk (yield, fat, and protein) for cows in Iran. The least absolute shrinkage selection operator (LASSO) and the Akaike information criterion (AIC) techniques are applied to select the best model for milk predictands with the smallest number of climate predictors. Uncertainty estimation is employed by applying bootstrapping through resampling. Cross validation is used to avoid over-fitting. Climatic parameters are calculated from the NASA-MERRA global atmospheric reanalysis. Milk data for the months from April to September, 2002 to 2010 are used. The best linear regression models are found in spring between milk yield as the predictand and THI, ESI, ETI, HLI, and RRP as predictors with p-value < 0.001 and R² (0.50, 0.49) respectively. In summer, milk yield with independent variables of THI, ETI, and ESI show the highest relation (p-value < 0.001) with R² (0.69). For fat and protein the results are only marginal. This method is suggested for the impact studies of climate variability/change on agriculture and food science fields when short-time series or data with large uncertainty are available.

Effects of energy drinks on blood pressure, heart rate, and electrocardiographic parameters: An experimental study on healthy young adults

Objective:

To evaluate the effects of the consumption of energy drinks on cardiovascular parameters in a group of healthy young individuals.

Methods:

In a quasi-experimental study, 44 healthy adult participants aged between 15 and 30 years were evaluated. The blood pressure (BP) as well as electrocardiographic indices, including heart rate (HR), PR interval, QRS duration, corrected QT (QTc) interval, and ST-T changes were recorded before consumption of a caffeine-containing energy drink and at the specific time points over a 4-h test duration.

Results:

We found statistically significant HR decline (p=0.004) and more frequent ST-T changes (p=0.004) after the participants consumed the energy drink. However, readings for systolic BP (p=0.44), diastolic BP (p=0.26), PR interval (p=0.449), QRS duration (p=0.235), and QTc interval (p=0.953) showed no significant change post-consumption.

Conclusion:

In conclusion, we demonstrated that the consumption of energy drinks could contribute to HR decline and ST-T change in healthy young adults.

Prevalence of self-medication among the elderly in Kermanshah-Iran

INTRODUCTION

Self-medication is consumption of one or several medications without the physician's prescription. Given the risks of self-medication, this study was carried out to assess the prevalence of self-medication and its related factors among the elderly in Kermanshah-Iran

METHOD

In this descriptive cross-sectional study, 272 elderly visiting the private offices in Kermanshah were selected through convenience sampling method. The instrument for data collection was a researcher made self-medication questionnaire. Data were analyzed using descriptive and analytic statistical methods (Chi-Square and Fisher exact test).

RESULTS

The prevalence of self-medication was 83%. The most common reasons for self-medication were certainty of its safety (93%), prior consumption of the drug (87.6%), busy offices of physicians (82%), non-seriousness of the illness (77.8%) and prior experience of the disease (73%).The most common drugs used for self-medication were analgesics (92%), cold drugs (74%), vitamins (61%), digestive drugs (54%) and antibiotics (43%). There was a significant correlation between self-medication and gender (p=0.001), education level (p=008), drug information (p=0.01), marital status (p=0.002), and medical insurance (p=0.001) variables.

CONCLUSION

considering the relatively high rates of self-medication among the elderly as well as its side effects, designing and performing educational programs are suggested for the elderly people.

Evaluation of clinical factors influencing pregnancy rate in frozen embryo transfer

BACKGROUND

Frozen embryo transfer (FET) is one of the most important supplementary procedures in the treatment of infertile couples. While general information concerning the outcome of fresh embryo transfer has been documented, paucity of investigations has addressed the clinical factors influenced on pregnancy rates in FET.

OBJECTIVE

In this study, we performed a retrospective analysis of clinical factors that potentially influence the outcome of FET.

MATERIALS AND METHODS

We reviewed the data from 372 women who were subjected to FET registered from April 2009-2011 at the Research and clinical center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Baseline data and pregnancy rate were collected. The data were analyzed statistically using the Kolmogorov-Smirnov, and Mann-Whitney tests.

RESULTS

The clinical pregnancy rate was 57.7 and 29.2% in women <35 years old, and women >35 years old, respectively (p<0.0001). Clinical pregnancy rates in women with FSH <10 IU/ml, and FSH >10 IU/ml were 56.3% and 17.5 %, respectively (p<0.0001). Whereas the other clinical parameters consist of reason of fetus freezing, primary IVF protocol, IVF procedure, endometrial thickness, treatment duration to fetal transfer found to be unrelated to FET outcomes (p>0.05).

CONCLUSION

Female age and basal FSH level are the most important factors influencing the clinical pregnancy rate following FET.

Identification of Streptococcus agalactiae by fluorescent in situ hybridization compared to culturing and the determination of prevalence of Streptococcus agalactiae colonization among pregnant women in Bushehr, Iran

BACKGROUND

Pregnant women colonized by Streptococcus agalactiae (group B streptococci [GBS]) may transfer this microorganism to their newborns. S. agalactiae is an important cause of pneumonia, sepsis, and meningitis in newborns. Fluorescent in situ hybridization (FISH) is considered as a method of identification in the field of diagnostic microbiology. In this paper, we have designed a study to compare the DNA FISH after 7 h Lim broth enrichment and culturing for the identification of S. agalactiae and to determine the prevalence of vaginal colonization by S. agalactiae among pregnant women in Bushehr, Iran.

METHODS

Vaginal swab specimens were obtained from 285 pregnant women at 35 weeks or more than 35 weeks of gestation. The specimens were inoculated into Lim broth. In order to evaluate the sensitivity and specificity of GBS DNA FISH after 7 h Lim broth enrichment, the specimens were tested using both FISH and conventional culture methods. In addition, the prevalence of GBS colonization was determined.

RESULTS

Based on the results of this study, both the sensitivity and specificity of FISH were 100%. S. agalactiae was detected by both culture and FISH in 27 of the 285 pregnant women. Thus, the prevalence of GBS colonization was 9.5%.

CONCLUSIONS

Since short-term (7 h) Lim broth enrichment followed by FISH using oligonucleotide probes showed a high sensitivity and specificity, this protocol is therefore a highly accurate and relatively rapid method for the detection of S. agalactiae. Our analysis suggests that the use of DNA FISH to screen for S. agalactiae colonization in pregnant women may be considered in the absence of GBS culture availability.

Assessing the efficacy of aspiration and ethanol injection in recurrent endometrioma before IVF cycle: A randomized clinical trial

BACKGROUND

Endometriosis is a common hormone-dependent gynecologic disease with a high recurrence. Laparotomy or laparoscopy is the standard surgery for the large endometrioma. Also, sclerotherapy is basically used to treat different diseases one of which is endometrioma.

OBJECTIVE

The study was designed to assess the value of transvaginal ultrasound-guided ethanol sclerotherapy in patients with a recurrent endometrioma.

MATERIALS AND METHODS

In a randomized clinical trial, an interventional group of 20 patients underwent transvaginal ethanol sclerotherapy for recurrent ovarian endometrioma. The patients were followed up first after one and two weeks and then after one, two, and three months. If the patients had no endometrioma, they were treated with in vitro fertilization (IVF) (standard long protocol). A control group of 20 patients with endometrioma were enrolled for an IVF protocol. They had no treatment by ethanol sclerotherapy. IVF parameters, pregnancy rates, and implantation rates were compared in both groups.

RESULTS

The demographic data showed no difference between the two groups. The initial mean endometria size was 41.45±15.9 cm, the recurrence rate after 6 months was 4 (20%), FSH before and after sclerotherapy was 6.97±2.25 IU/L and 6.78±1.88 IU/L (p=0.343). The clinical pregnancy rate was 6 (33.3%) vs. 3 (15%), (p=0.616). The fertilization rate emerged 63.06% in study group vs. 60.38%, (p=0.57). The implantation rate turned out 12.9% in study group vs. 7.5%, (p=0.52). None of these results were significant. However, the data pointed to a better trend toward the ethanol sclerotherapy group.

CONCLUSION

Ethanol sclerotherapy could be an effective strategy for the treatment of recurrent endometrioma especially before IVF.

Comparison of pregnancy outcome in half-dose Triptorelin and short-acting Decapeptyl in long protocol in ART cycles: A randomized clinical trial

BACKGROUND

Gonadotrophin-releasing hormone (GnRH) agonist is used for controlling ovarian stimulation in assisted reproductive technology (ART) cycles which has some benefits.

OBJECTIVE

To compare the efficacy of two different formulations of GnRH agonist: short-acting and long-acting, for ART protocols.

MATERIALS AND METHODS

In a prospective randomized study, one hundred women who underwent ART cycles were randomly divided into two groups. In group I, the patients received one single injection of 1.87 mg Triptorelin in previous mid-luteal phase. In group II, Decapeptyl 0.1 mg per day started from previous mid-luteal phase. Pregnancy outcome in in vitro fertilization (IVF) cycle was compared between two groups.

RESULTS

There were no statistically significant differences in the number of retrieved oocyte (p=0.545), fertilization (p=0.876), implantation (p=0.716) and pregnancy rate (p=0.727) between the two groups.

CONCLUSION

There were not any advantages in IVF outcome between half-dose long-acting and short-acting GnRH agonist groups in ART cycle.

A comparative study of luteal estradiol pre-treatment in GnRH antagonist protocols and in micro dose flare protocols for poor-responding patients

PURPOSE

This study aims to verify if luteal estradiol pre-treatment improves IVF/ICSI outcomes in a GnRH antagonist protocol as compared with a micro dose GnRH agonist protocol in poor-responding patients.

METHODS

A total of 116 IVF/ICSI cycles were included in this prospective randomized single blind clinical trial. The selected women were randomly assigned to receive an estradiol pre-treatment in a GnRH antagonist protocol (daily oral Estradiol Valerate 4 mg preceding the IVF cycle from the 21st day until the first day of the next cycle) or in oral contraceptive pill micro dose GnRH agonist protocol.

RESULTS

The patients in the luteal estradiol protocol required more days of stimulation (10.9 ± 1.6 vs. 10.2 ± 1.8) and a greater gonadotropin requirement (3,247.8 ± 634.6 vs. 2,994.8 ± 611 IU), yet similar numbers of oocytes were retrieved and fertilized. There was no significant difference between the two groups in terms of the implantation rates (9.8 vs. 7.9 %) and the clinical pregnancy rates per transfer (16.3 vs. 15.6 %).

CONCLUSION

This study demonstrates that the use of estradiol during a preceding luteal phase in a GnRH antagonist protocol can provide similar IVF outcomes when compared to a micro dose GnRH agonist protocol.

Surrogacy as a good option for treatment of repeated implantation failure: a case series

BACKGROUND

Repeated implantation failure (RIF) is defined as pregnancy failure after two to six times with at least ten high grade embryo transfer to uterus. A variety of causes have been anticipated for RIF, including anatomical, autoimmune, genetics, endocrine and thrombotic anomalies. Factors responsible for RIF have important implication regarding treatment however in many couples a perfect cause cannot be found.

CASES

In these case series, we reported nine couples with RIF that after investigation no definitive etiology was found for RIF and empirical therapy by heparin, aspirin and or immunotherapy was not effective. In these cases we recommended transfer of embryos to surrogate uterus. Nine patients were studied and six of them developed a normal pregnancy (pregnancy rate=66.66%).

CONCLUSION

This study showed that surrogacy is a good option for treatment of RIF.

Effect of progesterone supplementation on natural frozen-thawed embryo transfer cycles: a randomized controlled trial

BACKGROUND

The transfer of cryopreserved embryos can be timed with ovulation in a natural cycle or after artificially preparing the endometrium with exogenous hormones. Progesterone is essential for the secretory transformation of the endometrium that permits implantation as well as maintenance of early pregnancy. The purpose of this study is to assess the effect of luteal phase supplementation on pregnancy rates in natural frozen-thawed cycles.

MATERIALS AND METHODS

The study was designed as a prospective randomized clinical trial of 102 women who underwent embryo transfers in natural cycles. The women in the interventional group (n=51) received intra muscular (IM) progesterone 50 mg twice a day starting from 36 hours after hCG administration. The control group (n=51) did not receive any progesterone support.

RESULTS

There were no significant differences in demographic characteristics between the groups and no statistically significant differences were observed between study and control groups in clinical pregnancy rate (33.3% vs. 27.5%, p=0.66). There were no differences in implantation rate or spontaneous abortion rate.

CONCLUSION

Our results suggest that luteal phase support does not affect clinical pregnancy rates in natural frozen-thawed embryo transfer cycles (Registration Number: IRCT201108044339N6).

The efficacy of recombinant versus urinary HCG in ART outcome

BACKGROUND

Human chorionic gonadotropin (HCG) has been used as a replacement for the mid-cycle luteinizing hormone (LH) surge for several years. The recent arrival of recombinant DNA technology has made recombinant HCG (rHCG) accessible.

OBJECTIVE

To assess efficacy of rHCG compared to urinary HCG (uHCG) for triggering of ovulation and induction of final oocyte maturation in assisted reproductive cycles.

MATERIALS AND METHODS

200 patients who were candidate for ICSI were randomly divided in two groups. In group I (rHCG), patients received 250µg of rHCG for final oocyte maturation, and in group II (uHCG) the patients received 10000 IU of uHCG. Measured outcomes were number of retrieved oocyte and mature oocyte, maturation rate of oocyte, fertilization rate and clinical pregnancy rate.

RESULTS

The rates of oocyte maturity were similar in both groups. Fertilization rate was similar in two groups (58.58% in rHCG group versus 60.58% in uHCG group p=0.666). The clinical pregnancy rate per cycle was similar in both group 34.0% in rHCG group versus 39% in uHCG group (p=0.310).

CONCLUSION

We demonstrated that rHCG is as effective as uHCG, when it is used for final oocyte maturation in ICSI cycles. The numbers of retrieved oocyte and maturation rates were similar in both groups; also fertilization and clinical pregnancy rates were similar.

Outcome of cryopreserved-thawed embryo transfer in the GnRH agonist versus antagonist protocol

BACKGROUND

GnRH agonist and antagonist were developed to control the premature release of LH surge. There is some difference between two protocols.

OBJECTIVE

We compared the outcome of frozen-thawed embryo transfer in infertile women who used GnRH agonist or antagonist protocol for previous COH cycle and evaluation of any adverse effect of GnRH antagonist on oocyte and embryo.

MATERIALS AND METHODS

The study group included all infertile women who referred to Yazd Research and Clinical Center for Infertility. Overall 20-35 years old women who were candidate for frozen-thawed embryo transfer with regard to inclusion and exclusion criteria were participated in the study. The patients based on previous control ovarian stimulation (COH) protocol divided in to two groups: GnRH agonist long protocol (n=165) and GnRH antagonist multiple dose protocol (n=165). Frozen-thawed embryos were transferred after endometrial preparation in both groups. Main outcome measures were: implantation, chemical and clinical pregnancy rate.

RESULTS

The implantation and clinical pregnancy rate following cryopreserved embryo transfer in GnRH agonist group and antagonist group were 16.3% vs. 15.7% (p=0.806) and 38.1% (63/165) vs. 36.9% (61/165) (p=0.915) and chemical pregnancy rate was 44.8% (74/165) vs. 43.6% (72/165) (p=0.915) respectively.

CONCLUSION

There was no statistically difference between two groups in terms of implantation and pregnancy rate. Although pregnancy rate in fresh embryo transfer in antagonist cycles was lower than agonist groups, Therefore decrease in these parameters might be due to detrimental effect of GnRH antagonist on the endometrium, not embryo or oocyte.

Evaluating the association between insulin-like growth factor-1 values and short-term survival rates following acute myocardial infarction

Backgrounds:

In recent years, low levels of Insulin-like Growth Factor-1 (IGF-1) have been suggested to be associated with higher risks of developing heart failure and higher long-term mortality rates following Acute Myocardial Infarction (AMI). However, the effect of IGF-1 levels on short-term survival has been rarely studied. In this study we aimed to assess any possible association between serum IGF-1 concentration following AMI and short-term survival rates.

Methods:

In this study, serum total IGF-1 levels were measured in 56 patients within 24 hours following AMI and were compared to 56 individuals with no cardiovascular disease. Patients were followed up to death or discharge from hospital (median = 6 days) and survival curves were compared based on median IGF-1 value.

Results:

Mean (±SD) of serum IGF-1 levels were 232.73 ng/ml (±81.74) and 211.00 ng/ml (±58.22) in survived and expired patients respectively and the difference was not statistically significant (P value = 0.501). The difference between survival curves was also not statistically significant (P value = 0.246).

Conclusion:

According to findings of this study, serum total IGF-1 concentration does not seem to be associated with short-term survival rates.

High prevalence of multidrug-resistant strains of Vibrio cholerae, in a cholera outbreak in Tehran–Iran, during June–September 2008

Following the occurrence of suspected cases of Vibrio cholerae in Karaj in 2008, this study was conducted in order to determine whether or not the cases were infected with cholera and, if so, to describe the prevalence of serotypes, route of transmission and the antimicrobial resistance profile. In this cross-sectional study, 6505 rectal swabs were collected from patients with acute gastroenteritis. Serotypes and biotypes of the isolates were determined by standard procedures. The antimicrobial susceptibility of 45 Inaba and 30 non-agglutinating (NAG) strains was determined. From 6505 specimens, 110 (1.69%) were defined as V. cholerae, including 70 (63.3%) V. cholerae O1 serotype Inaba biotype El Tor and 40 (36.4%) NAG Vibrios. The case fatality rate was 0.9%. Inaba strains were 100% resistant to nalidixic acid and amoxicillin, 95.7% resistant to trimethoprim-sulfamethoxazole, 91.3% resistant to furazolidone while the highest frequency of resistance in NAG Vibrios was 77.4% to erythromycin. The lowest resistance rate belonged to ciprofloxacin to which just one NAG strain was resistant. Results suggests an increase in resistance of V. cholerae to several antibiotics. Ciprofloxacin can still be used as first-line treatment of cholera in this region.

Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice

BACKGROUND

Pathologic interpretation of biopsy specimens of columnar lined esophagus guides subsequent endoscopic surveillance and/or surgical intervention. The aim of this study was to evaluate pathologic interpretation of columnar lined esophagus by general pathologists in community practice.

METHODS

Five histologic slides representing different types of columnar lined esophagus were submitted for review by 20 randomly selected general pathologists in community practice. There were three cases with intestinal metaplasia (one with no dysplasia, one with low-grade dysplasia, and one with high-grade dysplasia) and two cases of gastric metaplasia (one fundic-type and one cardia-type).

RESULTS

High-grade dysplasia was identified as such by 30% of pathologists and was called invasive adenocarcinoma by 20%, low-grade dysplasia by 30%, and moderate dysplasia by the remaining 20%. Low-grade dysplasia was identified as such by 35% of pathologists and was called high-grade dysplasia by 20%, moderate dysplasia by 20%, and no dysplasia by 25%. Specialized columnar epithelium with no dysplasia was identified as such by 35%, called low-grade dysplasia by 35%, moderate dysplasia by 15%, indeterminate for dysplasia by 10%, and invasive adenocarcinoma by 5%. Gastric metaplasia without specialized columnar epithelium was identified as Barrett's esophagus in 38% of cases.

CONCLUSIONS

Pathologic interpretation of columnar lined esophagus by community pathologists may be subject to marked interobserver variation. The term Barrett's esophagus is often used to describe columnar lined esophagus without goblet cells. Because this finding is not clearly associated with an increased risk of cancer, these data support recent suggestions that the term Barrett's esophagus be abandoned. Interpretations of both high-grade and low-grade dysplasia should be considered for review by experts in esophageal pathology.

Neoplasia distal to the splenic flexure in patients with proximal colon cancer

BACKGROUND

Current American Cancer Society recommendations are that persons aged 50 years or older undergo screening flexible sigmoidoscopy every 3 to 5 years. In clinical practice, persons with adenomas at sigmoidoscopy are generally referred for full colonoscopy. However, cancers proximal to the splenic flexure may not be accompanied by neoplasia distal to the splenic flexure.

METHODS

In order to estimate how often screening flexible sigmoidoscopy would be negative in persons with proximal cancer, we retrospectively reviewed 2053 consecutive colorectal cancer cases diagnosed from 1988 to 1994. Seven hundred ninety-nine (38.9%) had tumors proximal to the splenic flexure. We selected 358 study cases based on full colonoscopy performed and the colonoscopy reports available.

RESULTS

Colonoscopy demonstrated distal adenomas in 77 cases (21.5%): 29 (8.1%) had hyperplastic polyps only, 4 (1.1%) had synchronous cancer, and 248 (69.3%) had no distal polyps. In this population, 77.4% of patients with proximal colon cancer had no distal neoplasia. We estimate that 30% of all patients with colorectal cancer would have a negative screening flexible sigmoidoscopy.

CONCLUSIONS

Prospective evaluation of colonoscopic findings in persons with proximal cancers is needed. Ongoing evaluation of colonoscopy as a general screening test is appropriate.