Maxillofacial trauma caused by e-scooters: a retrospective review prior to the extension of the UK scheme.

The nationwide extension of the electric scooter (e-scooter) scheme, which began in 2020, aimed to alleviate public transport congestion, to reduce pollution and peak-time road traffic. This retrospective study evaluates the range of e-scooter-related maxillofacial trauma before the recent scheme extension and compares the findings with existing literature on this topic. The Queen Elizabeth Hospital Birmingham, United Kingdom (UK) operates as a Level 1 Regional Major Trauma Centre and serves a population of four million. All patient records between September 2021 to September 2022 were analysed to establish the types of e-scooter-related maxillofacial trauma sustained. A Pearson's chi-squared test was used to assess for significant associations between variables recorded. Falls accounted for the majority of injuries (44.3%), and soft tissue lacerations were the most common maxillofacial injury (38%). Statistically significant results were measured in the following variables: gender and intoxication status (p = 0.007), helmet status and injuries sustained in maxillofacial and non-maxillofacial regions (p = 0.043), mechanism of injury and injuries sustained in both the maxillofacial and non-maxillofacial regions (p = 0.045). E-scooters are an emerging concern within the UK. Further studies across the UK are required to assess the frequency of e-scooter-related injuries. Such data may prove useful in determining the government's decision on e-scooter use on UK roads.

Diseases Pattern and Outcome among the Neonates in A Newly Established Special Care Newborn Unit (SCANU) At Secondary Level District Hospital in Bangladesh.

Although huge improvement in neonatal mortality reduction in last two decades in Bangladesh but it is still very high compare with many other countries. High neonatal mortality also significantly contribute deaths among the under five children. Neonatal mortality reflects a nation's socio-economic status, efficiency and effectiveness of health care services. This was cross sectional study. The objective of this study was to analyse the diseases pattern and outcome of the neonates admitted in the newly established SCANU (Special care neonatal unit) of 250 bedded General Hospital of Tangail district, Bangladesh. Study period was one year from January 2017 to December 2017. Information from medical records of the SCANU was analysed. During the study period 1,379 neonates were admitted in the SCANU. The ratio between male and female was 1.5:1, 61% of the neonates admitted at first day of life. The reasons for admissions in SCANU were 31% of preterm and low birth weight, 23%birth asphyxia, 13% neonatal sepsis, 9% transient tachypnea of newborn, 5% congenital anomalies and 4% neonatal jaundice. Out of all neonates survival rate was 56% (779), while 25% (349) ended with fatality, 9% (122) were referred to tertiary level hospital and 10% (129) were left the hospital against medical advice. Among the fatal cases 63% died in first 24 hours and 88% in first week of life. Data shows that 47% deaths were due to preterm and low birth weight with its complication, other significant causes were birth asphyxia (30%), septicemia (16%) and congenital anomalies were (6%). Preterm and low birth weight, neonatal sepsis, birth asphyxia, transient tachypnea of newborn; congenital anomalies were the main reasons for admission in SCANU. Prematurity and its complication, birth asphyxia and neonatal sepsis as the major contributors to the neonatal mortality. The study findings will help researchers and policy makers to initiate further research and interventions to reduce fatality among the neonates in the SCANU.

The cost implications of continuous glucose monitoring in pregnant women with type 1 diabetes in 3 Canadian provinces: a posthoc cost analysis of the CONCEPTT trial.

BACKGROUND: The Continuous Glucose Monitoring in Women with Type 1 Diabetes in Pregnancy Trial (CONCEPTT) found improved health outcomes for mothers and their infants among those randomized to self-monitoring of blood glucose (SMBG) with continuous glucose monitoring (CGM) compared with SMBG alone. In this study, we evaluated whether CGM or standard SMBG was more or less costly from the perspective of a third-party payer. METHODS: We conducted a posthoc analysis of data from the CONCEPTT trial (Mar. 25, 2013, to Mar. 22, 2016). Health care resource data from 215 pregnant women, randomized to CGM or SMBG, were collected from 31 hospitals in 7 countries. We determined resource costs posthoc based on prices from hospitals in 3 Canadian provinces (Ontario, British Columbia, Alberta). The primary outcome was the difference between groups in the mean total cost of care for mother and infant dyads, paid by each government (i.e., the third-party payer) from randomization to hospital discharge (time horizon). The secondary outcome included CGM and SMBG costs not paid by governments (e.g., glucose monitoring devices and supplies). RESULTS: The mean total cost of care was lower in the CGM group compared with the SMBG group in each province (Ontario: $13 270.25 v. $18 465.21, difference in mean total cost [DMT] -$5194.96, 95% confidence interval [CI] -$9841 to -$1395; BC: $13 480.57 v. $18 762.17, DMT -$5281.60, 95% CI -$9964 to -$1382; Alberta: $13 294.39 v. $18 674.45, DMT -$5380.06, 95% CI -$10 216 to -$1490). There was no difference in the secondary outcome. INTERPRETATION: Government health care costs are lower when CGM is paid by the patient, driven by lower costs from reduced use of the neonatal intensive care unit in the CGM group; however, when governments pay for CGM equipment, there is no overall cost difference between CGM and SMBG. Governments should consider paying for CGM, as it results in improved maternal and neonatal outcomes with no added overall cost. TRIAL REGISTRATION: ClinicalTrials.gov, no. NCT01788527.

A review on colorimetric methods for determination of organophosphate pesticides using gold and silver nanoparticles.

This review (with 99 refs.) summarizes the progress that has been made in colorimetric (i.e. spectrophotometric) determination of organophosphate pesticides (OPPs) using gold and silver nanoparticles (NPs). Following an introduction into the field, a first large section covers the types and functions of organophosphate pesticides. Methods for colorimetric (spectrophotometric) measurements including RGB techniques are discussed next. A further section covers the characteristic features of gold and silver-based NPs. Syntheses and modifications of metal NPs are covered in section 5. This is followed by overviews on enzyme inhibition-based assays, aptamer-based assays and chemical (non-enzymatic) assays, and a discussion of specific features of colorimetric assays. Several Tables are presented that give an overview on the wealth of methods and materials. A concluding section addresses current challenges and discusses potential future trends and opportunities. Graphical abstractSchematic representation of organophosphate pesticide determinations based on aggregation of nanoparticles (particular silver or gold nanoparticles). This leads to a color change which can be determined visually and monitored by a red shift in the absorption spectrum.

Resident Attitudes Towards Caesarean Delivery in Canadian Obstetrics and Gynaecology Residency Programs.

OBJECTIVE: This study aimed to explore the attitudes of obstetrics and gynaecology residents in Canada towards interventions that influence caesarean section rates. The study looked at residents' attitudes towards four guidelines that support vaginal and assisted delivery (vaginal birth after caesarean section, induction of labour, operative vaginal birth, and fetal health surveillance in labour) and towards Society of Obstetricians and Gynaecologists of Canada (SOGC) guidelines in general. The study also sought to investigate whether these attitudes vary by residency training location. METHODS: An online survey of obstetrics and gynaecology residents across Canada was conducted. Residents responded to statements derived from guidelines using a five-point attitudinal scale and to an optional long-answer question about how residency has prepared them to make decisions around interventions. Descriptive summary statistics are used to present the findings (Canadian Task Force Classification III). RESULTS: A total of 27% of residents completed the survey. The majority demonstrated attitudes congruent with guidelines and favourable towards SOGC guidelines in general. Residents attitudes were least favourable towards electronic fetal monitoring, with 67.4% of responses congruent with the guideline. Attitudes were most aligned with the operative vaginal birth guideline, with 87.9% of responses congruent with the guideline. This sample was underpowered to detect statistically significant differences among residency programs, although there was some variation in attitudes across programs, with the most congruent scoring program at 81.8% congruent responses and the lowest at 66.7%. CONCLUSION: Obstetrics and gynaecology residents in Canada have favourable attitudes towards interventions that support vaginal and assisted delivery. There was variability in observed attitudes across programs, although this was not statistically significant.

Birth Outcomes for Midwifery Clients Who Begin Postdates Induction of Labour Under Midwifery Care Compared With Those Who Are Transferred to Obstetrical Care.

OBJECTIVE: This study sought to compare clinical outcomes of midwifery clients who had postdates induction of labour with oxytocin under midwifery care with those transferred to obstetrical care. METHODS: This was a retrospective cohort study using 2006-2009 Ontario Midwifery Program data. All low-risk Ontario midwifery clients who had postdates oxytocin induction were included. Groups were established according to the planned care provider at onset of induction. The primary outcome was Cesarean section (CS). The secondary outcome was a composite of stillbirth, neonatal death, or serious morbidity. Other outcomes included assisted vaginal delivery, pharmaceutical pain relief, and use of episiotomy. We stratified by parity and used logistic regression to conduct analyses controlling for maternal age (Canadian Task Force Classification II-2). RESULTS: For nulliparas, postdates induction with oxytocin under midwifery care decreased the odds of interventions including assisted vaginal delivery (OR 0.68; 95% CI 0.48-0.97), episiotomy (OR 0.49; 95% CI 0.34-0.70), and pharmaceutical pain relief (OR 0.57; 95% CI 0.36-0.90), with no difference in odds of neonatal morbidity or mortality (OR 0.71; 95% CI 0.25-2.04) when compared with induction under obstetrical care. For multiparas, the use of pharmaceutical pain relief was significantly lower in the midwifery group (OR 0.65; 95% CI 0.44-0.96). CONCLUSION: For low-risk midwifery clients at 41 weeks or more gestation, the odds of Caesarean section and neonatal morbidity and mortality are similar when induction of labour with oxytocin under the care of a midwife is compared with induction of labour under obstetrical care, and rates of intervention are decreased.

The Cost Implications of Less Tight Versus Tight Control of Hypertension in Pregnancy (CHIPS Trial).

UNLABELLED: The CHIPS randomized controlled trial (Control of Hypertension in Pregnancy Study) found no difference in the primary perinatal or secondary maternal outcomes between planned "less tight" (target diastolic 100 mm Hg) and "tight" (target diastolic 85 mm Hg) blood pressure management strategies among women with chronic or gestational hypertension. This study examined which of these management strategies is more or less costly from a third-party payer perspective. A total of 981 women with singleton pregnancies and nonsevere, nonproteinuric chronic or gestational hypertension were randomized at 14 to 33 weeks to less tight or tight control. Resources used were collected from 94 centers in 15 countries and costed as if the trial took place in each of 3 Canadian provinces as a cost-sensitivity analysis. Eleven hospital ward and 24 health service costs were obtained from a similar trial and provincial government health insurance schedules of medical benefits. The mean total cost per woman-infant dyad was higher in less tight versus tight control, but the difference in mean total cost (DM) was not statistically significant in any province: Ontario ($30 191.62 versus $24 469.06; DM $5723, 95% confidence interval, -$296 to $12 272; P=0.0725); British Columbia ($30 593.69 versus $24 776.51; DM $5817; 95% confidence interval, -$385 to $12 349; P=0.0725); or Alberta ($31 510.72 versus $25 510.49; DM $6000.23; 95% confidence interval, -$154 to $12 781; P=0.0637). Tight control may benefit women without increasing risk to neonates (as shown in the main CHIPS trial), without additional (and possibly lower) cost to the healthcare system. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01192412.

Occurrence and distribution of antifouling biocide Irgarol-1051 in coral reef ecosystems, Zanzibar.

2-methythiol-4-tert-butylamino-6-cyclopropylamino-s-triazine (Irgarol-1051) has been widely used as effective alternative antifouling paint in marine structures including ships. However, it has been causing deleterious effects to marine organisms including reef building corals. The main objective of this study was to establish baseline levels of Irgarol-1051 around coral reefs and nearby ecosystems along coastline of Zanzibar Island. The levels of Irgarol-1051 ranged from 1.35ng/L around coral reefs to 15.44ng/L around harbor with average concentration of 4.11 (mean)±0.57 (SD) ng/L. This is below Environmental Risk Limit of 24ng/L as proposed by Dutch Authorities which suggests that the contamination is not alarming especially for coral reef ecosystem health. The main possible sources of the contamination are from shipping activities. This paper provides important baseline information of Irgarol-1051 around the coral reef ecosystems within the Western Indian Ocean (WIO) region and may be useful for formulation of marine conservation strategies and policies.

The Cost Implications in Ontario, Alberta, and British Columbia of Early Versus Delayed External Cephalic Version in the Early External Cephalic Version 2 (EECV2) Trial.

OBJECTIVE: According to the Early External Cephalic Version (EECV2) Trial, planning external cephalic version (ECV) early in pregnancy results in fewer breech presentations at delivery compared with delayed external cephalic version. A Cochrane review conducted after the EECV2 Trial identified an increase in preterm birth associated with early ECV. We examined whether a policy of routine early ECV (i.e., before 37 weeks' gestation) is more or less costly than a policy of delayed ECV. METHODS: We undertook this analysis from the perspective of a third-party payer (Ministry of Health). We applied data, using resources reported in the EECV2 Trial, to the Canadian context using 10 hospital unit costs and 17 physician service/procedure unit costs. The data were derived from the provincial health insurance plan schedule of medical benefits in three Canadian provinces (Ontario, Alberta, and British Columbia). The difference in mean total costs between study groups was tested for each province separately. RESULTS: We found that planning early ECV results in higher costs than planning delayed ECV. The mean costs of all physician services/procedures and hospital units for planned ECV compared with delayed ECV were $7997.32 versus $7263.04 in Ontario (P < 0.001), $8162.82 versus $7410.55 in Alberta (P < 0.001), and $8178.92 versus $7417.04 in British Columbia (P < 0.001), respectively. CONCLUSION: From the perspective of overall cost, our analyses do not support a policy of routinely planning ECV before 37 weeks' gestation.

Outcomes associated with planned place of birth among women with low-risk pregnancies.

BACKGROUND: Previous studies have shown that planned home birth is associated with a decreased likelihood of intrapartum intervention with no difference in neonatal outcomes compared with planned hospital birth. The purpose of our study was to evaluate different birth settings by comparing neonatal mortality, morbidity and rates of birth interventions between planned home and planned hospital births in Ontario, Canada. METHODS: We used a provincial database of all midwifery-booked pregnancies between 2006 and 2009 to compare women who planned home birth at the onset of labour to a matched cohort of women with low-risk pregnancies who had planned hospital births attended by midwives. We conducted subgroup analyses by parity. Our primary outcome was stillbirth, neonatal death (< 28 d) or serious morbidity (Apgar score < 4 at 5 min or resuscitation with positive pressure ventilation and cardiac compressions). RESULTS: We compared 11 493 planned home births and 11 493 planned hospital births. The risk of our primary outcome did not differ significantly by planned place of birth (relative risk [RR] 1.03, 95% confidence interval [CI] 0.68-1.55). These findings held true for both nulliparous (RR 1.04, 95% CI 0.62-1.73) and multiparous women (RR 1.00, 95% CI 0.49-2.05). All intrapartum interventions were lower among planned home births. INTERPRETATION: Compared with planned hospital birth, planned home birth attended by midwives in a jurisdiction where home birth is well-integrated into the health care system was not associated with a difference in serious adverse neonatal outcomes but was associated with fewer intrapartum interventions.

InVO4/TiO2 composite for visible-light photocatalytic degradation of 2-chlorophenol in wastewater.

InVO4/TiO2 composite was synthesized via amalgamation of InVO4 with TiO2 (Degussa P-25) powders. Application of the produced composite was evaluated as a catalyst for visible-light photocatalytic degradation of 2-chlorophenol (2-CP) in synthetic wastewater solutions. The catalyst was characterized by X-ray diffraction (XRD), scanning electron microscopy energy dispersive X-ray microanalyses and nitrogen physisorption. The degradation of 2-CP was affected by solution pH, light intensity, photocatalyst dosage and 2-CP initial concentration. InVO4/TiO2 showed higher photocatalytic degradation of 2-CP as compared with Degussa P-25 TiO2. Complete degradation of 2-CP was achieved with the InVO4/TiO2 catalyst under optimized conditions (1 g/L catalyst with a pollutant concentration of 50 mg/L at solution pH 5 and irradiation time of 180 min). Comparatively, 2-CP degradation efficiency of 50.5% was achieved with the TiO2 (Degussa P-25) at the same experimental conditions. The study confirmed that InVO4/TiO2 has high potential for degradation of 2-CP from wastewater under visible-light irradiation.

Pt nanoparticles/TiO2 for photocatalytic degradation of phenols in wastewater.

Pt nanoparticles/TiO2 catalysts were prepared and evaluated for UV-photocatalytic degradation ofphenol and 2-chlorophenol (2-CP) in synthetic wastewater solutions. The catalysts were synthesized by immobilizing colloidal Pt nanoparticles onto titanium dioxide (rutile TiO2). Analytical techniques, such as standard Brunauer-Emmett-Teller isotherms, X-ray diffraction, transmission electron microscope, were utillized for investigating the specific surface area, structure, and particle size distribution of the catalysts and its components. The photocatalytic activities of both phenol and 2-CP solutions were studied in a 1L batch photoreactor independently, under 450 W UV irradiation. Samples were drawn at regular intervals and residual concentration of phenol and 2-CP in the samples was analysed using an UV-visible spectrophotometer. Parameters controlling the photocatalytic process, including catalyst concentration, solution pH, and initial phenol (2-CP) concentration, were investigated. The obtained results revealed that Pt/TiO2 showed higher photocatalytic degradation for both phenol and 2-CP pollutants in solution (as compared to the rutile TiO2). The degradation efficiencies of 87.7% and 100% were obtained for phenol and 2-CP, respectively, under optimized conditions (0.5 g/L catalyst with a pollutant concentration of 50 mg/L after irradiation time of 180 min).

Frequency and type of toenail tumors in the dromedary camel.

A total of 275 dromedary camels (16 males and 259 females) of local "Arabiyat" breed suffering from different types and degrees of severity of toenail tumors were surgically treated. Histopathological examination of the tissue samples removed from 50 tumor-like growths (2 males and 48 females) revealed three types of tumors; squamous cell carcinoma (70%), spiny keratoderma (22%) and fibroma (8%). An increased incidence of tumors was recorded in the medial when compared to the lateral toenails in both sexes. In females, the incidence in the medial toenails was 90/259 (34.75%) and 71/259 (27.41%) in the right and left forelimbs respectively when compared to the lateral toenails which was 25/259 (9.65%) and 5/259 (1.93%) for the respective right and left forelimbs. In the hind limbs, this ratio was 29/259 (11.20%) and 20/259 (7.72%) for right and left medial toenails respectively, whereas it was 17/259 (6.56%) and 2/259 (0.77%) for the right and left lateral toenails respectively. Similar to the observations in female camels, male camels also showed a higher incidence of these tumors in the medial when compared to the lateral toenails in both fore and hind limbs. Based on these findings, we conclude that in the dromedary camels, the medial toenails of the fore limbs are most commonly affected with tumors; with the most common tumor being the squamous cell carcinoma.

A successful treatment of a Kenyan case of unresponsive cutaneous leishmaniasis with a combination of pentostam and oral allopurinol: case report.

A nine year aged male presented with facial lesions and the problem of responding to conventional treatment of leishmaniasis. Multiple injections of antimony and several topical ointments had been administered in hospital but fresh lesions erupted with potential to disfigure. Smears examined from nodular lesions confirmed presence of Leishmania amastigotes and parenteral pentostam was commenced for over eight weeks. A partial clinical outcome was achieved judged by extent of re-epithelialisation. Combined therapy of pentostam and oral allopurinol at a dose of 7mg/kg/day was started and finalised at 120 days. All facial lesions receded and 100% re-epithelialisation of the lesions established.

Atypical antipsychotics and seborrheic dermatitis: three case reports.

Seborrheic dermatitis (SD) has no diagnostic criteria and its etiology remains unknown. SD is distributed in the areas rich in sebaceous glands. Initially, MALASSEZIA FURFUR was thought to be the causing agent. Currently, SD is thought as not being proportional to the mean yeast count, but rather as an abnormal host immune response to the yeasts on the skin. There are a variety of topical and systemic antifungal agents available as a remedy. Corticosteroids and ultraviolet B are also used as treatment.

Hypothermic machine perfusion of liver grafts for transplantation: technical development in human discard and miniature swine models.

INTRODUCTION: Cold storage (CS) is the standard preservation technique for liver transplantation (LTx). Hypothermic machine perfusion (HMP) is an alternative preservation technique that provides a continuous supply of substrates and removes waste products. HMP improves early graft function in kidney transplantation, especially for marginal organs: To our knowledge there have been no reports HMP in human LTx. The aim of this study was to develop a reproducible technique for liver HMP prior to initiating a clinical trial. METHODS: For the discard protocol, between May 2001 and March 2002, 10 nontransplantable human livers were obtained. We designed a model of atraumatic, centrifugal HMP of the portal vein (PV) and hepatic artery (HA) via donor vascular conduit. Livers were perfused at 3 degrees C to 5 degrees C with Vasosol solution for 5 to 10 hours using a modified Medtronic Portable Bypass System. Perfusion variables (temp, flow, pressure) where recorded every 30 minutes. During the study, we also validated our techniques in an animal model. For the animal protocol; six swine were used as liver donors and randomized to 12 hours of CS in UW (n = 3) or 12 hours of HMP using Vasosol solution (n = 3). LTx was performed in six swine. Animals survived until postoperative day 5. RESULTS: For the discard protocol, mean HMP time was 6.7 +/- 1.8 hours. Target flow was 0.7 mL/g liver/min. PV and HA pressure ranged from 3 to 5 and 12 to 18 mm Hg, respectively. All grafts were maintained at 3 degrees C to 5 degrees C during HMP. For the animal protocol, all recipients had good liver function and survived to postoperative day 5. AST and TBili were similar between CS and HMP. CONCLUSIONS: Our method of liver HMP appears to be a safe and reliable method to preserve livers. A clinical trial is now underway to evaluate this technique in human LTx.

Effects of reviparin, a low-molecular-weight heparin, on mortality, reinfarction, and strokes in patients with acute myocardial infarction presenting with ST-segment elevation.

CONTEXT: Although reperfusion therapy, aspirin, beta-blockers, and angiotensin-converting enzyme inhibitors reduce mortality when used early in patients with acute myocardial infarction (MI), mortality and morbidity remain high. No antithrombotic or newer antiplatelet drug has been shown to reduce mortality in acute MI. OBJECTIVE: To evaluate the effects of reviparin, a low-molecular-weight heparin, when initiated early and given for 7 days in addition to usual therapy on the primary composite outcome of death, myocardial reinfarction, or strokes at 7 and 30 days. DESIGN, SETTING, AND PATIENTS: A randomized, double-blind, placebo-controlled trial (Clinical Trial of Reviparin and Metabolic Modulation in Acute Myocardial Infarction Treatment Evaluation [CREATE]) of 15,570 patients with ST-segment elevation or new left bundle-branch block, presenting within 12 hours of symptom onset at 341 hospitals in India and China from July 2001 through July 2004. INTERVENTION: Reviparin or placebo subcutaneously twice daily for 7 days. MAIN OUTCOME MEASURE: Primary composite outcome of death, myocardial reinfarction, or stroke at 7 and 30 days. RESULTS: The primary composite outcome was significantly reduced from 854 (11.0%) of 7790 patients in the placebo group to 745 (9.6%) of 7780 in the reviparin group (hazard ratio [HR], 0.87; 95% CI, 0.79-0.96; P = .005). These benefits persisted at 30 days (1056 [13.6%] vs 921 [11.8%] patients; HR, 0.87; 95% CI, 0.79-0.95; P = .001) with significant reductions in 30-day mortality (877 [11.3%] vs 766 [9.8%]; HR, 0.87; 95% CI, 0.79-0.96; P = .005) and reinfarction (199 [2.6%] vs 154 [2.0%]; HR, 0.77; 95% CI, 0.62-0.95; P = .01), and no significant differences in strokes (64 [0.8%] vs 80 [1.0%]; P = .19). Reviparin treatment was significantly better when it was initiated very early after symptom onset at 7 days (<2 hours: HR, 0.70; 95% CI, 0.52-0.96; P = .03; 30/1000 events prevented; 2 to <4 hours: HR, 0.81; 95% CI, 0.67-0.98; P = .03; 21/1000 events prevented; 4 to <8 hours: HR, 0.85; 95% CI, 0.73-0.99; P = .05; 16/1000 events prevented; and > or =8 hours: HR, 1.06; 95% CI, 0.86-1.30; P = .58; P = .04 for trend). There was an increase in life-threatening bleeding at 7 days with reviparin and placebo (17 [0.2%] vs 7 [0.1%], respectively; P = .07), but the absolute excess was small (1 more per 1000) vs reductions in the primary outcome (18 fewer per 1000) or mortality (15 fewer per 1000). CONCLUSIONS: In patients with acute ST-segment elevation or new left bundle-branch block MI, reviparin reduces mortality and reinfarction, without a substantive increase in overall stroke rates. There is a small absolute excess of life-threatening bleeding but the benefits outweigh the risks.

Challenges in the conduct of large simple trials of important generic questions in resource-poor settings: the CREATE and ECLA trial program evaluating GIK (glucose, insulin and potassium) and low-molecular-weight heparin in acute myocardial infarction.

BACKGROUND: Approximately 15.5 million deaths from cardiovascular diseases occur every year. About half are due to acute myocardial infarction (AMI), and 80% occur in low- and middle-income countries. Therefore, low-cost therapies would be invaluable. Although glucose-insulin-potassium (GIK) infusion and low-molecular-weight heparin (LMWH) appear to be promising in AMI, the available trials are inconclusive and these treatments require rigorous evaluation. METHODS: The Clinical Trial of Reviparin and Metabolic Modulation in Acute Myocardial Infarction Treatment and Evaluation-Estudios Clinicos Latino America (CREATE-ECLA) study is a randomized controlled trial in ST-elevation AMI patients evaluating a 24-hour infusion of Glucose-Insulin-Potassium (GIK) intravenous vs usual care (control) on 30-day mortality in 20,000 patients from 21 countries. Patients from India and China (n = 15,000) are also randomized using a factorial design to receive low-molecular-weight heparin (Reviparin) or placebo injection twice daily for 7 days to assess the impact on the composite outcomes of death, reinfarction or stroke (first co-primary outcome) or the composite + refractory ischemia (second co-primary outcome). RESULTS: Twenty thousand two hundred and one (20,201) GIK/control patients and 15,570 Reviparin/placebo patients have been included, with results expected in November 2004. CONCLUSIONS: The CREATE-ECLA trial will provide definitive answers to the role of 2 practical, promising and low-cost therapies, LMWH and GIK, in AMI patients. If effective, these therapies could be used in small medical centers in low- and middle- income countries. The experiences in this trial indicate that large trials of important questions can be successfully conducted in resource-poor settings, by academic groups without industry involvement.

Serum protein electrophoretic pattern in young and adult camels.

OBJECTIVE: To compare the electrophoretic pattern of serum proteins in clinically healthy adult camels (between 3 and 8 years of age) and camel calves (less than 3 months of age). DESIGN: Laboratory analysis of serum from healthy camels. PROCEDURE: Blood was collected from 30 healthy adult camels and 30 camel calves and the serum separated. Total protein of each serum sample was estimated by automated chemistry analyser. The proteins were fractionated by automated electrophoresis on agarose gel. RESULTS: Serum proteins migrated on the agarose gel as one albumin, two alpha (alpha1 and alpha2-globulins), two beta (beta1 and beta2-globulins) and one gamma-globulin fractions. In adult camels the mean concentration of total protein, albumin alpha1, alpha2, beta1, beta2 and gamma-globulins was 56.8 +/- 1.5, 30.7 +/- 0.8, 2.4 +/- 0.1, 3.2 +/- 0.1, 9.7 +/- 0.3, 3.4 +/- 0.2 and 8.6 +/- 0.3 g/L, respectively. These values in calves were 49.7 +/- 1.8, 23.7 +/- 0.8, 3.2 +/- 0.2, 3.1 +/- 0.2, 14.2 +/- 0.2, 4.0 +/- 0.2 and 4.1 +/- 0.2 g/L, respectively. CONCLUSION: The concentration of total proteins, albumin and gamma-globulins was higher (P < 0.05) in the adult camels than in camel calves. The concentrations of beta1 globulins was higher (P < 0.05) in calves as compared to adult camels.