A qualitative study of ethnic Korean women and men's experiences of HPV and HPV vaccination in the United States.

INTRODUCTION: Approximately 42.5% of adults aged 18-59 in the United States is estimated to be affected by human papillomavirus (HPV) infection. However, Asian Americans have the lowest HPV vaccination initiation rate compared to other racial groups. This study aims to explore the experiences of HPV and the HPV vaccination among ethnic Korean women and men in the United States. METHODS: A total of 33 ethnic Korean and Korean Americans aged 27-45 years living in the U.S. were recruited via word-of-mouth and social media using a purposive sampling strategy. They participated in an online survey. Of the 33 participants, 29 (14 females and 15 males) participated in in-depth interviews via password-protected Zoom. A content analysis approach was used to analyze the interviews. RESULTS: Only 32% of participants had received the HPV vaccine at least once (female: 35.3%, male: 12.5%). Six major themes emerged from data analysis: (1) awareness of HPV, HPV vaccine, and HPV-associated cancers; (2) attitudes toward the HPV vaccine; (3) barriers to HPV vaccination; (4) women's experiences and preferences for pap smear testing; (5) experiences with HPV diagnosis; and (6) HPV and HPV vaccination education preferences. CONCLUSION: The findings highlight cultural factors that may impede the discussion about and uptake of HPV vaccination and HPV-associated cancer screening, which emphasize the need for culturally appropriate interventions to overcome stigma around HPV and enhance vaccination rates. Healthcare providers should consider ethnic and cross-cultural differences perceptions to effectively HPV-related health information. This study provides insight into the experiences and understanding of HPV and vaccination among ethnic Korean men and women, laying the groundwork for developing culturally-tailored programs that sim to increase HPV vaccination rates and mitigate the stigma and impact of HPV-related disease in this community.

Genotyping and Molecular Identification of Acanthamoeba Genotype T4 and Naegleria fowleri from Cerebrospinal Fluid Samples of Patients in Turkey: Is it the Pathogens of Unknown Causes of Death?

PURPOSE: This study was aimed to investigate the presence of pathogenic free-living amoebae (FLA) in suspected cases of meningoencephalitis with unknown causes of death in Turkey. METHOD: A total of 92 patients, who were diagnosed as meningoencephalitis, were enrolled. All cerebrospinal fluid (CSF) samples were directly microscopically examined and cultured. Acanthamoeba, N. fowleri and B. mandrillaris were further investigated using molecular diagnostic tools including real-time PCR, sequencing, and phylogenetic analyses. RESULTS: The examined CSF samples were not found positive for the presence of FLA by microscopic examination and culture method. However, two CSF samples were detected positive by real-time PCR assay. Of the positive CSF samples, one was identified as Acanthamoeba genotype T4 and the second positive sample was identified as N. fowleri belonging to genotype II. Furthermore, the pathogens diagnoses was verified through Sanger sequencing. CONCLUSION: This study was significant to report the presence of Acanthamoeba genotype T4 and N. fowleri genotype II in CSF samples by real-time PCR assay. The present study shows the significance of primary amoebic meningoencephalitis (PAM) and granulomatous amoebic encephalitis (GAE) as one of the differential diagnoses to be considered by clinicians during the evaluation of suspected meningoencephalitis or cases of unknown cause in Turkey. Using real-time PCR, this has made the rapid detection, in a short time-frame, of Acanthamoeba and N. fowleri in CSF samples from patients. The problems with qPCR is that it is not available in every laboratory, reagents are expensive, and it requires skilled and expert personnel to set up these assays.

Effects of epidural morphine and levobupivacaine combination before incision and after incision and in the postoperative period on thoracotomy pain and stress response

Background/aim: This study aims to investigate the effects of thoracic epidural analgesia, before and after surgical incision and in the postoperative period, on thoracotomy pain and stress response. Materials and methods: A total of 45 patients who were scheduled for posterolateral thoracotomy were included in this study. A combination of epidural levobupivacaine and morphine was administered as a bolus before incision (Group 1; n=15), after incision (Group 2; n=15), or at the end of surgery (Group 3; n=15). Additionally, infusion was used in Group 1 and Group 2 during operation. Postoperative patient-controlled epidural analgesia infusion pumps were connected to all patients. Visual analog scale (VAS) scores and morphine consumption were recorded during the postoperative 48 h. Glucose, insulin, cortisol, and C-reactive protein (CRP) levels were compared before surgery and at 4, 24, and 48 h after the operation. Results: There were no differences in the morphine consumption and VAS scores for all measurements among the groups (P > 0.05). Both blood glucose levels at 4 h and CRP values at 48 h were higher in Group 2 than Group 1 (P < 0.05). Cortisol levels at 4, 24, and 48 h after the operation were similar to baseline values in all groups (P > 0.05). Conclusion: The application of thoracic epidural analgesia before and after surgical incision and in the postoperative period did not result in a significant difference in the severity of the postthoracotomy pain and stress response in all groups. Based on our results, we suggest that epidural levobupivacaine combined with morphine provides an effective and safe analgesia and can partially suppress surgical stress response.

Multidisciplinary clinical management of paroxysmal nocturnal hemoglobinuria.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired disease caused by clonal expansion of one or more hematopoietic stem cell (HSC) lines due to a somatic mutation of the phosphatidylinositol glycan anchor (PIG-A) gene located on Xp22.1. PNH incidence is 1.5-2 cases per million of the population per year. PNH can affect multiple systems in the body and requires multidisciplinary clinical management. Patients can manifest with severe pancytopenia, life-threatening thrombosis affecting the hepatic, abdominal, cerebral, and subdermal veins, and high requirements for blood transfusion due to haemolytic anemia. PNH can also be associated with bone marrow failure. Advances in diagnostic techniques and a targeted therapeutic approach for PNH have emerged in the last two decades. Eculizumab, a promising humanized monoclonal antibody against C5, is the first approved therapy for PNH.

Abnormal liver function test in hydatidiform moles: a retrospective study comparing the hyperthyroid state and the euthyroid state.

INTRODUCTION: The effect of a hyperthyroid or euthyroid state on liver function tests in patients with hydatidiform moles (HM) is not known. The aim of this study was to determine the effect of hyperthyroidism on liver transaminases in HM. PATIENTS AND METHODS: We retrospectively reviewed aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in 80 patients with HM (23 complete moles and 57 partial moles). RESULTS: Of the 80 HM patients, 52 (65%) were euthyroid and 28 (35%) were hyperthyroid. The number of gravida and the levels of serum ß-human chorionic gonadotropin (ß-HCG), AST, and ALT were significantly higher in the hyperthyroid state than in the euthyroid state (p = 0.033, p = 0.001, p = 0.001 and p = 0.001; respectively). Number of gravida, serum TSH and total T4 were significantly higher in complete HM than partial HM (p < 0.05, p < 0.001, p < 0.05; respectively). CONCLUSIONS: Our results demonstrated that HM-related ß-HCG may activate thyroid cells via TSH-related signalling, resulting in the release of high levels of FT4, FT3, TT3 and TT4, and a subsequent decrease in TSH.

Are consanguineous marriage and swaddling the risk factors of developmental dysplasia of the hip?

The purpose of this study was to investigate prospectively the effects of swaddling and consanguineous marriage on developmental dysplasia of the hip and associated risk factors. We screened by ultrasound 265 infants using the Graf method. The Pediatrics Department referred all newborn infants with suspected instability or a recognized risk factor to the orthopedic clinic. Risk factors of developmental dysplasia of the hip were searched and noted in these patients. Swaddling and consanguineous marriage were also determined and noted. We observed 164 of 265 infants (61.9 %) who had been swaddled and that 64 of 265 infants' parents were in a consanguineous marriage (24.2 %). In the statistical analysis that was conducted for swaddling and consanguineous marriage, highly significant differences were found. Our study showed that the rate of developmental dysplasia of the hip is very high, 11.7 %, in our region, eastern Turkey. Also, we commonly see improper swaddling and consanguineous marriage in our region, which affects many infants.

Transcervical intrauterine levobupivacaine infusion or paracervical block for pain control during endometrial biopsy.

The aim of this study was to determine pain during endometrial biopsy by comparing the use of intrauterine instillation of levobupivacaine or paracervical block with a placebo in a randomized, double-masked trial in premenopausal and postmenopausal women. A total of 90 women were enrolled in the study. Patients were allocated to either the control or case groups. Group 1 consisted of 30 cases with intrauterine anesthesia with 5 ml 0.5% levobupivacaine. Group 2 consisted of 30 patients who underwent paracervical block with lidocaine. No analgesic agent was given to the remaining 30 patients; these cases comprised the control group. The primary outcome measures were pain or discomfort experienced during the procedure. When the pain scores of the different groups were compared, the scores in the intrauterine levobupivacaine and paracervical block groups were found to be significantly lower compared to those in the control group. There was no difference between the levobupivacaine and paracervical block groups in terms of pain scores. There was a marked positive correlation between biopsy indications and pain scores. Pain scores were lower in cases with the indication of polymenorrhea, hypermenorrhea and metrorraghia compared to those in the cases with other indications. In conclusion, the transcervical intrauterine instillation of levobupivacaine or paracervical block with lidocaine brings about pain relief during and after endometrial biopsy.

Comparison of the efficacy of intrauterine lidocaine, paracervical block and oral etodolac for decreasing pain in endometrial biopsy.

OBJECTIVE: To compare the effectiveness of paracervical block, intrauterine lidocaine and oral etodolac in decreasing the pain caused by pipelle endometrial sampling. A secondary goal of this study was to determine the adverse effects and compare possible effects of these methods on pulse and blood pressure. MATERIAL AND METHODS: The study was performed between April 2006 and October 2006 in the Obstetrics and Gynecology Department of Van Yüzüncü Yil University Research Hospital. One-hundred twenty patients were randomized into four groups: 1. Group: Paracervical block was performed with 3 ml 2% prilocaine solution. 2. Group: Five ml of 2% lidocaine solution was instilled through the endocervix into the uterine cavity. 3. Group: Subjects received 400 mg oral etodolac tablet 1-1.5 hour before the procedure. 4. Group: No method of anesthesia was used in the control group. Endometrial sampling was performed with pipelle. Severity of pain during the procedure was scored by the subjects according to the "6-point Verbal Rating Scale (VRS)". Blood pressure and pulse rate were measured before, during and 30 minutes after the procedure. RESULTS: Pain scores in intrauterine lidocaine group (2(nd) group) were found statistically significantly lower than the other three groups (p<0.05). CONCLUSION: Intrauterine lidocaine anesthesia technique decreases pain in endometrial sampling with pipelle more efficiently than paracervical block or oral etodolac. While indication of menorrhagia and endometrial thickness more than 5 mm increased pain scores, intrauterine lidocaine application or paracervical block decreased the scores significantly (p<0.05).