Current Issue : July - September Volume : 2015 Issue Number : 3 Articles : 9 Articles
Birth weight discordance is the difference between the heaviest and the lightest fetus in a set of multiples. It is the most common aspect because some variation is expected among siblings. But growth discordance has been associated with adverse outcomes, mainly because it is associated with growth restriction. The specific cause is yet to be determined. Keeping these concepts as the background, in this study an attempt was made to determine the cause of discordance in twins and perinatal outcome of the discordant twins. This was a cross sectional study involving the pregnant women who were carrying twins. A thorough general examination and obstetric examination was carried out and ultrasonography was done. Discordance on ultrasonography, if present, was noted by estimating the fetal weights. The twins were considered to be discordant if the discordance was more than 15%. Discordance was categorized into mild if the discordance was between 15-25% and severe if the percentage of discordance was >25%. In the present study, a total of 210 cases of twin pregnancies were screened to identify the discordant twins. Out of them 70 cases were found to be with discordant twins and the incidence was found to be 33.3%. Among the 70 cases of discordant twins, 44 (63%) cases were found to be with mild discordance and 26 (37%) cases were observed to be with severe discordance. The main cause of the majority cases (97.1%) was observed to be with intra uterine growth restriction which is mainly due to placental insuffiency. In our study pre term delivery is the most common complication observed followed by pregnancy induced hypertension (PIH). In our study, the perinatal mortality was found to be 30.7%. Cesarean delivery gave a better perinatal outcome when compared to vaginal delivery. Perinatal mortality was found to be more common in monochorionic twins when compared with dichorionic twins. The perinatal mortality and morbidity is more for the second twin when compared with the first twin. It is the responsibility of the health care professionals to counsel the pregnant women carrying twins regarding growth discordance, the necessity and significance of regular antenatal visits, complications associated with discordant twins and the perinatal mortality and morbidity and increased financial burden....
Background: Although several face-to-face programs are dedicated to informal caregivers of persons with dementia, they are\nnot always accessible to overburdened or isolated caregivers. Based on a face-to-face intervention program, we adapted and\ndesigned a Web-based fully automated psychoeducational program (called Diapason) inspired by a cognitive approach.\nObjective: This study aimed to evaluate through a pilot unblinded randomized controlled trial the efficacy and acceptability of\na Web-based psychoeducational program for informal caregivers of persons with Alzheimer�s disease (PWAD) based on a mixed\nmethods research design.\nMethods: We recruited and randomized offline 49 informal caregivers of a PWAD in a day care center in Paris, France. They\neither received the Web-based intervention and usual care for 3 months (experimental group, n=25) or only usual care (control\ngroup, n=24). Caregivers� perceived stress (PSS-14, primary outcome), self-efficacy, burden, perceived health status, and depression\n(secondary outcomes) were measured during 3 face-to-face on-site visits: at baseline, at the end of the program (month 3), and\nafter follow-up (month 6). Additionally, semistructured interviews were conducted with experimental group caregivers at month\n6 and examined with thematic analysis.\nResults: Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and\ncontrol groups (P=.98). The experimental group significantly improved their knowledge of the illness (d=.79, P=.008) from\nbaseline to month 3. Of the 25 participants allocated to the experimental group, 17 (71%) finished the protocol and entirely viewed\nat least 10 of 12 online sessions. On average, participants used the website 19.72 times (SD 12.88) and were connected for 262.20\nminutes (SD 270.74). The results of the satisfaction questionnaire showed that most participants considered the program to be\nuseful (95%, 19/20), clear (100%, 20/20), and comprehensive (85%, 17/20). Significant correlations were found between\nrelationship and caregivers� program opinion (P=.01). Thus, positive opinions were provided by husbands and sons (3/3), whereas\nqualified opinions were primarily reported by daughters (8/11). Female spouses expressed negative (2/3) or neutral opinions\n(1/3). Caregivers expected more dynamic content and further interaction with staff and peers.\nConclusions: In this study, quantitative results were inconclusive owing to small sample size. Qualitative results indicated/showed\nlittle acceptance of the program and high expectations from caregivers. Caregivers did not rule out their interest in this kind of intervention provided that it met their needs. More dynamic, personalized, and social interventions are desirable. Our recruitment\nissues pointed out the necessity of in-depth studies about caregivers� help-seeking behaviors and readiness factors....
Background hospitalized patients with serious\ninfections treated with aminoglycosides are at risk of\ndeveloping nephrotoxicity. Previous clinical studies have\nshown that the pharmacokinetics of aminoglycosides in\nhumans follow a circadian rhythm. Therefore, the time of\nadministration could have important clinical implications\nwith respect to the risk of developing aminoglycosideassociated\nnephrotoxicity in patients treated with once daily\ndosing regimens. Objective To examine the effect of the time\nperiod of administration on aminoglycoside exposure and\nthe incidence of nephrotoxicity in a large population of\nhospitalized patients with serious infections. Setting General\nward and intensive care unit of a teaching hospital. Method In\nthis retrospective cohort study, patients treated with intravenous\ntobramycin or gentamicin were eligible for inclusion.\nPatients were divided into three groups by time of administration:\nmorning, afternoon and night. Main outcome measure\nPharmacokinetic parameters and the incidences of\nnephrotoxicity were compared between the morning, afternoon\nand evening groups. Results 310 general ward and 411\nintensive care unit patients were included. No significant\ndifferences were found in patient characteristics between the\nmorning, afternoon and night groups. The time period of\nadministration did not affect aminoglycoside pharmacokinetics\nor the incidence of nephrotoxicity. Conclusion The\ntime of administration has no effect on the pharmacokinetics\nor nephrotoxicity of once daily dosed aminoglycosides in\nhospitalized patients. Consequently, we advise aminoglycosides\nto be administered as soon as possible in case of\n(suspected) severe hospital-acquired infections and subsequent\ndosages to be based on therapeutic drug monitoring\nto optimize the efficacy/toxicity balance....
The study was aimed at determining the clinical and associated risk factor for intrauterine growth restriction (IUGR) at tertiary health care centre. The objective was to identify the group of infants of IUGR who needs intensive neonatal care. Retrospective analytical study of newborn included 1048 births. Mean age of mother was 25.35 years. A weight of 4.4 kg was considered as standard. The new born were screened by birth weight and their gestational age. Out of these 1048 cases 104 cases (10%) were of low birth weight deliveries. As regards of small gestational age (SGA) newborns, maximum 55% of babies had birth weight less than 2 kg. Pregnancy induced hypertension (PIH) had highest contribution (49%) Anaemia was present in 20% of cases, 12% cases were of twin gestation. Oligoamnios was associated in 11% cases. PIH was the major cause for IUGR (49%) which should be paid attention to in antenatal period. Anaemia is a preventable disease in pregnancy. Hence IUGR can also be prevented if measures are taken for correction of anemia in early pregnancy itself....
Background: Common mental disorders are strongly associated with long-term sickness absence, which has negative consequences\nfor the individual employeeââ?¬â?¢s quality of life and leads to substantial costs for society. It is important to focus on return to work\n(RTW) during treatment of sick-listed employees with common mental disorders. Factors such as self-efficacy and the intention\nto resume work despite having symptoms are important in the RTW process. We developed ââ?¬Å?E-health module embedded in\nCollaborative Occupational health careââ?¬Â (ECO) as a blended Web-based intervention with 2 parts: an eHealth module\n(Return@Work) for the employee aimed at changing cognitions of the employee regarding RTW and a decision aid via email\nsupporting the occupational physician with advice regarding treatment and referral options based on monitoring the employeeââ?¬â?¢s\nprogress during treatment.\nObjective: This study evaluated the effect of a blended eHealth intervention (ECO) versus care as usual on time to RTW of\nsick-listed employees with common mental disorders.\nMethods: The study was a 2-armed cluster randomized controlled trial. Employees sick-listed between 4 and 26 weeks with\ncommon mental disorder symptoms were recruited by their occupational health service or employer. The employees were followed\nup to 12 months. The primary outcome measures were time to first RTW (partial or full) and time to full RTW. Secondary\noutcomes were response and remission of the common mental disorder symptoms (self-assessed).\nResults: A total of 220 employees were included: 131 participants were randomized to the ECO intervention and 89 to care as\nusual (CAU). The duration until first RTW differed significantly between the groups. The median duration was 77.0 (IQR\n29.0-152.3) days in the CAU group and 50.0 (IQR 20.8-99.0) days in the ECO group (hazard ratio [HR] 1.390, 95% CI 1.034-1.870,\nP=.03). No significant difference was found for duration until full RTW. Treatment response of common mental disorder symptoms\ndid not differ significantly between the groups, but at 9 months after baseline significantly more participants in the ECO group\nachieved remission than in the CAU group (OR 2.228, 95% CI 1.115-4.453, P=.02). Conclusions: The results of this study showed that in a group of sick-listed employees with common mental disorders, applying\nthe blended eHealth ECO intervention led to faster first RTW and more remission of common mental disorder symptoms than\nCAU....
Background: Currently available over-thecounter\ncough remedies historically have been criticized\nfor lack of scientific evidence supporting their efficacy.\nAlthough the first-generation antihistamine diphenhydramine\nis classified as an antitussive by the United States\nFood and Drug Administration, to the authorsâ�� knowledge\nit has never been shown to inhibit cough reflex sensitivity\nin subjects with pathological cough. Objective: To evaluate\nthe effect of diphenhydramine on cough reflex sensitivity.\nSetting: Montefiore Medical Center, an academic medical\ncenter in New York City. Methods: Twenty two subjects\nwith acute viral upper respiratory tract infection (common\ncold) underwent cough reflex sensitivity measurement\nemploying capsaicin challenge on 3 separate days, 2 h\nafter ingesting single doses of study drug (to coincide with\npeak blood concentrations), administered in randomized,\ndouble-blind manner: a multicomponent syrup containing\ndiphenhydramine (25 mg), phenylephrine (10 mg), in a\nnatural cocoa formulation; dextromethorphan (30 mg)\nsyrup; and, placebo syrup. The standard endpoint of\ncough challenge was used: concentration of capsaicin\ninducing C5 coughs (C5). Main outcome measure: Effect\non cough reflex sensitivity (C5). Results: A significant\ndifference (p = 0.0024) was established among groups,\nwith pairwise analysis revealing a significant increase in\nmean log C5 (0.4 �± 0.55 (SD); p\\0.01) for the\ndiphenhydramine-containing medication versus placebo,\nbut not for dextromethorphan versus placebo. Conclusions:\nOur results provide the initial evidence of the\nability of diphenhydramine to inhibit cough reflex sensitivity\nin subjects with acute pathological cough. Timing\nof cough reflex sensitivity measurement may not have\nallowed demonstration of maximal antitussive effect of\ndextromethorphan....
Background In end-of-life care, symptoms of\ndiscomfort are mainly managed by drug therapy, the\nguidelines for which are mainly based on expert opinions.\nA few papers have inventoried drug prescriptions in palliative\ncare settings, but none has reported the frequency of\nuse in combination with doses and route of administration.\nObjective To describe doses and routes of administration of\nthe most frequently used drugs at admission and at day of\ndeath. Setting Palliative care centre in the Netherlands.\nMethod In this retrospective cohort study, prescription data\nof deceased patients were extracted from the electronic\nmedical records. Main outcome measure Doses, frequency\nand route of administration of prescribed drugs Results All\nregular medication prescriptions of 208 patients, 89 % of\nwhom had advanced cancer, were reviewed. The three\nmost prescribed drugs were morphine, midazolam and\nhaloperidol, to 21, 11 and 23 % of patients at admission,\nrespectively. At the day of death these percentages had\nincreased to 87, 58 and 50 %, respectively. Doses of these\nthree drugs at the day of death were statistically significantly\nhigher than at admission. The oral route of administration\nwas used in 89 % of patients at admission\nversus subcutaneous in 94 % at the day of death. Conclusions\nNearing the end of life, patients in this palliative care\ncentre receive discomfort-relieving drugs mainly via the\nsubcutaneous route. However, most of these drugs are\nunlicensed for this specific application and guidelines are\nbased on low level of evidence. Thus, there is every reason\nfor more clinical research on drug use in palliative care....
Background Although efficacious in stroke prevention\nin non-valvular atrial fibrillation, many warfarin\npatients are sub-optimallymanaged. Objective To evaluate the\nassociation of international normalized ratio control and clinical\noutcomes among new warfarin patients with non-valvular\natrial fibrillation. Setting Adult non-valvular atrial fibrillation\npatients (C18 years) initiating warfarin treatment were selected\nfrom the US Veterans Health Administration dataset\nbetween 10/2007 and 9/2012. Method Valid international\nnormalized ratio values were examined from the warfarin\ninitiation date through the earlier of the first clinical outcome,\nend of warfarin exposure or death. Each patient contributed\nmultiple in-range and out-of-range time periods. Main outcome\nmeasure The relative risk ratios of clinical outcomes\nassociated with international normalized ratio control were\nestimated. Results 34,346 patients were included for analysis.\nDuring the warfarin exposure period, the incidence of events\nper 100 person-years was highest when patients had international\nnormalized ratio\\2:13.66 for acute coronary syndrome; 10.30 for ischemic stroke; 2.93 for transient ischemic attack;\n1.81 for systemic embolism; and 4.55 for major bleeding.\nPoisson regression confirmed that during periods with international\nnormalized ratio\\2, patients were at increased risk of\ndeveloping acute coronary syndrome (relative risk ratio: 7.9;\n95 % confidence interval 6.9ââ?¬â??9.1), ischemic stroke (relative\nrisk ratio: 7.6; 95 % confidence interval 6.5ââ?¬â??8.9), transient\nischemic attack (relative risk ratio: 8.2; 95 % confidence\ninterval 6.1ââ?¬â??11.2), systemic embolism (relative risk ratio: 6.3;\n95 %confidence interval 4.4ââ?¬â??8.9) and major bleeding (relative\nrisk ratio: 2.6; 95 %confidence interval 2.2ââ?¬â??3.0). During time\nperiods with international normalized ratio[3, patients had\nsignificantly increased risk of major bleeding (relative risk\nratio: 1.5; 95 % confidence interval 1.2ââ?¬â??2.0). Conclusion In a\nVeterans Health Administration non-valvular atrial fibrillation\npopulation, exposure to out-of-range international normalized\nratio values was associated with significantly increased risk of\nadverse clinical outcomes....
Imaging has a major role in the diagnostic work-up of hepatobiliary or pancreatic diseases. Magnetic resonance cholangiopancreatography or MRCP technique uses a powerful magnetic field to evaluate the disorders of liver, gallbladder, bile ducts, pancreas and pancreatic duct. MRCP is non-invasive, does not require anesthesia or contrast enhancing material....
Loading....