Two duplex PCR assays were established for the detection of C. trachomatis (Ct), N. gonorrhoeae (GC), M. hominis (Mh), and U. urealyticum (Uu). These assays were used on clinical specimens obtained from women with Premature Rupture of Membrane or Post Partum Fever, from preterm infants, as well as from women with uneventful pregnancies and their babies delivered vaginally at term. The analytical sensitivity of the duplex PCR assays with internal controls incorporated is 7.0, 19.0, 5x10(3) and 7x10(2) genome copies per reaction for Ct, GC, Mh and Uu respectively. Specificity was demonstrated by the amplification of only target DNA in the presence of other organisms. Among 40 women with normal, at term, deliveries, there were 6 positives for Ct, 2 for GC and 1 for Uu. None of these women had signs of genital tract infection. The Mh/Uu PCR was positive in 11 of 40 PROM cases, with 7 women positive for Uu, 2 for Mh and 2 others for both organisms. Of 40 blood cultures taken from post-partum maternal infections, 6 were positive for Ct and 1 for Mh. Respiratory secretions from 30 premature neonates yielded 5 positives for Uu and one each for Mh and Ct. In contrast, there was only 1 positive result (for Mh) in 30 mature neonates. With 1 exception, all mycoplasma and ureaplasma positives were confirmed by culture and the concordance between paired tracheal aspirates and nasopharyngeal swabs from neonates was 96.7%. These results show the potential use of the duplex PCR assays for the diagnosis of maternal and neonatal disease caused by the four urogenital pathogens.
Polymerase Chain Reaction ; Human Females ; seconds ; Neisseria gonorrhoeae ; Infant, Newborn

The post-operatve course of amputees is poorly documented. This cross-sectional survey was unertaken to determine functional outcomes of 213 patients who had undergone either a below-knee or above-knee amputation from 2000 to 2002 in a state-hospital setting. The study comprises a self-constructed questionnaire and interview conducted by phone. Of the 213 amputees, 41 out of 61 documented telephone numbers of the patients were useful for contact. Only 30 amputees were available for the study as the remaining 11 had passed away. Included in the questionnaire was the modified Barthel Index, a measurement to assess the amputees' ability to carry out activities of daily living (ADL). It contains ten questions pertaining to ADL with a total score of 20 points. Two-thirds of the respondents (67%) use their prosthesis for less than six hours per day. The Barthel Index of 30 patients ranged from 9-20 (mean 17.7). However, the mean Barthel Index in those with and without prosthesis was 18.4 and 15.2 respectively, but this difference was not significant. Half of the respondents were unable to maintain their pre-amputation jobs, while the remaining 50% were still able to work. Forty seven percent of amputees took less than a year to return to their activities, while 33% took between one to two years. Regarding the adequacy of preamputation information provided by the doctors, 73% amputees responded in the affirmative, while 27% felt otherwise. Amputees were still facing substantial disabilities following major amputation of the lower limb. Although 80% of respondents surveyed own prosthesis, the full use of prosthesis is suboptimal due to prosthetic-related problems. Most amputees had a good functional outcome based on the modified Barthel Index. Some amputees were unhappy as they felt that they were insufficiently informed regarding post-amputation expectation prior to the amputation. Despite good support from family, the community support for amputees is still lacking.
Amputation ; Lower Extremity ; Indexes ; Prosthesis Implantation ; Surveys

A 43-year-old woman presented with a 10-day history of lower abdominal pain and two days of vaginal bleeding. Ultrasonography showed a sac-like structure within the endocervical canal. The structure had a thick echogenic rim. No foetal heartbeat was seen. Intramuscular methotrexate was given and evacuation of the uterus yielded a small amount of tissue which was revealed histologically as products of conception, confirming the diagnosis of a cervical ectopic pregnancy. The clinical and imaging features of cervical ectopic pregnancy are highlighted.
Abdominal Pain ; etiology ; Adult ; Female ; Humans ; Methotrexate ; therapeutic use ; Pregnancy ; Pregnancy, Ectopic ; diagnostic imaging ; drug therapy ; Ultrasonography

INTRODUCTIONAlthough a majority of ingested foreign bodies (FBs) pass down the gastrointestinal tract spontaneously, those that are sharp, pointed or large in size need removal to avert serious complications. We highlight the urgent need and utility of endoscopic accessories and technical artistry in safe retrieval of FBs in children.

CLINICAL PICTUREFour children had accidentally swallowed a nail, metallic dumbbell, open safety pin and a cushion pin respectively. They were symptom-free and the abdominal plain radiographs revealed foreign body in the stomach in all the cases.

TREATMENTOesophago-gastro-duodenoscopy (OGD) was done in all the patients and could retrieve the nail, metallic dumbbell and open safety pin successfully using a Dormia basket, a polypectomy snare and a pair of rat-tooth forceps respectively. The cushion pin had migrated to the duodeno-jejunal junction within 4 hours of ingestion and necessitated open duodenotomy and retrieval.

OUTCOMEAll patients did well after the procedure with no complications.

CONCLUSIONSSwallowed FBs with pointed or sharp ends or large enough to cross the pylorus and duodenal sweep need removal and in the majority of the cases they can be retrieved by OGD. Sharp or pointed FBs that have crossed the second part of the duodenum necessitate urgent laparotomy for retrieval to prevent complications.

Adolescent ; Child ; Child, Preschool ; Deglutition ; Endoscopy, Gastrointestinal ; Female ; Foreign Bodies ; diagnosis ; etiology ; Humans ; Infant ; Male

BACKGROUND/AIMS: Periampullary diverticulum (PAD) is frequently encountered during endoscopic retrograde cholangiopancreatography (ERCP) and has been associated with stone formation in the bile duct. The effects of PAD on the ERCP procedure have been often debated. We aimed to compare the therapeutic success of ERCP between patients with PAD and matched controls. METHODS: We reviewed all ERCPs with findings of PAD in a national database (n=1,089) and compared them with age- and gendermatched controls in a 1:3 fashion (n=3,267). Demographics, endoscopic findings, visualization of main structures, and therapeutic success rates were compared between groups. Secondary analysis compared PAD cases and controls who had gallstone disease. RESULTS: The average cohort age was 68.4±14.3 years and 55.1% were male. ERCP success was similar in both groups, and no significant inter-group differences were found in the multivariate analysis. The presence of PAD did not affect the rates of sphincterotomy or visualization of main biliary structures. Secondary analysis showed similar success rates for gallstone removal between patients with PAD and controls. CONCLUSIONS: PAD may not be considered a hinderance to ERCP success. Further research is needed to determine the best approach to cannulate the ampulla and provide endoscopic therapy for different subtypes of PAD.
Bile Ducts ; Case-Control Studies ; Cholangiopancreatography, Endoscopic Retrograde ; Cohort Studies ; Demography ; Diverticulum ; Gallstones ; Humans ; Male ; Multivariate Analysis

OBJECTIVES: This study aimed to develop and validate a simple questionnaire for chronic neuropathic pain that can be administered as a screening tool by general practitioners and internists in order to help them identify patients with probable neuropathic pain.
METHODS: Following a development phase and a pilot study, the revised version of the screening tool which included eleven descriptors associated with neuropathic pain both in English and Filipino languages was validated on 120 consecutive patients with any type of pain except psychogenic pain, recruited in the out-patient clinics of six hospitals. The questionnaire was validated by assessing the sensitivity, specificity, positive and negative predictive value of each item and the overall questionnaire. The internal consistency of the questionnaire items was assessed using the Kuder-Richardson formula 20.
RESULTS: Overall, the internal consistency of the SigN-PQ using the Kuder-Richardson formula 20 was 0.7837; the sensitivity was 91.89% with specificity of 80.22%, PV (+) was 65.38% and PV(-) was 96.0%. For the English version, the descriptors with the highest scores were burning (Sensitivity: 100%, Specificity: 93%) and electricity-like (Sensitivity: 100%, Specificity: 93%). For the Filipino version, mainit (burning) has the highest sensitivity of 88% with specificity of 82.6%, followed by gumagapang (tingling) with sensitivity of 86.96% and specificity of 85.42%. The sensation of saksak (stabbing) and hiwa (lancinating) have the lowest sensitivity, 60% and 54% respectively, although their specificity scores are high. Since this study is a validation of a screening tool for neuropathic pain, the investigators decided to choose descriptors with higher sensitivity. Thus, in the final version of the SignN-PQ, the descriptors saksak and hiwa were removed.
CONCLUSION: The SigN-PQ Neuropathic Pain Questionnaire has a high overall sensitivity of 91.89% and specificity of 80.22%. The pain descriptors in the questionnaire are consistent with the descriptors cited in the literature. It is a valid screening instrument for neuropathic pain that can be easily incorporated in the daily practice of general practitioners and internists.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Neuralgia ; Pain ; Diagnosis ; General Practitioners ; Outpatients ; Research Personnel ; Sensitivity And Specificity ; Surveys And Questionnaires

Objective: To analyze and reveal the distribution, research hotspots and study trend of worldwide published articles correlated with HIV/AIDS post-exposure prophylaxis (PEP), and provide information for related studies in China. Methods: CiteSpace software 5.1 was used to visualize all related papers in the web of science database published during 2000-2017. Results: The average growth rate of international PEP-related papers was 10.78%,and number of published papers in 2016 was highest (n=34), relevant research hotspots have shifted from the prevention of occupational HIV exposure to the prevention of non-occupational HIV exposure in group at high risk, such as MSM, in recent years. Clustering analysis classified research hotspots into three categories, including risk reduction through enhanced intervention, current status of global HIV PEP and German-Austrian Recommendation. Conclusions: Non-occupational HIV PEP in groups at high-risk, especially MSM, has received increasing attention in recent years, the research of PEP mainly focus on improving the awareness and use of PEP in MSM and compliance in the course of medication. In the context of severe HIV epidemic in MSM without effective control in China, PEP should be strengthened to assess and explore the risk of HIV infection in MSM to provide reference for medical personnel and related departments to implement HIV non-occupation exposure blockade and formulate PEP medication.
Anti-HIV Agents/administration & dosage* ; Bibliometrics ; Biomedical Research ; China ; HIV ; HIV Infections/prevention & control* ; Homosexuality, Male ; Humans ; Male ; Periodicals as Topic ; Post-Exposure Prophylaxis/methods*

The intra-articular use of hyaluronic acid (HA) for the treatment of synovitis and osteoarthritis is still controversial. As a consequence, corticosteroids remain the most frequently employed therapeutic agents, despite their potential systemic and local deleterious effects. This study examined the anti-inflammatory, antioxidant, and chondroprotective activities of low and high molecular weight hyaluronic acid (LMW-HA and HMW-HA) on lipopolysaccharide (LPS)-induced synovitis in horses compared to triamcinolone acetonide (TA). LPS was injected in the metacarpophalangeal joints, which were treated intra-articularly with either TA (as control) or LMW-HA or HMW-HA. Joint clinical evaluation and synovial fluid (SF) analysis were performed at 0, 8, 24, and 48 h. The white blood cell counts (WBC), prostaglandin E2 (PGE2), interleukin (IL)-1, IL-6, IL-10, tumor necrosis factor-α, chondroitin sulfate (CS) and HA concentrations, oxidative burst, and HA molecular weights were measured. TA reduced the lameness, swelling, and PGE2 release but increased the SF CS concentrations enormously at 24h and 48h, and decreased the SF HA modal molecular weight. These results indicate the breakdown of articular cartilage aggrecan and SF HA. In contrast, LMW-HA and HMW-HA were less effective in reducing the inflammation symptoms, but preserved the joints because only a modest increase in CS occurred at 24 h, decreasing at 48 h, and the SF HA was maintained. The HA-treatment also had anti-inflammatory actions, and LMW-HA was the most effective in reducing the release of cytokine. In summary, the HA treatment inhibited efficiently the digestion of cartilage proteoglycans and SF HA breakdown.
Adrenal Cortex Hormones ; Aggrecans ; Cartilage ; Cartilage, Articular ; Chondroitin Sulfates ; Digestion ; Dinoprostone ; Horses ; Hyaluronic Acid ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Interleukins ; Joints ; Leukocyte Count ; Metacarpophalangeal Joint ; Molecular Weight ; Necrosis ; Osteoarthritis ; Proteoglycans ; Respiratory Burst ; Synovial Fluid ; Synovitis ; Triamcinolone ; Triamcinolone Acetonide

Purinergic P2Y Receptor Antagonists ; Consensus ; Cardiovascular System ; Cardiology ; Asia