MVA Group Research Articles

Clinical Outcome of Chemotherapy and Radiation Therapy Versus Chemotherapy, Radiation Therapy, and Multilevel Vertebroplasty or Kyphoplasty for Multiple Myeloma.

Vertebral augmentation including vertebroplasty and kyphoplasty may restore function without interfering with the therapeutic regimen of patients with multiple myeloma. We sought to evaluate the effects of adding multilevel vertebral augmentation to conventional therapy protocols for patients with multiple myeloma. Forty-four patients recently diagnosed with multiple myeloma were randomly assigned to two groups. One group received multilevel vertebral augmentation (kyphoplasty or vertebroplasty) in addition to conventional therapy (MVA), and the other group received conventional therapy alone (CTA). Patients were evaluated before treatment and at 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, and 5 years after treatment by using the Oswestry Disability Index (ODI), the Stanford Score (SS), and the Spinal Instability Neoplastic Score (SINS). The mean ODI, SS, and SINS were nearly equal before treatment, being 34.19 (68.38%), 4.58, and 12.30, respectively, for the MVA group and 32.29 (64.58%), 4.63, and 13.88, respectively, for the CTA group. There were significant differences in the ODI, SS, and SINS between the two groups at all follow-up intervals. The ODI and SINS were statistically significantly different between the two groups (P=.020 and P<.001, respectively). There was an insignificant difference in SS between the two groups. This study found that performing kyphoplasty and vertebroplasty in addition to conventional therapy for patients with multiple myeloma resulted in enhanced morbidity and functional outcomes. [Orthopedics. 2024;47(4):225-231.].

MANUAL VACUUM ASPIRATOR (MVA)- A SAFE AND EFFECTIVE ALTERNATIVE TO CONVENTIONAL CURETTAGE IN THE SURGICAL MANAGEMENT OF 1ST TRIMESTER MISCARRIAGES

Objective: To compare the efficacy of manual vacuum aspiration and conventional evacuation &amp; curettage (ENC) for first-trimester miscarriage management. Materials and Methods: This quasi-experimental study was carried out at the Department of Gynecology and Obstetrics, Khyber Teaching Hospital, Peshawar, Pakistan from October 2022 to March 2023 including 150 patients with first trimester miscarriage dividing them into two groups (MVA and ENC) having equal number of patients. Efficacy in both groups was compared. Results: The mean age in the MVA group (group A) was 27.81±6.31years while in the ENC group (group B) it was 26.50±6.27 years. The mean gestational age in group A was 5.82±2.82 weeks while in group B it was 5.95±2.9 weeks. MVA was effective in 88% of participants while ENC was effective in 93.33% of participants (p-value, 261), which is not statistically significant. Conclusion: Surgical uterine evacuation utilizing MVA under local anesthetic is safe and successful, and it should be considered to minimize a lengthy hospital stay. MVA can be a viable alternative to surgical curettage like ENC. It is safe, cost-effective, and simple to conduct, eliminating general anesthetic, the requirement for theatre access, and an unnecessary hospital stay. Keywords: Manual Vacuum Aspiration, Evacuation, Curettage, miscarriage, efficacy.

A-03 Preliminary Evidence for Motor Vehicle Accidents and Associated Concussion Response Severity in Older Adults

Abstract Purpose To determine if mechanism of injury is associated with differences in initial response to concussion in older adults. Methods Fifty older adults (54% female) aged 50-84 (59.14±6.54) were recruited from a sports medicine concussion clinic at initial appointment. Inclusion criteria included age (50+) and injury date within the last year. Exclusion criteria included prior diagnosis of a neurological disorder and/or brain malformation, psychiatric diagnosis other than anxiety/depression, prior history of moderate or severe brain injury, and/or ongoing litigation. Mechanism of injury in the sample included 22 falls/accidents (44%), 20 MVAs (40%), 2 sport/recreation (4%), 1 assault (2%), and 5 other (10%). Participants were assigned to two independent groups, MVA and Non-MVA. Outcome measures included Vestibular/Ocular-Motor Screening (VOMS), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), and Concussion Clinical Profile Screening (CP Screen). Response severity was operationalized by VOMS Total and CP Screen Total. Two-tailed independent t-tests (alpha&amp;lt;.05) examined differences between groups at initial visit. Results There were no significant differences between groups in terms of demographics or other common risk factors. There were no differences between groups for response severity. The MVA group reported more severe vestibular complaints t(41) =2.07, p=.044, more severe cognitive complaints, t(44)=3.68, p&amp;lt;.001, and demonstrated worse scores on domains of visual memory, t(43)=-2.16, p=.037, reaction time, t(43)=3.07, p=.004, and visual motor speed, t(43)=-2.85, p=.007. Conclusions MVA-related concussions may result in more focal disruption of vestibular and cognitive performance in older adults. Future research is warranted to confirm the findings of this study, to explore potential explanations for these findings, and to further explore how concussion presents in older adults.

Manual Vacuum Aspiration vs Vaginal Misoprostol for the Management of First-Trimester Incomplete Miscarriage in term of complete abortion

Aim: To compare the complete abortion rate between manual vacuum aspiration and vaginal misoprostol for the management of First-Trimester Incomplete Miscarriage in term of complete abortion Study design: Randomized Controlled Trial. Study duration: April 2022 to October 2022. Setting: Department of Obstetrics &amp; Gynecology Bahawal Victoria Hospital Bahawalpur. Methods: A total of 120 patients with First-Trimester Incomplete Miscarriage were chosen and equally divided into the MVA group and the MM group. The effectiveness of achieving a complete abortion was compared between the two groups. Results: Total 120 patients were selected. In MVA group, mean age and mean gestational was 31.47±5.82 years and 6.92±3.39 weeks while in MM group was 30.87±6.86 years and 5.78±3.47 weeks. Complete abortion was noted in 53(88.33%) patients of MVA group while in 44(73.33%) patients of MM group. Significantly (P=0.036) higher Efficacy (Complete abortion) rate was noted in MVA group. Practical Implication: It is a very good option in hospitals with low resources and in developing countries like Pakistan. Conclusion: In this study, we found MVA had higher complete abortion rate as compared to misoprostol intra vaginally. So, MVA is better treatment option than misoprostol intra vaginally as it has no systemic effects and it is a very good option in hospitals with low resources and in developing countries like Pakistan. Key words: Miscarriage, MVA, vaginal misoprostol, incomplete abortion, Gynecology, Pakistan

COMPARISON OF ENDOMETRIAL TISSUE SAMPLE BY MANUAL VACUUM ASPIRATION VERSUS DILATION &amp; CURETTAGE IN FEMALES PRESENTING WITH ABNORMAL UTERINE BLEEDING

Abnormal uterine bleeding (AUB) is bleeding from uterine corpus , abnormal in volume, regularity, or timing.&#x0D; Objective: To compare the efficacy in terms of adequate endometrial sample received by pathologist of manual vacuum aspiration versus dilation &amp; curettage in females presenting with abnormal uterine bleeding.&#x0D; Methods: It was a Randomized Controlled Trial performed in Department of Obstetrics &amp; Gynecology, Lahore General Hospital, Lahore for one year (April 3, 2020 till april 2, 2021). 390 females were randomly divided in two groups by lottery method. In group A, females had endometrial sampling with MVA. In group B, it was by dilatation and curettage by single surgical team. Efficacy was labelled when a pathologist could identify the endometrial epithelium, gland, and stroma, and make particular diagnosis of sample.&#x0D; Results: The mean age of females in MVA group was 55.07 ± 6.10 years and 55.5 in D &amp; C group ± 6.07 years. The mean duration of AUB in MVA group was 17.26 ± 4.12 months and in D &amp;C group, it was 17.44 ± 2.51 months. In MVA group, 170(87.2%) cases had efficacy and in D &amp; C group efficacy,it was in 181(92.8%) cases, the frequency of efficacy in both groups was statistically same i.e. p-value &gt; 0.05. &#x0D; Conclusion: Although the efficacy in D &amp; C group was high but was not statistically significantly different than MVA.So being simple and quick procedure,MVA can be used as an outdoor procedure, with less blood loss, without general anesthesia

Randomized Trial of Vaccines for Zaire Ebola Virus Disease

BackgroundQuestions remain concerning the rapidity of immune responses and the durability and safety of vaccines used to prevent Zaire Ebola virus disease.MethodsWe conducted two randomized, placebo-controlled trials — one involving adults and one involving children — to evaluate the safety and immune responses of three vaccine regimens against Zaire Ebola virus disease: Ad26.ZEBOV followed by MVA-BN-Filo 56 days later (the Ad26–MVA group), rVSVΔG-ZEBOV-GP followed by placebo 56 days later (the rVSV group), and rVSVΔG-ZEBOV-GP followed by rVSVΔG-ZEBOV-GP 56 days later (the rVSV–booster group). The primary end point was antibody response at 12 months, defined as having both a 12-month antibody concentration of at least 200 enzyme-linked immunosorbent assay units (EU) per milliliter and an increase from baseline in the antibody concentration by at least a factor of 4.ResultsA total of 1400 adults and 1401 children underwent randomization. Among both adults and children, the incidence of injection-site reactions and symptoms (e.g., feverishness and headache) was higher in the week after receipt of the primary and second or booster vaccinations than after receipt of placebo but not at later time points. These events were largely low-grade. At month 12, a total of 41% of adults (titer, 401 EU per milliliter) and 78% of children (titer, 828 EU per milliliter) had a response in the Ad26–MVA group; 76% (titer, 992 EU per milliliter) and 87% (titer, 1415 EU per milliliter), respectively, had a response in the rVSV group; 81% (titer, 1037 EU per milliliter) and 93% (titer, 1745 EU per milliliter), respectively, had a response in the rVSV–booster group; and 3% (titer, 93 EU per milliliter) and 4% (titer, 67 EU per milliliter), respectively, had a response in the placebo group (P<0.001 for all comparisons of vaccine with placebo). In both adults and children, antibody responses with vaccine differed from those with placebo beginning on day 14.ConclusionsNo safety concerns were identified in this trial. With all three vaccine regimens, immune responses were seen from day 14 through month 12. (Funded by the National Institutes of Health and others; PREVAC ClinicalTrials.gov number, NCT02876328; EudraCT numbers, 2017-001798-18 and 2017-001798-18/3rd; and Pan African Clinical Trials Registry number, PACTR201712002760250.)

Clinical and imaging variables associated to Microvascular Angina, a 13N-AMMONIA MPI Approach

Abstract Funding Acknowledgements Type of funding sources: None. On Behalf of MiniFellows Research Group CLINICAL AND IMAGING VARIABLES IN MICROVASCULAR ANGINA. A 13N-AMMONIA MPI APPROACH Background Patients with typical angina may have no obstructive artery disease1 and 2/3 may present microvascular dysfunction(MVD)2 which is associated with poor prognosis3,4,5. In 2017 the Coronary Vasomotion Disorders International Study Group (COVADIS) included it as a criteria of MVA6; later, included in MINOCA ESC 2020 guidelines.7 For diagnosis6,7: symptoms of ischemia; absence of relevant epicardial CAD (&amp;lt;50% diameter reduction or FFR &amp;gt;0.80); myocardial ischemia; impaired coronary microvascular function (CFR &amp;lt; 2 or &amp;lt;2.5 depending on methodology). Our aim was to identify clinical and imaging variables in patients with MVA due to 13N-ammonia Positron Emission Tomography/Cardiac Tomography(PET/CT) and Cardiac Computed Tomography Angiography(CCTA) in a cardiovascular imaging referral center. Methods.Retrospective, cross-sectional study of patients with suspected CAD. For inclusion: ischemia quantitation (summed stress score,SDS &amp;lt; 3) and obstruction &amp;lt;50% in all vessels. Exclusion criteria: previous infarction, intervention, or incomplete study. Clinical data was assessed. Both studies performed on the same day. Frequencies and percentages to report categorical variables; x2 and Fisher´s exact tests to compare them. Mean (+/-DE) or median (interquartile range) to report continuous variables according to their distribution, and T student or Wilcoxon test to compare them. Results 274 patients included: Group A (CFR &amp;lt;2) and group B (CFR 2)(108vs166). Difference for systemic hypertension(p &amp;lt;0.001), type 2 diabetes mellitus(p &amp;lt;0.001), dyslipidemia(p = 0.019), smoking(p &amp;lt;0.001). Group B presented higher incidence for mild ischemia(p = 0.004) while MVA for severe ischemia(p = 0.002). Difference between groups for EDV and ESV at rest (p = 0.002), EDV at stress(p = 0.03) and at rest(p &amp;lt; 0.001), LVEF at rest and stress(p &amp;lt; 0.001) and for a negative change of LVEF(p &amp;lt; 0.001). Also, reduced Calcium Score(SC)(p &amp;lt; 0.001) Discussion With a higher prevalence reported in women8,9, no difference for women in both groups. Presentation been reported as atypical 3,6,10, as in our study. Traditional risk factors may affect the microvascular circulation earlier in the disease. Regarding mild and severe ischemia, CFR´s may be lower in defect perfusion zones and presence of both ischemia and MVD has worse prognosis11 suggesting ischemia could had already developed in this group. LVEF drop supports the relation between CFR and ventricular function12. Finally, MVA group had a reduced CS, associated with CAD and worse prognosis, suggesting it also affects the microvasculature function. Conclusions 13N-ammonia PET/CT MPI with CCTA is a great combination to diagnose MVA, whose main component is microvascular dysfunction. Recognizing the risk factors associated with this pathology allows making opportune detections, implementing early treatment strategies, controlling symptoms and avoiding the disease"s evolution

Endothelial dysfunction and features of nociceptive sensitivity in patients with microvascular angina

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): фГБ ОУ ВО СЗГМУ им. И.И. Мечникова Introduction. The pathogenesis of microvascular angina pectoris (MVA) is not completely clear to the end, some authors consider the violation of pain (nociceptive) sensitivity to be an important cause of this disease. The purpose of this study was to study the perception of pain and serum endothelin-1 in patients with MVA. Materials and methods. The criteria for inclusion in the group with MVA (49 patients): chest pain, positive stress test, unchanged coronary artery according to coronary angiography, the presence of a violation of myocardial perfusion and a decrease in the coronary reserve according to the positron emission tomography (PET) of the myocardium in rest, with a sample with adenosine and a cold test. Pain in the chest was noted in all 49 patients. Assessment of the nature of the pain syndrome was carried out using a 10-point visual-analogue scale (VAS), verbal rank scale (VRS). All subjects underwent a study of the functional activity of nociceptive and antinociceptive systems using the nociceptive flexor reflex method on the Nicolet VikingSelect expert class equipment, the pain threshold (Pb), the threshold of the reflex (Pr), and ratio coefficient (Pb / Pr), which in healthy people is approximately 0.9-1.0. The content of endothelin-1 in the serum of peripheral blood was determined by the method of enzyme immunoassay using test systems "Endotelin 1-21" (the normal values are up to 0.26 fmol / l) Fresh samples immediately after collection of blood were placed on ice and centrifuged during the day. Results. The intensity of pain in the usual attacks in patients with MVA according to the VAS data (5.51 ± 0.2) in most cases was moderate and none of the subjects reached the maximum possible values. According to VRS, moderate pain was described by 60% of patients with MVA, strong - 34.3%.In the study of NFR in patients with MVA, the group as a whole showed a decrease in the pain threshold, the threshold of the reflex, and the ratio coefficient (Pb / Pr) as compared with normal values. In the MVA group, Pb was equal to 9.5 ± 0.58 mA; Pr = 12.1 ± 0.58 mA; Pb / Pr = 0.78 ± 0.02. When studying the level of endothelin-1 in patients with MVA the level of this peptide was raised to 2.9 ± 0.82 fmol / l. According to the correlation analysis between endothelin-1 and the parameters of NFR, an inverse correlation was observed: between endothelin-1 and pain threshold (r = -0.4; p &amp;lt;0.01); between the level of endothelin-1 and the ratio coefficient of PB / PR (r = -0.9; p &amp;lt;0.01). Based on the results of the correlation analysis of the pain intensity index on the VAS scale and endothelin-1 level in patients with MVA, a significant relationship was found (r = 0.6, p &amp;lt;0.01) Conclusions. In patients with MVA, a decrease in the pain threshold and an elevated level of endothelin-1 were found. Thus, the severity of endothelial dysfunction in patients with MVA was interrelated with the process of perception of pain.

Safety and efficacy of misoprostol versus manual vacuum aspiration in missed abortion up to 12 weeks

Aims: To compare the safety and efficacy of Misoprostol versus manual vacuum aspiration in missed abortion up to 12 weeks.&#x0D; Methods: This is comparative study where Misoprostol 800 μg was administered sublingually four hourly till expulsion of products or maximum of three doses in one group and 400 μg misoprostol followed by manual vacuum aspiration 4 hours later was done under local anaesthesia in another group from October 2019 to March 2020 at Government Medical College and Hospital, Aurangabad, Maharashtra. Unpaired t-test and Chi squared test were performed with alpha-error set at 0.05.&#x0D; Results: The success rate in Misoprostol group was 88 % and in the MVA group, it was 98%. Mean duration of hospital stay in Misoprostol group was 2.46±1.18 days and in MVA group was 1.55 ± 1.52 days (p= 0.3). Mean induction abortion interval in Misoprostol group was 8.125±3.29 and 4.46±0.44 hours in MVA group (p=0.000). One woman from MVA group had perforation of uterus which could be attributed to previous LSCS with tight os.&#x0D; Conclusion: Single dose of Misoprostol followed by manual vacuum aspiration is better than the multiple dosage of Misoprostol for the treatment of first trimester missed abortion in terms of duration of treatment but not for the individual success rate. Hospital stay is similar.&#x0D; Keywords: manual vaccum aspiration, misoprostol, missed abortion

COMPARATIVE STUDY OF MANUAL VACUUM ASPIRATION AND DILATATION &amp; EVACUATION IN TERMS OF THEIRS ACCEPTABILITY AND COMPLICATIONS FOR THE SURGICAL MANAGEMENT OF EARLY PREGNANCY LOSS

Background: To compare efficacy and complication of manual vacuum aspiration and dilatation and evacuation as the method for early pregnancy loss surgical management.&#x0D; Methods: This study was conducted in the Department of Obstetrics and Gynaecology, SMS Medical College &amp; Associated group of Hospitals, Jaipur during this study, 200 pregnant women with below 12 weeks gestational age having a confirmed diagnosis of incomplete miscarriage and missed abortion were included. All selected cases divided into MVA group and D&amp;E group randomly.&#x0D; Results: MVA group 98% cases were successful and failure was in 2% which required re-procedure. In D&amp;E group 94% cases were successful and failure was in 6% cases which required re-procedure. Success rate was founded more in MVA group than D&amp;E group.&#x0D; Conclusion: On comparison of the two, in our study MVA was seen to be having an edge over D&amp;E, regarding complication and success rate.&#x0D; Keywords: MVA, D&amp;E, Complication, Success rate.

Misoprostol versus manual vacuum aspiration for treatment of first-trimester incomplete miscarriage in a low-resource setting: A randomized controlled trial.

Manual vacuum aspiration is a safe and effective technology for the treatment of incomplete miscarriage but it is not widely available and affordable in rural areas particularly in low-resource countries. Misoprostol is an alternative to manual vacuum aspiration for the treatment of incomplete miscarriage. To compare the effectiveness, client acceptability and satisfaction, and cost-effectiveness of misoprostol with manual vacuum aspiration for the treatment of the first-trimester incomplete miscarriage. This study was conducted between February 1, 2018 and August 31, 2018 at Alex Ekwueme Federal University Teaching Hospital Abakaliki, Nigeria. 100 participants were randomized to treatment with either manual vacuum aspiration or 600 μg oral misoprostol. The main outcome measures assessed at 1-week follow-up were complete uterine evacuation, client acceptability and satisfaction, and cost-effectiveness. Data were analyzed using SPSS version 25. Sociodemographic characteristics, treatment outcomes and other variables were summarized by descriptive statistics. Chi-square test was used for comparison between groups as regard categorical data while Student's't' test was used for comparison between groups for continuous data. P value of <0.05 was regarded as statistically significant. There was a higher failure rate in the misoprostol arm when compared with MVA. Although this difference in complete uterine evacuation rate did not reach statistical significance (81.3% versus 95.7%, RR = 4.3, 95% CI 0.98-18.9, P value = 0.05), more participants in the misoprostol arm would choose the method again when compared with women in the MVA group (47 versus 30, X[2] = 16.95, P < 0.001). The mean client satisfaction score was significantly higher among women in the misoprostol arm compared to MVA group (13.2 (2.1) versus 7.3 (4.6), P < 0.001). The mean cost of primary treatment was higher in the MVA group compared with misoprostol arm ($67.8 (8.9) versus 14.4 (4.0), P < 0.001). There was no significant difference in the mean cost of repeat uterine evacuation in both study arms (MVA, $64.9 (6.3) versus misoprostol, $65.76 (6.6), P = 0.86). Although medical treatment was associated with a higher failure rate, there was no statistically significant difference in the effectiveness of both treatment methods. However, medical treatment was associated with higher client acceptance and satisfaction and was more cost-effective than surgical treatment.

Migraine with Aura: Surface-Based Analysis of the Cerebral Cortex with Magnetic Resonance Imaging.

ObjectivePrevious migraine studies have reported gray matter alterations in various cortical regions with conflicting results. This study aimed to explore a cortical morphometric difference in migraineurs with aura (MA) compared to healthy subjects (HS) and to delineate a possible difference between the cortical morphological features and different aura phenotypes.Materials and MethodsForty-eight MA and 30 HS that were balanced by sex, age, and educational level were selected for this study. T2-weighted and three-dimensional T1-weighted magnetic resonance imaging (MRI) of the brain were acquired using a 1.5T MRI scanner. Surface-based morphometry from the MRI data was used to identify differences between the MA and HS group, and then between MA subgroups. The MA group was subdivided into migraineurs who experienced only visual aura (MVA) and migraineurs who had visual, somatosensory and dysphasic symptoms (MVA+).ResultsThe MVA+ group had significantly reduced cortical surface area of the left rostral middle frontal cortex compared with the MVA group (p < 0.001). Migraine patients had significantly reduced volume of the left fusiform gyrus relative to HS (p < 0.001). Also, the sulcal depth increased at the level of the left temporal pole in the MVA+ group relative to the MVA group (p < 0.001). The vertex-by-vertex analysis did not exhibit any significant difference in cortical thickness between MA and HS, and between MVA+ and MVA, when corrected for multiple comparisons.ConclusionMigraineurs with aura demonstrates different morphometric features from HS in multiple cortical regions. MVA+ have different morphometric features in the left frontal and temporal lobe relative to MVA, which could be a source of distinct symptoms and serve as potential biomarkers of different MA subtypes.

The spectrum and outcome of paediatric traumatic brain injury in KwaZulu-Natal Province, South Africa has not changed over the last two decades.

This retrospective review of a prospectively entered and maintained hybrid electronic trauma registry was intended to develop a comprehensive overview of traumatic brain injury (TBI) in children and adolescents and to compare it with previous audits from our local environment and from other developing world centres. All TBI patients admitted to hospital were included in this study. We reviewed the age, gender, outcomes, radiological findings and treatment of the patients. All patients aged ≤18 years old who were admitted by the Pietermaritzburg Metropolitan Trauma Service (PMTS) with TBI between December 2012 and December 2016 were included in this audit. During the 4-year period under review, a total of 563 children and adolescents were treated for TBI by the PMTS. The median age was 6.4 years and 29% (n=165) were females. The mechanism of TBI was blunt trauma in 96% (n=544) of cases, with 4% (n=19) suffering penetrating trauma. The penetrating mechanisms included impalement by a cow horn and miscellaneous injuries due to saws, axes, barbed wire, spades, stones and knives. The blunt mechanisms included falls (n=102), assaults (n=108), collapse of a building (n=28), bicycle-related injury (n=14), falling off a moving vehicle (n=280), motor vehicle accident (MVA; n=59), pedestrian vehicle accident (PVA; n=183) and animal-related injuries (n=8). There were 454 (80%) mild, 67 (12%) moderate and 42 (7%) severe cases of TBI. A total of 48 patients were admitted to the intensive care unit and 23 were admitted to the high care unit. Nine patients died. All the deaths were in the MVA and PVA group. The spectrum of TBI as diagnosed on computed tomography scans was nonspecific cerebral contusion (n=92), depressed skull fracture (n=70), sub-arachnoid haemorrhage (n=60), extradural haemorrhage (n=41), intracerebral haemorrhage (n=19), free air (n=19), subdural haemorrhage (n=13), intraventricular haemorrhage (n=9). A total of 62 (11%) patients required surgery. There is a significant burden of paediatric TBI in Pietermaritzburg. The majority of TBI was related to blunt trauma and assaults were very common. Although the short-term outcomes are good, the long-term consequences are poorly understood. Injury prevention programmes are needed to help reduce this burden of disease and a nationwide trauma registry is long overdue.

Original Research: Atorvastatin prevents rat cardiomyocyte hypertrophy induced by parathyroid hormone 1-34 associated with the Ras-ERK signaling.

We investigated the effects of atorvastatin (Ator) on cardiomyocyte hypertrophy (CMH) induced by rat parathyroid hormone 1-34 (PTH1-34) and Ras-extracellular signal regulated protein kinases 1/2 (ERK1/2) signaling. Rat cardiomyocytes were randomly divided into seven groups: normal controls (NC), PTH1-34 (10(-7) mol/L), Ator (10(-5) mol/L), farnesyl transferase inhibitors-276 (FTI-276, 4 × 10(-5) mol/L), PTH1-34 + Ator, PTH1-34 + FTI-276 and PTH1-34 + Ator + mevalonic acid (MVA, 10(-4) mol/L). After treatment, the hypertrophic responses of cardiomyocytes were assessed by measuring cell diameter, detecting protein synthesis, and single-cell protein content. The concentrations of hypertrophic markers such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured by ELISA. Protein expressions of ERK1/2, p-ERK1/2 and Ras were detected by western blotting. The results showed that compared with the PTH1-34 group, cellular diameter, 3H-leucine incorporation, single-cell protein content, ANP and BNP concentration decreased by 12.07 µm, 1622 cpm/well, 84.34 pg, 7.13 ng/L and 20.04 µg/L, respectively, and the expressions of Ras and p-ERK1/2 were downregulated in PTH1-34 + Ator group (P < 0.05). Compared to the PTH1-34 + Ator group, the corresponding hypertrophic responses and hypertrophic markers increased by 4.95 µm, 750 cpm/well, 49.08 pg, 3.12 ng/L and 9.35 µg/L, respectively, and the expressions of Ras and p-ERK1/2 were upregulated in the PTH1-34 + Ator + MVA group (P < 0.05). In conclusion, Ator prevents neonatal rat CMH induced by PTH1-34 and Ras-ERK signaling may be involved in this process.

English

OBJECTIVE :- To find out the efficacy of MVA, its comparison with S & E for 1st trimester MTP in terms of time taken and various complications. Safe abortion care the public health human rights rationale, approximately 47,000 pregnancy related deaths are due to complication of unsafe abortion and 5 million were estimated to suffer disability as a result of complication due to unsafe abortion. Almost in all countries the law permits abortion to save the women's life, preserve physical and mental health of women. There are four main methods for safe pregnancy termination - Dilation & Curettage, D & E by electric suction machine, MVA and medical abortion by misoprostol and mifepristone. MATERIAL & METHODS: In this study randomly selected 200 case upto 10 wk pregnancy for MTP were studied. Group-I: 100 cases underwent MTP by MVA and Group-II: 100 cases underwent MTP by suction evacuation observations were tabulated and analysed. p value of<0.05 considered as significant. RESULTS: In our study efficacy of MVA was 97% and by S & E 98%. Blood loss in MVA group was < 20cc in 64% of group-I and 40% in group-II clients. Perforation was seen in 1% in group-II whereas non in group-I. CONCLUSION: Study found that both methods have high efficacy but MVA is safe, cost effective, blood loss minimal, less time consuming, portable, Many MTP can be done in a day to hospital and PHC level which cater target population area.

Lung contusion-lacerations after blunt thoracic trauma in children.

Chest trauma in children is an indicator of injury severity and is associated with a high mortality rate. The aim of this study was to investigate the impact of pulmonary contusion-laceration on short and long-term outcome of pediatric patients after blunt thoracic trauma. A retrospective analysis of records of 41 children aged 10 months to 17 years who were treated for pulmonary and associated injuries between 1986 and 2000 was done concerning mode of injury, types of injuries, management and outcome. In addition, a follow-up investigation was performed 4.5+/-1 years after injury. Of the patients 27 were involved in motor vehicle accidents (MVA group) and 14 patients suffered other types of accidents (others group). The mean injury severity score (ISS) was 30+/-2 (range 9-75) with no significant difference between the groups. Patients from the MVA group suffered more frequently bilateral pulmonary lesions and needed more often chest tube placement ( p<0.05), 5 patients died (12%) all from the MVA group. The follow-up investigation of 34 patients showed unremarkable chest x-rays and normal lung function in all but 1 patient with bronchial asthma. In conclusion, children who recover after a pulmonary contusion-laceration trauma do not suffer from significant late respiratory problems.

Percutaneous transvenous mitral commissurotomy using Inoue balloon in children less than 12 years.

Rheumatic mitral stenosis in some parts of the world afflicts even young children. Percutaneous transvenous mitral commissurotomy (PTMC) using Inoue balloon in these children is not well reported. Forty-five children (aged 7-12 years, mean 11.0 +/- 1.2 years) with severe rheumatic mitral stenosis (mitral valve area [MVA] 0.64 +/- 0.14 cm2) underwent PTMC. The pulmonary artery wedge pressure (PAW) decreased from 24.3 +/- 8.6 to 14.7 +/- 7.2 mmHg (P < 0.0001) and mean diastolic gradient decreased from 24.3 +/- 7.7 to 7.9 +/- 5.9 mmHg with the final MVA of 1.63 +/- 0.45 cm2 (P < 0.0001). Complications included significant mitral regurgitation (MR) in three children and atrial shunting in two patients. No procedural death, systemic embolism, and cardiac tamponade were encountered. Twenty-four children had maximum balloon size (MBS) same as recommended balloon size (RBS) derived according to the height (group I) and 21 children had MBS 1-3 mm less than RBS (group II). Despite the lesser maximum balloon size, the final results were comparable in both groups (MVA group 1.66 +/- 0.44 vs. group II 1.61 +/- 0.48 P = NS). The incidence of significant MR (2 and 1 in group I and group II, respectively) was similar. On follow-up of 20.4 +/- 16.3 months (range 3-56 months), one child developed restenosis. We conclude that PTMC is safe and effective in children less than 12 years of age. However, the smaller balloon size than the RBS derived from height may be equally effective and possibly safer.

Percutaneous transvenous mitral commissurotomy using Inoue balloon in children less than 12 years

Rheumatic mitral stenosis in some parts of the world afflicts even young children. Percutaneous transvenous mitral commissurotomy (PTMC) using Inoue balloon in these children is not well reported. Forty-five children (aged 7–12 years, mean 11.0 ± 1.2 years) with severe rheumatic mitral stenosis (mitral valve area [MVA] 0.64 ± 0.14 cm2) underwent PTMC. The pulmonary artery wedge pressure (PAW) decreased from 24.3 ± 8.6 to 14.7 ± 7.2 mmHg (P < 0.0001) and mean diastolic gradient decreased from 24.3 ± 7.7 to 7.9 ± 5.9 mmHg with the final MVA of 1.63 ± 0.45 cm2 (P < 0.0001). Complications included significant mitral regurgitation (MR) in three children and atrial shunting in two patients. No procedural death, systemic embolism, and cardiac tamponade were encountered. Twenty-four children had maximum balloon size (MBS) same as recommended balloon size (RBS) derived according to the height (group I) and 21 children had MBS 1–3 mm less than RBS (group II). Despite the lesser maximum balloon size, the final results were comparable in both groups (MVA group 1.66 ± 0.44 vs. group II 1.61 ± 0.48 P = NS). The incidence of significant MR (2 and 1 in group I and group II, respectively) was similar. On follow-up of 20.4 ± 16.3 months (range 3–56 months), one child developed restenosis. We conclude that PTMC is safe and effective in children less than 12 years of age. However, the smaller balloon size than the RBS derived from height may be equally effective and possibly safer. Cathet. Cardiovasc. Diagn. 43:408–411, 1998. © 1998 Wiley-Liss, Inc.

Percutaneous coronary angioplasty in 1,001 multivessel coronary disease patients: an analysis of different patient subsets.

The prospectively collected data of 1,001 multivessel coronary disease patients who underwent percutaneous transluminal angioplasty (PTCA) was analyzed after categorization into single vessel angioplasty (SVA; group I) and multiple vessel angioplasty (MVA; group II) PTCA groups, which were each compartmentalized into "simple" (group A) and "complex" (group B) cohorts. Patients were assigned to the SVA or MVA group according to the physician's pre-PTCA assessment of how many lesions would be attempted (intention to treat) and not the number of lesions actually attempted. A "simple" patient was more likely than a "complex" patient to be clinically improved after PTCA whether or not the patient had a single dilatation (90% vs 78%; P less than 0.05) or multiple dilatations (97% vs 94%; P<0.05). Similarly, a lesion(s) was more likely to be successfully dilated in the "simple" than in the "complex" group (SVA: 90% vs 82%, P less than 0.05; MVA: 97% vs 91%, P<0.05). In addition, occluded vessels in the MVA group were more likely to be recanalized than in the SVA group (73% vs 44%, P less than 0.05). Group I-A patients had a significantly increased (10%) incidence of emergency bypass surgery. Follow-up, at 84 months, showed that "simple" cohorts had a better survival than the "complex" cohorts (MVA: 95% vs 71%, P less than 0.05; SVA: 90% vs 72%, P less than 0.05); and, nearly two thirds of all successful PTCA patients were angina free.(ABSTRACT TRUNCATED AT 250 WORDS)