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Neonatal chlamydial eye infection: an epidemiological and clinical study.

Neonatal chlamydial eye infection was detected in 39 cases of 281 infants with purulent conjunctivitis seen at the Department of Ophthalmology. Most cases of neonatal chlamydial eye infection (90%) were detected during the first month of life, and no case was found after 2 months of age. C. trachomatis was not isolated from any of 161 healthy control infants at 3-4 weeks of age. Genital chlamydial infection was demonstrated in 50% of the mothers to infected infants. Two of these women developed post-partum complications possibly due to chlamydial infection. Mothers of infected infants tended to be younger than average. Of 23 cases examined 2 years later, late sequelae were identified in 3.

Adolescent↗

Granulomatous uveitis in neurological disease.

Five women with granulomatous uveitis were diagnosed as having probable multiple sclerosis. Three of the women developed curious iris nodules that resolved with topical prednisolone acetate treatment. The association of granulomatous type uveitis, with or without iris nodules, should alert the ophthalmologist to inquire about neurological symptoms attributable to multiple sclerosis.

Adult↗

Relation between personality and ventilatory response to carbon dioxide in normal subjects: a role in asthma?

Ventilatory response to carbon dioxide, as an index of respiratory centre sensitivity, was measured in 50 normal subjects. Their personality was documented in terms of extraversion and neuroticism scores by the Eysenck Personality Inventory. A significant correlation was found between extraversion score and ventilatory response to carbon dioxide in women (P < 0.005) but not in men. No correlation was found between ventilatory responsiveness and neuroticism score in either sex. It is suggested that the degree of extraversion may play some part in determining the level of ventilation adopted, and hence of arterial carbon dioxide tension, if and when women develop lung disease such as asthma.

Arteries↗

Psychiatric morbidity and the menopause: clinical features.

A sample of 114 women from the general population aged 40-55 years were identified as possible psychiatric cases and subjected to a standardised psychiatric interview. Mean ratings for reported symptoms and observed abnormalities were assessed in relation to menopausal status. There was no evidence of any specific combination of symptoms and signs associated with the cessation of menstrual periods, though after the menopause insomnia and hypochondriacal preoccupations were more common. In comparison with matched normal controls have been previous psychiatric illness, and contact with general practitioners was more frequent. Many women developing psychiatric symptoms at the time of the menopause appear to belong to a vulnerable population who are likely to develop symptoms in relation to stress.

Adult↗

A case of Lassa fever: clinical and virological findings.

Five days after arriving in London from Jos a young Nigerian women developed a severe and prolonged illness that proved to be Lassa fever. Virus was not detected in urine during the first three weeks but then appeared and reached a peak during the sixth week, with continuing excretion for 67 days after the onset of illness. Laboratory investigations showed evidence of extensive tissue damage and disturbance of clotting, but there was no serious bleeding and she eventually made a complete recovery despite a high sustained viraemia and severe liver damage. Convalescent serum was used in treatment but it was difficult to assess its contribution to the favourable outcome.

Adolescent↗

Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial.

OBJECTIVE: To test whether oral or vaginal lactobacillus can prevent vulvovaginitis after antibiotic treatment. DESIGN: Randomised, placebo controlled, double blind, factorial 2x2 trial. SETTING: Fifty general practices and 16 pharmacies in Melbourne, Australia. PARTICIPANTS: Non-pregnant women aged 18-50 years who required a short course of oral antibiotics for a non-gynaecological infection: 278 were enrolled in the study, and results were available for 235. INTERVENTIONS: Lactobacillus preparations taken orally or vaginally, or both, from enrollment until four days after completion of their antibiotic course. MAIN OUTCOME MEASURES: Participants' reports of symptoms of post-antibiotic vulvovaginitis, with microbiological evidence of candidiasis provided by a self obtained vaginal swab. RESULTS: Overall, 55/235 (23% (95% confidence interval 18% to 29%)) women developed post-antibiotic vulvovaginitis. Compared with placebo, the odds ratio for developing post-antibiotic vulvovaginitis with oral lactobacillus was 1.06 (95% confidence interval 0.58 to 1.94) and with vaginal lactobacillus 1.38 (0.75 to 2.54). Compliance with antibiotics and interventions was high. The trial was terminated after the second interim analysis because of lack of effect of the interventions. Given the data at this time, the chances of detecting a significant reduction in vulvovaginitis with oral or vaginal lactobacillus treatment were less than 0.032 and 0.0006 respectively if the trial proceeded to full enrollment. CONCLUSIONS: The use of oral or vaginal forms of lactobacillus to prevent post-antibiotic vulvovaginitis is not supported by these results. Further research on this subject is unlikely to be fruitful, unless new understandings about the pathogenesis of post-antibiotic vulvovaginitis indicate a possible role for lactobacillus.

Administration, Intravaginal↗

Left atrial metastasis of chorion carcinoma, presenting as mitral stenosis.

A 35-year-old women developed symptoms of multiple system disease. Three months later she was admitted to hospital and died six days after admission, with signs suggestive of mitral stenosis. Postmortem examination indicated primary chorion carcinoma of the right ovary with metastases to the left atrium, lungs, brain, kidneys, pancreas, mesenteric arteries, and spleen. The signs and symptoms, and the morphological and histological findings at necroscopy, are discussed.

Adult↗

Prospective cohort study of female sex workers and the risk of HIV infection in Alicante, Spain (1986-96).

OBJECTIVE: To measure the incidence of HIV infection over a 10 year follow up in a cohort of female commercial sex workers in Alicante (Spain), and to determine factors associated with high risk of infection. METHODS: A prospective cohort study was carried in an AIDS information and prevention centre in Alicante, Spain. Of the 1388 female sex workers who initially sought the services of the centre since September 1986, 657 completed at least one additional follow up visit before December 1996. Main outcome measures were infection with HIV-1 and reported risk behaviours. RESULTS: During 1815 person years of observation among 657 female sex workers who were free of HIV infection (negative test), 16 women developed of HIV infection (incidence rate of HIV infection = 8.8 cases/1000 woman years, 95% confidence interval (CI): 5.4-14.4). Reported current use of injecting drugs at the first visit was associated with an increased risk of HIV infection (relative risk, RR = 12.87, 95% CI: 4.81-34.15) as well as having an usual partner with injecting drug addiction (RR = 20.89, 95% CI: 7.44-58.70). Infection also was associated with younger age (RR for 1 year = 0.86, 95% CI: 0.76-0.96). After multivariate adjustment using Poisson regression analysis, the factors that remained significantly associated with the risk of HIV infection were current use of injecting drugs (RR = 4.61, 95% CI: 1.37-15.46), and having a usual partner with injecting drug addiction (RR = 10.08, 95% CI: 2.94-34.57). There was also some evidence that a younger age could be related to infection. CONCLUSION: These data suggest that the risk of HIV infection among this cohort of female sex workers in Alicante is predominately associated with the use of injecting drugs, and having a regular partner with injecting drug addiction. An increasing number of clients did not play a role in the risk of infection.

Adult↗

Paradoxical vocal cord motion causing stridor after thyroidectomy.

Two women developed stridor immediately after thyroidectomy as a result of paradoxical vocal cord motion. In both cases the cord function showed a normal pattern during vocalisation but paradoxical movement was seen at laryngoscopy during tidal breathing. The abnormality improved in both patients over time with speech therapy. Whilst the syndrome of paradoxical vocal cord motion is classically thought to have a largely psychological aetiology, subtle interference with laryngeal innervation at surgery is more likely to have been the cause in these cases.

Adult↗

Female rats exhibit greater susceptibility to early alcohol-induced liver injury than males.

It is known that women develop hepatic injury more rapidly and with exposure to less ethanol than men; however, mechanisms remain unclear. The purpose of this study was to determine if an enteral alcohol delivery model could be used to study susceptibility of females to alcohol-induced liver injury. Male and female Wistar rats (age- or weight-matched) were given ethanol (11-12 g.kg-1.day-1) continuously for up to 4 wk via intragastric feeding, and control rats received a high-fat diet without ethanol. There were no significant differences in body weight among the groups studied. Furthermore, mean ethanol concentrations, their cyclic pattern in urine, and rates of ethanol elimination were also not different between the genders under these conditions. Ethanol treatment elevated serum aspartate aminotransferase levels in male rats to 126 +/- 10 IU/l after 4 wk. In females, however, values increased more rapidly and reached significantly higher values at 4 wk (168 +/- 18 IU/l). Steatosis, inflammation, and necrosis assessed histologically also developed more rapidly and were more severe in females than males. Steatosis due to ethanol exposure, which was localized in centrilobular areas in males, was panlobular in the female. Moreover, endotoxin in plasma, intercellular adhesion molecule 1 expression in hepatic sinusoidal-lining cells, and the number of infiltrating inflammatory cells in the liver were 2-2.5-fold greater in females than males. These changes possibly account for increased hepatic injury due to ethanol in the female.

Animals↗

Antibiotics and risk of breast cancer: up to 9 years of follow-up of 2.1 million women.

Antibiotic use has been associated with risk of breast cancer in previous reports. Using Cox proportional hazards analysis, we evaluated this association in 2,130,829 adult female subscribers of a health care program according to their receipt of prescriptions of antibiotics from outpatient pharmacies. Hormone use was taken into account. Altogether, 18,521 women developed breast cancer in up to 9.4 years of follow-up. Use of any antibiotic was associated with slightly increased risk [hazard ratio (HR), 1.14; 95% confidence interval (95% CI), 1.10-1.18] but there was little, if any, evidence of dose response, with HR of 1.17 (95% CI, 0.97-1.42) for >1,000 days of use compared with no use. The only two weakly associated antibiotic groups (HR >1.10 for >100 days of use) were tetracyclines and macrolides with HRs (95% CI) of 1.23 (1.11-1.36) and 1.16 (0.98-1.36), respectively. An association of lincosamides with breast cancer in an earlier, smaller database was not confirmed, but follow-up was too short in the present data for adequate evaluation. Medical record review suggested that acne and/or rosacea could be the underlying factor, associated with long-term antibiotic therapy and found by others to be associated with risk of breast cancer. Although causality cannot be ruled out, the observed associations of antibiotics overall, tetracyclines, and macrolides with breast cancer were weak and could be explained by uncontrolled confounding by the diseases being treated or by other factors.

Acne Vulgaris↗

Coasting may reduce the severity of the ovarian hyperstimulation syndrome in patients with polycystic ovary syndrome.

The aim of our study was to determine the efficacy of postponing administration of human chorionic gonadotropin while continuing daily gonadotropin-releasing hormone agonist therapy ('coasting') to prevent the occurrence of severe ovarian hyperstimulation syndrome (OHSS) for patients with polycystic ovary (PCO) syndrome. Five patients with PCO who had been hospitalized due to severe OHSS in previous in vitro fertilization and embryo transfer or intrauterine insemination cycles at the Tottori University Hospital were included in the study. The rates of mature oocytes and fertilization were comparable between the cycles. A singleton pregnancy was achieved in a patient during the coasting cycle, and none of the women developed severe OHSS in coasting cycles. The results suggest that coasting may be an alternative method for reducing the severity of OHSS in patients with PCO.

Adult↗

Preoperative risk factors for surgery female urethral diverticula. Our experience.

INTRODUCTION: This study describes the authors' experience about the most important risk factors in surgical treatment of female urethral diverticula. The attention is focused on the correlation between risk factors and common severe complications after surgical treatment. PATIENTS AND METHODS: Eighteen women underwent transvaginal diverticulectomy from 1990 to December 2000. Voiding cystourethrography and transvaginal ultrasonography were performed preoperatively. As far as location is concerned, 10 women developed a mid-urethral diverticula, the remaining had diverticula equally distributed over the distal and proximal urethra. Ten diverticula showed a posterior development, 6 a lateral one and 2 diverticula had horseshoe shape. In 6 cases, diverticulum was larger than 4 cm. RESULTS: Follow-up ranged from 44 to 121 months. We recorded one urethrovaginal fistula, two genuine stress incontinence of new onset, associated in one case with recurrent diverticulum, and one recurrent diverticulum as major complications. CONCLUSIONS: The most important risk factors, evaluated with a statistical analysis, are represented by delayed diagnosis, size over 4 cm, and lateral or horseshoe shape of the diverticulum.

Adult↗

Insulin secretion in patients with gestational diabetes: relationship with pregnancy outcome.

The authors observed that there is wide variability in insulin response to an oral glucose tolerance test in women developing carbohydrate intolerance during pregnancy. This variability ranges from a reduction of pancreatic islet function to a normal or exaggerated secretory pattern of insulin. Moreover the results also suggest that exaggerated insulin secretion and/or high insulin resistance may play a role in the regulation of gestational blood pressure and that a higher glucose/insulin ratio may be positively related to birth weight. Clearly, further studies are needed to investigate the impact of this metabolic situation on the optimization of the clinical control of glucose metabolism and fetal homeostasis.

Adult↗

Psychological differences between young male and female survivors of myocardial infarction.

BACKGROUND: The aim of this study was to investigate psychological differences between young male and female survivors of acute myocardial infarction (MI). METHODS: 35 male (mean age 37.3) and 29 female (mean age 38.6) patients with first MI made the study group. Type A behavior, anxiety, alexithymia construct and vital exhaustion were assessed by self-reported questionnaires. RESULTS: The results indicate that females suffer considerably more frequently from fatigue and exhaustion in the prodromal period of MI. Women develop a higher level of cognitive-worry, subscale score of anxiety; they are more irritable and less able to relax. CONCLUSIONS: These gender-related differences in psychological status should be taken into consideration for the optimal psychosocial rehabilitation of young patients with first acute MI.

Adult↗

Retinal vasculitis as a complication of rheumatoid arthritis.

Two middle-aged women developed retinal vasculitis in the moderately active phase of classical rheumatoid arthritis. Fluorescein angiography disclosed diffuse leakage from the retinal capillaries and cystoid macular edema, which subsided in response to oral steroid. They did not show any clinical signs of vasculitis in other parts of the body. Retinal vasculitis should be included in the list of complications observed in rheumatoid arthritis.

Adrenal Cortex Hormones↗

Inflammatory markers and risk of heart failure in elderly subjects without prior myocardial infarction: the Framingham Heart Study.

BACKGROUND: Experimental studies support a key role for cytokines in left ventricular remodeling. In congestive heart failure (CHF) patients, elevated plasma cytokine levels are associated with worse functional status and adverse prognosis. It is unclear whether cytokine levels can predict the incidence of CHF in asymptomatic individuals. METHODS AND RESULTS: We investigated the relations of serum interleukin-6 (IL-6), C-reactive protein (CRP), and spontaneous production of tumor necrosis factor-alpha (TNFalpha) by peripheral blood mononuclear cell (PBMC) to CHF incidence among 732 elderly Framingham Study subjects (mean age 78 years, 67% women) free of prior myocardial infarction and CHF. On follow-up (mean 5.2 years), 56 subjects (35 women) developed CHF. After adjustment for established risk factors, including the occurrence of myocardial infarction on follow-up, there was a 60 (PBMC TNFalpha) to 68% (serum IL-6) increase in risk of CHF per tertile increment in cytokine concentration (P=0.04, and 0.03, respectively, for trend). A serum CRP level > or =5 mg/dL was associated with a 2.8-fold increased risk of CHF (P=0.02). Subjects with elevated levels of all 3 biomarkers (serum IL-6 and PBMC TNFalpha >median values, CRP> or =5 mg/dL) had a markedly increased risk of CHF (hazards ratio 4.07 [95% CI 1.34 to 12.37], P=0.01) compared with the other subjects. CONCLUSIONS: In our elderly, community-based sample, a single determination of serum inflammatory markers, particularly elevated IL-6, was associated with increased risk of CHF in people without prior myocardial infarction. Additional epidemiological investigations are warranted to confirm the contribution of inflammation to the pathogenesis of CHF in the general population.

Aged↗

Electrocardiographic QRS duration and the risk of congestive heart failure: the Framingham Heart Study.

Prolonged electrocardiographic QRS duration is frequently observed in congestive heart failure (CHF) patients. We hypothesized that CHF risk increases with longer QRS interval in individuals free of CHF. We evaluated 1759 Framingham Study participants (mean age, 69 years; 63% women) without prior myocardial infarction or CHF who attended a routine examination. QRS duration was analyzed as a continuous (log-transformed) and a categorical variable [referent, <100 ms; incomplete bundle branch block (BBB), 100 to 119 ms; complete BBB, > or =120 ms]. During follow-up (mean, 12.7 years), 324 participants (205 women) developed CHF. CHF incidence increased across the 3 baseline QRS duration categories in both sexes. Each SD increment in log-QRS duration was associated with a multivariable-adjusted 23% increase in CHF risk [95% confidence interval [CI] 8% to 38%; P<0.001]. In time- dependent models with QRS category and risk factors updated every 2 years, incomplete BBB was associated with a 1.4-fold (95% CI, 1.05 to 1.96; P=0.03) and complete BBB with a 1.7-fold (95% CI, 1.28 to 2.35; P<0.001) risk of CHF. These associations were maintained on adjustment for baseline left ventricular mass. In our community-based sample, longer electrocardiographic QRS was associated with increased CHF risk, consistent with the hypothesis that depolarization delay may increase CHF risk.

Aged↗