RESUMO
In dairy cows, the efficacy of oxytocin treatment for preventing retained fetal membranes (RFM) is controversial. The physiological condition of cows associated with the calving process may affect the action of oxytocin. This study aimed to elucidate the difference in the efficacy of exogenous oxytocin treatment immediately after calving among cows that received various obstetric interventions. The calving ease was recorded using a score of 1-5, and assisted birth was defined as a score of 2 or more. Cows that required calving assistance (assisted, n = 28) due to delayed calving progression had a prolonged time from calving to expulsion of the fetal membrane (P < 0.01), and impaired reproductive performance compared to cows that did not receive calving assistance (unassisted, n = 78). The effect of oxytocin treatment was determined using cows that did not expel their fetal membrane within 3 h after calving. Cows were randomly divided into the control (unassisted, n = 41; assisted, n = 22) or oxytocin group (unassisted, n = 33; assisted, n = 10). Oxytocin (50 IU) was administered intramuscularly to the cows in the oxytocin group between 3 and 6 h after calving, while no treatment was administered in the control group. In cows with assisted birth, oxytocin administration accelerated placental expulsion (P < 0.05) and improved several reproductive parameters, such as the number of services until conception (P < 0.05) and the calving to conception intervals (P < 0.05) compared to the control group. On the other hand, oxytocin administration slightly accelerated placental expulsion (P < 0.05), but failed to improve fertility in cows with unassisted birth. The results indicate that the action of oxytocin varies depending on the calving situation of the cows. Oxytocin administration during the early postpartum period could prevent RFM and improve the decline in reproductive performance associated with calving assistance.
Assuntos
Doenças dos Bovinos , Placenta Retida , Animais , Bovinos , Membranas Extraembrionárias , Feminino , Fertilidade , Ocitocina/uso terapêutico , Placenta , Placenta Retida/tratamento farmacológico , Placenta Retida/prevenção & controle , Placenta Retida/veterinária , Período Pós-Parto , Gravidez , ReproduçãoRESUMO
The prevalence of undernutrition in hospitals in Africa is estimated at about 57 %. Simple anthropometric methods are available to detect it, including measurement of the brachial circumference (BC) and the body mass index (BMI). The aim of this study was to identify a threshold value that might make it possible to diagnose undernutrition in hospitals. It was a cross sectional study carried out at Douala General Hospital - Cameroon over a five months period. The measurements studied were: BMI, BC and percentage of weight loss. The Pearson test was used to compare the quantitative variables. The Receiving Operating Characteristic curve enabled us to determine a threshold value of the BC according to BMI. The study included 333 patients, with a mean age of 45 ± 16 years (range : 18-86). BMI and BC were strongly correlated; BC =11.69 + 0.68(BMI), with r2 = 0.65 (P < 0.01)). The threshold value of BC retained to detect undernutrition was 27 cm. The prevalence of undernutrition at the Douala General Hospital varies according to the anthropometric parameter used. At a BC threshold of 27 cm, the prevalence of undenutrition in our population was 24,3%.
Assuntos
Braço/anatomia & histologia , Pesos e Medidas Corporais , Desnutrição/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Camarões , Estudos Transversais , Feminino , Hospitalização , Hospitais , Humanos , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Prevalência , Encaminhamento e Consulta , Adulto JovemRESUMO
The aim of this study was to describe the clinical and immunological profile of patients infected with HIV after initiation of antiretroviral therapy. Sociodemographic characteristics, clinical and immunological patients were recorded. Chi square test and Mann-Whitney were used to compare variables. The multivariate regression model identified risk factors. So that, 936 (56.2%) patients were in stages III and IV of the WHO and 65.2% at an advanced stage of the disease. Factors associated with initiation at an advanced stage, were male sex (p = 0.007) and time to diagnosis (p = 0.005). In 2/3 cases, treatment is started at an advanced stage of disease. It is therefore important to intensify awareness campaigns for early detection and encourage patients to ensure regular medical follow-up screening.
Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Camarões/epidemiologia , Estudos Transversais , Feminino , HIV-1 , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
PURPOSE: To find the fastest and most effective/efficient method to economically deliver fractionated half-body irradiation (HBI) for widespread (WS), symptomatic, metastatic bone cancer. METHODS AND MATERIALS: A Phase III trial with 3 HBI arms: (Arm A) Control (15 Gy/5 fractions/5 days); (Arm B) Hyperfractionation (HF) (8 Gy/2 fractions/1 day); (Arm C) Accelerated HF (12 Gy/4 fractions/2 days). Six countries randomized 156 patients (all with WS bone metastases): 51, 56, and 49 patients to Arms A, B, and C, respectively. There were 72 (46%) breast, 50 (32%) prostate, 9 (6%) lung, and 25 (16%) miscellaneous primary tumors. Initial performance status (PS) was 1-2 in 101 (65%) and PS 3-4 in 55 (35%). The lower, upper, and middle halves of the body were treated 79, 68, and 9 times. RESULTS: Pain relief was seen in 91% of patients (45% complete [CR] and 46% partial [PR]) within 3-8 days. Overall (OS), median (MST), and pain-free (PFS) survival was 174, 150, and 122 days. Breast tumors had a higher OS (279 days) than that of other primary tumors, but when analyzed by treatment, was not significantly different than prostate tumors in Arm A. No survival differences were found in patients with PS 1-2 vs. 3-4, CR vs. PR, bone with/without visceral metastases, or by the number of metastases (< or > 15 bone lesions). Quality of life (QOL) assessed by the percent of the remaining life free of pain was 71%; furthermore significant improvements in PS, pain, and narcotic scores were seen after HBI. Toxicity was very acceptable (41% none, 50% mild/moderate, 12% severe but transitory); more was seen with upper HBI. CONCLUSION: In terms of response, time to response, OS, MST, PFS, QOL, and toxicity, schedules for Arms A and C were similar for all but prostate primaries. Schedule for Arm B, which delivered the lowest biologic dose in the shortest time, had significantly worse results in pain relief, OS, MST, PFS, and QOL. Results indicate that, for most primary tumor types (except prostate), delivering two HBI daily doses of 3 Gy in 2 consecutive days is as effective as delivering a daily dose of 3 Gy for 5 consecutive days. Thus, this is a faster and much more convenient HBI schedule for the palliation of pain in widespread cancer.
Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Irradiação Hemicorpórea/métodos , Cuidados Paliativos , Neoplasias Ósseas/complicações , Neoplasias da Mama/patologia , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Feminino , Irradiação Hemicorpórea/efeitos adversos , Irradiação Hemicorpórea/economia , Humanos , Masculino , Dor/etiologia , Neoplasias da Próstata/patologia , Qualidade de Vida , Taxa de SobrevidaRESUMO
With 47% of the population under 15 years of age and the control of infectious and other communicable diseases, cancer will likely constitute a major health problem in West Africa in future. Radiotherapy facilities and trained manpower to run them are very limited within the subregion. This paper quantifies the severity of the situation and discusses a practical approach aimed at coping with the situation through the organisation of a training programme for radiotherapists, medical physicists and radiation technologists as part of the strategies for cancer control in West Africa. A curriculum is proposed for the training of radiotherapists.
Assuntos
Pessoal Técnico de Saúde/educação , Radiologia/educação , Radioterapia , África/epidemiologia , África Ocidental/epidemiologia , Custos e Análise de Custo , Currículo , Física Médica/educação , Física Médica/estatística & dados numéricos , Humanos , Serviço Hospitalar de Medicina Nuclear/estatística & dados numéricos , Radiologia/economia , Radiologia/estatística & dados numéricos , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Radioterapia/economia , Radioterapia/estatística & dados numéricos , Tecnologia Radiológica/educação , Tecnologia Radiológica/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
PURPOSE: To assess magnetic resonance imaging as a diagnostic tool of neurovascular compression in a patient with abducens nerve palsy. METHODS: We performed magnetic resonance imaging of the brainstem of a 46-year-old patient with left abducens nerve palsy using spoiled gradient recalled acquisition in the steady state (SPGR), which allows high-resolution T1-weighted imaging and detection of the arteries across the plane of slices as a high-signal-intensity area. RESULTS: Computed tomography of the brain was unremarkable except for leftward shifting of the basilar artery. As disclosed by magnetic resonance imaging with the SPGR, the right vertebral artery was shifted to the left and joined with the left vertebral artery, and the left abducens nerve was compressed by the vertebral artery. No other abnormal signals were seen in the brainstem. CONCLUSIONS: These findings suggest that the abducens nerve palsy in this patient was caused by vascular compression at the root exit zone. Magnetic resonance imaging with the SPGR is useful for the diagnosis of vascular compressive neuropathy.
Assuntos
Nervo Abducente/patologia , Imageamento por Ressonância Magnética , Síndromes de Compressão Nervosa/diagnóstico , Paralisia/diagnóstico , Artéria Basilar/anormalidades , Artéria Basilar/patologia , Tronco Encefálico/patologia , Doenças dos Nervos Cranianos/diagnóstico , Doenças dos Nervos Cranianos/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/etiologia , Paralisia/etiologia , Artéria Vertebral/anormalidades , Artéria Vertebral/patologia , Insuficiência Vertebrobasilar/complicaçõesRESUMO
The aim of this study was to present the sites of cancers diagnosed in men and women aged 50 years and above in Cameroon. From the registries of the pathology laboratory of the Yaoundé Central Hospital which at the national level receives the majority of samples sent for histopathology analysis, we recorded all cases of cancers diagnosed in people aged 50 years and above, during the period from 1st January 1987 to 31st August 1996 (9 years 8 months). 1,925 cancers were recorded: -1,005 of these (52.2%) were issued from men aged fifty years and above. These 1,005 cancers came from seventeen sites, the most common being: liver (226 cases = 22.49%), prostate (222 cases = 22.09%), skin (195 cases = 19.40%) and ENT (100 cases = 9.95%); that made 73.93% (above 3/4) of cancers observed in men aged fifty years and above from this study. -920 of these (47.8%) were diagnosed from women aged fifty years and above. These 920 cancers came from twenty-two sites, the most common being: uterine cervix (292 cases = 31.74%), breast (170 cases = 18.48%), skin (111 cases = 12.07%) and liver (90 cases = 9.78%); that made 72.07% (about 3/4) of cancers observed in women aged fifty years and above, from this study.
Assuntos
Neoplasias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Camarões/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Sistema de Registros , Fatores SexuaisRESUMO
Clinical studies were performed on combination chemotherapy with Fosfomycin and Dibekacin. Sixteen patients with complicated urinary tract infections were treated with a combination of Fosfomycin (4 g/day, d.i.v.) and Dibekacin (200 mg/day, i.m.) for 5 days; and, 15 of them were clinically evaluated by criteria of UTI committee. The clinical effects proved excellent in 3 patients, good in 8 patients, and poor in 4 patients overall effective rate was 73.3%. Out of 19 strains isolated from the patients, 12 strains disappeared after the therapy. No side effect was observed in 16 cases. Clinical use of the combination chemotherapy with Fosfomycin and Dibekacin was thought to be effective and safe for patients with complicated urinary tract infections, because the combination acts not only synergistically, but also because Fosfomycin acts to protect against the nephrotoxicity induced by Dibekacin.
Assuntos
Antibacterianos/administração & dosagem , Dibecacina/administração & dosagem , Fosfomicina/administração & dosagem , Canamicina/análogos & derivados , Infecções Urinárias/tratamento farmacológico , Adulto , Idoso , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Urinárias/complicaçõesRESUMO
The patient was a 70-year-old male with complaint of macrohematuria at the first visit to our clinic on June 10, 1986. At that time, cystoscopy revealed a thumb sized papillary tumor and a rice sized non papillary tumor, and the biopsy specimen was pathologically diagnosed as undifferentiated carcinoma. But, he refused admission. On January 30, 1987, he came back to our clinic with complaints of dyspnea, general fatigue and weight loss. Moderate lt. gynecomastia was found and the level of serum hCG-beta was detected as high as 101 ng/ml. Excretory urogram and enhanced CT revealed a large mass in the bladder. In the seventeenth day after admission, he died of lung edema and heart failure. The findings of autopsy showed a large light greenish to light brownish tumor of 10 X 10 X 3 cm in the bladder. Distant metastases were observed in internal, common iliac and paraaortic lymph nodes, but without other distant metastasis. In histological and immunohistochemical studies, the final diagnosis is choriocarcinoma of the bladder, containing syncytiotrophoblastic giant cells with hCG-beta granules as an undifferentiated carcinoma. To our knowledge this case is the eighth described in Japan. Herein we report a new case of primary choriocarcinoma of the bladder and make a brief review of the literatures.
Assuntos
Coriocarcinoma/patologia , Neoplasias da Bexiga Urinária/patologia , Idoso , Coriocarcinoma/análise , Gonadotropina Coriônica/análise , Humanos , Imuno-Histoquímica , Masculino , Neoplasias da Bexiga Urinária/análiseRESUMO
We studied on subjective and objective findings of 69 patients with lumbar spinal canal stenosis. Of the patients 51 (73.9%) had not only orthopedical symptoms but also urological complaints of mostly emptying disorders such as protracted and retardated dysuria and urinary retention, 14 (20.3%) no urological symptom and four (5.8%) urological complaint alone. Cystometrographic findings investigated from all of the patients revealed normoactive detrusor in 34 (49.3%) of them, underactive or acontractile detrusor in 28 (40.6%) and overactive detrusor 7 (10.1%). Eighteen of the patients underwent a surgical treatment for the lumbar spinal canal stenosis. All of seven patients with normoactive detrusor had a good micturition and four of nine with underactive or acontractile detrusor and one of two with overactive detrusor required clean intermittent catheterization (CIC) even after the surgeries. Pre and post surgical urodynamic studies demonstrated that the seven patients resulted in normoactive in four and overactive in three, the nine underactive in six and overactive in three and the two overactive and underactive in one, respectively. It was suggested from the results that the bladder of a patient with limbar spinal canal stenosis could become more irritable state after the surgery than before the therapy.
Assuntos
Estenose Espinal/complicações , Transtornos Urinários/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Bexiga Urinária/fisiopatologia , Transtornos Urinários/fisiopatologia , UrodinâmicaRESUMO
A 44-year-old woman noticed edema of the lower limbs in May 1999 and visited our hospital in September 1999 to undergo further examination. On admission, severe hypoalbuminemia (1.9 g/dl) was detected with a negative urinary protein level. Protein leakage into the gastrointestinal tract and deposition of immune complex in the colonic mucosa were shown by the fluorescent antibody method. In addition, anti-centromere antibody, sclerodactyly, and findings indicative of histological sclerotic changes on a skin biopsy were observed. These findings supported a diagnosis of protein-losing gastroenteropathy complicated by scleroderma. Administration of oral corticosteroids was begun one month after admission and the patient experienced diminished visual acuity immediately after steroid pulse therapy in November. Central serous chorioretinopathy (CSC) was diagnosed at the Department of Ophthalmology of our hospital, and the administration of corticosteroids was suspected as a possible cause of CSC. Considering the severity of hypoproteinemia, the corticosteroid treatment was continued despite corticosteroids being strogly suspected as the primary cause of CSC. A complete disappearance of CSC was achieved in 30 days after the onset of symptoms despite continuation of the steroid therapy, and her serum albumin and complement levels both normalized. We concluded that damage to the retinal pigment epithelium secondary to the vascular lesion at the choroidal level plays a causative role in CSC. In the present case, the findings suggested that the deposition of immune complex in choroidal tissues as well as the gastrointestinal tract caused hyperpermeability of choroidal vessels and led to the development of CSC.
Assuntos
Coriorretinite/etiologia , Enteropatias Perdedoras de Proteínas/complicações , Escleroderma Sistêmico/complicações , Adulto , Feminino , Humanos , Metilprednisolona/administração & dosagem , Metilprednisolona/efeitos adversos , Prednisolona/administração & dosagem , Prednisolona/efeitos adversos , Enteropatias Perdedoras de Proteínas/tratamento farmacológico , Pulsoterapia , Escleroderma Sistêmico/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND: Some experimental and human data suggest that exposure to polychlorinated biphenyls (PCBs) may induce ototoxicity, though results of previous epidemiologic studies are mixed and generally focus on either prenatal or postnatal PCB concentrations exclusively. OBJECTIVES: Our aim was to evaluate the association between pre- and postnatal PCB concentrations in relation to cochlear status, assessed by distortion product otoacoustic emissions (DPOAEs), and to further clarify the critical periods in development where cochlear status may be most susceptible to PCBs. METHODS: A total of 351 children from a birth cohort in eastern Slovakia underwent otoacoustic testing at 45 months of age. Maternal pregnancy, cord, and child 6-, 16-, and 45-month blood samples were collected and analyzed for PCB concentrations. At 45 months of age, DPOAEs were assessed at 11 frequencies in both ears. Multivariate, generalized linear models were used to estimate the associations between PCB concentrations at different ages and DPOAEs, adjusting for potential confounders. RESULTS: Maternal and cord PCB-153 concentrations were not associated with DPOAEs at 45 months. Higher postnatal PCB concentrations at 6-, 16-, and 45-months of age were associated with lower (poorer) DPOAE amplitudes. When all postnatal PCB exposures were considered as an area-under-the-curve metric, an increase in PCB-153 concentration from the 25th to the 75th percentile was associated with a 1.6-dB SPL (sound pressure level) decrease in DPOAE amplitude (95% CI: -2.6, -0.5; p = 0.003). CONCLUSIONS: In this study, postnatal rather than maternal or cord PCB concentrations were associated with poorer performance on otoacoustic tests at age 45 months.