ABSTRACT
The present study was undertaken to evaluate the knowledge, attitude and practices about neonatal hypothermia among medical and paramedical staff dealing with newborn care. A total of 160 subjects were assessed (40 pediatric medicine residents, 40 obstetric residents, 40 private practitioners and 40 paramedical staff working in labor room and postnatal wards) A pre-tested structured questionnaire was used. Only 47.8% of the subjects defined neonatal hypothermia correctly. As many as 52.2% of the interviewees considered it to be an uncommon problem. Lethargy, refusal for feed and cold to touch were mentioned as common symptoms of neonatal hypothermia by 97.5%, 80% and 77.5% of the respondents respectively. Decreased body temperature, cyanosis, apnea and edema of feet were found as common signs. Only 18.6% of the interviewees had knowledge about correct method of recording the temperature in a newborn. The present study reveals the gross lacunae in the knowledge regarding various aspects of neonatal hypothermia among pediatric and obstetric residents and paramedical staff working in labor room and postnatal wards. To reduce the neonatal morbidity and mortality due to neonatal hypothermia, greater emphasis should be laid on this problem while designing curriculum for training of undergraduate and postgraduate doctors, paramedical staff and traditional birth attendants.
Subject(s)
Clinical Competence , Health Knowledge, Attitudes, Practice , Hypothermia , Allied Health Personnel , Humans , Hypothermia/diagnosis , Hypothermia/etiology , Hypothermia/therapy , Infant, Newborn , Internship and Residency , Obstetrics , PediatricsABSTRACT
The morphologic changes in atherosclerotic coronary arteries and saphenous vein bypass grafts after placement of a balloon-expandable flexible coil stent (Cook) are described. In each case, the vessels were patent despite morphologic evidence of injury and dissection in the vessel wall. The stented region was reendothelialized and the tissue overlying the stent wires consisted primarily of smooth muscle cells. There was minimal inflammatory reaction to the stent wires. These findings suggest that the balloon-expandable flexible coil stent can effectively maintain vessel patency even in the setting of postangioplasty lumen disruption. In addition, the vessels tolerate the metal prosthesis with little evidence of tissue inflammatory reaction.
Subject(s)
Coronary Artery Disease/therapy , Coronary Vessels/pathology , Endothelium, Vascular/ultrastructure , Muscle, Smooth, Vascular/ultrastructure , Saphenous Vein/pathology , Stents , Aged , Aged, 80 and over , Angioplasty, Balloon, Coronary , Coronary Artery Bypass , Coronary Artery Disease/pathology , Female , Humans , Male , Microscopy, Electron, Scanning , Middle AgedABSTRACT
Despite its tortuous course and small caliber, percutaneous transluminal coronary angioplasty of the internal mammary artery can be performed with a high initial success rate (82-94%). The successful deployment of a balloon expandable coil stent at the mid-right internal mammary artery in a patient with recurrent stenosis of that graft is reported.
Subject(s)
Mammary Arteries , Stents , Angioplasty, Balloon, Coronary , Coronary Angiography , Coronary Disease/diagnostic imaging , Coronary Disease/surgery , Coronary Disease/therapy , Graft Occlusion, Vascular/therapy , Humans , Internal Mammary-Coronary Artery Anastomosis , Male , Mammary Arteries/diagnostic imaging , Middle Aged , RecurrenceABSTRACT
Analog amplitude-modulated Holter devices are in widespread use for arrhythmia detection, but their reliability remains questioned for ST-segment analysis. In contrast, recently developed digital Holter devices immediately digitize and analyze the electrocardiogram (ECG) on-line and may therefore be more reliable for ST-segment analysis. To test this hypothesis, the results of digital, on-line, 2-channel ST-segment analysis were directly compared to those of analog amplitude-modulated recordings in identical leads (CM5 and CM3), using a stripchart recorder meeting the American Heart Association specifications as the standard. Thirty-five patients (25 with coronary artery disease and 10 control subjects) underwent graded treadmill exercise testing. The reference ECG mean value for ST-segment depression in CM5 was -1.4 +/- 1.2 mm and in CM3 -0.5 +/- 1.2 mm. For digital analysis, the mean values and correlation coefficients for CM5 were -1.5 +/- 1.1 mm (r = 0.97) and for CM3 -0.8 +/- 1.3 mm (r = 0.93). For analog recording, the results for CM5 were -2.1 +/- 1.7 mm (r = 0.88) and for CM3 -1.3 +/- 1.9 mm (r = 0.85). The mean duration of ST-segment depression with the reference ECG was 7.1 +/- 4.1 minutes. Digital Holter showed a significantly better agreement (7.4 +/- 4.4 min, r = 0.97) than analog Holter (9.6 +/- 5.6 min, r = 0.84). Because analog amplitude-modulated Holter recordings overestimated the degree and duration of ischemic episode, digital, on-line and full disclosure devices should be preferred to assess myocardial ischemia.
