Thrombosis in a mechanical aortic valve prosthesis during subcutaneous heparin therapy in pregnancy; a case report

Maternal death due to thrombosis in a mechanical aortic valve prosthesis during heparin therapy is described. The patient had a normal pregnancy during warfarin therapy. In this pregnancy, warfarin therapy was replaced by subcutaneous heparin injections, and the patient died of massive thrombosis in the valvuloprosthesis at 20 weeks of pregnancy. The effectiveness of heparin therapy and difficulties in the follow-up of heparin treatment during pregnancy are discussed.     

Global estimates of fatal work-related diseases

BACKGROUND: Work-related mortality is a relatively new concept which aims to widen occupational health and safety; to take into account not only recognized fatal occupational accidents and diseases but also other work-related deaths. Few countries in the world have a register for work-related diseases. METHODS: Estimates are calculated using baseline world mortality scenarios of all diseases for the year 2000 and attributable fractions made for work-related diseases in Finland, as adjusted. RESULTS: It is estimated that about 2 million work-related deaths take place annually. Men suffer two thirds of those deaths. The biggest groups of work-related diseases are cancers, circulatory diseases and communicable diseases. CONCLUSIONS: Information about work-related diseases is needed for prevention, as people in developed countries are working longer, and the age of retirement is being raised in many countries. As a result, workers are being exposed to different kinds of substances and working conditions for a longer time. In developing countries, work exposures may already start in infancy. Due to industrialization, workers in developing countries are facing new conditions with a lack of relevant knowledge and skills. With the help of information, nations can direct resources and skills for appropriate purposes such as regulatory measures on health and safety at work.     

Azide inhibits human cytochrome P -4502E1, 1A2, and 3A4

BACKGROUND: Recently, we showed that, in addition to cytochrome P-4502E1 (CYP2E1), CYP1A2 and CYP3A4 also contribute to the microsomal ethanol oxidizing system (MEOS). When MEOS activity is measured, sodium azide commonly is used to block the contaminating catalase. However, although CYP2E1 is considered insensitive to azide, its effect on the other P-450s is unknown. Therefore, the aim of the present study was to determine the effect of azide on human recombinant and hepatic CYP2E1, CYP1A2, and CYP3A4. METHODS AND RESULTS: Concentrations of sodium azide as low as 0.1 mM markedly inhibited the specific ethanol oxidation (mean +/- SEM) by recombinant CYP1A2 and CYP3A4 expressed in HepG2 cells (to 16 +/- 1% and 22 +/- 2% of control without azide, respectively; p < 0.01). By contrast, the specific activity of CYP2E1 was only slightly (and not significantly) inhibited at this azide concentration (to 79 +/- 12% of control). Similarly, in human liver microsomes (n = 6), 0.1 mM azide strongly inhibited CYP1A2-dependent (to 25 +/- 2%) and CYP3A4-dependent (to 15 +/- 2%) ethanol oxidation, whereas CYP2E1 was inhibited only at 10 mM azide (to 60 +/- 10%). Azide also strongly affected the apparent kinetic values of all three isoenzymes. Furthermore, azide inhibited the specific monooxygenase activities, both by recombinant and microsomal P-450s. CYP2E1-specific p-nitrophenol hydroxylation was the most sensitive to azide, whereas CYP1A2-dependent 7-methoxyresorufin O-dealkylation was only slightly inhibited. Judging from its effect on p-nitrophenol hydroxylation by human liver microsomes, the inhibition of azide was competitive (Ki 0.09 mM). CONCLUSIONS: Sodium azide at a concentration as low as 0.1 mM inhibited ethanol oxidation by CYP1A2 and CYP3A4. With CYP2E1, although oxidation of 50 mM ethanol was not inhibited by 0.1 mM azide, higher azide concentrations were inhibitory and 0.1 mM azide seemed to affect the kinetics of ethanol oxidation by CYP2E1. Therefore, azide should be avoided when measuring the MEOS activity because it may lead to underestimation, especially of CYP1A2- and CYP3A4-dependent ethanol oxidation.     

IgA-class autoantibodies against neuronal transglutaminase, TG6 in celiac disease: no evidence for gluten dependency

BackgroundIt has been suggested that antibodies against transglutaminase (TG) 6 could serve as a biomarker to identify a subgroup of gluten-sensitive patients who may be at risk of developing neurological disease. We here investigated whether TG6-targeted autoantibodies are a characteristic feature of celiac patients, especially those with neurological symptoms, and further, whether such antibodies are gluten-dependent.MethodsSerum IgA-class TG6 autoantibodies were measured in untreated and treated celiac patients with and without neurological manifestions and in non-celiac controls. The results were compared to TG2 autoantibody levels.ResultsDuring a gluten-containing diet the number of TG6 autoantibody-positive celiac patients with neurological problems (25%) did not significantly differ from that of TG6-seropositive patients without neurological impairment (16%) or from non-celiac controls (15%). This was in contrast to our finding in TG2 autoantibody-positive individuals, whose numbers differed significantly between all three study groups. On a gluten-free diet the levels of TG6 autoantibodies remained unchanged.ConclusionsWe conclude that the serum IgA-class TG6 autoantibody assay is not able to distinguish gluten-sensitive patients with neurological manifestations from celiac patients without neurological problems or from control subjects, and further, that TG6 autoantibodies are not gluten-dependent.     

Quality of life after mitral valve repair

BACKGROUND AND AIM OF THE STUDY: Mitral valve repair for degenerative and ischemic mitral valve regurgitation has been shown to be a durable procedure. The study aim was to evaluate the quality of life of patients who had undergone mitral valve repair, and to compare it to that of an age- and gender-adjusted Finnish general population. METHODS: Among 130 late survivors after mitral valve repair, 109 (83.8%) answered the RAND-36 Health Survey questionnaire; these patients form the basis of the present study. RESULTS: The Wilcoxon test showed significantly higher mental health (p = 0.04) and pain scores (p = 0.015) and a lower role functioning/physical score (p = 0.008) in the study group. The scores of the other RAND-36 Health Survey variables of the study group were similar to those of the age- and gender-adjusted general population. The mean total score for the study group was 512 (median 532, IQR 360-678), compared to 522 (median 538, IQR 468-549) in the general population (p = 0.72) (only 95 patients were included in the analysis due to isolated missing scores). CONCLUSION: The quality of life of long-term survivors after mitral valve repair, as assessed by the RAND-36 Health Survey, is similar to that of an age- and gender-adjusted general Finnish population.     

Evaluating nursing documentation – research designs and methods: systematic review

Title.  Evaluating nursing documentation – research designs and methods: systematic review.
Aim.  This paper is a report of a review conducted to assess the research methods applied in the evaluation of nursing documentation.
Data sources.  The material was drawn from three databases: CINAHL, PubMed and Cochrane using the keywords nursing documentation , nursing care plan , nursing record system , evaluation and assessment . The search was confined to relevant electronically-retrievable studies published in the English language from 2000 to 2007. This yielded 41 studies, including two reviews.
Methods.  Content analysis produced a classification into three themes: nursing documentation, patient-centred documentation and standardized documentation. Each study was assessed according to its research design, methodology, sample size and focus of data collection. In addition, the studies categorized under the heading of standardized documentation were assessed in terms of their outcomes.
Results.  Most of the studies ( n  = 19) focused on patient-centred documentation. Most ( n  = 20) were retrospective studies and used data collected from patient records ( n  = 35). An audit instrument was used to assess nursing documentation in almost all the studies. Studies classified under the heading of standardized documentation showed more positive than negative effects with respect to quality, the nursing process and terminology use, knowledge level and acceptance of computer use in documentation.
Conclusion.  The use of structured nursing terminology in electronic patient record systems will extend the scope of documentation research from assessing the quality of documentation to measuring patient outcomes. More data should also be collected from patients and family members when evaluating nursing documentation.