Genital tuberculosis associated with female infertility in the western Cape

ArticleThe original publication is available at http://www.samj.org.zaInfertility is a common presenting symptom in women with genital tuberculosis. A study was undertaken to determine the prevalence and characteristics of this disease among the infertile patients (A and B income group) attending the Reproductive Biology Unit at Tygerberg Hospital. Between June 1986 and December 1987, the menstrual fluid from 451 infertile women was cultured for Mycobacterium tuberculosis using Lowenstein-Jensen medium. A prevalence of 7.98% (36/451) was found. Laparoscopic examination of the pelvis revealed bilateral tubal occlusion in 3 patients (8,3%); peritubular adhesions were present in 17 patients (47,2%). In the remaining 16 patients (44,5%), the pelvis was considered normal. No culture-positive patient gave a history of previous infection or contact with tuberculosis. Radiography of the chest and histological examination of the endometrium showed no evidence of infection. Of the 34 patients treated, 13 (38.2%) became pregnant after antituberculosis treatment was completed. If tuberculosis occurs in a population, menstrual fluid of infertile women should be cultured routinely for M. tuberculosis, especially if there is evidence of tubal damage.Publisher’s versio

Does inflammation predispose to recurrent vascular events after recent transient ischaemic attack and minor stroke? The North West of England transient ischaemic attack and minor stroke (NORTHSTAR) study

Background and hypothesis Inflammation is implicated in the pathogenesis and outcome of ischaemic injury. Poststroke inflammation is associated with outcome but it remains unclear whether such inflammation precedes or results from ischaemic injury. We hypothesised that inflammatory markers are associated with an increased risk of recurrent vascular events soon after transient ischaemic attack and minor stroke.<p></p> Methods This was a multicentre, prospective, nested case–control study. Plasma concentrations of C-reactive protein, interleukin-6, interleukin-1-receptor antagonist and fibrinogen, leucocyte counts, erythrocyte sedimentation rate and inflammatory gene allele frequencies were analysed in 711 patients with recent transient ischaemic attack or minor stroke. Cases were defined by the incidence of one or more recurrent vascular events during the three-month follow-up. Association of inflammatory markers with case-status was determined using conditional logistic regression.<p></p> Results Plasma concentrations of C-reactive protein, interleukin-1-receptor antagonist and interleukin-6 were not associated with case-status. In secondary analyses, only erythrocyte sedimentation rate was significantly associated with case-status (odds ratio 1·39, 95% confidence interval 1·03–1·85; P=0·03), but this effect did not persist after adjustment for smoking and past history of transient ischaemic attack or stroke. Single nucleotide polymorphisms in four inflammatory genes (interleukin-6, fibrinogen, P-selectin and vascular cell adhesion molecule-1) were nominally associated with case-status.<p></p> Conclusions Circulating inflammatory markers were not associated with recurrent vascular events. Nominally significant associations between genetic markers and case-status will require replication. These data provide little evidence for an inflammatory state predisposing to stroke and other vascular events in a susceptible population.<p></p

Grassland-breeding waders: identifying key habitat requirements for management.

Habitat loss and degradation of wetland ecosystems, principally through large-scale drainage and conversion to arable farmland, have been implicated in the widespread, dramatic declines of breeding waders across Europe. Managing the remaining wetlands to reverse these declines will require a detailed understanding of their habitat requirements. In the UK, grazing marshes are key components of the remaining wetlands in both coastal and inland sites, and the structure of grazing marsh habitat can differ between these locations. Redshank Tringa totanus is a declining wader species that breeds in both marsh types. We quantified the habitat features that influence redshank selection of breeding and nest site locations, across coastal and inland marshes, in eastern England. On both marsh types, breeding location and breeding densities within fields were positively related to the lengths of pool edge and all wet features, respectively. Nest site location was principally influenced by vegetation characteristics, with soil penetrability also important on inland sites but proximity to wet features and vegetation type at the nest important on coastal sites. Hatching probability was higher when the surrounding soils were more penetrable. Synthesis and applications. The wet features of critical importance for breeding redshank are common on coastal marshes and can be deliberately established on inland sites. Coastal marshes are often rare and frequently threatened by dynamic coastal processes, whereas inland marshes are more abundant but largely unsuitable for breeding waders at present. These analyses highlight the scope for improving the management of inland marshes for breeding redshank. As habitat suitable for breeding redshank frequently supports a range of other wader species, this information can also direct management efforts to improve breeding wader populations in the wider countryside