Search

Improved health outcomes have resulted in people with HIV facing decisions about childbearing. We sought to understand the factors associated with desire for a child among men and women in Malawi. HIV-infected men and women ages 18-40 were invited to participate in a brief interview about fertility desires. Single variable logistic regression was used to evaluate the factors associated with the outcome of fertility desire. Additionally, multiple logistic regression was used to assess the relationship of all the factors together on the outcome of fertility desire. In-depth interviews with women were performed to understand experiences with reproductive health care. A total of 202 brief interviews were completed with 75 men (37.1%) and 127 women (62.9%), with 103 (51.0%) of respondents desiring a child. Being in a relationship (OR: 3.48, 95% CI: 1.58-7.65, p = 0.002) and duration of HIV more than two years (OR: 2.00, 95% CI: 1.08-3.67, p = 0.03) were associated with increased odds of desire for a child. Age 36-40 years (OR: 0.64, 95% CI: 0.46-0.90, p = 0.009) and having a living child (OR: 0.24, 95% CI: 0.07-0.84, p = 0.03) were associated with decreased odds of desire for a child. Seventy percent of women (n = 19 of 27 respondents) completing semistructured interviews who responded to the question about decision-making reported that their male partners made decisions about children, while the remainder reported the decision was collaborative (n = 8, 30%). Eighty-six percent of women (n = 36 of 42 respondents) reported no discussion or a discouraging discussion with a provider about having children. HIV-infected women and men in Malawi maintain a desire to have children. Interventions are needed to integrate safer conception into HIV care, to improve male participation in safer conception counseling, and to empower providers to help patients make decisions about reproduction free of discrimination and coercion.

Although patients with cerebral cavernous malformations may remain asymptomatic, they often present with neurological symptoms of headache, hemorrhage and, most commonly, seizure. A review of articles published between 1985 and 2009 was performed to elucidate the prognostic factors which may predict post-operative seizure control. The following characteristics were found to consistently correlate with a more favorable post-operative seizure-free outcome: (i) extent of resection of the cavernous malformation and its surrounding hemosiderin rim; (ii) single or sporadic seizures compared to chronic epilepsy; (iii) illness duration less than 1 or 2 years; and (iv) size of cavernous malformation less than 1.5 cm. Radiosurgery may achieve post-operative seizure-free rates ranging from 25% to 64.3%, and may be an alternative to surgical resection for deep or eloquent cavernous malformations, or those in patients with co-morbidities. There was no clear association between post-operative seizures and either lesion location, age, or gender. Prognostic features of cavernous malformations should be utilized for both guidance of lesion treatment, and prediction of post-operative seizure outcomes., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Meningiomas are mostly benign, slow-growing tumors of the CNS that originate from arachnoidal cap cells. While monosomy 22 is the most frequent genetic abnormality found in meningiomas, a multitude of other aberrant chromosomal alterations, signaling pathways, and growth factors have been implicated in its pathogenesis. Losses on 22q12.2, a region encoding the tumor suppressor gene merlin, represent the most common genetic alterations in early meningioma formation. Malignant meningioma progression, however, is associated with more complex karyotypes and greater genetic instability. Cytogenetic studies of atypical and anaplastic meningiomas revealed gains and losses on chromosomes 9, 10, 14, and 18, with amplifications on chromosome 17. However, the specific gene targets in a majority of these chromosomal abnormalities remain elusive. Studies have also implicated a myriad of aberrant signaling pathways involved with meningioma tumorigenesis, including those involved with proliferation, angiogenesis, and autocrine loops. Understanding these disrupted pathways will aid in deciphering the relationship between various genetic changes and their downstream effects on meningioma pathogenesis. Despite advancements in our understanding of meningioma pathogenesis, the conventional treatments, including surgery, radiotherapy, and stereotactic radiosurgery, have remained largely stagnant. Surgery and radiation therapy are curative in the majority of lesions, yet treatment remains challenging for meningiomas that are recurrent, aggressive, or refractory to conventional treatments. Future therapies will include combinations of targeted molecular agents as a result of continued progress in the understanding of genetic and biological changes associated with meningiomas.

The accuracy of measurement of tooth length and angulation on dental panoramic tomograms (DPTs) is thought to be highly dependent on head positioning technique. A model representing the dentition and the functional occlusal plane was designed using an acrylic framework and stainless steel wires. The aim was to investigate whether varying the position of the model affects the linear and angular measurements on DPTs. Four different positions were investigated: initial position representing natural head posture (NHP) (T1); lateral right cant of the occlusal plane (T2); lateral left cant of the occlusal plane (T3); and tilting the occlusal plane up anteriorly (T4). On each DPT, four sets of measurements were recorded: (1) Vertical linear measurements of the stainless steel pins and ratio calculations of the 'crown' and 'root' segments (represented by the wire above and below the occlusal plane, respectively); (2) angular measurements of the pins relative to the occlusal plane; (3) angular measurements of the pins relative to a constructed reference line; and (4) angular measurements of pins relative to each other in the same segment. The results showed a significant error (P < 0.05) in all measurements when the occlusal plane was tilted up anteriorly by 8 degrees. A lateral cant of the occlusal plane by less than 10 degrees without an upward anterior rotation showed no significant effect on the measurements. This would suggest that there is some tolerance of variation in head position.

The aim of this study was to evaluate the reliability of crown and root length, crown-root ratio and angular measurements of teeth relative to constructed reference lines and to other teeth in the same region on consecutive (T1 and T2) panoramic radiographs (OPGs). This retrospective study employed 20 cases; ten with five implants in each jaw (age range between 20 and 60 years) and ten with a full permanent dentition (age range between 12 and 16 years). The consecutive pairs of OPGs ranged from 6 months to 3 years apart. Four variables were measured and compared: 1) the crown or coronal segment length and the root or apical segment length; 2) the crown-root ratio; 3) the angulations of teeth and implants relative to specific reference lines in each jaw; 4) the angle between teeth and implants in the same sextant. The results revealed that comparisons of measurements taken of the same structures at T1 and T2, there were no statistically significant differences (p>0.05) between vertical linear measurements. The crown-root ratios and coronal-apical segment ratios too, showed no significant differences (p>0.05). Whereas, angulations of teeth or implants relative to respective reference lines showed significant differences (p=0.001) for some of the teeth. These differences, however, were less than 5 degrees; a clinically acceptable range. Angles measured between teeth or implants in the same sextant showed no significant differences (p>0.05). These results seem to support the hypothesis, therefore, that the linear vertical measurements, ratio calculations and angular measurements can be used to compare crown and root lengths, crown-root ratios and tooth angulations on OPGs taken of the same patient at different times with consistent accuracy.