Persistent reversed end diastolic flow in the fetal middle cerebral artery: an ominous finding

Fetal persistent middle cerebral artery reversed end diastolic flow is a rare and ominous finding. Previous cases have been associated with intracranial hemorrhage, growth restriction, anaemia, and hepatic anomaly. Intrauterine demise or early neonatal death is a common outcome. We report the case of persistent middle cerebral artery reversed end diastolic flow in a well-grown fetus at 32 weeks’ gestation resulting from acute, severe anaemia due to a large feto-maternal hemorrhage. An emergency cesarean section was performed and the neonate required advanced resuscitation and immediate blood transfusion. Postnatal magnetic resonance imaging confirmed a hemorrhagic parietal infarct and bilateral ischaemic changes in the basal ganglia. This provides further evidence that persistent middle cerebral artery reversed end diastolic flow in any fetus is an ominous finding warranting urgent diagnostic evaluation and/or delivery.     

Elevated glycosylated haemoglobin (HbA1c) is a risk marker in coronary artery bypass surgery

Objective. To evaluate if glycosylated haemoglobin 1 (HbA_1c) was associated with increased risk of infection and mortality after coronary artery bypass grafting (CABG). Design. Prospective observational study. Preoperative HbA_1c concentrations were correlated to outcome in patients followed for an average of 3.5 years after CABG. Results. HbA_1c was ≥6% in 68% of 161 patients with diabetes mellitus (DM) and in 3% of 444 patients without DM. Superficial sternal wound infection was observed in 13.9% if HbA_1c ≥6% versus in 5.5% if <6% (p=0.007). Mediastinitis occurred in 4.9% if HbA_1c≥6% and in 2.1% if HbA_1c<6% (p=0.20) (Hazard ratio (HR) 1.9, 95% CI 0.6-5.9). Follow-up mortality was 18.9% in patients with HbA_1c≥6% compared to 4.1% if HbA_1c<6% (p<0.001) with HR 5.4, (95% CI 3.0-10.0) after multivariable adjustment. The risk of death was similar regardless of DM diagnosis. Conclusions. HbA_1c ≥6% was associated with an increased risk of postoperative superficial sternal wound infections and a trend for higher mediastinitis rate and significantly higher mortality three years after CABG.     

Increased Parietal and Frontal Activation after Remission from Recurrent Major Depression: A Repeated fMRI Study

Nine patients with unipolar major depression were scanned with MRI twice over a 2-year period, and compared with 12 healthy control subjects. All patients fulfilled criteria for major depressive disorder, recurrent type, at first scanning. Level of depressive psychopathology was assessed by the Hamilton Depression Rating Scale. The participants had to work on a mental arithmetics/working memory task while in the MR scanner. The task consisted of single digits (1 to 9) that were shown to the participant, who had to add the numbers in successive pairs and press a response button when the sum was 10. Neuronal activation was recorded based on the BOLD contrast phenomenon in a functional MRI protocol. The results showed significant increase in activation for the patients in the inferior frontal gyrus and the superior and inferior parietal lobule at the second compared with the first MR scanning session. There were also significant correlations between the HDRS scores and neuronal activation which showed a negative correlation particularly in the inferior frontal and parietal lobe areas, which overlapped with similar areas activated in the healthy control participants. This may indicate normalization of brain activation in depressed patients as a function of time from an illness phase to a remission/recovery state.

Rapid prenatal diagnosis of beta thalassemia using DNA amplification and nonradioactive probes

We used in vitro DNA amplification by the polymerase chain reaction and nonradioactive probes for prenatal diagnosis of beta thalassemia in Chinese from the Guangdong province. Exact molecular diagnoses were made in all 20 fetuses studied over a 6-month period. We conclude that this method of prenatal diagnosis for beta thalassemia is a viable approach in many parts of the world where this disease is common.     

Restaurant owner perceptions of the effects of a smoking ban

In this paper business owner expectations regarding revenue changes due to a general smoking ban are analyzed using a survey mailed out to all restaurants, bars, cafés and nightclubs in Gothenburg, Sweden. A reasonable interpretation of the survey responses is that as many as 74% of the establishments do not expect to be severely hurt by a general smoking ban applying to the entire restaurant sector. The econometric results show that the owners are more likely to expect a decrease in revenues the larger their share of smoking customers. Moreover, establishments that are smoke-free are less likely to expect negative economic effects compared to those that currently allow smoking. Also, establishments with a non-smoking section are less likely to expect negative economic effects from a general smoking ban. No strong effect of the type of establishment (café, bar, or restaurant) on expected changes in revenues is detected, although establishments with late night hours are more likely to expect financial losses.