Immunological impression cytology of the conjunctival epithelium in patients with thyroid orbitopathy-related dry eye.

Thyroid orbitopathy (TO) is an autoimmune disease that is complicated by ocular surface disorders, leading to discomfort. Dry eye is very prevalent in patients with TO. Recent studies on the pathogenesis of dry eye have focused on the inflammatory process, and some supporting evidence has been discovered. Because TO is a disorder of autoimmune origin, we assumed that the association between TO and dry eye is related to inflammation. Inflammation of the ocular surface in TO-related dry eye has not been well studied. In this study, we assessed cellular inflammation of the ocular surface and the cytokine profiles in patients with TO-related dry eye. Conjunctival impression cytology (CIC) was assessed with an immunofluorescent assay. TO-related dry eye was diagnosed by using the Schirmer test, tear break-up time, thyroid function, and clinical signs. CIC was combined with immunological staining of interleukin-1a (IL-1a), IL-1b, and IL- 6. The immunological impression cytology (IC) grade was compared to the clinical activity score of TO. All TO patients with dry eye were positive for IL-1a, IL-1b, and IL-6. However, the normal controls were also positive for IL-1a. A trend was observed between the clinical inflammatory score and immunological IC grade. This study was the first to delineate the immunological IC of TO-related dry eye. Our study aimed to investigate the pathogenesis of dry eye in TO. Our findings suggest that the conjunctival cytokines IL-1a, IL-1b, and IL-6 may play a role. The results of this study will be useful for future studies of additional inflammatory cytokines, and the levels of these cytokines could be used as an outcome to assess the efficacy of treatment, such as anti-cytokine or immunosuppression therapy, in patients with TO-related dry eye or other ocular surface inflammatory disorders.

Role of interleukin-6 gene polymorphisms in the development of prostate cancer.

We investigated the role of two functional polymorphisms, IL-6-174G>C (rs1800795) and IL-6-572C>G (rs1800796), in the development of prostate cancer. A total of 212 consecutive primary prostate cancer patients and 236 control subjects were recruited between May 2012 and May 2014. The IL-6-174G>C (rs1800795) and IL-6-572C>G (rs1800796) polymorphisms were assessed by polymerase chain reaction-restriction fragment length polymorphism. The genotype distributions of IL-6-174G>C (rs1800795) and IL-6-572C>G (rs1800796) met the Hardy-Weinberg equilibrium in the controls. Unconditional logistic regression analyses showed that the GG genotype of IL-6-572C>G (rs1800796) was associated with an elevated risk of prostate cancer compared with the CC genotype, and the OR (95%CI) for the GG genotype was 2.06 (1.11-3.87). In conclusion, we suggest that the IL-6-572C>G (rs1800796) gene polymorphism influences the development of prostate cancer.

Nontyphoidal salmonella urinary tract infection in a case of hyperparathyroidism and nephrocalcinosis.

Nontyphoidal Salmonella infections often present with self-limited gastroenteritis. Extraintestinal focal infections are uncommon but have high mortality and morbidity. Urinary tract infection caused by nontyphoidal Salmonella is usually associated with structural abnormalities of the urinary tract. Nephrocalcinosis and nephrolithiasis are the major risk factors. Although primary hyperparathyroidism has been reported to increase the risk of nephrocalcinosis and nephrolithiasis, little is known about the association between hyperparathyroidism and Salmonella urinary tract infection. We report the case of a 37-year old man who had a history of primary hyperparathyroidism and bilateral nephrocalcinosis and who developed urinary tract infection. Salmonella Group D was isolated from his urine specimen. Salmonella should be considered as a possible causality organism in patients with primary hyperparathyroidism and nephrocalcinosis who develop urinary tract infection. These patients need to be aware of the potential risks associated with salmonellosis.

Nontyphoidal Salmonella urinary tract infection in a case of hyperparathyroidism and nephrocalcinosis / Infección de las vías urinaria por Salmonella no tifoidea en un caso de hiperparatiroidismo y nefrocalcinosis

Nontyphoidal Salmonella infections often present with self-limited gastroenteritis. Extraintestinal focal infections are uncommon but have high mortality and morbidity. Urinary tract infection caused by nontyphoidal Salmonella is usually associated with structural abnormalities of the urinary tract. Nephrocalcinosis and nephrolithiasis are the major risk factors. Although primary hyperparathyroidism has been reported to increase the risk of nephrocalcinosis and nephrolithiasis, little is known about the association between hyperparathyroidism and Salmonella urinary tract infection. We report the case of a 37-year old man who had a history of primary hyperparathyroidism and bilateral nephrocalcinosis and who developed urinary tract infection. Salmonella Group D was isolated from his urine specimen. Salmonella should be considered as a possible causality organism in patients with primary hyperparathyroidism and nephrocalcinosis who develop urinary tract infection. These patients need to be aware of the potential risks associated with salmonellosis.

Las infecciones por Salmonella no tifoidea se presentan a menudo con gastroenteritis auto-limitada. Las infecciones extra-intestinales focales son poco frecuentes, pero tienen una alta mortalidad y morbilidad. La infección de las vías urinarias causada por la Salmonella no tifoidea se asocia generalmente a anomalías estructurales de las vías urinarias. La nefrocalcinosis y la nefrolitiasis son los principales factores de riesgo. Aunque se ha reportado que el hiperparatiroidismo primario aumenta el riesgo de la nefrocalcinosis y la nefrolitiasis, poco se sabe sobre la asociación entre el hiperparatiroidismo y la infección de las vías urinarias por Salmonella. Damos a conocer aquí el caso de un hombre de 37 años con una historia de hiperparatiroidismo primario y nefrocalcinosis bilateral, que desarrolló una infección de las vías urinarias. La Salmonella del grupo D fue aislada de su muestra de orina. La Salmonella se debe considerar como un posible organismo de causalidad en pacientes con hiperparatiroidismo primario y nefrocalcinosis que desarrollan infección del tracto urinario. Estos pacientes necesitan tomar conciencia de los riesgos potenciales asociados con la salmonellosis.

Thymoma associated with myasthenia gravis and Sjögren syndrome.

Thymoma is the most common neoplasm of the anterior mediastinum but thymoma with Sjögren syndrome (SS) is rare. Sjögren syndrome is a systemic autoimmune inflammatory disorder. It is characterized by lymphocyte-mediated destruction of exocrine glands, which leads to absent glandular secretion. Here, we present the case of a 63-year-old man with thymoma and concurrent myasthenia gravis and SS, who achieved remission after thymectomy.

Comparative study of safety and efficacy of IUD insertions by physicians and nursing personnel in Brazil.

To assess whether trained nursing personnel could provide IUD services as safely and effectively as physicians in Brazil, an experimental study was conducted at the main clinic of the Center for Research on Integrated Maternal and Child Care in Rio de Janeiro. From November 1984 through April 1986, a total of 1,711 women who requested IUD insertion at the clinic were randomly assigned to have a Copper-T 200 IUD inserted by one of the clinic's 11 physicians or 13 nurses. All of the physicians and nursing staff members who provided these services had taken the Center's standard clinical family planning training course. Of 860 insertions attempted by the physicians and nurses, 1.3% and 3.3%, respectively, were unsuccessful. Statistically, this difference was very significant (P < 0.01). Also, mainly because the cervix was small and undilated, nulliparous women had a relatively high insertion failure rate of 8.0%, as compared to 1.5% for primiparas and 1.0% for multiparas. The overall rate of complications at insertion was 1.8%, these complications including diaphoresis, vomiting, syncope, cervical laceration, and one case of perforation of the uterus; no significant difference was found between the complication rates for insertions performed by physicians as compared to nurses. However, 9.0% of the study subjects reported severe pain during IUD insertion, with significantly higher percentages reporting pain if the IUD was inserted by a physician, or if the subject was nulliparous, had preinsertion symptoms, or had a history of pelvic inflammatory disease (PID) or sexually transmitted disease (STD). It was also found that the nurses had a dramatically high insertion failure rate (11.6%) with nulliparous subjects, while the physicians' failure rate with such subjects was a significantly lower 3.4%. No significant difference was found in the groups served by nurses and physicians with regard to postinsertion complaints or termination of use within 12 months of insertion. These findings suggest that future training, besides preparing nursing personnel in IUD insertion, should emphasize preparation in taking the client's medical history and diagnosing existing medical symptoms that could be associated with IUD insertion complications. In addition, if a nulliparous woman requests an insertion, it should be performed by a physician or more experienced nursing staff member with close medical supervision. Because of high rates of reported pain at insertion, such women, as well as those with medical symptoms associated IUD insertion complications and those with a history of PID or STD, should be considered candidates for extra care and counseling.(ABSTRACT TRUNCATED AT 400 WORDS)

PIP: In the mid-1980s in Brazil, health workers randomly assigned 1711 women aged 15-48 requesting IUD insertion at the Center for Research on Integrated Maternal and Child Care clinic in Rio de Janeiro to have the Copper-T 200 IUD inserted by a physician or by a nurse. The study aimed to determine whether trained nurses could perform as safe and effective IUD insertions as physicians. Insertion failure was more common when performed by nurses than physicians (3.3% vs. 1.3%; p = 0.005). Severe pain at insertion was more common during physician insertions than nurse insertions (10.8% vs. 7.1%; p = 0.008) and in women who had menstrual bleeding, bleeding, dysmenorrhea, or pelvic pain than in women lacking these preinsertion symptoms (14.2% vs. 7.8%; p 0.001). History of pelvic inflammatory disease (PID) or a sexually transmitted disease (STD) increased the likelihood of severe pain at insertion (14.5% vs. 8.5%; p = 0.022). Nulliparous women were more likely to experience insertion failure than parous women regardless of provider, especially for nurse insertions (11.6% vs. 1.6%; p 0.01). The higher failure rate among nurses was probably due to a higher proportion of nulliparous women in the nurse insertion group (17.2% vs. 13.6%; p 0.05). The overall IUD use-effectiveness rate at 12 months was 98.8% (98.6% for physicians and 99% for nurses). The cumulative IUD continuation rate at 12 months was slightly better for nurse insertions than for physician insertions (75.2% vs. 74.4%). There were no significant differences between termination rates regardless of reason (pregnancy, expulsion, or removal) between physicians and nurses. The increases in complaint rates between preinsertion and postinsertion were the same for both physicians and nurses (25.8% and 25.1%, respectively). These results indicate the need to emphasize taking the client's medical history and diagnosing existing medical symptoms that are possibly linked to IUD insertion complications. Physicians or more experienced nurses should insert an IUD in nulliparous women. More counseling and care are needed for women with IUD insertion complications and those with a history of PID or STD.

Analysis of sterilization failure in Brazil.

A study of 13,423 female sterilization procedures performed from 1981 to 1984 in Rio de Janeiro, Brazil, was conducted to determine the level of sterilization failure. The lifetable cumulative failure rate was 0.54 at 12 months per 100 initial sterilizations, increasing to 1.04 at 48 months. Results of a multivariate analysis indicated that the differential in the rate of sterilization failure by woman's age at sterilization at 12 and 24 months was statistically highly significant. However, the differential rate of failure by the other variables such as whether sterilized during a training period, number of sterilizations per surgeon per day, and year of sterilization were not statistically significant.

PIP: To determine the level of sterilization failure, an analysis of the 13,423 female sterilization procedures carried out in 1981-84 at a primary care center in Rio de Janeiro was performed. 97% of these procedures were performed with a laparoscope, and a band was used for 98% of occlusions. 144 women reported a pregnancy after their sterilization procedure; of these, 22 were defined as occurring before the surgery (luteal phase) and were excluded from the life-table analysis. The cumulative failure rate was 0.54/100 sterilizations at 12 months and 1.04/100 procedures at 48 months. Parity, method of sterilization, and occlusion technique were not correlated with sterilization outcome. However, logistic regression analysis indicated that the rates of sterilization failure at 12 and 24 months were consistently lower for older women (age 30 years and above) than women in the 17-29-year age group. (p0.01). The number of sterilizations performed per day was also a factor in sterilization failure, but this association was not statistically significant. 5.7% of the sterilization failures resulted in ectopic pregnancies. Overall, these findings are comparable to the failure rate in other countries. The occurrence of 22 luteal phase pregnancies in this study highlights the importance of thorough preoperative counseling and examination. It is recommended that contraception should be used in the cycle prior to sterilization to reduce this risk.

Impact of accessibility of contraceptives on contraceptive prevalence in Guatemala.

PIP: The 1978 National Survey of Fertility, Family Planning, and Communication of Guatemala provided the opportunity to study the effect of accessibility to contraceptive source on contraceptive prevalence. Guatemala's 2 ethnic groups are the Ladinos and the Indians. Demographic characteristics were represented by age of woman, number of living children, and desire for more children. Socioeconomic characteristics were educational status, urban-rural residence, and employment status. The survey found that a substantially lower proportion of Indian couples (4%) than Ladino couples (27%) was using contraception outside the Department of Guatemala, but the 2 groups have similar birth rates, probably due to the pattern of prolonged breastfeeding among Indians. Outside the Department of Guatemala, Indians marry younger than Ladinos; 50% of 15-19 year old Indian women were married (including consensual unions) compared with 32% of Ladino women. For Ladinos the use of reversible modern methods consistently decreased with an increase in average travel time to the source of contraception, but Indians' use of contraception apparently bears little relationship to accessibility. Thus, community-based contraceptive distribution programs may be effective for Ladinos, but different strategies may be required for Indians, including an independent design of information, education, and communications programs for either clinic or community-based programs.^ieng