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61.
Frederick W. Fiesseler DO Richard Shih MD Paul Szucs MD Michael E. Silverman MD Barnet Eskin MD PHD Martin Clement MD Rachna Saxena DO John Allegra MD PHD Renee L. Riggs DO Nima Majlesi DO 《The Journal of emergency medicine》2011,40(4):463-468
Background: Recurrence of migraine headache after treatment in the emergency department (ED) is common. Conflicting evidence exists regarding the utility of steroids in preventing migraine headache recurrence at 24–48 h. Objective: To determine if steroids decrease the headache recurrence in patients treated for migraine headaches in the ED. Methods: Double-blind placebo-controlled, two-tailed randomized trial. Patients aged >17 years with a moderately severe migraine headache diagnosed by treating Emergency Physician were approached for participation. Enrollees received either dexamethasone (10 mg i.v.) if intravenous access was utilized or prednisone (40 mg by mouth × 2 days) if no intravenous access was obtained. Each medication was matched with an identical-appearing placebo. Patients were contacted 24–72 h after the ED visit to assess headache recurrence. Results: A total of 181 patients were enrolled. Eight were lost to follow-up, 6 in the dexamethasone group and 2 in the prednisone arm. Participants had a mean age of 37 years (±10 years), with 86% female. Eighty-six percent met the International Headache Society Criteria for migraine headache. Of the 173 patients with completed follow-up, 20/91 (22%) (95% confidence interval [CI] 13.5–30.5) in the steroid arm and 26/82 (32%) (95% CI 21.9–42.1) in the placebo arm had recurrent headaches (p = 0.21). Conclusion: We did not find a statistically significant decrease in headache recurrence in patients treated with steroids for migraine headaches. 相似文献
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Jitendra Pandey Anand V. Singh Ashima Singh Rachna Singh 《Bulletin of environmental contamination and toxicology》2013,91(2):184-190
Investigations on atmospheric deposition (AD) and water chemistry along a 35 km stretch of Ganga River indicated that although N:P stoichiometry of AD did not change, there were over 1.4–2.0 fold increase in AD-NO3 ?, AD-NH4 + and AD-PO4 3?overtime. Concentration of dissolved inorganic-N (DIN) in river showed significant positive correlations with AD-NO3 ? and runoff DIN. Similarly, dissolved reactive-P (DRP) in river showed significant positive correlation with AD-PO4 3? and runoff DRP. The study shows that AD has become an important source of N and P input to Ganga River. 相似文献
67.
Rachna Kapoor Alayne Ronnenberg Elaine Puleo Robert Treat Chatterton Jr. Joanne F. Dorgan Navindra P. Seeram 《Nutrition and cancer》2013,65(7):1113-1119
Pomegranate is a rich source of polyphenols. Laboratory studies suggest polyphenols may exert breast cancer preventive effects through modulation of endogenous sex hormone levels. The aim of this study was to determine the effect of pomegranate juice consumption on serum levels of estradiol, estrone, testosterone, androstenedione, and sex hormone binding globulin (SHBG). Sixty-four healthy postmenopausal women were randomly assigned to drink 8 ounces of either 100% commercial pomegranate juice (intervention) or apple juice (control) for 3 weeks. Overall, women in the intervention group did not experience any significant decline in serum sex hormones or SHBG compared to women in the control group. In subgroup analyses restricted to 38 normal weight women, women in the intervention group compared to control group had a significant decline in estrone (pg/mL) and testosterone levels (pg/mL): pomegranate: ?61.6 [95% confidence interval (CI): ?175.8 to 52.6), apple: 1.1 (95% CI: ?5.4 to 7.7), P = 0.05, and pomegranate: ?289.1 (95% CI: ?630.7 to 52.5), apple: 79.6 (95% CI: ?77.8 to 236.9), P = 0.03, respectively. Because of several study limitations, results should be considered preliminary. Additional larger trials would be needed to determine effects in normal versus overweight/obese women. 相似文献
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Rachna Bahl Deirdre J. Murphy Bryony Strachan 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
To identify the decision-making process involved in determining when to intervene, where to deliver and the optimal choice of instrument for operative vaginal deliveries in the second stage of labour.Study design
A qualitative study using interviews and video recordings took place at two university teaching hospitals (St. Michael's Hospital Bristol and Ninewells Hospital, Dundee). Ten obstetricians and eight midwives were identified as experts in conducting or supporting operative vaginal deliveries. Semi-structured interviews were carried out using routine clinical scenarios. The experts were also video recorded conducting low cavity vacuum and mid-cavity rotational forceps deliveries in a simulation setting. The interviews and video recordings were transcribed verbatim and analysed using thematic coding. The anonymised data were independently coded by three researchers and then compared for consistency of interpretation. The experts reviewed the coded interview and video data for respondent validation and clarification. The themes that emerged following the final coding were used to identify the decision-making process when planning and conducting an operative vaginal delivery. Key decision points were reported in selecting when and where to conduct an operative vaginal delivery and which instrument to use.Results
The final decision-making list highlights the various decision points to consider when performing an operative vaginal delivery. We identified clinical factors that experts take into consideration when selecting where the delivery should take place and the preferred choice of instrument.Conclusion
This detailed illustration of the decision-making process could aid trainees’ understanding of the approach to safe operative vaginal delivery, aiming to minimise morbidity. 相似文献69.
Rachna Bahl Deirdre J. Murphy Bryony Strachan 《European journal of obstetrics, gynecology, and reproductive biology》2013
Objective
To define the skills of a mid-cavity rotational forceps delivery to facilitate transfer of skills from expert obstetricians to trainee obstetricians.Study design
Qualitative interviews and video analysis carried out at maternity units of two university teaching hospitals (St. Michael's Hospital, Bristol, and Ninewells Hospital, Dundee). Ten obstetricians were identified as experts in conducting operative vaginal deliveries. Semi-structured interviews were carried out to identify key technical skills. The experts were also video recorded conducting mid-cavity rotational deliveries in a simulation setting. The interviews and video recordings were transcribed verbatim and analysed using thematic coding. The anonymised data were individually coded by the three researchers and then compared for consistency of interpretation. The experts reviewed the data for respondent validation. The themes that emerged following the coding were used to formulate a taxonomy of skills.Results
Rotational forceps were preferred by eight experts and two experts preferred manual rotation followed by direct traction forceps. The final taxonomy included detailed technical skills for Kielland rotational forceps delivery and manual rotation followed by direct traction forceps delivery.Conclusion
This explicitly defined skills taxonomy could aid trainees’ understanding of the technique of rotational forceps delivery. This is an important potential contributor to safely reducing the rate of second-stage caesarean section. 相似文献70.
Visual field defects and other abnormalities are reported in patients receiving the newer antiepileptic Vigabatrin (VGB).
Field testing in children younger than 6 years and those with mental retardation is difficult. The authors, therefore, studied
ophthalmoscopic abnormalities in seven pediatric patients receiving VGB for median duration of 9 month (range, 3–32 months).
Abnormal findings were seen in two (33.3%) in the form of surface wrinkling retinopathy and abnormal macular reflexes. The
proportion of abnormal findings was in agreement with previous reports. Thus it is concluded that simple ophthalmoscopy by
an ophthalmologist picks up the abnormalities due to ocular toxicity of VGB, and helps in rationalizing further AED therapy
in the clinic. 相似文献