Recombinant activated factor VII in post partum haemorrhage

Post-partum haemorrhage (PPH) is a life-threatening obstetric complication and the leading cause of maternal death. Any bleeding that results in or could result in haemodynamic instability, if untreated, must be considered as PPH. There is no controversy about the need for prevention and treatment of PPH. The keystone of management of PPH entails first, non-invasive and nonsurgical methods and then invasive and surgical methods. However, mortality remains high. Therefore, new advancements in the treatment are most crucial. One such advancement has been the use of recombinant activated factor VII (rFVIIa) in PPH. First used 12 years back in PPH, this universal haemostatic agent has been effectively used in controlling PPH. The best available indicator of rFVIIa efficacy is the arrest of haemorrhage, which is judged by visual evidence and haemodynamic stabilization. It also reduces costs of therapy and the use of blood components in massive PPH. In cases of intractable PPH with no other obvious indications for hysterectomy, administration of rFVIIa should be considered before surgery. We share our experience in a series of cases of PPH, successfully managed using rFVIIa.     

In Vivo Viscoelastic Response (VisR) Ultrasound for Characterizing Mechanical Anisotropy in Lower-Limb Skeletal Muscles of Boys with and without Duchenne Muscular Dystrophy

Our group has previously found that in silico, mechanical anisotropy may be interrogated by exciting transversely isotropic materials with geometrically asymmetric acoustic radiation force excitations and then monitoring the associated induced displacements in the region of excitation. We now translate acoustic radiation force-based anisotropy assessment to human muscle in vivo and investigate its clinical relevance to monitoring muscle degeneration in Duchenne muscular dystrophy (DMD). Clinical anisotropy assessments were performed using Viscoelastic Response ultrasound, with a degree of anisotropy reflected by the ratios of Viscoelastic Response relative elasticity (RE) or relative viscosity (RV) measured with the asymmetric radiation force oriented parallel versus perpendicular to muscle fiber alignment. In vivo results from rectus femoris and gastrocnemius muscles of boys aged ～7.9–10.4 y indicate that RE and RV anisotropy ratios in rectus femoris muscles of boys with DMD were significantly higher than those of healthy control boys (RE: DMD?=?1.51 ± 0.87, control?=?0.99 ± 0.69, p?=?0.04, Wilcoxon rank sum test; RV: DMD?=?1.04 ± 0.71, control?=?0.74 ± 0.22, p?=?0.02). In the gastrocnemius muscle, only the RV anisotropy ratio was significantly higher in dystrophic than control patients (DMD?=?1.23 ± 0.35, control?=?0.88 ± 0.31, p?=?0.04). In the dystrophic rectus femoris muscle, the RE anisotropy ratio was inversely correlated (slope?=?–0.03/lbf, r?=?–0.43, p?=?0.07, Pearson correlation) with quantitative muscle testing functional output measures but was not correlated with quantitative muscle testing in the dystrophic gastrocnemius. These results suggest that Viscoelastic Response RE and RV measures reflect differences in mechanical anisotropy associated with functional impairment with dystrophic degeneration that are relevant to monitoring DMD clinically.     

Changes in Choroidal Thickness after Cataract Surgery

Objective: The aim of this study is to compare subfoveal choroidal thickness (SFCT) before and after uneventful phacoemulsification using enhanced depth imaging optical coherence tomography (EDI-OCT).Background: Cataract is a major cause of visual impairment in the elderly. Cataract surgery is the most common ophthalmic surgery and is performed simultaneously with glaucoma or vitreous surgery in many cases. However, according to the results in epidemiology studies, cataract surgery is associated with the onset of age-related macular degeneration (AMD) and cataract surgery increases visual acuity in these patients without an increased risk of progression to exudative AMD. Methods: A prospective study was conducted on 53 eyes of 53 patients who had phacoemulsification. Measurements of SFCT were performed preoperatively, 7 days (D7), 1 month (M1), and 3 months (M3) postoperative using the EDI-OCT technique. Central retinal thickness was also measured at the same time. Results: Twenty-seven male (50.9%) and 26 female (49.1%) with a mean age of 56.43 years ± 10.34 (SD) were analyzed. The mean choroidal thickness was 199.9 ± 60.74 µm. It significantly increased to 228.42 ± 59.77 µm at D7, then decreased to 210.78 ± 59.59 µm at M1, and then decreased to 200.63 ± 61 µm at M3. The mean retinal thickness was 260.79 ± 6.12 µm. It significantly increased to 294.09 ± 7.20 µm at D7 and then decreased to 274.70 ± 6.00 µm at M1 and 258.92 ± 5.89 µm at M3. Conclusion: Mean SFCT increased after cataract surgery. The changes in SFCT return to near the baseline after 3 months.     

Natural and anthropogenic radioactivity levels and the associated radiation hazard in the soil of Oodalia Tea Estate in the hilly region of Fatickchari in Chittagong,Bangladesh

Radioactivity in the soil of a tea garden in the Fatickchari area in Chittagong, Bangladesh, was measured using a high-resolution HPGe detector. The soil samples were collected from depths of up to 20 cm beneath the soil surface. The activity concentrations of naturally occurring ²³⁸U and ²³²Th were observed to be in the range of 27 ± 7 to 53 ± 8 Bq kg⁻¹ and 36 ± 11 to 72 ± 11 Bq kg⁻¹, respectively. The activity concentration of ⁴⁰K ranged from 201 ± 78 to 672 ± 81 Bq kg⁻¹, and the highest activity of fallout ¹³⁷Cs observed was 10 ± 1 Bq kg⁻¹. The average activity concentration observed for ²³⁸U was 39 ± 8 Bq kg⁻¹, for ²³²Th was 57 ± 11 Bq kg⁻¹, for ⁴⁰K was 384 ± 79 Bq kg⁻¹ and for ¹³⁷Cs was 5 ± 0.5 Bq kg⁻¹. The radiological hazard parameters (representative level index, radium equivalent activity, outdoor and indoor dose rates, outdoor and indoor annual effective dose equivalents, and radiation hazard index) were calculated from the radioactivity in the soil.     

Burden of pediatric hepatitis C

Hepatitis C virus(HCV)is a major health burden infecting 170-210 million people worldwide.Additional 3-4millions are newly-infected annually.Prevalence of pediatric infection varies from 0.05%-0.36%in the United States and Europe;up to 1.8%-5.8%in some developing countries.The highest prevalence occurs in Egypt,sub-Saharan Africa,Amazon basin and Mongolia.HCV has been present in some populations for several centuries,notably genotypes 1 and 2 in West Africa.Parenteral anti-schistosomal therapy practiced in the 1960s until the early 1980s had spread HCV infection throughout Egypt.Parenteral acquisition of HCV remains a major route for infection among Egyptian children.Insufficient screening of transfusions,unsterilized injection equipment and re-used needles and syringes continue to be major routes of HCV transmission in developing countries,whereas vertical transmission and adolescent high-risk behaviors(e.g.,injection drug abuse)are the major routes in developed countries.The risk of vertical transmission from an infected mother to her unborn/newborn infant is approximately 5%.Early stages of HCV infection in children do not lead to marked impairment in the quality of life nor to cognitive,behavioral or emotional dysfunction;however,caregiver stress and family system strain may occur.HCV slowly progresses to serious complications as cirrhosis(1%-2%)and hepatocellular carcinoma(HCC)especially in the presence of risk factors as hemolytic anemias,obesity,treated malignancy,and concomitant human immune deficiency and/or hepatitis B virus co-infection.HCV vaccine remains elusive to date.Understanding the immune mechanisms in patients who successfully cleared the infection is essential for vaccine development.The pediatric standard of care treatment consists of pegylated interferon-α2a or b plus ribavirin for 24-48 wk.The new oral direct acting antivirals,approved for adults,need further evaluation in children.Sustained virologic response varies depending on the viral load,genotype,duration of infection,degree of am