Recombinant activated factor VII in post partum haemorrhage

Post-partum haemorrhage (PPH) is a life-threatening obstetric complication and the leading cause of maternal death. Any bleeding that results in or could result in haemodynamic instability, if untreated, must be considered as PPH. There is no controversy about the need for prevention and treatment of PPH. The keystone of management of PPH entails first, non-invasive and nonsurgical methods and then invasive and surgical methods. However, mortality remains high. Therefore, new advancements in the treatment are most crucial. One such advancement has been the use of recombinant activated factor VII (rFVIIa) in PPH. First used 12 years back in PPH, this universal haemostatic agent has been effectively used in controlling PPH. The best available indicator of rFVIIa efficacy is the arrest of haemorrhage, which is judged by visual evidence and haemodynamic stabilization. It also reduces costs of therapy and the use of blood components in massive PPH. In cases of intractable PPH with no other obvious indications for hysterectomy, administration of rFVIIa should be considered before surgery. We share our experience in a series of cases of PPH, successfully managed using rFVIIa.     

Prior antiplatelet drug use and short-term mortality in older patients with acute ischemic stroke (AIS)

Some studies suggest that previous treatment with antiplatelet agents (AA) might reduce ischemic stroke severity and improve outcomes in terms of clinical deficits or mortality. We evaluated the effect of the prior chronic use of AA on short-term (30 days) mortality in a sample of consecutive patients with AIS. Four hundred thirty-nine older patients (>65 years) with “major” AIS (modified Rankin scale ≥ 3) consecutively admitted to the University ward of Internal Medicine or Geriatrics were enrolled. Stroke was classified according to Oxfordshire Community Stroke Project (OCSP). Data recorded included: (1) clinical features; (2) medical history including home therapies, and vascular risk factors; (3) routine clinical chemistry analyzes (verb)/analyses (noun). Short-term (30 days) mortality was 27.6%. One hundred fifteen subjects (26.2%) were taking AA before admission. Compared with subjects not treated, subjects taking AA were characterized by higher prevalence of recurrent stroke (35% vs. 22%). In this group, a trend toward a higher prevalence of congestive heart failure (CHF), smoking, and altered levels of consciousness (ALC) was noted. Stroke type and short-term mortality (33% vs. 26.2%; odds ratio = OR = 1.25; 95% confidence interval = CI = 0.75-2.10, age and gender adjusted) were not different between the two groups. Adjustment for glucose, CHF, previous stroke, smoking, and ALC did not change mortality risk (OR = 0.83; 95%CI = 0.40-1.72). We conclude that in older patients hospitalized for “major” AIS, prior use of AA was not associated with any benefit in terms of short-term mortality both in patients with first, as well as in those with recurrent ischemic stroke.     

Volume loss in the deep gray matter and thalamic subnuclei: a longitudinal study on disability progression in multiple sclerosis

Journal of Neurology - Volume loss in the deep gray matter (DGM) has been reported in patients with multiple sclerosis (MS) already at early stages of the disease and is thought to progress...     

Short timescale modulation of cortical and cerebellar activity in the early phase of motor sequence learning: an fMRI study

Brain Imaging and Behavior - Motor learning is a multi-stage process, in which the involvement of different brain regions is related to the specific stage. We aimed at characterising short...     

Female Cosmetic Genital Surgery: Delivering What Women Want

Female cosmetic genital surgery (FCGS) is the latest and fastest growing sub-specialty in the broad specialty of gynecology. It encompasses procedures designed to change aesthetic and/or functional aspects of women’s genitalia. In case of FCGS, there is difficulty in separating purely aesthetic concerns from medical concerns, because there is much overlap. The initial controversies over FCGS have almost settled down in the light of the mounting scientific evidence suggesting that a number of procedures that currently exist are safe, effective, and capable of treating to a considerable extent the suite of conditions associated with course-of-life vulvo-vaginal changes. Also, the rapidly expanding demands that have arisen for FCGS procedures from women across the globe have made it imperative for the reconstructive pelvic surgeons to master the cosmetic genital procedures so as to deliver the women what they want, in the most scientific manner. The issue of asking for and provisioning of FCGS is essentially a matter of individual patient and physician decision-making.