An assessment of medical resource utilization and hospitalization cost associated with a diagnosis of anemia in women with obstetrical bleeding in the United States.

OBJECTIVE: Anemia during pregnancy has been associated with adverse maternal and fetal outcomes. Although women with obstetrical bleeding are at increased risk for developing anemia, little is known about the prevalence and burden associated with anemia in hospitalized women with this condition. This study was conducted to estimate the prevalence, demographic characteristics, medical resource utilization, and hospitalization cost associated with a diagnosis of anemia in hospitalized women with obstetrical bleeding in the United States. METHODS: The Healthcare Cost and Utilization Project Nationwide Inpatient Sample (2003) was queried using ICD-9-CM codes to identify all pregnancy-related discharges as well as discharges with diagnosis codes for conditions associated with obstetrical bleeding. Descriptive statistics were used to evaluate demographic characteristics, medical resource utilization components and hospitalization cost for two groups: patients with a diagnosis of anemia and patients without a diagnosis of anemia. RESULTS: Of the estimated 4,525,714 pregnancy-related discharges in the United States in 2003, more than 250,000 recorded diagnosis codes associated with obstetrical bleeding. Nearly 1 in 5 of these women had an anemia diagnosis. A diagnosis of anemia in hospitalized women with obstetrical bleeding was associated with a 9-fold increase in blood transfusion (p < 0.0001), 33% longer average length of stay (p < 0.0001), and 50% higher average total cost per hospitalization (p < 0.0001). CONCLUSIONS: Anemia and blood transfusion are frequently observed in hospitalized women with obstetrical bleeding. To improve outcomes in these patients and alleviate the adverse impact of anemia on postpartum health status, greater provider awareness of the prevalence and burden of illness associated with a diagnosis of anemia in hospitalized women with obstetrical bleeding is warranted.

Assessment of the prevalence and impact of anemia on women hospitalized for gynecologic conditions associated with heavy uterine bleeding.

OBJECTIVE: Women with heavy uterine bleeding often are untreated or inadequately treated for anemia. This study was conducted to estimate the prevalence and impact of anemia in women hospitalized for gynecologic conditions associated with heavy uterine bleeding. STUDY DESIGN: The largest all-payer inpatient care database, the Healthcare Cost and Utilization Project's 2003 Nationwide Inpatient Sample, was queried using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes to identify and group women with gynecologic diagnoses associated with heavy uterine bleeding into 2 categories: those with or without anemia. Groups were evaluated for demographic characteristics, medical resource utilization and hospitalization costs using descriptive statistics. RESULTS: More than 25% of the estimated 300,589 women in the study had a diagnosis of anemia. Compared to patients without a diagnosis of anemia, those with an anemia diagnosis were more likely to have a blood transfusion (24% vs. 0.7%, p<0.0001), an emergency department admission (26.8% vs. 3.2%, p<0.0001) and higher hospitalization costs ($5,631 vs. $5,101, p <0.0001). CONCLUSIONS: Anemia and blood transfusions are common in women hospitalized for gynecologic conditions associated with heavy uterine bleeding. Greater patient and provider awareness of the prevalence and burden associated with anemia may increase opportunities to reduce blood transfusions and improve general health status and quality of life in this patient population.

Attitudes and practices of postgraduate medical trainees towards research--a snapshot from Faisalabad.

OBJECTIVE: To assess the attitudes and practices of postgraduate medical trainees towards research. METHODS: It was a self-administered questionnaire based cross-sectional survey conducted on 55 conveniently selected trainees in Allied Hospital, Faisalabad. RESULTS: Only 11 trainees read journals monthly, seven had written an article for a journal, 51 regarded reading literature important, 39 intended to engage in future research and 37 said they received inappropriate research training. The major reasons cited for poor research activity in Pakistan were poor research training and awareness. CONCLUSION: Though the attitudes towards research were positive, they were deficient practically in terms of reading and writing literature. There is an immediate need to improve research training in our educational institutes to facilitate the development of the local literature both in terms of research utilization and production

Caulerpin.

The crystal structure of caulerpin (dimethyl 6,13-dihydrodibenzo[b,i]phenazine-5,12-dicarboxylate, C(24)H(18)N(2)O(4)), an indole alkaloid, reported in space group Cc with an acute beta angle, has been redetermined in the correct space group, C2/c. The molecule has twofold crystallographic symmetry and is composed of two essentially planar indole groups fused to an eight-membered cyclooctatetraene ring which adopts a boat conformation. The molecular dimensions are normal. The structure is stabilized by intermolecular and intramolecular interactions involving the indole N-H atom and carbonyl O atom [N.O 3.211 (4) and 2.836 (4) A].

Cytotoxic activity of marine macro-algae on Artemia salina (brine shrimp).

A total of 22 ethanol extracts of seaweed species (13 brown, 6 green and 3 red) collected from the Karachi coast were investigated for brine shrimp cytotoxicity. Of all the species, only six namely Stoechospermum marginatum, Sargassum swartzii, S. binderi, Spatoglossum asperum, Stokeyia indica (brown) and Caulerpa racemosa (green) showed significant activity. n-Hexane-soluble fractions of the ethanol extract of S. marginatum and S. swartzii were found to be responsible for the activity, whereas the methanol-soluble fractions of S. asperum and S. binderi were most active. The water extract of S. indica and C. racemosa exhibited the most prominent activity (LC50 value below 70 micrograms/mL) when compared with the ethanol extracts and their fractions. Cytotoxic activity may be due to the compounds differing in polarity.

Changes in physical and chemical constituents of crab meat during storage at refrigerator temperature (7+/-2 degrees C).

The present study was initiated to determine the deteriorative changes occurred in the nutritive quality of crabmeat during storage at refrigerator temperature (7+/-2) for the period of one week. The parameters studied for the assessment of quality are pH, water, total protein and salt soluble protein, TMA-N, TVB-N content. The results indicate a significant increase (p < or = 0.001) in pH, water, TMA. TVB while total protein salt soluble protein, and total lipid contents were significantly decreased (p < or = 0.001) as compared to fresh tissue. Our finding recommended that the quality of crabmeat is acceptable upto one day of storage at refrigerator temperature after that it becomes deteriorated.

Enzymatic activities of some snake venoms from families Elapidae and Viperidae.

Alkaline phosphomonoesterase, phosphodiesterase, L-amino acid oxidase, hyaluronidase, 5'-nucleotidase, arginine ester hydrolase, phospholipase A2 and proteinase activities were determined in eight snake venoms, including three from sea snake, of families Elapidae and Viperidae from Pakistan. The species includes three sea snakes Hydrophis cyanocinctus, Enhydrina schsitosa, Microcephalophis gracilis gracilis and two land snakes Naja naja naja, Bungarus caeruleus of family Elapidae while three land snakes Vipera russelli russelli, Echis carinatus and Eristocophis macmahoni of family Viperidae. The venoms of family Elapidae are characterized by low levels to traces of proteinase, L-amino acid oxidase and arginine ester hydrolase activities with the exception of Naja naja naja and a moderate to high levels of phospholipase A2 activities. The venoms of family Viperidae, on the other hand, are characterized by the presence of moderate to high levels of 5'-nucleotidase, proteinase, phosphodiesterase and phosphomonoesterase activities.

Effects of drugs against cytotoxic compoundsfrom marine animals iv-hepatotoxic activity ofsea-snake hydrophis cyanocinctus venom.

Hepatotoxic activity and pathogenesis of sea snake Hydrophis cyanocinctus venom have been studied in guinea pigs and albino rats by histopathological examination and determining total Ca(2+). Concentration in liver tissue. Efficacy of two Ca(2+). antagonist drugs, verapamil and diltiazem was also studied against the cytotoxic activity of this venom. Administration of both lethal and sublethal doses of Hydrophis cyancinctus crude venom induced increased cellularity within the portal area in liver accompanied by increased tissue Ca(2+) concentration. This elicit a close correlation between tissue necrosis and increased Ca(2+) content in tissues. Both verapamil and diltiazem administration after an injection of H. cyanocinctus venom showed significant decrease in Ca(2+) concentration and tissue necrosis. Increase in survival time was also noted in almost all animals receiving Ca(2+) - antagonist drugs. It is thus suggested that cytotoxic compounds present in this marine venom cause tissue and cellular necrosis by increasing Ca(2+) influx within the cells which in turn stimulates Ca(2+) -dependent processes resulting in both organ dysfunction and sometimes fatality in few cases. But both these effects could be inhibited by using antagonizing drugs which could reduce the pathological conditions induced by such compounds by blocking the cation influx and its dependent processes.

Changes in serum components induced by venoms of marine animals.

Serum enzyme and chemical component levels were investigated in a rat model after experimental envenomation by venoms of coelentrate, Physalia species, four sea-snakes, Hydrophis spiralis, H. Cyanocinctus, H. Lapemoides and Lapemis curtus and a gastropod molluse Conus coronatus. The LD(50)s through i.v. route were found to be 4.2 mg/kg for Physalia, 0.4 mg/kg for H.spiralis 0.60 mg/kg for H.cyanocinctus, 0.60 mg/kg for H. lapemoides, 0.70 mg/kg for L.curtus and 2.9 mg/kg for C.coronatus. Marked elevation of serum enzyme levels was induced by sea-snake and Physalia venom while C.coronatus venom showed no significant change in serum levels. The results also indicate gross morphological changes in liver, spleen, gall bladder, lungs and heart by Physalia and sea snake venoms.

Toxicology of Physalia's (Portuguese man-o' war) venom.

The venomous pelagic coelentrate Physalia species (Blue bottle) or the Portuguese man-o'war has recently been studied in detail due to their hazardous effects on community. It was observed that the venom of the animal is lethal to man and can also produce cutaneous stings of varying severity. Physalia species also possess significant cardiotoxicity to man, rats, mice and are lethal to lower animals. Thu effect has been attributed to the abnormality in ionic transport across membranes. The cutaneous pain and musculotoxic action in human produced by Physalia venom may be induced by one or several high molecular weight polypeptides. Blockage of specified neurons and neuromuscular junction besides alteration in end plate potential (EPP) and end plate current (EPC) was also attributed to high molecular weight toxic fractions. Survey of enzymatic contents of Physalia venom reveals the presence of a wide variety of enzymes whose presence and actions were similar to that of complex enzyme mixture of snake venom. Besides these clinical manifestations neurotoxicity cytotoxicity and other physiopharmacological effects were also demonstrated.

Amino acid composition of some common seaweeds.

The nutritive evaluation of seaweed proteins on the basis of amino acid composition has been reported in the present communication. Seventeen of the common amino acids including almost all essential amino acids have been detected in the protein hydrolysate of eighteen species of seaweeeds. Significant variations were observed in amino acid composition among the different genera of seaweeds. Little variation was noted in total nitrogen and inorganic contents. The acidic amino acids were significantly higher in species of green seaweeds.