Midwives of India: Missing in action

India had well-trained European and indigenous midwives during the time of British rule. The strong midwifery profession lost its importance after independence for various reasons. As a result maternal mortality remains high in India. This paper analyses reasons for the dilution in the midwifery profession, which include amended regulations, lack of social or political priorities, and change in health programme directions. This paper also presents a framework for midwifery-based maternal health services. This analysis shows that there are local as well as internationally supported efforts to improve midwifery in India.     

Long-term results of total body irradiation in adults with acute lymphoblastic leukemia

Purpose

The aim of this chart review of adult patients treated for acute lymphoblastic leukemia (ALL) with total body irradiation (TBI) was to evaluate early and late toxicity and long-term outcome.

Patients and methods

A total of 110 adult patients (34?±?12 years) with ALL underwent TBI (6?fractions of ?2 Gy for a total of 12 Gy) as a part of the treatment regimen before transplantation. Treatment-related toxicity, mortality, and hematologic outcome are reported.

Results

Mean follow-up was 70 months. The 2- and 5-year leukemia-free survival rates were 78 and 72?%, respectively. In all, 29?% (32/110) patients suffered from medullary recurrence after a median time of 7 months. Gender was the only statistically significant prognostic factor in terms of overall survival in favor of female patients. Treatment-related mortality and overall survival after 2 and 5 years were 16 and 22?%, and 60 and 52.7?%, respectively. The most frequent late reaction wascGVHD of the skin (n?=?33, 30?%). In addition, 15.5?% (17/110 patients) suffered pulmonary symptoms, and 6 patients developed lung fibrosis. Eyes were frequently affected by the radiation (31/110?=?28?%); 12 of 110 patients (11?%) presented with symptoms from osteoporosis, 5 of 110 patients (4.5?%) developed hypothyreosis and 2 patients diabetes mellitus. Of the male patients, 11?% reported erectile dysfunction or loss of libido, while 2 of 36 women reported menopausal syndrome at the mean time of 28 months after treatment with requirement for substitution. No women became pregnant after treatment. No acute or late cardiac toxicities were documented in our patients. No secondary malignancies were documented.

Conclusion

Although hematologic outcome was in the upper range of that reported in the literature, treatment-related mortality (TRM) and medullary recurrences remain a challenge. Sophisticated radiation techniques allow for decreasing toxicity to certain organs and/or dose escalation to the bone marrow in highly selected patients in order to improve therapeutic breadth.     

Helical High-Resolution Volume-Rendered 3-Dimensional Computer Tomography Angiography in the Detection of Intracranial Aneurysms

BACKGROUND AND PURPOSE: This study was carried out to determine whether high-resolution 3-dimensional prospective-volume-rendered computed tomographic (CT) angiography can replace conventional intra-arterial digital subtractional angiography in the diagnostic evaluation of patients with an acute subarachnoid hemorrhage (SAH) due to ruptured intracranial aneurysm. METHODS: Both techniques were performed in 30 consecutive patients within 2 to 12 hours after their admission to the hospital. RESULTS: In this group of 30 patients, CT angiography with 3-dimensional volume-rendered reconstruction detected 31 aneurysms in 25 patients. Two aneurysms were missed on CT angiography. Conventional angiography detected 33 aneurysms in 27 patients. The authors considered angiograms in 3 patients presenting with SAH as normal. In all cases where an aneurysm was detected on CT angiography, the finding was confirmed by conventional angiography. CONCLUSIONS: CT angiography with 3-dimensional post-processing is a sensitive, noninvasive method that provides a 3-dimensional view of intracranial vessels and the aneurysm. It is also very useful in planning either surgical or endovascular treatment.     

The prevalence of homelessness among injection drug users with and without HIV infection

Cross-sectional investigations of homelessness have many potential biases. Data from 2,452 individuals enrolled in a longitudinal cohort study of Baltimore, Maryland, residents recruited in 1988-1989 with a history of injection drug use were analyzed to identify the extent and determinants of homelessness. Proportions having ever experienced homelessness were compared across subgroups of injection drug users (IDUs) who were human immunodeficiency virus (HIV) negative, HIV positive, and HIV seroconverting. Logistic regression identified independent predictors of homelessness. In the cohort, 1,144 (46.7%) participants experienced homelessness during the course of the study. There were differences in prevalence of homelessness by serostatus: 42.4% (n = 621) of participants who remained HIV negative were ever homeless, while 50.6% (n = 346) of HIV-infected individuals and 58.9% (n = 178) of those who seroconverted during the study were ever homeless (P < .001). Participants who consistently denied active injection drug use during follow-up were unlikely to experience homelessness (19%). Independent predictors of homelessness were male sex, HIV seroprevalence, and HIV seroconversion. Following participants over time captures more experiences of homelessness than cross-sectional studies and more accurately identifies risk characteristics. Our data suggest that homelessness is a significant problem among IDUs, especially those with HIV/AIDS.