A randomized controlled trial of complete bed rest versus ambulation in the management of proteinuric hypertension during pregnancy

Summary. Forty patients participated in a randomized controlled trial of complete bed rest versus ambulation as desired in the management of proteinuric hypertension during pregnancy. Daily increases in serum human placental lactogen and oestriol concentrations were greater in the rested group. An especially'at risk' group of 10 patients with both hyperuricaemia and severe fetal growth retardation was identified. Strict confinement to bed in these cases seemed to encourage the development of the premonitory symptoms of eclampsia, but was associated with a better prognosis for the fetus.     

Soft Neurological Signs and EEG Pattern in Rural Malnourished Children

ABSTRACT. The present study was carried out in 208, 8–10 yr old male, rural, primary school children of Kashi Vidyapith Block, Varanasi. These children were examined for anthropometry, soft neurological signs and electroencephalographic pattern. It was found that the presence of soft neurological signs was related to the severity of malnutrition. The relationship between nutritional status and motor tasks showed that the performance in successive finger tapping, toe tapping, heel toe tapping, hand patting and alternating hand pronation supination in both hands while finger tapping with the right, was significantly affected. The EEG pattern in 16 children with soft neurological signs showed abnormalities in the form of slow and sharp waves, particularly in the frontal lobe, but also in the parietal and temporal lobes. The motor deficits were more marked on the contralateral side of the EEG abnormality.     

Storage Iron in Human Foetal Organs

ABSTRACT. Maternal plasma iron and storage iron (non-heme) in the foetal liver were estimated in 108 foetuses whose gestational ages ranged from 12–44 weeks. Simultaneous estimations of storage iron were also made on the spleen and kidney in 70 and 69 of these foetuses respectively. Although the concentration of iron per g wet tissue in these organs remained practically the same at all gestations, the total storage iron content increased with the increase in gestation due to growth of these organs. The liver, in particular, showed a steep rise in total iron content in the last 8 weeks of gestation. There was a significant positive correlation between the total storage iron content in the foetal organs and the birth weight and gestational age of the foetus, suggesting that the preterm infants had smaller iron stores at birth as compared to infants born at term. The direct relation of the concentration as well as the total content of storage iron in the foetal liver with the maternal plasma iron levels suggested that babies born to iron deficient mothers had poor iron stores in their livers.     

VARICOCELE IS ASSOCIATED WITH ELEVATED SPERMATOZOAL REACTIVE OXYGEN SPECIES PRODUCTION AND DIMINISHED SEMINAL PLASMA ANTIOXIDANT CAPACITY

PURPOSE: Because varicocele is seen often in infertile men and oxidative stress has been implicated in sperm dysfunction, we assessed spermatozoal reactive oxygen species and seminal total antioxidant capacity in men with and without varicocele. MATERIALS AND METHODS: Levels of reactive oxygen species and total antioxidant capacity were measured in the semen of 21 infertile men with varicocele, 15 men with incidential varicocele and 17 normal donors without varicocele (controls). Men with leukocytospermia (more than 1 x 10(6) white blood cells per ml.) were excluded from study. Reactive oxygen species were measured in washed spermatozoa with a luminol dependent chemiluminescence assay. Total seminal antioxidant capacity was measured with an enhanced chemiluminescence assay, and the results were expressed as trolox equivalents. Sperm characteristics were assessed with a computer assisted semen analyzer, and sperm morphology was assessed using World Health Organization and Kruger's strict criteria. RESULTS: Patients with varicocele had significantly higher reactive oxygen species levels than controls (p = 0.02). Reactive oxygen species levels did not differ significantly between infertile and men with incidental varicocele. Total antioxidant levels were significantly lower among men with varicocele (p = 0.02) and those with incidental varicocele compared to controls (p = 0.05). Reactive oxygen species and total antioxidant capacity levels did not correlate in any group. CONCLUSIONS: Our results suggest that elevated reactive oxygen species and depressed total antioxidant capacity levels are associated with varicocele. These changes may be related to functional sperm abnormalities and infertility seen commonly in these patients. These findings support a possible rationale for controlled clinical trials of antioxidant supplementation in infertile men with varicocele.     

Comparative performance of gene‐based warfarin dosing algorithms in a multiethnic population

Summary. Background: Gene‐based warfarin dosing algorithms have largely been developed in homogeneous populations, and their generalizability has not been established. Objectives: We sought to assess the performance of published algorithms in a racially diverse and multiethnic sample, and determine if additional clinical variables or genetic variants associated with dose could enhance algorithm performance. Patients and methods: In 145 compliant patients on warfarin with a goal international normalized ratio (INR) of 2–3, stable, therapeutic doses were compared with predicted doses using 12 reported algorithms that incorporated CYP2C9 and VKORC1 variants. Additional covariates tested with each model included race, concurrent medications, medications known to interact with warfarin and previously described CYP4F2, CALU and GGCX variants. Results: The mean patient age was 67 ± 14 years; 90 (62%) were male. Eighty‐two (57%) were Caucasian, 28 (19%) African‐American, 20 (14%) Hispanic and 15 (10%) Asian. The median warfarin dose was 35 mg per week (interquartile range 23–53 mg per week). Gene‐based dosing algorithms explained 37–55% of the variation in warfarin dose requirements. Neither the addition of race, number of concurrent medications nor the number of concurrent medications interacting with warfarin enhanced algorithm performance. Similarly, consideration of CYP4F2, CALU or GGCX variant genotypes did not improve algorithms. Conclusions: Existing gene‐based dosing algorithms explained between approximately one‐third and one‐half of the variability in warfarin dose requirements in this racially and ethnically diverse cohort. Additional clinical and recently described genetic variants associated with warfarin dose did not enhance prediction in our patient population.     

Comparison of closed loop vs. manual administration of propofol using the Bispectral index in cardiac surgery

Background: In recent years, electroencephalographic indices of anaesthetic depth have facilitated automated anaesthesia delivery systems. Such closed‐loop control of anaesthesia has been described in various surgical settings in ASA I–II patients (1–4), but not in open heart surgery characterized by haemodynamic instability and higher risk of intra‐operative awareness. Therefore, a newly developed closed‐loop anaesthesia delivery system (CLADS) to regulate propofol infusion by the Bispectral index (BIS) was compared with manual control during open heart surgery. Methods: Forty‐four adult ASA II–III patients undergoing elective cardiac surgery under cardiopulmonary bypass were enrolled. The study participants were randomized to two groups: the CLADS group received propofol delivered by the CLADS, while in the manual group, propofol delivery was adjusted manually. The depth of anaesthesia was titrated to a target BIS of 50 in both the groups. Results: During induction, the CLADS group required lower doses of propofol (P<0.001), resulting in lesser overshoots of BIS (P<0.001) and mean arterial blood pressure (P=0.004). Subsequently, BIS was maintained within ± 10 of the target for a significantly longer time in the CLADS group (P=0.01). The parameters of performance assessment, median absolute performance error (P=0.01), wobble (P=0.04) and divergence (P<0.001), were all significantly better in the CLADS group. Haemodynamic stability was better in the CLADS group and the requirement of phenylephrine in the pre‐cardiopulmonary bypass period as well as the cumulative dose of phenylephrine used were significantly higher in the manual group. Conclusion: The automated delivery of propofol using CLADS was safe, efficient and performed better than manual administration in open heart surgery.     

An unusual case of knee monoarthritis

A 61‐year‐old woman, a known case of diabetic nephropathy on chronic ambulatory peritoneal dialysis, presented with acute onset severe pain in the right knee, of 7 days duration. She had red hot and tender knee and was unable to bear weight. The lower half of the right thigh was swollen and tender. Right knee synovial fluid revealed 130 cells/µL (all lymphocytes). The fluid was negative for crystals and bacterial cultures. Three week later she returned with worsening of her symptoms despite receiving non‐steroidal anti‐inflammatory drugs and intra‐articular glucocorticoid. Magnetic resonance imaging of the right thigh showed heterogeneously hyperintense right vastus medialis muscle on T2‐weighted image, suggestive of diabetic muscle infarction. Therapy with analgesics and physiotherapy led to recovery in pain and thigh swelling. Diabetic muscle necrosis is a rare complication of diabetes mellitus and may present with abrupt onset of pain and loss of function of the involved extremity, mimicking septic/reactive arthritis or pyomyositis. A high index of suspicion may avoid delay in diagnosis.