Medical care solicitation by criminals with gunshot wound injuries: a survey of Washington, DC, jail detainees

BACKGROUND: The best estimates of nonfatal gunshot wounds in the United States come from hospital emergency room data and may miss, among other things, wounded individuals who do not seek medical treatment. Criminals may be those least likely to rely on professional care for their wounds. This study provides evidence of whether medical care is solicited by criminals after gunshot wounds. In addition, the circumstances of the injury events are described. METHODS: A case series of 79 detainees at a Washington, DC, jail who had previously been shot in 93 separate incidents were interviewed using a standardized questionnaire. Data were obtained concerning the age and race of the victim, the location of the wound, and the length of hospital stay. RESULTS: In 92% of the incidents, respondents reported going to the hospital; one-third of those shot were hospitalized for more than 1 week. More than half (54%) had been hit in the head or torso, and 40% had a current disability attributable to the wound. CONCLUSION: Among these "criminals," the vast majority reported that they obtained professional care for their gunshot wounds. Such evidence suggests that individuals previously thought unlikely to enter the medical care system after a firearm injury usually do so. Statistics on medically treated nonfatal gunshot wounds probably do not substantially underestimate the actual number of nonfatal shootings.     

Screening for avascular necrosis of the hip with rapid MRI: preliminary experience

PURPOSE: The purpose of this work was to compare rapidly acquired MR images with routinely employed SE and turbo SE (TSE) images in screening for hip avascular necrosis (AVN). METHOD: Twelve patients with findings suspicious for radiographically occult AVN of one or both hips were studied with our routine screening protocol (imaging time >7 min) and similarly weighted, rapidly acquired MR sequences (imaging time <1 min). RESULTS: The rapidly acquired MR images were judged to be similar to the routine protocol in demonstrating marrow edema, irregular lines within the femoral head characteristic of AVN, and osteoarthritis. CONCLUSION: The rapidly acquired MR sequences that we studied reliably revealed the presence or absence of AVN, marrow edema, and osteoarthritis of the hip in our sample population when compared with SE and TSE sequences that we routinely perform. Further investigation of rapidly acquired MR sequences is warranted, as imaging time may be dramatically reduced and patient throughput increased.     

Measurement of aggregate risk with copulas

Summary When aggregating financial risk on a portfolio level, the specification of the dependence structure between the risk factors plays an important role. Promising parametric models are often based on a so-called copula approach. Case studies of market crashes suggest the application of concepts allowing for extremal dependence. We present a transformed copula as a new model that both fits the data and allows for exact prediction in the tails. It turns out that the new model improves benchmark models like the t- or Clayton copula with respect to risk measures like VaR or Expected Shortfall. By performing different goodness-of-fit tests, the quality of the estimation is examined.     

Clinical and serum lipid findings in a large family with autosomal dominant retinitis pigmentosa

Retinitis pigmentosa, of unknown cause, has recently been associated with decreased amounts of the polyunsaturated fatty acid, docosahexaenoic acid, in the plasma of affected as compared with unaffected relatives. It has been suggested that this finding may serve as a marker for the disease and might indicate alterations in photoreceptor cell metabolism. The authors studied 54 members of a family with dominantly inherited retinitis pigmentosa in five generations. In addition to the typical clinical findings of retinitis pigmentosa, eight persons also had a bull's eye maculopathy, and four persons had uni- or bilateral optic nerve drusen. When the authors determined the plasma fatty acid and lipid contents, they saw the expected age-related effect on cholesterol and triglycerides, but an unexpected, significant reduction in fatty acids in the unaffected controls as compared with persons with retinitis pigmentosa. The authors' results emphasize the heterogeneity of phenotypic expression of retinitis pigmentosa within a single family.     

Threshold Amsler grid testing in maculopathies

The Amsler grid is a suprathreshold target and thus may fail to detect relative scotomas. If the grid is viewed through two cross-polarizing filters creating low luminance conditions (threshold Amsler grid testing) the test is far more sensitive. Ten patients with disorders of the macula with normal standard white Amsler grid testing were studied with three other Amsler grid tests. Of the 15 involved eyes, 12 had visual field defects present with threshold Amsler grid testing. Tangent screen examination showed defects in 10 of these 12 eyes. The two red grids used were not as sensitive as the threshold grid. Three eyes had metamorphopsia with the white grid which became the site of a visual field defect with threshold testing. Threshold Amsler grid testing is a rapid and sensitive technique for the evaluation of the central 10 degrees of visual field in patients with maculopathies.     

Endometriosis and angiogenesis

Endometriosis is a common gynecological condition, responsible for significant morbidity and social-economic impact. Although the condition has been recognized for many years, the underlying pathophysiology is poorly understood. In turn, this results in inadequate treatment and high recurrence rates. Various theories try to explain the presence of endometrial tissue outside the uterine cavity. However, none of them can explain all disease locations and appearances, and it is unclear how these fragments establish into endometriotic lesions. New vessel formation has long been recognized as a feature of endometriosis, often clearly visible at laparoscopy. Recent work has focused on identifying the role of vascularization in the pathogenesis of endometriosis, by allowing lesions to establish and grow. In this review the authors outline the basic mechanisms of angiogenesis and vasculogenesis in the human eutopic endometrium, and consider how this data can be applied to endometriotic implants. Furthermore, the authors discuss molecular mechanisms of angiogenesis and vasculogenesis, and how this may be used to therapeutic advantage in the treatment of endometriosis.     

Intravaginally applied metronidazole is as effective as orally applied in the treatment of bacterial vaginosis, but exhibits significantly less side effects

Objective

Metronidazole is the drug of choice for the treatment of bacterial vaginosis (BV). However, so far the oral administration has not been clinically compared to the intravaginal application regarding efficacy, side effects and patient satisfaction in a scientific sound fashion.

Study design

Therefore, this randomized, double-blind, placebo-controlled clinical trial was designed to demonstrate non-inferiority of short-term intravaginal (i.vag.) application of metronidazole (2× 1000 mg pessaries 24 h apart) vs. a single oral dose (p.o.) of metronidazole (1 × 2000 mg tablets) in 263 patients with BV (double-dummy design). The follow-up period was 12 weeks. In addition, the number and the type of adverse events induced by the two regimens were compared, assuming better tolerability of the intravaginal application.

Results

Following the diagnosis of BV a total of 129 women (mean age 36.2 years) was orally treated with a single dose of 2 g metronidazole whereas a total of 134 patients (mean age 35.5 years) was treated intravaginally with 1 g metronidazole each day on two consecutive days and included in the per-protocol analysis. Non-inferiority of i.vag. application compared to p.o. administration was statistically significant regarding efficacy: Following intravaginal application the cure rate, assessed on day 8 after starting of the treatment, was 92.5% as compared to 89.9% after oral administration. Nausea was the most common adverse event reported in 10.2% i.vag. vs. 30.4% p.o. of all cases (p < 0.001), abdominal pain in 16.8% i.vag. vs. 31.9% p.o. (p < 0.01), a “metallic taste” in 8.8% i.vag. vs. 17.9% p.o. (p < 0.05). Women treated i.vag. were highly satisfied with the treatment and more content as compared to the women treated p.o. with metronidazole (p < 0.05, intent-to-treat analysis).

Conclusion

In this clinical trial the intravaginal application was as effective as the oral administration of metronidazole in treating BV. However, significantly less adverse events were reported after short-term intravaginal as compared to oral application (p = 0.023) and probably led to a better patient compliance.