Load Rate of Facet Joints at the Adjacent Segment Increased After Fusion

Background:

The cause of the adjacent segment degeneration (ASD) after fusion remains unknown. It is reported that adjacent facet joint stresses increase after anterior cervical discectomy and fusion. This increase of stress rate may lead to tissue injury. Thus far, the load rate of the adjacent segment facet joint after fusion remains unclear.

Methods:

Six C2–C7 cadaveric spine specimens were loaded under four motion modes: Flexion, extension, rotation, and lateral bending, with a pure moment using a 6° robot arm combined with an optical motion analysis system. The Tecscan pressure test system was used for testing facet joint pressure.

Results:

The contact mode of the facet joints and distributions of the force center during different motions were recorded. The adjacent segment facet joint forces increased faster after fusion, compared with intact conditions. While the magnitude of pressures increased, there was no difference in distribution modes before and after fusion. No pressures were detected during flexion. The average growth velocity during extension was the fastest and was significantly faster than lateral bending.

Conclusions:

One of the reasons for cartilage injury was the increasing stress rate of loading. This implies that ASD after fusion may be related to habitual movement before and after fusion. More and faster extension is disadvantageous for the facet joints and should be reduced as much as possible.     

Evaluation of Vitreous Substitutes in Managing Complicated Vitreo-retinal Surgeries

Background

Vitreous substitutes presently in use for intraoperative tamponade are perfluorocarbon liquids (PFCL) and for post operative tamponade are silicon oil (SO), sulphur hexafluoride (SF₆) and perfluorocarbon gas (PFC). Several factors are important for a thorough understanding of each of these vitreous substitutes. The absorption or necessity for removal, indications for use (including clinical studies and special surgical methods), additives and complications of use have to be considered.

Methods

Three port standard pars plana vitrectomy was performed in 60 consecutive cases requiring intra-vitreal intervention. PFCL was used intra-operatively in 30 cases (PFCL group and X group). The eyes were implanted with SO (silicon oil subgroup), PFC (C₃F₈ sub-group) and SF₆ (SF₆ sub-group) in twenty cases each. Apart from best corrected visual acuity (BCVA), the retinal status and the longevity of gas when used, changes and reaction in both the anterior and posterior segments were noted.

Result

The difference of postoperative BCVA in the PFCL and non-PFCL groups was statistically significant with p < 0.001. In both the PFCL and non-PFCL groups the difference between preoperative and postoperative BCVA was statistically significant with p < 0.0001. All three vitreous substitutes studied are effective given the case where they had been utilised.

Conclusion

PFCL is invaluable in the management of complicated retinal detachment (RD). Where a vitreous microsurgery is indicated, the visual outcome is good. SF₆ is useful for short-term tamponade. Silicon oil and C₃F₈ are useful for longer tamponade.Key Words: Tamponade, Perfluorocarbon liquids, Silicon oil, Sulphur hexafluoride, Perfluorocarbon gas, Retinal detachment     

Comparison of posterior versus transforaminal lumbar interbody fusion using finite element analysis: Influence on adjacent segmental degeneration

Objectives:

To compare the influence of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) on adjacent segment degeneration.

Methods:

The study was carried out in the Traumatology and Orthopedics Laboratory, Department of Traditional Chinese Medicine, Medical School, Jinan University, Guangzhou, China, between December 2013 and November 2014. A normal, healthy finite element model of L3-5 was developed, a PLIF and a TLIF model were modified from the normal model, and interbody fusions were performed in the L4-5 segment. An 800 N compressive loading plus 10 Nm moments simulating flexion, extension, lateral bending, and axial rotation were imposed on the L3 superior endplate. Intradiscal pressure and intersegmental rotation in L3-4 were investigated.

Results:

The values of intradiscal pressure and intersegmental rotation in the PLIF or TLIF model were higher than those in the normal, healthy model, but the values in the TLIF model were relatively lower than those in the PLIF model in all directions.

Conclusion:

Posterior lumbar interbody fusion has more adverse influence on the superior adjacent segment than TLIF.Both transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are standard techniques of lumbar fusion to treat degenerative lumbar disorders.1,2 Many clinical studies have been performed to compare the surgical results of the 2 techniques, most of which suggested TLIF and PLIF had no significant difference in clinical outcomes.3,4 In addition, Zhang et al5 found in a meta-analysis that patients undergoing PLIF had a higher incidence of complications than those undergoing TLIF. In a retrospective study of 163 patients, Hey and Hee6 found a reduced risk of vessel and nerve injury, shortened operating time, and reduced intraoperative bleeding in TLIF. Subsequently, TLIF became an optimal selection when spine surgeons developed treatment strategies. However, in terms of adjacent segment degeneration (ASD), and the long-term complications after lumbar fusion, few studies have been performed to compare the influence of PLIF and TLIF on the adjacent segment. In a unique biomechanical study performed using human cadavers, Sim et al7 found PLIF and TLIF had similar biomechanical properties regarding range of motion, intradiscal pressure, and laminar strain at adjacent segments. In our opinion, these 2 techniques have differences in cage selection and excision of posterior elements, which may affect the conduction of stress, and produce different influences on adjacent segment. In addition, Sim et al’s7 study was an immediate test after cage placement and instrumentation fixation, but ASD usually occurs after solid fusion and a study using samples with solid fusion, may be better in clarifying the issues. The limitations in clinical study make discrete characterization of the effects of lumbar interbody fusion on the adjacent segment significantly difficult. In addition, specimens for cases and controls in clinical studies are difficult to obtain and standardize.8 By contrast, the finite element technique, which is highly reproducible and repeatable, can mitigate these problems. A finite element model can be adjusted in material properties, loading mode or structural shape, to simulate normal, degenerative, fusion or other different situations. Compared with other experimental methods, a finite element method presents many advantages, which facilitates a comparative study among models with different biomechanical situations.8 Therefore, we developed a 3-dimensional finite element model of L3-5 for the normal, healthy spine, along with a PLIF and a TLIF model, our aim was to compare the biomechanical influence of PLIF and TLIF on adjacent segments.     

Wireless capsule endoscopy for the detection of small bowel diseases in HIV-1-infected patients

Background and Aims

In HIV-infected patients, manifestations of the disease are common in the gastrointestinal tract. The objective of our study was to evaluate the diagnostic yield of the Given^® Video Capsule System (Given Imaging, Yoqneam, Israel) in these patients.

Methods

After exclusion of GI-tract stenosis by anamnestic exploration, 49 patients were included into the study. Stratification: Group A (n = 19): HIV-positive, CD₄ cell count < 200/μl, gastrointestinal symptoms present. Group B: HIV-positive, CD₄ < 200/μl, without gastrointestinal symptoms (n = 19 Group) C: healthy volunteers (n = 11).

Results

In group A there was a total of 30 pathological findings, 15 of which with therapeutic implications. In group B, there was a total of 22 pathological findings, 5 relevant for therapy. In group C there was a total of 13 pathological findings, 3 with therapeutic relevance. In 89% (group A) vs. 26% (group B), pathological findings were detected distal the ligament of Treitz (p = 0.001). All capsules were recovered without complications after 12 to 96 h from the stool.

Conclusion

Wireless capsule endoscopy of the small intestine should be considered for HIV-infected patients with marked immunosuppression and gastrointestinal symptoms.     

Increased serum nitric oxide and malondialdehyde levels in patients with acute intestinal amebiasis

Objective

To determine the level of oxygen-nitrogen stress parameters in the pathogenesis of amebiasis.

Methods

Twenty-four acute intestinal amebiasis patients and 20 healthy controls were enrolled in the present study. Serum malondialdehyde and nitric oxide levels were determined spectrophotometrically.

Results

Serum malondialdehyde and nitric oxide levels were significantly higher in acute intestinal amebiasis patients than healthy controls (P<0.001).

Conclusions

These results suggest that oxidative and nitrosative stress may play a major role in tissue damage in acute intestinal amebiasis patients. Also these parameters can be used to supplement the conventional microscopic method for reliable diagnosis of intestinal amebiasis.     

Long-term spatial memory and morphological changes in hippocampus of Wistar rats exposed to smoke from Carica papaya leaves

Objective

To investigate the effects of smoking of dried leaves of Carica papaya (pawpaw) based on ethnopharmacological information which indicated that smoking of papaya leaves could influence motor performance and learning.

Methods

Twenty-four rats were used for the study, and were grouped into four groups. Groups 1 served as the control (not exposed to papaya leaves smoke), while Groups 2, 3 and 4 were exposed to smoke from 6.25 g, 12.50 g and 18.75 g of dry pawpaw leaves respectively in a smoking chamber twice daily for 21 d with each exposure lasting for 3 min. Lastly, hippocampus was harvested in each group for histological study.

Results

The results showed that there were significant (P<0.05) increases in mean of recall latencies of long-term spatial memory in the animal administered the high dose while the other groups had significantly (P<0.05) lower frequencies. Histological investigation showed signs of mild neural degeneration in high dose group and hypochromic appearance of the Nissl substance in all treated groups.

Conclusions

In conclusion, the findings from this study has demonstrated that smoking of papaya leaves has the ability to maintain an intact long-term spatial memory at all doses but retrieving such memory is faster with the low and medium dosages.     

In vivo antioxidant and hepatoprotective activity of methanolic extracts of Daucus carota seeds in experimental animals

Objective

To assess the In vivo antioxidFant and hepatoprotective activity of methanolic extract of Daucus carota (D. carota) seeds in experimental animals.

Methods

Methanolic extracts of D. carota seeds is used for hepatoprotection assessment. Oxidative stress were induced in rats by thioacetamide 100 mg/kg s.c, in four groups of rats (two test, standard and toxic control). Two test groups received D. carota seeds extract (DCSE) at doses of 200 mg/kg and 400 mg/kg. Standard group received silymarin (25 mg/kg) and toxic control received only thioacetamide. Control group received only vehicle. On the 8th day animals were sacrificed and liver enzyme like serum glutamic pyruvic transaminase (SGPT), serum glutamic-oxaloacetic transaminase (SGOT) and alkaline phosphatase (ALP) were estimated in blood serum and antioxidant enzyme like superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GRD), glutathione peroxidase (GPX), glutathione-S-transferase (GST) and lipid peroxidation (LPO) were estimated in liver homogenate.

Results

A significant decrease in SGPT, SGOT and ALP levels was observed in all drug treated groups as compared to thioacetamide group (P < 0.001) and in case of antioxidant enzyme a significant (P < 0.001) increase in SOD, CAT, GRD, GPX and GST was observed in all drug treated groups as compared with thioacetamide group. But in case of LPO a significant (P < 0.001) reduction was observed as compared to toxic control group.

Conclusions

DCSE has contributed to the reduction of oxidative stress and the protection of liver in experimental rats.     

Can poison control data be used for pharmaceutical poisoning surveillance?

Objective

To determine the association between the frequencies of pharmaceutical exposures reported to a poison control center (PCC) and those seen in the emergency department (ED).

Design

A statewide population-based retrospective comparison of frequencies of ED pharmaceutical poisonings with frequencies of pharmaceutical exposures reported to a regional PCC. ED poisonings, identified by International Classification of Diseases, Version 9 (ICD-9) codes, were grouped into substance categories. Using a reproducible algorithm facilitated by probabilistic linkage, codes from the PCC classification system were mapped into the same categories. A readily identifiable subset of PCC calls was selected for comparison.

Measurements

Correlations between frequencies of quarterly exposures by substance categories were calculated using Pearson correlation coefficients and partial correlation coefficients with adjustment for seasonality.

Results

PCC reported exposures correlated with ED poisonings in nine of 10 categories. Partial correlation coefficients (r_p) indicated strong associations (r_p>0.8) for three substance categories that underwent large changes in their incidences (opiates, benzodiazepines, and muscle relaxants). Six substance categories were moderately correlated (r_p>0.6). One category, salicylates, showed no association.

Limitations

Imperfect overlap between ICD-9 and PCC codes may have led to miscategorization. Substances without changes in exposure frequency have inadequate variability to detect association using this method.

Conclusion

PCC data are able to effectively identify trends in poisonings seen in EDs and may be useful as part of a pharmaceutical poisoning surveillance system. The authors developed an algorithm-driven technique for mapping American Association of Poison Control Centers codes to ICD-9 codes and identified a useful subset of poison control exposures for analysis.     

Effect of Solanum surattense seed on the oxidative potential of cauda epididymal spermatozoa

Objective

To evaluate the effect of aqueous seed extract of Solanum surattense (S. surattense) on the oxidative potential of cauda epididymal spermatozoa.

Methods

S. surattense seed extract was orally administered at the dosage of 10 mg/kg b.w. for 15 days, after which aspartate transferase (AST), alanine transferase (ALT), glutamate dehydrogenase (GDH), citric acid and iso-citrate dehydrogenase (ICDH) were assayed.

Results

The activity levels of the enzymes AST and ALT, which are considered to be the androgenicity in the sperm suspension, were depleted in the extract fed rats. The activity level of the enzyme ICDH, was reduced significantly in the treated group (P<0.001).

Conclusions

It can be concluded that the oral administration of the aqueous seed extract of S. surattense can deplete the oxidative stress of cauda epididymal spermatozoa in albino rats.     

Plasma levels of vitamin E and carotenoids are decreased in patients with nonalcoholic steatohepatitis (NASH)

Objectives

Oxidative stress is suggested to play an important role in the pathogenesis of nonalcoholic steatohepatitis (NASH). The present study was aimed to compare plasma levels of antioxidants in patients suffering from NASH and healthy controls.

Methods

Plasma levels of the antioxidants α-tocopherol, γ-tocopherol, lutein, zeaxanthin, β-cryptoxanthin, lycopene, α-carotene β-carotene were determined in 57 patients with biopsy-proven NASH and 40 healthy controls.

Results

Levels of α-tocopherol (22.4 vs. 26.8 nmol/ ml; p < 0.01), lutein (0.19 vs. 0.33 nmol/ml; p < 0.0001), zeaxanthin (0.04 vs. 0.08 nmol/ml; p < 0.0001), lycopene (0.15 vs. 0.42 nmol/ml; p < 0.0001), α-carotene (0.03 vs. 0.06 nmol/ml; p < 0.005) and β-carotene (0.25 vs. 0.39 nmol/ml; p < 0.01) were significantly decreased in NASH patients compared to controls. Age, aminotransferase status (ALT, AST) and BMI were not correlated with the levels of tocopherols or carotenoids.

Conclusions

Given the decreased levels supplementation of lipophilic antioxidants might be a rational treatment option for patients with NASH.     

Urothelial bladder carcinoma in young patients is characterized by a relatively good prognosis

Introduction and aim.

Urothelial bladder carcinoma (UBC) is a very rare condition in patients aged below 50 years. The aim of the study was to answer the question whether the characteristics of cancer in this group of patients differ from general UBC features.

Material and methods.

Altogether 2160 patients treated with primary transurethral resection due to a bladder tumor were included in the study. The mean age of the cohort was 69.1 years (range 11–100). Patients were divided into three subgroups depending on age: age <41 years (group 1), age 41–50 years (group 2), age >50 years (group 3). Sex ratio, tumor grade, and stage of disease were recorded.

Results.

Women constituted 18.5%, 19.2%, and 25.8% of the patients in groups 1, 2, and 3, respectively (P < 0.05). WHO grade 3 tumors were diagnosed in 0%, 8.5%, and 17.2%, respectively (P < 0.05). Non-invasive papillary carcinoma was found in 100.0%, 76.7%, and 62.7%, respectively (P < 0.05). The incidence of muscle-invasive bladder cancer was 0%, 11.0%, and 15.6%, respectively (P < 0.05).

Conclusions.

Pathological characteristics of UBC are dependent on the patients’ age. Being a very rare condition, UBC in young patients is characterized by a relatively good prognosis.     

Acute and subacute oral toxicity study on the flavonoid rich fraction of Monodora tenuifolia seed in albino rats

Objective

To investigate the effects of the flavonoid rich fraction of Monodora tenuifolia seed on the haematology, histopathology and liver profile of Wistar albino rats.

Methods

Toxicity study was investigated on the flavonoid rich fraction of Monodora tenuifolia in rats administered different concentrations orally for 28 d using standard laboratory procedures.

Results

The LD₅₀ of the flavonoid rich fraction was found to be above 5 000 mg/kg body weight in mice observed for 48 h. After the Day 14, biochemical markers of liver injury such as serum alanine aminotransferase, and aspartate aminotransferase decreased significantly (P<0.05 at doses of 100 and 200 mg/kg body weight and P<0.01 at 400 mg/kg) while serum alkaline phosphatase increased non-significantly (P>0.05). There was non-significant (P>0.05) effect observed across the groups in the levels of serum total protein, albumin, globulin, urea and creatinine. The result of histological examination showed various degrees of peribiliary hepatitis after the Day 14 which fizzled out after the Day 28.

Conclusions

The result therefore suggests that the seed extract is potentially safe.     

Analgesic,anti-inflammatory and anti-diarrheal activities of ethanolic leaf extract of Typhonium trilobatum L. Schott

Objective

To explore the efficacy of ethanolic leaf extract of Typhonium trilobatum L. Schott in treating diarrhea, pain and inflammation using experimental models.

Methods

In the present study, acetic acid-induced writhing, xylene-induced ear edema and castor oil-induced diarrheal model were used to evaluate the analgesic, anti-inflammatory and anti-diarrheal activities, respectively. Acute toxicity test was carried out to fix the safe doses of the plant extract.

Results

The plant extract demonstrated a significant inhibition of writhing (P<0.01) compared with the control group in acetic acid-induced writhing test in mice. The extract also significantly inhibited the xylene induced ear edema formation (P<0.05). In anti-diarrheal test, the extract significantly decreased the frequency of defecation and increased the mean latent period (P<0.01) in castor oil-induced diarrheal model mice at the doses of 250 and 500 mg/kg body weight.

Conclusions

These results suggest that the extract possesses significant analgesic, anti-inflammatory and anti-diarrheal activities that support to the ethnopharmacological uses of this plant.     

Analytical characterization and structure elucidation of metabolites from Aspergillus ochraceus MP2 fungi

Objective

To isolate and characterize the bioactive secondary metabolites from Aspergillus ochraceus (A. ochraceus) MP2 fungi.

Methods

The anti bacterial activity of marine sponge derived fungi A. ochraceus MP2 was thoroughly investigated against antagonistic human pathogens. The optimum inhibitory concentration of the fungi in the elite solvent was also determined. The promising extracts that showed good antimicrobial activity were subjected to further analytical separation to get individual distinct metabolites and the eluants were further identified by GC MS instrumental analysis. The molecular characterization of the elite fungal strains were done by isolating their genomic DNA and amplify the internal transcribed spacer (ITS) region of 5.8s rRNA using specific ITS primer. The novelty of the strain was proved by homology search tools and elite sequences was submitted to GENBANK.

Results

Three bioactive compounds were characterized to reveal their identity, chemical formula and structure. The first elutant was identified asα- Campholene aldehyde with chemical formula C₁₀ H₁₆ O and molecular weight 152 Da. The second elutant was identified as Lucenin-2 and chemical formula C₂₇ H₃₀ O₁₆ and molecular weight 610 Da. The third elutant was identified as 6-Ethyloct- 3-yl- 2- ethylhexyl ester with Chemical formula C₂₆ H₄₂ O₄ with molecular weight 418 Da.

Conclusions

The isolated compounds showed significant antimicrobial activity against potential human pathogens. Microbial secondary metabolites represent a large source of compounds endowed with ingenious structures and potent biological activities.     

Biliary tract external drainage increases the expression levels of heme oxygenase-1 in rat livers

Background

Heme oxygenase-1 (HO-1) protects cells by anti-oxidation, maintaining normal microcirculation and anti-inflammatory under stress. This study investigated the effects of biliary tract external drainage (BTED) on the expression levels of HO-1 in rat livers.

Methods

Biliary tract external drainage was performed by inserting a cannula into the bile duct. Sixty Sprague–Dawley rats were randomized to the following groups: sham 1 h group; BTED 1 h group; bile duct ligation (BDL) 1 h group; sham 6 h group and BTED 6 h group. The expression levels of HO-1 mRNA were analyzed using real-time RT-PCR. The expression levels of HO-1 were analyzed using immunohistochemistry.

Results

The expression levels of HO-1 mRNA in the liver of the BTED group increased significantly compared with the sham group 1 and 6 h after surgery (p < 0.05).The expression levels of HO-1 in the BTED group increased significantly compared with the sham group 1 and 6 h after surgery. The expression levels of HO-1 mRNA in the liver in the BDL group decreased significantly compared with the sham group 1 h after surgery (p < 0.05).The expression levels of HO-1 in the BDL group decreased significantly compared with the sham group at this time.

Conclusion

Biliary tract external drainages increase the expression levels of HO-1 in the liver.     

Clinical presentation and incidence of complications in patients with coeliac disease diagnosed by relative screening

Background

There is an increased prevalence of coeliac disease (CD) among relatives of those with the disease.

Aims

To compare the clinical features in patients with CD detected via family screening with those in patients diagnosed routinely.

Methods

Information on screening was provided to relatives of patients. Those who wished to be screened were tested for endomysial and/or tissue transglutaminase antibodies. Duodenal biopsy was performed in those with positive antibodies. The clinical details of the relative screening group were compared with those of 105 patients diagnosed routinely.

Results

183 relatives underwent screening, of whom 32 had positive serology, 24 had histology diagnostic of CD, six had normal biopsies and two declined duodenal biopsy. Patients in the relative screening group were younger with a median age of 33 years (range 17–72 years) compared to the routine group which had a median age of 54 years (range 25–88 years). In the relative screening group, there was a male preponderance (M:F ratio 16:8), anaemia at presentation was significantly less common (13% v 58%; p<0.001) and osteoporosis was less frequent (9% v 22%; p<0.244) compared with the routine group. 65% of the relative screening group had gastrointestinal symptoms or anaemia at diagnosis.

Conclusions

Patients detected by family screening are younger with a male preponderance, but fewer had anaemia and osteoporosis.     

Low Level Laser Therapy in Treatment of Stress Fractures Tibia: A Prospective Randomized Trial

Background

Standard treatment of Stress fracture includes rest, compression, elevation and passive stretching. Low level laser therapy (LLLT) has been described in treatment of joint conditions, tendophaties, musculofascial pains and dermatological conditions. A prospective randomized control study was carried out to assess efficacy of LLLT in treatment of stress fractures in tibia.

Method

68 cases were enrolled. 34 each in control and test group. Control cases were treated with placebo and test group with laser-therapy. Complete resolution of pain and tenderness, and return to painless ambulation was taken as end point of therapy in both groups.

Result

The test group showed earlier resolution of symptoms and painless ambulation with fewer recurrence.

Conclusion

LLLT appears beneficial in treatment of stress fracture in this preliminary study. A larger multicentric study is indicated to prove the benefit conclusively.Key Words: Stress fracture tibia, Low level laser therapy     

A limited sampling strategy for estimation of the area under the curve (0 to 8 hours) of mycophenolic acid administered three times daily to liver transplant recipients

Objectives

Gastrointestinal side-effects caused by mycophenolic acid (MPA) are frequent in liver transplant recipients, and in these cases a switch from two to three daily doses is usually recommended. However, a limited sampling strategy for the estimation of MPA area under the curve from 0 to 8 hours (AUC_(0–8h)) has not been made.

Design and methods

In 22 liver transplant patients who were administered MPA three times daily, the trapezoidal extrapolated MPA AUC_(0–8h) values using a sampling time from 0 to 2 hours were calculated.

Results

A tentative therapeutic range for MPA AUC_(0–8h) of about 20–40 μg.h/mL is proposed, and in the 13 patients with supratherapeutic values the total leukocyte blood count was significantly lower than in the 9 patients with AUC_(0–8h) ≤ 40 μg.h/mL (P < 0.001). Significant negative correlations were found between the total leukocyte blood count and the MPA trough levels (r = −0.458; P < 0.05), AUC_(0–8h) (r = −0.479; P < 0.05), and AUC_(0–2h) (r = −0.437; P < 0.05). A significant correlation was found between the trapezoidal extrapolated AUC_(0–8h) and trapezoidal AUC_(0–2h) results (r = 0.850; P < 0.001).

Conclusions

The trapezoidal extrapolated AUC_(0–8h), and possibly trapezoidal AUC_(0–2h), may be useful for routine therapeutic MPA monitoring in liver transplant recipients in which the dosing frequency is increased from twice to three times a day.     

Contraceptive Effectiveness of Levonorgestrel Releasing Intrauterine System

Background

This study evaluated the contraceptive effectiveness of progesterone releasing intrauterine contraceptive devices (IUCD) and compared it with the Copper T device.

Methods

Seventy patients were selected in each group. Menstrual charts were maintained and data recorded at one, three, six months and one year after insertion of the device.

Result

One year follow up was completed by 66 patients in the Levonorgestrel Releasing Intrauterine System (LNG-IUS) group and 62 in the Cu T group. They were age, parity and education level matched. The mean duration of menstrual flow for the LNG-IUS group was 3.6 days and that for CuT group was 5.1 days (p>0.05). Insertion of LNG-IUS was found to be significantly difficult than the Cu T 380, with increased pain at insertion (p<0.05). There was no pregnancy in the LNG-IUS group and expulsion rates were low. The most significant difference was scanty periods and at times amenorrhoea in the LNG-IUS group. Termination rates for various reasons were almost equal in both groups.

Conclusion

Both devices were effective, safe, well accepted and tolerated. LNG-IUS scores high in patients with preexisting menorrhagia or dysmenorrhoea while Cu T 380 has advantages of lower cost, ease of insertion and comparable efficacy.Key Words: Copper T 380, Levonorgestrel intrauterine system, Contraception, Menorrhagia, Amenorrhea     

Electronic health records in small physician practices: availability,use, and perceived benefits

Objective

To examine variation in the adoption of electronic health record (EHR) functionalities and their use patterns, barriers to adoption, and perceived benefits by physician practice size.

Design

Mailed survey of a nationally representative random sample of practicing physicians identified from the Physician Masterfile of the American Medical Association.

Measurements

We measured, stratified by practice size: (1) availability of EHR functionalities, (2) functionality use, (3) barriers to the adoption and use of EHR, and (4) impact of the EHR on the practice and quality of patient care.

Results

With a response rate of 62%, we found that <2% of physicians in solo or two-physician (small) practices reported a fully functional EHR and 5% reported a basic EHR compared with 13% of physicians from 11+ group (largest group) practices with a fully functional system and 26% with a basic system. Between groups, a 21–46% difference in specific functionalities available was reported. Among adopters there were moderate to large differences in the use of the EHR systems. Financial barriers were more likely to be reported by smaller practices, along with concerns about future obsolescence. These differences were sizable (13–16%) and statistically significant (p<0.001). All adopters reported similar benefits.

Limitations

Although we have adjusted for response bias, influences may still exist.

Conclusion

Our study found that physicians in small practices have lower levels of EHR adoption and that these providers were less likely to use these systems. Ensuring that unique barriers are addressed will be critical to the widespread meaningful use of EHR systems among small practices.