Anticoagulants ; therapeutic use ; Carotid Arteries ; diagnostic imaging ; pathology ; Cerebral Infarction ; diagnostic imaging ; drug therapy ; pathology ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Thromboembolism ; complications ; diagnostic imaging ; drug therapy ; Ultrasonography

Family planning is a method of controlling fertility which helps to prevent unwanted pregnancies among couples. Unwanted pregnancy has negative effects for mothers and children. The aims of this study were to determine the prevalence of family planning practices among women in Serdang area and associated factors with their family planning practices. A cross sectional study was conducted with a systematic random sampling of 349 women of reproductive age, who attended Sri Kembangan Polyclinic. Descriptive analysis with chi-square and multiple regression analysis were conducted to identify factors associated with the family planning practice. The prevalence of family planning practice was 38.4%. Family planning was significantly associated with age (p=0.001), marital status (p=0.001), mode of delivery of the last pregnancy (p=0.001), number of children (p=0.001), source of information (p=0.004), level of knowledge (p=0.001), and the attitude (p=0.004). Using multiple logistic regression, four factors contributed to family planning practice, were identified as statistically significant: marital status (married OR=40, 95% CI: 9.45, 169.8), religion (Muslim OR=1.9, 95% CI: 1.14, 3.4), number of children (children>4 OR=2.98, 95% CI:1. 74, 5.09) and attitude (positive attitude OR=1.88, 95% CI:1.11, 3.18). The prevalence of family planning practice in Serdang was low even though knowledge was sufficient. The use of pamphlets and booklets are still needed to enhance efforts in health education. Currently, practice on family planning will determine the future structure of the community and the economic wellbeing of a country. Future study should focus on family planning practice among teenager and types of methods for women.

The authors experienced an anesthesia for surgical removal of insulinoma of pancreas in 66 year old woman. The patient showed symptoms of Whipples triad (hypoglycemia, low circulating glucose level and prompt relief of symptoms after glucose administration). On the abdominal CT scanning, round distal pancreatic tumor mass was detected. The patient was premedicated with Robinul 0.2 mg, diazepam 10 mg. On arrival in operating theater, the patients blood glucose level was 38 mg/dl (measured with Glucometer), despite of the low blood glucose level, she was free without any apparent symptoms. But we infused 50% D/W 50 ml rapidly and subsequently dropped 5%D/W solution and the blood gucose level was increased to 162 mg/dl before induction of anesthesia. Anesthesia was induced with thiopental sodium 250 mg IV, followed by succinylcholine 50 mg IV for endotracheal intubation and maintained with enflurane-N2O-O2, pancuronium 4 mg was administered intravenously for muslce relaxant. The blood glucose level was measured with Glucometer every 15 minute. No hypoglycemic episode was observed during anesthesia.
Aged ; Anesthesia* ; Blood Glucose ; Diazepam ; Enflurane ; Female ; Glucose ; Humans ; Insulinoma* ; Intubation, Intratracheal ; Pancreas ; Pancuronium ; Succinylcholine ; Thiopental ; Tomography, X-Ray Computed

OBJECTIVES: The present study investigated the potential adverse effects of multi-wall carbon nanotubes (MWCNTs) on pregnant dams and embryonic development following maternal exposure in rats. METHODS: MWCNTs were orally administered to pregnant rats from gestational day (GD) 6 through 19 at dose levels of 0, 8, 40, 200, and 1000 mg/kg/day. During the test period, clinical signs, mortality, body weights, food consumption, serum biochemistry, oxidant-antioxidant status, gross findings, organ weights, and Caesarean section findings were examined. RESULTS: All animals survived to the end of the study. A decrease in thymus weight was observed in the highest dose group. However, maternal body weight, food consumption, serum biochemical parameters, and oxidant-antioxidant balance in the kidneys were not affected by treatment with MWCNTs. No treatment-related differences in gestational index, embryo-fetal mortality, or fetal and placental weights were observed between treated and control groups. CONCLUSIONS: The results show that 14-day repeated oral dosing of MWCNTs during pregnancy induces minimal maternal toxicity at 1000 mg/kg/day in rats. Under these experimental conditions, the no-observed-adverse-effect level of MWCNTs is considered to be 200 mg/kg/day for dams and 1000 mg/kg/day for embryonic development.
Animals ; Biochemistry ; Body Weight ; Carbon ; Cesarean Section ; Embryonic Development ; Female ; Kidney ; Maternal Exposure ; Nanotubes, Carbon ; No-Observed-Adverse-Effect Level ; Organ Size ; Oxidative Stress ; Pregnancy ; Rats ; Thymus Gland ; Weights and Measures

Honeybee venom consists of melittin, apamin, phospholipase A2, hyaluronidase and other biologically active substances. It can cause potentially lethal reaction after mass envenomation. But, acute renal failure following multiple bee stings is rare and its pathogenesis is not well known. The possible causes of acute renal failure due to multiple bee stings are rhabdomyolysis, hemolysis and direct nephrotoxicity of bee venom. A 60-year-old man was the victim of a bee(Apis mellifera) attack. More than 780 bee stings were found over his face, neck and upper extremities. Gross hematuria, oliguria and generalized edema was developed within a few hours. He has fully recovered after general supportive care including hemodialysis. This case demonstrates that multiple bee stings may cause rhabdomyolysis with consequent acute renal failure.
Acute Kidney Injury* ; Apamin ; Bee Venoms ; Bees ; Bites and Stings* ; Edema ; Hematuria ; Hemolysis ; Humans ; Hyaluronoglucosaminidase ; Melitten ; Middle Aged ; Neck ; Oliguria ; Phospholipases A2 ; Renal Dialysis ; Rhabdomyolysis* ; Upper Extremity ; Venoms

This study was conducted to investigate the potential effects of alpha-chlorohydrin (ACH) on epididymal function and antioxidant system in male rats. The test chemical was administered to male rats by gavage at doses of 0, 3, 10, and 30 mg/kg/day for 7 days. Twenty-four male rats were randomly assigned to four experimental groups, with six rats in each group. Spermatotoxicity was assessed by measurement of reproductive organ weight, testicular sperm head count, epididymal sperm motility and morphology, histopathologic examination, and oxidative damage analysis in rats. At 30 mg/kg/day, an increase in the incidence of clinical signs, epididymis weight, and gross necropsy findings of the epididymis, a decrease in the sperm motility, and an increased incidence of histopathological changes of the epididymis were observed in a dose-dependent manner. At 10 mg/kg/day, an increased incidence of clinical signs and histopathological changes and decreased sperm motility were observed. In the oxidative damage analysis, an increase in the malondialdehyde concentration and a decrease in the glutathione content and glutathione peroxidase and catalase activities in the epididymal tissue were detected at > or =3 mg/kg/day. The results show that graded doses of ACH elicit depletion of the antioxidant defense system and that the spermatotoxicity of ACH may be due to the induction of oxidative stress.
alpha-Chlorohydrin ; Animals ; Catalase ; Epididymis ; Glutathione ; Glutathione Peroxidase ; Humans ; Incidence ; Male ; Malondialdehyde ; Organ Size ; Oxidative Stress ; Rats ; Sperm Head ; Sperm Motility ; Spermatozoa

Background: There is growing evidence that abnormal liver function tests (LFTs) are common in patients with coronavirus disease 2019 (COVID-19). However, it is not known whether viral involvement in the liver differs according to the strain. We investigated the impact on liver injury in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta (B.1.617.2) variants. Materials and Methods: We conducted a single-center, retrospective cohort study, including 372 patients admitted during the pre-Delta period (PDP: between February 1 and November 30, 2020) and 137 patients admitted during the Delta period (DP: between August 1 and August 31, 2021). Initial liver injury was defined as alanine aminotransferase (ALT) or aspartate aminotransferase (AST) levels ≥3 × the upper limit of normal (ULN) or alkaline phosphatase (ALP) or total bilirubin ≥2 × the ULN within 3 days from admission. Results: Of 509 patients with COVID-19 included in our study, 38 (7.5%) patients had initial liver injury. The DP group had a significantly higher rate of initial liver injury than the PDP group (PDP: 5.9% vs. DP: 11.7%, P = 0.028). The DP group (adjusted odds ratio [aOR]: 2.737, 95% confidence interval [CI]: 1.322 – 5.666) was independently associated with initial liver injury. During hospitalization, 160 (31.4%) patients had severe COVID-19. The DP group and initial liver injury had higher odds of progressing to severe COVID-19 (aOR: 2.664, 95% CI: 1.526 - 4.648, and aOR: 4.409, 95% CI: 1.816 - 10.707, respectively). The mediation analysis suggested that initial liver injury mediates the relationship between SARS-CoV-2 Delta variant infection and severe COVID-19 (unstandardized beta coefficient = 0.980, Standard error = 0.284, P = 0.001). Conclusion Initial liver injury is more common in COVID-19 patients with Delta variants. Also, Delta variants and initial liver injury are associated with poor clinical outcomes.

Background: Because of the very low incidence of human immunodeficiency virus (HIV) coinfection in Korea, data on hepatitis C virus (HCV)/HIV coinfection are limited. This study aimed to investigate the clinical characteristics and treatment outcomes of patients with HCV/HIV coinfection in Korea. Methods: We performed a retrospective cohort study of all HCV-monoinfected and HCV/ HIV-coinfected patients treated with antivirals at National Medical Center in Seoul, Korea, between January 2009 and March 2020. Results: We enrolled 220 HCV-monoinfected and 23 HCV/HIV-coinfected patients treated with antivirals. The HCV/HIV-coinfected patients were younger (HCV vs. HCV/HIV: 57.3 ± 11.3 vs. 40.7 ± 10.1 years, P < 0.001) and had a higher proportion of men (HCV vs. HCV/ HIV: 54.5% [n = 120] vs. 91.3% [n = 21], P < 0.001) than the HCV-monoinfected patients.Genotype 1b and 2 were most common in both HCV monoinfection and HCV/HIV coinfection groups. HCV-monoinfected patients had a higher incidence of genotype 1b and 2 than HCV/HIV-coinfected patients (HCV vs. HCV/HIV: 95.4% [n = 210] vs. 73.9% [n = 17], P < 0.001), while the HCV/HIV-coinfected patients had genotype 1a (HCV vs. HCV/HIV: 1.8% [n = 4] vs. 21.7% [n = 5], P < 0.001). The fibrosis-4 index was significantly lower in the HCV/ HIV-coinfected patients than in the HCV-monoinfected patients (HCV vs. HCV/HIV: 3.81 ± 3.38 vs. 1.66 ± 1.10, P < 0.001). Among the direct-acting antivirals (DAA)-treated patients, the sustained viral response (SVR) rate did not differ significantly between both groups (HCV vs.HCV/HIV: 94.9% [93/99] vs. 90.9% [10/11], P = 0.480). Conclusion In Korea, the HCV/HIV-coinfected patients who received antiviral treatment were younger, had higher proportion of men and incidence of genotype 1a, and had less advanced fibrosis than the HCV-monoinfected patients. In actual clinical settings, HCV/HIV-coinfected patients show excellent SVR to DAA treatment, similar to HCVmonoinfected patients.

Humans ; Pilot Projects ; Singapore ; Hospitals ; Primary Health Care ; Accidents ; Emergency Service, Hospital

The Academy of Medicine (AMS) and the Ministry of Health (MOH) have developed the clinical practice guidelines on Attention Deficit Hyperactivity Disorder (ADHD) to provide doctors and patients in Singapore with evidence-based treatment for ADHD. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on ADHD, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.
Attention Deficit Disorder with Hyperactivity ; diagnosis ; drug therapy ; therapy ; Caregivers ; Child ; Evidence-Based Medicine ; Humans ; Methylphenidate ; therapeutic use ; Parents ; Psychiatry ; methods ; standards ; Singapore ; Societies, Medical