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University Teaching Hospital (university + teaching_hospital)
Selected AbstractsEtiologic spectrum and pattern of antimicrobial drug susceptibility in bacterial meningitis in Sokoto, NigeriaACTA PAEDIATRICA, Issue 8 2000FE EmeleArticle first published online: 2 JAN 200 Etiologic agents of meningitis were prospectively investigated among patients admitted to Usman Danfodio University Teaching Hospital, Sokoto. Of 1097 cerebrospinal fluid (CSF) samples submitted to the microbiology laboratory from various wards of the hospital, 289 (26%) were microscopically, culturally and/or serologically proven to be bacterial meningitis. The etiologic spectrum was as follows: Neisseria meningitidis (61%), Streptococcus pneumoniae (18%), Haemophilus influenzae (10%), Staphylococcus aureus (6%), Coliform bacilli (3%), Escherichia coli (0.7%), Mycobacterium tuberculosis (0.7%), Listeria monocytogenes (0.4%), Flavobacterium meningosepticum (0.4%) and Pseudomonas putrifasciens (0.4%). Bacterial meningitis was most prevalent (195 or 68%) among children aged 1-9 y, while adults and neonates were least affected. Coliform bacilli caused five of eight neonatal cases. Males were more frequently affected than females (x2=12.50;p < 0.05). Culture and microscopy were comparatively less efficient than the search for bacterial antigens, especially in the diagnosis of Haemophilus meningitis. Antimicrobial susceptibility of N. meningitidis to ampicillin and benzyl penicillin reduced progressively over the years (F = 406.98;p < 0.001). Nineteen (11%) of the isolates (5 Meningococci, 7 Staph. aureus, 1 Haem. influenza and 6 others) showed simultaneous resistance to chloramphenicol, ampicillin and benzyl penicillin. [source] Serum lipid profile in highly active antiretroviral therapy-naïve HIV-infected patients in Cameroon: a case,control studyHIV MEDICINE, Issue 6 2010Nf Nguemaïm Background HIV status has commonly been found to affect the serum lipid profile. Objectives The aim of this study was to determine the effect of HIV infection on lipid metabolism; such information may be used to improve the management of HIV-infected patients. Methods Samples were collected from December 2005 to May 2006 at Yaounde University Teaching Hospital, Yaounde, Cameroon. Lipid parameters were obtained using colorimetric enzyme assays, while low-density lipoprotein cholesterol (LDLC) values were calculated using the formula of Friedewald et al. (1972) and atherogenicity index by total cholesterol (TC)/high-density lipoprotein cholesterol (HDLC) and LDLC/HDLC ratios. Results HIV infection was most prevalent in subjects aged 31 to 49 years. Most of the HIV-positive patients belonged to Centers for Disease Control and Prevention categories B (43.0%) and C (30.23%). Compared with control subjects, patients with CD4 counts<50 cells/,L had significantly lower TC (P<0.0001) and LDLC (P<0.0001) but significantly higher triglyceride (TG) values (P<0.001) and a higher atherogenicity index for TC/HDLC (P<0.01) and HDLC/LDLC (P=0.02); patients with CD4 counts of 50,199 cells/,L had significantly lower TC (P<0.001) and significantly higher TG values (P<0.001); patients with CD4 counts of 200,350 cells/,L had significantly higher TG (P=0.003) and a higher atherogenicity index for TC/HDLC (P<0.0002) and HDLC/LDLC (P=0.04); and those with CD4 counts >350 cells/,L had a higher atherogenicity index for TC/HDLC (P<0.0001) and HDLC/LDLC (P<0.001). HDLC was significantly lower in HIV-positive patients irrespective of the CD4 cell count. Lipid parameters were also influenced by the presence of opportunistic infections (OIs). Conclusion HIV infection is associated with dyslipidaemia, and becomes increasingly debilitating as immunodeficiency progresses. HDLC was found to be lower than in controls in the early stages of HIV infection, while TG and the atherogenicity index increased and TC and LDLC decreased in the advanced stages of immunodeficiency. [source] The Effect of Preemptive Analgesia in Postoperative Pain Relief,A Prospective Double-Blind Randomized StudyPAIN MEDICINE, Issue 1 2009Seetharaman Hariharan MD ABSTRACT Objective., To analyze the effect of infiltration of local anesthetics on postoperative pain relief. Design., Prospective randomized double-blind trial. Setting., University Teaching Hospital in Barbados, West Indies. Patients., Patients undergoing total abdominal hysterectomy. Interventions., Patients were randomly allocated into one of four groups according to the wound infiltration: 1) preoperative and postoperative 0.9% saline; 2) preoperative saline and postoperative local anesthetic mixture (10 mL 2% lidocaine added to 10 mL 0.5% bupivacaine); 3) preoperative local anesthetic mixture and postoperative saline; and 4) preoperative and postoperative local anesthetic mixture. Both patients and investigators were blinded to the group allocation. All patients received pre-incision tenoxicam and morphine, standardized anesthesia, and postoperative morphine by patient-controlled analgesia. Outcome measures., The amount of morphine used and the intensity of pain as measured by visual analog pain scale were recorded at 1, 2, 3, 4, 8, 12, 24, and 48 hours postoperatively. Results., Eighty patients were studied with 20 in each group. Total dose of morphine used by patients who received preoperative and postoperative local anesthetic infiltration was lesser compared to other groups, although there was no statistically significant difference. Similarly, there was no difference in the intensity of pain between any groups. Conclusions., Local anesthetic infiltration before and/or after abdominal hysterectomy does not reduce the intensity of postoperative pain and analgesic requirements. [source] Fertility control: Oral versus self-administered vaginal misoprostol at home before surgical termination of pregnancy: a randomised controlled trialBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2006Kevin Sunde Oppegaard Objective, To compare the impact of 400 ,g oral versus self-administered vaginal misoprostol at home on pre-operative cervical priming in both primigravid and multigravid women prior to first trimester surgical abortion. Design, Randomised controlled trial. Setting, Norwegian University Teaching Hospital. Sample, Three hundred and thirty-eight women undergoing surgical abortion between 7 and 12 weeks of gestation. Methods, The women were randomised to either 400 ,g of oral misoprostol the evening before or 400-,g of self-administered vaginal misoprostol at home the same day as vacuum aspiration. Main outcome measures, Pre-operative cervical dilatation, complications and acceptability. Results, The median cervical dilatation was 6.2 mm (range 0,11 mm) for the women in the 400 ,g oral misoprostol and 6.5 mm (range 0,11 mm) in the 400-,g vaginal misoprostol groups. The median pre-operative dilatation was larger in multigravidae (6.4 and 6.7 mm for the oral and vaginal routes, respectively) than in primigravidae (5.8 and 6.0 mm, respectively). In primigravidae, 19% achieved a pre-operative dilatation of ,7 mm, with no significant difference between oral and vaginal dosage. In multigravidae, 52% achieved a pre-operative dilatation of ,7 mm with vaginal dosage, compared with 36% with oral dosage (P= 0.03). There was no difference between non-immigrant versus immigrant women in pre-operative cervical dilatation. The 400-,g oral dosage group had a higher risk of bleeding, compared with the group receiving 400-,g vaginal misoprostol [odds ratio (OR) = 10.4; confidence interval (CI) 5.2,20.8]. There was no difference between non-immigrant and immigrant women in acceptability of self-administered vaginal misoprostol; almost all women found this administration route acceptable. Complications were minor and were distributed equally between the two dosage groups. Conclusions, The vaginal route will result in a satisfactory dilatation in about half of multigravidae but is much less effective in primigravidae. The oral route does not lead to satisfactory dilatation in either group and is associated with a higher occurrence of pre-operative bleeding. Self-administered vaginal misoprostol at home is highly acceptable. [source] The impact of past pregnancy experience on subsequent perinatal outcomesPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 4 2008Jennifer A. Hutcheon Summary In perinatal epidemiology, the basic unit of analysis has traditionally been the individual pregnancy. In this study, we sought to explore the idea of a ,reproductive life'-based approach to modelling the effects of reproductive exposures and outcomes, where the basic unit of analysis is a woman's entire reproductive experience. Our objective was to explore whether a first pregnancy risk factor, excess gestational weight gain, has a direct effect on the birthweight outcomes of a subsequent pregnancy, independent of the weight gain and other risk factors of the second pregnancy. A study population was created by linking the obstetric records of 1220 women who delivered their first and second offspring at a McGill University teaching hospital in Montreal, Canada. Multivariable linear and logistic regression analyses were used to model the effects of gestational weight gain above recommendation on the birthweight Z -score and risk of large-for-gestational age (LGA) subsequent offspring. After adjusting for the risk factors of the second pregnancy, an independent effect from the first pregnancy was seen on the birthweight Z -score, (effect size OR 0.17 [95% CI 0.05, 0.28] but not risk of LGA of the second pregnancy 1.30 [95% CI 0.89, 1.89]). We concluded that a pregnancy-centred approach to research that conceptualises pregnancies as self-contained and interchangeable events may not always be appropriate, and propose that analytical methods for some perinatal research questions may need to consider a given pregnancy in the context of a woman's past reproductive experiences. [source] Combined Anterior-to-Posterior and Posterior-to-Anterior Approach to Paranasal Sinus Surgery: An Update,THE LARYNGOSCOPE, Issue 4 2006FACS, Steven D. Schaefer MD Abstract Objectives: To develop an anatomically and functionally based approach to endoscopic intranasal ethmoidectomy; to develop such an approach using the salient features of the anterior-to-posterior (AP) and posterior-to-anterior (PA) intranasal sinus operations; to assess the safety of this form of ethmoidectomy in a patient population. Study Design: Retrospective chart review of patients undergoing ethmoidectomy by the authors or by residents under their direct supervision. Setting: University teaching hospital. Results: Two thousand three hundred and forty-four patients underwent either unilateral or bilateral ethmoidectomies between April 1992 and August 2005. A complication rate of 0.34% was observed. Conclusions: Combining an AP approach to conserve sinus anatomy with a PA approach to avoid surgery directed toward the skull base provides a functional and safe procedure, as demonstrated by the reported results. [source] Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methodsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2010SJ Meltzer Please cite this paper as: Meltzer S, Snyder J, Penrod J, Nudi M, Morin L. Gestational diabetes mellitus screening and diagnosis: a prospective randomised controlled trial comparing costs of one-step and two-step methods. BJOG 2010;117:407,415. Objective, To conduct a cost minimisation analysis of three methods of gestational diabetes mellitus (GDM) screening and diagnosis. Design, Prospective randomised controlled trial. Setting, University teaching hospital. Population, Pregnant women (n = 1594) presenting for GDM screening. Methods, Women presenting for GDM screening, who consented to participate, were randomised to GR1 [1-hour, 50-g glucose screen (GS) ± 3-hour, 100-g oral glucose tolerance test (OGTT)], GR2 (50-g GS ± 2-hour, 75-g OGTT) or GR3 (2-hour, 75-g OGTT). Demographics, health and time/travel cost information were assessed for each glucose testing visit. Main outcome measures, Costs (direct and indirect) and prevalence of GDM diagnosis. Results, The direct sampling costs of the glucose tests per woman were as follows: GS, CAN$12.57; 75-g OGTT, $36.10; 100-g OGTT, CAN$48.13. Among women in the two-step method groups diagnosed with GDM, 39% of the GR1 and 61% of the GR2 groups were diagnosed at the first step by GS , 10.3 mmol/l, according to the Canadian Diabetes Association recommendations, contributing to a lower total cost in these groups. The total costs per woman screened were as follows: GR1, CAN$91.61; GR2, CAN$89.03; GR3, CAN$108.38. The GDM prevalence was similar (3.7%, 3.7% and 3.6%, respectively). The higher costs of GR3 were related to more blood draws and the time required for all women to undergo the 2-hour OGTT. Conclusions, Careful consideration should be given to an internationally recommended method of universal screening for GDM which minimises the burden and cost for individual women and the healthcare system, yet provides diagnostic efficacy. The two-step method (GS ± OGTT) accomplished this better than the one-step method (75-g OGTT). [source] A randomised controlled trial of 6 and 12 hourly administration of vaginal misoprostol for second trimester pregnancy terminationBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2005Yongyoth Herabutya Objective To compare the effectiveness of vaginal misoprostol administered 6 or 12 hourly for second trimester pregnancy termination. Design A randomised controlled trial. Setting University teaching hospital. Sample Two hundred and seventy-nine pregnant women at gestations between 14 and 26 weeks undergoing pregnancy termination. Methods Women were randomised to receive 600-,g misoprostol tablets vaginally either every 6 hours or every 12 hours until abortion occurred. Main outcome measures Induction,abortion interval, success rate within 24 and 48 hours and adverse effects. Results There was no significant difference in the median induction to abortion interval 6 hours (16 hours) and 12 hours (16 hours; P= 0.80). The total dose of misoprostol was higher in the 6-hour group (1800 vs 1200 ,g). The cumulative abortion rates within 24 hours were 74% and 67% and within 48 hours 94% and 92%, in the 6- and 12-hour groups, respectively. Fever was more common in the 6-hour group (53%) versus the 12-hour group (31%; P < 0.001). The incidence of nausea, vomiting, diarrhoea, severe bleeding and abdominal pain were similar. Conclusions Misoprostol (600 ,g) administered at 12-hour intervals was associated with fewer adverse effects and was as effective as a 6-hour interval. [source] Morbidity of incontinence surgery in women over 70 years old: a retrospective cohort studyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2005Harriet Pugsley Objective To compare the success rate and complications after colposuspension and tension-free vaginal tape (TVT) insertion in women aged 70 years or more compared with younger women. Design A retrospective study of patients having surgery between November 2000 and October 2002. Setting A tertiary referral, academic urogynaecology unit in a University teaching hospital. Population Two hundred and twenty-six women having surgical treatment for urinary incontinence. Methods Data on cure/improvement and complications were extracted from the notes. Patients were grouped by age at surgery and the odds ratios (OR) and 95% confidence intervals (CI) for each outcome were calculated. Main outcome measures Subjective cure rate and the incidence of complications by age group. Results One hundred and three patients had colposuspension, 11 (10.7%) aged 70 or more. One hundred and twenty-three patients had TVT insertions, 23 (18.7%) aged 70 or more. The cure rate for each procedure was similar between age groups. After colposuspension, urinary tract infection (UTI; OR 11.33; 95% CI 2.61, 49.28) and long term self-catheterisation (percentage of difference 9.1; 95% CI 3.0, 15.2) were more common in women over 70. After TVT, repeat urodynamics (OR 3.91; 95% CI 1.11, 13.76), recurrent UTI (OR 4.22; 95% CI 1.03, 17.26) and tape division (OR 29.12; 95% CI 3.20, 264.86) were more common in older women. Conclusions Incontinence surgery carries a higher risk of complications in the elderly including UTI and voiding dysfunction. Extended antibiotic prophylaxis and intermittent self-catheterisation training should be offered to elderly women before surgery. [source] Endothelial cell expression of adhesion molecules is induced by fetal plasma from pregnancies with umbilical placental vascular diseaseBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 7 2002Xin Wang Objective To test the hypothesis that local production with spill into the fetal circulation of factor(s) injurious to endothelium is responsible for the vascular pathology present when the umbilical artery Doppler study is abnormal. Expression of adhesion molecules is a feature of endothelial cell activation. Design Case,control study. Setting University teaching hospital. Samples Fetal plasma was collected from 27 normal pregnancies, 39 pregnancies with umbilical placental vascular disease defined by abnormal umbilical artery Doppler and 11 pregnancies with pre-eclampsia and normal umbilical artery Doppler. Methods Isolated and cultured human umbilical vein endothelial cells from normal pregnancies were incubated with fetal plasma from three study groups. mRNA expression of intercellular cell adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and platelet-endothelial cell adhesion molecule-1 (PECAM-1) were assessed by reverse transcription-polymerase chain reaction. To confirm the occurrence of this in vivo, we measured the levels of soluble fractions of sICAM-1, sVCAM-1 and sPECAM-1 in the fetal circulation in the fetal plasma used for endothelial cell incubation. Results The mRNA expression of ICAM-1 [median 1.1 (interquartile range 0.5,1.9) vs 0.7 (0.3,1.2), P < 0.05] and PECAM-1 [2.1 (1.2,3.0) vs 1.5 (0.7,2.1), P < 0.05] was significantly higher following incubation with fetal plasma from umbilical placental vascular disease compared with the normal group. There was no difference in the expression of VCAM-1 [1.2 (0.9,1.8) vs 1.1 (0.8,1.6), ns]. The group with maternal pre-eclampsia and normal umbilical artery Doppler did not differ from the normal group. In the umbilical placental vascular disease group, the results were similar in the presence or absence of pre-eclampsia. For soluble fractions of the adhesion molecules released into the fetal circulation, we found the levels (ng/mL) of sICAM-1 [median 248.5 (interquartile range 197.3,315.7) vs 174.2 (144.5,212.9), P < 0.05] and sPECAM-1 [9.3 (6.2,11.1) vs 6.1 (5.4,7.7), P < 0.05] in fetal plasma to be significantly increased in the presence of umbilical placental vascular disease compared with the normal. Conclusions Vascular disease in the fetal umbilical placental circulation is associated with an elevation in mRNA expression by endothelial cells of ICAM-1 and PECAM-1. Our study provides evidence for endothelial cell activation and dysfunction in umbilical placental vascular disease. We speculate that the plasma factor(s) affecting the vessels of the umbilical villous tree is locally released by the trophoblast. The occurrence of the maternal syndrome of pre-eclampsia appears to be independent of this. [source] High incidence of obstetric interventions after successful external cephalic versionBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2002Louis Yik-Si Chan Objective To investigate the delivery outcome after successful external cephalic version (ECV). Design Case,control study. Setting University teaching hospital. Population The study group consisted of 279 consecutive singleton deliveries at term over a six-year period, all of which had had successful ECV performed. The control group included 28,447 singleton term deliveries during the same six-year period. Methods Between group differences were compared with the Mann,Whitney U test or Student's t test where appropriate. Odds ratio and 95% confidence interval (CI) were calculated for categorical variables. Main outcome measures Incidence of and indications for obstetric interventions. Results The risk of instrumental delivery and emergency caesarean section was higher in the ECV group (14.3%vs 12.8%; OR 1.4; 95% CI 1.0,2.0, and 23.3%vs 9.4%; OR 3.1; 95% CI 2.3,4.1, respectively). The higher caesarean rate was due to an increase in all major indications, namely, suspected fetal distress, failure to progress in labour and failed induction. The higher incidence of instrumental delivery was mainly due to an increase in prolonged second stage. The odds ratio for operative delivery remained significant after controlling for potential confounding variables. There were also significantly greater frequencies of labour induction (24.0%vs 13.4%; OR 2.0; 95% CI 1.5,2.7) and use of epidural analgesia (20.4%vs 12.4%; OR 1.8; 95% CI 1.4,2.4) by women in the ECV group. The higher induction rate is mainly due to induction for post term, abnormal cardiotocography (CTG) and antepartum haemorrhage (APH) of unknown origin. Conclusion The incidence of operative delivery and other obstetric interventions are higher in pregnancies after successful ECV. Women undergoing ECV should be informed about this higher risk of interventions. [source] A randomised controlled trial of routine suction drainage after elective thyroid and parathyroid surgery with ultrasound evaluation of fluid collectionCLINICAL OTOLARYNGOLOGY, Issue 1 2007S. Ahluwalia Objective:, To determine the need for suction drainage after elective thyroid and parathyroid surgery. Design:, Randomised controlled trial. Setting:, University teaching hospital. Participants:, Patients requiring elective thyroid or parathyroid surgery were recruited and informed consent was obtained (n = 100). Before wound closure, patients were randomised into either group A (to remain without suction drainage) or group B (to receive suction drainage). Excluded patients were those requiring associated neck dissection and those with bleeding diatheses, all of whom would necessarily require drainage in our unit. Main outcome measures:, Primary , ultrasound evaluation of any collection in the thyroid bed, performed 1-day postoperatively. Secondary , postoperative complications; length of in-patient stay. Results:, One hundred patients completed the study, and groups A and B comprised 50 patients each. Patients in each group exhibited a mean age of 49 years, and a male to female ratio of 1 : 9. Both groups were also well-matched regarding type of operation, size of tumour and histopathological diagnosis. Modal and median postoperative neck collection volume on ultrasound examination was 0 and 0 cm3 respectively (range 0,16 cm3) in group A and was 0 and 0 cm3 (range 0,70 cm3) in group B. This difference was not statistically significant, but three patients with a haematoma were all in the suction drainage group. Difference in complication rates between groups was also not statistically significant. Modal and median length of in-patient stay was 2 and 2 days respectively (range 2,3 days) in group A and 3 and 3 days (range 2,4 days) in group B, and this difference was statistically significant (P = 0.0006). Conclusion:, Routine suction drainage after uncomplicated elective thyroid and parathyroid surgery appears unnecessary, and prolongs in-patient stay. [source] Medicinal plants and the treatment of diabetes in Senegal: survey with patientsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 2 2008Amadou Moctar Dièye Abstract Diabetes is the most common metabolic disorder worldwide and is a major public health problem. Its frequency increases every day in all countries. However, in developing African countries, few people have access to drugs. In addition, in Africa, traditional beliefs induce people to use medicinal plants whenever they have health problems. Thus, many people in these developing countries use plants for the treatment of diabetes. Yet, few studies are focused on the knowledge and attitudes of the users on medicinal plants in Africa in general and in Senegal in particular. Hence we undertook this survey on the use of medicinal plants for the treatment of diabetes in Senegal in order to make recommendations which could contribute to the increase of the value of herbal medicines in developing countries. We did a cross-sectional survey by direct interview at a university teaching hospital, in Dakar with a representative sample of 220 patients. Forty-one plants were used by the patients and the two most frequently cited were Moringa oleifera Lam (65.90%) and Sclerocarya birrea (A. Rich) Hochst (43.20%). Patients gave several reasons for using medicinal plants (traditional treatment: 40%, efficacy: 32%, low cost: 20%). The principal suppliers of plants were tradesmen in the market (66.8%) and traditional therapists (5%). Sixty-five per cent of patients think that medicinal plants are efficient for the treatment of diabetes and 20% have reported adverse effects which could be caused by medicinal plants. In conclusion, many people in our study think that medicinal plants are efficient for the treatment of diabetes, which requires research work by scientists in developing countries in this field in order to prove their efficacy and innocuousness. [source] Influence of climate on the incidence of thiazide-induced hyponatraemiaINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2007K. M. Chow Summary The role of hot temperature has been implicated in thiazide-induced hyponatraemia; however, it has never been studied in a systematic manner. The aim of this retrospective study is to correlate the incidence of thiazide-induced hyponatraemia and climate factors in a university teaching hospital from June 1996 to February 2002. We evaluated a representative sample of 201 subjects with thiazide-induced hyponatraemia. Overall, 2.9 ± 2.2 (range 0,10, median 3) cases of thiazide-induced hyponatraemia were encountered each month during the study period. There was no seasonal variation in the rate of thiazide-induced hyponatraemia (overall ,2 test, p = 7.0). Thiazide-induced hyponatraemia was not more frequently reported in summer. There was no discernible correlation between the monthly number of cases and average air temperature (r = ,0.056, p = 0.65) and relative humidity (r = 0.103, p = 0.40). On the other hand, patients who presented with thiazide-induced hyponatraemia in July and August had significantly higher serum sodium concentration, 118 ± 7 mmol/l vs. 114 ± 8 mmol/l in other calendar months (p = 0.016). Temperature showed a statistically significant positive correlation with the level of serum sodium (r = 0.20, p = 0.004). These data demonstrate that there are no seasonal variations in thiazide-induced hyponatraemia disorders, at least in countries with subtropical climate. The question arises whether hypotonic sweat loss mitigates the risk of excessive water drinking in hot summer. [source] Lesson from performing SCORADs in children with atopic dermatitis: Subjective symptoms do not correlate well with disease extent or intensityINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2006K. L. E. Hon MBBS Background, Atopic dermatitis (AD) is a distressing disease associated with pruritus and sleep disturbance. It is not known how well these symptoms correlate with the extent and intensity of eczematous involvement. We evaluated whether: (i) the level of sleep loss correlates with pruritus and (ii) the level of pruritus correlates with the extent or severity of AD in children according to the SCORing Atopic Dermatitis (SCORAD) index. Method, Patients with AD younger than 18 years old were recruited from the pediatric dermatology clinic of a university teaching hospital, and AD severity was evaluated by the SCORAD index. Results, One hundred and eighty-two Chinese children with AD (107 boys and 75 girls) [mean (SD) age of 9.6 (4.2) years] were recruited. Their mean (SD) overall SCORAD was 30.1 (19.2). Sleep loss was strongly correlated with pruritus (r = 0.57, P < 0.001). However, the two subjective symptoms were only weakly correlated with the objective signs (extent and intensity) of AD. The correlations between pruritus and extent and intensity were 0.42 (P < 0.001) and 0.38 (P < 0.001), respectively, and the correlations between sleep loss and extent and intensity were 0.38 (P < 0.001) and 0.34 (P < 0.001), respectively. Conclusion, We speculate that the lack of a better correlation was either because pruritus and sleep loss as reported by parents were imprecise, or that mechanisms other than disease extent or severity are responsible for the pathogenesis of these subjective symptoms. [source] Outcome Predictors of Pneumonia in Elderly Patients: Importance of Functional AssessmentJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 10 2004Olga H. Torres MD Objectives: To evaluate the outcome of elderly patients with community-acquired pneumonia (CAP) seen at an acute-care hospital, analyzing the importance of CAP severity, functional status, comorbidity, and frailty. Design: Prospective observational study. Setting: Emergency department and geriatric medical day hospital of a university teaching hospital. Participants: Ninety-nine patients aged 65 and older seen for CAP over a 6-month recruitment period. Measurements: Clinical data were used to calculate Pneumonia Severity Index (PSI), Barthel Index (BI), Charlson Comorbidity Index, and Hospital Admission Risk Profile (HARP). Patients were then assessed 15 days later to determine functional decline and 30 days and 18 months later for mortality and readmission. Multiple logistic regression was used to analyze outcomes. Results: Functional decline was observed in 23% of the 93 survivors. Within the 30-day period, case-fatality rate was 6% and readmission rate 11%; 18-month rates were 24% and 59%, respectively. Higher BI was a protective factor for 30-day and 18-month mortality (odds ratio (OR)=0.96, 95% confidence interval (CI)=0.94,0.98 and OR=0.97, 95% CI=0.95,0.99, respectively; P<.01), and PSI was the only predictor for functional decline (OR=1.03, 95% CI=1.01,1.05; P=.01). Indices did not predict readmission. Analyses were repeated for the 74 inpatients and indicated similar results except for 18-month mortality, which HARP predicted (OR=1.73; 95% CI=1.16,2.57; P<.01). Conclusion: Functional status was an independent predictor for short- and long-term mortality in hospitalized patients whereas CAP severity predicted functional decline. Severity indices for CAP should possibly thus be adjusted in the elderly population, taking functional status assessment into account. [source] Evaluation of Propofol-Ketamine Anesthesia for Children Undergoing Cardiac Catheterization ProceduresJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2007F.F.A. (DUBLIN), F.R.C.A. (LOND), Parthasarathi GAYATRI M.D. The aim of this study was to assess the safety and efficacy of the continuous intravenous administration of a combination of propofol and ketamine for children undergoing cardiac catheterization procedures (CCP). Thirty-two children scheduled for CCP in a university teaching hospital were included in this prospective randomized study. Patients in group 1 (n = 15) were given a combination of propofol (25 ,g/kg per minute) and ketamine (25 ,g/kg per minute), whereas patients in group 2 (n = 17) received a combination of propofol (25 ,g/kg per minute) and ketamine (12.5 ,g/kg per minute) for the maintenance of anesthesia. There were no statistically significant differences with age, weight, duration of the procedure, and the number of diagnostic and interventional procedures between the two groups. There was no hemodynamic instability, airway compromise, excessive salivation, or arterial desaturation in either of the two groups. There was more incidence of movements in patients who received less dose of ketamine; however, it did not reach to statistically significant level. The total dose of ketamine used in group 1 was 309.25 ± 90.97 ,g/min, whereas in group 2, it was 148.06 ± 34.05 ,g/min. The time to awakening was significantly less in group 2 (P < 0.05). We conclude that a combination of propofol (25 ,g/kg per minute) and two different doses of ketamine (25 and 12.5 ,g/kg per minute, respectively) are safe and efficacious for CCP in children. Although the time to awaken was more in patients receiving 25 ,g/kg per minute of ketamine compared to those receiving 12.5 ,g/kg per minute of ketamine, it was well within acceptable limits. [source] Severe chronic neutropenia in Chinese children in Hong KongJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 2 2001TF Leung Objective: Severe chronic neutropenia (SCN) is a rare and heterogeneous disorder in children. The epidemiology, clinical features and outcomes of SCN in Chinese children were reviewed. Methodology: A retrospective analysis of case records was undertaken for 18 children with SCN managed during a 12-year period in a university teaching hospital in Hong Kong. Results: The median (range) age of the patients at initial presentation was 6.5 months (4 days,19 months). The initial and lowest median absolute neutrophil counts (ANC) were 0.29 × 109 /L and 0.06 × 109 /L, respectively. Patients with congenital SCN had significantly fewer neutrophils in peripheral blood at diagnosis. Only five subjects received granulocyte colony-stimulating factor (G-CSF) treatment. All children were free from serious infection on follow up for 51 months. Only one child suffered from long-term infection-related morbidity. One patient with chronic neutropenia was subsequently shown to have common variable immunodeficiency. Conclusions: Most children with SCN in our series had favourable clinical outcomes. Our results support the recommendation that G-CSF should be used only in those with recurrent or severe infections. [source] Evaluation of acute congestive heart failure in dogs and cats: 145 cases (2007,2008)JOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 3 2010Caroline M. Goutal DVM Abstract Objective , To characterize the clinical presentation, management, and in-hospital outcomes of dogs and cats diagnosed with acute congestive heart failure (CHF). Design , Retrospective study of animals seen between January 2007 and May 2008. Setting , Emergency service at a university teaching hospital. Animals , Ninety dogs and 55 cats with CHF. Measurements and Main Results , Patient characteristics, including age, clinical signs, clinicopathologic abnormalities, diagnostic testing, and outcome were recorded. Forty-eight of the animals already were receiving cardiac medications at the time of presentation. The most common diseases represented were chronic valvular disease and cardiomyopathies. Cats had significantly lower median body temperature at admission compared with dogs (P<0.001). The most common abnormalities were elevated lactate (64%), elevated BUN (52%), hypochloremia (31%), hyperglycemia (27%), and elevated liver enzymes (26%). Many of these became even more prevalent during hospitalization. One hundred and sixteen animals were discharged from the hospital, for a survival rate of 80%. There was no survival difference between dogs and cats (P=0.39). Dogs that developed hypokalemia during hospital stay (P=0.04) were more likely to survive compared with those without hypokalemia and initial body temperature was lower for those cats that did not survive (P=0.02). Of those that did not survive, the majority were euthanized (n=25), while 4 dogs died. Conclusions , Dogs and cats presented to the emergency service with CHF had a high survival rate. In cats, initial body temperature was lower for those cats that did not survive. Although clinicopathologic abnormalities were common in both species, only dogs with hypokalemia had improved survival to hospital discharge. [source] Comparison of the USCOM ultrasound cardiac output monitor with pulmonary artery catheter thermodilution in patients undergoing liver transplantation,LIVER TRANSPLANTATION, Issue 7 2008Lai-Sze Grace Wong The aim of the study was to compare the standard technique of cardiac output determination by pulmonary artery catheter thermodilution (PAC-TD) with a noninvasive ultrasound Doppler monitor (USCOM Pty., Ltd., Coffs Harbour, Australia) in surgery for liver transplantation. We wished to determine if the degree of accuracy would allow the ultrasound cardiac output monitor (USCOM) to be used as an alternative monitor in a clinical setting in which wide fluctuations in cardiac output could be expected. This was a prospective method comparison study, with 71 paired measurements obtained in 12 patients undergoing liver transplantation in a university teaching hospital. Bland-Altman analysis of the 2 techniques showed a bias of 0.39 L/minute, with the USCOM cardiac output lower compared with that of PAC-TD. The bias was small and did not vary with the magnitude of the cardiac output. The 95% limits of agreement were ,1.47 and 2.25 L/minute. There was good repeatability for USCOM measurements, with a repeatability coefficient of 0.43 for USCOM versus 0.77 for PAC-TD. We conclude that USCOM is acceptable for the clinical determination of noninvasive cardiac output, particularly in situations in which tracking changes over time is more important than knowing the precise value. However, the utility of USCOM is limited by its inability to measure pulmonary artery pressure. Liver Transpl 14:1038,1043, 2008. © 2008 AASLD. [source] Paracetamol use in musculoskeletal pain: an audit of use and patient perceptions of paracetamol as an effective analgesicMUSCULOSKELETAL CARE, Issue 4 2005Emma J Boger RGN BSc(Hons) DipHE Nurse Researcher Abstract Musculoskeletal pain is a complex problem with often very detrimental consequences which affects a high proportion of the general population. Health care professionals, when prescribing for musculoskeletal pain, often overlook simple analgesia. Patient perceptions of analgesia may vary to those of health care professionals, and in part affect the use of simple analgesia for musculoskeletal pain. This paper describes an audit of paracetamol use and patient perceptions of paracetamol as an effective analgesic agent, in 113 patients attending a musculoskeletal pain outpatient clinic in a university teaching hospital. The audit has helped prompt the development of a multi-disciplinary strategy to achieve optimum management. Copyright © 2005 John Wiley & Sons, Ltd. [source] Communication effectiveness of nurses working in a variety of settings within one large university teaching hospital in western JapanNURSING & HEALTH SCIENCES, Issue 4 2002Misae Ito RN Abstract This survey study measured the communication effectiveness of 176 nurses working on a variety of clinical units within one large university hospital in western Japan. The vast majority of the nurses demonstrated fair effectiveness in their communication skills. Although some of the nurses did demonstrate slightly higher communication effectiveness scores, few of the nurses' demographic characteristics appeared to influence how well they communicated. The major limitations of the present study were the use of one hospital for data gathering, and the possible lack of cultural sensitivity of the communication questionnaire. [source] Eleven-year study of causes of neonatal bacterial meningitis in Ahvaz, IranPEDIATRICS INTERNATIONAL, Issue 3 2010Mohammad Hasan Aletayeb Abstract Background:, Bacterial meningitis is a devastating infection with a high mortality rate, especially in neonates. The aim of this study was to determine the causative agents that cause bacterial meningitis in Khuzestan province in the south-western region of Iran. Methods:, A descriptive, cross-sectional study was carried out from 1997 to 2007 at the neonatal ward of a university teaching hospital (Emam Khomeini hospital) in Ahvaz. All infants younger than 29 days old who suffered from meningitis were included. Laboratory tests included Gram stain, culture, and biochemical tests. Cases were defined as meningitis if the cerebrospinal fluid culture was positive. Results:, Based on cerebrospinal fluid culture, 31 infants were identified as having bacterial meningitis. Eleven (35.5%) of these cases were caused by Klebsiella pneumoniae, nine (29%) were caused by Enterobacter spp., three (9.6%) were caused by Escherichia coli, three (9.6%) were caused by Enterococcus spp., two (6.4%) were caused by Acinetobacter, and one case each (3.2%) was caused by Staphylococcus aureus, Pseudomonas aeruginosa and nontypeable Haemophilus influenzae. The male-to-female ratio was 2 : 1 (67.7% were male). The birthweights of 20 (64.5%) patients were under 2500 g and 11 (35.4%) patients had normal birthweights. Thirteen (42%) were early-onset cases and 18 (58%) were late-onset cases. More than half of the cases (54.8%) acquired the infection from the hospital. Blood cultures were positive for 18 (58%) patients. Thirty-two percent of cases died in spite of treatment. Conclusions:,Klebsiella pneumoniae and Enterobacter spp. were the two main causative agents that caused neonatal bacterial meningitis, and nosocomial meningitis was the most common type in our ward. [source] Peri-conceptual folic acid supplementation in type 1 diabetesPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 4 2001C.J. Wills Specialist Registrar in Diabetes, Endocrinology Abstract Aim To document peri-conceptual folic acid supplementation in women with type 1 diabetes mellitus (DM) attending the diabetic ante-natal clinic of a university teaching hospital. Methods Women with pre-existing type 1 DM who booked at the diabetes antenatal clinic at University Hospital, Nottingham over 3 years (1996,98) took part in a telephone survey about folic acid supplements. Results Data was available on 50 women, 65 pregnancies. Folic acid supplements were used before 50.7% (33) pregnancies, all planned, and started on confirmation of pregnancy in 34% (22), at a mean gestation of 5.8 weeks. No folic acid was used before or during 10 (15.4%) pregnancies. 75.4% (49) pregnancies were planned. 24 planned pregnancies were in women who had never had pre-pregnancy counselling. 70.8%(17) of these were in multiparous women, and folic acid was taken before 41.1% (seven) of such pregnancies. Lack of awareness was the predominant reason for failure to take folic acid supplements in all groups. Conclusions Folic acid was taken before conception in only half of the pregnancies in the survey, due to lack of awareness of its importance. Three-quarters of pregnancies were planned but a disappointing number of women had pre-pregnancy counselling, probably due to poor advertising and the assumption that women who had been pregnant before did not need such a session. Women with DM should be informed about folic acid and offered pre-pregnancy counselling. It should not be assumed that women who have had a pregnancy know about folic acid. Copyright © 2001 John Wiley & Sons, Ltd. Key Points Folic acid supplementation prior to conception and in the first trimester helps to prevent neural tube defects. Almost half of the women in this survey failed to take folic acid prior to conception. Women who did not take folic acid were unaware of its importance. We need to ensure that women with diabetes understand the importance of folic acid. [source] Dilatation for Assisted Ventilation-Induced Laryngotracheal StenosisTHE LARYNGOSCOPE, Issue 9 2005Philippe Clément MD Abstract Objective: To assess the long-term results of dilatation and our experience with dilatation for assisted ventilation-induced laryngotracheal stenosis. Design: A retrospective study of 32 patients primarily treated with dilatation for assisted ventilation-induced laryngotracheal stenosis between 1977 and 2002. Setting: A tertiary care center and university teaching hospital. Patients: There were 19 men and 13 women aged 15 to 76 years. The stenosis was cicatricial with some inflammatory process in 27 patients and completely mature in 5 patients. The stenosis involved the cricoid and the trachea in four patients. In 28 patients, the stenosis involved only the trachea. Methods: Dilatation was performed with serially sized rigid bronchoscopes. Endoscopic laser vaporization was never performed in this series. Six patients were treated with only one dilatation. The 26 remaining patients were treated with successively 2 to 10 dilatations (mean, 3.3 dilatations). The dilatation success rate was analyzed using the Kaplan-Meier method. Results: Median duration of follow-up was 1.8 years. Mortality rate was 9.4%. The overall failure rate was 71.8%. Twenty patients presented with recurrent stenosis. The treatment of recurrent stenosis consisted of tracheal resection with end-to-end anastomosis (11 patients, 55%), cricotracheal anastomosis (5 patients, 25%), tracheal endoprosthesis (2 patients, 10%), and tracheotomy (1 patient, 5%). All patients who underwent tracheal or cricotracheal anastomosis were successfully treated. None of the variables under analysis (sex, age, medical history, cause for intubation, intubation type and duration, delay from initial injury, degree of stenosis, length of trachea involved, number of dilatations) were statistically related to the incidence of complications and the success rate of dilatations. Conclusions: We do not recommend dilatation technique as the sole treatment for assisted ventilation-induced laryngotracheal stenosis. This technique is helpful in case of emergency to restore an airway and useful for the assessment of stenosis. [source] Iron supplement in pregnancy and development of gestational diabetes,a randomised placebo-controlled trialBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2009KKL Chan Objective, To test the hypothesis that iron supplement from early pregnancy would increase the risk of gestational diabetes mellitus (GDM). Design, Randomised placebo-controlled trial. Setting, A university teaching hospital in Hong Kong. Population, One thousand one hundred sixty-four women with singleton pregnancy at less than 16 weeks of gestation with haemoglobin (Hb) level between 8 and 14 g/dl and no pre-existing diabetes or haemoglobinopathies. Methods, Women were randomly allocated to receive 60 mg of iron supplement daily (n= 565) or placebo (n= 599). Oral glucose tolerance tests (OGTTs) were performed at 28 and 36 weeks. Women were followed up until delivery. Outcome measures, The primary outcome was development of GDM at 28 weeks. The secondary outcomes were 2-hour post-OGTT glucose levels, development of GDM at 36 weeks and delivery and infant outcomes. Results, There was no significant difference in the incidence of GDM in the iron supplement and placebo groups at 28 weeks (OR: 1.04, 95% confidence interval [CI]: 0.7,1.53 at 90% power) or 36 weeks. Maternal Hb and ferritin levels were higher in the iron supplement group at delivery (P < 0.001 and P= 0.003, respectively). Elective caesarean section rate was lower in the iron supplement group (OR: 0.58, 95% CI: 0.37,0.89). Infant birthweight was heavier (P= 0.001), and there were fewer small-for-gestational-age babies in the iron supplement group (OR: 0.46, 95% CI: 0.24,0.85). Conclusion, Iron supplement from early pregnancy does not increase the risk of GDM. It may have benefits in terms of pregnancy outcomes. [source] Comparison of self-administered vaginal misoprostol versus placebo for cervical ripening prior to operative hysteroscopy using a sequential trial design,BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2008KS Oppegaard Objective, To compare the impact of 1000 micrograms of self-administered vaginal misoprostol versus self-administered vaginal placebo at home on preoperative cervical ripening in both premenopausal and postmenopausal women before operative hysteroscopy. Design, Two separate but identical parallel, randomised, double-blind, placebo-controlled sequential trials, one in premenopausal women and one in postmenopausal women. The boundaries for the sequential trials were calculated on the primary outcomes of a difference of cervical dilatation ,1 mm, with the assumption of a type 1 error of 0.05 and a power of 0.95. Setting, Norwegian university teaching hospital. Sample, Eighty-six women referred to outpatient operative hysteroscopy. Methods, The women were randomised to either 1000 micrograms of self-administered vaginal misoprostol or self-administered vaginal placebo the evening before outpatient operative hysteroscopy. Main outcome measures, Preoperative cervical dilatation (primary outcome), number of women who achieve a preoperative cervical dilatation ,5 mm, acceptability, complications and adverse effects (secondary outcomes). Results, In premenopausal women, the mean cervical dilatation was 6.4 mm (SD 2.4) in the misoprostol group and 4.8 mm (SD 2.0) in the placebo group, the mean difference in cervical dilatation being 1.6 mm (95% CI 0.5,2.7). Among the premenopausal women receiving misoprostol, 88% achieved a cervical dilatation of ,5 mm compared with 65% in the placebo group. Twelve percent of the women who received misoprostol were difficult to dilate compared with 32% who received placebo. Dilatation was also quicker in the misoprostol group. Misoprostol had no effect on cervical ripening in postmenopausal women compared with placebo, and 43% of the women were difficult to dilate. The trials were terminated after analysis of 21 postmenopausal women and 65 premenopausal women after reaching a conclusion on the primary outcome with only 28% of the number of women needed in a fixed sample size trial. Three of 45 women who received misoprostol experienced severe lower abdominal pain, and there was an increased occurrence of light preoperative bleeding in the misoprostol group. Most women did not experience misoprostol-related adverse effects. The majority (83% of premenopausal and 76% of postmenopausal women) found self-administered vaginal misoprostol at home to be acceptable. There were two serious complications in the premenopausal misoprostol group: uterine perforation with subsequent peritonitis and heavy postoperative bleeding requiring blood transfusion, but these were not judged to be misoprostol related. Complications were otherwise comparatively minor and distributed equally between the two dosage groups. Conclusions, One thousand micrograms of self-administered vaginal misoprostol 12 hours prior to operative hysteroscopy has a significant cervical ripening effect compared with placebo in premenopausal but not in postmenopausal women. Self-administered vaginal misoprostol of 1000 micrograms at home the evening before operative hysteroscopy is safe and highly acceptable, although a small proportion of women experienced severe lower abdominal pain. There is a risk of lower abdominal pain and light preoperative bleeding with this regimen, which is very cheap and easy to use. [source] Comparison of self-administered vaginal misoprostol versus placebo for cervical ripening prior to operative hysteroscopy using a sequential trial design,BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2007KS Oppegaard Objective, To compare the impact of 1000-microgram self-administered vaginal misoprostol versus self-administered vaginal placebo at home on preoperative cervical ripening in both premenopausal and postmenopausal women prior to outpatient resectoscopy. Design, Randomised, double-blind, placebo-controlled sequential trial. Setting, Norwegian university teaching hospital. Sample, Premenopausal and postmenopausal women referred to outpatient resectoscopy. Methods, The women were randomised to either 1000 micrograms of self-administered vaginal misoprostol or self-administered vaginal placebo the evening before outpatient resectoscopy. Main outcome measures, Preoperative cervical dilatation, acceptability and complications. Results, (a) Intraoperative findings and distribution of cervical dilatation in the two treatment groups. Values are given as median (range) or n (%). (b) Acceptability in the two treatment groups. Values are given as completely acceptable, n (%); fairly acceptable, n (%); fairly unacceptable, n (%) and completely unacceptable, n (%). (c) Pain in the two treatment groups. Pain was measured with a visual analogue scale score, scale ranges from 0 (no pain) to 10 (unbearable pain). Values are given as median (range). (d) Occurrence of adverse effects in the two treatment groups. Values are given as n (%). (e) Complications, given as n (%). [source] Deterioration in cord blood gas status during the second stage of labour is more rapid in the second twin than in the first twinBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2004Tak-Yeung Leung Objective To compare in twin pregnancy the rate of deterioration in umbilical blood gas status during the second stage of labour, and to investigate whether the duration of the first twin's delivery has any effect on the blood gas status of the second twin. Design A retrospective study. Setting Department of Obstetrics and Gynaecology in a university teaching hospital. Population Twin pregnancies with both of the twins delivered by normal cephalic vaginal mode, at or beyond 34 weeks of gestation, over a period of seven years. Twins with any maternal or fetal complications including discordant growth, intrauterine growth restriction, intrauterine death, fetal malformations, fetal distress, pre-eclampsia and diabetes were excluded. Methods The first twins' second stage was defined as from the start of maternal pushing to his/her delivery, while the second twins' second stage started after the delivery of the first twin and ended by his/her delivery. The total duration of the second stage was the sum of the above two intervals. The correlations between the first twins' umbilical cord blood gas parameters and the duration of their own second stage, the second twins' umbilical cord blood gas parameters and the duration of their own second stage, as well as that of the total second stage, were studied. Main outcome measures The changes of umbilical arterial pH of each twin with the duration of the corresponding second stage of labour, and the difference among them. Results A total of 51 cases were reviewed. The median gestation at delivery was 37 weeks. The median duration of first twins' second stage was 10 minutes (range 1,75) while that of the second twins' was 10 minutes (range 3,26). The first twins' second stage was inversely correlated with their arterial pH, venous pH and base excess [BE] (P < 0.01). Both the second twins' second stage and the total second stage were inversely correlated with both of their arterial and venous pH and BE (P < 0.01). However, further multiple regression analysis suggested that the correlation of the total second stage with the second twins' cord blood parameters could be solely explained by their own second stage. The rate of reduction in the second twins' arterial pH was 4.95 × 10,3 per minute, and was significantly faster than that of the first twins', which was 1.55 × 10,3 per minute (P < 0.05). Conclusions During normal vaginal delivery, the umbilical cord blood gas status of both the first and the second twins deteriorated with the duration of their corresponding second stages, but the effects are greater in the latter. Furthermore, the duration of the first twins' second stage does not affect the blood gas status of the second twins'. These observations support the postulation of a diminished uteroplacental exchange function after the delivery of the first twin. Close monitoring and expeditious delivery of the second twins are important. [source] The frequency of significant pathology in women attending a general gynaecological service for postcoital bleedingBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 1 2001Adam N. Rosenthal Objectives To document the frequency of pathology in women who complain of postcoital bleeding. To determine whether negative cervical cytology excludes serious pathology in women with postcoital bleeding. To determine whether postcoital bleeding increases the risk of serious pathology in women with an abnormal smear. Design A retrospective study. Setting A university teaching hospital. Population 314 women with postcoital bleeding seen in the gynaecology service from first January 1988 to 31 December 1994. Methods Women were identified from the computerised records of the colposcopy service and copies of correspondence, which was routinely retained on computer. The latter was searched for the text strings coital and intercourse. Main outcome measure Histopathological diagnosis. Results Twelve women (4%) had invasive cancer: 10 were cervical or vaginal cancers and two endometrial cancers. Eight of the 10 cervical or vaginal cancers were clinically apparent. Four women of these 10 had had a normal smear before being referred for further investigation of postcoital bleeding. Two of these cancers were visible only with the aid of the colposcope. Thus, 0.6% of women attending a gynaecology service with postcoital bleeding, a normal looking cervix and a normal smear had invasive cancer of the cervix. Cervical intraepithelial neoplasia were found in 54 women (17.%) and 15 women (5%) had cervical polyps. Nineteen of the 63 women (30%) with significant pathology had a normal or inflammatory cervical smear. No explanation for the postcoital bleeding was found in 155 women (49 %). Conclusions Although invasive cancer is rare in women with postcoital bleeding, it is much commoner than in the general population. It seems likely that cervical intraepithelial neoplasia is also associated with postcoital bleeding, perhaps because the fragile cervical epithelium becomes detached during intercourse. Postcoital bleeding should continue to be regarded as an indication of high risk for invasive cervical cancer and for cervical intraepithelial neoplasia. Prompt referral to a colposcopy clinic is indicated, but most women with postcoital bleeding will have no serious abnormality. [source] | |||||||||||||||||||||||||