Hepatitis B screening in a New York City obstetrics service.

A cross-sectional chart review study was performed of hepatitis B virus (HBV) surface antigen screening of 532 women admitted to a New York City hospital obstetrics service from 1984 to 1985. Comparison of serologic results to risk factors for hepatitis B revealed that women born outside the United States and those with a positive test for or history of a sexually transmitted disease were more likely to be infected with HBV. Obstetric clinics with large immigrant populations should consider screening all patients for HBV.     

Conjunctival flaps in the treatment of refractory pseudomonas corneal abscess

Pseudomonas corneal abscess can result in a rapid downhill clinical course despite institution of appropriate medical measures. In this situation the clinician is faced with surgical intervention. A series of patients treated and stabilized through conjunctival flap therapy are presented. The role of conjunctival flap therapy in halting the progression of this entity is described.     

Preliminary observation of speech disorder in obstructive and mixed sleep apnea

Clinical observation suggested that speech disorder seemed to be associated with sleep apnea. We recorded a standard speech sample from 39 matched subjects in three groups, 13 sleep apnea individuals, 13 subjects with COPD, and 13 subjects without sleep apnea or COPD. Three speech pathologists in a single blind listening task of the recorded samples judged whether or not speech disorder was present. Eight of the sleep apnea subjects were judged to have disordered speech compared to three of the COPD group and one of the non-sleep apnea, non-COPD (normal) group. These results were statistically significant. This supports a clinical impression that speech disorder is more common in sleep apnea than expected. There may be common anatomic and physiologic disturbances present between the two conditions, and perhaps disordered speech is a sign of sleep apnea.     

Short-term changes in tonic accommodation

Experiments were performed to determine the diurnal variation of, as well as the influence of total darkness on, tonic accommodation. In general, under both conditions trend analysis showed that variations in tonic accommodation over time were either nonsystematic in nature or could be best described by a simple linear function. Given the relatively small range of mean tonic accommodation values over time (0.5 to 1.1 D), the results demonstrate the robustness and stability of tonic accommodation under naturally occurring viewing conditions during the course of a day. In contrast, during the 2-hr period in total darkness, tonic accommodation exhibited a three-fold increase in mean range (0.6 to 2.5 D) as well as a significant increasing linear trend in some subjects, suggesting less stability of tonic accommodation in the absence of visual stimuli.     

Evaluating the effectiveness of interventions: exploration of two statistical methods.

Repeated measures designs are often used to evaluate the effectiveness of interventions. In these designs, the outcomes are measured on several occasions before and after implementation of the intervention. Two statistical methods, the repeated measures analysis of variance (RM-ANOVA) and hierarchical linear models (HLM), can be used to analyze the data. The authors provide an overview of the statistical models underlying RM-ANOVA and HLM and discuss the strengths and limitations of each. They propose that the 2 methods are complementary in determining the effectiveness of interventions.     

Biphasic insulin aspart given thrice daily is as efficacious as a basal-bolus insulin regimen with four daily injections: a randomised open-label parallel group four months comparison in patients with type 2 diabetes.

AIMS: To show that a thrice daily meal-time biphasic insulin aspart (BIAsp) treatment regimen is as efficacious as a 4 times daily basal-bolus regimen with human isophane insulin (NPH) and insulin aspart (IAsp). METHODS: A multinational, randomised, open-label parallel-group trial in 394 patients with type 2 diabetes on a once or twice daily insulin regimen. Patients were randomised 1:1 to BIAsp or IAsp+NPH for 16 weeks. The BIAsp group was treated according to individual needs using BMI as a surrogate index of insulin resistance. Subjects administered BIAsp 70 (BMI< or =30 kg/m (2)) or BIAsp 50 (BMI>30 kg/m (2)) with breakfast and lunch and BIAsp 30 with dinner. The IAsp+NPH group injected IAsp at meals and NPH at bedtime as basal insulin. HbAlc levels after 16 weeks were compared between treatments using a predefined non-inferiority criterion of 0.4%. The incidence of hypoglycaemic episodes and adverse events was evaluated. RESULTS: Mean HbAlc (+/-SD) decreased from 9.1+/-0.7% to 7.8+/-1.0% with both treatments. Glycaemic control provided by BIAsp was non-inferior to that obtained by the IAsp+NPH (intention to treat ITT) population: diff, HbAlc -0.05%; 95% CI (-0.24; 0.14); per protocol (PP) population: diff, HbAlc -0.03%; 95% CI (-0.23; 0.16). Similar improvements in glycaemic control in both groups were confirmed by self-measured 8-point plasma glucose (PG) profiles, average and fasting PG concentrations, and average prandial PG increments. The incidence of adverse events and hypoglycaemic episodes was similar in the two treatment groups. CONCLUSIONS: A thrice daily meal-time BIAsp regimen is a suitable alternative to an intensified insulin regimen in people with inadequately controlled type 2 diabetes mellitus, and requires fewer daily injections than a basal-bolus therapy without compromising efficacy and safety.     

Acute coronary syndromes

The first 150 words of the full text of this article appear below. Key points Coronary artery disease accounts for >30% ofdeaths in Western society. The diagnosis of myocardial infarctionshould be qualified by size, causation and time from occurrence. Mortalityis reduced by immediate or ‘primary’ percutaneouscoronary intervention or thrombolysis within the first 24 hof onset of ST-segment elevation myocardial infarction. Strategiesto reduce platelet activation (glycoprotein IIb/IIIa receptorantagonists, or clopidogrel) are now recommended in the treatmentof high-risk non-ST-segment myocardial infarction/unstable angina. Elevatedserum troponins may be the result of non-ischaemic myocardialdamage, especially in critical illness.