Levels and correlates of maternal nutritional status in urban Bangladesh

OBJECTIVE: To determine the levels and correlates of maternal nutritional status. DESIGN: Cross-sectional maternal weight, height, and mid-upper arm circumference (MUAC) data were correlated with sociodemographic data. SETTING: Slums of Dhaka, Bangladesh. SUBJECTS: Weight, height and MUAC were collected from a representative sample of 2417 nonpregnant mothers. Socioeconomic data such as age, education, religion and household economic status was collected from 2048 mothers; data on reproductive experiences such as number of pregnancies and number of children born alive now dead was available from 1314 mothers; and both sets of data from 1185 mothers. METHODS: Using weight, height, MUAC and body mass index (BMI) data, the levels of maternal nutritional status were estimated. Bivariate and multivariate relationships of maternal nutritional status with socioeconomic and reproductive experiences variables were examined. RESULTS: Mothers' mean weight, height, MUAC and BMI were 41.8 kg, 148.8 cm, 232.5 mm, and 18.8 respectively. In multivariate regression analyses, mothers' weight, BMI and MUAC were significantly positively correlated with mothers' years of schooling (P < 0.05) and household economic status (P < 0.01). Mothers' height was significantly positively correlated with years of schooling (P < 0.05), but not with household economic status. Maternal height and weight were significantly negatively correlated with number of child deaths (P < 0.05). CONCLUSIONS: The findings suggest a possible inter-generational effect; thus, improvement of the nutritional status of girls of this generation would improve child survival in the next generation. This, however, will require complex and long-term planning. As an interim measure, shorter mothers should be targeted for appropriate antenatal and obstetric services.     

Factitious orbital emphysema: an unusual presentation of Munchausen''s syndrome

The role of radical cystectomy as the standard treatment of localised infiltrating bladder malignancy is challenged by the development radiotherapy and chemotherapy combinations. The published studies are difficult to compare because of large differences in the patients selection criteria and in the assessment of local involvement (only clinical in combined treatment, based on pathology and therefore unquestionable in surgical series). The advantages of radical surgery are its precedence and a well-established technique, simplified follow-up procedures and seemingly higher survival rates acquired after 3 years. Conversely, the combination of radiotherapy and chemotherapy allows bladder preservation in about 40% of the patients (at 5 years), but only in 23% without bladder relapses. A complete initial endoscopic resection is the best and only prognostic factor of these results which nevertheless needs a very carefully and endless follows. The comparison of the quality of life achieved by both treatment modalities remains insufficiently documented.     

Benign postpartum pleural effusion

The conditions of labour appear to favour the development of pleural effusion. The frequency of postpartum pleural effusion was investigated in this study using thoracic ultrasonography. Thirty one postpartum and 22 healthy nonpregnant women of the same age-group were examined, both supine and seated, via an intercostal approach. Seven of the 31 (23%) postpartum women had pleural effusion within 1-24 h of normal delivery. None of the nonpregnant women had pleural effusion. No correlation was found between postpartum pleural effusion and age, weight-gain during pregnancy, duration of labour, use of intravenous fluid, or oxytocin administration. Pleural effusion seems to be a common finding postpartum, but of no clinical significance.     

Thomas G. Orr Memorial Lectureship. The general, general surgeon

BACKGROUND: The obvious advantages of rapid arterial anastomoses have prompted the continuing search for more rapid anastomotic techniques to complement the standard sutured anastomosis. Nonpenetrating, arcuate-legged titanium vascular closure staple (VCS) clips were initially developed for microvascular anastomoses. The purpose of this study was to compare VCS clips with sutured arterial end-to-end anastomosis in larger vessels. METHODS: In 6 pigs, transacted iliac arteries were reanastomosed with VCS clips on one side and continuous 6-0 polypropylene suture on the other. RESULTS: The reconstruction time was 8.4+/-5.2 minutes for clip closure and 12.0+/-6.6 minutes for suture closure (P = 0.033). All vessels were patent half an hour after completing the anastomoses with no signs of early thrombosis. CONCLUSIONS: Arterial end-to-end anastomosis can be performed more rapidly with VCS clips than continuous sutures, and are potentially useful in situations where the clamp time of the vessel is critical.     

Runt determines cell fates in the Drosophila embryonic CNS

BACKGROUND AND PURPOSE: Our purpose was to evaluate the ability of transcranial color-coded Doppler sonography (TCCD) to 1) identify Guglielmi detachable coils (GDCs) within intracranial aneurysms, 2) show endovascular aneurysmal occlusion and patency of parent and branch arteries, 3) determine the flow velocities within parent arteries and major branches before and after treatment, and 4) assess persistence of aneurysmal occlusion. METHODS: The sonographic appearance of GDCs was established experimentally by TCCD (2 to 2.5 MHz), which was then performed in 40 patients with 43 aneurysms occluded by GDCs. The patency of parent arteries and major branches was assessed qualitatively and compared with the immediate posttherapeutic angiographic appearance in every patient. Flow velocities were selectively measured and compared before and after treatment in 21 parent arteries and 24 major branches. Follow-up TCCD studies performed in 26 patients were compared with angiographic (16 cases) and MR angiographic (10 cases) findings for signs of recanalization of the treated aneurysms. RESULTS: The GDCs were identified experimentally and in the patients as hyperechoic structures of the size and shape, and in the location of, the treated aneurysm in 41 of 43 cases. TCCD in accordance with angiography showed a lack of flow in 42 aneurysms and the presence of flow signal in one large aneurysm. Patency of the parent artery was shown in 40 aneurysms and in all branches. Follow-up TCCD showed the coils unchanged in 23 of 26 cases. In three large aneurysms, TCCD indicated recanalization and reappearance of a flow signal separate from the parent artery. CONCLUSION: TCCD is a reliable, noninvasive means to assess parent artery and major branch patency and to reveal a lack of hemodynamic compromise in the vicinity of aneurysms after endovascular therapy. On follow-up examinations, TCCD was able to detect signs of aneurysmal recanalization.     

Spectral properties of fluorescein in solvent-water mixtures: applications as a probe of hydrogen bonding environments in biological systems

In a 4-year study we examined the longitudinal effects of deinstitutionalization programs on those who remain in institutions being downsized. Individual outcomes investigated were community access, social activities, community inclusion, family relationships, and choice. Effects of residential relocation on individual outcomes such as adaptive behavior were evaluated and total daily per-person expenditure on institutional services for participants was determined. Downsizing was associated with decreased community integration but no change in most other outcomes. Availability of therapy services fell over time, and individuals experienced many residential and day program moves within the institution. Per person expenditure on services increased substantially. Finally, no significant changes in adaptive behavior were associated with intrainstitutional moves.     

Esophageal atresia and tracheoesophageal fistula: success and failure rates in the United Arab Emirates

Randomized, prospective trials examining the effectiveness of carotid endarterectomy have given distinct information into the mechanisms and prevention of embolic strokes. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Asymptomatic Carotid Atherosclerosis Study (ACAS) have demonstrated the benefits of carotid endarterectomy for patients who meet the precise selection criteria and are treated according to established study protocols. The existing challenge to clinicians lies in the application of trial results to the individual patient.     

Modulation of membrane currents and mechanical activity by niflumic acid in rat vascular smooth muscle

The effects of niflumic acid on whole-cell membrane currents and mechanical activity were examined in the rat portal vein. In freshly dispersed portal vein cells clamped at -60 mV in caesium (Cs+)-containing solutions, niflumic acid (1-100 microM) inhibited calcium (Ca2+)-activated chloride currents (IC1(Ca)) induced by caffeine (10 mM) and by noradrenaline (10 microM). In a potassium (K+)-containing solution and at a holding potential of - 10 mV, niflumic acid (10-100 microM) induced an outward K+ current (IK(ATP)) which was sensitive to glibenclamide (10-30 microM). At concentrations < 30 microM and at a holding potential of -2 mV, niflumic acid had no effect on the magnitude of the caffeine- or noradrenaline-stimulated current (IBK(Ca)) carried by the large conductance, Ca(2+)-sensitive K+ channel (BKCa). However, at a concentration of 100 microM, niflumic acid significantly inhibited IBK(Ca)) evoked by caffeine (10 mM) but not by NS1619 (1-(2'-hydroxy-5'-trifluoromethylphenyl)-5-trifluoromethyl-2(3 H) benzimidazolone; 20 microM). In Cs(+)-containing solutions, niflumic acid (10-100 microM) did not inhibit voltage-sensitive Ca2+ currents. In intact portal veins, niflumic acid (1-300 microM) inhibited spontaneous mechanical activity, an action which was partially antagonised by glibenclamide (1-10 microM), and contractions produced by noradrenaline (10 microM), an effect which was glibenclamide-insensitive. It is concluded that inhibition of ICl(Ca) and stimulation of IK(ATP) both contribute to the mechano-inhibitory actions of niflumic acid in the rat portal vein.