Induced abortion in Sri Lanka: who goes to providers for pregnancy termination?

The sociodemographic characteristics of abortion seekers and the reasons they give for procuring termination were studied in 356 clients selected from two abortion clinics in the city of Colombo. Nearly 80% were Buddhists and about 10% were Christians. Almost all had some formal education but only 20% were employed outside the home. Over 95% were currently married and at the peak of their childbearing age. More than one-half were aged 30 years or over, while adolescents only constituted about 3%. Fourteen per cent were nulliparous and about two-thirds had one or two living children at the time of obtaining the abortion. A significantly high proportion also had a very young child. In total, the 356 women had had 1130 pregnancies, and the mean rate of abortion was 42 per 100 pregnancies. Over one-quarter had had more than one abortion and about 10% had had three or more. Almost all abortions were performed within the first trimester with a mean gestation period of 6 weeks. About one-third of the clients were using some method of contraception at the time they became pregnant. The most common reasons cited for the present abortion were 'pregnancy too soon after previous delivery', 'no more children desired' or 'curtailment of opportunity for foreign employment'. Unmarried women constitute a special group of abortion seekers who have different needs and behave differently from married women. Their needs are not currently being met by reproductive health programmes in Sri Lanka, and it is important that they should be given special attention in the future. An interesting finding is that a significant minority of the abortion seekers answered negatively to the question regarding providing medical facilities for abortions without difficulty. This underscores the ambivalence many people have to abortion.     

Trichomonasfetus—Induced abortion

$\text{History}$ and $\text{Clinical}$$\text{Signs}$: Herds infected with $\text{Trichomonas}$$\text{fetus}$ have histories of infertility, occasional abortions, and pyometra.$\text{Gross}$$\text{Lesions}$: There are no specific gross lesions in the fetus. The fetuses are usually aborted in the first half of gestation and may or may not be accompanied by the placenta.$\text{Microscopic}$$\text{Lesions}$: There are no specific microscopic lesions.$\text{Cultural}$$\text{Procedures}$: It is ordinarily not necessary to culture $\text{T.}$$\text{fetus}$ in order to demonstrate its presence in placental fluids and/or abomasal contents.$\text{Serologic}$$\text{Procedures}$: There are no suitable seroligic procedures for diagnosing Trichomoniasis.$\text{Special}$$\text{Procedures}$: Wet mounts of abomasal contents and/or placental fluids are examined microscopically for $\text{T.}$$\text{fetus}$.$\text{Preferred}$$\text{Diagnostic}$$\text{Procedures}$: Demonstrate the presence of $\text{T.}$$\text{fetus}$ by microscopic examination of wet mounts of placental fluids and/or abomasal contents.     

Autochthonous Leptospirosis in South-East Austria, 2004–2012

Background

Leptospirosis is one of the world’s mostly spread zoonoses causing acute fever. Over years, leptospirosis has been reported to occur rarely in Austria and Germany (annual incidence of 0.06/100,000 in Germany). Only imported cases have been on the increase. Objectives of this case-series study were to retrospectively assess epidemiologic and clinical characteristics of leptospirosis illnesses in South-East Austria, to describe risk exposures for autochthonous infections, and to compare patients with imported versus autochthonous infection.

Methodology/Principal Findings

During the 9-year period between 2004 and 2012, 127 adult patients (49 females, 78 males) who tested positive by rapid point-of-care test for Leptospira-specific IgM (Leptocheck®) were identified through electronic hospital databases. Follow-up telephone interviews were conducted with 82 patients. A total of 114 (89.8%) of the 127 patients enrolled had acquired leptospirosis within Austria and 13 (10.2%) had potentially imported infections. Most autochthonous cases were diagnosed during the months of June and July, whereas fewest were diagnosed during the winter months. Exposure to rodents, recreational activities in woods or wet areas, gardening, cleaning of basements or huts were the most common risk exposures found in autochthonous infection. Serogroups Australis (n = 23), Sejroe (n = 22), and Icterohaemorrhagiae (n = 11) were identified most frequently by MAT testing in autochthonous infections. Patients with imported leptospirosis were significantly younger, less likely to be icteric and had significantly lower liver transaminase levels (p = 0.004) than those with autochthonous infections.

Conclusions/Significance

Leptospirosis is endemic in South-East Austria. In contrast to reports from other countries we found a relatively high proportion of leptospirosis cases to be female (39% vs. ∼10%), likely the result of differing risk exposures for South-East Austria.     

Has Madagascar Lost Its Exceptional Leptospirosis Free-Like Status?

Background

Leptospirosis is a widespread but underreported cause of morbidity and mortality. It has rarely been reported in either humans or animals in Madagascar.

Methods

We conducted a cross-sectional survey of the inhabitants in Moramanga, Madagascar, in June 2011, to estimate the prevalence of human infection using the microscopic agglutination test (MAT). This activity was carried out as part of a workshop implemented by the Pasteur Institute of Madagascar, focusing on surveillance with a one week field study and targeting the health staff of the district level.

Results

In total, we sampled 678 inhabitants from 263 households. The sex ratio (M/F) was 0.65 and the mean age 26.7 years. We obtained a value of 2.9% for the first recorded seroprevalence of this disease in the human community of Moramanga. Questionnaire responses revealed frequent contacts between humans and rodents in Moramanga. However, activities involving cattle were identified as a risk factor significantly associated with seropositivity (OR=3).

Conclusion

Leptospirosis remains a neglected disease in Madagascar. This study highlights the need to quantify the public health impact of this neglected disease in a more large scale, in all the country and to establish point-of-care laboratories in remote areas.     

Cerebrovascular Involvement in Liposome—Induced Cardiopulmonary Distress in Pigs

Intravenous administration of liposomes, including Doxil, can cause severe life-threatening hemodynamic changes in pigs. The reaction is due to complement activation, and it is characterized by massive pulmonary hypertension, systemic hypotension, and severe cardiac abnormalities including falling cardiac output, tachy-or bradycardia with arrhythmia. There were no data suggesting the involvement of cerebrovascular changes in this reaction; however, clinical observations allowed this hypothesis. Here we measured the accompanying changes during liposome infusion by monitoring pulsatile electrical impedance (rheoencephalogram- REG) on the skull (n = 24 pigs, 57 trials, 19 types of liposomes). A transient but significant decrease of REG pulse amplitudes followed the injection of liposomes (78.43% in the total sample, and 91.66% in the Doxil subgroup; P = 0.003, n = 12), indicating the involvement of cerebrovascular reaction during liposome infusion.     

El Ni?o Southern Oscillation and Leptospirosis Outbreaks in New Caledonia

Leptospirosis is an important cause of seasonal outbreaks in New Caledonia and the tropics. Using time series derived from high-quality laboratory-based surveillance from 2000–2012, we evaluated whether climatic factors, including El Niño Southern Oscillation (ENSO) and meteorological conditions allow for the prediction of leptospirosis outbreaks in New Caledonia. We found that La Niña periods are associated with high rainfall, and both of these factors were in turn, temporally associated with outbreaks of leptospirosis. The sea surface temperature in El Niño Box 4 allowed forecasting of leptospirosis outbreaks four months into the future, a time lag allowing public health authorities to increase preparedness. To our knowledge, our observations in New Caledonia are the first demonstration that ENSO has a strong association with leptospirosis. This association should be tested in other regions in the South Pacific, Asia or Latin America where ENSO may drive climate variability and the risk for leptospirosis outbreaks.     

Colonial growth and ramihyphin A — Induced changes in cell walls ofNeurospora sitophila

Colonial growth ofNeurospora sitophila phenotypically induced by ramihyphin A is accompanied by marked changes in the contents of DNA, RNA and proteins in the mycelium, and in the relative proportion of hexoses in cell wall hydrolysates. The glucosamine/glucose ratio is also characteristic for colonial growth. X-ray analysis of cell walls showed that ramihyphin A suppresses the crystalline arrangement of chitin in cell walls. A combination of microbiological, biochemical and physico-chemical methods yielded a general picture of the changes accompanying the colonial growth ofNeurospora sitophila.     

Calcium Induced Regulation of Skeletal Troponin — Computational Insights from Molecular Dynamics Simulations

The interaction between calcium and the regulatory site(s) of striated muscle regulatory protein troponin switches on and off muscle contraction. In skeletal troponin binding of calcium to sites I and II of the TnC subunit results in a set of structural changes in the troponin complex, displaces tropomyosin along the actin filament and allows myosin-actin interaction to produce mechanical force. In this study, we used molecular dynamics simulations to characterize the calcium dependent dynamics of the fast skeletal troponin molecule and its TnC subunit in the calcium saturated and depleted states. We focused on the N-lobe and on describing the atomic level events that take place subsequent to removal of the calcium ion from the regulatory sites I and II. A main structural event - a closure of the A/B helix hydrophobic pocket results from the integrated effect of the following conformational changes: the breakage of H-bond interactions between the backbone nitrogen atoms of the residues at positions 2, 9 and sidechain oxygen atoms of the residue at position 12 (N²-OE¹²/N⁹-OE¹²) in sites I and II; expansion of sites I and II and increased site II N-terminal end-segment flexibility; strengthening of the β-sheet scaffold; and the subsequent re-packing of the N-lobe hydrophobic residues. Additionally, the calcium release allows the N-lobe to rotate relative to the rest of the Tn molecule. Based on the findings presented herein we propose a novel model of skeletal thin filament regulation.     

The impact of climate on Leptospirosis in São Paulo,Brazil

In this work, we correlate the daily number of human leptospirosis cases with several climatic factors. We used a negative binomial model that considers hospital daily admissions due to leptospirosis as the dependent variable, and the climatic variables of daily precipitation pattern, and maximum and minimum temperature as independent variables. We calculated the monthly leptospirosis admission probabilities from the precipitation and maximum temperature variables. The month of February showed the highest probability, although values were also high during the spring months. The month of February also showed the highest number of hospital admissions. Another interesting result is that, for every 20 mm precipitation, there was an average increase of 31.5% in hospital admissions. Additionally, the relative risk of leptospirosis varied from 1.1 to 2.0 when the precipitation varied from 20 to 140 mm.     

Manipulation Therapy Prior to Diagnosis Induced Primary Osteosarcoma Metastasis—From Clinical to Basic Research

Osteosarcoma (OS) patients who suffer manipulation therapy (MT) prior to diagnosis resulted in poor prognosis with increasing metastasis or recurrence rate. The aim of the study is to establish an in vivo model to identify the effects of MT on OS. The enrolled 235 OS patients were followed up in this study. In vivo nude mice model with tibia injection of GFP-labeled human OS cells were randomly allocated into MT(+) that with repeated massage on tumor site twice a week and no treatment as MT(−) group. The five-year survival, metastasis and recurrence rates were recorded in clinical subjects. X-ray plainfilm, micro-PET/CT scan, histopathology, serum metalloproteinase 2 (MMP2), metalloproteinase 9 (MMP9) level and human kinase domain insert receptor (KDR) pattern were assayed in mice model. The results showed that patient with MT decreased 5-year survival and higher recurrence or metastasis rate. Compatible with clinical findings, the decreased body weight (30.5±0.65 g) and an increased tumor volume (8.3±1.18 mm³) in MT(+) mice were observed. The increasing signal intensity over lymph node region of hind limb by micro-PET/CT and the tumor cells were detected in lung and bilateral lymph nodes only in MT(+) group. MMP2 (214±9.8 ng/ml) and MMP9 (25.5±1.81 ng/ml) were higher in MT(+) group than in MT(−) group (165±7.8 ng/ml and 16.9±1.40 ng/ml, individually) as well as KDR expression. Taking clinical observations and in vivo evidence together, MT treatment leads to poor prognosis of primary osteosarcoma; physicians should pay more attention on patients who seek MT before diagnosis.     

Hyperbaric Oxygen in Therapy of Gas Gangrene—Report of a Case Following Induced Abortion

The treatment of gas gangrene has been revolutionized by oxygen drenching of tissues infected with Clostridia. This was used in a massive infection of the abdominal wall following a traumatic abortion attempt. The clostridial infection was controlled, but the patient almost succumbed to a secondary infection of gram-negative organisms. This responded to drainage, antibiotics and general supportive measures. In the course of treatment, the value of a team approach to complicated special problems was documented.     

Influence of Temperature on Pythium Splendens — Induced Root Disease on Carambola,Averrhoa Carambola

A series of glasshouse and incubator studies were conducted to investigate the role played by Pythium splendens in a decline disorder of carambola, Averrhoa carambola. Plants, 4-6 months old, were grown in native calcareous soil either infested or not infested with the pathogen. Isolates recovered from atemoya, carambola and passion fruit grew optimally at 30 degrees C, and significantly (P < 0.05) increased root necrosis and reduced root, shoot and total biomass of carambola. Temperature had a profound impact on the latter relationships. Two or more times more necrosis developed at 10 and 15 degrees C than at 25 and 30 degrees C. Total biomass accumulations were over four times greater at 30 degrees C than at 10 degrees C, and were always lower in soil infested with P. splendens. When biomass totals from infested and noninfested soil were compared, relative values were lowest at 15 and 20 degrees C and were almost two times greater at 30 degrees C than at 20 degrees C. Root infection by P. splendens was greatest at 15 and 20 degrees C, far below the species' optimum for growth, and at 30 degrees C was over nine times lower than at 15 and 20 degrees C. This is the first detailed report of P. splendens as a pathogen of carambola.     

Medical abortion: what does the research tell us?

Dr. Ellen R. Wiebe''s study of the use of methotrexate and misoprostol in combination for early termination of intrauterine pregnancy (see pages 165 to 170 of this issue) is the first Canadian study of the use of this drug combination for medical abortion. The authors compare Wiebe''s findings with those of earlier studies on methotrexate and misoprostol, as well as with European findings on the use of mifepristone with prostaglandins. The authors argue that although the methotrexate-misoprostol combination appears to be reasonably safe for the woman, the failure rate and the teratogenicity of methotrexate and misoprosol give cause for concern. The authors conclude that medical abortions ought to be offered only where there is adequate access to laboratory and surgical facilities and where losses to follow-up are systematically minimized to reduce the potential for continued pregnancy resulting in congenital abnormality.     

Does polyovulation counterbalance a high abortion rate in humans?

We tested the fertilization insurance hypothesis of human twinning, which suggests that twin births should be seen as an unadaptive consequence of polyovulation compensating for high spontaneous abortion rates in humans. Females with high incidence of polyovulation were predicted to benefit by becoming pregnant more rapidly and by having a higher likelihood of successful pregnancy than other females. As a disadvantage, polyovulating mothers should be more prone to presumably maladaptive twin deliveries. We studied birth intervals of twin and singleton mothers living in pre-industrial Finland by using demographic records of local churches. The analysis revealed that, contrary to the prediction of the fertilization insurance hypothesis, polyovulating females did not display shorter intervals between deliveries. Therefore, if the tendency towards polyovulation and therefore occasional twin births in humans is adaptive and maintained by natural selection, other benefits should be evident.