Terbutaline versus nifedipine for prolongation of pregnancy in patients with preterm labor.

OBJECTIVE: To compare the effectiveness, safety, and possible adverse effects of terbutaline and nifedipine in prolonging pregnancy beyond 48 h. METHODS: A randomized controlled trial was conducted with 174 pregnant women admitted with preterm labor randomized into 2 groups, which were given terbutaline (95 patients) and nifedipine (79 patients), respectively. Bivariate and multivariate analyses, using logistic regression, were used to analyze the data. RESULTS: No statistically significant difference was found between the 2 groups in terms of prolongation of gestation to 48 h. The failure rate in terms of prolonging gestation for 24 h was found to be 12.6% for the terbutaline group and 10.1% for the nifedipine group, which was not found to be statistically significant (P value=0.61). Side effects were significantly more common in the terbutaline group, except for maternal hypotension. CONCLUSION: Terbutaline and nifedipine appear to be equally effective in their tocolytic action. However, nifedipine did have the advantage of ease of administration. It also had significantly less effect on the fetal heart rate.     

Is Morbidity Influenced by Staging in the Fontan Palliation? A Single Center Review

In a retrospective study of 32 consecutive patients undergoing a total cavopulmonary connection (TCPC), we tried to determine if the trend for decreasing age at Fontan completion and reducing the intervals between the staged procedures during the past decade was associated with a change in morbidity and outcome. In 8 patients the Fontan circulation was completed in one stage and in 24 patients an intermediate step by hemi-Fontan or bidirectional cavopulmonary anastomosis was performed before Fontan completion. Mean age at TCPC and mean interval since the previous palliation have decreased significantly during the past decade. Although major complications were significantly reduced over time the occurrence and duration of postoperative pleural effusions were not. Decreasing age as well as intervals in staged Fontan palliation have beneficial influence on major complications and outcome, without significantly affecting the duration of pleural effusions at Fontan completion.     

Arterial stiffness is associated with orthostatic hypotension in elderly subjects with history of falls

OBJECTIVES: To test the hypothesis that impaired hemodynamic orthostatic changes commonly observed in the elderly may be related to age-related increase in arterial wall stiffness. DESIGN: Convenience sample of consecutive patients admitted for falls. SETTING: Acute- and intermediate-care geriatric ward of a French hospital. PARTICIPANTS: Fifty-seven elderly patients (46 women) consecutively admitted to a geriatric ward with a history of recent falls. MEASUREMENTS: Orthostatic hypotension (OH) was assessed using blood pressure measurements in the supine position and 1, 2, and 3 minutes after standing. Arterial wall stiffness was assessed using upper-limb and aortic pulse-wave velocities, measured with an external pressure transducer connected to a computer. RESULTS: OH was present in 18 patients with a mean age+/-standard deviation of 85.4+/-7.6 (5 men, 13 women) and absent in 39 patients aged 83.7+/-6.2 (6 men, 33 women). Upper-limb pulse-wave velocity was significantly higher, by 16%, in patients with OH than those without (9.91 vs 8.53 m/s; P<.02). Significant correlations were found between upper-limb pulse-wave velocity and systolic blood pressure changes after 1 minute of standing (r=0.263, P<.05) and maximal diastolic blood pressure change after standing (r=0.351, P<.01). CONCLUSION: Upper-limb arterial wall stiffness was significantly greater in elderly patients with OH than in patients without OH and was significantly related to blood pressure changes after standing. These results highlight the possible role of age-related changes in the arterial tree in the hemodynamic response to orthostatic challenges.     

Effectiveness of a disease management program for patients with diabetes

Diabetes disease management programs (DDMPs) are proliferating, but their effectiveness in improving quality and mitigating health care spending has been difficult to measure. Using two quasi-experimental methods, this study analyzed the first-year results of a multistate DDMP for people with diabetes sponsored by a national managed care organization. In both analyses, overall cost of care were significantly lower in DDMP sites, and the payer saved more than it spent. Pharmacy costs showed mixed results. Quality scores in the DDMP sites were significantly better than in sites without the program.     

Tobacco use by university students,Lebanon, 2001

Aims The objective was to determine the prevalence of smoking [cigarettes and/or narghile (i.e. water‐pipe)] among university students and to examine multiple correlates. Design Cross‐sectional. Setting Beirut, Lebanon. Participants A proportionate random sample of 1964 students from public and private universities in Beirut, Lebanon. Measurements Participants completed a self‐administered anonymous questionnaire that included demographic and scholastic items and health behavioral aspects, including smoking, alcohol, physical activity, weight control measures and seat belt use. Findings The overall prevalence of smoking was 40% (21.1%, 7.6% and 11.3% of the students were smoking only narghile, only cigarettes and both cigarettes and narghile, respectively). Regression analyses showed that males, those of non‐Lebanese origin, pursuing undergraduate degrees, performing risky weight control measures and drinking excessive amounts of alcohol had increased odds of smoking cigarettes. Also, age, high level of paternal education and field of study were significant predictors. Narghile smoking was significantly higher among males who drank excessive alcohol. Conclusions The authors advocate a collaborative effort to alleviate the consequences of smoking among university students.     

Consanguinity and apnea of prematurity

Consanguinity, marriage between relatives, has been associated with perinatal mortality and morbidity. Apnea of prematurity is defined as the cessation of breathing for longer than 20 seconds or that of any duration if accompanied by cyanosis and sinus bradycardia, for infants born before 37 weeks of gestation. The objective of the study was to examine the association between consanguinity and apnea of prematurity in Greater Beirut, an area having a relatively high prevalence rate of consanguineous marriages. The study was cross-sectional. Between September 1, 1998, and March 31, 2001, 21723 newborn infants were admitted to the National Collaborative Perinatal Neonatal Network in Greater Beirut, Lebanon. The inclusion criteria were infants less than 37 weeks of gestation who were admitted to the intensive care unit, with no congenital malformations, sepsis, or neurologic disorders. Analysis was based on 597 infants of whom 66 had apnea of prematurity. With adjustment for weeks and type of gestation, pregnancy complications, and Apgar score, the odds ratio of apnea of prematurity for first-degree consanguineous parents as compared with other marriages was 2.9 (95% confidence interval: 1.3, 6.4). In addition to the recognized etiologic factors for apnea of prematurity, this study suggests a role played by genetic factors.