MOET: Bangladesh--an initial experience

OBJECTIVES: To summarize the quantitative and qualitative immediate assessments of the Managing Obstetric Emergencies and Trauma (MOET) course and to examine the individual changes in score obtained for each of the scenarios. METHODS: Students' knowledge before and after the course was evaluated with a standardized comprehensive questionnaire. RESULTS: All candidates showed an improvement in postcourse, compared to precourse, scores. In the individual score analysis only one scenario showed a non-significant change. The majority of other scenarios showed highly significant improvement between the two scores. CONCLUSION: This paper summarises the development of the first MOET course to be run outside the UK. It demonstrates the reliability of the model-based scenario foundation with a highly significant improvement in knowledge about obstetric emergency management. Further evaluation of longer term practice changes is now required.     

Abdominopelvic inspection during nonemergent laparoscopic procedures: who looks?

OBJECTIVE: A study was performed to determine whether surgeons and gynecologists inspect the entire abdomen/pelvis at the time of nonemergent laparoscopic surgery. STUDY DESIGN: A retrospective chart audit was conducted of patients who underwent elective laparoscopic cholecystectomy or laparoscopic tubal ligation. Dictated and hand-written operative notes were reviewed. Any documentation of the pelvic structures from cholecystectomy operative notes or the upper abdomen from tubal ligation operative notes was determined to be positive for abdominopelvic surveillance. RESULTS: A total of 771 operative notes were reviewed, which included 358 tubal ligations and 413 laparoscopic cholecystectomies. Two hundred four of 358 (57%) tubal ligations performed by gynecologists had a survey of the upper abdomen versus 36 of 413 (8.7%) cholecystectomies performed by surgeons that had a survey of the pelvis. CONCLUSION: Gynecologists and general surgeons either do not document or do not perform total abdominopelvic inspection universally.     

Neural plasticity is impaired in cold-exposed hippocampal slices from senescent but not from age-matched presenescent F344 rats

Near the end of their natural life, many mammals enter a terminal state identifiable by a rapid loss of body weight resulting from hypophagia. This study extends characterization of this senescent state by comparing viability of metabolic mechanisms supporting neural plasticity in hippocampal slices from 24 to 30 month old senescent and age-matched presenescent (body-weight stable) F344 male rats. Half of the slices from each rat were incubated at 22-23 degrees C, and half were immersed in cool incubation medium (12-15 degrees C) immediately after slicing and allowed to passively warm to room temperature over approximately 50 min to impose a cold stressor on recovery mechanisms. Following incubation, CA1 pyramidal cell population spike (PS) amplitudes were measured before and after tetanus. In slices incubated at 22-23 degrees C, the 221.0+/-24.2 % increase in PS amplitude following tetanus in seven slices from five senescent rats was not significantly different from the 202.5+/-23.8% increase in six slices from five age-matched presenescent rats. In contrast, in cold-exposed slices, the 133.8+/-13.1% increase in PS amplitude following tetanus in 14 slices from 10 senescent rats was significantly smaller (p<0.05) than the 184.7+/-10.2% increase in 13 slices from seven age-matched presenescent rats. This smaller PS enhancement in senescent rats cannot be attributed to weight loss because robust potentiation was induced in cold-exposed slices from five food-restricted presenescent rats having a weight loss comparable to their senescent counterparts. Thus, the blunted enhancement observed in cold-exposed slices appears to be a characteristic of senescence.     

Direct coronary stenting without balloon or device pretreatment: acute success and long-term results.

Improvements in coronary stents have made planned direct coronary stenting technically feasible, though safety, acute success, cost-effectiveness, and long-term results remain to be determined. Sequential patients eligible for direct stenting were prospectively characterized and treated with either direct or secondary stenting. Major adverse cardiovascular events (MACE) such as cardiac death, myocardial infarction (MI), target vessel ischemia, or revascularization (TVR) were followed for 6 months post-PCI. Enrollment included 128 direct (1.38 lesions/patient) and 69 secondary (1.39 lesions/patient) stented patients. Direct stenting was successful in 99% (with 5% crossover to secondary stenting) without major procedural complications and with a similar rate of vessel wall dissection or no-reflow phenomenon (2.3% vs. 2.1%; P > 0.05) as the secondary stenting group. There was a trend toward less postprocedural CPK-MB elevation in the nonacute MI patients with direct vs. secondary stenting (3% vs. 11%, respectively). At 6 months, there were no statistically significant differences in overall MACE. Direct stenting has a high success rate, low complication rate, and durable long-term results. Procedural cost and time savings, less contrast use and radiation exposure make direct stenting attractive in properly selected patients.     

A multivessel model describing replenishment kinetics of ultrasound contrast agent for quantification of tissue perfusion

To improve the quantification of tissue perfusion using intermittent sonography, a new model describing replenishment kinetics of microbubbles is proposed. The new approach takes into account the variability of blood flow velocities found in vivo, especially in tumors, and consistently describes the refilling process of microbubbles. Based upon this model, blood volume, blood velocity, blood flow and perfusion in 17 experimental tumors were calculated, and compared with the results obtained with the established, phenomenologically derived exponential kinetic model. In contrast to the existing model, our approach describes tissue vascularization more physiologically and allows deduction of a consistent new hyperbolic model for quantification of intermittent sonography. Blood volume and mean blood velocity did significantly correlate between both the new and the established model (k=0.99; k=0.94, both p<0.001). However, mean tumor blood velocity was lower (-19%, p<0.01) with the established model compared to the newly developed model. In addition, the range and distribution of blood flow velocities found in vivo can be estimated with the new model. Furthermore, it uses simpler mathematical fitting routines and allows easier data acquisition, which may allow a more practicable clinical application of intermittent sonography. In conclusion, a more valid, detailed and accurate calculation of perfusion parameters, especially of tumors, can be derived in vivo with the new multivessel model of intermittent sonography.     

Barrett’s oesophagus with oesophageal stricture

A rare case of congenital Barrett's oesophagus with stricture, which responded well to oesophageal dilatation, is reported along with brief review of pertinent literature.     

Management of iatrogenic ureteric injuries associated with gynecological surgery

Objective: This retrospective study defines the presentation and managementof iatrogenic ureteric injuries consequent upon gynecological surgery in ateaching hospital in Punjab, Pakistan.Patients and methods: 18 patients with median age 35 years (range 18–80years) with iatrogenic ureteric injuries associated with gynecological surgerywere referred to the department of urology at Nishtar Hospital Multan Pakistan.Main presenting symptoms were urinary incontinence, loin pain and anuria.Median time since injury and presentation was 3 weeks (range 1 day to 7 years). In 16 (88%) patients injury resulted from abdominal hysterectomy. Othercauses included ovarian cystectomy (one patient) and vaginal hysterectomy (onepatient). 11 (61%) patients had ureterovaginal fistula, 5 (28%) patients hadcomplete unilateral ureteric obstruction and 2 (11%) patients had bilateral ureteric obstruction and anuria. In 11 patients with ureterovaginal fistula ureteroneocystostomy was performed. In five patients with unilateral uretericobstruction, one had end to end anastomosis of ureter, three had ureteroneocystostomy only and one had ureteroneocystostomy and psoas hitch done. Two had anuriasecondary to bilateral ureteric obstruction. In one of these patients Boari flapand ureteroneocystostomy was carried out. The second patient had deligation ofcatgut sutures on ipsilateral side and ureteroneocystostomy on the contra-lateralside.Results: In 17 patients no major complication occurred. One patient whohad deligation of catgut sutures, the distal ureter sloughed and re-explorationand ureteroneocystostomy was performed. Renal salvage was achieved in all cases.Conclusion: Open surgical procedures for repair of iatrogenic uretericinjuries are associated with good outcome. Strategies to prevent these injuriesinclude adequate surgical training and meticulous surgical techniques.     

Assessing association of waist-height ratio (WHtR) and body mass index (BMI) with non-communicable disease risk factors

Aim

The aim of this study is to determine the potential of the waist-height ratio (WHtR) and body mass index (BMI) as predictors of non-communicable disease (NCD) risk factors.

Subjects and methods

A retrospective study using data from the 2016 National NCD survey (STEPS). A total of 3808 data points were retrieved including sociodemographic factors, anthropometric measurements, NCD prevalence and risk factors. Multiple logistic and linear regression was applied for analysis.

Results

Men (OR?=?0.77, 95% CI: 0.63, 0.95), aged ≥ 45 years (OR?=?4.24, 95% CI: 3.15, 0.97), of Malay ethnicity, with no formal schooling, and with existing hypertension and diabetes had significantly higher odds of having WHtR > 0.5. BMI ≥ 25 and BMI?≥?30 are significantly associated with age group, ethnicity, education level, alcohol consumption, hypertension, diabetes and hypercholesterolaemia.

Conclusion

Both WHtR and BMI were important predictors of NCD prevalence. These findings can contribute to the validity of the WHtR in clinical application and encourage the use of these anthropometric indices in clinical settings.

     

Predictors of non-communicable diseases screening behaviours among adult population in Brunei Darussalam: a retrospective study

Journal of Public Health - To explore sociodemographic factors, anthropometric measurements, and non-communicable disease risk factors as predictors of screening behaviours in Brunei Darussalam....