Antenatal steroids at 37 weeks,does it reduce neonatal respiratory morbidity? A randomized trial

Objective: To assess the effect of prophylactic corticosteroids administration at 37 weeks before term elective cesarean section (CS) in reducing neonatal respiratory morbidity and admission to neonatal intensive care unit (NICU).

Methods: This randomized trial was conducted focusing on women subjected to term elective CS. Women who were eligible for the study were divided into two groups. At 37 weeks' gestation; study group received two intramuscular doses of 12?mg dexamethasone 24?h apart, while the control group given the usual care without steroids. Outcome measures were adverse neonatal respiratory outcomes (respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN)) and rates of admission to NICU.

Results: Neonates in the treatment group had lower overall incidence of respiratory distress morbidity 7.9% versus 23% when compared to the control group. The main morbidity was TTN (7% in study versus 19.6% in control group). There was significantly lower incidence of both mild and moderate degrees of respiratory distress in the study group (7 and 0.9%, respectively) compared to 17 and 5.3% in the control group. The most significant benefit of steroid administration was noted in those babies 37–37⁺⁶ weeks.

Conclusion: Antenatal administration of steroids at 37 weeks appears to be beneficial in reducing neonatal respiratory morbidity in women undergoing elective term CS.     

Evolution and Progression of Spondylodiskitis: A Case Presentation

Pyogenic infection of the spinal column is a relatively rare condition. Spondylodiskitis is characterized by infection of the intervertebral disk and the adjacent vertebrae. Diagnosis is often delayed because the symptoms are often nonspecific and also because of the high incidence of nonspecific low back pain in the general population. We report the case of a 42-year-old woman who developed low back pain secondary to spondylodiskitis. Her diagnosis was delayed because of a lack of supporting findings on initial magnetic resonance imaging. The case highlights the clinical scenario in which maintaining a high index of suspicion may lead to follow-up imaging and an accurate diagnosis.

WONCA研究论文摘要汇编——基层抑郁症风险患者的连续性服务

背景目前已开展了对重性精神病患者进提供连续性服务的研究。目的探讨基层对有抑郁症风险患者提供连续性服务的水平,并与对心力衰竭患者的服务水平进行对比。方法采用抑郁症风险患者与心力衰竭患者对比的探索性研究。采用患者问卷评估服务的持续性,包含如下内容:(1)联系的服务提供者数(个人连续性);(2)诊所内服务提供者之间的合作(团队连续性)(6个项目,分数1~5分);(3)诊所外全科医师与服务提供者之间的合作(跨界连续性)(4个项目,分数1~5分)。结果大多数抑郁症风险患者在过去1年中寻遍整个服务提供界联系了几个服务提供者,曾遇到过高水平团队连续性服务及低水平跨界连续性服务。在诊所中可接触到的不同服务提供者要明显多于心力衰竭患者服务提供者(P<0.01)。抑郁症风险患者的服务提供者之间的合作更好一些,每项平均得分4.3分,心力衰竭患者得分为4.0分(P=0.03)。然而,跨界连续性服务方面正好相反:抑郁症风险患者每项平均得分3.5分,心力衰竭患者得分为4.0分(P=0.01)。结论抑郁症风险患者与心力衰竭患者之间的探索性对比显示:体验服务连续性方面的差距不大。对此还应行进一步分析。     

Challenges in the Management of Mucopolysaccharidosis Type II (Hunter's Syndrome) in a Developing Country: a Case Report

Background

Mucopolysaccharidosis type II (Hunter''s syndrome) is an X-linked chromosomal storage disorder due to deficiency of the lysosomal enzyme iduronate-2-sulfatase with patients rarely living till adulthood. Failure to identify patients early could contribute to an increased morbidity as identified in this case report.

Case Details

An eight year old patient with Hunter''s syndrome identified five years after disease onset with severe cardiovascular complications exemplifies the challenges faced in resource-limited countries towards making diagnosis and treatment of rare conditions. Elevated urinary glycosaminoglycans levels or a strong clinical suspicion of Hunter''s syndrome, as identified in the index case, is a prerequisite for enzyme activity testing. Urinary mucopolysaccharide(MPS) level was 69.6mg/mmol(normal range is 0.0 – 11.6mg/mmol), and the confirming MPS electrophoresis analysis showed elevated heparan sulphate in the urine sample. Enzyme activity testing, with absent or very low iduronate-2-sulfatase activity, is diagnostic. However, the scarce availability and high cost of these tests is another constraint in making a diagnosis.

Conclusion

Identification and management of mucopolysaccharidosis type II pose a problem in resource-constrained countries due to late presentation, lack of facility for diagnosis and treatment, cost and expertise required for the management.     

Effect of cobalt addition on the corrosion behavior of near equiatomic NiTi shape memory alloy in normal saline solution: electrochemical and XPS studies

The electrochemical and corrosion (uniform and localized) behavior of a binary Ni₅₂Ti₄₈ shape memory alloy (SMA) and two ternary Ni₅₂Ti_48−xCo_x (x = 1.5 and 4.0 wt%) SMAs were studied. Measurements were conducted in 0.9% NaCl solution at 37 °C employing various electrochemical methods. These include: linear polarization resistance (LPR), linear sweep voltammetry (LSV), chronoamperometry and dynamic electrochemical impedance spectroscopy (DEIS). Such measurements were complemented with scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analysis. Results revealed that the addition of alloyed Co to NiTi significantly reduced the uniform corrosion rate of the studied SMA and greatly enhanced its pitting corrosion resistance. XPS measurements evidenced high stability of the passive layer and limited adsorption of chloride ions. Additionally, it was found that the passive layer remained primarily composed of titanium oxides. Microstructure changes accompanying the addition of Co were also used to account for its role in improving the corrosion resistance of these materials.

The electrochemical and corrosion (uniform and localized) behavior of a binary Ni₅₂Ti₄₈ shape memory alloy (SMA) and two ternary Ni₅₂Ti_48−xCo_x (x = 1.5 and 4.0 wt%) SMAs were studied.