Consecutive Month Research Articles

An Obstetrics Catastrophe Internal Bleeding Following Caesarean Section

The objective of this study was to find out the incidence ,indication of primary caesarean section, risk factor, place and expatriation of the primary surgeon and outcome of the cases suffering from internal bleeding following caesarean section in Chittagong Medical College Hospital. This is a prospective observational study carried out in the department of Obstetrics and gynaecology in Chittagong Medical College Hospital from September 2011 to Feb 2012. Over a period of September 2011-Feb 2012 total 11 cases were reported as internal bleeding. Among them 3 patient underwent primary surgery in this institution and 8 patient were referred from outside as internal bleeding following caesarean section. Relaparotomy was done in 10 cases after resuscitation. One patient died before operation. Abdominal cavity was full with huge clotted and non clotted blood in all cases. Bilateral broad ligament hematoma in 45.45% cases. Loosening and disruption of uterine incision in 27.27% cases. Sprouting vessel from mesentery in 9.09% cases. Bleeding from mesenteric vessels in 9.09% cases. Main surgeries performed were subtotal hysterectomy in 36.27% cases. Total abdominal hysterectomy were done in 18.11% cases. Exploration of haematoma and coagulation of sprouting mesenteric vessels with peritoneal toileting in 18.11% cases. Resuturing of uterine incision in 18.11% cases. 63.63% patients were needed ICU support. 45.45% patients died following internal bleeding after caesarean section due to irreversible shock. Though caesarean section is a common obstetrics practice now a days and a life saving procedure for the mother and child but sometimes it complicates as life threatening situation. Repeat laparotomy required in 10 cases within last 6 consecutive month in gynae unit-III in this institution. Case fatality rate was high 45.45%. Near miss mortality was also common. Majority of these were preventable. Identification of risk factor, adequate knowledge about pelvic anatomy, proper attention during primary surgery, expert decision, early diagnosis, prompt intervention and proper case management during laparotomy may improve the outcome. JCMCTA 2013; 24 (1):58-63

Baby on the way: Was an ambulance in the plan?

Objectives The East of England Ambulance Service NHS Trust (the trust) sought the views of patients it attended who were imminently about to give birth at the time of the 999 call to the trust. This was a patient group who had previously never been specifically targeted by the trust as part of its on-going patient feedback activity to inform service development. Methods All imminent birth patients during a four consecutive month period from August to November 2008 were sent a questionnaire asking them about their contact and satisfaction with the ambulance service at the time of the birth. Results Results of this survey have shown that almost a fifth (19.4 %) of patients who had intended to give birth in hospital had planned to use the ambulance service for their transport. Perceived complications, severe pain, labour not progressing, or the advice of a midwife were the main reasons given for unplanned use of the service. In this sample, a greater percentage of patients who planned to give birth at a hospital or maternity centre actually gave birth at home (25.5 %), than was achieved by patients who had planned a home birth (16.7 %). Conclusions Further investigation is needed to inform developments in partnership working between ambulance and maternity services to better serve this patient group.

Cross-training and injury risk in british olympic distance triathletes

BackgroundTriathlon injury research is in its early stages- with no consensus on injury definition and recording methods having been reached, and few prospective data yet available. Levy et al., (1986)...

A Reassessment of Needs and Practice Patterns in Pharmacologic Prophylaxis of Venous Thromboembolism Following Elective Major Surgery

Objective: To provide an accurate account of venous thromboembolism (VTE) risk and rates in patients undergoing major elective surgery, as related to the use of pharmacologic prophylaxis. Background: Venous thromboembolism, comprising deep venous thrombosis and pulmonary embolus, has long been described in ill hospitalized patients as a silent killer. Elective major surgery, however, is a specialty scenario in which potential risks of pharmacologic prophylaxis are magnified by the surgical procedure itself. Methods: Following approval by the University of Louisville Institutional Review Board (HSPPO 08.0028), we queried the University HealthSystem Consortium database, which comprises data from 123 academic teaching hospitals, for 18 consecutive month periods in 2003/2004 and compared that with an identical period of observations in 2007/2008 for 4 elective major operations: colorectal resections, total hip replacement, total knee replacement, and hysterectomy. Results: Venous thromboembolism rates ranged from 0.6% to 3.2% and pulmonary embolism rates ranged from 0.28% to 1.09%. Use of pharmacologic prophylaxis increased for all procedures between 2003/2004 and 2007/2008, except for hysterectomy. Venous thromboembolism rates, however, were not significantly affected among patients who received pharmacologic prophylaxis and actually decreased among patients who did not receive any pharmacologic prophylaxis despite an absence of significant change of severity of illness of patient populations. This may represent remarkable judgment by treating surgeons in choosing patients who were candidates for pharmacologic prophylaxis. Conclusions: When combining the much lower incidence rate of VTE observed among non-prophylaxed patients undergoing elective major surgery with physicians' seemingly wise clinical judgment in determining patient susceptibility to VTE, the genuine risk of VTE and pulmonary embolus is very small and must be carefully balanced with the risks of pharmacologic prophylaxis.

Estabilidade do coeficiente beta do setor de energia elétrica

This article is aimed at evaluating the stability of the beta coefficient over time, which is the usual risk indicator of stocks. The research work embraces common (ON) and preferred (PN) stocks of eighteen Brazilian corporations of the energy industry, which are classified as governmental or private ones, and refers to the period from January 1999 to June 2008. Therefore, there are four classes of stocks: governmental common, governmental preferred, private common, and private preferred. A three-stage analysis is developed. In the first stage, a regression analysis is performed to estimate beta coefficients according to the Market Model on the basis of consecutive sixty month periods, with a lag of six months between them. In view of the fact that estimates of betas show an oscillating pattern, additive and multiplicative dummy variables are introduced in the second stage, and new regression analysis is performed by means of the stepwise procedure. In the third stage, a Panel Data Analysis is developed initially by means of the stepwise procedure and then by means of the enter procedure. The results of the first stage show a clear oscillating pattern for the four classes of stocks. In the second stage statistical evidence of the instability of the betas for the four groups of stocks is found, and more unstable beta’s estimates are observed for governmental corporations. The results from the Panel Data Analysis confirm the beta’s capacity to differentiate portfolios and to capture changes in the economic and financial scenario. Key words: risk, stocks, beta coefficient, Brazilian energy industry.

Strategies for Business Firms in Declining Markets

The economic crisis that has engulfed the world since 2007 has become serious by the first quarter of 2009.Many developed countries too are affected severely, namely the US, Germany, the UK and others. Fortunately, India as of now seems to be less affected, yet the winds of global recession are now felt. The Indian economy grew at an annual rate of 7.6% in the quarter ending in September, 2008. As per the projections of the government growth in the fiscal year, 2008-09 could be in the range of 7 to 8 %, which is, lower than 9% in the last year. The government has unveiled a multibillion dollar stimulus on 7th December, 2008 and 2nd January, 2009 respectively. The Reserve Bank of India has cut interest rates aggressively. India Inc has felt the heat of the global meltdown in the third quarter ending in December, 2008 where the income has dropped by a massive 23% points compared to the previous year. Indian manufacturing activity has contracted for the second consecutive month in December, 2008 to its lowest in more than three and half years. India’s exports too have declined by 12.1 % in October, 2008 showing a negative trend for the first time in the last five years.

EVALUASI LAHAN PERSAWAHAN PADA TIGA DAERAH ALIRAN SUNGAI DI SUMATERA BARAT

Research on soils fertility of rice soils has been done on three catchment in West Sumatra province ie; Ulu Selo ( inland areas of selo river) at Tanah Datar district conducted three Kenagarian ( traditional village) Simpurut, Gurun, and Padang Laweh. Lembang catcment at Solok district is conducted ubo irrigation scheme ubo which divided as Ubo atas irrigation scheme and Sirukam. Sumpur cathment at East Pasaman District conducted three Kenagarian, Lundar, Petok and Kuamang. All of irrigation scheme located at agroclimatic zone C1 up to D2, with charaterize 2 or 3 consecutive wet month and 3 or 4 consecutive dry month. Soils were developed from volcanic parents materials. Rice soils of Ulu Selo shown lower pH value compared to the soils with land use is mixed garden, which some of the sampling point has shown the pH lower than 4. the rice soils of Lembang and Sumpur also shown the similar trend of pH but the value not so extremely like the soils from Ulu Selo. Related to the minimum value of carbon in rice soils is indicate that some of the rice soils in the research areas could be grouping as degraded land. The rice soils from Sumpur has high natural soil fertility which which shown on the natural reserved of nitrogen, phosphor and potassium. The soils condition could support the rice production up to 8t/ha/ GS without additional nutrient. While soils from Ulu Selo shown lower content of phosphor. Based on this research author suggested to fertilizer program is better done based on the condition of soils itself. Even the natural soils fertility is high is not reccomended to use addtional artificials fertilizer.Key words: cathment studies, natural soil fertility, rice production and land degradation.

Longitudinal changes in everyday life after home modifications for people aging with disabilities

Objective: To investigate longitudinal impacts of home modifications on the difficulty of performing everyday life tasks for people aging with disabilities, and to investigate whether other factors had any additional impacts on difficulty in everyday life tasks for people receiving home modifications. Methods: The sample consisted of 103 persons aging with disabilities and in need of home modifications, divided into an intervention group and a comparison group. The data were first subjected to Rasch analysis and a random coefficient model was used. Results: Participants in the intervention group reported a significantly lower level of difficulty in everyday life tasks compared with those in the comparison group. One confounding factor, number of months waiting for home modification, had an impact on difficulty in everyday life. Conclusion: Home modifications are effective in decreasing difficulty in performing everyday life tasks up to six months after the installation. Furthermore, to be effective home modifications need to be installed in a timely fashion. For each consecutive month the person waited for their home modification the difficulty of performing everyday life tasks increased. Therefore, it is important that home modifications be installed as soon as possible after the need has been identified.

In vitro and in vivo anti-allergic effects of ‘benifuuki’ green tea containing O-methylated catechin and ginger extract enhancement

'Benifuuki', a tea (Camellia Sinensis L.) cultivar in Japan, is rich in anti-allergic epigallocatechin-3-O-(3-O-methyl) gallate (EGCG3''Me). 'Benifuuki' green tea and simultaneous addition of ginger extract remarkably suppressed cytokine (TNF-alpha and MIP-1alpha) secretion from mouse bone marrow-derived mast cells after antigen stimulation and, as expected, suppressed delay-type allergy. After drinking 'benifuuki' green tea containing 43.5 mg of EGCG and 8.5 mg of EGCG3''Me, the AUC (area under the drug concentration time curve; min mug/ml) of EGCG was 6.72 +/- 2.87 and EGCG3''Me was 8.48 +/- 2.54 in healthy human volunteers. Though the dose of EGCG was 5.1 times the dose of EGCG3''Me, the AUC of EGCG3''Me was higher than that of EGCG. A double blind clinical study on subjects with Japanese cedar pollinosis was carried out. At the 11th week after starting the study, in the most severe cedar pollen scattering period, symptoms, i.e., blowing the nose and itching eyes, were significantly relieved in the 'benifuuki' intake group compared with the placebo group, and blowing the nose, itching eyes and nasal symptom score, and at the 11th and 13th weeks, stuffy nose, throat pain and the nasal symptom medication score were significantly relieved in the 'benifuuki' containing ginger extract group compared with the placebo group. These results suggested that over one consecutive month, drinking 'benifuuki' green tea was useful to reduce some of the symptoms from Japanese cedar pollinosis, and did not affect any normal immune response in subjects with seasonal rhinitis, and the ginger extract enhanced the effect of 'benifuuki' green tea.

Survival and vitality of Gremmeniella abietina on Pinus sylvestris slash in northern Sweden

SummarySurvival and vitality of Gremmeniella abietina on Pinus sylvestris slash was studied in northern Sweden during 2003 and 2004. Once a month between September 2003 and April 2004, two to three trees were cut down and debranched. Shoots with pycnidia were sampled at the felling date and then at every consecutive month. The percentage of germinated conidia from each shoot was calculated after 24, 48 and 72 h incubation. The vitality of G. abietina pycnidia in the slash remained high the whole period. Intact pycnidia were found on slash several months after the time of conidial sporulation, which indicates that new pycnidia may be produced on dead pine branches. Sampling of shoots from slash on 13‐ to 18‐month‐old clear‐cuts showed conidial germination capacity as high as in pycnidia collected in fresh slash. Due to survival of G. abietina in slash it is recommended to postpone planting of P. sylvestris seedlings in northern boreal areas to the third vegetation period after sanitary clear‐cuts.

Prevention of cardiovascular events in end-stage renal disease: Results of a randomized trial of fosinopril and implications for future studies

Cardiovascular events (CVEs) are the leading cause of death in chronic hemodialysis patients. Results of trials in non-end-stage renal disease (ESRD) patients cannot be extrapolated to patients with ESRD. It is critical to test cardiovascular therapies in these high-risk patients who are usually excluded from major cardiovascular trials. The study objective was to evaluate the effect of fosinopril on CVEs in patients with ESRD. Eligible patients were randomized to fosinopril 5 mg titrated to 20 mg daily (n=196) or placebo (n=201) plus conventional therapy for 24 months. The primary end point was combined fatal and nonfatal first major CVEs (cardiovascular death, resuscitated death, nonfatal stroke, heart failure, myocardial infarction, or revascularization). No significant benefit for fosinopril was observed in the intent to treat analysis (n=397) after adjusting for independent predictors of CVEs (RR=0.93, 95% confidence interval (CI) 0.68-1.26, P=0.35). The per protocol secondary supportive analysis (n=380) found a trend towards benefit for fosinopril (adjusted RR=0.79 (95% CI 0.59-1.1, P=0.099)). In the patients who were hypertensive at baseline, systolic and diastolic blood pressures were significantly decreased in the fosinopril as compared to the placebo group. After adjustment for risk factors, trends were observed suggesting fosinopril may be associated with a lower risk of CVEs. These trends may have become statistically significant had the sample size been larger, and these findings warrant further study.

Effects of Chai Hu (Radix Burpleuri) Containing Formulation on Plasma β-endorphin, Epinephrine and Dopamine in Patients

Chai Hu (Radix Burpleuri), a major ingredient in many traditional Chinese medicine formulas, such as Xiao Yan Wan, is used in the treatment of liver stagnation and spleen deficiency syndrome (LSSDS). The objectives of this study were to examine the effects of Xiao Yao Wan containing Chai Hu on the changes of plasma indices in patients with LSSDS. Fifty-eight cases of LSSDS were randomly divided into two groups: 41 cases in the experimental group were treated with Xiao Yao Wan containing Chai Hu and 17 cases in the control group were treated with Zhi Bai Di Huang Wan for one consecutive month in a single blind design. Before and after treatment, high performance liquid chromatography (HPLC) was applied to determine the changes of plasma norepinephrine (NE), epinephrine (E) and dopamine (DA). Radioimmunoassay was performed to measure the amount of plasma beta-endorphin (beta-EP), adrenocorticotropin hormone (ACTH), estradiol (E2) and testosterone (T), and laser nephelometry was also conducted to measure plasma immunoglobulin A (Ig A) and G (Ig G). Compared to baseline levels, plasma beta-EP was significantly increased (p < 0.01), while E and DA were markedly decreased (p < 0.01) after the administration of Xiao Yao Wan in the experimental group. The other indices did not change. This is the first evidence showing that the effect of Xiao Yao Wan containing Chai Hu on the treatment of patients with LSSDS may be through enhancing plasma beta-EP and decreasing E and DA release. We conclude that Xiao Yao Wan containing Chai Hu regulates nervous and endocrine systems and contributes to the improvement of the clinical status of patients with LSSDS.

COMPLETE AND PROLONGED SUPPRESSION OF SYMPTOMS AND CONSEQUENCES OF ALCOHOL-DEPENDENCE USING HIGH-DOSE BACLOFEN: A SELF-CASE REPORT OF A PHYSICIAN

To test whether the dose-dependent motivation-suppressing effect of baclofen in animals could be transposed to humans, and suppress craving and sustain abstinence. Neurologists safely use up to 300 mg/day (10 times the dosage currently used for alcohol dependence) of high-dose oral baclofen, to control spasticity, in order to avoid invasive therapy. I am a physician with alcohol dependence and comorbid anxiety. I self-prescribed high-dose baclofen, starting at 30 mg/day, with 20 mg increments every third day and an (optional) additional 20-40 mg/day for cravings. Cravings became easier to combat. After reaching the craving-suppression dose of 270 mg/day (3.6 mg/kg) after 5 weeks, I became and have remained free of alcohol dependence symptoms effortlessly for the ninth consecutive month. Anxiety is well controlled. Somnolence disappeared with a dosage reduction to 120 mg/day, now used for the eighth consecutive month. High-dose baclofen induced complete and prolonged suppression of symptoms and consequences of alcohol dependence, and relieved anxiety. This model, integrating cure and well-being, should be tested in randomized trials, under medical surveillance. It offers a new concept: medication-induced, dose-dependent, complete and prolonged suppression of substance-dependence symptoms with alleviation of comorbid anxiety.

SEASONAL TEMPERATURE VARIATION IN THE PAINTED TURTLE (CHRYSEMYS PICTA)

We measured temperature variation in a free-ranging ectotherm by attaching micro- dataloggers to the carapaces of 34 painted turtles (Chrysemys picta) in a farm pond located in Davidson, NC. Water and mud temperatures (Tw) were simultaneously monitored. We successfully recorded external shell temperature (Ts) in 18 turtles from September 2001-April 2002 and 23 turtles from April 2002-October 2002. Turtle temperatures steadily decreased through the fall and basking continued until the middle of December. Minimum yearly Ts (1-3 C) occurred during the same week (2-7 January 2002) for all turtles. Turtle temperatures then steadily rose and basking resumed in February. More basking events took place during February and March than during other months of the year when C. picta used basking to reach Ts 5- 16 C above the maximum water temperature. During the summer, turtle Ts reached values similar to those achieved via basking during cooler months, apparently without leaving the water. The number of basking events per month was significantly different between consecutive months for seven of eleven consecutive month pairs. Contrary to our predictions, more basking events were recorded for male turtles than for females overall for the year. Monthly basking profiles were also significantly different for male and female turtles, with males basking earlier in spring than females. Mean maximum weekly Ts were significantly higher for males than for females. Our research documents seasonal variation in temperature and basking behavior in C. picta, as well as the importance of basking for achieving high temperatures during cooler months. We demonstrate the effectiveness of microdatalogger technology for measuring temperature variation in small reptiles and we contribute to a more complete understanding of the thermal biology of C. picta.

A survey of factor prophylaxis in boys with haemophilia followed in North American haemophilia treatment centres.

A survey was conducted in 2002 to determine the pattern of factor prophylaxis use in boys <or=18 years of age with haemophilia followed in North American treatment centres. Responses were obtained from 4553 cases (74% haemophilia A, 26% haemophilia B). The frequency of prophylaxis, defined as factor infusion greater than or equal to once per week for >or=45 weeks per year, was significantly higher for haemophilia A vs. haemophilia B cases (51% vs. 32%, P< 0.0001), and for boys with severe haemophilia A living in Canada vs. the USA (77% vs. 47%, P< 0.0001). Use of full-dose prophylaxis, defined as the infusion of 25-40 IU kg(-1) of factor VIII on alternate days (minimum three times per week) or 25-40 IU kg(-1) of factor IX twice weekly, was similar for boys <or=5 years of age in both Canada and the USA (30% and 33% haemophilia A and 35% and 13% haemophilia B). Reasons for initiating prophylaxis included a history of joint bleeding (88%) and age <or=2 years (23%). For prophylaxis triggered by joint bleeding, 38% of haemophilia treatment centres indicated that they would initiate prophylaxis after the first joint bleed and 66% after a history of target joint bleeding, defined most frequently as 2-4 bleeds over a 3-6 consecutive month period. A central venous line was used to ensure easy venous access for full-dose prophylaxis therapy in 80% of boys <or=5 years of age. These data offer a basis for projecting long-term factor concentrate needs for persons with haemophilia living in North America.

Advanced Materials for Energy Storage

As this MRS Bulletin issue on “Advanced Materials for Energy Storage” was being finalized, the North American continent suffered one of its warmest summers ever recorded. The past two to three years have also been the warmest on record, August 1999 being the 21st consecutive month with above-average temperatures. Such deviations could be quite natural. Indeed, these temperature increases can be explained in part by increased solar activity. Yet, burning of fossil fuels and other human factors are considered likely contributors. Whether from human activities or cosmic effects, for human survival, technological solutions may be needed to keep the global temperature within tolerable margins.In a parallel development, the price of oil on the New York market has nearly doubled since the beginning of 1999. This current increase is directly related to self-controls imposed by the oil-producing countries. The price will probably not climb to excessive values, mainly because the oil-producing countries do not want other nations to develop competitive alternative technologies. However, these increases in oil prices could have devastating effects on the general economy, and again, the future is unpredictable.This situation poses an interesting dilemma for the scientific community. Scientists are trained to base conclusions on facts and respond with appropriate engineering solutions. Yet the extrapolation of global climate change is far from conclusive; the economies of nations can be volatile and often are determined by politics as opposed to science; and the needs of individual nations are varied and continue to evolve based on their local resources, economies, and environmental regulations.

Epidemiological study of brucellosis and its effect on reproduction failures in dairy cattle in DKI Jakarta

The purposes of this research were to observe prevalence, distribution and reproduction failure evidence of dairy cattle brucellosis in DKI Jakarta . To determine the group of cattle infected with Bntcella abortus, senim and milk samples were carried out . At the beginning, bulk of milk samples were collected from containers . Futhermore, the blood samples were simple randomly collected on cattle that were suspected positive brucellosis in the milk ring test . Those serum samples were tested by using rose bengal plate and complement fixation test . Questioner data in relation with on any reproductive failures, such as abortion, premature dead and born weak, were gathered from farmer within 8 consecutive month period . The result indicate that screening of brucellosis using milk ring test based on bulk milk sample was effective tools to determine the infected group of cattle . The average prevalence of brucellosis in DKI Jakarta area was 4 .5 %. Distribution of brucellosis prevalence were 8 .5% at Setiabudi, 2 .3% at Mampang Prapatan, and 2 .9% at Pasar Minggu . Brucellosis was found at least 201 cattle from 38 dairy cattle farm in DKI Jakarta . Brucellosis was caused abortion about 62 .5% dairy cattle and this value was significantly different than that of uninfected cattle (P<0.05) . Brucellosis also cause stillbirth around 9 .8% and born weakness 15 .2% . The widely distributed and high prevalence brucellosis of dairy cattle in DKI Jakarta was influenced by uncontrol of cattle movement and high abortion cases rate .

Crocodylus johnstoni and C. porosus Coexisting in a Tidal River

A 52.5-km section of the Adelaide River, N.T. (12�13'S., 131�13'E.). was spotlight-surveyed 20 times between June 1979 and September 1981. C, johnstoni (15.3 � 9.2 sighted per survey) were less abundant than C. porosus (137.6 � 36.5 sighted per survey), and were mainly in the upstream 20 km of the survey route (96% of C. johnstoni sightings); here considered a zone of syntopy within the survey route. C. johnstoni congregate in the main stream during the dry season and disperse from it during the wet season, which parallels similar seasonal movements to and from dry-season refuges in non-tidal areas lacking C. porosus. As the dry season progresses, C. johnstoni are located further and further upstream, and this movement (or loss ofanimals) appears unrelated to changes in salinity. Numbers of C.johnstoni within the zone of syntopy are negatively correlated with numbers of C. porosus (r*2 = 0.50, P=0.005). and competitive exclusion may be occurring. Independent of seasonal factors, numbers of C. johnstoni within the zone of syntopy declined with consecutive month (1979-81: r*2=0.47, P= O.004), whereas numbers ofthe more recently protected C, porosus increased (r2 = 0.48, P= 0,006). The location of the syntopic zone was unchanged.

PUBLIC HEALTH, NURSING AND MEDICAL SOCIAL WORK

THE charts reprinted below illustrate the situation in 1949 and early 1950 for the national birth, death, infant mortality and marriage license rates. As explained in the November 1949 issue of Pediatrics, these rates are estimated by the National Office of Vital Statistics on the basis of preliminary reports coming from the various states. Such estimates are, of course, open to subsequent correction, but may with safety be considered as reflecting the true situation very closely. [See. Table source in Pdf.] During each month in 1949 the birth rate was very close to that for the corresponding month in 1948. Only toward the end of the year were the monthly rates for 1949 consistently under the preceding year. The trend in 1950 continues downward but the differences are relatively small. Each month in 1949 witnessed a well marked decrease from the year before in the marriage license rate. Only January 1950 is available for comparison at this time but the downward trend has not been reversed and will be related subsequently to still lower birth rates. February is the third consecutive month in which the estimated death rate was lower than the corresponding rate of any previous year. Thus, the estimated rate of 10.1 for the three months, December 1949-February 1950 sets a new low for this season.