Termination of second trimester pregnancy with single intra-amniotic and extra-amniotic instillation of prostaglandin F2 alpha and 15-methyl prostaglandin F2 alpha

The use of high doses of prostaglandin F2 Alpha and 15-Methyl prostaglandin F2 Alpha have proved highly successful in the termination of second trimester pregnancy. The present study evaluates experience obtained from using the recommended single dosage schedules and compares the relative effectiveness and safety of intra-amniotic and extra-amniotic routes. The success rates of intra-amniotic administration of PGF2 alpha and 15-methyl PGF2 alpha by transabdominal amniocentesis via polyethylene catheter threaded through an 18 gauge needle were 93.9% and 98% respectively. The number of incomplete abortions were also higher in the extra-amniotic group, being 80.2% with 15-me-F2 alpha as compared with 28.0% with intra-amniotic 15-me-F2 and 23.9% with intra-amniotic F2 alpha. This difference, however, is probably due to the fact that women in the intra-amniotic group had a completely formed placenta. The mean induction time was approximately the same for all groups and occurred within 24 hours. Parity had no significant correlation with the success rate, nor did the period of gestation (between 10 and 20 weeks). The latter factor had no correlation with complete or incomplete abortion, or the abortion induction interval. 18 cases out of the 20 studied failed to abort due to unresponsiveness of the uterus to the drug. The incidence of major side effects such as vomiting and diarrhea were comparable and clinically acceptable.     

Tay-sach’s disease

Summary A typical case of Tay-Sach’s disease in an Indian infant is reported. From the departments of Pediatrics and Ophthalmology, K. G. Medical College, Lucknow.     

Congenital midline dermoid cyst with sinus of nose

An unusual case of congenital, extranasal, and extracranial dermoid cyst with a supratip sinus of the nose is reported.     

Relationship between processes of care and coronary bypass operative mortality and morbidity

BACKGROUND: Information is limited regarding the effects of processes of care on cardiac surgical outcomes. Correspondingly, many recommended cardiac surgical processes of care are derived from animal experiments or clinical judgment. This report from the VA Cooperative Study in Health Services, "Processes, Structures, and Outcomes of Cardiac Surgery," focuses on the relationships between 3 process groups (preoperative evaluation, intraoperative care, and supervision by senior physicians) and a composite outcome, perioperative mortality and morbidity. METHODS: Data on 734 risk, process, and structure variables were collected prospectively on 3,988 patients who underwent coronary artery bypass grafting at 14 VA medical centers between 1992 and 1996. Data reduction was accomplished by examining data completeness and variation across sites and surgeon, using previously published data and clinical judgment. We then applied multivariable logistic regression to the 39 remaining processes of care to determine which were related to the composite outcome after adjusting for 17 patient-related risk factors and controlling for intraoperative complications. RESULTS: Our first analysis showed several measures of operative duration, the use of inotropic agents, transesophageal echo, lowest systemic temperature, and hemoconcentration/ultrafiltration, to be powerful predictors of the composite outcome. Because the use of inotropic agents and operative duration may be related to an intermediate outcome (eg, intraoperative complications), we performed a second analysis omitting these processes. The use of intraoperative transesophageal echo and hemoconcentration/ultrafiltration remained significantly associated with an increased risk of an event (odds ratios 1.60 and 1.36, respectively). CONCLUSIONS: Our results viewed in the context of past studies suggest the possibility that inotropic use, TEE, and hemoconcentration/ultrafiltration may have adverse effects on operative outcome. Further evaluation of these processes of care using observational data, as well as randomized trials when feasible, would be of interest.     

Master's performance in the New York City Marathon 1983-1999

Background: Physical activity in older people is believed to slow down the natural aging process through its effects on disuse atrophy.     

Effect of nutrition education of mothers on infant feeding practices

Objective : To assess current infant feeding practices (IFP) in a relocated slum, to identity the lacunae, to outline, implement, and evaluate the gain in awareness and IFP followed by mothers.Methods. Thirty–five mothers of infants aged 5–19 months were interviewed. Based on lacunae, Nutrition Education (NE) was imparted to mothers over two months. Tools used were individual counseling, participatory learning methods, positive deviance and early adopters approach aided with existing information education communication materials. Monthly weight and length of infants was also taken. Awareness and practices on infant feeding (IF) were reviewed at mid and post NE.Results. Areas of concern at baseline were (i) discarding colostrum (77.0%), (ii) feeding prelacteals (80.0%), (iii) initiation of breast-feeding (BF) after 3 days (54.3%), (iv) absence of exclusive breast-feeding (86.3%), (v) delayed complementary feeding (CF) and (vi) feeding CF grossly inadequate in quality, quantity, frequency and consistency. Post NE results revealed an improved awareness about IF amongst the mothers. An improvement was seen in variety, quantity and consistency of CF fed. Active feeding behaviours were adopted (6.6% pre-NE vs 66.6% post-NE). Early adopters (24%) served as motivators. Weight for age and weight for length showed improvement.Conclusion : NE programs of shorter duration using a ‘communication mix’ of channels with repeated reinforcement can bring about improvement not only in awareness but also in IFP.