Percentage Fall Research Articles

The Promise of Circulating Tumor Cells in Metastatic CRPC

The Promise of Circulating Tumor Cells in Metastatic CRPC

Prevalence of Exercise Induced Bronchoconstriction in Recreational Adult Hockey Players as determined by Sport Specific Field Exercise Challenge Test

BACKGROUND: Exercise induced bronchoconstriction (EIB) is provoked by exercise and results in narrowing of the airways. Studies have shown an EIB prevalence of 11-50% in athletic populations. The diagnosis of EIB is dependent upon objective measurement of respiratory function, as respiratory symptoms are unreliable. Cold and dry ambient conditions contribute to the severity of EIB. The environmental conditions and manner of exertion an athlete is exposed to in ice hockey are significantly different than any current standardized laboratory test to evaluate for EIB. In a prior study of elite women hockey players, 39.5% presented symptoms of asthma and 21% demonstrated EIB. Sport-specific field exercise challenge tests (SSFECT) have been validated for the assessment of EIB, and are more sensitive than laboratory challenges in elite winter athletes. PURPOSE: To use a SSFECT to determine the prevalence of EIB in adult recreational ice hockey players, and the correlation between reported symptoms and diagnosis by this method. METHODS: Participants were 18 males and 2 females (mean age of 34.7 yrs, mean height of 1.78 m); who participated in 1 of 2 recreational ice hockey leagues in Chicago, IL. Using a Piko-1 portable spirometer, FEV1 was measured prior to the hockey game and immediately following periods 1, 2, and 3. All respiratory measurements occurred with hockey equipment adorned. Airway response was expressed as the percent fall in FEV1 from the baseline value. Diagnosis of EIB was given if athletes had a greater than 10% decrease in FEV1 from baseline measured at any time point. Athletes also completed an intake questionnaire prior to testing which included clinical symptoms, exercise history, and past medical history. RESULTS: EIB was diagnosed in 3/20(15%) athletes. A prior diagnosis of asthma or exercise induced asthma was reported in 5/20 (25%) athletes, yet only one of these had a decrease of > 10 % of FEV1 as measured by this test. Of the three EIB+, two were symptomatic (67%); and of the EIB-, 9/17 (53%) reported respiratory symptoms. Diagnosis of EIB was consistent for all three periods in all but one athlete. Mean FEV1 for the three periods was 4.08, 4.07, and 4.07 respectively. CONCLUSIONS: Symptoms remain unreliable for diagnosis of EIB. SSFECT can be utilized for diagnosis of EIB in ice hockey athletes.

Falling Third-Trimester Insulin Requirements and Adverse Pregnancy Outcomes: A Systematic Review [32E

INTRODUCTION: There is conflicting evidence on whether falling insulin requirements in the third-trimester are associated with adverse pregnancy outcomes. Our objective was to systematically review the literature to determine the association between a ≥15 percent fall in insulin dose (PFID) and adverse pregnancy outcomes. METHODS: We searched Medline, Embase and PubMed from inception until October 2016 for English language articles describing falling insulin requirements and pregnancy outcomes. Article screening and data extraction was performed in duplicate. As significant clinical and methodological heterogeneity was anticipated, no formal meta-analysis was planned. Outcomes were described as proportions. RESULTS: We identified 1011 publications, of which three observational studies met eligibility criteria. Two studies that used ≥15 PFID were included in the quantitative analysis. Pregnancies with ≥15 PFID were associated with small-for-gestational-age (SGA) fetuses (6/40 vs. 7/153, p=0.04; risk ratio (RR) 2.95 [1.08, 8.07]). There were no differences in large-for- gestational-age fetuses (14/40 vs. 58/153; RR 1.07 [0.68, 1.70]), low 5-minute Apgar scores (6/40 vs. 16/153; RR 1.93 [0.52, 7.14]), caesarean deliveries (25/40 vs. 105/153; RR 0.90 [0.70, 1.17]), extreme preterm (3/35 vs. 2/104) birth, stillbirths (1/35 vs. 1/104) or hypertensive disorders (9/35 vs. 19/104, p=0.34). CONCLUSION: This systematic review of observational studies found no association between ≥15 PFID and adverse pregnancy outcomes, except for a higher number of SGA fetuses. This was not causal. Early delivery based on ≥15 PFID cannot be recommended. Instead, clinical management should involve continued maternal-fetal surveillance, exploring possible obstetric and metabolic reasons for this PFID, and treatment of the primary cause.

The Price Effects of Cash versus In-Kind Transfers

This paper examines the effect of cash versus in-kind transfers on local prices. Both types of transfers increase the demand for normal goods; in-kind transfers also increase supply in recipient communities, which should cause prices to fall relative to cash transfers. We test and confirm this prediction using a program in Mexico that randomly assigned villages to receive boxes of food (trucked into the village), equivalently valued cash transfers, or no transfers. We find that prices are significantly lower under in-kind transfers compared with cash transfers; relative to the control group, in-kind transfers lead to a 4 percent fall in prices while cash transfers lead to a positive but negligible increase in prices. Prices of goods other than those transferred are also affected, but by a small amount. Thus, households' purchasing power is only modestly affected by these price effects, even in this setting where program eligibility is high, the transfer per household is sizeable, and hence the supply influx is large. The exception is in remote villages, where the price effects (both the negative effects of in-kind transfers and the positive effects of cash transfers) are larger in magnitude. The effects do not dissipate over the two years of program duration we observe.

Exercise-induced Bronchoconstriction with Firefighting Contained Breathing Apparatus.

Protective self-contained breathing apparatus (SCBA) used for firefighting delivers decompressed (cold) dehumidified air that may enhance the severity of exercise-induced bronchoconstriction (EIB) in those susceptible. We investigated the effect of SCBA during exercise on airway caliber in people with asthma and healthy controls. Two exercise challenges (EC) designed to elicit EIB were performed on separate days within 1 wk. The initial challenge was breathing room air (ECRA) with workload titrated to elicit >60% estimated maximum voluntary ventilation. The exercise intensity was repeated for the second challenge using SCBA (ECSCBA). Forced expiratory volume in 1 s (FEV1) was measured before and up to 20 min after exercise. Bronchial hyperresponsivenss (BHR) to the hyperosmolar mannitol test was measured in the subjects with asthma. Twenty subjects with current asthma (mean [SD]: age 27 [6] yr) and 10 healthy controls (31 [5] yr, P = 0.1) were studied. The percent fall in FEV1 after ECSCBA was greater in the mannitol-positive asthma subjects (14.4% [15.1%]) compared with mannitol-negative asthmatic subjects (1.6% [1.7%]; P = 0.02) and controls (2.3% [2.3%]; P = 0.04). The FEV1 response was not different between ECRA and ECSCBA (0.49% [5.57%]; P = 0.6). No BHR to mannitol (n = 7) was highly sensitive for identifying a negative response to ECSCBA (negative predictive value 100%). The SCBA does not increase the propensity or severity for EIB in subjects with BHR. Those subjects with asthma but no BHR to inhaled mannitol did not exhibit EIB. The BHR to a hyperosmolar stimulus maybe considered a useful screening tool for potential recruits with a history of asthma.

Treatment before macular grid in patients of diabetic macular edema.

AIM:The aim of this study is to compare the efficacy of intravitreal bevacizumab and posterior subtenons triamcinolone acetate in the management of diffuse diabetic macular edema (DME) and to evaluate their efficacy as an adjunct to modified grid laser in management of DME.DESIGN:This was a prospective, randomized clinical trial of 30 patients.MATERIALS AND METHODS:A total of 30 patients attending the medical ophthalmology clinic at a tertiary care hospital were included in the study. These 30 patients were divided into two groups. Group I (15 eyes) received intravitreal bevacizumab followed by modified grid photocoagulation 2 weeks after injection. Group II (15 eyes) received posterior subtenons triamcinolone followed by modified grid photocoagulation 2 weeks after injection. Each patient in our study was followed up at 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after the initial injection to record the central macular thickness (CMT) and best-corrected visual acuity (BCVA).RESULTS:Both the combination therapies have efficacy to reduce the CMT (P = 0.001). The percentage fall in CMT was greater in bevacizumab + laser group, and there was a significant difference in the CMT values at the end of the study in the bevacizumab group (P = 0.013). The mean BCVA improved in both the groups and this difference was statistically significant compared to the baseline (P = 0.005). However, there was no statistically significant difference in BCVA between the two groups at the end of the study.CONCLUSION:Both intravitreal bevacizumab and posterior subtenons triamcinolone given as an adjuvant therapy along with modified grid laser are equally efficacious in the reduction of the CMT; however, the percentage fall in the CMT was greater in bevacizumab + laser group, and there was a significant difference in the fall in CMT at all the visits as compared to a plateau in the fall of CMT in posterior subtenons triamcinolone group.

Heavy Metals Adsorption from Aqueous Solutions onto Unmodified and Modified Jordanian Kaolinite Clay: Batch and Column Techniques

Awareness of, and concern about, water pollution all over the world has been increasing. In Jordan, water also has been polluted by different kinds of pollutants such as heavy metals, It is widely agreed that a properly developed green, low – cost and more efficient adsorbent is desired approach towards removing pollutants. Jordan has huge reserves of kaolinite. Unfortunately, it has a relative low cation–exchange capacity and a small surface area. However, it can be modified to enhance its adsorption capacity towards heavy metal ions. Humic acid was used to this purpose. Two types of humic acid were used; one was commercial from Fluka Company and the other was natural extracted from King Talal Dam sediments. Comparison of Pb (II), Cd (II) and Zn (II) adsorption from aqueous solutions onto unmodified and modified Jordanian kaolinite clay were studied using batch technique at different temperatures (25, 35 and 45°C) and different pH (4, 5 and 6). The effects of contact time, adsorbent dose, and the initial metal ion concentration were also studied. The uptake at low concentration reaches above 90% for Pb (II). The adsorbed amount trend was as follows: Pb (II) > Cd (II) > Zn (II) for both modified kaolinite clay. The column technique was used effectively for the determination of metal ion loading capacity. The uptake percentage fall in the same order (Pb (II) > Cd (II) > Zn (II)) for both modified kaolinite clay.

Time-Effect of Formoterol Added to Inhaled Fluticasone on Exercise- Induced Bronchoconstriction in Asthmatic Adolescents

Background: Asthma is characterized by chronic airway inflammation that is controlled by a complex cytokine network. Inhaled corticosteroid and short acting β2-agonists treatment improve asthma control. Objective: The aim of the study is to evaluate if a combination of fluticasone and formoterol is effective to assure a protective effect against EIB 15 min and 4 hours after administration in adolescent with persistent asthma. Method: In this study we selected 20 adolescents age 8 and 19 years affected by mild to moderate persistent asthma and EIB. At screening the following were assessed: eligibility, demography, medical history, medications, spirometry and clinical examination. During the study all the patients continued to regularly take a low dose of inhaled steroids; albuterol as rescue medication has been discontinued 8 hours before the exercise test. Results: Formoterol plus fluticasone offered good protection against EIB in 18 patients (90%), the mean maximum percent fall in FEV1 after formoterol was 7.1 ± 4.9% at 15 min (p<0.001). The combination formoterol plus fluticasone was more effective after 4 hours protecting against bronchoconstriction 19 patients (95%) and the mean maximum percent fall in FEV1 after formoterol plus fluticasone was 4.3 ± 4.2% at 4 h (p < 0.001). Conclusions: This study suggests that fluticasone 100 mcg + formoterol 10mcg by MDI + spacer is effective in protecting asthmatic adolescents as early as 15 min after dosing. Furthermore, the data confirm the long duration of its protective effect and the absence of any significant adverse effects after administration. Keywords: Children, exercise-induced bronchoconstriction, fluticasone, formoterol, physical activity.

Dyspnea Perception During Induced Bronchoconstriction Is Complicated by the Inhaled Methacholine in Children With Clinical Asthma.

PurposeDyspnea is not widely utilized as an indicator of asthma provocation despite its universal presentation. We hypothesized that dyspnea severity was proportionate with the lung function decline, methacholine dose-step, and the degree of bronchial hyperresponsiveness (BHR).MethodsWe retrospectively analyzed 73 children's bronchial provocation test data with an assessment of dyspnea at every dose-step. Dyspnea severity was scored using a modified Borg (mBorg) scale. A linear mixed effect analysis was performed to evaluate the relationship between the mBorg scale, the percentage fall in the forced expiratory volume in 1 second (FEV1) (ΔFEV1%), the methacholine dose-step, and the degree of BHR (BHR grade).ResultsSubjects were divided into 5 BHR groups based on their last methacholine dose-steps. The mBorg scores did not differ significantly among BHR groups (P=0.596, Kruskal-Wallis test). The linear mixed effect analysis showed that ΔFEV1% was affected by the methacholine dose-step (P<0.001) and BHR grade (P<0.001). The mBorg score was affected by the dose-step (P<0.001) and BHR grade (P=0.019). We developed a model to predict the mBorg score and found that it was affected by the methacholine dose-step and ΔFEV1%, elevating it by a score of 0.039 (χ2 [1]=21.06, P<0.001) and 0.327 (χ2 [1]=47.45, P<0.001), respectively. A significant interaction was observed between the methacholine dose-step and ΔFEV1% (χ2 [1]=16.20, P<0.001).ConclusionsIn asthmatic children, inhaled methacholine, as well as the degree of BHR and lung function decline, may affect dyspnea perception during the bronchial provocation test. If we wish to draw meaningful information from dyspnea perception, we have to consider various complicating factors underlying it.

ANTIDIABETIC EFFECT OF EXTRACTS OF BLUMEA LACERA DC. IN STREPTOZOTOCIN INDUCED HYPERGLYCEMIC RATS

Objective: Present study of this research was undertaken to evaluate the antidiabetic activities of extracts of aerial parts of Blumea lacera DC. (Asteraceae) in streptozotocin (STZ) induced hyperglycemic rat.Methods: The methanol extracts (MEBL) and aqueous extract (AEBL) of B. lacera DC. were investigated in streptozotocin (STZ) induced hyperglycemic rats at a dose level of 200 and 400 mg/kg body weight, in oral glucose tolerance test (OGTT), acute and subacute antidiabetic (30 d) models keeping a parallel group of metformin (250 mg/kg body weight) as standard drug. The serum biochemical parameters, histopathology of liver and pancreaswere examined and analyzed statistically.Results: Treatment with methanol extract of B. lacera (MEBL) at a dose of 200 mg/kg and 400 mg/kg body weight, significantly decrease (p&lt;0.05) blood glucose level from 289.83±9.83 and 289.83±2.71 to 201.83±8.87 and 105.00±2.05 respectively with corresponding percentage fall of blood glucose to 30.40±1.79 and 63.78±0.59. It also improved the glycated haemoglobin (HbA1c) near to normal value, restored the lipid and bio-chemical level and rejuvenate beta cells of pancreas, thereby improve insulin secretion.Conclusion: The result of the present study concluded that extracts of B. lacera DC possess marked antidiabetic activity. However, methanol extract of B. lacera (MEBL) at the dose of 400 mg/kg showed significant dose dependent antidiabetic effects without any destruction and restores the structure of liver and pancreas of hyperglycemic rats.

90 Comparison of Emergency Department Antihypertensive Agents on Cerebral Blood Flow

Data on the cerebral effects of commonly administered emergency department (ED) antihypertensive agents are limited. These effects are potentially important in patients requiring blood pressure reduction in neurological emergencies or those with known intracranial stenosis. The study objective was to measure the effect of common ED antihypertensive agents on cerebral blood flow in ED patients with severely elevated blood pressure. We conducted a prospective, quasi-experimental study of patients with a SBP > 180 mmHg and planned antihypertensive treatment in the ED. Patients who were < 18 years, pregnant, unable to consent prior to treatment, or had a known acute stroke were excluded. Non-invasive hemodynamic and cerebral vascular measurements were obtained prior to and post treatment. Cerebral vascular measurements were obtained with a transcranial Doppler fixed to a head-frame to detect middle cerebral artery mean flow velocities (MFV). Antihypertensive therapy was at the discretion of the treating physician. Analysis included descriptive statistics and generalized linear modeling, adjusted for baseline BP, to test the effect of four categories of antihypertensive agents on MFV. Categories included oral clonidine, intravenous (IV) labetalol, IV hydralazine and combination therapy (agents from ≥ 2 classes given within a 30-minute period). We enrolled 35 patients (37% female) with a mean age of 49 ± 13 years. A total of 8 (23%) patients received clonidine, 6 (17%) IV labetalol, 5 (14%) IV hydralazine and 16 (46%) combined therapy. Combination therapy most frequently included IV hydralazine and IV labetalol. The mean baseline SBP was 214 ± 24 mmHg and MFV was 49 ± 13 cm/sec. The mean percentage fall in mean arterial pressure by medication was: clonidine -12 ±7%, labetalol -13 ±12%, hydralazine -23 ± 11%, and combination -23 ± 16%. The overall change in MFV was -9 ± 15%, and by medication was: clonidine -10% (95% CI -2 to -21%), labetalol -11% (95% CI -5 to -27%), hydralazine +1% (95% CI -18 to +21%), and combination -11% (95% CI -2 to -19%). Adjusting for baseline BP, patients receiving hydralazine had less change in MFV compared to other medications (difference between means +12%, 95% CI -3 to +26%, p=0.1). In this study with modest BP reductions, common rapid-acting ED antihypertensive medications have comparable effects on cerebral blood flow. These results hint that cerebral blood flow may be more stable with hydralazine administration, but further testing is required.

Safety of primaquine given to people with G6PD deficiency: systematic review of prospective studies

BackgroundHaemolysis risk with single dose or short course primaquine was evaluated in glucose-6-phosphate dehydrogenase (G6PD) deficient people.MethodsMajor electronic databases (to August 2016) were searched for single or short course 8-aminoquinolines (8-AQ) in (1) randomized comparisons against placebo in G6PD deficient people; and (2) observational comparisons in G6PD deficient compared to replete people. Two authors independently assessed eligibility, risk-of-bias, and extracted data.ResultsFive randomized controlled trials and four controlled observational cohorts were included. In G6PD deficient individuals, high-dose (0.75 mg/kg) PQ resulted in lower average haemoglobin levels at 7 days (mean difference [MD] −1.45 g/dl, 95% CI −2.17 to −0.74, 2 trials) and larger percentage fall from baseline to day 7 (MD −10.31%, 95% CI −17.69 to −2.92, 3 trials) compared to placebo. In G6PD deficient compared to replete people, average haemoglobin was lower at 7 days (MD −1.19 g/dl, 95% CI −1.94 to −0.44, 2 trials) and haemoglobin change from baseline to day 7 was greater (MD −9.10%, 95% CI −12.55 to −5.65, 5 trials). One small trial evaluated mid-range PQ dose (0.4–0.5 mg/kg) in G6PD deficient people, with no difference detected in average haemoglobin at day 7 compared to placebo. In one cohort comparing G6PD deficient and replete people there was a greater fall with G6PD deficiency (MD −4.99%, 95% CI −9.96 to −0.02). For low-dose PQ (0.1–0.25 mg/kg) in G6PD deficient people, haemoglobin change from baseline was similar to the placebo group (MD 1.72%, 95% CI −1.89 to 5.34, 2 trials). Comparing low dose PQ in G6PD deficient with replete people, the average haemoglobin was lower in the G6PD deficient group at 7 days (−0.57 g (95% CI −0.97 to −0.17, 1 trial)); although change from baseline was similar (MD −1.45%, 95% CI −5.69 to 2.78, 3 trials).ConclusionsFalls in average haemoglobin are less marked with the 0.1 to 0.25 mg/kg PQ than with the 0.75 mg/kg dose, and severe haemolytic events are not common. However, data were limited and the evidence GRADE was low or very low certainty.

A study to evaluate the pattern and types of treatment of tibial plateau fracture at BPKIHS Dharan

Background: Tibial plateau fractures occur due to a combination of axial loading and varus/valgus forces leading to articular cartilage damage, mal-alignment and secondary osteoarthritis and functional loss.Objective: To know pattern and types of treatment of tibial plateau fractures and effect of fracture pattern on functional outcome. Method: We conducted prospective study over a period of one year. Fifty-three patients with tibial plateau fractures were presented during that period. Eighteen patients were excluded due to significant polytrauma and major limb injuries. Four patients did not give consent for the study. Thirty-one patients meeting the criteria were enrolled in the study. Two patients were lost during follow up. Remaining patients were evaluated at the end of one year. Data were recorded and analyzed using appropriate statistical methods.Result: Among 29 patients, 21 were male. Mean age was 35.07±11.96 years. 55.2% had RTA followed by 31 percent fall injury. 65% were treated with open reduction and internal fixation with plating followed by AK pop cast, cannulated cancellous screw and ilizarov fixation. Bone grafting was done in 3 cases. Twenty-five patients had excellent, two had good, two had fair and no patients had poor result. Three patients (10%) had complications. One had common peroneal nerve palsy, two had wound infections and no patient demonstrated early arthritic changes.Conclusion: Tibial plateau fractures treated with different modalities at our institute has been associated with excellent and good functional outcome at the end of short term follow up.Health Renaissance 2015;13 (3): 65-72

The effect of glycopyrronium and indacaterol, as monotherapy and in combination, on the methacholine dose-response curve of mild asthmatics: a randomized three-way crossover study

BackgroundMethacholine dose-response curves illustrate pharmacologic bronchoprotection against methacholine-induced airway hyperresponsiveness and can be used to quantitate changes in airway sensitivity (position), reactivity (slope), and maximal responsiveness following drug administration. Our objective was to determine the influence of single-dose glycopyrronium (long-acting muscarinic antagonist) and indacaterol (ultra-long acting β2 agonist), as monotherapy and in combination, on the methacholine dose-response curve of mild asthmatics and to compare these findings with a non-asthmatic control curve.MethodsThis was a randomized, double blind, double dummy, three-way crossover study. For asthmatic participants (n = 14), each treatment arm included a baseline methacholine challenge, drug administration, and repeat methacholine challenges at 1, 24, and 48 h. Non-asthmatic control participants (n = 15) underwent a single methacholine challenge and did not receive any study treatment. Methacholine dose-response curves were graphed as the percent fall in forced expiratory volume in 1 s (FEV1) for each methacholine concentration administered. Best-fit curves were then generated. Differences in airway reactivity were calculated through linear regression. Changes in airway sensitivity were assessed as the shift in the provocative concentration of methacholine causing a 20% fall in FEV1.ResultsCompared to baseline, all treatments significantly reduced airway sensitivity to methacholine at 1 h post-dose (indacaterol ~1.5 doubling concentrations; glycopyrronium ~5 doubling concentrations; combination ~5 doubling concentrations). Bronchoprotection at 24 and 48 h remained significant with glycopyrronium and combination therapy only. Airway reactivity was not influenced by indacaterol whereas glycopyrronium significantly reduced airway reactivity at all time-points (p = 0.003-0.027). The combination significantly decreased slope at 1 (p = 0.021) and 24 (p = 0.039) hours only. The non-asthmatic control and 1-h glycopyrronium curves are nearly identical. Only the non-asthmatic control and 1-h post-combination therapy curves appeared to generate a true response plateau (three data points within 5%), which occurred at a 14% fall in FEV1.ConclusionsMethacholine dose-response curves differentiate the bronchoprotective mechanisms triggered by different classes of asthma medications. Assessment of bronchoprotection using methacholine dose-response curves may be useful during clinical development of respiratory medications when performing superiority, equivalence, or non-inferiority trials.Trial registrationclinicaltrials.gov (NCT02953041). Retrospectively registered on October 24th 2016.

Changing ethnic inequalities in mortality in New Zealand over 30\xa0years: linked cohort studies with 68.9 million person-years of follow-up

BackgroundInternationally, ethnic inequalities in mortality within countries are increasingly recognized as a public health concern. But few countries have data to monitor such inequalities. We aimed to provide a detailed description of ethnic inequalities (Māori [indigenous], Pacific, and European/Other) in mortality for a country with high quality ethnicity data, using both standard and novel visualization methods.MethodsCohort studies of the entire New Zealand population were conducted, using probabilistically-linked Census and mortality data from 1981 to 2011 (68.9 million person years). Absolute (standardized rate difference) and relative (standardized rate ratio) inequalities were calculated, in 1–74-year-olds, for Māori and Pacific peoples in comparison to European/Other.ResultsAll-cause mortality rates were highest for Māori, followed by Pacific peoples then European/Other, and declined in all three ethnic groups over time. Pacific peoples experienced the slowest annual percentage fall in mortality rates, then Māori, with European/Other having the highest percentage falls – resulting in widening relative inequalities.Absolute inequalities, however, for both Māori and Pacific males compared to European/Other have been falling since 1996. But for females, only Māori absolute inequalities (compared with European/Other) have been falling.Regarding cause of death, cancer is becoming a more important contributor than cardiovascular disease (CVD) to absolute inequalities, especially for Māori females.ConclusionsWe found declines in all-cause mortality rates, over time, for each ethnic group of interest. Ethnic mortality inequalities are generally stable or even falling in absolute terms, but have increased on a relative scale. The drivers of these inequalities in mortality are transitioning over time, away from CVD to cancer and diabetes; such transitions are likely in other countries, and warrant further research. To address these inequalities, policymakers need to enhance prevention activities and health care delivery, but also support wider improvements in educational achievement and socioeconomic position for highest need populations.

Fluid supplementation in term neonates with severe hyperbilirubinemia: a randomized controlled trial study

Background: Severe neonatal jaundice can cause fatality and serious permanent effect, called kernicterus, in which the brain stem nuclei and basal ganglia are damaged. We are encouraged to work on efficacy of fluid supplementation in addition to photo therapy as a measure to reduce bilirubin level more efficiently.Methods: A randomized control trial study was conducted in Department of Paediatric Medicine, Neonatal Unit, R.G. Kar Medical College &amp; Hospital, Kolkata, from April 2011 to March 2012. A total 100 term neonates presenting with severe non-hemolytic hyperbilirubinemia (&gt;18 mg/dl to &lt;25 mg/dl) were enrolled as study population. The study subjects were divided into two equal groups, study group and control group by randomization. The study group was given IV fluid supplementation in addition to photo therapy. Total serum bilirubin (TSB) level assessed periodically and results compared with control group.Results: The study results reveal a statistically significant association between the percent fall in TSB at 12 (Chi2= 7.18, p=0.000) and 24 hours (Chi2=10.69, p=0.000) in the intervention arm compared to the control group.Conclusions: Fluid supplementation along with double surface phototherapy in term neonates presenting with severe hyperbilirubinemia decreases the rate of exchange transfusion and duration of phototherapy.

Global shocks and their impact on the Tanzanian economy

Abstract Plummeting commodity prices, China’s economic slowdown and rebalancing, and global financial market turbulence have recently raised concerns about their effects on African economies. This paper investigates whether, and to what extent, these intertwined shocks spillover into the Tanzanian economy. The author finds that a 1 percentage point (ppts) drop in China’s investment growth is associated with a decline in Tanzania’s export growth of roughly 0.60 ppts. A 1 percent fall in commodity prices leads to 0.65 percent lower exports value. The results suggest that a hard landing of the Chinese economy to its ‘new normal’ would doubtless send shock waves through the Tanzanian economy by further driving down commodity demand and prices as well as lowering development finance. In contrast, financial market volatility has a fairly negligible impact on economic growth. The main results stand up well to a wide-array of robustness checks.

Thyroid profile and its relationship with response to treatment with lithium in bipolar mood disorder patients

IntroductionThere is substantial evidence that even minor perturbation of thyroid function plays a significant role in clinical course and treatment outcome in depressive disorder; however the same is not yet clear in bipolar disorders.Aims and objectivesTo study the relationship between pretreatment thyroid profile and response to treatment with lithium along with other predictors of response to treatment with lithium in cases of bipolar mood disorder.MethodsThis study was conducted in the indoor facilities of a regional Institute of Mental Health, Tezpur, India in the year of 2012. Forty-five consecutive indoor patients diagnosed with bipolar mood disorder using DSM-IV-TR criteria were selected. On day 1, blood was collected for thyroid profile and BPRS 24 item scale version 4.0 was applied. They were started on lithium monotherapy and only lorazepam was used on S.O.S basis. On day 30, the BPRS was applied again to check the response to treatment, statistical analysis was done using SPSS version 16.ResultsThe mean percentage fall of the BPRS score was 40%, with the maximum fall in the subscale of grandiosity and minimum for depression. Age, illness duration, substance use, family history second or later episodes were negatively correlated with treatment response. Pretreatment T4 level was positively correlated, while pretreatment TSH level was negatively correlated with the treatment response.ConclusionLithium monotherapy proved to be a good agent for first episode of bipolar Mood disorder patients with manic symptoms and pretreatment T4 and TSH level were predictors of treatment response.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Does Tranexamic Acid Reduce Bleeding during Femoral Fracture Operation?

Proximal Femoral shaft fractures are commonly associated with marked blood loss which can lead to postoperative acute anemia and some other complications. Tranexamic acid (TA) is an antifibrinolytic medication that reduces intra-and postoperative blood loss and transfusion requirements during some elective surgeries. The aim of this study is to evaluate the effect of intravenous Tranexamic acid (TA) on intraoperative blood loss and a subsequent need for transfusion in patients who were undergoing surgery for femoral shaft fractures in trauma setting. Thirty-eight ASA grade I-II patients undergoing proximal femoral shaft fracture surgery with intra medullary nailing were included in this double blind randomized controlled clinical trial. They were allocated into two groups. Group I, the intervention group with eighteen patients received 15 mg/kg (TA) via intravenous infusion before surgical incision. Patients in the placebo group received an identical volume of normal saline. Hemoglobin level was measured four hours before and after the surgeries. Postoperative blood loss and hemoglobin change as well as transfusion rates and volumes were compared between the two groups. Mean Percentage fall in hemoglobin after surgery were 1.75±0.84 and 2.04±1.9 in the study and placebo groups, respectively (P=0.570). Hemoglobin loss was higher in the placebo group. Transfusion rates was lower in TA group (5.6%) compared to the placebo group (30%) (P=0.06). No significant difference in The Allowable Blood Loss during the surgery was found between the two groups (P=0.894). Preoperative treatment with TA reduces postoperative blood loss and the need for blood transfusion during traumatic femoral fracture operation.

Changes in serum osmotic pressure following haemodialysis treatments lead to changes in bioimpedance spectroscopy estimates of lean and adipose tissue.

Haemodialysis (HD) patients are at risk of sarcopenia. Newer bioimpedance devices (BIS) using a three-compartmental body composition model, separate extracellular water overhydration from normo-hydrated lean tissue mass (LTM) and adipose tissue mass (ATM). During HD hydration status changes, along with changes in electrolytes and solutes, and may alter body composition measurements. As such, we measured BIS and serum osmotic pressure (sOP) pre- and post dialysis in 43 patients. There were no significant changes in LTM (39.5±15.1 vs 39.3±15.2 kg) or sOP (33.2±8.3 vs 35.9±9.7 mm Hg). Higher post-dialysis sOP was associated with a greater percentage fall in LTM (r=0.43, P=0.08) and increase in ATM (r=-0.43, P=0.017). Increased sOP post dialysis was associated with a reduction in LTM (r=0.36, P=0.033) and increased ATM (r=-0.44, P=0.013). Changes in sOP with HD are associated with changes in BIS body composition measurements. BIS measurements should preferably be made when patients are least overhydrated.