Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002871 (anemia)
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Over a six-year period (1982-1987), 36 cases of vaginal trauma at sexual intercourse managed in the gynaecological unit of the University of Ilorin Teaching Hospital are presented. The serious nature of this accident is stressed. The frequent involvement of the posterior fornix of the vagina, accounting for 50% of the cases is shown. Perforation of the pouch of Douglas with possible intestinal prolapse, and involvement of the urinary bladder resulting in vesicovaginal fistula are not common in Ilorin. The predisposing factors like rough coitus, first sexual intercourse, puerperium, surgical alteration of the vagina, peno-vaginal disproportion and multiparity are discussed. The importance of adequately preparing the women emotionally and physically for coitus, a matter which certain males tend to ignore, is emphasized. The necessity for thorough digital as well as speculum examination in all cases of vaginal bleeding is made. There was no death recorded, while the morbidity was mainly hypovolaemic shock with haemorrhagic anaemia.
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PMID:Vaginal trauma at sexual intercourse in Ilorin, Nigeria. An analysis of 36 cases. 248 1

The prevention of pregnancy in ileostomy patients presents a special problem because of the delicacy of the choice of contraceptive methods. They include chemical methods, such as suppositories, gels, salves, or foams which contain spermicidal substances, but these can be used only as long as there is no injury to the vagina. These methods are relatively safe, provided the time required for action of the preparation is observed. Mechanical means of contraception include the diaphragm and other cervical caps placed on the cervix, possibly in combination with a chemical agent, except when the cervix is injure,d which is not always the case with Crohn's disease. The IUD is very reliable; however, it should be contraindicated in case of vaginal or rectal fistulas. It is not known, if IUD use would contribute to the formation of fistulas; however, IUDs have been implicated in increased monthly menstrual flow and resultant anemia. Ovulation inhibitors containing hormonal components, such as oral contraceptive are absorbed in the small and large intestines; however, as ileostomy suffers have increased passage of stool, the effectiveness of these preparations is not fully reached, and reliable protection is uncertain. When no childbirth is desired, an alternative is the 1 or 3 month injectable contraceptive, although its side effects (sterility, amenorrhea, and dysmenorrhea) are frequent. The advice and counselling of a gynecologist is recommended to assess individual physical and psychological needs.
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PMID:[Contraception in women with ileostomies]. 313 20

In the past Actinomycosis has been associated with diverticular disease of the colon, abdominal surgery, cholecystitis, and penetrating trauma. Recent reports have demonstrated an increased incidence in women using IUDs. Such a case is presented. a 40-year-old woman experienced lower abdominal pain and a 20 pound weight loss over a 2 month period. The patient had had an IUD (a Dalkon shield) placed 7 years previously and had not sought medical attention since then. Pelvic examination revealed an IUD in place and an 8 cm mass fixed to the left side wall and displacing the rectum. The IUD was removed after the pelvic examination. Laboratory studies were all within normal limits except for mild anemia. A computed tomographic scan of the pelvis showed a left hydroureter, an 8 cm pelvic mass with left side wall extension, and displacement of the rectum to the right. A barium enema examination showed fixed narrowing of the rectum and mucosal irregularity. A fine needle aspiration biopsy showed endometritis and frank pus with the presence of Actinomyces. Surgery confirmed these findings. The patient responded to antibiotic therapy after surgery and did well. The colonization of the vagina, cervix, and uterus by Actinomyces and complications such as tubo-ovarian and pelvic abscesses have been reported in IUD users. 1 study reported Actinomyces in as many as 25% of IUD users, although all patients in that study were asymptomatic. In addition, this group had an increased incidence of abnormal pap smears, which may add a confusing note in the event of a pelvic mass. The association if IUD use and abscess appears increased in those patients who have had the same iud in place for more that 2 years, although the complication has been reported only 2 1/2 months following IUD insertion. Actinomycosis is a diagnosis seldom made before biopsy or surgery. Culture of the organism is essential and the diagnosis is best made using immunofluorescent staining of formaldehyde-fixed, paraffin-embedded tissue. This needle biopsy can provide a quick diagnosis. Therapy includes high dose penicillin, to which the disease responds quickly, and incision and drainage if necessary. Prompt diagnosis and adequate treatment reduce the morbidity of dissemination and of chronic infection.
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PMID:Pelvic actinomycosis. 686 30

Zidovudine (ZDV), an antiviral drug active in the treatment of acquired immunodeficiency syndrome (recommended human dose, 100 mg every 4 hr while awake), was evaluated for mutagenic and carcinogenic potential in a battery of short-term in vitro and in vivo assays and in lifetime studies in mice and rats. In L5178Y mouse lymphoma cells (tk+/- locus), a weak positive result was obtained only at the highest concentrations tested (4000 to 5000 micrograms/ml) in the absence of metabolic activation. In the presence of metabolic activation, the drug was weakly mutagenic at concentrations of 1000 micrograms/ml and higher. Following 24 hr treatment in the absence of metabolic activation, ZDV was moderately mutagenic at concentrations up to 600 micrograms/ml; dose-related structural chromosomal alterations were seen at concentrations of 3 micrograms/ml and higher in cultured human lymphocytes. Such effects were not noted at the two lowest concentrations tested, 0.3 and 1 microgram/ml, and BALB/c-3T3 cells were transformed at concentrations of 0.5 microgram/ml and higher. No effects were seen in the Ames Salmonella plate incorporation and preincubation modification assays (possibly due to bacteriocidal activity of ZDV at low concentrations) at concentrations ranging from 0.01 to 10 micrograms/plate or in a single-dose intravenous bone marrow cytogenetic assay in CD rats. In multidose micronucleus studies, increases in micronucleated erythrocytes were seen in mice at doses of 100 to 1000 mg/kg/day. Similar results were seen in rats and mice after 4 or 7 days of dosing at 500 mg/kg/day. In carcinogenicity bioassays, adjusted doses of 20, 30, or 40 mg/kg/day and 80, 220, and 300 mg/kg/day were given to CD-1 mice and CD rats, respectively, for up to 22 months in mice and 24 months in rats. ZDV caused a macrocytic, normochromic anemia in both species. No evidence of carcinogenicity was seen in male mice or rats. In female mice, five malignant and two benign vaginal epithelial neoplasms occurred in animals given 40 mg/kg/day. A single benign vaginal epithelial tumor was seen in a mouse given 30 mg/kg/day. In rats, two malignant vaginal epithelial neoplasms were seen in animals given 300 mg/kg/day. In a 7-day study in mice, ZDV was shown to be devoid of estrogenic activity. In an oral pharmacokinetics study, the AUC was 17 and 140 micrograms/ml.hr in female mice and rats given 40 or 300 mg/kg of ZDV, respectively. In contrast, the average steady-state concentration in humans at the recommended daily dose is 0.62 microgram/ml. Twenty-four hour urine concentrations were 1245 and 4417 micrograms/ml in female mice and rats given 40 or 300 mg/kg of ZDV, respectively. These values were approximately 26- and 136-fold higher than the human urine concentration at the recommended daily dose. In a one- to three-day study with intravenously administered sodium fluoroscein in rats and mice, retrograde flow of urine into the vagina was demonstrated. In a subsequent lifetime carcinogenicity bioassay in mice in which ZDV was given intravaginally at concentrations of 5 or 20 mg ZDV/ml in saline, 13 vaginal squamous cell carcinomas were seen at the highest concentration tested. It was concluded that the vaginal tumors seen in the oral carcinogenicity studies were the result of chronic local exposure of the vaginal epithelium to high urine concentrations of ZDV.
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PMID:Nonclinical toxicology studies with zidovudine: genetic toxicity tests and carcinogenicity bioassays in mice and rats. 892 18

Chimeric simian/human immunodeficiency virus (SHIV) consists of the env, vpu, tat, and rev genes of human immunodeficiency virus type 1 (HIV-1) on a background of simian immunodeficiency virus (SIV). We derived a SHIV that caused CD4+ cell loss and AIDS in pig-tailed macaques (S. V. Joag, Z. Li, L. Foresman, E. B. Stephens, L. J. Zhao, I. Adany, D. M. Pinson, H. M. McClure, and O. Narayan, J. Virol. 70:3189-3197, 1996) and used a cell-free stock of this virus (SHIV(KU-1)) to inoculate macaques by the intravaginal route. Macaques developed high virus burdens and severe loss of CD4+ cells within 1 month, even when inoculated with only a single animal infectious dose of the virus by the intravaginal route. The infection was characterized by a burst of virus replication that peaked during the first week following intravenous inoculation and a week later in the intravaginally inoculated animals. Intravaginally inoculated animals died within 6 months, with CD4+ counts of <30/microl in peripheral blood, anemia, weight loss, and opportunistic infections (malaria, toxoplasmosis, cryptosporidiosis, and Pneumocystis carinii pneumonia). To evaluate the kinetics of virus spread, we inoculated macaques intravaginally and euthanized them after 2, 4, 7, and 15 days postinoculation. In situ hybridization and immunocytochemistry revealed cells expressing viral RNA and protein in the vagina, uterus, and pelvic and mesenteric lymph nodes in the macaque euthanized on day 2. By day 4, virus-infected cells had disseminated to the spleen and thymus, and by day 15, global elimination of CD4+ T cells was in full progress. Kinetics of viral replication and CD4+ loss were similar in an animal inoculated with pathogenic SHIV orally. This provides a sexual-transmission model of human AIDS that can be used to study the pathogenesis of mucosal infection and to evaluate the efficacy of vaccines and drugs directed against HIV-1.
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PMID:Animal model of mucosally transmitted human immunodeficiency virus type 1 disease: intravaginal and oral deposition of simian/human immunodeficiency virus in macaques results in systemic infection, elimination of CD4+ T cells, and AIDS. 909 79

A total of 32 human diphyllobothriasis cases have been reported so far in Korea, excluding 21 egg-positive cases from stool examinations. Authors experienced five more human cases of Diphyllobothrium latum infection, especially infected due to eating raw flesh of redlip mullet, Liza haematocheila. Five cases were neighbors residing in the Puchon area, Kyonggi-do, who ate raw mullets (L. haematocheila) in a party in February 1996. The mullets were purchased at the Noryangjin fisheries market in Seoul. All of cases (2 males and 3 females) were 35 to 43 years old and healthy with the body weight range of 56-62 kg. They complained about gastrointestinal trouble and abdominal discomfort, but were in normal ranges of their hematology and urinalysis data. None revealed any sign of anemia. The patients experienced natural discharge of a chain of segments before, and showed diphyllobothriid eggs in their stool specimens when they visited our laboratory. They were administered with praziquantel (15 mg/kg of body weight) and 30 g of magnesium sulfate as a purgative. Two whole worms with the scolices (310-340 cm in length; 8-13 mm in width) were expelled each from two out of five cases after anthelmintic treatment, and the others expelled the parts of strobilae without scolex. The worms were identified as D. latum, based on the following biological characters: external morphologies, coiling of uterus, the number of uterine loops, position of genital opening, morphologies of cirrus, cirrus sac and seminal vesicle on the histological sections, position of vagina and uterine pore, and microscopical and SEM morphologies of the eggs.
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PMID:[Five human cases of Diphyllobothrium latum infection through eating raw flesh of redlip mullet, Liza haematocheila]. 944 11

The prevalence of genital actinomyces infection and possible routes of transmission in IUD users were analyzed in a high-risk population of predominantly indigent Mexican-American family planning clients. The Papanicolaou (Pap) smears of 12 (9%) of the 134 IUD users cultured were positive for actinomyces-like organisms. The IUD involved was the Lippes Loop in 7 cases, the Cu 7 in 2 women, the Dalkon Shield in another 2 cases, and the Saf-T-Coil in the final case. The duration of IUD use ranged from 1-10 years, with a mean of 6 years. Oral-genital sexual contact was the sexual preference in 3/4 of the women with actinomyces infection compared with under 2/3 of the general clinic population. Most of the women with actinomyces-like organisms had a concomitant condition, including gastroenteritis, cholecystitis, scabies, schizophrenia, drug abuse, anemia, herpes genitalis, venereal disease, and urinary tract infection. All of these women complained of vaginal discharge with pelvic pain during their initial visits. Eikenella corrodens was recovered in 1 of these cases and had an overall prevalence of 0.17% in the clinic population. Eikenella corrodens is found in the mouth, on dental plaques, and is not yet recognized as a normal inhabitant of the vagina or gastrointestinal tract. Oral-genital contact appears to be the mode of transmission of both actinomyces and Eikenella corrodens.
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PMID:IUDs and actinomyces. 1228 Aug 26

An analysis of causes of maternal deaths in the Southern Highlands Zone of Tanzania, concentrating on avoidable factors contributing to these deaths, was conducted in 1983. Deaths were ascertained by forms sent to doctors in hospitals and assistants in health centers, by visiting hospital and centers regularly, and from reports to Regional Medical Officers. The majority of deaths occurred in hospitals, producing a maternal mortality rate of 2.5/1000 in hospitals, compared to 0.8/1000 for the Zone overall. Total numbers and notable cases were discussed in each of the following etiologies: ectopic pregnancy (1), sepsis after abortion (20), placenta previa (3), eclampsia (4), postpartum hemorrhage (21), anemia (3), obstructed labor (6), puerperal infection (10), sepsis after surgery (7), puerperal pulmonary embolism (2), aspiration after anesthesia (1), herbal medicines (2). The greatest number of deaths were in gravida 3 women. The main avoidable factors were lack of blood for transfusion, no partogram being kept in labor, and risk factors noted but not acted upon. Blood was not available for several reasons: blood not kept in maternity ward, equipment not available to transfuse and relatives refused to give blood. Some other avoidable risk factors were: lack of or slow transport to facility, interference abortion, no antenatal care, lack of gas gangrene serum, packing vagina with cloths to stop bleeding, staff errors. It was felt that isolation of rural doctors contributed to errors, which may possibly be avoided by holding periodic seminars and reviews.
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PMID:Preliminary report on maternal deaths in the Southern Highlands of Tanzania in 1983. 1228 47

A vesicovaginal fistula is an abnormal passage between the bladder and the vagina. It is a hole in the lower posterior wall of the bladder and sometimes the urethra through which urine continuously drips toward the vagina, without possibility of control. Since women suffering from vesicovaginal fistulas are commonly infertile, the problem affects their entire social, family and gyneco-obstetrical lives. Fistulas are a complication of difficult deliveries and occur frequently in some rural and isolated regions of Africa insufficiently served by maternity hospitals. Fistulas develop in the course of deliveries prolonged by any cause when the baby's head presses against the bladder wall, causing necrosis of the wall by ischemia. The fistula appears several days after delivery of an usually stillborn infant. Fistulas are most commonly seen in young women, over half of whom are primiparas. Risk factors include small stature with narrow pelvis and excision. But the lack of obstetric care and midwives in rural zones and the difficulty of transfer to a hospital are the major factors. The fistula may measure several mm to several cm in length. The bladder has a reduced capacity because of sclerosis. The fistula may affect the urethra, uterus, vagina, and in very severe cases the rectum. Continuous local and urinary infection is almost always present. Early diagnosis is important because treatment is simpler, but it is more difficult than later diagnosis and symptoms may be masked by postpartum incontinence caused by trauma to the perineum which usually regresses spontaneously. An evaluation of the size and exact location of the fistula and the condition of the bladder and other affected organs is necessary before corrective surgery can be planned. 1 or 2 weeks of preoperative preparation may be needed to treat anemia, parasites, urinary infections, and cutaneous lesions. Treatment may require from several weeks to several months. Numerous surgical procedures are possible. The choice depends on the lesions and the habits of the surgeon. Curative surgery may not be possible in the most severe cases. Palliative surgery requires careful longterm follow-up that is seldom possible in Africa. When the final outcome is good, the patient must be carefully advised that hospital care is imperative during any subsequent pregnancies to avoid another fistula. Prevention in the form of screening of difficult deliveries and transfer to the nearest hospital at any moment is the best form of treatment for this condition.
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PMID:[Vesico-vaginal fistulas]. 1228 72

Various separate studies indicate maternal morbidity is more common than had been believed. A Safe Motherhood Survey was conducted in 1993 in the Philippines among 9000 women, as part of efforts to study women's language and perceptions about pregnancy and symptoms of morbidity. In El Salvador, interviews were conducted among 2000 women on morbidity issues. Preliminary results from a Family Health International (FHI) five-country survey of 16,000 women revealed that 7 out of every 10 women reported a health problem related to maternity or chronic conditions stemming from pregnancy or childbirth. Conditions ranged from obstructed labor, complications from unsafe abortions, and bacterial infections, to anemia, hemorrhage, and eclampsia. The quality of care determines whether the health problems are life threatening. Less serious morbidity cases involve fatigue or back pain, which is exacerbated by poor nutrition and hard physical labor. Other reproductive morbidities are sexually transmitted diseases, side effects from contraceptives, and general gynecological problems. The FHI results from Ghana, Indonesia, and Egypt showed 240-300 morbidities for every maternal death; maternal mortality worldwide is estimated at 500,000 annually. A study of fistula (an injury during labor to the vagina and bladder that results in urinary or fecal incontinence) found that Nigerian community norms and limited access to emergency health care were factors. The women reported costs, poor roads, and transportation problems. A study in Ethiopia found that, in an Addis Ababa hospital between 1983-88, 600 fistulas were repaired every year, of which almost 66% occurred at first delivery. A study in Cairo in 1988 found that nearly 6 out of every 10 women reported a prolapsed uterus. Women in the studies were able to talk openly and willingly about their problems, when concepts and language were appropriate and interviewers were trained. A small study in India confirmed the correlation between reported symptoms and clinical conditions. Philippine pretests found that women's memories of morbidity were accurate for up to 4 years.
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PMID:Maternal morbidities affect tens of millions. 1228 12


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