Esophageal varices during pregnancy in the course of cirrhosis.

Esophageal variceal bleeding is one of the most severe complications that may occur during pregnancy in patients with liver cirrhosis. It may result in death of the mother and the fetus. Therefore, screening endoscopy should be performed both before the conception and in the second trimester. Endoscopic band ligation is a method of choice in case of variceal bleeding. Close cooperation of hepatologist, obstetrician-gynecologist and endoscopist is recommended in order to provide maximum care and increase the chances of successful delivery. We present a case of 28-years-old primigravida, at 27 weeks pregnant with esophageal varices and liver cirrhosis.

Correlates of whole-blood polyunsaturated fatty acids among young children with moderate acute malnutrition.

BACKGROUND: Severe acute malnutrition (SAM) has been associated with low polyunsaturated fatty acid (PUFA) status. However, investigations regarding PUFA status and correlates in children with moderate acute malnutrition (MAM) from low-income countries are scarce. The aim of this study was to describe whole-blood PUFA levels in children with moderate acute malnutrition (MAM) and to identify correlates of PUFAs. METHODS: We conducted a cross-sectional study using baseline data from a prospective nutritional intervention trial among 1609 children with MAM aged 6-23 months in Burkina Faso,West Africa. Whole-blood PUFAs were measured by gas chromatography and expressed as percent of total whole-blood fatty acids (FA%). Potential correlates of PUFAs including infection, inflammation, hemoglobin, anthropometry (difference between children diagnosed as having MAM based on low mid-upper-arm-circumference (MUAC) only, low MUAC and weight-for-height z-score (WHZ), or low WHZ only) and diet were assessed by linear regression adjusted for age and sex. RESULTS: Children with MAM had low concentrations of whole-blood PUFAs, particularly n-3 PUFAs. Moreover, children diagnosed with MAM based only on low MUAC had 0.32 (95% confidence interval (CI), 0.14; 0.50) and 0.40 (95% CI, 0.16; 0.63) FA% lower arachidonic acid (AA) than those recruited based on both low WHZ as well as low MUAC and those recruited with low WHZ only, respectively. Infection and inflammation were associated with low levels of all long-chain (LC)-PUFAs, while hemoglobin was positively associated with whole-blood LC-PUFAs. CONCLUSION: While PUFA deficiency was not a general problem, overall whole-blood PUFA concentrations, especially of n-3 PUFAs, were low. Infection, inflammation, hemoglobin, anthropometry and diet were correlates of PUFAs concentrations in children with MAM. TRIAL REGISTRATION: The trial is registered at http://www.isrctn.com ( ISRCTN42569496 ).

Cortical representation of proximal and distal arm muscles as assessed by focal transcranial magnetic stimulation.

In 21 healthy volunteers, a mapping of cortical areas from which motor evoked potentials in deltoid muscle and first dorsal interosseal muscle (FDI) could be elicited by focal transcranial magnetic stimulation was performed. For this purpose, magnetic stimuli were applied using a figure-of-eight shaped magnetic coil and a Magstim 200 stimulator at an intensity of 15% above motor threshold for the deltoid muscle. There was a considerable overlap between the cortical areas from which motor responses of the two muscles could be evoked with the FDI represented more laterally than the deltoid muscle. The cortical location from which maximal amplitudes of motor evoked potentials were elicited was 4-8 cm lateral of Cz with the FDI and 2-6 cm lateral of Cz with the deltoid muscle. Calculated centres of cortical points with maximal muscle responses were significantly separated with the FDI represented 5.7 cm lateral of Cz and deltoid muscle 4.3 cm lateral of Cz. The anterior-posterior extension of the cortical maps did not show significant differences between the proximal and distal arm muscle. In no subject an ipsilateral representation of either muscle could be found even when stimulating at maximal intensity.