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Previous studies have suggested a relationship between reproductive history, pregnancy and birth factors, and the risk of neuroblastoma. We conducted a case-control telephone interview study that included a total of 504 children under the age of 19 years with newly diagnosed neuroblastoma identified by two national collaborative clinical trials groups, the Children's Cancer Group and the Pediatric Oncology Group. A total of 504 controls, matched to cases on age, were identified by random digit dialing. Conditional logistic regression was used to estimate the matched odds ratio (OR) and 95% confidence interval (CI) with adjustment for household income, and maternal race and education. In addition, case subgroups defined by age at diagnosis, tumour MYCN oncogene amplification status, and stage were evaluated. A suggestive pattern of increased risk was seen for a greater number of prior pregnancies, history of previous miscarriages and induced abortions, with nearly a twofold increase in risk for two or more prior induced abortions (OR = 1.9, 95% CI [1.0,3.7]). No association was found for the following diseases or conditions during pregnancy: hepatitis, rubella, measles, mumps, chickenpox, mononucleosis, vaccinations, morning sickness, pre-eclampsia, bleeding, proteinuria, anaemia, urinary tract infections, heart disease, kidney disease, liver disease and diabetes. A weak association was found for hypertension during pregnancy. Several labour and delivery factors were related to an increased risk, including threatened miscarriage, anaesthetic during labour (specifically epidural) and caesarean delivery. We found associations between premature delivery (<33 weeks: OR = 1.9, 95% CI [0.7,4.8]), very low birthweight (<1500 g: OR = 2.6, 95% CI [0.7,10.3]) and risk of neuroblastoma. There was no consistent pattern of increased risk found for most factors within subgroups defined by age at diagnosis, stage or MYCN status.
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PMID:Association of pregnancy history and birth characteristics with neuroblastoma: a report from the Children's Cancer Group and the Pediatric Oncology Group. 1170 80

We examined the prevalence of HIV, general medical, and psychiatric comorbidities by age based on a recent multisite cohort of HIV infected veterans receiving care: the Veterans with HIV/AIDS 3 Site Study (VACS 3). VACS 3 includes 881 adult patients with HIV infection enrolled between June 1999 and July 2000. Providers reported their patients' CDC-defined HIV comorbidities, general medical comorbidities (based on Duke and Charlson comorbidity scales), and psychiatric comorbidity. Mean age of participants was 49 years and 54% were African-American. The most common HIV comorbidities were oral candidiasis (21%), peripheral neuropathy (16%), and herpes zoster (16%). The most common general medical comorbidities included chemical hepatitis (53%), hypertension (24%), and hyperlipidemia (17%). The mean number of HIV and general medical comorbidities experienced by patients were respectively 1.1 and 1.4 (P < .001). Older (> or = 50 years) HIV-infected patients experienced a greater number of general medical comorbidities than those < 50 years (respectively 1.7 versus 1.2, P < .001). There was no significant difference in mean HIV comorbidity number by age. Based on patient report, 46% had significant depressive symptoms (> or = 10 on 10-item CES-D) and 21% reported at-risk drinking (> or = 8 on AUDIT). Providers reported 32% of patients had anxiety, 4% mania, 4% schizophrenia, and 11% cognitive impairment/dementia. General medical and psychiatric comorbidities constituted a higher disease burden for HIV-infected veterans than HIV comorbidities. Whether these comorbidities are due to antiretroviral drug toxicity or are age or lifestyle-associated conditions, the substantial prevalence of these "non-HIV" comorbidities suggest an important role for general medical and psychiatric management of HIV-infected patients.
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PMID:General medical and psychiatric comorbidity among HIV-infected veterans in the post-HAART era. 1175 Feb 6

This unit carried out 29 live donor transplants over a 3-year period. Many potential donors did not proceed to transplant. For those who had an acceptable tissue type, were blood group compatible and lymphocytotoxic crossmatch negative, we looked at the reasons for cancelling the donor work up. The reasons were impaired renal function (5 potential donors), cardiac/hypertension (4 potential donors), renovascular (1 potential donor), cancer (1 potential donor), cross-match positive at a late stage (3 potential donors), failure to attend at clinic/change of mind (6 potential donors) and hepatitis (2 potential donors). Improvements carried out following the audit include a list of tests which potential donors living away from this unit--especially those abroad--are asked to do before travelling here. An information leaflet has also been produced for potential donors.
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PMID:Drop-out rate during living donor selection. 1186 56

This is a case report of a reservist who presented for a physical examination with hypertension. It was discovered that the reservist was unknowingly taking large doses of Ephedra sinica, or ma huang, a Chinese herbal supplement, for body-building. One of the ingredients in ma huang is ephedrine, an active alpha- and beta-adrenergic stimulant that produces increases in heart rate, blood pressure, and cardiac output. Ma huang has been reported to cause hypertension, hepatitis, nephrolithiasis, and sudden death in healthy, normotensive people. Ma huang will produce a positive urinary drug screen for stimulants and can be a drug of abuse. A recommendation is made to screen for dangerous supplement use before physical readiness training and to stop the supplement for 1 month before beginning any exercise program.
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PMID:A mysterious blood pressure increase in a drilling Naval reservist. 1209 92

The paper presents the maternal mortality rates in St. Mary's Hospital Urua Akpan from the period of 1979-1985 excluding (1981 Author on leave). 70% of maternal deaths were among unbooked local Annang women who lived within a radius of 15-20 miles from the hospital. They had been attended to by traditional birth attendant (TBAs) and referred too late. The maternal rate decreased from 10/1000 in 1979 to 4/1000 in 1985. The main causes of maternal death during this period include ruptured uterus, septicemia, hepatitis, hemorrhage, eclampsia, and hypertension/nephritis. A community survey (190 interviewed women) revealed that up to 50% of women still prefer to deliver at home and are attended to by TBAs. A training program for TBAs in the Local Government Area (LGA) was started in June 1983. Each course lasted 3 months in which basic instruction in hygiene, simple antenatal care, labor and its complications, and care of mother and child was given. Since starting the program, the TBAs have referred 320 patients with medical pregnancies, vacuum, and symphysiotomy. From 1983-1986, there were 38 perinatal deaths and 2 maternal deaths among the TBAs referrals. Since 1983, the maternal death rate and morbidity have fallen especially among women from the LGA; maternal mortality declined 50% among these women which account for only 30% of the total hospital births/year. Furthermore, 16,000 children have been vaccinated. The beneficial aspects of TBA training include observing the principles of hygiene, early referral of patients to hospital, encouraging village children to come for vaccinations and generally using their influence in the cultural, ritual and religious life of traditional society to become good health educators.
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PMID:Training traditional birth attendants reduces maternal mortality and morbidity. 1217 76

Earlier and more frequent sexual activity and the significant risk of pregnancy have increased the need for contraception among young adolescent girls. The problem for the physician is to choose a contraceptive method which will not affect future fertility or the psychological and biological maturity of adolescents. Condoms, diaphragms, and spermicides are quite effective if used correctly; they have no deleterious side effects, and they provide protection against sexually transmitted diseases. They appear to be well-adapted to the sporadic sexual activity of adolescents. The efficacy of combined oral contraceptives (OCs) is also high. Side effects depend on the synthetic estrogen component and are dose dependent. Absolute contraindications to OC use in women of any age include thromboembolic disease, cerebral vascular accidents, severe cardiac or hepatic disorders, breast or genital cancer, pregnancy, undiagnosed genital bleeding, and pituitary adenoma. Relative contraindications include hypertension, diabetes, hyperlipidemia, obesity, history of hepatitis, migraines, epilepsy, asthma, renal insufficiency, cystic breast disease, and mammary fibroadenomas. Combined OCs do not seem to interfere with subsequent maturation of the hypothalamopituitary axis. The frequency of ovulatory cycles in adolescents who have discontinued pill use is the same as that in adolescents who have never used pills. However, estrogens accelerate the process of maturation in the bones, so combined OCs should never be prescribed for girls who have not terminated their growth. Minidose OCs containing 30-45 mcg of ethinyl estradiol aggravate the relative hyperestrogenism of adolescents and are associated with menstrual problems, functional ovarian cysts, and breast problems. They should only be prescribed for adolescents with regular sexual activity, no less than 3 years following menarche, with regular ovulatory menstrual cycles and no history of breast disorders. Otherwise, a standard-dose combined pill with 50 mcg EE should be selected. Continuous dose progestin minipills depend on peripheral effects such as modifications in the cervical mucus for their contraceptive effects. They are associated with frequent menstrual problems, functional ovarian cysts, and extrauterine pregnancies. They may be indicated for adolescents with regular sexual activity but with contraindications to combined OCs. Trimonthly injections of medroxyprogesterone acetate have major effects on endocrine metabolism and should be used only for adolescents with severe mental problems. IUD efficacy is high but they may be less well tolerated by adolescents than by older women and the risk of infection may be heightened. They should only be used for adolescents with absolute contraindications to use of hormonal contraceptives who have no history of genital infections.
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PMID:[Choosing contraception for adolescents]. 1228 May 85

Outlined is a protocol for the administration of emergency contraceptive pills. The indication for such treatment is unprotected intercourse within the past 72 hours. Absolute contraindications include the possibility of an existing pregnancy and a family history of stroke, heart attack, thrombophlebitis, breast or endometrial cancer, or liver tumor. Possibly excluded, depending on evaluation by a physician, are women with abnormal vaginal bleeding, active hepatitis, active gallbladder disease, high blood pressure, acute focal migraine, breastfeeding women, and those unable to understand instructions. The recommended regimen consists of six tablets of Ovral (two taken immediately, two more in 12 hours) or 12 tablets of Lo/Ovral, Nordette, or Levlen (four taken immediately, repeat dosage in 12 hours). The extra pills are to be used in cases of vomiting within three hours of pill ingestion. Women with a history of oral contraceptive-related nausea and vomiting should be provided with Compazine. Women should be informed that this method is effective in only about 92% of cases. All women who receive emergency contraception should be counseled that this is strictly a back-up method and helped to formulate a long-term birth control strategy.
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PMID:Emergency contraceptive pills (ECP) protocol. 1228 80

Morbidity from pregnancy complications was 19.6% of inpatients in 1990 in Bangkok Metropolis. This study examines the impact of local customs on prenatal, delivery, and postpartum care; the factors affecting use of health services for prenatal care and delivery; and the nature of women's involvement in IEC for maternal health. Data was obtained from a community survey in May 1992 among 526 ever married women, 15-40 years old, from low-income communities in Bangkok Metropolis. In-depth interviews with hospital personnel were conducted at two general hospitals and three health centers, and focus groups were conducted in two communities. Findings show that Hospital A received 220 old and 80 new prenatal patients daily; Hospital B accommodated 130 old and 50 new ones. According to nurses, the major hospital problem was doctors' attitudes toward nurses. Comprehensive services were available at both hospitals. Hospital B encountered patient health problems of minor malnutrition, syphilis, and hepatitis, while Hospital A treated diarrhea and high blood pressure problems. A lack of medical personnel was reported in both settings. Low level of education was reported as related to noncompliance. Incorrect practices were identified as adherence to food taboos that led to deficiencies, consumption of whiskey with traditional medicine, which contaminated breast milk, and discarding mother's first milk. At health centers, which included family planning, doctors only saw high risk patients; complications generally were for swelling, high blood pressure, and vaginal bleeding. Not all centers had a prenatal care diagnostic manual or licensed nurses. Obstacles to delivery of health care included a lack of nurses, refusals at referral centers by low level personnel, and a poor rapport between nurses and patients, which improved with bribes. Poorly educated patients had trouble understanding their health condition. Nurses and focus groups reported that services were not convenient for patients. Migration interfered with keeping appointments. Male doctors were preferred to female doctors as nicer to patients.
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PMID:Health services providers and users' opinions on maternal health services in Bangkok metropolis. 1231 92

The purpose of this study was the evaluation of the xanthine oxidase (XO) inhibition produced by some synthetic 2-styrylchromones. Ten polyhydroxylated derivatives with several substitution patterns were synthesised, and these and a positive control, allopurinol, were tested for their effects on XO activity by measuring the formation of uric acid from xanthine. The synthesised 2-styrylchromones inhibited xanthine oxidase in a concentration-dependent and non-competitive manner. Some IC50 values found were as low as 0.55 microM, which, by comparison with the IC50 found for allopurinol (5.43 microM), indicates promising new inhibitors. Those 2-styrylchromones found to be potent XO inhibitors should be further evaluated as potential agents for the treatment of pathologies related to the enzyme's activity, as is the case of gout, ischaemia/reperfusion damage, hypertension, hepatitis and cancer.
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PMID:2-styrylchromones as novel inhibitors of xanthine oxidase. A structure-activity study. 1236 60

We assessed the cardiovascular risk factors (CVRFs) in 116 stable liver transplant patients surviving for 5 years or more (median: 102 months). The prevalence of smokers was 29.3%, hypertension 49.1%, obesity 22.4%, hypercholesterolemia 34.5%, hypertriglyceridemia 11.2%, and hyperhomocysteinemia 57.8%. Diabetes was found in 21.5% of the patients, being more frequent in patients with hepatitis-C-virus infection (31.8% vs 15.3%; P=0.03). Patients on cyclosporine therapy had a higher prevalence of hypertension, hypercholesterolemia and hyperhomocysteinemia than those treated with tacrolimus. Multivariate analysis showed only an association between cyclosporine therapy and cholesterol concentrations (odds ratio:1.02; 95% confidence interval (CI): 1.00-1.03; P=0.01). The prevalence of hypertension, diabetes, hypercholesterolemia and hypertriglyceridemia was lower at the time of the study than at 1 and 3 years after transplantation ( P<0.05), probably related to steroid withdrawal. Comparing 87 patients' CVRFs with the general Spanish population, we found that the age-gender standardized prevalence ratio was not different: smoking 1.46 (95% CI: 0.88-1.76), obesity 1.16 (95% CI: 0.60-1.44), hypertension 1.55 (95% CI: 0.98-1.81), and hypercholesterolemia 0.64 (95%CI: 0.35-1.90). We conclude that the prevalence of CVRFs in liver transplant patients after 5 years or more is lower that found in the first years after the transplantation, and no different from that found within the Spanish population.
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PMID:Cardiovascular risk factors in 116 patients 5 years or more after liver transplantation. 1246 60


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