The HPV Vaccine: A Comparison of Focus Groups Conducted in South Africa and Ohio Appalachia

Worldwide, cervical cancer is one of the leading causes of morbidity and mortality among women. Even though women in developing countries account for approximately 85 % of the cervical cancer cases and deaths, disparities in cervical cancer rates are also documented in developed countries like the United States (U.S.). Recently, formative research conducted in the U.S. and developing countries like South Africa have sought to gain a better understanding of the knowledge, beliefs, and attitudes about cervical cancer prevention, HPV, and the acceptance of the HPV vaccine. This study compares findings from two independent focus group studies. One study was conducted in a segregated township in Johannesburg, South Africa (n = 24) and the other study was conducted in Ohio Appalachia (n = 19). The following seven themes emerged during the discussions from both studies: HPV and cervical cancer; health decision making; parent–child communication; healthy children; HPV vaccine costs; sexual abuse; and HPV vaccine education. Findings from both studies indicate the importance of the role of mothers and grandmothers in the health care decision-making process for children and a lack of awareness of HPV and its association with cervical cancer. While there was interest in the HPV vaccine, participants voiced concern about the vaccine’s cost and side effects. Some participants expressed concern that receipt of the HPV vaccine may initiate adolescent sexual behavior. However, other participants suggested that the HPV vaccine may protect young women who may experience sexual abuse. The importance of developing culturally appropriate educational materials and programs about cervical cancer prevention and the HPV vaccine were expressed by participants in both countries.     

Insecticidal Activities of the Leaf Oils of Eight Cinnamomum. species Against Aedes aegypti. and Aedes albopictus.

Abstract

The leaf oils of eight Cinnamomum. species (C. rhyncophyllum. Miq., C. microphyllum. Ridl., C. pubescens. Kochummen, C. mollissimum. Hook. f., C. impressicostatum. Kosterm, C. scortechinii. Gamb., C. sintoc. Bl., and C. cordatum. Kosterm) were investigated for their larvicidal and adulticidal activities against Aedes aegypti. (Aedes aegypti Lynn) and Aedes albopictus. (Aedes albopictus Skuse). Acute mortalities of the fourth instar larvae and the adult mosquitoes were determined according to the standard WHO methods. Among the essential oils studied, the leaf oils of C. rhyncophyllum., C. microphyllum., C. pubescens., C. mollissimum., and C. impressicostatum. showed significant effects against the larvae of Ae. aegypti. and Ae. albopictus. with concentrations that caused 50% mortality (LC₅₀) values of less than 12.8 and 11.8 µg ml^?1, respectively. The essential oils that showed strong larvicidal effects also demonstrated relatively strong adulticidal effects on the mosquitoes after 3 h exposure with LC₅₀ values ranging from 133.0 to 243.0 µg ml^?1 against Ae. aegypti. and from 118.0 to 194.0 µg ml^?1 against Ae. albopictus.. The efficacy of the oils toward the larvae and adult mosquitoes of both species was nonselective as the LC₅₀ values showed little variation. The chemical composition of the oils was investigated by gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). This study suggested that the essential oils containing high levels of benzyl benzoate and benzyl salicylate exhibited strong insecticidal activities against the larvae and adult mosquitoes.     

A Case of Congenital Adrenal Hyperplasia Mimicking Cushing's Syndrome

Congenital adrenal hyperplasia (CAH) is characterized by decreased adrenal hormone production due to enzymatic defects and subsequent rise of adrenocorticotrophic hormone that stimulates the adrenal cortex to become hyperplastic, and sometimes tumorous. As the pathophysiology is basically a defect in the biosynthesis of cortisol, one may not consider CAH in patients with hypercortisolism. We report a case of a 41-yr-old man with a 4 cm-sized left adrenal tumorous lesion mimicking Cushing''s syndrome who was diagnosed with CAH. He had central obesity and acanthosis nigricans involving the axillae together with elevated 24-hr urine cortisol level, supporting the diagnosis of Cushing''s syndrome. However, the 24-hr urine cortisol was suppressed by 95% with the low dose dexamethasone suppression test. CAH was suspected based on the history of precocious puberty, short stature and a profound suppression of cortisol production by dexamethasone. CAH was confirmed by a remarkably increased level of serum 17-hydroxyprogesterone level. Gene mutation analysis revealed a compound heterozygote mutation of CYP21A2 (I173N and R357W).     

3D reconstruction of peripheral nerves from optical projection tomography images: A method for studying fascicular interconnections and intraneural plexuses

The general microscopic characteristics of nerves are described in several textbooks of histology, but the specific microanatomies of most nerves that can be blocked by anesthesiologists are usually less well known. Our objective was to evaluate the 3D reconstruction of nerve fascicles from optical projection tomography images (OPT) and the ability to undertake an internal navigation exploring the morphology in detail, more specifically the fascicular interconnections. Median and lingual nerve samples were obtained from five euthanized piglets. OPT images of the samples were acquired and 3D reconstruction was performed. The OPT technique revealed the inner structure of the nerves at high resolution, including large and small fascicles, perineurium, interfascicular tissue, and epineurium. The fascicles were loosely packed inside the median nerve and more densely so in the lingual nerve. Analysis of the 3D models demonstrated that the nerve fascicles can show six general spatial patterns. Fascicular interconnections were clearly identified. The 3D reconstruction of nerve fascicles from OPT images opens a new path for research into the microstructure of the inner contents of fascicular nerve groups and their spatial disposition within the nerve including their interconnections. These techniques enable 3D images of partial areas of nerves to be produced and could became an excellent tool for obtaining data concerning the 3D microanatomy of nerves, essential for better interpretation of ultrasound images in clinical practice and thus avoiding possible neurological complications. Clin. Anat. 31:424–431, 2018. © 2017 Wiley Periodicals, Inc.     

Acute coronary syndromes with ongoing myocardial ischemia (ACS with OMI) versus acute coronary syndromes without ongoing ischemia (ACS without OMI): The new classification of acute coronary syndromes should replace old classification based on ST segment elevation presence or absence—Expert consensus statement of the Czech Society of Cardiology

The Czech Society of Cardiology is proposing here the new classification of acute coronary syndromes at the time of the first medical contact. The proposal suggests to remove the terms “ST elevation myocardial infarction” and “non-ST elevation acute coronary syndrome” and to replace these terms by “acute coronary syndrome with ongoing myocardial ischemia” and “acute coronary syndrome without ongoing myocardial ischemia”. The proposed new classification better reflects current treatment approaches and will facilitate the decision making at the first medical contact.