BACKGROUND: Immunosuppressive medication therapy after organ transplantation is essential for preventing transplant rejection and minimizing the need for re-transplantations. Nonadherence to immunosuppressant therapy has been identified as a major risk factor for acute complications and allograft rejection, as well as late graft rejection, and a return to dialysis after failed renal transplantation, leading to an increase in health care costs and potentially even death.

No abstract

In Japan, the screening rates for breast and cervical cancers have been lower than in other countries, with rates below 20%. Breast cancer screening has been conducted biennially for over 40 years, and cervical cancer screening has been conducted biennially for over 20 years. Since lack of resources is an important barrier to increasing cancer screening rates, relationships between resources and cancer screening rates were investigated for breast and cervical cancers in Japan. METHODS: Based on the national data from 2008, the resource gap among 47 prefectures was compared. Resources were defined by the number of mammography equipment installations (per 100,000 women) for breast cancer screening and the number of gynecologists (per 100,000 women) for cervical cancer screening. Correlations between the screening rates and the availability of resources were calculated. RESULTS: The national average breast cancer screening rate was 14.7%, varying from 2.5% to 35% among the 47 prefectures. The national average number of mammography equipment installations was 5.88 per 100,000, ranging from 8.81 to 4.41 per 100,000 among the 47 prefectures. The correlation between mammography equipment installations and the screening rate for breast cancer was 0.420 (PϽ0.01). The national average cervical cancer screening rate was 19.4%, varying from 12.1% to 34.8% among the 47 prefectures. The national average number of gynecologists was 18.0 per 100,000, ranging from 13.1 to 25.9 per 100,000 among the 47 prefectures. The correlation between the number of gynecologists and the cervical cancer screening rate was -0.079 (n.s). CONCLUSIONS: Although the breast cancer screening rate shows a close relationship with medical resource availability, there is no relationship for cervical cancer screening. Since medical resources to increase breast cancer screening are limited in local areas, sufficient resources should be provided. In cervical cancer screening, other factors that affect the screening rate should be investigated.

We present a case of sigmoid volvulus in a young male patient with culture-proven Salmonella Typhi in the blood which was sensitive to Meropenem and Azithromycin only, presented with fever, vomiting, loose stools, hematochezia, abdominal distention and tenderness with no signs of perforation on erect chest x-ray. Further, radiological imaging showed signs of sigmoid volvulus. An urgent colonic decompression with untwisting of the mesentery was performed. In our case, it can be said that sigmoid volvulus was developed as a complication of multiple drug-resistant strains of Salmonella Typhi. The resistance is acquired by alteration in the genome sequence. Currently, it is important to control such an unknown outbreak of multiple drugresistant strains of Salmonella Typhi as it is a serious health care issue of disease control and prevention in Pakistan.