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The prevalence of gynecological and related morbidity in a rural Egyptian community was assessed as part of the Program of Research and Technical Consultation in Family Resources. Child Survival, and Reproductive Health. A medical examination was conducted on a sample of 509 ever-married, nonpregnant women from November 1989 to July 1990. A logistic regression using Generalized Linear Interactive Modeling was performed for each type of morbidity. For gynecological morbidities, genital prolapse was diagnosed in 56%, reproductive tract infections in 52%, and abnormal cervical cell changes in 11% of the women. For related morbidities, anemia was present in 63% of the women, followed by obesity (43%), hypertension (19%), and urinary tract infection (14%). Most of the women were suffering from at least 1 morbidity, with only 3% free of all the morbidity conditions considered. Gynecological morbidity, together with urinary tract infection and syphilis, showed that 35% of the women had 1 morbidity, 34% had 2, and 17% had 3 or more morbidities. Regression analysis of risk factors demonstrated that social conditions and medical factors contributed to these diseases. Reproductive tract infections occurred more frequently with uterovaginal prolapse, IUD use, presence of husband (regular sexual activity), and unhygienic behavior. Genital prolapse increased with age and number of deliveries. Age, recent pregnancy, education, socioeconomic class, and workload revealed significant associations with related morbidity conditions. The risk of anemia was significantly related to age and to a pregnancy within the previous 2 years. With every increase of 1 year of age, the risk of hypertension increased by 9%. For every increase of 1 year of age, the risk of obesity increased by 7%. Women with the highest level of education had a 3 times greater risk of urinary tract infection than did uneducated women, while women of low-middle socioeconomic status had almost 4 times the risk of women in the lowest class.
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PMID:A community study of gynecological and related morbidities in rural Egypt. 835 98

This paper describes the history of an 81-year-old female suffering from a giant dissecting aortic aneurysm with concealed perforation within the thorax. The patient had suffered from arterial hypertension for about 10 years and had been treated with thiazide. Nine months prior to admission the patient was in a state of collapse, and ultrasound examination revealed an intra-abdominal aortic aneurysm. At this time thoracic x-ray showed aortic sclerosis and elongation of the aorta but no signs of aneurysm formation. After this episode the patient was symptom-free for the next 9 months. Following a further syncopal attack with severe thoracic pain, the patient was hospitalized at the intensive care unit. Both in thoracic x-ray and computed tomography of the thorax, a pronounced dissecting aortic aneurysm with perforation of the thoracic aorta into the mediastinum could be established. Because of the patient's poor general condition and advanced age, as well as far-reaching pathological findings, surgery was not advised by either the heart and vascular surgeon or the anesthetist. Following 1 week's intensive therapy, the patient's general condition improved greatly, with stabilization of thoracic pain, blood pressure, and respiratory action. On the other hand, thoracic x-ray, computed tomography, and magnetic resonance imaging produced a distinct progression of the aneurysm with consequent mild displacement of mediastinum and left lung. Laboratory examinations for syphilis showed no evidence of that disease. After further improvement the patient was discharged 4 weeks after admission and has been symptom-free for 6 months in spite of the extensive pathological findings described herein.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Giant dissecting aortic aneurysm with concealed perforation in an 81-year-old female. 845 18

In developing countries, child mortality declined during the 1980s, but neonatal mortality did not improve. Ministries of Health do not consider reduction of early neonatal mortality to be a priority. Underreporting of perinatal deaths is common (e.g., at least 40% of perinatal deaths). Researchers sometimes categorize perinatal deaths as other causes of infant mortality. Many people believe too technological or costly interventions are needed to reduce perinatal mortality, but simple, low-cost principles of newborn care do exist: keep the newborn warm, feed often, avoid infection, and keep the newborn close to the mother. A study in Zimbabwe shows that asphyxia, a preventable condition, occurred in 76% of cases. Prenatal care; education; improved treatment of syphilis, hypertension, diabetes, and amniotic fluid infection; closer monitoring of the fetal condition during labor; and proper management of abnormal labor would reduce perinatal deaths. Premature infants are at greater risk of death than are intrauterine growth retarded infants. Research is needed to learn more about the epidemiology, causes,, and sequelae of asphyxia as well as the most cost-effective interventions. 38% of newborns at a hospital in Kathmandu had mild or moderate hypoglycemia, 44% of whom experienced at least 3 hypoglycemic episodes in the first 2 days. Known hypoglycemic risk factors are low birth weight and hypothermia. Possible hypoglycemic risk factors are prelactal feeds and a delay in beginning breast feeding. Effective perinatal health care in developing countries requires a tired system of referral and a motivated community health worker trained to manage safe delivery and newborn care. Unfriendly staff and user charges are obstacles to primary perinatal health care, however. UNICEF's Baby Friendly Hospital initiative aims to stop distribution of free infant formula in maternity wards and to improve perinatal care.
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PMID:Perinatal health in developing countries. 846 75

Differential diagnosis of dementing diseases is very important to rule in the so-called treatable dementia. The new DSM-IV criteria for dementia include memory disturbances and one or more of aphasia, apraxia, or frontal lobe dysfunctions as essentials. Alzheimer disease requires, in addition, slowly progressive course and ruling out other brain or systemic diseases. Vascular dementia requires focal neurological or neuroimaging signs. Other diseases which cause dementia include chronic subdural hematoma, infection and brain tumor. CT or MRI can readily diagnose them if suspected and they may be treated. Systemic diseases associated with treatable dementia include electrolyte disturbances, hypothyroidism, vitamin deficiency, alcohol or drug intoxication, syphilis and HIV infection. Prevention of dementia seems to be the future problem as we could prevent cerebrovascular diseases by treating hypertension.
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PMID:[Clinical aspects of dementia]. 875 26

Blood and urinary tests which are necessary for pregnancy diagnosis and follow-up, for newborn and mother medical supervision, during the month following birthday, are today described in reglementary texts, laws, and recommendations such as advised medical references (RMO). These documents specify the nature of obligatory tests, the checking rhythm and the list of useless tests. hCG research remains necessary for pregnancy diagnosis, but hCG dosage is essential only in case of programmed medical assistance or pathological pregnancy (extrauterine pregnancy, hydatiform mole, choriocarcinoma). The obligatory follow-up of a pregnant woman includes determination of blood groups, research of infectious agents responsible for diseases (toxoplasmosis, rubeola, hepatitis B, syphilis), proteinuria and glycosuria research and blood count according to a given calendar. When the mother's condition is bad and reminiscent of a pathological pregnancy, when a genetic risk exists for the fetus or when fetal growth is abnormal as indicated by echographic control (intra-uterine growth retardation), laboratory tests are used to follow the maternal pathological course (arterial hypertension, diabetes mellitus, anemia, bacterial, viral or parasitic disease), to verify the existence of a genetic disease, to know about the fetal functional state (by amniocentesis or cordocentesis), to identify an erythrocyte fetomaternal incompatibility. Since last trimester pregnancy accidents are able to endanger mother's and fetus lives, the feto-maternal follow-up must be adjusted to pathological diagnosis types and requires a particular supervision of the delivery. Finally mother and child must undergo a post-natal follow-up during the four weeks after birthday (perinatality control).
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PMID:[Pregnancy and perinatality: biological follow-up]. 930 27

This article presents, to the author's best knowledge, the first reported case of a fatal pulmonary artery dissecting hematoma that was a long-term complication of a Waterston shunt procedure (aortopulmonary anastamosis). Pulmonary artery dissecting hematomas are rare and generally fatal, and they are usually not diagnosed until the autopsy is performed. They occur in young adults, are almost always associated with pulmonary hypertension, and often present with the sudden onset of excruciating lancet-like retrosternal pain. Risk factors for the development of dissecting hematomas, in addition to hypertension, include vascular turbulence, trauma, connective tissue disorders, syphilis, infection, previous surgery, and iatrogenic events (e.g., catheterization). The treatment is prompt medical reduction of pulmonary hypertension.
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PMID:Dissecting hematomas of the pulmonary artery: rare and fatal catastrophies. 943 Feb 86

We report a patient with a dissecting aortic aneurysm associated with polymyalgia rheumatica (PMR). The patient is a 55-year-old Japanese man without a history of hypertension, diabetes mellitus and syphilis. He was admitted to an emergency hospital because of severe back pain, and was diagnosed as having a dissecting aneurysm of the descending aorta. After the admission, he began to notice severe muscle pain in his bilateral shoulder. Although his back pain gradually improved, his muscle pain progressively worsened, and his lower extremities were also involved. Then, he was introduced to our hospital. On neurological examination, he was alert and oriented. His cranial nerves were all intact. There was no muscle weakness nor sensory disturbance. Laboratory studies revealed that his erhythrocyte sedimentation rate was extremely high without elevation of the serum level of creatine phoshpokinase, rheumatoid factors and c-reactive protein. He was diagnosed as having PMR, and oral administration of prednisolone++ was started. Within several days, his muscle pain dramatically disappeared. As is known, there is a close relationship between PMR and temporal arteritis of giant cell arteritis. In general, PMR is a benign disease and responds well to steroid therapy, and prevalence of the giant cell arteritis is low in Japanese people. However, it should be kept in mind that the dissecting aneurysm is a relevant, severe complication of PMR because arteritis can be latently present in PMR.
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PMID:[The dissecting aortic aneurysm associated with polymyalgia rheumatica: a case report]. 1065 1

Human immunodeficiency virus (HIV) infection has impacted on all the systems of the body, and the cardiovascular system is no exception, with small to medium-sized vessel vasculitis being most frequently described. We present 16 HIV-positive patients with large vessel disease consisting of either aneurysms (often multiple) or occlusive disease. Nine men and 7 women ranging in age from 18 to 38 years presented with rupture of aneurysm, transient ischemic attacks, hypertension, ischemia to the lower extremity, or a mass at the site of the aneurysm. Eight patients had 1 aneurysm, 2 had 2 lesions, and the remaining 6 cases had from 3 to 7 aneurysms. Arteries affected included the common carotid, abdominal aorta, common iliac, femoral, and popliteal. Three patients had intercurrent infections, but none had any obvious infective vascular lesion. Only 1 patient had a positive TPHA test for syphilis. Microbiologic culture of both blood and thrombus contents was positive for Staphylococcus aureus in 1 case; no other organisms were cultured. The key histological features were within the adventitia: leukocytoclastic vasculitis of the vasa vasora and periadventitial vessels, proliferation of slit-like vascular channels, chronic inflammation, and fibrosis. There was associated medial fibrosis with loss and fragmentation of muscle and elastic tissue. Intimal changes consisted of duplication and fragmentation of the internal elastic lamina with calcification. Atheroma and marked intimal thickening were not evident We believe that the occurrence of this large vessel vasculopathy (mainly aneurysmal) often with multiple lesions in young HIV-positive patients, is characteristic of possible infective or immune complex origin, with leukocytoclastic vasculitis of vasa vasora and periadventitial vessels being pivotal in many cases.
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PMID:Large artery vasculopathy in HIV-positive patients: another vasculitic enigma. 1074 82

From September 1995 to May 1997, 315 consecutive stillbirths and 315 randomly selected controls were studied at the Port Moresby General Hospital to determine the causes of the deaths, to describe the sociodemographic and reproductive characteristics of the mothers, and to see if there were any avoidable factors in the stillbirths and where the responsibility for them lay. 249 (79%) of the stillbirths were antepartum and 14% were intrapartum; the timing of death could not be determined in the remaining 21 (7%). 36% of the stillbirths were unexplained. The common identified causes were: syphilis (VDRL and TPHA positive) 10%, intrauterine growth restriction/placental insufficiency 9%, antepartum haemorrhage 9%, malaria 6%, major congenital abnormalities 6%, cord accidents 6%, pregnancy-induced hypertension 5% and acute intrapartum asphyxia 4%. Multiple logistic regression analysis showed a significant association between stillbirth and the following variables: husband's occupation unskilled, age over 35 years, poor antenatal attendance, a past history of stillbirth, syphilis and malaria. An avoidable factor was established in 41% of the cases; in 60% the responsibility for the avoidable factor lay with the patient and her relatives.
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PMID:A case-control study of stillbirths at the Port Moresby General Hospital. 1093 55

An ethnobotanical investigation on the medicinal uses of some species of Terminalia and Combretum (Combretaceae) was carried out in Mbeya, Tanzania during a 5-weeks field expedition. Of the sixteen species collected, Combretum fragrans F. Hoffm., Combretum molle G. Don., Combretum psidioides Welw., Combretum zeyheri Sond., Terminalia kaiserana F. Hoffm. and Terminalia sericea Burch ex. DC. have medical applications against various bacterial infections, such as gonorrhoea and syphilis, and against symptoms like diarrhoea, hypertension and even cancer. Antimicrobial screening of the crude extracts of the selected Combretum and Terminalia species was performed by the agar diffusion method. Among the most effective extracts were methanol extracts of the roots of Terminalia sambesiaca Engl. & Diels., T. kaiserana Guill. & Perrott., T. sericea Burch. ex DC., C. fragrans F. Hoffm. and Combretum padoides Engl. & Diels., all of which showed marked inhibition against Gram-positive bacteria, and were also good inhibitors of Enterobacter aerogenes. All four of the extracts of the roots of T. sericea tested, (methanol, ethanol, acetone and hot water) had good antimicrobial activity. A methanolic leaf extract of T. kaiserana was the only extract to have a bacteriocidic effect on Escherichia coli. Methanol root extracts of T. sambesiaca and methanol leaf extracts of T. sericea were the most effective against Candida albicans. The results of the antimicrobial screening support the ethnomedical uses of these plants.
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PMID:Ethnobotanical and antimicrobial investigation on some species of Terminalia and Combretum (Combretaceae) growing in Tanzania. 1180 78


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