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The circumcision question.

Neonatal circumcision continues to be a controversial subject. The American Academy of Pediatrics has revised its earlier policy, stating that newborn circumcision has potential benefits as well as risks and emphasizing the need to explain these issues to parents considering the procedure so that an informed decision can be made. Compared with circumcised males, uncircumcised males are at greater risk for urinary tract infection, sexually transmitted disease, phimosis, paraphimosis, and balanoposthitis. Complications of circumcision include infection, hemorrhage, and meatal stenosis. Analgesia should be prescribed for the substantial pain associated with the procedure. Alternatives to circumcision include retraction of the foreskin with use of local or general anesthesia. Regular foreskin hygiene is important for all males, whether circumcised or not.

Circumcision, Male↗

Brainstem microstimulation differentially inhibits pudendal motoneuron reflex inputs.

Sensory information from the genitourinary tract is transmitted to perineal muscle reflex circuits in the spinal cord and to the medullary reticular formation (MRF). This is the first report of a functional descending connection between neurons in the MRF and sensory inputs of the pudendal motoneuron reflex circuitry. In anesthetized rats, microstimulation of the MRF produced a decrease in amplitude and increase in latency of pudendal motoneuron reflex discharges (PMRD) elicited by stimulation of the dorsal nerve of the penis. No effects on pelvic nerve-elicited PMRD were found. The most robust reflex depression was observed when the lateral paragigantocellular reticular nucleus was microstimulated bilaterally. Reproductive abnormalities that occur following severe spinal cord injury probably result from disruption of these descending connections.

Animals↗

Expression of the chlamydial genus-specific lipopolysaccharide epitope in Escherichia coli.

The obligate intracellular prokaryote Chlamydia trachomatis is the etiological agent of trachoma and is a primary causative pathogen of sexually transmitted genital tract disease; both diseases affect millions of people each year. The cloning of genes encoding the enzyme or enzymes producing the genus-specific lipopolysaccharide antigen of Chlamydia into Escherichia coli is reported here. The cloned chlamydial lipopolysaccharide antigen appears to be a hybrid lipopolysaccharide molecule composed of both Chlamydia and Escherichia coli components. The chlamydial lipopolysaccharide antigen is expressed on the surfaces of the viable Escherichia coli recombinants. These findings may have a significant impact on defining the role of this highly conserved antigen in the pathogenesis and diagnosis of chlamydial infections.

Chlamydia Infections↗

Gestational psittacosis in a Montana sheep rancher.

In humans, psittacosis is primarily a flulike illness following exposure to psittacine birds. In rare cases, pregnant women exposed to Chlamydia psittaci can contract gestational psittacosis: atypical pneumonia, sepsis, and placental insufficiency resulting in premature birth or miscarriage. In the United States, only two cases of gestational psittacosis have been reported, both from exposure to psittacine birds. Eleven other cases have been reported worldwide, mostly in the United Kingdom, all from exposure to infected birth fluids and membranes of farm mammals, notably sheep and goats. In these mammals, C. psittaci inhabit the reproductive tract, are transmitted sexually or by the fecal-oral route, and cause miscarriages. The case of gestational psittacosis in a Montana sheep rancher is the first farm animal-related case reported in the United States. Pregnant women should avoid close contact with C. psittaci-infected animals, particularly sheep and goats during the birthing season. Obstetricians should consider this diagnosis along with early antibiotic treatment and cesarean section delivery in the context of the patient's case history.

Adult↗

A non-invasive method for gastrointestinal parameter monitoring.

AIM: To propose a new, non-invasive method for monitoring 24-h pressure, temperature and pH value in gastrointestinal tract. METHODS: The authors developed a miniature, multi-functional gastrointestinal monitoring system, which comprises a set of indigestible biotelemetry capsules and a data recorder. The capsule, after ingested by patients, could measure pressure, temperature and pH value in the gastrointestinal tract and transmit the data to the data recorder outside the body through a 434 MHz radio frequency data link. After the capsule passed out from the body, the data saved in the recorder were downloaded to a workstation via a special software for further analysis and comparison. RESULTS: Clinical experiments showed that the biotelemetry capsules could be swallowed by volunteers without any difficulties. The data recorder could receive the radio frequency signals transmitted by the biotelemetry in the body. The biotelemetry capsule could pass out from the body without difficulties. No discomfort was reported by any volunteer during the experiment. In vivo pressure and temperature data were acquired. CONCLUSION: A non-invasive method for monitoring 24-h gastrointestinal parameters was proposed and tested by the authors. The feasibility and functionality of this method are verified by laboratory tests and clinical experiments.

Adult↗

Smooth pursuit disorders.

Smooth pursuit is a relatively recent eye movement which has developed in frontal-eyed species. The smooth pursuit system is involved during foveal smooth pursuit, the 'rapid' component of OKN slow phase and VOR suppression. The cortical areas controlling smooth pursuit (at the temporo-parieto-occipital junction and in the FEF) send ipsilateral projections onto the pontine nuclei, mainly the DLPN, passing through the anterior part of the midbrain. A midbrain or DLPN lesion results in ipsilateral smooth pursuit impairment (i.e. decreased gain) (Table 1). After the pontine nuclei, all smooth pursuit pathways pass through the cerebellum. They project onto the flocculus, mainly contralaterally (first decussation of the lateral smooth pursuit circuitry), and bilaterally onto the posterior vermis. Eye velocity is encoded in the activity of the floccular Purkinje cells, whereas target velocity is encoded in that of the vermal Purkinje cells. Unilateral floccular lesions and posterior vermal lesions (involving both sides of this structure) result in ipsilateral and bilateral smooth pursuit impairment, respectively. The flocculus sends an ipsilateral inhibitory projection onto the MVN, the y-group nucleus and the SVN, controlling contralateral, upward and perhaps downward smooth pursuit, respectively. Alternatively, the downward smooth pursuit pathway could pass through the dentate nuclei. The MVN sends a contralateral excitatory projection onto the abducens nucleus (second decussation of the lateral smooth pursuit circuitry). These anatomical and physiological characteristics of lateral smooth pursuit pathways, in addition to the results of lesion studies, suggest that, besides the floccular inhibitory Purkinje cell, there is another inhibitory neurone in the circuitry preceding this cell, perhaps within the flocculus itself. The posterior vermis projects onto the fastigial nuclei, which also control smooth pursuit. These nuclei could send efferents to those periabducens cells involved in ipsilateral smooth pursuit. The final part of the pathways involved in vertical smooth pursuit could pass mainly through the BC, originating in the y-group nucleus for upward movement and in the SVN or the dentate nuclei for downward movement. Alternatively, a ventral tegmental tract could transmit upward smooth pursuit signals between the y-group nucleus and the oculomotor nucleus. The MLF also belongs to this vestibulo-oculomotor circuitry, but does not appear to be crucial for vertical smooth pursuit since this eye movement is only partially impaired after MLF lesions. Lastly, parallel to the direct vestibulo-ocular motor nuclei pathways, there are other pathways passing through the brain stem integrators, converting eye velocity signals to eye position signals during all eye movements, including smooth pursuit.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Knowledge of men and women about reproductive tract infections and AIDS in a rural area of north India: impact of a community-based intervention.

This study of a community-level health-education intervention on reproductive tract infections/sexually transmitted diseases (RTIs/STDs) was conducted in three villages of Haryana in north India. The study was aimed at increasing awareness among men and women of reproductive age about the prevention and treatment of RTIs, modes of HIV/AIDS transmission, and methods of prevention. Health education was imparted through one-to-one interactions with men and women during home visits, at village-based clinics and health camps, and through health-education talks with men and women. Cumulative effects of the intervention were examined at the end of the survey by comparing the change in knowledge from the baseline. Records of clinic attendance were examined to assess the probable impact of the intervention on clinic attendance. Baseline and follow-up evaluations revealed that there was an improvement in the median total knowledge score of women from 0 to 6, whereas it remained at 5 for men both at baseline and follow-up. Knowledge about RTI/STIs increased among both men and women from the median score of 0 to 2 and from 0 to 3 respectively. The median knowledge score on HIV/AIDS declined among men from 4 to 2 but increased from 0 to 3 among women. Clinic attendance for RTI/STI cases, referred to the Naraingarh hospital, showed an eight-fold rise from an average of four cases per month in 1998-1999 to an average of 35 cases per month in 1999-2000. The findings of the study suggest that health-education strategy through home visits, RTI case management and counselling, and organizing a weekly clinic and occasional camps and health-education talks can increase the level of awareness about RTIs/STIs among both men and women and improve clinic attendance.

Acquired Immunodeficiency Syndrome↗

Syndromic management of vaginal discharge and pelvic inflammatory disease among women in a rural community of Haryana, India: agreement of symptoms enquiry with clinical diagnosis.

World Health Organisation (1984) advocated syndromic approach for management of reproductive tract infections/sexually transmitted diseases. Some investigators have cautioned against using this approach to diagnose and treat vaginal discharge and pelvic inflammatory disease. The prevalence of RTIs in rural areas of Haryana is high and availability of per-speculum examination facility is scarce. The scope for laboratory diagnosis of RTI in rural areas is remote in near future. A community-based study was conducted to assess the agreement of symptoms enquiry with the syndromic diagnosis of RTIs/STDs (based upon per speculum examination). A total of 812 women were interviewed by ANMs and were examined by a lady doctor. History based ANM's diagnosis was found to be having high sensitivity (80.5%) and high positive predictive value (81.3%). However it had low specificity (48.6%) and low negative predictive value (47.5%) compared to clinical diagnosis. Level of agreement was found to be fair (Kappa = 0.28, 95% CI = 0.20-0.36). The chances of over treatment for vaginal discharge and pelvic inflammatory disease were only 16% and 15% respectively. However, history based syndromic protocols need revision. Proposed protocol is discussed in this paper.

Adolescent↗

[Ictus emeticus. Vomiting as epileptic manifestation].

Autonomic and visceral phenomena are well-known manifestations of epileptic seizures, but recurrent vomiting as ictal epileptic events are less known. Three patients with ictus emeticus, i.e. with nausea and vomiting as their main ictal symptoms, are described. Vomiting is a complex symptom preceded by several phenomena in the gastrointestinal tract and transmitted by the vagal nerve to the vomiting centre in the lateral reticular formation of the medulla oblongata. This autonomic centre in the brain stem is influenced by several cerebral structures. There is both experimental and clinical evidence to support the hypothesis that epileptic disturbances in the insula and the mesial temporal structures are responsible for ictus emeticus.

Adult↗

Relationship between sexual intercourse and urinary-tract infection in women attending a clinic for sexually transmitted diseases.

The prevalence of urinary-tract infection (UTI), diagnosed by examination of a single midstream urine from sexually active women was found to be 6.4%. Significant bacteriuria was most common in women who presented within 24 h of coitus but was not related to the number of sexual partners. UTI occurred significantly more often in women who presented within 4 days of intercourse than in women seen after a longer interval. Whether frequency of intercourse affects the prevalence of UTI remains to be determined.

Adolescent↗

Fluoroquinolones.

The fluoroquinolone class of antimicrobial agents has expanded dramatically in the last 5 years and will continue to grow over the next decade. This article discusses the newer fluoroquinolones in detail, including pharmacokinetics, pharmacodynamics, safety, and drug interactions, and the spectrum of in vitro activity. Newer agents are compared and contrasted with the older ones, particularly ciprofloxacin and ofloxacin, and problems with liver toxicity and trovafloxacin are described. Finally, appropriate use of the fluoroquinolones is discussed, including their role in the treatment of urinary tract infections, sexually transmitted diseases, gastrointestinal infections, osteomyelitis, and respiratory tract infections.

Anti-Infective Agents↗

Mucinases and sialidases: their role in the pathogenesis of sexually transmitted infections in the female genital tract.

BACKGROUND: Mucinases and sialidases contribute to the process of invasion and colonisation in many conditions and infections of the female reproductive tract by degrading the protective cervical mucus. The role of hydrolytic enzymes in the pathogenesis of sexually transmitted diseases and their effect on cervical mucus are discussed in this review. METHODS: Articles were searched for using the keywords "sialidase," "mucinase," "protease," and "sexually transmitted infections." As well as review and other articles held by our group, searches were conducted using PubMed, Grateful Med, and the University of Bath search engine, BIDS. RESULTS: Numerous publications were found describing the production of hydrolytic enzymes in sexually transmitted diseases. Because the number of publications exceeded the restrictions imposed on the size of the review, the authors selected and discussed those which they considered of the most relevance to sexually transmitted infections.

Cervix Mucus↗

The thalamic intergeniculate leaflet modulates photoperiod responsiveness in Siberian hamsters.

Siberian hamsters are seasonal breeders that use changes in day length to synchronize their reproductive effort with those times of the year most favorable for successful reproduction. The ability of Siberian hamsters to measure and respond to changes in day length depends upon accurate photoentrainment of the circadian clock in the suprachiasmatic nucleus (SCN) of the hypothalamus. Two pathways have been characterized through which entraining stimuli reach the SCN: the retinohypothalamic tract (RHT), which transmits light information from the retinae, and the geniculohypothalamic tract (GHT) from the intergeniculate leaflet of the thalamus (IGL), which is involved in transmitting both photic and nonphotic cues. Ablating the IGL/GHT results in only modest alterations in entrainment to static day lengths and fails to interfere with seasonal responses induced by transfer from static long day to static short day lengths. Because several studies suggest that the IGL may be involved in tracking the time of dusk and dawn, we sought to determine whether an intact IGL is necessary for hamsters to respond to a simulated natural photoperiod (SNP) in which the time of dusk and dawn gradually changes in a pattern approximating the rate of change in day length that occurs during autumn at the latitude this species inhabits in nature. The results indicate that neurochemical lesions of the IGL alter both the pattern of circadian entrainment and photoperiodic responsiveness of Siberian hamsters to an SNP. Both intact and IGL-lesioned hamsters exhibited testicular regression in shortening day lengths, but only IGL-intact hamsters exhibited seasonal pelage molt.

Animals↗

Neonatal circumcision revisited. Fetus and Newborn Committee, Canadian Paediatric Society.

OBJECTIVE: To assist physicians in providing guidance to parents regarding neonatal circumcision. OPTIONS: Whether to recommend the routine circumcision of newborn male infants. OUTCOMES: Costs and complications of neonatal circumcision, the incidence of urinary tract infections, sexually transmitted diseases and cancer of the penis in circumcised and uncircumcised males, and of cervical cancer in their partners, and the costs of treating these diseases. EVIDENCE: The literature on circumcision was reviewed by the Fetus and Newborn Committee of the Canadian Paediatric Society. During extensive discussion at meetings of the committee over a 24-month period, the strength of the evidence was carefully weighed and the perspective of the committee developed. VALUES: The literature was assessed to determine whether neonatal circumcision improves the health of boys and men and is a cost-effective approach to preventing penile problems and associated urinary tract conditions. Religious and personal values were not included in the assessment. BENEFITS, HARMS AND COSTS: The effect of neonatal circumcision on the incidence of urinary tract infection, sexually transmitted diseases, cancer of the penis, cervical cancer and penile problems; the complications of circumcision; and estimates of the costs of neonatal circumcision and of the treatment of later penile conditions, urinary tract infections and complications of circumcision. RECOMMENDATION: Circumcision of newborns should not be routinely performed. VALIDATION: This recommendation is in keeping with previous statements on neonatal circumcision by the Canadian Paediatric Society and the American Academy of Pediatrics. The statement was reviewed by the Infectious Disease Committee of the Canadian Paediatric Society. The Board of Directors of the Canadian Paediatric Society has reviewed its content and approved it for publication. SPONSOR: This is an official statement of the Canadian Paediatric Society. No external financial support has been received by the Canadian Paediatric Society, or its members, for any portion of the statement's preparation.

Canada↗

Impact of microbicides and sexually transmitted infections on mucosal immunity in the female genital tract.

Human immunodeficiency virus, genital herpes, and other sexually transmitted infections are a critical national and global health priority requiring the rapid development of safe and effective control methods. Topical microbicides, self-administered agents designed for vaginal use, that block transmission at the mucosal surface may provide a realistic method of intervention that could be distributed worldwide. An optimal microbicide should protect against infection but must also be safe, without adversely affecting the mucosal environment, including mediators of host defense. Thus, a critical component in microbicides development is to identify optimal assays that could serve as surrogate markers to predict safety of microbicides prior to embarking on large-scale clinical trials. This will require a greater understanding of the mediators of mucosal immunity in the female genital tract.

Animals↗

[Sexually transmitted recurrent urinary infection of the male].

We describe a case of recurrent urinary tract infection in a male patient that had been repeatedly associated with sporadic sexual intercourse with his partner. The timing of the episodes and the bacteriological findings indicate this to be another uncommon case of urinary tract infection sexually transmitted by the female to the male.

Adult↗

Urinary tract infection among women attending a clinic for sexually transmitted diseases.

The symptoms, signs, and laboratory findings for 69 women who were seen at a sexually transmitted disease (STD) clinic and who had acute urinary tract infection (UTI) were compared with those for women who had vaginitis, gonorrhea, or chlamydial infection. Escherichia coli and Staphylococcus saprophyticus were the two most common causes of acute cystitis in this population and accounted for 62 (90%) of 69 infections. Forty-three percent of the women had positive tests for antibody-coated bacteria (ACB), an observation implying renal infection although symptoms of upper tract infection were infrequent. Frequency, urgency, dysuria, and suprapubic tenderness were significantly associated with cystitis, whereas vaginal discharge and vulvar itching were associated with vaginitis. There was, however, considerable overlap in symptoms among the four groups of women, and their accurate differentiation required objective information based upon pelvic examination, examination of vaginal fluid, and urinalysis. In the absence of vaginitis on wet mount and mucopurulent cervicitis on examination, pyuria, as determined by examination of centrifuged urine, had an 88% sensitivity, 76% specificity, 61% positive predictive value, and 93% negative predictive value for acute UTI. Because of the high prevalence of positive ACB tests and the possibility that infection with Chlamydia trachomatis and/or Neisseria gonorrhoeae may be mistaken for cystitis, we prefer a five- to seven-day course of antibiotics over single-dose therapy for treatment of patients with possible UTI in the setting of an STD clinic.

Acute Disease↗