Inadequate (Ax) Transbronchial Lung Transplant Biopsies-Scope and the Potential Contributing Factors

BACKGROUND

Transbronchial biopsy is the cornerstone for the evaluation of graft function after lung transplant and a standard of care to diagnose acute cellular rejection. However, the yield from these biopsies is variable, with about 15% to 50% of samples being judged as nondiagnostic, leading to additional procedures. The factors contributing to the nondiagnostic sampling have not been delineated, and the discordance in sample assessment between the bronchoscopist and pathologist has not been quantified.

METHODS

A retrospective cohort of patients who had bronchoscopies with biopsies for surveillance and graft assessment at a large-volume transplant center was studied. The occurrence of nondiagnostic alveolar sampling was assessed, and the patient demographics and procedural characteristics were compared with the diagnostic group.

RESULTS

We included 128 patients in our study and found the inadequacy rate for alveolar tissue sampling to be 15.5%. The median number of passes made by the bronchoscopist was 9, and the number of samples assessed by the bronchoscopist was 8, with a median of 6 adequate samples identified by the pathologist. The frequency of previous biopsies, history of prior inadequate samples, need for a higher number of pass attempts, presence of airway abnormalities, and the use of general anesthesia increased the odds of inadequate sampling.

CONCLUSIONS

Patients with the identified factors may be at risk of inadequate sampling on transbronchial biopsies. The bronchoscopist could consider getting additional samples to avoid a nondiagnostic alveolar sample. Further multicenter studies would help to elucidate other contributing factors.

Evaluation of knowledge about osteoporosis risk factors among adults above 40 years of age in Qassim region, Saudi Arabia

OBJECTIVE

Osteoporosis is a bone disease that develops when bone mineral density and bone mass decrease, or when the quality of bone changes. It is the most common bone disease, representing a major public health problem. This study aimed to assess the knowledge of risk factors for osteoporosis among adults above 40 in the Qassim region, Saudi Arabia.

SUBJECTS AND METHODS

This is a cross-sectional study conducted among adults who were above 40 years of age and living in the Qassim region, Saudi Arabia. A survey questionnaire was distributed to respondents while they attended primary health care as well as online via social media.

RESULTS

390 participants responded to our survey (65.6% females vs. 34.4% males). The most common age group was 41 to 50 years (59.7%). The prevalence of participants who were having information about osteoporosis was 59%. Overall, the knowledge of participants about osteoporosis was good (63.1%), 33.3% had moderate knowledge and only 3.6% were assumed to have a poor knowledge level. Factors associated with increased knowledge was being a female and being an employee.

CONCLUSIONS

Although the knowledge of the adult population aged above 40 years old seems adequate, there is still room for improvement. Female participants who were currently employed demonstrated a better understanding of osteoporosis than other adults. Further research is warranted to establish the effect of advanced age on their level of understanding regarding osteoporosis and its risk factors.

Impact of Tacrolimus Trough Variability on Acute Rejection Following Lung Transplantation

BACKGROUND

Acute rejection is a risk factor for the development of chronic lung allograft dysfunction, the leading cause of morbidity and mortality in lung transplant recipients. Calcineurin inhibitors are the cornerstone of immunosuppression regimens after lung transplantation.

METHODS

We retrospectively evaluated the association of tacrolimus level variability with total acute rejection score at 12 months post-transplant. Secondary outcomes included the development of chronic lung allograft dysfunction and antibody-mediated rejection at 24months post-transplant. There were 229 lung transplant recipients included.

RESULTS

The mean (standard deviation) total rejection score of the cohort was 1.6 (1.7). Patients with high tacrolimus variability at 0 to 3, 3 to 6, and 6 to 12 months on average scored 0.18 (mean 1.6 vs 1.5; 95% CI): -0.3 to 0.66, P =.46), 0.14 (mean 1.7 vs 1.5; 95% CI: -0.32 to 0.6, P = .55), and 0.12 (mean 1.6 vs 1.5; 95% CI: -0.34 to 0.58, P = .62) point higher in 12-month total acute rejection scores, respectively; however, these differences were not statistically significant. The incidences of chronic lung allograft dysfunction and antibody-mediated rejection were numerically greater in the high variability group throughout certain periods; however, this was not consistent throughout all study timeframes and statistical significance was not evaluated.

CONCLUSIONS

High tacrolimus variability was not associated with increased 12-month total acute rejection score. Further studies are needed to assess long-term outcomes with tacrolimus level variability.

In Egyptian Patients with Hepatocellular Carcinoma the role of MicroRNA-215

Introduction/Objective

MicroRNAs (miRNAs) are a class of evolutionarily conserved small non-coding RNAs which are make a contribution in the regulation of gene expression and protein translation, and they play vital roles in differentiation, cell growth, and the development of diverse types of cancers.

Methods/Case Report

Our research was done in hepatology and gastroenterology department at the National Liver Institute, Menoufia University. It included 135 patients and 60 healthy subjects serving as control group. We have 3 groups:

Group I (Control)

This group included 60 apparently healthy individuals. They were 32 males and 28 females, whose ages ranged from 39 to 67 years old (mean ±SD= 51.67 ± 6.40 years).

Group II (Cirrhosis)

This group included 75 patients with liver cirrhosis due to chronic HCV infection. They were 41 males and 34 females whose ages ranged from 41 to 68 years old (mean ±SD= 54±6.73 years).

Group III (HCC)

Sixty patients with HCC were included. They were 35 males and 25 females, whose ages ranged from 41 to 70 years old (mean ±SD= 53.97±6.15 years).

Laboratory Investigations

Complete blood count (CBC), Liver tests: aspartate transaminase (AST) and alanine transaminase (ALT), serum albumin, total and direct bilirubin, alkaline phosphatase and INR were measured. Serum creatinine was also measured. The analysis of serum alpha fetoprotein (AFP) (ng/ml) was done. Chronic HCV infection was diagnosed by detection of HCV antibody and HCV RNA by real time PCR. Anti-HCV antibody was detected by means of a third generation enzyme immunoassay. Quantification of HCV RNA level was performed by means of COBAS Taqman 84 (Roche) real time HCV RNA Assay with lower detection limit 15 IU/ml.

Results (if a Case Study enter NA)

In control group, miRNA-215 ranged from 1.60 to 21.30 with a median value of 6.89. In cirrhotic patients group, it ranged from 0.70 to 14.65 with a median value of 2.85. In patients with HCC group, it ranged from 0.03 to 10.95 with a median value of 0.52 (pg/ml). MiRNA-215 and AFA mean levels showed a statistically significant difference (p <0.001) between the three studied groups.

Conclusion

In conclusion, MicroRNA-215 was proved to be significantly lower in HCC patients compared to cirrhotic patients and control group. This marker might be used as a potential serologic marker for HCC and a complementary diagnostic tool in monitoring cirrhotic patients for detection of HCC.

Complications of Lung Transplantation: Update on Imaging Manifestations and Management

As lung transplantation has become the most effective definitive treatment option for end-stage chronic respiratory diseases, yearly rates of this surgery have been steadily increasing. Despite improvement in surgical techniques and medical management of transplant recipients, complications from lung transplantation are a major cause of morbidity and mortality. Some of these complications can be classified on the basis of the time they typically occur after lung transplantation, while others may occur at any time. Imaging studies, in conjunction with clinical and laboratory evaluation, are key components in diagnosing and monitoring these conditions. Therefore, radiologists play a critical role in recognizing and communicating findings suggestive of lung transplantation complications. A description of imaging features of the most common lung transplantation complications, including surgical, medical, immunologic, and infectious complications, as well as an update on their management, will be reviewed here. Keywords: Pulmonary, Thorax, Surgery, Transplantation Supplemental material is available for this article. © RSNA, 2021.

Anti-viral therapy is associated with improved survival but is underutilised in patients with hepatitis B virus-related hepatocellular carcinoma: real-world east and west experience

BACKGROUND

Hepatitis B virus (HBV) is the leading cause of hepatocellular carcinoma (HCC) worldwide. It remains incompletely understood in the real world how anti-viral therapy affects survival after HCC diagnosis.

METHODS

This was an international multicentre cohort study of 2518 HBV-related HCC cases diagnosed between 2000 and 2015. Cox proportional hazards models were utilised to estimate hazard ratios (HR) with 95% (CI) for anti-viral therapy and cirrhosis on patients' risk of death.

RESULTS

Approximately, 48% of patients received anti-viral therapy at any time, but only 17% were on therapy at HCC diagnosis (38% at US centres, 11% at Asian centres). Anti-viral therapy would have been indicated for >60% of the patients not on anti-viral therapy based on American criteria. Patients with cirrhosis had lower 5-year survival (34% vs 46%; P < 0.001) while patients receiving anti-viral therapy had increased 5-year survival compared to untreated patients (42% vs 25% with cirrhosis and 58% vs 36% without cirrhosis; P < 0.001 for both). Similar findings were seen for other patient subgroups by cancer stages and cancer treatment types. Anti-viral therapy was associated with a decrease in risk of death, whether started before or after HCC diagnosis (adjusted HR 0.62 and 0.79, respectively; P < 0.001).

CONCLUSIONS

Anti-viral therapy improved overall survival in patients with HBV-related HCC across cancer stages and treatment types but was underutilised at both US and Asia centres. Expanded use of anti-viral therapy in HBV-related HCC and better linkage-to-care for HBV patients are needed.

Protective potency of clove oil and its transcriptional down-regulation of Aeromonas sobria virulence genes in African catfish (Clarias gariepinus L.)

Disease episodes of fish caused by Aeromonas species are moved to the top list of limiting problems worldwide. The present study was planned to verify the in vitro antibacterial activities as well as the in vivo potential values of clove oil and ciprofloxacin against Aeromonas sobria in African catfish (Clarias gariepinus). The in vitro phenotypic virulence activities and the successful amplification of aerolysin and hemolysin genes in the precisely identified A. sobria strain were predictive for its virulence. In the in vivo assay, virulence of A. sobria strain was fully demonstrated based on constituent mRNA expression profile of tested virulence genes and typical septicemia associated with high mortalities of infected fish. Apparent lower mortality rates were correlated well with both decrescent bacterial burden and significant down-regulated transcripts of representative genes in the treated groups with clove oil, followed by ciprofloxacin as a prophylactic use for 15 days (P < 0.0001); however, the essential oil apart from ciprofloxacin significantly enhanced different hematological parameters (P < 0.05). In addition, administration of antibiotic may be considered as a pronounced stress factor in the fish even when it used in the prophylactic dose. In conclusion, medicinal plants-derived essential oils provide a virtually safer alternative to chemotherapeutics on fish, consumers and ecosystems.

Evaluating the ameliorative efficacy of Spirulina platensis on spermatogenesis and steroidogenesis in cadmium-intoxicated rats

The present study was conducted to evaluate the ameliorative efficacy of Spirulina platensis (SP) on reproductive dysfunctions induced by cadmium chloride (CdCl2) in male rats. Rats (n = 40) were divided into five groups (eight rats/each). Group 1: served as control without any treatment. Group 2: Rats were administered SP (150 mg/kg body weight (BW)) in drinking water for 10 days. Group 3: Rats were subcutaneously injected with CdCl2 (2 mg/kg BW) daily for 10 days. Group 4: Rats were co-treated with both CdCl2 (2 mg/kg BW) and SP (150 mg/kg BW) daily for 10 days (SP prophylactic group). Group 5: Rats received CdCl2 for 10 days followed by administration of SP alone in drinking water daily for another 30 days with the same mentioned routes and doses (SP treatment group). From our findings, the administration of SP alone or co-administration with Cd significantly attenuated the harmful effects of Cd, suggesting its beneficial role in improving spermatogenesis and steroidogenesis after Cd exposure.

Quercetin mitigates fenitrothion-induced testicular toxicity in rats

Fenitrothion (FNT) is a widely used organophosphorus pesticide in agriculture. Quercetin (QR), a plant-derived flavonoid, has a free radical scavenging property. This study investigated the protective effect of QR on FNT-induced testicular toxicity in rats. Twenty-four male rats were divided into four groups. Group I (control) received normal saline. Group II was administered QR at the dose of 50 mg kg(-1) b.wt. Group III was orally administered FNT (20 mg kg(-1) b.wt). Group IV was gavaged FNT and QR together at the same doses. All administrations were performed daily by gavage and maintained for 70 days. Sperm parameters and histopathological changes in testes were investigated. Serum testosterone and luteinising hormone were estimated using radioimmunoassay kits. In testes, expressions of steroidogenic genes (3β-hydroxysteroid dehydrogenase type 6, 17 β-hydroxysteroid dehydrogenase type 3 and steroidogenic factor-1) and oxidative stress genes (catalase and superoxide dismutase) were determined using real-time PCR. FNT administration caused significant decreases in sperm count, motility and hormonal levels, a significant increase in abnormal sperm morphology and a significant down-regulation of steroidogenic and antioxidant genes in the testis. However, QR administration ameliorated FNT-induced toxic effects. Our results concluded that QR effectively mitigated testicular damage induced by FNT in rats.

A role for human endogenous retrovirus-K (HML-2) in rheumatoid arthritis: investigating mechanisms of pathogenesis

Human endogenous retroviruses (HERVs) are remnants of ancient retroviral infections within the human genome. These molecular fossils draw parallels with present-day exogenous retroviruses and have been linked previously with immunopathology within rheumatoid arthritis (RA). Mechanisms of pathogenesis for HERV-K in RA such as molecular mimicry were investigated. To clarify a role for HERVs in RA, potential autoantigens implicated in autoimmunity were scanned for sequence identity with retroviral epitopes. Short retroviral peptides modelling shared epitopes were synthesized, to survey anti-serum of RA patients and disease controls. A novel real-time polymerase chain reaction (PCR) assay was also developed to quantify accurately levels of HERV-K (HML-2) gag expression, relative to normalized housekeeping gene expression. Both serological and molecular assays showed significant increases in HERV-K (HML-2) gag activity in RA patients, compared to disease controls. The real-time PCR assay identified significant up-regulation in HERV-K mRNA levels in RA patients compared to inflammatory and healthy controls. Exogenous viral protein expression and proinflammatory cytokines were also shown to exert modulatory effects over HERV-K (HML-2) transcription. From our data, it can be concluded that RA patients exhibited significantly elevated levels of HERV-K (HML-2) gag activity compared to controls. Additional factors influencing HERV activity within the synovium were also identified. The significant variation in RA patients, both serologically and transcriptionally, may be an indication that RA is an umbrella term for a number of separate disease entities, of which particular HERV polymorphisms may play a role in development.

The potential role of human endogenous retrovirus K10 in the pathogenesis of rheumatoid arthritis: a preliminary study

OBJECTIVE

To examine whether human endogenous retrovirus K10 is associated with autoimmune rheumatic disease.

DESIGN

A novel multiplex reverse transcription polymerase chain reaction (RT-PCR) system was developed to investigate HERV-K10 mRNA expression in patients with rheumatoid arthritis.

METHODS

40 patients with rheumatoid arthritis, 17 with osteoarthritis, and 27 healthy individuals were recruited and total RNA was extracted from peripheral blood mononuclear cells (PBMCs) and analysed using multiplex RT-PCR for the level of HERV-K10 gag mRNA expression. Southern blot and DNA sequencing confirmed the authenticity of the PCR products.

RESULTS

Using the histidyl tRNA synthetase (HtRNAS) gene as a housekeeping gene in the optimised multiplex RT-PCR, a significantly higher level of HERV-K10 gag mRNA expression was found in rheumatoid arthritis than in osteoarthritis (p = 0.01) or in the healthy controls (p = 0.02).

CONCLUSION

There is enhanced mRNA expression of the HERV-K10 gag region in rheumatoid arthritis compared with osteoarthritis or healthy controls. This could contribute to the pathogenesis of rheumatoid arthritis.

Prevalence of hypovitaminosis D in Indo-Asian patients attending a rheumatology clinic

This study was performed to determine the prevalence of hypovitaminosis D (HD) and hypovitaminosis D associated with secondary hyperparathyroidism (HD-SHPT) among Indo-Asians attending rheumatology clinics in Wolverhampton. A cross-sectional survey of 98 clinic attenders and 36 normal controls subjects was undertaken. The groups were matched for age, gender, and body mass index. There was a high prevalence of vegetarianism, and milk consumption was low in both groups. Clinical scores for musculoskeletal pain, gait, and muscle strength were all significantly worse in clinic attenders (p < 0.001). Comparing clinic attenders with controls, 25-OH-vitamin D levels were 6.6 +/- 3.9 vs. 8.2 +/- 4.8 microg/L (p < 0.01) and the prevalence of HD (<8 microg/L) was 78% vs. 58% (p < 0.05), but neither parathyroid hormone levels (53 +/- 60 vs. 50 +/- 18 ng/L, n.s.) nor HD-SHPT prevalence (22% vs. 33%, n.s.) were significantly different. Routine biochemical tests were not discriminant, but none of the controls and 10 of 98 (10%) clinic attenders had elevated alkaline phosphatase levels: 6 with HD and 3 with HD-SHPT. Vitamin D deficiency has an extremely high prevalence among Indo-Asians in the U.K., particularly in those attending rheumatology clinics. Detection of HD and HD-SHPT is only possible using measurements of 25-OH-vitamin D and PTH.

Antipyrine clearance and metabolite excretion in Saudi patients with non-alcoholic chronic liver disease

In this report, we examined the hepatic microsomal enzyme activity in 34 Saudi patients with chronic liver disease (CLD) and in 21 healthy Saudi subjects by measuring antipyrine clearance (APCI) and the fraction (%) of antipyrine (AP) dose excreted in urine unchanged (fAP) and in the form of its main metabolites: 3-hydroxymethylantipyrine (fHMAP), norantipyrine(fNORAP), and 4-hydroxyantipyrine (f4OHAP). While APCI, fHMAP, fNORAP, f4OHAP were significantly reduced in patients with CLD, fAP was significantly higher in these patients. Correlation was observed between serum albumin and APCI, fHMAP, fNORAP, or f4OHAP and between each two of the last three variables. We conclude that Saudis with CLD have uniform rather than selective reduction of hepatic microsomal enzyme activity and that serum albumin is a sensitive indicator of this activity.

Antipyrine clearance and metabolite excretion in patients with chronic hepatitis C

BACKGROUND/AIMS

Our aim was to study whether chronic hepatitis C affects the three metabolic pathways of the model drug antipyrine differently.

METHODS

We measured antipyrine clearance from saliva as well as urinary excretion of its main metabolites 4-hydroxy-antipyrine, 3-hydroxy-methyl-antipyrine, and nor-antipyrine in 24 patients with chronic hepatitis C and in 21 healthy control subjects. Due to incomplete urine collection, 12 liver patients and three controls were excluded.

RESULTS

Antipyrine clearance (mean +/- SD) was significantly lower in patients with chronic hepatitis C, 1.2 +/- 0.7 l.h-1 (n = 12), than in controls (n = 18), 2.2 +/- 1.0 l.h-1 (p = 0.006). The urinary excretion of each of the metabolites was depressed to an equal extent in liver patients. The severity of the liver disease, as assessed by Child Pugh score, serum albumin and bilirubin, correlated significantly with antipyrine clearance and urinary excretion of the metabolite 3-hydroxy-methyl-antipyrine. The hepatitis activity index (Knodell) correlated with 3-hydroxy-methyl-antipyrine and 4-hydroxy-antipyrine, only.

CONCLUSIONS

Moderate-severe chronic hepatitis C does not seem to depress the three main metabolic pathways of antipyrine differently.

Elimination studies of antipyrine and its metabolites in healthy Saudi Arabians

1. We measured the antipyrine clearance in 18 healthy Saudi subjects and determined the urinary excretion of three of its metabolites: 4-hydroxyantipyrine (4-OH AP), norantipyrine (NOR AP) and 3 hydroxymethylantipyrine (3-OHM AP) in 21 subjects. 2. The mean +/- SD of the antipyrine clearance was 2.4 +/- 1.1 h-1 (range 1.0-5.5 l h-1) and the corresponding value per kg body weight was 0.6 +/- 0.2 ml min-1 kg-1. Urinary excretion of antipyrine (AP), 4-OH AP, NOR AP and 3-OHM AP expressed as a percentage of the oral dose of antipyrine given was 2.8 +/- 2.2, 14.5 +/- 6.9, 12.3 +/- 5.6 and 7.6 +/- 3.2 respectively. 3. Compared to Africans, Saudis preferentially metabolize AP to NOR AP and compared to Caucasians to 3-OHM AP, rather than to 4-OH AP. These discrepancies may reflect age differences between the study populations rather than genetic or ethnic variations.

Dental procedures in patients receiving oral anticoagulation therapy

Over a 10-year period a uniform management plan for patients receiving long term oral anticoagulation therapy for prosthetic heart valves and needing dental procedures was instituted. Those undergoing dental extraction or gum hygiene in the presence of gross gum pathology (Group A) had their oral anticoagulation discontinued two days prior to the procedure which was carried out only if the INR was 1.5 or less on the day of the procedure. Patients who needed dental fillings or gum hygiene in the absence of gross gum pathology (Group B) continued their anticoagulation therapy and had these procedures completed provided the INR was 3.0 or less. The main outcome measured were valve thrombosis, thromboembolism and excessive bleeding requiring hospitalization and/or blood transfusion. In Group A, 240 procedures were carried out; 212 dental extractions and 28 dental hygiene in the presence of gross gum pathology. They had a brief period of under-anticoagulation (3-7 days) to an INR of 1.5 or less. In Group B, 156 procedures were performed. No patient developed valve thrombosis or thromboembolism. Two patients, both in Group A needed hospitalization for observation but no blood transfusion. This management plan was easy to implement. Patients needed one extra visit to the anticoagulation clinic within one week of the procedure. It was both safe and effective.

Histologically advanced chronic hepatitis C treated with recombinant alpha-interferon: a randomized placebo-controlled double-blind cross-over study

Chronic hepatitis C is common in Saudi Arabia and most often presents in an advanced stage. To assess the response of patients to interferon, a randomized placebo-controlled double-blind study was undertaken. All but 1 patient had cirrhosis or fibrosis before interferon. After a 24-week observation period patients received alpha 2a interferon, 3 mega units sc tiw or placebo for 24 weeks, then the opposite treatment for another 24 weeks followed by 24 weeks of observation. Liver biopsies were performed before and after each of the treatment phases. Twenty-two out of 24 patients completed the study. The mean alanine aminotransferase (ALT) levels fell from 150.7 +/- 118.7 units/l to 91.0 +/- 42.6 units/l after 6 months interferon treatment (P = 0.03) but only 3 patients (14%) had complete normalization of mean ALT levels and 4 (18%) had > 50% reduction. The mean hepatitis activity index fell from 12.2 +/- 2.6 immediately before to 11.6 +/- 2.5 just after interferon (P = 0.4). After interferon there was an insignificant raise in 6-month mean ALT. Hepatitis C virus-RNA was positive in all 17 patients tested and remained so after treatment. Side-effects were mild and well tolerated. Alpha interferon 3 mega units tiw for 24 weeks is not an effective treatment of histologically advanced chronic hepatitis C.

Atracurium after an anticholinesterase. Does prior reversal with edrophonium or neostigmine influence the response to atracurium?

This study documents the response to atracurium (75 micrograms.kg-1) administered 30 min after a pancuronium- or tubocurarine-induced neuromuscular block has been reversed with either neostigmine (50 micrograms.kg-1) or edrophonium (0.5 mg.kg-1). Twenty-one ASA 1 or 2 patients were studied, of whom 11 received neostigmine and 10 edrophonium. The degree of neuromuscular block was measured electromyographically from the first dorsal interosseous muscle of the hand using train-of-four stimulation of the ulnar nerve. When atracrium was administered, the single twitch response compared with control was 100% in all patients and the mean train-of-four ratios were 91% and 65% in the neostigmine and edrophonium groups respectively. After atracurium (75 micrograms.kg-1), minimum values for the single twitch response compared with control were 52% and 66% in the neostigmine and edrophonium groups respectively. Prior administration of atracurium appears to potentiate the neuromuscular blocking effects of atracurium administered 30 min later.

Toxocara eggs in the soil of public places and schools in Basrah, Iraq

One hundred and eighty soil samples were collected from public places and school yards in urban and rural areas in Basrah between October 1991 and March 1992. Each sample was examined by zinc sulphate flotation and sedimentation. Toxocara eggs were found in 22 samples (12.2%). Of the recovered positive samples 10 contained viable and fully embryonated eggs. Viable eggs were observed in higher proportions of soils collected from the surroundings of Basrah slaughter-house, where there are large numbers of dogs and cats. The observed mean number of eggs per 5 g of soil was 2.8 +/- 1.9 S.D. The contamination rate in urban areas (17.3%) was significantly higher (P < 0.05) than that in rural areas (6.1%). Thirteen of 116 samples (11.2%) collected from public places and nine of 64 samples (14.1%) from school yards contained Toxocara eggs. Urban public places and schools have higher contamination rates (18.0% and 16.2%, respectively) than those in rural areas (3.6% and 11.1%), but the differences are significant (P < 0.05) between public places only.

Reproductive health of adolescents in Bangladesh

The health and social effects of pregnancy in married women 13-23 years of age were studied among a population of 175,000 in rural Bangladesh. Data collected by a structured questionnaire identified pregnant women who were followed twice during pregnancy and twice postpartum. Maternal mortality for the 13-17 age group was 5.8/1000 compared to 1.8/1000 for the 18-23 year olds. Major causes of death in the younger group were obstructed labor and toxemia. The neonatal death rate was 80/1000 for the younger group and 43/1000 for the older group. The major cause of death of infants born to the younger mothers was birth injury. In infants born to older mothers, it was tetanus. Perinatal death rate was 66.4/1000. All deliveries occurred at home, and 89% of births were attended by relatives, neighbors or an untrained birth attendant. Only 13% of the women had ever used contraceptives. Use varied from 2.9% at 16 years to 24.7% at 23 years. Suggestions are made for improving maternal and child health care in rural Bangladesh.

Avian enteric nerve plexuses. A histochemical study

The enteric nerve plexuses of the domestic fowl (Gallus domesticus) were investigated in sections and stretch preparations by means of the cholinesterase and glyoxylic acid fluorescence histochemical techniques. Cholinesterase-positive and varicose and non-varicose fluorescent nerve fibers were distributed at all levels of the gut in myenteric, submucosal, muscle and mucosal plexuses, and in a perivascular plexus. The density of the innervation and the detailed distribution of the nerves varied in different parts of the intestinal tract. All nerve plexuses appeared to be best developed in the rectum. Whereas the circular muscle coat contained a substantial number of nerves at all levels of the gut, the longitudinal coat was well innervated only in the rectum. The major portion of the mucosal plexus appeared to be associated with the intestinal glands. The nerve cell bodies were restricted to the myenteric and submucosal plexuses and were mainly cholinesterase-positive. Fluorescent ganglion cells were not observed. Pretreatment of stretch preparations with NADH: Nitro BT to stain ganglion cells showed that the majority of the cells were surrounded by a meshwork of fluorescent varicose fibres, although none of the fibres appeared to be associated with individual cells. The perivascular plexus was mainly associated with the arteries. The functional significance of the innervation is discussed.

On the morphology of the accessory male glands and histochemistry of the ampulla ductus deferentis of the camel (Camelus dromedarius)

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Some histochemical studies on the prostate, urethral and bulbourethral glands of the one-humped camel (Camelus dromedarius)

The histochemical localization of carbohydrates, ribonucleoproteins (RNA), lipids, some hydrolytic enzymes, succinate and lactate dehydrogenase and acetylcholinesterase were investigated in the prostate, urethral and bulbourethral glands of the camel. These glands probably secrete carbohydrate-protein complexes. In the bulbourethral glands, they are sulphated mucopolysaccharides. RNA was seen in the cytoplasm of the prostate and urethral glands. Neutral lipids were cytoplasmic and present in moderate amounts in the prostate and urethral glands and in traces, in the bulbourethral gland. Acid phosphatase-containing granules were abundant in the prostate, moderate in the urethral glands and in traces in the bulbourethral glands. Alkaline phosphatase was observed in the apical cytoplasm of the prostate and bulbourethral glands and in the ducts of the urethral glands. ATPase and adenosine 5-monophosphatase were seen in the basal laminae and interstitial tissue. In the urethral glands, adenosine 5-monophosphatase was distributed diffusely in the cytoplasm. Succinate dehydrogenase was seen in the urethral and bulbourethral glands. Varying degrees of lactate dehydrogenase activity was observed in all the glands. Acetylcholinesterase was confined to neural elements. The pars disseminata and the urethral glands were considered as two distinct glandular zones along the pelvic urethra. The significance of these histochemical results is discussed.