Showing papers by "Bethesda Hospital published in 2017"

Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep

Abstract: The complexity of central breathing disturbances during sleep has become increasingly obvious. They present as central sleep apnoeas (CSAs) and hypopnoeas, periodic breathing with apnoeas, or irregular breathing in patients with cardiovascular, other internal or neurological disorders, and can emerge under positive airway pressure treatment or opioid use, or at high altitude. As yet, there is insufficient knowledge on the clinical features, pathophysiological background and consecutive algorithms for stepped-care treatment. Most recently, it has been discussed intensively if CSA in heart failure is a "marker" of disease severity or a "mediator" of disease progression, and if and which type of positive airway pressure therapy is indicated. In addition, disturbances of respiratory drive or the translation of central impulses may result in hypoventilation, associated with cerebral or neuromuscular diseases, or severe diseases of lung or thorax. These statements report the results of an European Respiratory Society Task Force addressing actual diagnostic and therapeutic standards. The statements are based on a systematic review of the literature and a systematic two-step decision process. Although the Task Force does not make recommendations, it describes its current practice of treatment of CSA in heart failure and hypoventilation.

Acute undifferentiated fever in India: a multicentre study of aetiology and diagnostic accuracy

Abstract: The objectives of this study were to determine the proportion of malaria, bacteraemia, scrub typhus, leptospirosis, chikungunya and dengue among hospitalized patients with acute undifferentiated fever in India, and to describe the performance of standard diagnostic methods. During April 2011–November 2012, 1564 patients aged ≥5 years with febrile illness for 2–14 days were consecutively included in an observational study at seven community hospitals in six states in India. Malaria microscopy, blood culture, Dengue rapid NS1 antigen and IgM Combo test, Leptospira IgM ELISA, Scrub typhus IgM ELISA and Chikungunya IgM ELISA were routinely performed at the hospitals. Second line testing, Dengue IgM capture ELISA (MAC-ELISA), Scrub typhus immunofluorescence (IFA), Leptospira Microscopic Agglutination Test (MAT), malaria PCR and malaria immunochromatographic rapid diagnostic test (RDT) Parahit Total™ were performed at the coordinating centre. Convalescence samples were not available. Case definitions were as follows: Leptospirosis: Positive ELISA and positive MAT. Scrub typhus: Positive ELISA and positive IFA. Dengue: Positive RDT and/or positive MAC-ELISA. Chikungunya: Positive ELISA. Bacteraemia: Growth in blood culture excluding those defined as contaminants. Malaria: Positive genus-specific PCR. Malaria was diagnosed in 17% (268/1564) and among these 54% had P. falciparum. Dengue was diagnosed in 16% (244/1564). Bacteraemia was found in 8% (124/1564), and among these Salmonella typhi or S. paratyphi constituted 35%. Scrub typhus was diagnosed in 10%, leptospirosis in 7% and chikungunya in 6%. Fulfilling more than one case definition was common, most frequent in chikungunya where 26% (25/98) also had positive dengue test. Malaria and dengue were the most common causes of fever in this study. A high overlap between case definitions probably reflects high prevalence of prior infections, cross reactivity and subclinical infections, rather than high prevalence of coinfections. Low accuracy of routine diagnostic tests should be taken into consideration when approaching the patient with acute undifferentiated fever in India.

The impact of antenatal Bisphenol A exposure on male reproductive function at 20–22 years of age

Abstract: Bisphenol A (BPA) is a ubiquitous chemical suspected to possess oestrogenic hormonal activities. Male population studies suggest a negative impact on testicular function. As Sertoli cell proliferation occurs during fetal or early postnatal life, it is speculated that oestrogenic environmental exposures may influence mature testicular function. Among 705 Western Australian Pregnancy Cohort (Raine) Study men aged 20-22 years, 404 underwent testicular ultrasound examination (149 had maternal serum available), and/or 365 provided semen (136 had maternal serum) and/or 609 serum samples for sex steroids, gonadotrophins and inhibin B analysis (244 had maternal serum). Maternal serum collected at 18 and 34 weeks' gestation was pooled and assayed for concentrations of total BPA (free plus conjugated) as an estimate of antenatal exposure. Testicular volume was calculated by ultrasonography, and semen analysis performed. Serum LH, FSH and inhibin B were measured by immunoassay; testosterone, oestradiol, oestrone andBPA were measured by liquid chromatography-mass spectrometry. BPA levels were detectable in most (89%) maternal serum samples. After adjustment for maternal smoking, abstinence and varicocele, sperm concentration and motility were significantly correlated to maternal serum BPA (r = 0.18; P = 0.04 for both). No other associations of maternal serum BPA with testicular function were observed.

Feasibility of establishing an Australian ACL registry: a pilot study by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR)

Abstract: Rupture of the anterior cruciate ligament (ACL) is a common and debilitating injury that impacts significantly on knee function and risks the development of degenerative arthritis. The outcome of ACL surgery is not monitored in Australia. The optimal treatment is unknown. Consequently, the identification of best practice in treating ACL is crucial to the development of improved outcomes. The Australian Knee Society (AKS) asked the Australian Orthopaedic Association (AOA) to consider establishing a national ACL registry. As a first step, a pilot study was undertaken by the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to test the hypothesis that collecting the required information in the Australian setting was possible. Surgeons completed an operative form which provided comprehensive information on the surgery undertaken. Patients provided pre- and post-operative questionnaires including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Marx Activity Scale (MA Scale). The number of ACL procedures undertaken at each hospital during the recruitment period was compared against State Government Health Department separation data. A total of 802 patients were recruited from October 2011 to January 2013. The overall capture rate for surgeon-derived data was 99%, and the capture rate for the pre-operative patient questionnaire was 97.9%. At 6 months, patient-reported outcomes were obtained from 55% of patients, and 58.5% of patients at 12 months. When checked against State Government Health Department separation data, 31.3% of procedures undertaken at each study hospital were captured in the study. It is possible to collect surgeon-derived and pre-operative patient-reported data, following ACL reconstruction in Australia. The need to gain patient consent was a limiting factor to participation. When patients did consent to participate in the study, we were able to capture nearly 100% of surgical procedures. Patient consent would not be an issue in for a national registry where inclusion is automatic unless the patient wishes to opt out. The collection of post-operative patient-reported outcome measures (PROMs) is more problematic, due to an insufficient proportion of individuals providing patient-reported outcomes. Alternative outcome measures are required for an ACL registry in Australia to be successfully implemented. Diagnostic, Level III.

Implementation of a Clinical Reasoning Course in the Internal Medicine trimester of the final year of undergraduate medical training and its effect on students' case presentation and differential diagnostic skills.

Abstract: Background: Clinical reasoning, comprising the processes of clinical thinking, which form the basis of medical decisions, constitutes a central competence in the clinical routine on which diagnostic and therapeutic steps are based. In medical curricula in Germany, clinical reasoning is currently taught explicitly only to a small extend. Therefore, the aim of this project was to develop and implement a clinical reasoning course in the final year of undergraduate medical training. Project description: A clinical reasoning course with six learning units and 18 learning objectives was developed, which was taught by two to four instructors on the basis of 32 paper cases from the clinical practice of the instructors. In the years 2011 to 2013, the course of eight weeks with two hours per week was taught seven times. Before the first and after the last seminar, the participating students filled out a self-assessment questionnaire with a 6-point Likert scale regarding eight different clinical reasoning skills. At the same times, they received a patient case with the assignment to prepare a case presentation and differential diagnoses. Results: From 128 participating students altogether, 42 complete data sets were available. After the course, participants assessed themselves significantly better than before the course in all eight clinical reasoning skills, for example in “Summarizing and presentation of a paper case” or in the “Skill to enumerate differential diagnoses” (p<0.05). The greatest increase occurred in the skill to recognize typical cognitive errors in medicine and to identify risk situations for their occurrence (pre: 2.98±0.92 and retro-pre: 2.64±1.01, respectively, versus post: 4.38±0.88). Based on the ratio of number of words used per keywords used the problem presentation of the paper case was significantly more focused after the course (p=0.011). A significant increase in the number of gathered differential diagnoses was not detected after the course. Conclusion: The newly developed and established Clinical Reasoning Course leads to a gain in the desired skills from the students’ self-assessment perspective and to a more structured case presentation. To establish better options to exercise clinical reasoning, a longitudinal implementation in the medical curriculum seems to be desirable. Faculty training would be useful to implement the concept as standardized as possible.

Effects of Shaker exercise in stroke survivors with oropharyngeal dysphagia.

Abstract: BACKGROUND Dysphagia after stroke can cause a variety of complications, especially aspiration pneumonia, which can be life-threatening. Therefore, rehabilitation methods to reduce aspiration in patients with dysphagia are important. OBJECTIVE In the present study, we aimed to investigate the effects of Shaker exercise on aspiration and oral diet level in stroke survivors with dysphagia. METHODS Participants were randomly assigned to an experimental group (n = 16) or a control group (n = 16). Participants in the experimental group performed Shaker exercise and conventional dysphagia therapy, whereas those in the control group performed only conventional dysphagia therapy. All participants performed training 5 days a week for 4 weeks. Degree of aspiration was assessed using the Penetration-Aspiration Scale (PAS) based on videofluoroscopic swallowing study, while oral diet level was assessed using the Functional Oral Intake Scale (FOIS). RESULTS The experimental group showed greater improvement on both the PAS (p < 0.05) and FOIS (p < 0.05) compared with the control group. CONCLUSIONS The results of this study suggest that Shaker exercise is a effective exercise for recovery of swallowing function in stroke survivors with dysphagia.

Molecular detection of multidrug-resistant Mycobacterium leprae from Indian leprosy patients.

Abstract: Objectives The emergence of multidrug-resistant (MDR) organisms for any infectious disease is a public health concern. Global efforts to control leprosy by intensive chemotherapy have led to a significant decrease in the number of registered patients. Currently recommended control measures for treating leprosy with multidrug therapy (MDT) were designed to prevent the spread of dapsone-resistant Mycobacterium leprae strains. Here we report the identification of MDR M. leprae from relapse leprosy patients from endemic regions in India. Methods Resistance profiles to rifampicin, dapsone and ofloxacin of the isolated strains were confirmed by identification of mutations in genes previously shown to be associated with resistance to each drug. Between 2009–2016, slit-skin smear samples were collected from 239 relapse and 11 new leprosy cases from hospitals of The Leprosy Mission across India. DNA was extracted from the samples and was analysed by PCR targeting the rpoB, folP and gyrA genes associated with resistance to rifampicin, dapsone and ofloxacin, respectively, in M. leprae. M. leprae Thai-53 (wild-type) and Zensho-4 (MDR) were used as reference strains. Results Fifteen strains showed representative mutations in at least two resistance genes. Two strains showed mutations in all three genes responsible for drug resistance. Seven, seven and one strain, respectively, showed mutations in genes responsible for rifampicin and dapsone resistance, for dapsone and ofloxacin resistance and for rifampicin and ofloxacin resistance. Conclusion This study showed the emergence of MDR M. leprae in MDT-treated leprosy patients from endemic regions of India.

The effect of a VR exercise program on falls and depression in the elderly with mild depression in the local community.

Abstract: [Purpose] The purpose of this study is to explore the effect of a VR exercise program on falls and depression in the elderly with mild depression who reside in the local community. [Subjects and Methods] This study was performed by targeting 15 elderly subjects with mild depression who resided in the local community. The targeted subjects voluntarily selected 3 VR exercise programs (each lasting 10 minutes) among 4 activities, and a resting time of 5 minutes was given for an interval after each activity. The VR exercise program was performed for total 12 weeks (36 times), 3 times a week, 45 minutes per session. [Results] After exercise, scores of static balance test (anteroposterior), Falls Efficacy Scale, and the Activities-specific Balance Confidence Scale in the test subjects were improved and depression and internal stress scores were significantly decreased after the intervention. [Conclusion] It can be concluded that the VR exercise program exerts a positive effect not only on the physical factor but also on the mental factor of the elderly subjects with mild depression who reside in the local community. It is expected that based on the VR exercise program, diversified home programs for the elderly should be developed in the future.

International core curriculum for capsule endoscopy training courses.

Abstract: Capsule endoscopy (CE) has become a first-line noninvasive tool for visualisation of the small bowel (SB) and is being increasingly used for investigation of the colon. The European Society of Gastrointestinal Endoscopy (ESGE) guidelines have specified requirements for the clinical applications of CE. However, there are no standardized recommendations yet for CE training courses in Europe. The following suggestions in this curriculum are based on the experience of European CE training courses directors. It is suggested that 12 hours be dedicated for either a small bowel capsule endoscopy (SBCE) or a colon capsule endoscopy (CCE) course with 4 hours for an introductory CCE course delivered in conjunction with SBCE courses. SBCE courses should include state-of-the-art lectures on indications, contraindications, complications, patient management and hardware and software use. Procedural issues require approximately 2 hours. For CCE courses 2.5 hours for theoretical lessons and 3.5 hours for procedural issued are considered appropriate. Hands-on training on reading and interpretation of CE cases using a personal computer (PC) for 1 or 2 delegates is recommended for both SBCE and CCE courses. A total of 6 hours hands-on session- time should be allocated. Cases in a SBCE course should cover SB bleeding, inflammatory bowel diseases (IBD), tumors and variants of normal and cases with various types of polyps covered in CCE courses. Standardization of the description of findings and generation of high-quality reports should be essential parts of the training. Courses should be followed by an assessment of traineesʼ skills in order to certify readers’ competency.

Diagnostic accuracy of [ 99m Tc]Tc-Sestamibi in the assessment of thyroid nodules.

Abstract: // Anna Yordanova 1, * , Soha Mahjoob 1, * , Philipp Lingohr 2 , Jorg Kalff 2 , Andreas Turler 3 , Holger Palmedo 4 , Hans-Jurgen Biersack 1 , Glen Kristiansen 5 , Jamshid Farahati 6 , Markus Essler 1 and Hojjat Ahmadzadehfar 1 1 Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany 2 Department of Surgery, University Hospital Bonn, Bonn, Germany 3 Department of General and Visceral Surgery, Johanniter-Krankenhaus Bonn, Bonn, Germany 4 Institute of Radiology and Nuclear Medicine, PET-CT Center, Bonn, Germany 5 Institute of Pathology, University Hospital Bonn, Bonn, Germany 6 Department of Nuclear Medicine, Bethesda Hospital, Duisburg, Germany * These authors have contributed equally to this work Correspondence to: Hojjat Ahmadzadehfar, email: hojjat.ahmadzadehfar@ukbonn.de Keywords: sestamibi, MIBI, thyroid nodules, thyroid cancer, cold nodule Received: June 20, 2017 Accepted: September 16, 2017 Published: October 17, 2017 ABSTRACT [ 99m Tc]Tc-Sestamibi (MIBI) is an increasingly used tool for evaluation of thyroid nodules. However, there is a lack of evidence about the accuracy of this method in the European population. The aim of this study was to assess the utility of MIBI for the differentiation of thyroid nodules in a large cohort. 161 patients underwent MIBI, followed by a thyroidectomy. We used a dual phase MIBI protocol. Interpretation of the images included a scoring system from 0 (absent) to 3 (increased); this was to provide a scale for the uptake of the thyroid nodule in comparison to the paranodular tissue. Additionally, we evaluated the tracer uptake trend in late images compared to early images. We used the final histopathology as the reference standard. Scores 0-1 in early images, scores 0-2 in late images, and an absence of increasing uptake in the thyroid nodule in late images, showed the best predictive values to exclude malignancy, respectively (negative predictive value (NPV) 89%). Highest sensitivity (91%) for malignant nodules was evident in early images with a score 1-3. Highest specificity (91%) was obtained when the negative was defined as an absence of uptake-increase, in the late images. This study confirms that the most valuable feature of MIBI is the high NPV. Thus, with the appropriate interpretation method, high sensitivity and specificity, and moderate PPV can be obtained.

REM Sleep Imposes a Vascular Load in COPD Patients Independent of Sleep Apnea.

Abstract: Arterial stiffness, a marker for cardiovascular risk, is increased in patients with Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnea (OSA). The specific influence of both on arterial stiffness during sleep is unknown. Nocturnal arterial stiffness (Pulse Propagation Time (PPT) of the finger pulse wave) was calculated in 142 individuals evaluated for sleep apnea: 27 COPD patients (64.7 ± 11y, 31.2 ± 8 kg/m2), 72 patients with cardiovascular disease (CVD group, 58.7 ± 13y, 33.6 ± 6 kg/m2) and 43 healthy controls (HC group 49.3 ± 12y, 27.6 ± 3 kg/m2). Sleep stage related PPT changes were assessed in a subsample of COPD patients and matched controls (n = 12/12). Arterial stiffness during sleep was increased in COPD patients (i.e. shortened PPT) compared to healthy controls (158.2 ± 31 vs. 173.2 ± 38 ms, p = 0.075) and to patients with CVD (161.4 ± 41 ms). Arterial stiffening was particular strong during REM sleep (145.9 ± 28 vs. 172.4 ± 43 ms, COPD vs. HC, p = 0.003). In COPD, time SaO2 < 90% was associated with reduced arterial stiffness (Beta +1.7 ms (1.1-2.3)/10 min, p < 0.001). Sleep apnea did not affect PPT. In COPD, but not in matched controls, arterial stiffness increased from wakefulness to REM-sleep (ΔPPT-8.9 ± 10% in COPD and 3.7 ± 12% in matched controls, p = 0.021). Moreover, REM-sleep related arterial stiffening was correlated with elevated daytime blood pressure (r = -0.92, p < 0.001) and increased myocardial oxygen consumption (r = -0.88, p < 0.01). Hypoxia and REM sleep modulate arterial stiffness. In contrast to healthy controls, REM sleep imposes a vascular load in COPD patients independent of sleep apnea indices, intermittent and sustained hypoxia. The link between REM-sleep, vascular stiffness and daytime cardiovascular function suggests that REM-sleep plays a role for increased cardiovascular morbidity of COPD patients.

The MOVE-trial: Monocryl® vs. Vicryl Rapide™ for skin repair in mediolateral episiotomies: a randomized controlled trial

Abstract: Previous studies have shown that complaints after episiotomy repair depend on the method and material used for repair. The objective of our study was to determine which of two frequently used suture materials, Monocryl® (poliglecaprone 25) and Vicryl Rapide™ (polyglactin 910), is superior for intracutaneous closure of the skin in mediolateral episiotomies. In a randomized controlled trial performed in a teaching hospital in the Netherlands between 2010 and 2013 250 primiparous women with uncomplicated mediolateral episiotomies were randomly allocated to intracutaneous skin closure with either Monocryl® or Vicryl Rapide™. All other layers were sutured with Vicryl 2-0 and Vicryl 0 in both groups. Pain scores and complications were documented using questionnaires during the first three months post partum. The primary outcome was pain 10 days after delivery in sitting position established by Visual Analogous Scale (VAS). Secondary outcomes were pain scores at different time points and reported complications such as infections, dehiscence and dyspareunia one day, 10 days, six weeks and three months after delivery. Of 250 allocated women 54% returned questionnaires. No statistical difference was found between both groups for the primary outcome (VAS 2,8 (95% CI 2,18-3,44) vs. VAS 2,5 (95% CI 2,00-2,98), p = 0,43). With regard to secondary outcomes only self-reported dehiscence was significantly different, favouring Monocryl® (10% vs. 25%, p = 0.016). Use of Monocryl® 3-0 and Vicryl Rapide™ 3-0 for intracutaneous closure of the skin after mediolateral episiotomy leads to equal pain scores ten days after delivery and therefore both materials may be considered for this use. Monocryl® 3-0 might be favourable over Vicryl Rapide™ 3-0 due to less self-reported dehiscence after intracutaneous closure of the skin in mediolateral episiotomies. The trial was retrospectively registered under trial nr. ISRCTN29869308 on 20-04-2016.

Antifungals susceptibility pattern of Candida spp. isolated from female genital tract at the Yaoundé Bethesda Hospital in Cameroon

Abstract: Introduction : Vaginal candidiasis is considered as an important public health problem worldwide and its incidence has increased nowadays. In recent years, inappropriate and disproportionate use of antifungal drugs, automedication as well as non compliance have caused drug resistance. Methods : This study aimed at determining the in vitro antifungal susceptibility patterns of Candida speciesisolated from female genital tract at Yaounde Bethesda Hospital in Cameroon. Two hundred and fourthy five women (age range: 15 years to 49 years) attending the hospital were recruited between January and June 2014 in this cross sectional study. Vaginal smears were collected using sterile swabs from each participant and cultured on sabouraud dextrose agar supplemented with chloramphenico l 0.5%; identification of Candida spp . was performed following standard methods. The disk diffusion method was used for antifungal susceptibility testing. Results : Out of the 245 vaginal smears collected, 94 (38.4%) strains of yeast were isolates among which 43 (45.7%) were Candida albicans and 51 (54.3%) were non albicans. The highest susceptibility of the isolates was seen for nystatin 62 (83.78%), ketoconazole 61 (82.43%) and fluconazole 60 (81.08%). Conclusion : Despite the noticeable resistance of Candida spp . isolates to miconazole and itraconazole, the results indicate that nystatin, ketoconazole and fluconazole are the drugs of choice for the therapy of vaginal candidiasis in this region.

11C-acetate positron-emission tomography/computed tomography imaging for detection of recurrent disease after radical prostatectomy or radiotherapy in patients with prostate cancer.

Abstract: Objectives To evaluate, in a prospective study, the effectiveness of computed tomography (CT)-matched 11C-acetate (AC) positron-emission tomography (PET) in patients with prostate cancer (PCa) who had prostate-specific antigen (PSA) relapse after radical prostatectomy (RP) or radiotherapy (RT). Patients and Methods In 103 relapsing patients after RP (n = 97) or RT (n = 6) AC-PET images and CT scans were obtained. In patients with AC-PET-positive results with localized PCa recurrence, detected lesions were resected and histologically verified or, after local RT, followed-up by PSA testing. Patients with distant disease on AC-PET were treated with androgen deprivation/chemotherapy. Results Of 103 patients, 42 were AC-PET-positive. PSA levels were <1.0, <2.0 and <4.0 ng/mL in six, 16 and 20 patients, respectively. In 25/42 patients AC-PET suggested lymph node metastases: 16/25 patients underwent surgery (10/16 metastasis, 6/16 inflammation); 9/25 patients underwent RT of lymph node metastases, which was followed by decreasing PSA level. In 17/42 patients who had distant disease, systemic treatment was commenced. Combining patients who underwent surgery and those who underwent RT, 19/25 patients were true-positive in terms of AC-PET (positive predictive value 76%). In 5/19 patients, PSA level was <2.0 ng/mL, in 2/19 patients it was <1.0 ng/mL and in 14/19 patients it was 5.4–23.1 ng/mL. In AC-PET-positive patients after surgery or RT (without androgen deprivation), median (range) time to renewed PSA increase was 6 (5–9) months. Conclusions Only a minority of patients with relapsing PCa appear to benefit from AC-PET for guiding potential local treatment. False-positive results show that factors other than tumour metabolism induce increased AC uptake. The time free of recurrence after local treatment was shorter than expected.

Medical rehabilitation system for patients in acute rehabilitation units

Abstract: 전 세계적으로 양질의 재활을 필요로 하는 모든 사람들에 게 최대한 제공될 수 있도록 재활이 강화되어야 하며 이러 한 재활 강화에 대한 요구는 기본적인 인권일 뿐 아니라 건 강을 증진시키고 사회, 경제에도 긍정적인 이익을 가져다 줄 수 있다[1,2]. 재활은 조기퇴원을 촉진할 수 있고 불필요한 재입원을 막고[3,4] 가정 복귀해서 생활할 수 있도록 해준다 [5-7]. 즉, 재활은 장애를 가지고 있거나 장애에 이를 가능 성이 높은 사람들을 대상으로 처한 환경에서 최적의 기능상 태에 도달할 수 있도록 지원하는 수단이므로 재활의료는 보 건의료시스템의 특정 단계에서만 공급되도록 하는 것이 아 니라 급성기(초기재활), 회복기(집중재활), 만성기(유지재활) 의 각각에서 다른 의료 부문과 통합적으로 공급되어야 한다 [2,8]. 각 시기별로 제공되는 재활의료서비스의 내용, 인력, 시설에서 차이가 있을 수 있으며 발병시기와 중증도에 따라 적합한 재활의료서비스를 제공받을 수 있도록 재활의료전달 체계의 구축이 중요하나 국내의 재활의료전달체계는 아직 국내 급성기 재활의료 공급체계

The contribution of multiple pregnancies from overseas fertility treatment to obstetric services in a Western Australian tertiary obstetric hospital

Abstract: Background Increasingly couples are travelling overseas to access assisted reproductive technology, known as cross border reproductive care, although the incidence, pregnancy outcomes and healthcare costs are unknown. Aims To determine obstetric and neonatal outcomes for multiple pregnancies conceived through fertility treatment overseas, and estimate cost of these pregnancies to the health system. Materials and methods Retrospective study of women receiving care for a multiple gestation between July 2013 and June 2015 at Western Australia's sole tertiary obstetric hospital, where conception was by overseas fertility treatment. Obstetric and neonatal outcomes were recorded and cost estimates calculated. Results Of 11 710 births, 422 were multiple pregnancies. Thirty-seven pregnancies were conceived with fertility treatment, with 11 (29.7%) conceived overseas. Median antenatal clinic attendances, ultrasound examinations, and fetal assessments for the overseas fertility cases were six, 10, and nine, respectively. The gestational age at delivery ranged from 30 to 38 weeks (median 34 + 1). Median neonatal admission duration was 18 days (range 0–47). Cost for obstetric care was estimated between $170 000 and $216 000, and cost of neonatal care was estimated as $810 000, giving a combined total cost of between $980 000 and $1 026 000. Conclusion At the sole tertiary obstetric centre in WA, approximately one-third of all multiple pregnancies conceived with fertility treatment resulted from treatment overseas. The Australian healthcare cost for these 11 women and their infants exceeded $1 000 000. This study suggests that overseas fertility treatment has a significant health-related cost to the mother and infant, and the local healthcare system.

Port Placement via the Anterior Jugular Venous System: Case Report, Anatomic Considerations, and Literature Review.

Abstract: We report on a patient who was referred for port implantation with a two-chamber pacemaker aggregate on the right and total occlusion of the central veins on the left side. Venous access for port implantation was performed via left side puncture of the horizontal segment of the anterior jugular vein system (AJVS) and insertion of the port catheter using a crossover technique from the left to the right venous system via the jugular venous arch (JVA). The clinical significance of the AJVS and the JVA for central venous access and port implantation is emphasised and the corresponding literature is reviewed.

Supplementation of Vitamin A and D in the Medication of Lung Tuberculosis

Abstract: At District of Wonosobo , Indonesia incidence rate of lung tuberculosis ( TB ) is increasing over years. In 2011 sputum conversion rate had reached 83.8%. Incidence rate of lung TB is still relatively high. This is influenced by many factors, one of which is the process of transmission. Potential of transmission may still occur until end of intensive medication (2 months). Vitamin A and D as immunoprotection can be used as supplements that can accelerate sputum conversion. To find out effect of vitamin A and D supplementation in accelerating sputum conversion of lung TB patients during intensive phase. The study was true experimental ( double blinded randomized controlled trial). Subject of the study consisted of two groups; one comprised as many as 30 positive acid fast bacillus lung TB patients supplemented with vitamin A at dosage of 1 x 5000 IU/day and vitamin D at dosage of 1 x 400 IU/day whereas another group was placebo during intensive phase. There was effect of vitamin A and D supplementation to acceleration of sputum conversion with score of p 0.003; HR 2.45. Sputum conversion acceleration occurred in the experiment group during the second week with vitamin A and D supplementation as much as 86%. Vitamin A and D supplementation could accelerate the incidence of sputum conversion as much as 2.45 times greater than placebo group; thus vitamin A and D could be used as complementary supplements in the medication of lung TB medication during intensive phase.

Broad Thumbs and Toes with Mental Retardation; Syndrome of Rubinstein and Taybi

Abstract: Seeing the unusual syndrome in an Indonesian baby we considered publication worthwhile. The Rubinstein and Taybi syndro- me consists of a large number of congenital anomalies. Some of these are common to all cases, many are seen in some cases only.

The Effect of Different Types of Resting Hand Splints on Spasticity and Hand Function among Patients with Stroke

Abstract: After stroke, these changes consequently result in the limitation of upper limb joint range of motion or muscle shortening, and spasticity, causing the reduction of hand functions. This study aimed to investigate the effect according to the types of resting hand splints, particularly the effect of the application of resting hand splint. This study was performed in two groups, which were determined by random assignment according to the order of visits of 52 subjects who were diagnosed of stroke. The patients were divided into a dorsal resting hand splint group (n=26) and volar resting hand splint group (n=26). The data collected in this study was analyzed using SPSS version 18.0.For the difference in Modified Ashworth Scales (MAS), surface ElectroMyoGraphy (sEMG), and Wrist Active Range of Motion(AROM) before and after the intervention in two groups, paired t-test was performed, and independent sample t-test was performed to compare the change(s) before and after the intervention in two groups. Statistical significance level was α=.05. First, there was a significant difference in wrist MAS, AROM, and sEMG in the group of dorsal resting hand splint. Second, there was no significant difference in wrist MAS and AROM in the group of volar resting hand splint, but there was a significant difference in wrist sEMG. Third, there was a significant difference in wrist MAS and AROM in the group of resting dorsal hand splint as a result of comparing change(s) between two groups, but there was no significant difference in wrist sEMG. Through this study, it was found that dorsal resting hand splint was more effective in the reduction of wrist spasticity and improving AROM than volar resting hand splint in stroke patients. Applying resting hand splint to stroke patients would not only have preventive effects but also have great influence on the improvement of hand function.

Comment on "CIRSE Guidelines on Percutaneous Needle Biopsy (PNB)".

Abstract: 1. The well-intentioned recommendation ‘‘to prevent air embolism, the introducer needle should always (!) be occluded by the inner stylet or a finger’’ is not even theoretically possible without the use of a hemostatic valve. In 2014, we developed and published the method of hemostatic-valve-coaxial-technique (Fig. 1) for percutaneous lung biopsy [2]. With this technical innovation, a decisive factor for air embolism during percutaneous lung biopsy definitely can be eliminated. Since 2014 we use the hemostatic-valve-coaxial-technique in most cases of percutaneous lung biopsy in our institution. 2. I would also like to express my concerns about the recommendation ‘‘If air embolism occurs, the needle is immediately removed, the patient is placed in a mild Trendelenburg position to avoid cerebral embolism, and ...’’. The Trendelenburg position generally is defined as ‘‘a supine (!) position in which the feet are higher than the head.’’ Whenever air embolism is recognized during percutaneous lung biopsy with the patient still lying on the CT table, the most important thing is to keep a cool head and to avoid any rash change in the patient position. For example, in the case of a biopsy in right-dependent position with air in the apex of the left ventricle, the patient should stay in this position and not be repositioned on the back, as this maneuver alone carries a significant risk to displace the air from the relevant safe place of the left ventricle to the aortic arch and the cerebral or coronary circulation. In the situation of air embolism in left-dependent position, the air would be trapped in the left atrium and again patient should stay in this position to prevent air entering the left ventricle [3, 4]. 3. Another essential point to prevent air embolism due to percutaneous lung biopsy that has to be mentioned in a guideline on percutaneous needle biopsy is patient positioning. The large retrospective observational study of Freund et al. [4] highlighted prone position to be a significant risk factor for air embolism and recommended avoiding prone position in CT-guided lung biopsy. This view has been confirmed by our

Investigation of allergen proteins in five tomato cultivars

Abstract: Investigation of putative allergens from tomato berries is challenging as differences between human serum IgE specificity and reactivity as well as the non-specific binding of the primary and secondary antibodies often cause difficulties. In this study five tomato cultivars were investigated to evaluate their potential allergenicity in Hungarian tomato sensitive patients. The major allergens proved to be low molecular weight proteins, but several previously described allergens could be identified as well using IgE-Western blotting. IgE binding to cross-reactive carbohydrate determinants (CCDs) was ruled out through the use of CCD inhibitor, but non-specific binding of the secondary antibody remained an issue. IgE binding activity of a purified, immunoblot positive protein (band at 40 kDa), and non-specific binding of the secondary antibody to the same protein, was demonstrated with an Optical Waveguide Lightmode Spectroscopy (OWLS) based immunosensor. LC-ESI-MS/MS analysis showed this protein is an as-yet undescribed vicilin-type putative allergen.