Effect of negative-pressure wound therapy on wound complications in obese women after caesarean birth: a systematic review and meta-analysis.

BACKGROUND: Obesity is associated with increased surgical-site infection (SSI) following caesarean section (CS). OBJECTIVE: To summarise the evidence on the effectiveness of negative-pressure wound therapy (NPWT) for preventing SSI and other wound complications in obese women after CS. SEARCH STRATEGY: MEDLINE, Embase, CINAHL, Cochrane CENTRAL databases and ClinicalTrials.gov were systematically searched in March 2021. SELECTION CRITERIA: Randomised controlled trials (RCTs) of NPWT compared with standard dressings after CS birth. DATA COLLECTION AND ANALYSIS: Pooled effect sizes were calculated using either fixed or random effects models based on heterogeneity. The Cochrane risk of bias and Grading of Recommendations Assessment, Development and Evaluation tools were used to assess the quality of studies and overall quality of evidence. MAIN RESULTS: Ten RCTs with 5583 patients were included; studies were published between 2012 and 2021. Nine RCTs with 5529 patients were pooled for the outcome SSI. Meta-analysis results suggest a significant difference favouring the NPWT group (relative risk [RR] 0.79, 95% CI 0.65-0.95, P < 0.01), indicating an absolute risk reduction of 1.8% among those receiving NPWT compared with usual care. The risk of blistering in the NPWT group was significantly higher (RR 4.13, 95% CI 1.53-11.18, P = 0.005). All studies had high risk of bias relative to blinding of personnel/participants. Only 40% of studies reported blinding of outcome assessments and 50% had incomplete outcome data. CONCLUSIONS: The decision to use NPWT should be considered both in terms of its potential benefits and its limitations. TWEETABLE ABSTRACT: NPWT was associated with fewer SSI in women following CS birth but was not effective in reducing other wound complications.

Prophylactic antibiotics for preventing genital tract infection in women undergoing surgical procedures for incomplete abortion: a systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Findings about the effect of prophylactic antibiotics in preventing genital tract infection (GTI) associated with surgical procedures used for incomplete abortions are conflicting. Some reported a decrease in infection associated with the use of antibiotic prophylaxis, whereas others found no significant reduction in GTI. OBJECTIVE: To synthesise systematically the evidence on the effect of prophylactic antibiotics compared with placebo in women undergoing surgical procedures for incomplete abortion. SEARCH STRATEGY: In February 2020, PubMed, Embase and Cochrane Central for Register of Controlled Trials were searched for relevant published randomised controlled trials. SELECTION CRITERIA: Randomised controlled trials reporting GTI following surgical procedures for incomplete abortion and comparing antibiotic prophylaxis with placebo. DATA COLLECTION AND ANALYSIS: Meta-analysis using inverse variance heterogeneity model included subgroup and sensitivity analyses determined a priori were conducted. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). MAIN RESULTS: A total of 16 178 women who participated in 24 eligible randomised controlled trials published between 1975 and 2019 were included. Pooled estimates showed the risk of GTI following surgical procedures after incomplete abortion was significantly lower among those who had prophylactic antibiotics (relative risk [RR] = 0.72; 95% CI 0.58-0.90; I2  = 49%). There was no significant effect of antibiotics in women in low- and middle-income countries (three studies, 3579 participants, RR = 0.90; 95% CI 0.50-1.62; I2  = 63%), but it was clinically and statistically significant among women high-income countries (21 studies, 12 599 participants, RR = 0.67; 95% CI 0.53-0.84; I2  = 44%), with a strong level of evidence as assessed by GRADE. CONCLUSION: This study provides evidence that antibiotic prophylaxis is beneficial in reducing post-abortion GTI among women undergoing surgical procedures for incomplete abortion. More studies are needed from low- and middle-income countries. TWEETABLE ABSTRACT: Prophylactic antibiotics after incomplete abortion are effective in reducing GTI. More studies are needed from low- and middle-income countries.

Impact of opening a new emergency department on healthcare service and patient outcomes: analyses based on linking ambulance, emergency and hospital databases.

BACKGROUND: Emergency department (ED) crowding caused by access block is an increasing public health issue and has been associated with impaired healthcare delivery, negative patient outcomes and increased staff workload. AIM: To investigate the impact of opening a new ED on patient and healthcare service outcomes. METHODS: A 24-month time series analysis was employed using deterministically linked data from the ambulance service and three ED and hospital admission databases in Queensland, Australia. RESULTS: Total volume of ED presentations increased 18%, while local population growth increased by 3%. Healthcare service and patient outcomes at the two pre-existing hospitals did not improve. These outcomes included ambulance offload time: (Hospital A PRE: 10 min, POST: 10 min, P < 0.001; Hospital B PRE: 10 min, POST: 15 min, P < 0.001); ED length of stay: (Hospital A PRE: 242 min, POST: 246 min, P < 0.001; Hospital B PRE: 182 min, POST: 210 min, P < 0.001); and access block: (Hospital A PRE: 41%, POST: 46%, P < 0.001; Hospital B PRE: 23%, POST: 40%, P < 0.001). Time series modelling indicated that the effect was worst at the hospital furthest away from the new ED. CONCLUSIONS: An additional ED within the region saw an increase in the total volume of presentations at a rate far greater than local population growth, suggesting it either provided an unmet need or a shifting of activity from one sector to another. Future studies should examine patient decision making regarding reasons for presenting to a new or pre-existing ED. There is an inherent need to take a 'whole of health service area' approach to solve crowding issues.

Level of empathy among medical students in Kuwait University, Kuwait.

OBJECTIVES: To evaluate the level of empathy among medical students in Kuwait University Medical School and its association with sociodemographic factors, stress levels and personality. SUBJECTS AND METHODS: A cross-sectional survey of 264 medical students was conducted in the Faculty of Medicine, Kuwait University. Empathy levels were measured using the Jefferson Scale, personality was assessed using the Zuckerman-Kuhlman Personality Scale and the Perceived Stress Scale was used to measure stress levels. Factors associated with empathy were evaluated using t test/ANOVA for categorical variables and correlation for continuous predictors. RESULTS: Mean empathy score was 104.6 ± 16.3. Empathy scores were significantly associated with gender, year of study, mother's level of education, household income, satisfactory relationship with the mother and stress levels. Male medical students in their clinical years also had significantly lower empathy levels. However, factors such as grade point average, desired specialty, marital status of parents, father's educational level and relationship with father were not significantly (p > 0.05) associated with levels of empathy. Stress scores were significantly and positively associated with empathy (r = 0.13; p = 0.041). CONCLUSION: Medical students in Kuwait University had low empathy level and this may be a cause for concern; as such we suggest a possible inclusion of emphasis on empathy in the curriculum.

EffEctiveness of Prophylactic fOam dressings in the prevention of saCral pressure injuries in at-risk hospitalised patients: the EEPOC trial.

BACKGROUND: Prophylactic dressings are increasingly used to prevent pressure injuries in hospitalised patients. However, evidence regarding the effectiveness of these dressings is still emerging. This trial aims to determine the clinical and cost-effectiveness of a prophylactic silicone foam border dressing in preventing sacral pressure injuries in medical-surgical patients. METHODS: This is a multicentre, pragmatic, parallel group, randomised controlled trial. A sample size of 1320 was calculated to have >90% power to detect a 5% difference in the primary outcome at an alpha of 0.05. Adult patients admitted to participating medical-surgical wards are screened for eligibility: ≥18 years, admitted to hospital within the previous 36 h, expected length of stay of ≥24 h, and assessed high risk for hospital-acquired pressure injury. Consenting participants are randomly allocated to either prophylactic silicone foam dressing intervention or usual care without any dressing as the control group via a web-based randomisation service independent of the trial. Patients are enrolled across three Australian hospitals. The primary outcome is the cumulative incidence of patients who develop a sacral pressure injury. Secondary outcomes include the time to sacral pressure injury, incidence of severity (stage) of sacral pressure injury, cost-effectiveness of dressings, and process evaluation. Participant outcomes are assessed daily for up to 14 days by blinded independent outcome assessors using de-identified, digitally modified sacral photographs. Those who develop a sacral pressure injury are followed for an additional 14 days to estimate costs of pressure injury treatment. Analysis of clinical outcomes will be based on intention-to-treat, per-protocol, and sensitivity analyses. DISCUSSION: This trial aims to provide definitive evidence on the effect prophylactic dressings have on the development of hospital-acquired sacral pressure injuries in medical-surgical patients. A parallel economic evaluation of pressure injury prevention and treatment will enable evidence-informed decisions and policy. The inclusion of a process evaluation will help to explain the contextual factors that may have a bearing on trial results including the acceptability of the dressings to patients and staff. The trial commenced 5 March 2020 and has been significantly delayed due to COVID-19. TRIAL REGISTRATION: ANZCTR ACTRN12619000763145. Prospectively registered on 22 May 2019.

Folate, vitamin B12 and total homocysteine levels in Arab adolescent subjects: reference ranges and potential determinants.

BACKGROUND & AIMS: Elevated circulating fasting total homocysteine (tHcy) concentration is associated with an increased risk of occlusive vascular disease in adults. Important determinants of tHcy levels are folate, vitamin B(12) and vitamin B(6). This study aimed to investigate age, gender, and body mass as determinants of folate, vitamin B(12) and tHcy levels in Arab older children and adolescents and to propose population, gender and age-specific reference ranges for these biomarkers. METHODS & RESULTS: 774 (316 boys, 458 girls) healthy 10-19 yr olds attending secondary schools in Kuwait were assessed for anthropometry and fasting blood levels of Hcy, folate and vitamin B(12). The mean (95% CI) serum levels of tHcy, folate and vitamin B(12) were respectively 6.57 µmol/L (6.42-6.73), 16.0 ng/ml (15.6-16.3) and 354.3 pg/ml (343.0-365.7). Boys had significantly higher tHcy and folate concentrations than the girls, although vitamin B(12) levels were greater in the latter. Folate and vitamin B(12) levels decreased significantly with age, while correspondingly, tHcy levels increased, with mean values (µmol/L) for boys (6.71; 8.25) and girls (5.36; 6.67) aged 10-14 yr and 14-19 yr respectively. Bivariate and multivariate analyses with adjustment for confounders such as age, gender, need for dietary control and socio-demographic variables indicated that the independent determinants of levels of tHcy were age, gender and body mass. CONCLUSION: There is an age-related increase in tHcy in adolescents reflecting decreased levels of folate and vitamin B(12), with the suggestion that age-related reference ranges for these biomarkers be used. These observations may have implications for prevention of future atherogenic disease.

Harassment of newly admitted undergraduates by senior students in a Faculty of Dentistry in Sri Lanka.

BACKGROUND: Harassment of new students by senior colleagues appears to be widespread in the industrialised countries. Although 'ragging' of new entrants to universities in Sri Lanka gets frequently publicised, its prevalence, severity and the consequences have not been documented. AIMS: This study aims to ascertain the extent of mistreatment of new dental students, the measures they take when harassed and any resulting negative effects. METHODS: We surveyed the year 2008 Dental students using 80 statements dealing with verbal/emotional, sexual and physical harassment. Sixty five students (91.5%) responded anonymously indicating whether a specific action occurred, the degree to which it affected them and any action taken to deal with it. RESULTS: Fifty percent of students had experienced mistreatment. Verbal and emotional abuse was more frequent than sexual or physical. Eighteen percent experienced sexual harassment, with a significantly higher proportion of males than females reporting it. A fifth of the students had upsetting memories of the event. Eighty five percent of the respondents stated that they did not suffer any ethnic or racial discrimination. CONCLUSIONS: Emotional harassment of new students by the seniors is a pervasive, yet under-reported problem. Definitive interventions need to be implemented to prevent untoward consequences that can undermine the educational goals of training.

Mesial migration and loss of first molars among young adolescents in Kuwait.

OBJECTIVE: Our aim was to determine the prevalence of and factors associated with mesial migration and/or loss of first molars in 13-14-year-old school children in Kuwait. METHODS: A population-based sample of 1,583 eighth grade students of mean age 13.23 +/- 0.42 yrs, representing about 7% of the target population, were selected using multistage cluster sampling methods. Information on nationality, family income, and number of siblings was collected through subject and family interview. Any mesial migration or loss of first molars as well as visible caries was recorded in a well lit classroom. RESULTS: The prevalence of mesial migration and/or loss was 11.4%. Almost 70% of this occurred only in the mandible, and the majority (75.7%) had only one tooth affected (p < 0.01). Although the prevalence differed with residential geographical regions (p < 0.01), there were no gender differences (p > 0.05). The prevalence also differed with family income (p < 0.05), increased (p < 0.05) with increasing number of siblings, and was higher (p < 0.001) in subjects with presence of caries lesions (22.2%) than in those without (9.6%). CONCLUSIONS: About 12% of current age cohorts of school children in Kuwait are likely to experience mesial migration and/or loss of one or more first molars. The conditions are associated with presence of untreated caries lesions. Private school attendance and high as well as low family income are associated with a decreased level of mesial migration and/or loss of one or more first molars. Increased number of siblings is a risk factor.

Screening for diabetes in Kuwait and evaluation of risk scores.

This study aimed to develop a simple risk score to identify individuals at high risk for undiagnosed diabetes in the Kuwaiti adult population and to assess the performance of previously published diabetes risk scores. A cross-sectional survey with a sample of 562 Kuwaiti public sector employees was carried out in 2007. Data were collected through a self-administered questionnaire and a blood glucose test. The overall prevalence of diabetes using American Diabetes Association 2003 criteria was 21.4% (4.1% newly detected). The proposed score had 87% sensitivity and 64% specificity in predicting undetected diabetes using only 4 questions (age, waist circumference, use of blood pressure medication and diabetes in a sibling). Most previously published risk scores were not applicable to this population.

Diagnostic accuracy of urinary creatinine concentration in the estimation of differential renal function in patients with obstructive uropathy.

OBJECTIVES: To determine the diagnostic accuracy of spot urine creatinine concentration (UCC) as a new test for the evaluation of differential renal function in obstructed kidneys (DRF(ok)) drained by percutaneous nephrostomy tube (PCNT). METHODS: In patients with obstructed kidneys drained by PCNT, DRF(ok) was derived from UCC by comparing the value of UCC in the obstructed kidney to the value in the contralateral kidney, and was derived from dimercaptosuccinic acid (DMSA) renal scans and creatinine clearance (CCr) using standard methods. Subsequently, the results of UCC were compared to the results of DMSA and CCr. RESULTS: 61 patients were enrolled. Bland-Altman plots to compare DMSA and UCC showed that the upper limit of agreement was 14.8% (95% CI 10.7-18.5) and the lower limit was -19.9% (95% CI -23.8 to -16.1). The sensitivity and specificity of detecting DMSA DRF(ok) < or = 35% using UCC was 85.2 and 91.2%, respectively. When UCC was compared to CCr, Bland-Altman tests gave an upper limit of agreement of 10.4% (95% CI 7.9-12.8) and a lower limit of agreement of -11.3% (95% CI -13.8 to -8.9). CONCLUSIONS: UCC is accurate in the estimation of DRF(ok) drained by PCNT.

Body mass index of Kuwaiti adolescents aged 10-14 years: reference percentiles and curves.

The aim of this population-based study was to develop body mass index (BMI) reference standards for Kuwaiti adolescents for use in Kuwait and other Gulf countries. All available intermediate school students aged 10-14 years (32 624 males and 30 209 females) were measured for weight and height. Polynomial regression smoothing techniques were used to obtain the best-fitting curves for BMI percentiles. The BMI of boys at lower centiles and ages was almost always higher than girls. At higher centiles, the BMI of girls was almost always higher than boys. The data were compared with the United States National Center for Health Statistics standards and data from Saudi Arabian and Iranian adolescents.

Climatic variables and transmission of falciparum malaria in New Halfa, eastern Sudan.

The study investigated the role of climatic variables and irrigated agricultural on the seasonality of malaria transmission in New Halfa, eastern Sudan. A time-series analysis was performed using monthly climatic variables, monthly water available for irrigation of crops and monthly slide positive rate of malaria during the period 1986-2002. Cases of malaria were reported every month of the year with a mean of 13.0/100 persons/month (95% CI: 11.9-14.2), and bimodal annual pattern in autumn and winter seasons. Rainfall was the significant climatic variable in the transmission of the disease, whereas heavy rainfall was found to initiate epidemics. Temperature, relative humidity and irrigation water were not significant factors.

Does endurance training affect orthostatic responses in healthy elderly men?

PURPOSE: To investigate the effects and time course of endurance training on the regulation of heart rate (HR), arterial pressure (AP), norepinephrine (NE), and plasma volume (PV) during orthostatic stress in healthy elderly men. METHODS: Thirty-one healthy men (65--75 yr) were randomly allocated into endurance training (N = 20, EX) and control (N = 11, CON) groups. The EX group cycled 3 d x wk(-1) for 30 min at 70% VO(2peak) for 12 wk x VO(2peak) was determined on an electronically braked cycle ergometer, before training and after 4, 8, and 12 wk of endurance training. The immediate (initial 30 s), early steady-state (1 min), and prolonged (5, 10, 15 min) beat-by-beat HR and AP responses during 90 degrees head-up tilt (HUT) were measured at least 3 d after each VO(2peak) test. Spontaneous baroreflex slopes were determined by application of linear regression to sequences of at least three cardiac cycles in which systolic blood pressure (SBP) and R-R interval changed in the same direction. Venous blood was collected during 90 degrees HUT and analyzed for changes in plasma NE concentrations, as well as hematocrit and hemoglobin to determine changes in PV. RESULTS: Endurance training significantly (P < 0.01) increased VO(2peak) (mL x kg(-1) x min(-1)) in EX by 10 +/- 2%. The immediate, early steady-state, and prolonged HR and AP responses and spontaneous baroreflex slopes during 90 degrees HUT were not significantly different (P > 0.05) between EX and CON groups before or after 4, 8, or 12 wk of endurance training. No significant differences (P > 0.05) were observed between EX and CON groups for peak changes in PV during orthostasis before (-15.0 +/- 1.4% vs -11.9 +/- 1.3%) or after 4 (-12.2 +/- 1.0% vs -12.7 +/- 1.4%), 8 (-13.7 +/- 1.2% vs -12.4 +/- 0.7%), and 12 wk (-10.8 +/- 1.6% vs -10.6 +/- 0.6%) of endurance training, suggesting a similar stimulus presented by 90 degrees HUT in both groups. Peak changes in NE concentrations during HUT were similar (P > 0.05) between EX and CON groups before (119 +/- 23 pg x mL(-1) vs 191 +/- 36 pg x mL(-1)) and after 4 (139 +/- 29 pg x mL(-1) vs 146 +/- 25 pg x mL(-1)), 8 (114 +/- 32 pg x mL(-1) vs 182 +/- 41 pg x mL(-1)), and 12 wk (143 +/- 35 pg x mL(-1) vs 206 +/- 42 pg.mL-1) of endurance training. CONCLUSIONS: These data indicate that in healthy elderly men, improvements in VO(2peak) can occur without compromising the regulation of HR, AP, NE, and PV during orthostatic stress.

Effects of ambient particle pollution on daily mortality in Melbourne, 1991-1996.

This paper presents the results of a study in Melbourne, Australia, of the short-term effects of ambient fine particle pollution on daily mortality occurring between 1991 and 1996. The methodological approach used Poisson regression and Generalized Additive Models (GAM) with LOESS smoothing to control for temporal and meteorological effects. The association between particles and increases in daily mortality was examined using nephelometry data (bsp, mean 24 h average = 0.26 x 10(-4) m(-1), mean 1 h maximum = 0.60 x 10(-4) m(-1)), PM2.5 (24 h mean = 9.42 microg/m3) and PM10 (24 h mean = 19 microg/m3). Both the PM10 and PM2.5 data were estimated from nephelometry data using previously derived relationships for the Melbourne airshed. Significant positive associations between the particle measures considered and all cause and respiratory mortality were found in the warm season (November-March). A 1 x 10(-4) m(-1) increase in maximum 1-h bsp levels was associated with a 2.19% (95% CI = 0.01-4.43%) increase in risk of death for all cause mortality and a 10.40% (95% CI = 2.44-18.97%) increase in risk for respiratory mortality in the warm season. A 1 microg/m3 increase in 24-h PM2.5 in the warm season was associated with a 0.38% (95% CI = 0.06-0.70%) increase in risk of death for all cause mortality and a 1.18% (95% CI = 0.05-2.32%) increase in risk for respiratory mortality. For PM10, a 1 microg/m3 increase was associated with an increased risk of 0.18% (95% CI = 0.03-0.33%) for all cause mortality and 0.59% (95% CI = 0.06-1.13%) for respiratory mortality. Significant associations were also found in the 65+ age group in the warm season. However, for these warm periods, the effects of ozone (average 1 h maximum = 127 ppb) and nitrogen dioxide (average 1 h maximum = 70.7 ppb) were also significant and, due to high correlations between these pollutants, it was not possible to separate the particle effects from those of O3 and NO2. Sulfur dioxide was not examined as concentrations of this pollutant in Melbourne are very low (max 1 h = 15-24 ppb, annual average 0.8 ppb). Comparison with other Australian studies in Sydney and Brisbane indicates different results for particle pollution.

Effects of environmental factors on the seasonally change of phytoplankton populations in a closed freshwater pond.

The effect of environmental factors affecting the population dynamic of phytoplankton population was studied seasonally in a closed freshwater pond with the natural water of Lake Kasumigaura, Japan. The predominant phytoplankton species in the pond were classified as Oscillatoria tenuis, Synedra ulna, Chlamydomonas cingulata and Cyclotella kutzingiana, with dominant species of Melosira italica, Synechococcus sp. and Cryptomonas ovata. The most important limiting factor for filament length and cell size of most of the phytoplankton community was temperature. Availability of most nutrients had profound effects on the phytoplankton growth as nonlimiting factors. Based on our results, it is suggested that cell cycle progression was also temporally regulated by a multiplicity of external factors such as temperature, nutrients, dissolved oxygen (DO) and pH. At high pH and high temperature, consistent increase of cell division of some phytoplanketers such as Synedra, Cyclotella, Chlamydomonas and Melosira occurs, and there also may be species-specific responses for other species of phytoplankters. In addition, the cell divisions of phytoplankters are differentially regulated in different phytoplankton species.

Prediction of fetal anemia by middle cerebral artery peak systolic velocity in pregnancies complicated by rhesus isoimmunization.

OBJECTIVES: To study the correlation of peak systolic velocity in the middle cerebral artery with hemoglobin concentration in fetuses at risk of anemia due to Rhesus isoimmunization. DESIGN: Peak systolic velocity of middle cerebral artery (MCA-PSV) was measured before 66 cordocentesis procedures in 20 isoimmunized fetuses. Reference values were derived from a study of 300 control fetuses. MCA-PSV values and hemoglobin concentrations were expressed as multiples of the median (MoM) for gestational age. The following hemoglobin concentration MoM thresholds defined degrees of anemia: mild, between 0.83 and 0.65; moderate, between 0.64 and 0.55; and severe, less than 0.55. Regression analysis was performed and receiver-operator-characteristic curves were constructed to determine the diagnostic accuracy of different thresholds of MCA-PSV for the prediction of moderate to severe anemia, either at the initial or repeat cordocentesis procedures. RESULTS: The mean (+/-SD) gestational age at cordocentesis was 28.5+/-4.6 weeks. Moderate to severe anemia was observed on 29 (44%) and hydrops on 27 (41%) occasions. MCA-PSV correlated weakly with hemoglobin concentrations. At threshold values 1.50 MoM, the sensitivity, specificity, and negative predictive value for moderate to severe anemia were 9.0, 100, and 48.0% at the initial cordocentesis procedures, and 44.0, 96.0, and 73.0% at repeat cordocentesis procedures, respectively. CONCLUSIONS: Although MCA-PSV is highly specific, negative values do not rule out fetal anemia. Further research is required before it can be recommended in clinical practice.

Norepinephrine and epinephrine responses during orthostatic intolerance in healthy elderly men.

In young individuals, orthostatic intolerance is associated with marked increases in plasma epinephrine (EPI) concentrations and attenuated rises in plasma norepinephrine (NE) concentrations. This study investigated the cardiovascular, EPI and NE responses of healthy elderly males during orthostatic stress. Twelve men (68 +/- 1 yr) with a recent history of orthostatic hypotension and who exhibited orthostatic intolerance (HYPO) during 90 degrees head-up tilt (HUT) were compared with 12 men (69 +/- 1 yr) without a history of orthostatic hypotension and who remained normotensive (NORMO) throughout 90 degrees HUT. Beat-by-beat recordings of heart rate (HR), mean (MAP), systolic (SBP), diastolic (DBP), and pulse (PP) pressures were made throughout 90 degrees HUT. Blood samples obtained during supine rest and 90 degrees HUT were analyzed for changes in EPI and NE concentrations, hematocrit, hemoglobin and plasma volume. Compared to supine rest, orthostatic intolerance was characterized by significant reductions (p < 0.0001) in MAP, SBP, DBP, and PP. The HR, MAP, SBP, DBP, and PP at the termination of 90 degrees HUT was significantly lower (p < 0.0001) for HYPO than NORMO. The 90 degrees HUT position resulted in significant increases (p < 0.01) in NE for both HYPO and NORMO, with the rise in NE significantly lower (p < 0.05) in HYPO. There were no differences between groups regarding EPI concentrations at the termination of 90 degrees HUT. These results suggest that the magnitude of arterial pressure (AP) reduction does not influence the EPI response during orthostasis in healthy elderly men. However, marked reductions in AP, leading to orthostatic intolerance, are associated with inadequate increases in NE in these individuals.

Randomized clinical trial comparing two natural surfactant preparations to treat respiratory distress syndrome.

OBJECTIVES: Natural surfactant preparations have been shown to reduce the severity and mortality of respiratory distress syndrome (RDS) in preterm infants. The objective of this study was to compare the efficacy of two natural surfactants, namely SF-RI 1 (Alveofact) and barectant (Survanta), on the incidence of chronic lung disease (CLD) and other associated complications of RDS in preterm infants. METHODS: Preterm infants with RDS requiring artificial ventilation were randomly selected to receive an initial dose of either Alveofact or Survanta. The two treatment groups were tested for variation in gas exchange, ventilatory settings and neonatal complications such as CLD and mortality. RESULTS: After 5 days the Survanta-treated infants had a lower fraction of inspired oxygen (FiO2) compared with the Alveofact-treated infants. There were no differences in the ventilatory settings. More infants in the Survanta group were extubated at 3 days and fewer required the use of postnatal steroids. Less CLD and duration of oxygenation were experienced by the Survanta-treated group. CONCLUSIONS: Improved oxygenation and reduced ventilatory requirements were greater with Survanta compared to Alveofact, which in turn was associated with a trend towards a lower incidence of serious pulmonary complications.

A randomized study of the safety and efficacy of reused angioplasty balloon catheters.

BACKGROUND: To lower costs, many centers around the world utilize previously used, resterilized balloon catheters to perform coronary angioplasty There are no controlled trials regarding their safety and efficacy. METHODS AND RESULTS: We performed the first randomized, double-blind, controlled, single-center clinical trial comparing the safety (clinical success) and efficacy (angiographic success) of reused versus new coronary angioplasty balloon catheters. A total of 377 procedures were included, 178 in the reused catheter arm and 199 in the new catheter arm. There were no significant differences in clinical or lesion characteristics among the two arms. The incidence of first balloon failure in the reused catheter arm was similar to that of the new catheter arm (12 cases [7%] v. 10 cases [5%], respectively). The angiographic success rate was also similar-176 cases (98.9%) in the reused catheter arm and 196 cases (98.5%) in the new catheter arm. The number of balloon catheters used per lesion, amount of contrast, and procedural and fluoroscopy time were similar in the two arms. At 30 days, the incidence of major adverse cardiac events was similar in both arms, 8 cases (4.5%) in the reused catheter arm and 10 cases (5%) in the new catheter arm. The incidence of fever was also similar. CONCLUSIONS: When performing coronary angioplasty, reused catheters are as effective (similar angiographic success) and safe (similar clinical success) as new catheters.

Associations between outdoor air pollution and hospital admissions in Brisbane, Australia.

The authors investigated the effects of ambient air pollution on hospital admissions in Brisbane, Australia. The authors used the Air Pollution on Health: European Approach protocol to examine the effects of particles, ozone, sulfur dioxide, and nitrogen dioxide on daily hospital admissions for asthma and respiratory, cardiovascular, and digestive disorders (control diagnosis) that occurred during the period 1987-1994. Ozone was consistently associated with admissions for asthma and respiratory disease-with little evidence of a threshold. In two-pollutant models, the ozone effect was relatively unaffected by the control for high levels of other pollutants. Particulate pollution (measured by nephelometry) was associated positively with admissions for respiratory disease and admissions for asthma in summer, whereas a negative association was observed for cardiovascular admissions. Although sulfur dioxide was associated significantly with admissions for respiratory and cardiovascular disese, a significant association was also found for the control diagnosis of digestive disorders. No significant associations were found for nitrogen dioxide over the study period, although significantly positive seasonal interactions were found for asthma and respiratory disease in autumn, winter, and spring. It was concluded that current levels of ambient air pollution in Brisbane make a significant contribution to the variation in daily hospital admissions for asthma and respiratory disease.