Pregnancy rate and ovarian hyperstimulation after luteal human chorionic gonadotropin in in vitro fertilization stimulated with gonadotropin-releasing hormone analog and menotropins

The value of luteal phase supplementation with human chorionic gonadotropin (hCG) was assessed after a combined protocol of ovarian stimulation, using a long acting gonadotropin releasing hormone analog (GnRH-a) and human menopausal gonadotropins (hMG), in a randomized prospective study of 36 consecutive cycles in an in vitro fertilization (IVF) program. The patients were allocated on the transfer day to either luteal phase supplementation with hCG (Group A, n = 18) or none (Group B, n = 18). Nine patients of Group A conceived as compared with 3 in Group B. Five patients, all in Group A, developed ovarian hyperstimulation syndrome (OHSS) (3 moderate and 2 severe forms). Analysis of the hormonal profiles disclosed similar progesterone (P), estradiol (E2), and E2/P ratio up to the 6th post ovum pick-up day. Then, E2 and mainly P levels decreased only in Group B resulting in a rising E2/P ratio. These findings stress the importance of luteal support in IVF cycles treated with GnRH-a. In light of the increased risk of OHSS among hCG treated patients, further studies are needed to assess the optimal preparation needed.     

An Analysis of Teacher Investment in the Context of a Family–School Intervention for Children with ADHD

Intervention researchers have often failed to assess treatment integrity; when integrity is examined, the focus is typically on whether the steps of intervention have been applied and not on quality of implementation. In the few studies that have investigated intervention quality, the emphasis has been on how intervention is delivered and not how it is received or the degree of participant engagement. This study was designed to examine participant engagement, specifically teacher investment, in the context of family interventions for children with attention-deficit/hyperactivity disorder (ADHD) that were linked with the school. The interventions included Family–School Success (FSS), a program that engages families and schools in a problem solving partnership, and Coping with ADHD through Relationships and Education (CARE), a program designed to provide education and support to families. Participants included the families and teachers of children in grades 2 through 6; 45 sets of families and teachers participated in FSS and 48 were in CARE. The Teacher Investment Questionnaire (TIQ) was designed to assess teacher engagement in intervention. The TIQ is a rating scale for clinicians to be completed during and after treatment. The findings provided support for the reliability and validity of the TIQ. Level of teacher involvement was demonstrated to decline with advancing grade level for FSS, but not CARE. Parent ratings of the quality of the family–school relationship as well as the level of teacher support for homework, assessed at baseline, were shown to be significantly related to clinician ratings of teacher investment post-intervention. The findings highlight the importance of assessing participant engagement in intervention. Strategies to refine the assessment of teacher investment were discussed.     

Iron supplementation in female blood donors deferred by copper sulfate screening

Female blood donors with low hematocrit levels detected by copper sulfate screening were selected randomly to receive either 75 mg of iron per day, as ferrous gluconate, or a calcium phosphate placebo. Their ferritin, serum iron, total iron-binding capacity, zinc protoporphyrin, and hemoglobin values, as well as their suitability to donate blood, were determined initially (Visit 1) and at four follow-up visits (Visits 2-5). By the second visit, the serum ferritin and iron values of donors receiving iron supplementation differed significantly from those of donors receiving placebo. By the fifth visit, a less marked but significant increase in hemoglobin had occurred in the iron group, but not in the placebo group. At no time was there a significant difference between the groups' suitability to donate blood, with each group donating at almost half of their visits. The authors conclude that iron supplementation at this dose level in deferred female blood donors improves their iron status and hemoglobin levels, but does not significantly increase their suitability to donate blood as compared with the suitability of placebo-treated donors.     

Diabetic gastropathy: a practical approach to a vexing problem

The clinical presentation of diabetic gastropathy varies, and a diagnosis usually must be confirmed with tests that evaluate the structure and function of the upper gut. Although glucose control, dietary changes, and drug therapy are the current mainstays of treatment, they may not be effective. Gastric pacing, a new technique that stimulates gastric motility, may give physicians another management tool.     

The challenge of irritable bowel syndrome: creating an alliance between patient and physician

The most important component of the treatment of irritable bowel syndrome (IBS) is to establish a therapeutic physician-patient relationship, coupled with patient education. We describe a stepwise approach to management, including judicious use of invasive tests, and setting realistic treatment goals that address the dominant symptoms, their severity, and psychosocial factors.     

Total radical trapping antioxidant potential (TRAP) and exercise

The relationship between physical activity, physical fitness and total radical trapping antioxidant potential (TRAP) was examined in the Northern Ireland Health and Activity Survey. This was a cross-sectional population study (n = 1600) using a two-stage probability sample of the population. TRAP was calculated using the sum of the individual serum antioxidant concentrations (urate, protein thiols, ascorbate, alpha tocopherol and bilirubin) multiplied by their respective stoichiometric values. Physical fitness was determined by estimation of VO2max by extrapolation from submaximal oxygen uptake, and physical activity was recorded by computer-assisted interview. Mean serum TRAP concentrations were significantly higher in males (653 +/- 8.2 mumol/l, mean +/- SEM) compared to females (564 +/- 8.0 mumol/l) (p < 0.0001). Both male and female smokers had significantly lower TRAP values than non-smokers (males p < 0.0001, females p = 0.02). In females, there was a positive relationship of TRAP with age (p < 0.001) and body mass index (p < 0.001) but a negative relationship with physical fitness (p < 0.05). The known beneficial effects of exercise and activity do not appear to be directly mediated through increased antioxidant status.      

Ganglioglioma with neurofibrillary tangles (NFTs): neoplastic NFTs share antigenic determinants with NFTs of Alzheimer's disease

A cerebral ganglioglioma contained abundant neurofibrillary tangles (NFTs) of the paired helical filament (PHF) type. The NFTs in the tumor were argyrophilic and Congo red and thioflavin-S positive. Immunohistochemically, the NFTs were reactive with antibodies to phosphorylated neurofilament protein, PHF/tau and abiquitin. The demonstration in the neoplasm of abnormally phosphorylated and ubiquitinated cytoskeletal components, similar in morphology and in immunoreactivity to those seen in NFTs of Alzheimer's disease, suggest that similar pathogenetic mechanisms may operate in both conditions.     

Population evacuations in industrial accidents: a review of the literature about four major events

This article reviews the literature describing four chemical and nuclear accidents and the lessons learned from each regarding the evacuation of civilian populations. Evacuation may save lives however, if poorly orchestrated, it may cause serious problems. For example, an inaccurate assessment of danger may lead to the evacuation of the same population twice, as the area requiring evacuation becomes larger than originally expected. Evacuation programs should focus on the vulnerable components of the populations, such as the elderly, children, and the disabled, and also should include plans for the care of pets and other animals. Training programs for civilians living near industrial centers and other high-risk areas should be considered. Finally, pre-event planning and preparation can improve the evacuation process and prevent panic behavior, and thus result in fewer casualties.     

Reliability of Cardiac Output Calculation by the Fick Principle and Central Venous Oxygen Saturation in Emergency Conditions

Background  For many years thermodilution has been the gold standard for determining cardiac output in the critically ill patients. Less invasive methods have recently been introduced. This study aimed at evaluating the agreement between cardiac output (CO) measured by a new Fick method, using central venous saturation (Scvo₂), and that measured by the classic thermodilution technique, in patients requiring emergent CO evaluation. Settings  Prospective clinical study in a university-affiliated, tertiary hospital, at surgical and general intensive care units. Patients and methods  Fifteen mechanically ventilated patients arriving in the emergency department in hemodynamic shock, had immediately a pulmonary artery catheter introduced under fluoroscopy upon arrival into the ICU. Cardiac output (CO) was obtained in each patient via both thermodilution and the Fick method, using oxygen consumption, SpO₂ and Scvo₂. Results  COs ranged between 2 and 2.3 (in the Fick and thermodilution methods, respectively) and 19 or 19.5 l/min (respectively). Mean thermodilution-derived CO was 6.2 ± 4.2 l/min whereas the Fick’s was 7.0 ± 4.3 l/min. There was statistical significant correlation between the two modalities of measurements, with an r ² = 0.9 (P < 0.001). Conclusions  The new method of Fick assessed emergent CO as reliably as the thermodilution, regardless of whether it was low or high. The use of Scvo₂ allows for prompt bedside calculation for most emergency patients. Avi A. Weinbroum and Philippe Biderman concurred equally to the present investigation. Weinbroum AA, Biderman P, Soffer D, Klausner JM, Szold O. Reliability of cardiac output calculation by the Fick principle and central venous oxygen saturation in emergency conditions.