The relationship between maternal serum alpha-fetoprotein and maternal haemoglobin

OBJECTIVES: To test the hypothesis that both second-trimester maternal serum alpha-fetoprotein (MSAFP) levels and Down syndrome-screening test are related to maternal haemoglobin concentration. METHODS: Three hundred and seventeen women in three groups according to their haemoglobin levels: normal haemoglobin concentration (between 10.5 and 13.2 g/dL) (n = 262; 82.6%), anaemia (less than 10.5 g/dL) (n = 11; 3.5%), or high haemoglobin levels (greater than 13.2 g/dL) (n = 44; 13.9%) were studied. MSAFP and Down syndrome risk (on the bases of maternal age, MSAFP and maternal serum beta-hCG concentrations) were recorded. RESULTS: MSAFP (MoM) was lower in women with high haemoglobin levels (0.79 MoM (0.66-1.14)) (p = 0.001) than in women with normal haemoglobin concentrations (1.00 MoM (0.81-1.26)). It was also decreased in women with anaemia (0.90 MoM (0.65-0.94)), even though the difference with women with normal haemoglobin levels was of borderline statistical significance (p = 0.06). The Down syndrome risk was higher in both anaemic women (1:850 (1:380-1:1400)) (p = 0.009) and women with high haemoglobin levels (1:1425 (1:460-1:3100)) (p = 0.036) than in women with normal haemoglobin concentration (1:1950 (1:800-1:5000)). A quadratic model was the best predictive model for both MSAFP (p = 0.02) and Down syndrome risk (p = 0.001) when considering maternal haemoglobin as the independent variable. CONCLUSIONS: MSAFP is decreased and Down syndrome risk is increased in both anaemic and pregnant women with high haemoglobin concentration. Further studies are needed to establish whether adjustments for maternal haemoglobin are needed when giving Down syndrome risks based on biochemical markers. Copyright 2004 John Wiley & Sons, Ltd.     

Cultural sensitivity in providing reproductive care to adolescents

PURPOSE OF REVIEW: To provide an exploration of the global attitudes towards reproductive healthcare by adolescent patients, and to review key points in promoting healthy sexual development among adolescents and appropriate guidelines for communicating within the adolescent population. RECENT FINDINGS: The adolescent's perception of healthcare providers and communication with adolescents are inextricably intertwined, hence the need to address both topics. In addition, we will briefly examine the topic of female circumcision and its impact on women's sexuality. It is necessary to approach this subject because of the increase in the number of individuals that emigrate each year to the United States and Canada from countries that still practise female circumcision. Providing reproductive care for these women has considerable implications for gynecologists and other healthcare providers dealing with reproductive care issues. SUMMARY: Healthcare providers who are aware of adolescent patients' developmental stage and cultural diversity are more able to gain the trust of their patients, and consequently are more effective at addressing their needs.     

Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review

Introduction  

Despite the integral role played by tracheostomy in the management of trauma patients admitted to intensive care units (ICUs), its timing remains subject to considerable practice variation. The purpose of this study is to examine the impact of early tracheostomy on the duration of mechanical ventilation, ICU length of stay, and outcomes in trauma ICU patients.     

Appropriateness of requests for therapeutic drug monitoring of antiepileptic drugs: the experience in southwestern Saudi Arabia

The purpose of this study was to evaluate request forms of therapeutic drug monitoring of antiepileptic drugs for appropriateness criteria according to published data. Request forms received by the laboratory were sampled as all requests in one day per week on an alternating basis. Drugs monitored were phenytoin (PHT), phenobarbital (PB), carbamazepine (CBZ) and valproic acid (VPA). A total of 420 request forms were collected. Age, gender and weight were provided in 95.5%, 97.1% and 56.9% of request forms, respectively. The diagnosis, seizure type and the indication for therapeutic drug monitoring were provided in 81.6%, 3.2% and 55.5%, respectively. Sampling times were provided in 45% and were considered appropriate in 25.2% of the request forms. The indications for therapeutic drug-monitoring were considered appropriate in 28.6% of the request forms, and only 19.2% of these were appropriately sampled. Only 37.9% of all samples were drawn at steady-state. Serum albumin and creatinine concentrations were lacking in 93.6% and 53.3% of requests, respectively. The potential for drug-drug interactions was detected in 28.6% of all requests. Thus, the information needed for the proper interpretation of therapeutic drug monitoring results and that was provided in the request forms was surprisingly scarce. Most of the appropriateness criteria for therapeutic drug monitoring were not met.     

The detection of Brucella spp. using PCR-ELISA and real-time PCR assays

Brucellosis is a worldwide 're-emerging' zoonosis causing high economic losses and severe human disease. Consequently, rapid and reliable, sensitive and specific, easy to perform and automated detection systems for Brucella spp. are urgently needed to allow early diagnosis and adequate antibiotic therapy in time. Real-time PCR assays using hybridization probes meet all these requirements. In 2003 various assays have been developed and evaluated for use in human and animal brucellosis. Genus-specific real-time PCR assays e.g. based on the bcsp31 gene will lead to an early diagnosis but for the purpose of epidemiological surveillance a species-specific real-time PCR deriving from the conventional AMOS (AbortusMelitensisOvisSuis)-PCR is necessary. Advantages and disadvantages of the different methods for real-time detection of Brucella spp. and a newly developed PCR-ELISA system for the high throughput of clinical samples will be discussed.     

Single-stage repair of tetralogy of Fallot with pseudoaneurysm: a unique approach

Pseudoaneurysm is a potentially lethal complication after modified Blalock-Taussig shunt. This report describes a frequently misdiagnosed clinical presentation along with noninvasive diagnosis of pseudoaneurysm after a modified Blalock-Taussig shunt. We report a novel single-stage surgical management of the pseudoaneurysm with concomitant complete repair of tetralogy of Fallot.     

Lung cancer and skeletal muscle metastases

Skeletal muscle metastases from lung cancer are rare, and the optimal treatment strategy is unknown. Three cases of skeletal muscle metastases from lung cancer are described. In 2 patients surgical biopsy of muscle swelling disclosed the presence of the lung tumor; the first patient underwent lung resection to remove the primary lesion, the second was not operable because of the metastatic extension of the disease. In the third patient muscle metastasis was observed and excised after lung resection. Adenocarcinoma, squamous cell, and small cell carcinoma were the histologic types diagnosed. Various regimens of radiotherapy and chemotherapy were adopted. Survival times were 3, 6, and 30 months.     

Indications for esophageal replacement in children

Esophageal substitution in children is required in several types of esophageal atresia, as well as following strictures caused by caustic ingestion or peptic esophagitis. Nowadays, two main types of procedures are used for esophageal replacement: colon segment esophagoplasty (that seems to be preferred by most pediatric surgeons) and gastric tube esophagoplasty. The paper presents the personal experience in the management of a series of 56 children with esophageal replacement, during the last 10 years. In 46 patients, the stricture cause was caustic ingestion, while peptic esophagitis accounted for 3 cases. The remaining 7 cases were long-gap esophageal atresias that could not be managed by primary neonatal anastomosis. The results are rated as good in 42 cases. Complications occurred in 13 cases, while fatal outcome occurred in 5 patients. The most remarkable feature of the series is the high number of procedures required after caustic ingestion.     

Posterior capsular repair following total hip arthroplasty: a modified technique

Various techniques of posterior capsular repair following THA have been reported and studies have demonstrated the merits of posterior capsular repair with respect to decreasing the incidence of dislocation. Our modified technique using three sutures offers excellent fixation of the hip capsule on the greater trochanter. The small drill holes needed for the #2 Fiberwire minimize the risk of a greater trochanteric fracture through the drill holes and osteoporotic bone. To date, we have not experienced any complications or reaction to this material. The importance of a posterior capsule repair has been well documented in the literature. A rigid capsular repair can prevent excess internal rotation and therefore minimize the incidence of postoperative dislocation following THA.