Hypertension in pregnancy

Formal assessment of the risk of pre-eclampsia should be made early in pregnancy and antenatal care planned accordingly. Recommendations will emerge by the end of this year in a consensus statement (PRECOG guidelines) prepared by clinicians and the lay organisation Action on Pre-eclampsia (APEC) www.apec.org.uk. Some hospitals complement clinical risk assessment with Doppler screening of uterine artery waveforms in mid-pregnancy. Severe pre-eclampsia often takes an explosive course, evolving over a period of hours. Recognition may, therefore, not be amenable to intermittent blood pressure recording and urine testing, but requires women reporting relevant symptoms and GPs being sensitive to the possible significance of complaints such as vomiting and epigastric pain. Severe hypertension demands urgent antihypertensive treatment in hospital. Magnesium sulphate now has an accepted role in the prevention of eclampsia. Possible prevention of pre-eclampsia by antioxidant therapy is the subject of a clinical trial. Low-dose aspirin has a modest but beneficial effect in high-risk women. Delivery remains the definitive treatment for pre-eclampsia, but there may be initial deterioration after birth, especially in the HELLP syndrome.     

Laparoscopic Management of Adnexal Masses

Retrospective study of 121 cases of adnexal masses which were managed laparoscopically was carried out. The aim of study was to evaluate the safety and effectiveness of laparoscopic management of adnexal masses. In 120 cases, procedure was completed safely with minimum morbidity. In one case laparotomy had to be done to complete the procedure. In 76 cases cystectomy was done, 26 required salpingo-oophorectomy and 19 required only salpingectomy. Histologic evaluation revealed 30 functional cysts, 36 endometriotic cysts, 11 dermoids, 9 serous cystadenomas, 3 mucinous cystadenomas, 11 parovarian cysts, 19 cases of hydrosalpinx and 2 cases of tuberculosis.Key Words: Adnexal mass, Laparoscopy, Ovarian cyst     

Impact of bispectral index monitoring on fast tracking of gynecologic patients undergoing laparoscopic surgery

BACKGROUND: The need for increasing operating room efficiency has led to various initiatives, one of which is the elimination of mandatory admission to the phase I recovery area postoperatively, also referred to as fast tracking of ambulatory surgery patients. This Institutional Review Board-approved study was conducted to evaluate the effect of Bispectral Index (BIS) monitoring on the ability of patients to successfully bypass the phase I recovery area following gynecologic laparoscopy during general anesthesia. METHODS: Ninety-nine consenting patients were randomly assigned to one of two groups: group one, in which the BIS monitor (Aspect Medical Systems, Natick, MA) was used, and group two, in which no BIS monitor was used. All patients received a standardized anesthetic that included 1 microg/kg sufentanil and sevoflurane in oxygen, titrated in group one to a BIS value of 50-60 and in group two to maintain vital signs within 20% of preoperative values. All patients received prophylactic nonsteroidal antiinflammatory drugs and antiemetics. Postoperatively, patients were evaluated using the modified Aldrete scoring system, and those who achieved a score of 9 or higher within 10 min were permitted to bypass the phase I recovery area. RESULTS: There was no statistically significant difference between the two groups with respect to the number of patients who successfully bypassed the phase I recovery area, postoperative length of hospital stay, or cost of hospitalization. CONCLUSION: With a standardized anesthetic regimen and a strict discharge scoring system, BIS monitoring does not have a significant effect on the ability to fast track outpatients.     

African-American Muslim women and health care

Muslims constitute a growing proportion of the African-American population. This paper explores the health practices, health behaviors, and code of ethics as informed by the Islamic religion within the context of African-American Muslim women's lives. An overview of the history of Islam in the world, and in the U.S., the main Islamic tenets, and the socio-cultural context of African-American Muslim women provides the broad framework for this paper. This information will be helpful in meeting the health needs of African-American Islamic women, within an outreach/community health promotion setting, within a clinical/hospital setting, or within a home care setting.     

Effects of dietary proteins and trypsin inhibitor on growth and lipid metabolism in hamsters

The purpose of this study was to determine trypsin inhibitor (TI) activity in sweetpotato and soy flour diets and their effects on the growth and lipid metabolism of hamsters. Male Golden Syrian hamsters were fed different types of dietary protein containing casein, soyprotein, transgenic sweetpotato plus soy flour (TSPF+SF), nontransgenic sweetpotato (NTSPF) plus soy flour (NTSPF+SF), transgenic sweetpotato (TSPF) and nontransgenic sweetpotato flour for 28 days. The TI activity was highest in TSPF+SF (19.30 TIU/mg) and NTSPF+SF (17.20 TIU/mg) diets that induced growth retardation in animals, lowest in TSPF (5.80 TIU/mg) and NTSPF (5.50 TIU/mg) diets, which did not affect the growth of the animals, and negligible in casein (<1.00 TIU/mg) and soyprotein (2.00 TIU/mg) diets. Plasma total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C) and triglyceride (TG) concentrations were significantly higher in hamsters fed the casein diet compared to those fed the soy protein, TSPF+SF, NTSPF+SF, TSPF and NTSPF diets. A positive correlation was observed between plasma TC concentrations of hamsters and dietary methionine, lysine, leucine content and methionine/glycine ratios. Liver TC and TG concentrations of hamsters fed casein were significantly higher than those of all other diet groups. The supplementation of sweetpotato flour with soy flour increased both protein and TI activity in the diets and the lipid metabolism of hamsters were unaffected by TI activity.