Screening for chlamydia and/or gonorrhea in primary health care: protocol for systematic review

BACKGROUND

Chlamydia trachomatis and Neisseria gonorrhoeae are the most commonly reported sexually transmitted infections in Canada. Existing national guidance on screening for these infections was not based on a systematic review, and recommendations as well as implementation considerations (e.g., population groups, testing and case management) should be explicit and reflect the quality of evidence. The aim of this systematic review is to synthesize research on screening for these infections in sexually active individuals within primary care. We will also review evidence on how people weigh the relative importance of the potential outcomes from screening, rated as most important by the Canadian Task Force on Preventive Health Care (CTFPHC) with input from patients and stakeholders.

METHODS

We have developed a peer-reviewed strategy to comprehensively search MEDLINE, Embase, Cochrane Library, CINAHL, and PsycINFO for English and French literature published 1996 onwards. We will also search trial registries and conference proceedings, and mine references lists. Screening, study selection, risk of bias assessments, and quality of findings across studies (for each outcome) will be independently undertaken by two reviewers with consensus for final decisions. Data extraction will be conducted by one reviewer and checked by another for accuracy and completeness. The CTFPHC and content experts will provide input for decisions on study design (i.e., when and whether to include uncontrolled studies for screening effectiveness) and for interpretation of the findings.

DISCUSSION

The results section of the review will include a description of all studies, results of all analyses, including planned subgroup and sensitivity analyses, and evidence profiles and summary of findings tables incorporating assessment based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods to communicate our confidence in the estimates of effect. We will compare our findings to others and discuss limitations of the review and available literature. The findings will be used by the CTFPHC-supplemented by consultations with patients and stakeholders and from other sources on issues of feasibility, acceptability, costs/resources, and equity-to inform recommendations on screening to support primary health care providers in delivering preventive care.

SYSTEMATIC REVIEW REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733.

Surgical wound dehiscence in an Australian community nursing service: time and cost to healing

OBJECTIVE

Surgical wound dehiscence (SWD) increases the length of hospital stay and impacts on patient wellbeing and health-care costs. Globally, the health-care costs associated with SWD are poorly reported and those reported are frequently associated with surgical site infection (SSI), rather than dehiscence of non-microbial cause. This retrospective study describes and reports on the costs and time to healing associated with a number of surgical patients who were referred to a community nursing service for treatment of an SWD following discharge from a metropolitan hospital, in Perth, Western Australia.

METHOD

Descriptive statistical analysis was carried out to describe the patient, wound and treatment characteristics. A costing analysis was conducted to investigate the cost of healing these wounds.

RESULTS

Among the 70 patients referred with a SWD, 55% were treated for an infected wound dehiscence which was a significant factor (p=0.001). Overall, the cost of treating the 70 patients with a SWD in a community nursing service was in excess of $56,000 Australian dollars (AUD) (£28,705) and did not include organisational overheads or travel costs for nurse visits. The management of infection contributed to 67% of the overall cost.

CONCLUSION

SWD remains an unquantified aspect of wound care from a prevalence and fiscal point of view. Further work needs to be done in the identification of SWD and which patients may be 'at risk'.

DECLARATION OF INTEREST

The authors declare they have no competing interests.

Parents' Attitudes and Children's Deprivation: Child-Rearing Attitudes of Parents as a Key to the Advantaged-Disadvantaged Distinction in Pre-School Children

Nine groups of kindergarten children in Israel were ranked on the advantaged-disadvantaged scale. The ranking was correlated with their parents' child-rearing attitudes. A strong positive relation was found between rigid parental directiveness and the ranking of a kindergarten group as disadvantaged. The parental attitudes were found to correlate to some degree with certain socio-cultural factors, such as educational level and national origin.

It is suggested that the parents' attitudes should serve as an early predictive factor for identifying disadvantaged children for purposes of establishing intervention programs to work with children, parents, and educators.

Photochemiluminescent detection of antiradical activity. VII. Comparison with a modified method of thermo-initiated free radical generation with chemiluminescent detection

The method of photosensitized chemiluminescence (PCL) allows the quantification of water- and lipid-soluble antioxidants and activity of superoxide dismutase (SOD) in the same measuring system. However, it needs a special device, which we have described in a previous paper in this series. Another method suitable for the assay of water- and lipid-soluble antioxidants is the thermo-initiated decay of azo-compounds combined with the measurement of O2 consumption (Niki, 1985; Wayner et al., 1985). Its long duration and the complicated measuring procedure is not acceptable for routine medical applications. We show that a modification using CL detection of free radicals with luminol, has results comparable with PCL for the determination of non-enzymic water- and lipid-soluble antioxidants, SOD activity and oxidative modification of proteins. In contrast to PCL, it is possible to use any luminometer with a heatable measuring cell and to investigate coloured samples. While the new method has an overall higher sensitivity and is scalable to microtitre plates, PCL measurements can be made at different pH. The advantages and analytical information content of certain components of the integral antioxidative capacity of blood plasma are discussed in comparison with other methods.

Semisynthesis of heterocyclic analogues of squamocin, a cytotoxic annonaceous acetogenin, by an unusual oxidative decarboxylation reaction

In addition to two expected pyrazin derivatives, two imidazole analogues of squamocin 1 have been semisynthetised from squamocin derived alpha-ketoesters/alpha-ketoacid, via an unusual condensation-oxidative decarboxylation reaction with 1,2 diamines in presence of acetic acid and oxygen as the key step. Some of these analogues exhibited potent, although significantly reduced cytotoxicities relatively to squamocin 1. In addition, benzimidazole 8 possessed in comparison with the natural acetogenin some interesting cell cycle effects.

Eyelid reconstruction in seven dogs using a split eyelid flap

The use of a split eyelid flap to reconstruct both a normal palpebral aperture and a smooth, hairless eyelid margin following the excision of eyelid neoplasia, in a series of seven dogs, is described. The patterns of reconstruction used in the procedure are discussed, and previously reported methods of eyelid reconstruction are reviewed.

Photochemiluminescent detection of antiradical activity. V. Application in combination with the hydrogen peroxide-initiated chemiluminescence of blood plasma proteins to evaluate antioxidant homeostasis in humans

Disturbance of the steady state between pro- and antioxidants in tissues is an important aetiopathogenetic factor. Two method--(i) photosensitized chemiluminescence for detection of antiradical activity and (ii) hydrogen peroxide-initiated chemiluminescence of plasma proteins (CLP) and erythrocytes (CLE)--were tested in 136 healthy donors and 82 patients with untreated breast tumours for their applicability to detecting disturbances in antioxidant homeostasis in humans. The total antiradical capacity of water-soluble substances (ACW) and its urate-independent proportion (ACU) were lower (P <0.05) and CLP higher (P <0.001) in smokers in comparison to non-smokers. A significant negative correlation was found between the content of ascorbate in plasma and the intensity of CLP: r = -0.39, P <0.001. A significant reduction in ACU and increased values of CLP and CLE were seen according to the stage of disease in breast cancer patients. On the basis of these observations and model experiments we suggest that hydrogen peroxide-initiated chemiluminescence can serve as a parameter of oxidative modification of blood components and, in combination with the antioxidant parameters, can be used to describe the antioxidant homeostasis in humans and possibly to have value as a predictor of disease states.

Synthesis of a novel series of cytotoxic bisindole alkaloids

Original cytotoxic bisindole alkaloids with a 1,2,3,4-tetrahydroquinoline bridge were synthesized by reductive amination with various anilines. The most cytotoxic compounds display a high and dose-dependent cell cycle effect with accumulation in the G1 phase. Influence of substitution of the starting aniline on the reaction and on cytotoxicity of produced dimers was pointed out.

Photochemiluminescent detection of antiradical activity. VI. Antioxidant characteristics of human blood plasma, low density lipoprotein, serum albumin and amino acids during in vitro oxidation

During investigation of the mechanism of therapeutic efficacy of UV (254 nm)-irradiated autologous blood, the antioxidant capacity (AC) of plasma, serum albumin, 20 amino acids, uric acid, ascorbic acid and alpha-tocopherol was measured after irradiation in vitro. AC of plasma demonstrated a biphasic time course (decrease to in a minimum (greater zero) followed by an increase). AC of uric acid, ascorbic acid and alpha-tocopherol diminished under irradiation to zero. In contrast, albumin and seven amino acids developed AC following irradiation. During the Cu(+2)-induced oxidation of low-density lipoprotein (LDL), the AC measured in a system for water-soluble substances appeared, after a lag-phase, to be comparable to that of the conjugated diene formation; AC of LDL measured in a system for lipid-soluble substances demonstrated a biphasic course. Our results suggest that: (a) the oxidized products of some amino acids and proteins acquire antiradical properties at the same time that they are being produced; (b) the biphasic character of changes of antioxidant properties of blood plasma during UV irradiation represents the overlapping of two processes: disappearing of antioxidants and acquisition of AC by (lipo)proteins; and (c) the measurement of AC of blood plasma (lipo)proteins can possibly serve to detect the existence and extent of oxidative stress in human organism.

Flavonoid-related modulators of multidrug resistance: synthesis, pharmacological activity, and structure-activity relationships

A series of 28 flavonoid derivatives containing a N-benzylpiperazine chain have been synthesized and tested for their ability to modulate multidrug resistance (MDR) in vitro. At 5 microM, most compounds potentiated doxorubicin cytotoxicity on resistant K562/DOX cells. They were also able to increase the intracellular accumulation of JC-1, a fluorescent molecule recently described as a probe of P-glycoprotein-mediated MDR. This suggests that these compounds act, at least in part, by inhibiting P-glycoprotein activity. As in other studies, lipophilicity was shown to influence MDR-modulating activity but was not the only determinant. Diverse di- and trimethoxy substitutions on N-benzyl were examined and found to affect the activity differently. The most active compounds had a 2,3, 4-trimethoxybenzylpiperazine chain attached to either a flavone or a flavanone moiety (13, 19, 33, and 37) and were found to be more potent than verapamil.

The antioxidant properties of lycopene

The antioxidant properties of the carotenoid lycopene were compared in three different model oxidative systems. In egg yolk liposomes, in the presence of 2.5 mM FeSO4 and 200 mM ascorbate, lycopene, alpha-tocopherol, and beta-carotene inhibited the accumulation of lipid peroxidation products reacting with 2-thiobarbituric acid (TBARS) in a dose-dependent mode, with the concentration of half-inhibition being 80, 30 and 130 mM, respectively. In the liposomes subjected to illumination with a He-Ne laser (632.8 nm) at a dose of 10.5 J/cm2, in the presence of 32.5 micrograms/ml hematoporphyrin derivatives (Fotogem, NIOPIC, Russia) TBARS accumulated, and this effect was inhibited by lycopene, alpha-tocopherol, and dihydroquercetin with approximately equal efficiencies (the half-inhibition concentrations were 10(-5) mM). In both systems studied, sodium azide at a concentration of 10 mM inhibited the TBARS accumulation by no more than 20%. Apparently, the inhibitory action of not only alpha-tocopherol, but also beta-carotene and lycopene was the result of their antiradical action, rather than quenching of the singlet oxygen in an aqueous medium. The introduction of lycopene, as well as beta-carotene in liposomes subjected to Fe(2+)-induced lipid peroxidation decreased the chemiluminescence (CL) intensity at the stage of CL slow flash, with no essential influence on the lag period. These data suggest that the effect of lycopene on lipid peroxidation was the result of its interaction with free radicals rather than chelating ferrous ions. The antiradical activity of lycopene was also confirmed by the method of luminol photochemiluminescence (PCL). Lycopene increased the PCL lag period (L) and decreased the PCL amplitude (A), which implies its antiradical and SOD-like activity in this system.

[A simple method of measuring superoxide dismutase activity using photochemiluminescence]

At present, photochemical detection of SOD-activity is used in most cases, where superoxide production is based on the NADPH oxidase activity or autooxidation of some substances, for instance, adrenaline. The shortcomings of these assays are the requirement of stable pH and temperature and need long-term experiments and sophisticated preliminary work. For this reason a novel method to determine SOD activity have been proposed, based on the photochemiluminescence (PCL), where riboflavine is used as a photosensitizer and lucigenin as a free-radical detector. Minimal concentrations of the system components have been selected, at which PCL intensity became virtually independent on the concentration and was sufficient for proper measurements: 25 nmole/ml of riboflavine, 3 nmole/ml of lucigenin and 250 nmole/ml of methionine. Under this conditions, the amount of SOD causing two-fold inhibition of PCL was 10 +/- 0.3 ng of SOD (Sigma, USA). Antioxidants occurring in the blood changed the PCL intensity by 5% at following concentrations: ascorbic acid--above 3.6 microM, uric acid--above 0.3 microM, glutathione--above 4.0 microM. Taking into account the amount of these antioxidants in whole blood and erythrocytes, it has been calculated that the antioxidants containing in the sample do not influence the results of SOD assay, even without erythrocytes washing. The proposed method was compared with a procedure offered by Calbiochem. The amounts of SOD causing two-fold decrease of PCL in our method and that of Calbiochem, were 10 and 40 ng (Sigma, USA), and standard deviations 0.45 and 0.96%, respectively. The SOD activity from 107 healthy donors (76 males and 31 females, 40 smokers and 67 non-smokers) has been determined and was found to be 15.1 +/- 0.4 ng SOD/1 x 10(9) erythrocytes.

Perhydrogenation of tabersonine, ans Aspidiosperma indole alkaloid

The natural indole alkaloid (-)-tabersonine (1) easily provided (-)-decahydrotabersonine (4a), isolated as dihydrochloride (4b), by catalytic hydrogenation. Saponification of 4a led to the beta-amino acid 5. A binding study of 1, 4b, and 5 on various receptors and ionic channels showed that none of the compounds had a strong affinity for the receptors tested.

Photochemiluminescent detection of antiradical activity; IV: testing of lipid-soluble antioxidants

A new method for quantification of antiradical properties of pure lipid-soluble antioxidants and for measurement of integral antioxidant capacity in the lipid phase (ACL) of polycomponent systems, such as blood plasma or tissue homogenates, is developed. It is based on an antioxidant-sensitive inhibition of a photo-induced, chemiluminescence accompanied autoxidation of luminol. The sensitivity of the photochemiluminescent (PCL) assay lies within nmol quantities of substances, the measuring range for alpha-tocopherol is between 0.1 and 3 nmol. The interassay variability of the method is lower than 5%, the intraassay variability <2%. The antioxidant efficiency of gamma-tocopherol was found to be 43% of alpha-tocopherol. The results of the PCL measurements on pure antioxidants and on lipid extracts from blood plasma were compared with the level of, 'vitamin E' (VE) determined as a sum of alpha- and gamma-tocopherol by HPLC. Very good coincidence of both methods was observed for pure substances (r = 0.998, P<0.001). The ACL of human blood plasma was found to be 27.98 +/- 0.68 mumol equivalents of alpha-tocopherol/l (mean +/- mean error, n = 142), it is approximately 25% more than the concentration of VE found in the same samples (22.09 +/- 0.59 mumol/l). In this case, the correlation of both parameters was lower. r = 0.811, P<0.001. The animal experiments showed that synthetic antioxidants may not only increase the value of ACL of blood plasma but in the same time reduce the concentration of biological antioxidants, e.g. VE drastically. The prooxidant activity of synthetic antioxidants in vivo or the replacing of structured alpha-tocopherol from its position can be the cause. This important circumstance has to be considered during the testing of new antioxidants for clinical application.

Synthesis and evaluation of 3',5'-di-tert-butyl-4'-hydroxyflavones as potential inhibitors of low density lipoprotein (LDL) oxidation

The novel flavones 6-28, which display structural analogies with the two well-known lipid peroxidation inhibitors, probucol [1] and butylated hydroxytoluene [2], were synthesized and studied in vitro for their ability to inhibit the copper sulfate or endothelial cell-induced lipid peroxidation of human low-density lipoprotein (LDL). Most of the flavones were active in the range of 0.1-1 microM.

[Cytotoxicity of aspidospermane indole alkaloids with a modified tryptamine chain]

Eight synthetic indole alkaloids with the aspidospermane structure have ben evaluated for cytotoxicity in the L-1210 cell culture test system. Two of them (compounds 9 and 5), bearing a modified tryptamine chain, were significantly active (IC50 values of 0.7 and 3.1 microM, respectively).

Photochemiluminescent detection of antiradical activity: II. Testing of nonenzymic water-soluble antioxidants

A method for testing and quantification of nonenzymic antioxidants, such as ascorbic acid and uric acid, and of polycomponent systems, e.g., blood plasma, is described. This method is based on a photo-induced, chemiluminescence-accompanied, and antioxidant-inhibitable autoxidation of luminol. The sensitivity of the assay lies in a region of nanomolar quantities of substances. The interassay variability of the method is lower than 5%, the intraassay variability is 2%. The mean values of an integral antioxidant capacity (AC) of human blood plasma, measured with this method as a duration of the chemiluminescence inhibition, were between 10 and 20 arbitrary Units (10 arb.U. = 1 min) per 1 microliter, and showed the age-dependent patterns with maximal values (+/- SD) with newborns (n = 7): 20.8 +/- 4.1 arb.U. and aged persons (46 +/- 9.4 years old, n = 16): 15.4 +/- 5.2 arb.U., and minimal with children (7.3 +/- 3 years old, n = 10): 9.9 +/- 2.6 arb.U. AC of young people (28.7 +/- 6.5 years old, n = 22) was 12.1 +/- 2.7 arb.U. AC of six tested animal species was lower as that of humans, with maximal values with guinea pigs: 8.5 arb.U. (mean value) and spontaneously hypertensive rats: 8.6 arb.U. The lowest values were registered with minipigs: 1.4 arb.U. Mice (strain 17) showed 3.8, Lewis and Wistar rats accordingly 4.6 and 6.2 arb.U.

Photochemiluminescent detection of antiradical activity; III: A simple assay of ascorbate in blood plasma

A simple procedure to determine the ascorbate in blood plasma was elaborated based on a temporary inhibition of the photo-induced, O(-.)2-mediated, chemiluminescence emanating from oxidation of luminol. To remove the interferences, mainly from urate, a simple enzyme-free one-step method for plasma sample preparation by means of a gel filtration was combined with the photochemiluminescent investigation of the eluate. The results of the photochemiluminescent assay of ascorbate coincide well (r = 0.994) with a photometric method with ascorbate oxidase. The mean value of ascorbate in human blood plasma, obtained from 37 healthy volunteers, was 59.6 +/- 25.8 mumol/l. Patients with atherosclerosis having a myocardial infarction in their anamnesis displayed significantly lower values: 27.2 +/- 12.8 mumol/l (n = 32), P < 0.001.

Antioxidant effects of aqueous garlic extract. 1st communication: Direct detection using the photochemiluminescence

The antioxidant effect of the aqueous extract from the garlic preparation Kwai was investigated using the method of photochemiluminescence. The method is based on the photo-induced, superoxide radical mediated autoxidation of luminol, and allows for the capability of substances to inhibit the free radical processes in this test system to be quantified, and hence for their antioxidant properties in respect of a standard substance (e.g. ascorbic acid, alpha-tocopherol) to be compared. The aqueous extract obtained from 1 mg of the garlic preparation was found to be anti-oxidatively as effective as 30 nmol of ascorbic acid and/or 3.6 nmol of alpha-tocopherol.

Antioxidant effects of aqueous garlic extract. 2nd communication: Inhibition of the Cu(2+)-initiated oxidation of low density lipoproteins

The aqueous extract from the garlic preparation Kwai the antioxidant effect of which has been previously detected by the authors using the method of photochemiluminescence was tested in respect of the Cu(2+)-initiated oxidation of low density lipoprotein (LDL). The formation of conjugated diene which accompanies the lipid peroxidation process was detected photometrically. In this test system too, a dose-related oxidation-inhibiting effect of the extract was established. Further experiments will be required to find out whether such effect is due to the reduction of intrinsic antioxidants or to the increase of the integral antioxidant capacity of LDL.

The antioxidant system of the organism. Theoretical basis and practical consequences

On the basis of the literature and our own investigations, the antioxidant mechanisms and substances of the human organism are described and classified as compartmentalization, detoxification, repair and utilization. The existence and the structure of an antioxidant system, which serves as support of the antioxidant homeostasis, are hypothesized. A parameter for characterizing the state of the antioxidant system and for detecting its changes under pathological conditions--the integral antioxidant capacity of blood plasma--and a method for its determination are suggested.

Thermal behavior and elastic properties of phospholipid bilayers under the effect of a synthetic flavonoid derivative, LEW-10

We have investigated the effect on phospholipidic bilayers of LEW-10, a synthetic flavonoid, derivative of diosmin. Two optical techniques, Quasi-elastic Light Scattering (QLS) and Fourier Transform Infrared Spectroscopy (FT-IR) were used. The results show that in the presence of LEW-10, the phase transition of the bilayers is lowered and that the elastic modulus is decreased. The FT-IR results indicate interactions in the aqueous interface regions of the bilayers. We also discuss LEW-10 comparatively with another derivative, LEW-7/S1, whose effect has been previously studied.

A deficient function of the antioxidative system of the organism as an aetiopathogenetic factor in psoriasis

The main idea of a new hypothesis about the aetiopathogenesis of psoriasis concerns the significance of interrelation between pro- and antioxidants, vitamin A-dependent keratin synthesis and proliferation of keratinocytes. On the basis of postulated deregulation in the antioxidative system of the organism, we explain the predisposition, the initiation and pathogenesis of lesions, their persistence and resolution and the operation mechanisms of antipsoriatics.

[Equivalence values of the antioxidative capacity in serum of children with chronic renal failure, chronic hemodialysis and kidney transplantation]

It is reported on the results of measurements of the antitoxydative capacity (AC) in the serum of children suffering from chronic renal failure, during hemodialysis and after kidney Transplantation. The results show in comparison with healthy children (19.95 +/- 5.22 mm, n = 19) that children suffering from chronic renal failure may develop an increased AC (66.18 +/- 29.14 mm, n = 24). In dialyzed children different values are found previous and after hemodialysis (58.11 +/- 9.25 vs. 17 +/- 3.6 mm). Children show after transplantation the highest values (78.9 +/- 26.04 mm, n = 13). If the increase of the AC is a compensatory and regulatory mechanism or the result of accumulation of antioxydative substances should realized in further investigations. The measurements of vitamin-E-supplemented sera may show that an oral application of vitamin E increase the AC in vivo.

Increase of blood flow in skin and spinal cord following activation of small diameter primary afferents

Activation of unmyelinated primary afferents produces vasodilatation and plasma extravasation in the skin. Here, using the laser Doppler technique to measure changes in blood flow and the Evans blue technique for quantification of plasma extravasation, we have asked whether the stimulation of C-fibre precipitates the same phenomena in the spinal cord. Our results show that there is an increase of blood flow, but no extravasation in the ipsilateral lumbar enlargement of the spinal cord following supramaximal electrical stimulation of the sciatic nerve. The blood flow increases were small and short-lived compared with those seen in skin, and could be completely explained by concomitant blood pressure changes. Hence, whilst the same substances are apparently released from the peripheral and central terminals of primary afferent fibres, their ability to produce vasodilatation and extravasation is absent or severely restricted in the spinal cord.