Use of parenteral magnesium sulphate in eclampsia and severe pre-eclampsia cases in a rural set up of Bangladesh.

This was a quasi-experimental interventional study to see the role of injection magnesium sulphate in eclampsia and severe pre-eclampsia patients at community level in a rural set up before referral to the hospital. This study was conducted on 265 cases of eclampsia and severe pre-eclampsia over a period of six months from July 2001 to December 2001. Among 265 cases, 133 were in intervention group who had received loading dose of injection magnesium sulphate before referral and the rest 132 were in non-intervention group, had not received injection magnesium sulphate before admision in hospital. The number (mean +/- SD) of convulsion before treatment in intervention and non-intervention groups were 4.7 +/- 2.64 & 6.86 +/- 2.97 respectively. Recurrence of fits observed more in non-intervention group and the difference was statistically significant (p<.001). Mean (+/- SD) time taken to regain full consciousness was 12.0+9.6 and 17.4+7.4 hours in the intervention and non-intervention group respectively (p<.05). Control of convulsion by loading dose of 10 gm of injection magnesium sulphate was achieved in 94.0% of the intervention group and 74.0% in non-intervention group. There was only 3(2.3%) maternal death in study group whereas in non-intervention group maternal death was 14(10.4%) and the difference was highly significant (p<.005). Fourteen (13.7%) babies were still born in intervention group and 21(20%) in non-intervention group. The difference was statistically highly significant (p<.001). Remarkable achievements were obtained through use of magnesium sulphate at the community level at rural setting among the eclampsia and severe pre-eclampsia cases.

Dental care of a child in pain -- a comparison of treatment planning options offered by GDPs in California and the North-west of England.

OBJECTIVE: To compare the treatment plans offered by general dental practitioners (GDPs) in the North-west of England (UK) and California (USA) in dealing with a child in pain. METHODS: A cross-sectional postal survey of a convenience sample of 135 UK and 170 USA GDP. These GDPs were asked to consider a case scenario of a 5-year-old child with pain from a lower first primary molar and to offer a treatment plan. The plan was to have three phases: immediate care, follow-up care and longer term preventive strategy. The influence of cost on treatment plans was also recorded. RESULTS: Response rates for the GDPs were 117 (86.6%) from the UK and 139 (81.8%) from the USA. The major differences in immediate care were as follows: 98% of Americans would take a radiograph, 41% would consider extraction, 37% would place a space maintainer and 4% would use general anaesthesia to extract a tooth. Comparable proportions for the English dentists were 20%, 21%, 2% and 40%. Later clinical options also showed differences: 39% of UK dentists would extract all first primary molars compared to only 1% of Americans. Eighty-eight per cent of USA dentists would place a nickel chrome crown compared to 4% of UK respondents. There were also differences in the longer term preventive measures. Greater proportions of American dentists would offer fluoride varnish (30%) and fluoride mouthrinse (37%). Comparable UK responses were 13% and 28%. Cost of care was only mentioned by 3% of UK dentists, whereas 70% of USA dentists mentioned cost as a factor in treatment planning. CONCLUSION: There were marked differences in the treatment of a child in pain between general practitioners in the UK and the USA. Further investigations are required to elucidate the reasons for these differences.

Predicting and preventing pressure ulcers in adults with paralysis.

A questionnaire mailed to all 2,295 members of the Eastern Paralyzed Veterans Association measured 45 potential risk factors for pressure ulcers. Logistic-regression analysis and Cox proportional-hazards analyses were used to identify the variables that were independently associated with pressure ulcers. The survey response rate was 42.2%. Among 15 risk factors from a previously published scale by the authors, 7 were independent predictors of pressure ulcer development: level of activity, level of mobility, complete spinal cord injury, urine incontinence or moisture, autonomic dysreflexia, pulmonary disease, and renal disease. In addition, 2 new variables added significant predictive value: being prone to infections that cause breathing problems and paralysis caused by trauma (as opposed to disease). Using these 9 risk factors, a new pressure ulcer risk assessment scale was designed specifically for persons with paralysis who are living in a community setting. It appears to be a more accurate method of predicting pressure ulcers than currently used risk assessment scales.