The effect of multiple interventions for women at risk for cervical cancer on their health responsibility, beliefs regarding cervical cancer and having screening: a randomized controlled trial.

This study was intended to analyze the effect of multiple initiations on beliefs about cervical cancer, health responsibility, and screening participation. In total, 134 women aged 40-55 years, who were at risk of cervical cancer and had never had a Pap smear before, were randomly assigned to the experimental (n = 67) and control (n = 67) groups. The 14 weeks of sessions involving the experimental group included group training on cervical cancer, counselling, reminder phone calls and delivery materials, all aimed to increase motivation to be screened regularly for cervical cancer. The control group received the usual care. The study data were collected using an information form, the Health Belief Model Scale, the Healthy Lifestyle Behaviors Scale II and the Assessment Form for Undergoing Pap-Smear Test. After the multiple interventions, there was a significant difference between the experimental and control group's Health Responsibility, Pap smear benefit and motivation, obstacle and health motivation scores (P < 0,05). The participation rate of women in the experimental group to cervical cancer screening was found to be 93%. Multiple nursing interventions (group training, counselling, reminder phone calls and delivery materials) were effective in increasing participation in cervical cancer screening programs.

Virulence Characterization of International Collections of the Wheat Stripe Rust Pathogen, Puccinia striiformis f. sp. tritici.

Wheat stripe rust (yellow rust [Yr]), caused by Puccinia striiformis f. sp. tritici, is an economically important disease of wheat worldwide. Virulence information on P. striiformis f. sp. tritici populations is important to implement effective disease control with resistant cultivars. In total, 235 P. striiformis f. sp. tritici isolates from Algeria, Australia, Canada, Chile, China, Hungary, Kenya, Nepal, Pakistan, Russia, Spain, Turkey, and Uzbekistan were tested on 20 single Yr-gene lines and the 20 wheat genotypes that are used to differentiate P. striiformis f. sp. tritici races in the United States. The 235 isolates were identified as 129 virulence patterns on the single-gene lines and 169 virulence patterns on the U.S. differentials. Virulences to YrA, Yr2, Yr6, Yr7, Yr8, Yr9, Yr17, Yr25, YrUkn, Yr28, Yr31, YrExp2, Lemhi (Yr21), Paha (YrPa1, YrPa2, YrPa3), Druchamp (Yr3a, YrD, YrDru), Produra (YrPr1, YrPr2), Stephens (Yr3a, YrS, YrSte), Lee (Yr7, Yr22, Yr23), Fielder (Yr6, Yr20), Tyee (YrTye), Tres (YrTr1, YrTr2), Express (YrExp1, YrExp2), Clement (Yr9, YrCle), and Compair (Yr8, Yr19) were detected in all countries. At least 80% of the isolates were virulent on YrA, Yr2, Yr6, Yr7, Yr8, Yr17, YrUkn, Yr31, YrExp2, Yr21, Stephens (Yr3a, YrS, YrSte), Lee (Yr7, Yr22, Yr23), and Fielder (Yr6, Yr20). Virulences to Yr1, Yr9, Yr25, Yr27, Yr28, Heines VII (Yr2, YrHVII), Paha (YrPa1, YrPa2, YrPa3), Druchamp (Yr3a, YrD, YrDru), Produra (YrPr1, YrPr2), Yamhill (Yr2, Yr4a, YrYam), Tyee (YrTye), Tres (YrTr1, YrTr2), Hyak (Yr17, YrTye), Express (YrExp1, YrExp2), Clement (Yr9, YrCle), and Compair (Yr8, Yr19) were moderately frequent (>20 to <80%). Virulence to Yr10, Yr24, Yr32, YrSP, and Moro (Yr10, YrMor) was low (≤20%). Virulence to Moro was absent in Algeria, Australia, Canada, Kenya, Russia, Spain, Turkey, and China, but 5% of the Chinese isolates were virulent to Yr10. None of the isolates from Algeria, Canada, China, Kenya, Russia, and Spain was virulent to Yr24; none of the isolates from Algeria, Australia, Canada, Nepal, Russia, and Spain was virulent to Yr32; none of the isolates from Australia, Canada, Chile, Hungary, Kenya, Kenya, Nepal, Pakistan, Russia, and Spain was virulent to YrSP; and none of the isolates from any country was virulent to Yr5 and Yr15. Although the frequencies of virulence factors were different, most of the P. striiformis f. sp. tritici isolates from these countries shared common virulence factors. The virulences and their frequencies and distributions should be useful in breeding stripe-rust-resistant wheat cultivars and understanding the pathogen migration and evolution.

The impact of the South African Covid-19 lockdown on incidence and severity of traumatic brain injury at Tshepong hospital: A multivariate retrospective cohort study.

Background: Globally traumatic brain injuries (TBIs) are the leading cause of death in people under the age of 45. 2020 saw a series of social lockdowns as a response to the COVID-19 pandemic. We aimed to unveil the impact of the different levels of lockdown on TBI incidence at Tshepong Hospital. Method: A retrospective review of patients with TBIs during the first 30 days of each of the 5 lockdown levels, between 1st of April -20th October 2020 was conducted. Each lockdown level was compared to a control of a similar period in 2019. Results: Level 5 lockdown resulted in a 66% reduction in total incidence of TBI, with a decrease in the daily incidence median value to 0 when compared to its control group median of 1 (P-value 0.004). However, Level 3 and 2 resulted in a significant 133% and 200% increase respectively in TBI incidence for similar period the year before.There was a 0,75% decrease in total trauma during the non-lockdown periods in relation to the lock down periods with a lockdown mean incidence of 53,4 (std Dev. 26.6) and non-lockdown mean of 53 (std Dev 20.8). Conclusion: The cumulative effect of the lockdowns made miniscule changes in the overall TBI incidence but led to significant variation in TBI incidence in the comparative months. A "rebound trauma" phenomena is observed in transitioning from severe social restrictions to milder ones with unemployment and unbanning of alcohol as possible contributary factors. Further studies are needed to investigate these complex interactions.

Serum heavy metal and antioxidant element levels of children with recurrent wheezing.

STUDY OBJECTIVES: The aim of the study is to investigate the levels of toxic heavy metals related with environmental pollution and trace elements involved in antioxidant system in children suffering from recurrent wheezing. STUDY DESIGN: One hundred children with recurrent wheezing (at least three recurrences) between the ages from 1 to 6 years took part in the study, and also 116 age- and sex- matched healthy children were involved in the study as a control group. Venous blood samples were collected and serum mercury, lead, aluminium, zinc, selenium, and copper levels were studied using ICP-MS. RESULTS: Serum lead (0.76±0.15 vs. 0.27±0.01, p:0.001) and mercury levels (1.31±0.15 vs 0.71±0.05, p<0.001) were higher in wheezy group than those acquired from the control group. Serum zinc (69.4±1.65 vs. 78.9±2.78, p:0.005) and selenium (115.6±1.87 vs. 125.4±2.94, p:0.008) levels were lower in wheezy group than those acquired from the control group. Serum zinc levels were found to be correlated with number of ARTIs (r(p):-0.332, p:0.001) and the number of wheezy attacks (r(p):-0.776, p<0.001) during the previous year in the wheezy group. CONCLUSION: Elevated levels of serum lead and mercury and low levels of zinc and selenium may suggest some disturbances in the antioxidant system in children with recurrent wheezing. This means that children with recurrent wheezing are much more susceptible to environmental pollutants and respiratory tract infections than healthy children and this heavy metal-antioxidant relationship may play a role as a contributing factor in the pathogenesis of recurrent wheezing in children.

The transcultural nursing concept: a study of nursing students in Turkey.

BACKGROUND: Cultural differences are known to be pronounced in Turkey, and some difficulties are encountered in patient care. Cultural sufficiency in providing health care to the patients is of great importance in satisfactory care delivery. AIM: To determine the cultural diversity that the students experienced between the patients and themselves while providing care to patients. Knowledge of transcultural nursing was also investigated. DESIGN AND METHODS: This was a descriptive study. The population comprised of 650 undergraduate students attending the nursing schools of three universities. A total of 622 students were included in the sample. The survey method was used for data collection. Percentages and chi-square test were used. RESULTS: Most of the students (85.5%) had experienced cultural differences while giving care to their patients and 73.8% did not know the definition of this concept. The issues where cultural differences were experienced to the highest degree were differences in dialect and pronunciation (53.4%), differences of language (37%), traditions and customs of the individual (30.7%), and religious belief and sect (30.2%). It was found that the grade the students were in had a significant effect on the experience of cultural differences (P<0.05). CONCLUSIONS: The majority of students experience cultural diversity in patient care. It is thought that transcultural care placed in curriculum even as a separate course will guide nursing students in all stages of patient care. Thus, the effect of cultural diversity in patient care can be minimized with the help of education.

Homozygous feature of isolated triphalangeal thumb-preaxial polydactyly linked to 7q36: no phenotypic difference between homozygotes and heterozygotes.

Preaxial polydactyly is a common limb malformation in humans with variable clinical expression. Different types of triphalangeal thumb-preaxial polydactyly phenotypes were mapped to the chromosome 7q36 region. We studied a large Turkish family of 69 individuals, of whom 22 individuals were affected. In all, 11 affected family members were clinically and radiologically evaluated. All affected individuals had a triphalangeal thumb and a preaxial (hypoplastic) extra digit bilaterally, with minimal intrafamilial variation. No feet involvement was observed. Linkage and haplotype analyses using 20 informative meioses confirmed the 7q36 region contained the LIMBR1 gene. Maximum logarithm of the odds (LOD) scores were obtained with DNA markers D7S550 and D7S2423. We have further identified a novel C to T alteration at position 4909 bp in the critical zone of polarizing activity regulatory sequence (ZRS) region, in the intron 5, of the LMBR1 gene. One affected male with homozygous status and no phenotypic difference from affected family members with heterozygous status represented the first homozygote case of the triphalangeal thumb-preaxial polydactyly phenotype.

Splenic abscess after splenic artery ligation in living donor liver transplantation: a case report.

Although recent developments in living donor liver transplantation (LDLT) yield promising results, a size mismatch between the weights of the graft and the recipient remains a significant problem. Recipients of LDLT may have hyperdynamic splanchnic circulations resulting in graft hyperperfusion and increased portal vein flow leading to small-for-size syndrome. Splenic artery ligation is one of the least invasive measures to prevent occurrence of this syndrome. Despite its potentially devastating consequences, splenic infarction following splenic artery ligation has received little attention to date. Herein we have reported a patient who developed a splenic abscess due to a splenic infarction following splenic artery ligation during LDLT.

A very rare venous anomaly in a living liver donor: left hepatic venous connection to the right atrium.

In humans, three main hepatic veins drain the liver into the inferior vena cava below the diaphragm. This report represents the first living donor liver that had a rare anatomic variation of the left hepatic vein draining directly to the right atrium, which was detected preoperatively by routine investigations of the living donor transplantation. This type of anomaly may present potentially fatal challenges to a donor operation if not detected preoperatively, especially when the left lobe is the choice for explantation.

Efficacy of the routine admission urinalysis.

The clinical efficacy of routine admission urinalyses was evaluated in 301 patients admitted to the internal medicine wards of a university teaching hospital. Using a consensus analysis approach, three Department of Medicine faculty members reviewed the patients' charts to determine which tests were performed routinely and which test results led to diagnostic or therapeutic management changes. Of the 243 urinalyses performed, 123 (51 percent) were ordered routinely for patients without recognizable medical indications. Results of the routine urinalyses were abnormal in 42 (34 percent) of the patients and led to additional laboratory testing in 20 (16 percent) of the cases. However, the test results led to therapeutic changes in only three (2.4 percent) of the patients, and in two of these patients, the treatment instituted probably was unnecessary. It is concluded that the impact of routine admission urinalysis on patient care is very small and that there is little justification for ordering this test for all patients admitted to the hospital.

Direct trocar insertion versus Veress needle insertion in laparoscopic cholecystectomy.

BACKGROUND: Direct insertion of the trocar is an alternative method to Veress needle insertion for the creation of pneumoperitoneum. The safety of direct disposable shielded trocar insertion for the creation of pneumoperitoneum was assessed by comparing with Veress needle insertion during laparoscopic cholecystectomy (LC). METHODS: One thousand five hundred patients undergoing LC with pneumoperitoneum were included in this study. In 470 patients the Veress needle insertion technique was used, and in 1,030 patients direct trocar insertion technique was used. Patients having indications for open trocar insertion were excluded from the study. RESULTS: Complication rate was significantly higher in the Veress needle group (14% versus 0.9%; P <0.01), and the two major complications, gastric perforation and iliac artery laceration, were also encountered in this group. CONCLUSIONS: Our results suggest that with a lower complication rate, direct insertion of the disposable trocar is a safe alternative to Veress needle insertion technique for the creation of pneumoperitoneum. Such an approach has further advantages such as less cost/instrumentation and rapid creation of pneumoperitoneum.

Financial barriers to medical care: a prospective study in a university-affiliated community clinic.

Access to medical care in the United States is deteriorating, particularly for the poor. The authors evaluated patients who could not afford medical care recommended by physicians in a university-affiliated clinic that serves a predominantly indigent population. The authors determined the patients' demographic characteristics, their medical problems, and the types of care for which financial barriers existed. In addition, the authors compared the patients' demographic characteristics and medical illnesses with those of a control group of patients from the clinic who did not experience financial barriers to medical care. Of the 1,950 patients evaluated, 94 (4.8%) were unable to afford care recommended by their physicians. Sixty-seven percent were US citizens, 73% were unemployed, 63% had monthly family incomes of less than $500, and only 33% had health insurance. The patients had a variety of medical problems, ranging from hearing loss, for which they could not obtain hearing aids, to breast masses, for which they could not obtain mammographies or biopsies. When compared to patients who did not experience financial barriers to recommended care, the study patients tended to be poorer, more likely to be undocumented, more likely to be uninsured, and less likely to have acute, self-limited illnesses. Our findings support the argument that the nation's current piecemeal approach to providing indigent health care may lead to serious financial barriers to access in some localities.

Dual left lobe living donor liver transplantation using donors unacceptable for right lobe donation: a case report.

Living donor liver transplantation (LDLT) has become a viable alternative for end-stage liver disease. The shortage of brain-dead donors has led to development of advanced surgical approaches. Dual lobe LDLT has been performed successfully in the recent years. The major indication for this complex procedure has been insufficient graft size from a single donor or insufficient remnant in the donor. We performed a dual left lobe LDLT using 2 donors who were unacceptable for right lobe donation.

Skewed X inactivation in an X linked nystagmus family resulted from a novel, p.R229G, missense mutation in the FRMD7 gene.

AIMS: This study aimed to identify the underlying genetic defect of a large Turkish X linked nystagmus (NYS) family. METHODS: Both Xp11 and Xq26 loci were tested by linkage analysis. The 12 exons and intron-exon junctions of the FRMD7 gene were screened by direct sequencing. X chromosome inactivation analysis was performed by enzymatic predigestion of DNA with a methylation-sensitive enzyme, followed by PCR of the polymorphic CAG repeat of the androgen receptor gene. RESULTS: The family contained 162 individuals, among whom 28 had NYS. Linkage analysis confirmed the Xq26 locus. A novel missense c.686C>G mutation, which causes the substitution of a conserved arginine at amino acid position 229 by glycine (p.R229G) in exon 8 of the FRMD7 gene, was observed. This change was not documented in 120 control individuals. The clinical findings in a female who was homozygous for the mutation were not different from those of affected heterozygous females. Skewed X inactivation was remarkable in the affected females of the family. CONCLUSIONS: A novel p.R229G mutation in the FRMD7 gene causes the NYS phenotype, and skewed X inactivation influences the manifestation of the disease in X linked NYS females.

MAGIC Tool: integrated microarray data analysis.

SUMMARY: Several programs are now available for analyzing the large datasets arising from cDNA microarray experiments. Most programs are expensive commercial packages or require expensive third party software. Some are freely available to academic researchers, but are limited to one operating system. MicroArray Genome Imaging and Clustering Tool (MAGIC Tool) is an open source program that works on all major platforms, and takes users 'from tiff to gif'. Several unique features of MAGIC Tool are particularly useful for research and teaching. AVAILABILITY: http://www.bio.davidson.edu/MAGIC

Patient, nurses, and physicians collaborating in the management of a patient following autotransplant parathyroidectomy.

The nephrology nurses in collaboration with the nephrologist worked closely to avoid severe symptomatology related to calcium phosphorus imbalance. The surgical team support was discontinued 48 hours after the removal of the autotransplant. The patient exhibited classic signs of secondary hyperparathyroidism, as indicated by laboratory tests, anemia, and pruritus. Despite the level of anemia, the patient did not complain of fatigue or dyspnea. A hypocalcemic crisis was avoided by the ongoing assessment and intervention the patient received from the nursing staff. Four of the five stated goals were met. The patient is free of disability as evidenced by steady gait, normal range of motion, and adequate muscle strength. The calcium and phosphorus levels and the calcium phosphorus product are within acceptable ranges (see Figure 1). J.I. has always had information about diet and medication management but has demonstrated variable adherence to the regimen. However, the nephrology nurses plan to continue with counseling and education as needed.

A clinical project to evaluate reuse of a CAPD disconnect system minicap as a safe, effective practice.

The current health care environment is being driven by approaches to health care services that focus on quality and at the same time cost-effectiveness. With this in mind, a clinical project was designed to investigate the possibility of reusing the disconnect minicap as a safe, effective clinical practice. During a two-phase project, continuous ambulatory peritoneal dialysis (CAPD) disconnect caps were purposely touch contaminated and cultured before and after povodine iodine was instilled in the minicap. During the second phase of the project a simulated peritoneal effluent system was constructed and fluid cultures obtained. The specimen analyses demonstrated negative reports of the minicap after dwelling in povidine iodine and fluids after reuse of the minicap. The pilot project opens an area of research for nephrology nurses that could potentially lead to cost savings in the provision of care for patients with chronic renal failure.

Enhanced phosphorus removal by glucose fed sequencing batch reactor.

In this study an anaerobic/aerobic sequencing batch reactor was used for an enhanced biological phosphorus removal. These conditions were tested by a laboratory scale reactor (14 liter) with a synthetic feed, glucose being the sole carbon source. However, enhanced biological phosphorus removal (EBPR) was not achieved during this study. A series of batch tests were conducted with various substrates; acetic acid, glucose and the mixture of acetic acid and glucose. High phosphate removal was obtained when acetate was the substrate (68.7%). It was observed that when the acetic acid was used as a sole substrate, the bacteria growing in the alternating anaerobic/aerobic system removed the organic substrate under anaerobic conditions. However, in case of the glucose feed most of the COD removal took place under not truly anaerobic conditions. This also coincides with low phosphate removal (37.8%). These results are in consistent with the results of the continuous operation. When the acetic acid-glucose mixture was used, the phosphate removal decreased down to 60.8%. This was thought to be due to the glucose that reduced the dependency on poly-P as an energy source.

Short-term gemfibrozil treatment reverses lipid profile and peroxidation but does not alter blood glucose and tissue antioxidant enzymes in chronically diabetic rats.

In this study, we investigated the efficiency of short-term treatment with gemfibrozil in the reversal of diabetes-induced changes on carbohydrate and lipid metabolism, and antioxidant status of aorta. Diabetes was induced by a single injection of streptozotocin (45 mg/kg, i.p.). After 12 weeks of induction of diabetes, the control and diabetic rats were orally gavaged daily with a dosing vehicle alone or with 100 mg/kg of gemfibrozil for 2 weeks. At 14 weeks, there was a significant increase in blood glucose, plasma cholesterol and triglyceride levels of untreated-diabetic animals. Diabetes was associated with a significant increase in thiobarbituric acid reactive substances (TBARS) in both plasma and aortic homogenates, indicating increased lipid peroxidation. Diabetes caused an increase in vascular antioxidant enzyme activity, catalase, indicating existence of excess hydrogen peroxide (H2O2). However, superoxide dismutase (SOD) and glutathione peroxidase (GSHPx) activities in aortas did not significantly change in untreated-diabetic rats. In diabetic plus gemfibrozil group both plasma lipids and lipid peroxides showed a significant recovery. Gemfibrozil treatment had no effect on blood glucose, plasma insulin and vessel antioxidant enzyme activity of diabetic animals. Our findings suggest that the beneficial effect of short-term gemfibrozil treatment in reducing lipid peroxidation in diabetic animals does not depend on a change of glucose metabolism and antioxidant status of aorta, but this may be attributed to its decreasing effect on circulating lipids. The ability of short-term gemfibrozil treatment to recovery of metabolism and peroxidation of lipids may be an effective strategy to minimize increased oxidative stress in diabetic plasma and vasculature.

Routine admission laboratory testing for general medical patients.

We evaluated the usefulness of commonly ordered routine admission laboratory tests in 301 patients admitted consecutively to the internal medicine wards of a university teaching hospital. Using a consensus analysis approach, three Department of Medicine faculty members reviewed the charts of admitted patients to determine the impact of the test results on patient care. The evaluated tests were the urinalysis, hematocrit, white blood cell count, platelet count, six-factor automated multiple analysis (serum sodium, potassium, chloride, bicarbonate, glucose, and blood urea nitrogen), prothrombin time, partial thromboplastin time, chest x-ray, and electrocardiogram. Forty-five percent of the 3,684 tests were ordered for patients without recognizable medical indications. Twelve percent of these routine tests were abnormal, 5% led to additional laboratory testing, but only 0.5% led to change in the treatment of patients. We conclude that the impact of routine admission laboratory testing on patient care is very small and that there is little justification for ordering tests solely because of hospital admission.