Management of patent foramen ovale in embolic stroke of undetermined source patients: Malaysian experts' consensus.

INTRODUCTION: About 20 to 40% of ischaemic stroke causes are cryptogenic. Embolic stroke of undetermined source (ESUS) is a subtype of cryptogenic stroke which is diagnosed based on specific criteria. Even though patent foramen ovale (PFO) is linked with the risk of stroke, it is found in about 25% of the general population, so it might be an innocent bystander. The best way to treat ESUS patients with PFO is still up for discussion. MATERIALS AND METHODS: Therefore, based on current evidence and expert opinion, Malaysian expert panels from various disciplines have gathered to discuss the management of ESUS patients with PFO. This consensus sought to educate Malaysian healthcare professionals to diagnose and manage PFO in ESUS patients based on local resources and facilities. RESULTS: Based on consensus, the Malaysian expert recommended PFO closure for embolic stroke patients who were younger than 60, had high RoPE scores and did not require long-term anticoagulation. However, the decision should be made after other mechanisms of stroke have been ruled out via thorough investigation and multidisciplinary evaluation. The PFO screening should be made using readily available imaging modalities, ideally contrasttransthoracic echocardiogram (c-TTE) or contrasttranscranial Doppler (c-TCD). The contrast-transesophageal echocardiogram (c-TEE) should be used for the confirmation of PFO diagnosis. The experts advised closing PFO as early as possible because there is limited evidence for late closure. For the post-closure follow-up management, dual antiplatelet therapy (DAPT) for one to three months, followed by single antiplatelet therapy (APT) for six months, is advised. Nonetheless, with joint care from a cardiologist and a neurologist, the multidisciplinary team will decide on the continuation of therapy.

Rituximab-induced lung disease.

Pulmonary toxicity is a rare complication of Rituximab therapy. Although Rituximab is relatively safe and can be administered in an outpatient setting, Rituximab-associated lung disease has been reported and may cause mortality despite early detection. Typically the pulmonary toxicity occurs at around the fourth cycle of Rituximab. High index of suspicion is crucial and other concurrent pathology such as infective causes should be excluded. Radiological imaging and histological confirmation should be obtained and early treatment with corticosteroid should be initiated. Patients should receive counselling regarding respiratory symptoms and possible pulmonary toxicity.

Urea inhibits the Na-K pump in human erythrocytes.

Recent studies have established that urea alters the activity of several volume-sensitive cation transport pathways. However, it has remained unclear whether urea has any effect on transport pathways that are not volume-sensitive. We examined the effect of urea on Na-K pump in the human erythrocytes. In cells from nine subjects, 500 mM urea inhibited 52 +/- 10% of the pump activity measured as the ouabain-sensitive (OS) K influx. Urea inhibited the OS K influx reversibly, in a concentration-dependent manner. [3H] oubain binding, a measure of the number of Na-K pump sites remained unchanged with urea. Urea decreased the Vmax for ouabain-sensitive K influx, but did not alter the apparent K(m) for external K. Furthermore, urea did not alter the apparent K(m) for intracellular Na. The ion turnover per pump site was decreased in the presence of urea. Thus, physiologically relevant urea concentration inhibit the Na-K pump in human erythrocyte. The inhibition of the Na-K pump by urea suggests that the effects of urea may not be limited to volume-sensitive transporters, but may be more widespread.

Characteristics and performance of family planning organizers in West Pakistan.

PIP: A survey was conducted among family planning organizers in 8 districts, both rural and urban, in West Pakistan in 1967. The survey was designed to determine the personal characteristics and measure of success of the dais, or indigenous midwives, being used as family planning motivators. In general, the organizers had completed the reproductive period of their lives. More than 60% were married at the time of the interview. Although more than 80% mentioned that they were practicing dais, 72 out of the 442 interviewed delivered less than 3 babies monthly. Most of the respondents considered the monthly allowance as the most important incentive to their working while few cited the referral fee or the sales commission. Respondents varied in the number of visits they considered necessary in order to induce a client to accept family planning, with 3.1 being the mean number mentioned. The majority felt their prestige in the village had increased since they started work for the family planning program. The IUD seems to be the increasingly most popular method while foam tablets are losing popularity and condoms and sterilization do not interest female workers. Performance was measured on the number of IUD referrals per month or the number of condoms sold; information available was very limited.^ieng

PIA - a comparison of male and female responses relating to knowledge, attitude and practice regarding family planning.

PIP: A study in 1964 of 317 males and 314 females was conducted in Pakistan to determine knowledge, attitudes, and practice of family planning; a comparison of the results is presented. The median age of the subjects was 30.9 for men and 25.7 for women. 13% of the men and 2% of the women knew the correct mechanism of conception. 51% of the males and 42% of the females knew of temporary methods of contraception, while 30% of the females knew of no methods. The most common method known was the condom. The most important reason for having childeren was love and care for males, and God's will for women. Economic reasons were those most often given for not having children. Reasons given most often for family planning were mother's health, care and education of children, and freedom for parents. The mean ideal number of children was 3.6. 71% of the men and 78% of the women wanted to adopt family planning.^ieng