A study of maternal mortality in 8 principal hospitals in Pakistan in 2009

Objectives

To determine maternal mortality to assess the achievement of Millennium Development Goal 5 in Pakistan and suggest remedial measures.

Methods

Throughout 2009, maternal deaths occurring in obstetrics and gynecology departments in 8 hospitals in Rawalpindi and Islamabad, Pakistan, were recorded. A data form was filled in by the duty registrar at the time of death. Data were analyzed via SPSS.

Results

During the study period, there were 47 209 live births and 108 maternal deaths (age 17-45 years). Among those who died, 30% were primigravidas, 50% had a parity of 1-4, and 20% had a parity of 5 or more; 20.4% had not delivered, 40.7% had vaginal delivery, and 36.1% had cesarean delivery; 67.6% were unbooked and 32.4% were booked (14 under care of a consultant and 21 under care of a medical officer); 73%, 22%, and 5% died in the first, second, and third trimesters, respectively; 17.5% died prenatally, 4.6% during labor, and 78% postpartum; 73% were in a critical condition and 8% were dead on arrival. Eclampsia, postpartum hemorrhage, and sepsis caused 23, 13, and 13 deaths, respectively.

Conclusion

Maternal death can be effectively managed by skilled care during pregnancy, childbirth, and the postnatal period.     

Individual vulnerability and the nurturing state: The case of self-reported health and relative income

This paper develops a method to model the effect of income on self-reported health at the individual level. The model is estimated using the meta-analytic data of 68 studies from 13 countries, and is used to test two hypotheses. The first hypothesis is that income affects health at the individual level. If this is the case, the incidence of poor health will differ across people from different income groups. The second hypothesis is that income differentials are associated with differential vulnerability to poor health. If so, the influence of income on health outcomes will differ across members of different income groups in different countries.     

Daily vitamin K supplementation improves anticoagulant stability

BACKGROUND: One of the causes of unstable anticoagulant control in patients using vitamin K antagonists is a fluctuating intake of vitamin K. Research suggests that patients with a low dietary intake of vitamin K have a less stable anticoagulant control than patients with a higher intake. OBJECTIVES: To study whether supplementation with a low daily dose of vitamin K improves anticoagulant control. METHODS: We performed a double-blind, randomized, placebo-controlled trial. 200 patients of the Leiden anticoagulation clinic, who used the vitamin K antagonist phenprocoumon, were randomized to receive either adjusted-dose phenprocoumon and 100 mug vitamin K once daily or adjusted-dose phenprocoumon and a placebo. Treatment duration was 24 weeks. The primary outcome was the percentage of time the International Normalized Ratio was within the therapeutic range. RESULTS: The time in the therapeutic range was 85.5% in the placebo group and 89.5% in the vitamin K group (adjusted difference 3.6%; 95% CI -0.8% to 8.0%). The time below the therapeutic range was 3.1% in the placebo group and 2.1% in the vitamin K group (adjusted difference -0.7%; 95% CI -2.5% to 1.1%) and the time above the therapeutic range was 11.4% in the placebo group and 8.5% in the vitamin K group (adjusted difference -2.9%; 95% CI -6.9% to 1.1%). The relative risk (RR) of a maximal stability in the vitamin K group compared to the placebo group was 1.8 (95%, CI 1.1-2.7). CONCLUSION: Supplementation of vitamin K antagonists with 100 mug vitamin K improves stability of anticoagulant therapy. Because the risk of side effects is inversely related to anticoagulant stability, such an improvement is likely to reduce the number of bleeding and thrombotic events.     

健康成人二氧化碳通气当量与生理死腔的相关性研究

目的:通过健康成人二氧化碳通气当量(EqCO2)和生理死腔/潮气量(VD/VT)比率的相关性探讨,用无创的方法代替有创的方法研究呼吸生理。方法:28例受试者行心肺运动试验,同步实时测定分钟通气量(VE)和二氧化碳产生量(VCO2),计算出静态二氧化碳通气当量(EqCO2rest)、无氧阈二氧化碳通气当量(EqCO2AT)及最大运动状态下二氧化碳通气当量(EqCO2max)。并分别在运动前及运动高峰时抽取动脉血,根据改良Bohr的公式,得出实际生理死腔/潮气量比率(VD/VT)。结果:正常人静态时EqCO2rest与VD/VTrest有显著相关关系(r=0.601,P=0.011);运动高峰时EqCO2max与VD/VTmax无相关性(r=-0.223,P=0.334),且EqCO2AT和EqCO2max较EqCO2rest明显下降,差异有统计学意义(P<0.001),EqCO2max与EqCO2AT比较也有下降,但差异无统计学意义(P=0.417)。结论:正常成人静息状态下用无创方法测定EqCO2可反映实际VD/VT。     

Prediction of tumor grade and lymphovascular space invasion in endometrial adenocarcinoma with MR imaging-based radiomic analysis

PurposeTo evaluate the capabilities of two-dimensional magnetic resonance imaging (MRI)-based texture analysis features, tumor volume, tumor short axis and apparent diffusion coefficient (ADC) in predicting histopathological high-grade and lymphovascular space invasion (LVSI) in endometrial adenocarcinoma.Materials and methodsSeventy-three women (mean age: 66 ± 11.5 [SD] years; range: 45–88 years) with endometrial adenocarcinoma who underwent MRI of the pelvis at 1.5-T before hysterectomy were retrospectively included. Texture analysis was performed using TexRAD® software on T2-weighted images and ADC maps. Primary outcomes were high-grade and LVSI prediction using histopathological analysis as standard of reference. After data reduction using ascending hierarchical classification analysis, a predictive model was obtained by stepwise multivariate logistic regression and performances were assessed using cross-validated receiver operator curve (ROC).ResultsA total of 72 texture features per tumor were computed. Texture model yielded 52% sensitivity and 75% specificity for the diagnosis of high-grade tumor (areas under ROC curve [AUC] = 0.64) and 71% sensitivity and 59% specificity for the diagnosis of LVSI (AUC = 0.59). Volumes and tumor short axis were greater for high-grade tumors (P = 0.0002 and P = 0.004, respectively) and for patients with LVSI (P = 0.004 and P = 0.0279, respectively). No differences in ADC values were found between high-grade and low-grade tumors and for LVSI. A tumor short axis ≥ 20 mm yielded 95% sensitivity and 75% specificity for the diagnosis of high-grade tumor (AUC = 0.86).ConclusionMRI-based texture analysis is of limited value to predict high grade and LVSI of endometrial adenocarcinoma. A tumor short axis ≥ 20 mm is the best predictor of high grade and LVSI.     

Sudden nasal bleeding and brodifacoum: A case of accidental exposure or attempted homicide?

A 50-year-old man was admitted to the emergency department with abrupt massive epistaxis. An accurate anamnesis and physical evaluation could not reveal any other anomalies, while coagulation tests showed potentially life threatening prolonged prothrombin time, with activated partial thromboplastin and thrombin time, with fibrinogen and antithrombin III within limits. Despite the prompt pharmacological and compressive local treatment, bleeding continued and the patient was therefore hospitalized. Highly specific coagulation and toxicological testing-among others high-performance liquid chromatography assessment on plasma-were performed, leading to the unexpected identification of brodifacoum. Police and criminal justice authorities revealed the source of exposure to brodifacoum after several months of investigation, residing in his everyday life. Brodifacoum is a long-lasting anticoagulant, acting as a vitamin K antagonist, and belongs to the family of superwarfarins. Brodifacoum use is authorized as rodenticide in many countries worldwide, but has been reported as cause of severe coagulopathies in humans, both intentional or involuntary, even consumed as a contaminant of herbal drugs, such as cannabis. The original contribution of this case to the knowledges of human brodifacoum intoxication resides in the multidisciplinary approach and the collaborative interplay of clinical and toxicology experts as well as judicial authorities.     

锌元素治疗妊娠呕吐疗效观察

用锌元素治疗妊娠呕吐５３例，对照组４１例。经ｘ２检验，治疗组的治愈率和总有效率均明显高于对照组，Ｐ＜０．００１并对妊娠呕吐的病因和锌元素的治疗作用作了分析。