Obstetric neuraxial analgesia - is it a matter of ethnic disparity?

OBJECTIVE: Pain is an essential element of humane childbirth. Neuraxial analgesia is the most effective method for relieving pain during childbirth. More and more women are using this type of analgesia in childbirth. The aim of the study was to identify ethnic differences in the application of neuraxial analgesia. SUBJECTS AND METHODS: The research was conducted through a face-to-face survey. The respondents are patients after vaginal delivery. The experimental group consists of patients of the ethnic minority, the Romani group (32 women), and the control group consists of patients of the majority, the Serb group (99 women). We investigated the quality and quantity of prenatal care, information about regional anesthesia, and its application in these two groups. RESULTS: There is a significant ethnic disparity between the Serb and Romani ethnic groups. Patients of the Romani ethnic group have qualitatively and quantitatively poorer antenatal care, less information regarding the use of neuraxial analgesia, and use it significantly less often. CONCLUSIONS: Neuraxial analgesia must be available to all patients regardless of ethnicity or social status.

[Prosthetic rehabilitation in patient with forced class III malocclusion].

The paper presents clinical case of 63 years old edentulous patient with slight class III malocclusion. For 15 years he was using inadequately fabricated dentures causing forced severe class III malocclusion. Forced progeny was corrected by newly fabricated dentures which restored normal orofacial function and facial harmony.

Scanning magneto-optical Kerr microscope with auto-balanced detection scheme.

We have developed a scanning magneto-optical Kerr microscope dedicated to localization and measurement of the in-plane magnetization of ultra-thin layered magnetic nanostructures with high sensitivity and signal-to-noise ratio. The novel light detection scheme is based on a differential photodetector with automatic common mode noise rejection system with a high noise suppression up to 50 dB. The sensitivity of the developed detection scheme was tested by measurement of a single Co layer and a giant magnetoresistance (GMR) multilayer stack. The spatial resolution of the Kerr microscope was demonstrated by mapping an isolated 5×5 µm spin-valve pillar.

Novel magnetic tips developed for the switching magnetization magnetic force microscopy.

Using micromagnetic calculations we search for optimal magnetic properties of novel magnetic tips to be used for a Switching Magnetization Magnetic Force Microscopy (SM-MFM), a novel technique based on two-pass scanning with reversed tip magnetization. Within the technique the sum of two scans images local atomic forces and their difference maps the local magnetic forces. The tip magnetization is switched during the scanning by a small magnetic field. The technology of novel low-coercitive magnetic tips is proposed. For best performance the tips must exhibit low magnetic moment, low switching field, and single-domain state at remanence. Such tips are equipped with Permalloy objects of a precise shape that are defined on their tilted sides. We calculate switching fields of such tips by solving the micromagnetic problem to find the optimum shape and dimensions of the Permalloy objects located on the tips. Among them, hexagon was found as the best shape for the tips.

Prolene hernia system, ultrapro hernia system and 3D patch devices in the treatment of inguinal, femoral, umbilical and small incisional hernias in outpatient surgery.

INTRODUCTION: The employment of a diversity of prosthetic materials and several types of mesh different in construction is opening a new chapter in hernia surgery and tension-free techniques are becoming a "golden standard" for repairing abdominal wall defects, whereas the conventional methods, i.e., the tension techniques are performed on young patients having small direct, indirect, or femoral hernias. AIM: The aim of this retrospective study is to present the results of using Prolene Hernia System (PHS), Ultrapro Hernia System (UHS) and 3D Patch (3DP) devices in the treatment of inguinal, femoral, umbilical and small incisional hernias in outpatient surgery. MATERIAL AND METHODS: From January 2006 to January 2009, 70 patients were operated on for abdominal wall hernias (54 inguinal, 4 femoral, 8 umbilical and 4 small incisional hernias) using PHS, UHS and 3DP devices. All the patients underwent surgery under local infiltrative anaesthesia. All the surgical operations were performed by a single surgeon, 19 of them in the General Hospital and 51 in a private polyclinic. RESULTS: The mean size of the hernia defect in the inguinal, femoral and umbilical hernias was 2.5 cm (1-4 cm), while in the incisional hernias it was 4.5 cm (3-6 cm). The mean operating time was 2.4 hrs (2-6 hrs). There were no requirement for urinary drains. The mean follow-up was 18 months (0-36 months). The incidence of infection, chronic pain and recurrence was 0%. Three of the patients had complications: seroma in one patient with an incisional hernia and hematoma in two patients after inguinal hernia repair. CONCLUSION: The employment of PHS, UHS and 3DP devices, which have not yet been widely accepted in our hospitals, has had outstanding results in outpatient surgery. In addition, the type of anaesthesia and the 3D mesh construction prepare the way for a short hospital stay, smooth recovery and a swift return to normal activity.

UVC radiation-induced effect on human primary thyroid cell proliferation and HLA-DR expression.

The aim of this study was to examine how UVC irradiation will affect normal human thyroid cell proliferation and HLA-DR expression. Primary human thyroid cells were exposed to UVC (254 nm wavelength) irradiation. In some experiments 0.5 mM buthionine sulfoximine (BSO) was added. Apoptosis was detected measuring annexin V, proteins involved in apoptotic process (p53, Bax, Bcl-2, caspase 3, and 9) by immunoblot analysis and HLA-DR expression by FACS. UVC induced a cell cycle arrest in G0/G1 phase in the first 24 h, accumulation of cells in the S phase 72 h after treatment, and an increase of apoptotic cells. BSO pretreatment showed an earlier appearance and a higher percentage of apoptosis. p53, caspase 3 and 9 were increased, while Bax and Bcl-2 were decreased. We also observed a transient significant increase in HLA-DR expression. UVC inhibited cell proliferation and induced apoptosis in normal human primary thyroid cells. An inhibitor of glutathione synthesis induced an earlier appearance and higher percentage of apoptosis suggesting that oxidative stress may play a role. Apoptotis involved components of the intrinsic mitochondrial pathway. A transient increase in HLA-DR expression after UVC irradiation could play a role in inducing AITD.

On-tip sub-micrometer Hall probes for magnetic microscopy prepared by AFM lithography.

We developed a technology of sub-micrometer Hall probes for future application in scanning hall probe microscopy (SHPM) and magnetic force microscopy (MFM). First, the Hall probes of approximately 9-mum dimensions are prepared on the top of high-aspect-ratio GaAs pyramids with an InGaP/AlGaAs/GaAs active layer using wet-chemical etching and non-planar lithography. Then we show that the active area of planar Hall probes can be downsized to sub-micrometer dimensions by local anodic oxidation technique using an atomic force microscope. Such planar probes are tested and their noise and magnetic field sensitivity are evaluated. Finally, the two technologies are combined to fabricate sub-micrometer Hall probes on the top of high-aspect ratio mesa for future SHPM and MFM techniques.

Service quality in public and private pharmacies in the city of Kragujevac, fr Yugoslavia.

AIM: To compare the service quality in public and private pharmacies in the city of Kragujevac by measuring patient care and health facility indicators. METHODS: The patient care indicators and health facility indicators, established by the World Health Organization in 1995, were measured prospectively in 7 public and 7 private pharmacies in Kragujevac, Yugoslavia, during November and December 1999. A sample of 100 patient-visits was analyzed in each pharmacy. RESULTS: Our study showed that the average drug dispensing time ranged from 20.5 to 48.2 seconds, being significantly longer in private (21.1-48.2 s) than in public pharmacies (20.5-33.7 s) (F=13.12, p<0.001). The percentage of actually dispensed drugs ranged from 29% to 63%, and no significant difference was found between public and private pharmacies. Patients' knowledge of a correct dosage ranged from 30% to 74% and the availability of key drugs ranged from 67% to 93% with no significant difference between public and private pharmacies. There was serious negligence in labeling the dispensed drugs in both public and private pharmacies: not a single drug package was labeled according to the World Health Organization recommendations. Key drugs were highly available in both public and private pharmacies. CONCLUSION: The average drug dispensing time was too short for a proper interaction between a pharmacist and a patient in both public and private pharmacies. The results of our study suggest that there was no real difference in the service quality between the public and the private pharmacies.

[Results of kidney transplantation at the Institute of Urology and Nephrology of the Serbian Clinical Center in Belgrade]. / Rezultati transplantacije bubrega u Institutu za urologiju i nefrologiju klinickog centra Srbije u Beogradu. Rezultati Rezultati Rezultati transplantacije bubrega u Institutu za urologiju i nefrologiju Klinickog centra Srbije u Beogradu.

UNLABELLED: Over the period 1980-1992 256 kidney transplantations were carried out in the Institute of Urology and Nephrology, Clinical Centre, Belgrade: 105 (41%) from cadaveric and 151 (59%) from alive related donors. The first kidney transplantation was performed in our Institution in 1974; however, in the first decade only 27 kidney transplantations were performed. Since 1987, thanks to an increasing number of living kidney donors, the number of transplantations continually increased, and after that period an average of 30 kidney transplantations are performed annually (Figure 1). The aim of the study was to establish the survival of patients and grafts, and factors influencing this survival, as well as to determine the causes of patients' death and graft loss. All the patients were followed-up in our outpatient department within at least 5 years to maximum 17 years. Drug combination therapies were changed in the observation period. From 1983 cyclosporin A (CyA) was added to azathioprine (Aza) and prednisolone (Pr). An increasing number of patients with high immunological risks necessitated the strongest initial immunosuppressive treatment with ALG in addition to Aza and Pr. CyA in a dose of 8 mg/kg b.w. was introduced when serum creatinine concentration fell below 300 mumol/L. The triple treatment including CyA, Aza and Pr was the most common maintenance immunosuppressive therapy in our patients. RESULTS: One and five years survived 95% and 75% of patients, and 84% and 52% of grafts. In assessing the impact of donor source, the year of transplantation, and age of donors we obtained the following results: Living related grafts survived better than cadaver grafts, especially during the first posttransplantation year (Figure 2). Furthermore, graft survival rates from 1987 to 1992 were significantly better than those from early period i.e. 1980 to 1986 (Figure 3). The significantly worse survival rate for grafts from donors older than 60 was noted than for grafts from younger donors. Searching for factors influencing the survival, non immunological and immunological differences between donors and recipients were analyzed. Our analysis showed that 50 living related donors were older than 60. In addition, the majority of them were 20 years older than their graft recipients. Two and more HLA mismatches were observed in 46% of our transplant patients, and 20 patients were highly sensitized. However, the immunological risks were higher in living related transplantations: different ABO blood groups, historical positive cross match reaction between donors and recipients (Table 1). A multivariate analysis using Cox proportional hazards model was performed to determine the important independent predictors of graft survival, and it revealed the following factors (Table 2): number of acute rejections, graft function at the end of the first month and until the end of the first posttransplant year, donors' age, and age and sex differences between donors and recipients. The occurrence of acute rejection at any time had a significant negative effect on graft survival. Since better HLA matching is likely to mean less early rejection it could be concluded that HLA matching influenced graft function and survival in our patients. Absence of acute rejection and delayed graft function or acute tubular necrosis were associated with an improvement of the graft function based on serum creatinine concentration, indicating that delayed graft function also influenced graft survival. The relative risk of graft loss was 2 times higher for patients receiving graft from donors older than 60. Until December 1997, when our analysis was done, of 256 kidney transplant patients 156 lost their grafts. The major causes of graft loss (Table 3) in the early period from 1980 to 1986 were non immunological such as acute tubular necrosis, vascular thrombosis and patients death with functioning graft. (ABSTRACT TRUNCATED)

[Kidney transplantation in high-risk patients]. / Transplantacija bubrega u bolesnika sa visokim rizikom.

Immunosuppression with Cyclosporine A in kidney transplantation, triple therapy (CyA + Imuran + corticosteroids) and plasmapheresis before and after kidney transplantation in high risk recipients (positive cytotoxic antibody, MLC at the level of non related persons), also in high risk patients (juvenile diabetes, patients over 50 years old). In 1988 we had done in our Centre, kidney transplantation in 52.8% (28: 53) in high and increased risk patients. Triple therapy with plasmapheresis before and after kidney transplantation (if the level of cytotoxic antibodies is over 15%) allows successful kidney transplantation in high risk kidney recipients. Patients with juvenile diabetes are also available kidney recipients with therapy and permanent regulation of blood sugar. The patients of the age group between 50-60 years should be considered as suitable for kidney transplantation.

Correction of coarctation of the aorta in neonates and young infants. An individualized surgical approach.

Because of the controversy concerning the ideal surgical repair for symptomatic coarctation of the aorta presenting in neonates and infants, our entire series of 179 children under the age of 12 months undergoing repair between January 1, 1976 and December 31, 1984 was reviewed. Of this group, 109 were neonates, 43 infants aged 31-90 days and 27 infants aged 90 days-12 months. Twenty patients had a simple coarctation and 159 had complex coarctation with additional intracardiac anomalies such as ventricular septal defect (37 patients also had pulmonary artery banding). One hundred and twenty-four were repaired with a subclavian flap operation, 32 with resection and end-to-end anastomosis and 23 with complex repairs (e.g. patch and reversed flap). Type of repair was the surgeon's choice and was selected on the basis of the anatomy of the coarctation. Total perioperative mortality was 15% (N = 27) while late mortality was 12% (N = 21). Twenty-one risk factors for mortality were evaluated by logistic analysis and the method of Cox. There was no risk difference between end-to-end versus subclavian flap repairs and all but one death occurred in patients with complex coarctations. Risk for in hospital death was increased by only one variable: the need for repair in the neonatal period. Risk for death in the first year of life was increased by the presence of congestive heart failure at initial presentation while later death correlated with intracardiac surgery. Recoarctation occurred in 28 patients (18.4%), all but 4 of these occurred in patients undergoing neonatal repairs.(ABSTRACT TRUNCATED AT 250 WORDS)