The changing face of gastroschisis and omphalocele in southeast Georgia

Objective: To document trends in the clinical characteristics of gastroschisis and omphalocele in southeast Georgia, USA, from 1994 to 2002.

Methods: All babies with an abdominal wall defect in a 19-county region were referred to one Perinatal Center for genetic counseling, level II ultrasound scans, pregnancy follow-up and delivery. Karyotyping was offered for omphalocele, advanced maternal age, family history predisposing to aneuploidy, and gastroschisis with an additional anomaly.

Results: There were 64 patients, 34 with gastroschisis and 30 with omphalocele. From 1994 to 2002, the birth prevalence of gastroschisis was 1:3600 and omphalocele 1:3400, but from 2000 to 2002, gastroschisis increased to 1:1667, while omphalocele increased to only 1:2709. Gender distribution was different: for gastroschisis the M:F ratio was 1:2.1; for omphalocele the ratio was 1.7:1. In the patients with omphalocele, 90% had an amniocentesis and 9/27 were aneuploid: five had trisomy 18, three had trisomy 13 and one had trisomy 21. Seventy-six per cent of the patients with omphalocele had associated anomalies, but only 17.6% of those with gastroschisis. Mothers whose babies had gastroschisis showed a trend to progressively younger age, while no such trend was observed among mothers whose babies had omphalocele.

Conclusion: The birth prevalence of abdominal wall defects in general is increasing, but more notably for gastroschisis. Maternal age continues to decrease for gastroschisis. In the study population, gender distribution showed a statistically significant variation between the defects.     

Neuromuscular control of lumbar instability following static work of various loads

Neuromuscular control of lumbar stability following exposure to prolonged static work, under low and high loads, was assessed in the in vivo feline model. Six sessions of 10 min work at 20N with 10 min between rest was compared to a group subjected to the same protocol but carrying high loads of 60N. Displacement and tension developed in the spine at the instant the multifidus muscles applied stabilizing contractions, and their amplitudes were obtained from their electromyogram (EMG). Significant (P < 0.001) laxity developed in the various viscoelastic tissues of the lumbar spine that did not recover during and up to 7 h of rest postwork. Simultaneously, there was a significant (P < 0.001) decrease in muscular activity in the 3–4 h immediately postwork under low load but only during the first hour in the high load group. After that period the musculature compensated for the laxity of the viscoelastic tissues by a significant (P < 0.001) increase in activity in the high‐load group and a nonsignificant increase in the low group. It was concluded that during 1–3 h immediately poststatic work a significant decrease in the stabilizing function of viscoelastic tissues together with a significant decrease in muscular activity is present, and they render the spine unstable and exposed to high risk of injury. Performance of prolonged static work under low loads, while not harmful during the work, cannot be designated as a “no‐risk” condition, as it may result in injury postwork. Muscle Nerve 39: 71–82, 2009     

A comparative study of bacterial isolates from the urine samples of AIDS and non—AIDS patients in Benue,Nigeria

ObjectiveTo determine the common bacterial causes of urinary tract infection and their antibiotic susceptibility pattern in AIDS patients versus non-AIDS patients.MethodsOne thousand consecutive AIDS patients with signs and symptoms of AIDS and non-AIDS patients (served as control) each on admission were recruited into the study between January 2005 to January 2008, in Federal Medical Center, Makurdi. Urine samples were collected with sterile universal bottles and analysed with appropriate laboratory methods and antibiotic susceptibility test was carried out by disk diffusion technique in accordance with National Committee for Clinical Laboratory Standards (NCCLS, now CLSI) criteria. The results were analysed using SPSS 11.0 statistical software.ResultsUrine samples of AIDS patients with urinary infection had a more spectrum of micro-organisms including Candida organisms, Pseudomonas aeruginosa and Staphylococcus aureus. Ceftriaxone, Ceftazidime or Ciprofloxacin had a remarkably high anti-bacterial activity across the two study groups. A general resistance was recorded in ampicillin, tetracycline and co-trimoxazole. There was no significant difference in antibiotic susceptibility patterns between AIDS and non-AIDS patients (P>0.05).ConclusionsA reduction in unnecessary use of antibiotics as well as infection control should be encouraged in our health facilities.     

HIV/AIDS related mortality among adult medical patients in a tertiary health institution in South–South,Nigeria

ObjectiveTo determine the causes of death among human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients as a step to planning strategies to improve mortality from this condition.MethodsThis study retrospectively analyzed the mortality pattern of adult HIV/AIDS patients in the University of Calabar Teaching Hospital from January 2005 to December 2007. The data were obtained from sexually transmitted infection/acquired immunodeficiency syndrome (STI/AIDS) clinic register, admissions and discharge/death registers as well as the patients' case records and the hospitals monthly mortality reviews. Information obtained included age, sex, diagnosis and cause(s) of death. The causes of death considered were the direct causes of death, since the originating antecedent cause of death is the same in all the patients, in this case, HIV/AIDS. Data was analysed using Epi Info 2002.ResultsThe total number of mortalities during the study period was 350,100 were HIV positive representing 28.6% of all deaths. While advanced HIV/AIDS disease was the leading cause of death in our study representing 27.0%, tuberculosis was the single leading cause of deaths in HIV/AIDS patients constituting about 24.0% of deaths. This was followed by sepsis and septicaemia (13.0%), meningitis and encephalitis, and anaemia accounting for 11.0%, while respiratory diseases constituted 5.0% of the mortality burden. The highest number of deaths occurred in those aged between 21–50 years (82.0%).ConclusionsThe study has shown that HIV/AIDS is a major cause of morbidity and mortality in our hospital. The causes of death reflect the varied spectrum of infection and other forms of organ involvement that affect HIV/AIDS patients. The present dismal situation of adult patients living with HIV/AIDS calls for enhanced strategies to decrease the mortality trend observed in Nigeria and sub-Saharan Africa.     

Realization of Fast track surgery principles during cesarean section

The aim of the study was to evaluate the efficiency of Fast Track Surgery (FTS) program application and determine the role of the anesthesiologist in its realization during planned Cesarean section. There were 2 randomized groups formed (basic and control), which contained 22 patients each. The groups were identical by all anthropometrical indicators. The FTS was applied in the basic group while the control group was led in traditional postoperative mode. The level of postoperative pain was estimated by Visual Analogue Scale (VAS) in rest and during cough 6, 12 and 24 hours after surgery, cortisol and glucose level dynamics, Baevskiy index, nausea and vomiting frequency, defecation and urination delay, presence of anxiety and weakness were assessed. The VAS and Baevskiy index were lower in the basic group during 12th and 24th hour of investigation, p < 0.05. There was no difference in dynamic cortisol levels in both groups. The values of cortisol levels didn't exceed those of presurgical levels. The tendency of hypoglycemia in control group that testified the prevalence of ketabolic proccesses was accompanied by weakness and orthostatic reactions. In both groups urination delay, nausea and vomiting were present. The obtained data proved the efficacy and safety of FTS during Cesarean section. The study shows that the decision of FTS has to be made by the anesthesiologist. It can improve perioperative conduction of patients and result in the promt stabilization of mother's condition after surgical intervention and result to the optimized contact with the child as well as reduce the period of hospital stay and decrease the expenses.     

Growth hormone and prolactin stimulation by Madopar in Parkinson's disease

Madopar, a combination of levodopa with benserazide, induced an inconsistent rise in plasma growth hormone in unmedicated patients with Parkinson's disease and in controls, and a greater growth hormone rise in Parkinsonian subjects on chronic Madopar therapy. In subjects on chronic therapy with levodopa and carbidopa (Sinemet), the growth hormone releasing effect of Madopar was blunted. Madopar increased plasma prolactin (PRL) in controls, unmedicated patients and patients on Madopar therapy while in patients on Sinemet therapy the PRL-releasing effect of Madopar was strikingly reduced. Since these data were interpreted as due to a defective dopamine tone in the hypothalamus of Parkinsonian subjects on Madopar but not Sinemet therapy, a direct dopamine receptor agonist, lisuride was administered. Lisuride, however, elicited a blunted growth hormone response both in patients on Madopar and Sinemet therapy, without revealing a state of supersensitivity of dopamine receptors for growth hormone control in Parkinsonian subjects on Madopar therapy. No difference was present in the PRL-lowering effect of lisuride in the different experimental groups. These findings suggest that: (1) hypothalamic dopamine function is impaired in Parkinsonian subjects on Madopar therapy, preserved in unmedicated patients and enhanced in patients on Sinemet therapy; (2) the endocrine effects observed in Parkinsonian subjects on chronic Madopar therapy may be due to some penetration of benserazide across the blood brain barrier in the region of the hypothalamus; (3) since Madopar and Sinemet are in essence equally effective antiparkinsonian remedies, penetration of benserazide does not occur across the blood brain barrier surrounding the nigrostriatal system.     

Cine CT of the mediastinum in pediatric patients

Cine computed tomographic (CT) examinations of the mediastinum were performed in 83 pediatric patients. Lesions imaged include neoplastic, inflammatory, and vascular abnormalities. The 50-msec scan time of cine CT provides for superb depiction of the heart and airway, minimizes motion artifact, allows examinations to be done with little or no sedation, and permits optimal opacification of all vascular structures with as little as 0.5 mL of intravenously administered contrast medium per kg of body weight. Scanning time for an examination in which images in 20 sections are obtained is approximately 10 seconds. Radiation dose is significantly lower than that in comparable CT or plain radiographic studies. Preliminary experience shows cine CT to be an excellent imaging modality for the examination of the mediastinum in children.     

Red cells in sickle cell crisis: observations on the pathophysiology of crisis

The pathophysiology of the occurrence and resolution of sickle cell crisis is unknown. The molecular abnormality is constant, while crisis is episodic. In the present study, red cell filterability and sickling with deoxygenation have been measured during sickle cell crises. Recovery from sickle crisis is associated with an increased filterability of the circulating red cell and a decreased susceptibility of the red cell to sickle with deoxygenation (p less than 0.05). The possibility that these changes are responsible for the resolution of crisis is suggested.     

EFFECT OF KETANSERIN ON INTRAOPERATIVE BLOOD LOSS DURING TOTAL HIP ARTHROPLASTY IN ELDERLY PATIENTS UNDER GENERAL ANAESTHESIA

We have studied the effect of ketanserin, a selective serotoninS-receptor antagonist, on surgical bleeding in a double-blind,placebo-controlled study in elderly patients undergoing totalhip arthroplasty. One group of patients (n = 9) received ketanserin10 mg i.v. followed by an infusion of 0.075 mg kg^–1 h^–1The second group (n = 8) received placebo. Both groups werecomparable with regard to age, height and body weight. Meanintraoperative blood loss was 454 ml with ketanserin and 894ml with placebo (P = 0.004; Wilcoxon two-sample test). Meanduration of the operation was less with ketanserin (112 min)than with placebo (134 min) (P = 0.004), but rate of blood losswas also less with ketanserin (4.1 vs 6.7 ml min^–1; P= 0.03). In the ketanserin group, mean arterial pressures tendedto be less than in the placebo group. Reductions in centralvenous pressure were similar in both groups. There were no complicationsin relation to the use of ketanserin.     

Unintended pregnancies in women delivering at 18 South American hospitals. NFP-ECLAMC Group. Latin American Collaborative Study of Congenital Malformations

Unintended pregnancies are accepted as associated with social, maternal and perinatal risks, but few data exist in South America. In a selected network of hospitals participating in the ECLAMC (Spanish acronym for Latin American Collaborative Study of Congenital Malformations), the frequency of unintended pregnancies was 49.8% in 5155 mothers of normal liveborns, as interviewed in the post-partum period (1992-1994). Compared with the intended pregnancy group, these mothers were more frequently multiparous, conceived easily, had a surprisingly higher mean maternal age, lower educational level, and Black ancestors. The frequency of mistimed pregnancies was the highest among primiparae. No adverse perinatal outcome could be found with regard to low birthweight (< 2500 g), prematurity (< 37 weeks), and early neonatal death. The rates of Caesarean delivery, twinning and sex ratio were similar in intended and unintended groups. Logistic regression analysis showed that maternal education could be a confounding factor associated with other maternal variables. The rate of unintended pregnancies in the present study is significantly higher than that described for other regions. Knowledge of the characteristics of women experiencing unintended pregnancies would allow proper public health strategies.