Emergency versus Elective Cervical Cerclage: An Audit of Our First Two Years of Service.

One of the biggest obstetric challenges is the diagnosis and management of a short cervix as cervical length has an inverse relationship with risk of preterm birth. A cervical cerclage is a surgical procedure to reduce the risk of preterm birth and can be placed in an elective or emergency setting. This is a retrospective review of cervical cerclages inserted at an outer metropolitan hospital from February 2014 to May 2017. Since the introduction of the service, a total of 43 patients were identified as requiring a cervical cerclage. Four of these patients were transferred to tertiary hospitals. Of the 39 cerclages inserted, 26 were elective and 13 were emergency, placed at a mean gestation of 15.6 and 19.6 weeks. In total, there were 35 live births, 2 stillbirths, and 2 neonatal deaths. The maternal demographics (age, gravidity, parity, and preterm risk factors) were not statistically significant between the two groups. The mean pregnancy prolongation and birthweight was greater in the elective than the emergency group (21.4 versus 14.1 weeks; 3148.2 versus 2447.2 grams). There was no obvious pattern with which patients received antibiotics pre-, intra-, or postoperatively or received a vaginal swab. This audit identified the need for improvements to guidelines to standardise the use of antibiotics and progesterone in women with a cervical cerclage.

Is technology still a major driver of health expenditure in the United States? Evidence from cointegration analysis with multiple structural breaks.

Using a longer span of available time series data and employing powerful unit root and cointegration tests that allow for multiple structural breaks, developed recently by Carrion-i-Silvestre et al. (Econ Theory 25:1754-1792, 2009), Perron and Yabu (J Bus Econ Stat 27:369-396, 2009), Kejriwal and Perron (J Econ 146(1):59-73, 2008; J Bus Econ Stat 28(4):503-522, 2010a; J Time Ser Anal 31:305-328, 2010b) and Maki (Econ Model 29:2011-2015, 2012), this paper empirically investigates, whether technology continues to be a major driver of real per capita health expenditure, along with some control variables such as per capita income and life expectancy, in the United States, during the period 1960-2012. Specifically, the paper applies the most recent cointegration tests under multiple structural breaks and extends the work of Okunade (J Health Econ 21(1):147-159, 2002) with the possibility whether a linear cointegration model with multiple structural breaks would provide a better economic model to quantify the impact of some major determinants of US real per capita health expenditure. This paper presents evidence to show that per capita real income, technology as indicated by four proxy measures and life expectancy at birth are some major drivers of real per capita health expenditure in the United States. Contrary to the available evidence in the literature, the finding of this paper is that the point aggregate income elasticity of health expenditure estimate is less than one, indicating that health care has evolved to become a necessity in the United States. Policy implications of the empirical findings are discussed in the paper.

Utility of blood pressure genetic risk score in admixed Hispanic samples.

Hypertension is strongly influenced by genetic factors. Although hypertension prevalence in some Hispanic sub-populations is greater than in non-Hispanic whites, genetic studies on hypertension have focused primarily on samples of European descent. A recent meta-analysis of 200 000 individuals of European descent identified 29 common genetic variants that influence blood pressure, and a genetic risk score derived from the 29 variants has been proposed. We sought to evaluate the utility of this genetic risk score in Hispanics. The sample set consists of 1994 Hispanics from 2 cohorts: the Northern Manhattan Study (primarily Dominican/Puerto Rican) and the Miami Cardiovascular Registry (primarily Cuban/South American). Risk scores for systolic and diastolic blood pressure were computed as a weighted sum of the risk alleles, with the regression coefficients reported in the European meta-analysis used as weights. Association of risk score with blood pressure was tested within each cohort, adjusting for age, age2, sex and body mass index. Results were combined using an inverse-variance meta-analysis. The risk score was significantly associated with blood pressure in our combined sample (P=5.65 × 10-4 for systolic and P=1.65 × 10-3 for diastolic) but the magnitude of the effect sizes varied by degree of European, African and Native American admixture. Further studies among other Hispanic sub-populations are needed to elucidate the role of these 29 variants and identify additional genetic and environmental factors contributing to blood pressure variability in Hispanics.

Innate immune factors modulate ethanol interaction with GABAergic transmission in mouse central amygdala.

Excessive ethanol drinking in rodent models may involve activation of the innate immune system, especially toll-like receptor 4 (TLR4) signaling pathways. We used intracellular recording of evoked GABAergic inhibitory postsynaptic potentials (eIPSPs) in central amygdala (CeA) neurons to examine the role of TLR4 activation by lipopolysaccharide (LPS) and deletion of its adapter protein CD14 in acute ethanol effects on the GABAergic system. Ethanol (44, 66 or 100mM) and LPS (25 and 50µg/ml) both augmented eIPSPs in CeA of wild type (WT) mice. Ethanol (44mM) decreased paired-pulse facilitation (PPF), suggesting a presynaptic mechanism of action. Acute LPS (25µg/ml) had no effect on PPF and significantly increased the mean miniature IPSC amplitude, indicating a postsynaptic mechanism of action. Acute LPS pre-treatment potentiated ethanol (44mM) effects on eIPSPs in WT mice and restored ethanol's augmenting effects on the eIPSP amplitude in CD14 knockout (CD14 KO) mice. Both the LPS and ethanol (44-66mM) augmentation of eIPSPs was diminished significantly in most CeA neurons of CD14 KO mice; however, ethanol at the highest concentration tested (100mM) still increased eIPSP amplitudes. By contrast, ethanol pre-treatment occluded LPS augmentation of eIPSPs in WT mice and had no significant effect in CD14 KO mice. Furthermore, (+)-naloxone, a TLR4-MD-2 complex inhibitor, blocked LPS effects on eIPSPs in WT mice and delayed the ethanol-induced potentiation of GABAergic transmission. In CeA neurons of CD14 KO mice, (+)-naloxone alone diminished eIPSPs, and subsequent co-application of 100mM ethanol restored the eIPSPs to baseline levels. In summary, our results indicate that TLR4 and CD14 signaling play an important role in the acute ethanol effects on GABAergic transmission in the CeA and support the idea that CD14 and TLR4 may be therapeutic targets for treatment of alcohol abuse.

Bony Impressions on Caput and Neck of Human Femora in Indian Population

Idiopathic osteoarthritis of the hip has been currently attributed by researchers to the repetitive microtrauma caused to the femoral neck by its impingement against the acetabular rim. This impingement occurs as a result of abnormal morphological traits like Allen’s fossa, Poirier’s Facet, and Posterior Cervical Imprint that appear on the proximal end of femur especially on the neck. Hence, this study was undertaken to investigate the incidence of these traits in the Indian population and to find a correlation between the occurrence of the trait and the side and sex of the bone. The study was conducted on 152 adult dried femora in the Department of Anatomy, Maulana Azad Medical College, New Delhi, India. The positive findings were photographed. The significance of the correlation was found out using Chi-square test. Allen’s Fossa was found to occur in 71.1% of the total bones assessed Poirier’s Facet in 31.6% and Posterior Cervical Imprint in 19.7%. Out of these, a significant side association was found for the Poirier’s Facet with a predominance of the left side. All the traits were found to be more in males with a significant sex variation for Poirier’s Facet. Each trait demonstrated a significant side and gender dimorphism.

Salvadora persica.

Salvadora persica (kharijal) is a large, well-branched, and evergreen shrub or a tree resembling Salvadora oleoides (meethijal) found in the dry and arid regions of India. Chewing sticks have been used for centuries for tooth cleaning, and are recommended by the World Health Organization in areas where their use is customary. Salvadora persica has enormous reported activities. It has potential medicinal and research activities. Salvadora persica is a promising product and is useful to produce antiplaque, analgesic, anticonvulsant, antibacterial, antimycotic, cytotoxic, antifertility, deobstruent, carminative, diuretic, astringent, and also used in biliousness, and rheumatism. This review highlights the pharmacologic effects and therapeutic effects of Salvadora persica. The chemical constituents present in different parts of the plant are also discussed.

The core determinants of health expenditure in the African context: some econometric evidence for policy.

This paper, using cross-sectional data from 44 (83% of all) African countries for year 2001, presents econometric model estimates linking real per-capita health expenditure (HEXP) to a host of economic and non-economic factors. The empirical results of OLS and robust LAE estimators indicate that real per-capita GDP (PRGDP) and real per-capita foreign aid (FAID) resources are both core and statistically significant correlates of HEXP. Our empirical results suggest that health care in the African context is technically, a necessity rather than a luxury good (for the OECD countries). This suggests that the goal of health system in Africa is primarily 'physiological' or 'curative' rather than 'caring' or 'pampering'. The positive association of HEXP with FAID hints that external resource inflows targeting health could be instrumental for spurring economic progress in good policy environments. Most African countries until the late 1990s experienced economic and political instability, and faced stringent structural adjustment mandates of the major international financial institution lenders for economic development. Therefore, our finding a positive effect of FAID on HEXP could suggest that external resource inflows softened some of the macroeconomic fiscal deficit impacts on HEXP in the 2000s. Policy implications of country-specific elasticity estimates are given.

A rare constellation of multiple upper limb anomalies.

We describe an unusual combination of unilateral upper limb variations, including an axillary arch, absence of a "typical" musculocutaneous nerve, direct lateral cord innervation of the muscles usually supplied by the musculocutaneous nerve, variant superficial brachial artery, a high anomalous origin of the common interosseous artery and a superficial ulnar artery noted during routine cadaver dissection. The embryological basis, recent molecular insights concerning such a constellation of anomalies and its clinical relevance are discussed.

Are physician and non-physician providers of outpatient mental healthcare substitutes or complements? a conceptual clarification.

Solving the health care consumers' (producers') utility maximization (cost minimization) problem could entail the substitution of alternative care providers (factor inputs) when the relative out-of-pocket costs (factor prices) change, ceteris paribus. The conceptual advancement in this contribution is illustrated with an earlier paper (P. Deb and A. Holmes, Health Economics 7(4):347-362, 1998) on the economic relationship of physicians (M.D.s) and 'other providers' (Ph.D.s, other) in the US outpatient demand for mental health care services. Many aspects of our conceptual progress are insightful. Foremost, our conclusion on whether M.D. and non-M.D. providers of outpatient mental health care are economic complements or substitutes depends on the alternative measure of the substitution elasticity used. Second, when correctly measured the expenditure-minimizing substitutions among mental health providers can be useful policy decision guides for consumers covered under traditional indemnity insurance with deductibles or managed care plans with user co-payments. Finally, our conceptual clarification should motivate future investigators of health services demand (or use) and cost models to consider a wider conceptual foundation for assessing the structure and implications of provider relationships.

Entrapment of plantaris tendon between the tibial nerve and its branch: a case report

The plantaris muscle arises from the lateralsupra condylar line and the long slender tendonof the muscle descends between the gastrocnemiusand the soleus muscles. The tibialnerve, a branch of the sciatic nerve, is thenerve of the posterior compartment of the leg.The tibial nerve is related superficially to theplantaris tendon, but in the present case wereport an anomalous plantaris tendon that passed between the tibial nerve and its branch to the soleus muscle. Such an entrapment of the plantaris tendon between the tibial nerve and its branch to the soleus is an extremelyrare finding, which is neither reported in standardtextbooks of anatomy nor in any other research report. The pull of the plantaris tendon may press upon the nerve to the soleus,thereby causing compression neuropathy. Also, surgical exploration of the thin plantaris tendon must be carefully performed, especiallywhen it is trapped between the two nerves. Knowledge and awareness of such anomalies may be important for academic, clinical and surgical purposes (AU)

No disponible

Estrogenic and Pregnancy Interceptory Effects of Achyranthes Aspera Linn. Root

Achyranthes aspera Linn. (Amaranthaceae) is an abundant indigenous herb in India. It is traditionally being used as an abortifacient. Four successive solvent extracts of the root were screened for antifertility activity in female albino rats. The chloroform and ethanol extracts exhibited 100anti-implantation activity when given orally at 200 mg/kg body weight. Both the extracts at the dose of 200 mg/kg body weight also exhibited estrogenic activity. Histological studies of the uterus were carried out to confirm this estrogenic activity

Technology as a 'major driver' of health care costs: a cointegration analysis of the Newhouse conjecture.

Per capita real income on the demand-side and technological change, proxied by total R&D and health R&D spending, on the supply-side are hypothesized as major drivers of per capita real health care expenditure in the US during the 1960-1997 period. The findings are robust to a battery of unit root and cointegration tests. They support the Newhouse [Journal of Economic Perspectives 6 (1992) 3] conjecture that technological change is a major escalator of health care expenditure and confirm a significant and stable long-run relationship among per capita real health care expenditure, per capita real income and broad-based R&D expenditures. Policy implications are noted.

Precondylar tubercles on the basiocciput of adult human skulls.

The basiocciput of 265 Indian adult human skulls was examined for precondylar tubercles, which are single or paired osseous formations anterior to the occipital condyles and foramen magnum. Of the 14% of skulls displaying these tubercles unilaterally or bilaterally, 5.3% demonstrated ridges, 4.9% showed spines and 3.8% exhibited processes. Sexual dimorphism was evident with female skulls showing a higher incidence (8.7%) compared with male skulls (5.3%). The corresponding atlas vertebrae were normal. These craniovertebral anomalies may have clinical relevance for lesions at the foramen magnum.

Cytogenetic evaluation of medical students exposed to formaldehyde vapor in the gross anatomy dissection laboratory.

Formaldehyde (FA) is a potential carcinogen and mutagen. In addition to inducing genotoxic effects in subhuman laboratory tests, FA has been found to be mutagenic to cultured human cells. Evidence regarding the genotoxic potential of FA on exposed individuals at occupational levels is insufficient and conflicting. The authors of this study examined chromosomal aberrations in peripheral blood lymphocytes from a group of 30 medical students exposed to FA for 15 months in a gross anatomy dissection laboratory. The results were compared with similar analyses from 30 off-site, matched, unexposed controls. At average exposures of less than 1 ppm, 72-hour lymphocyte cultures of the study cohort did not reveal any difference in the incidences of chromosomal aberrations among the exposed and the control group by conventional Giemsa staining and G-banding.

Absence of foramen transversarium in the human atlas vertebra: a case report.

Anatomical texts allude to many variations in the foramen transversarium of the seventh cervical vertebra, including its absence, but absent foramen transversarium of the atlas vertebra has not been mentioned. This is the case report of an atlas vertebra, the transverse process of which did not exhibit this foramen on the left side. However, the groove for the vertebral artery was present bilaterally on the posterior arch. The possible factors responsible for this interesting variant are discussed.

Evaluation of a dual-antigen ELISA test for the serodiagnosis of tuberculosis.

Two antigen preparations from Mycobacterium tuberculosis and M. bovis, respectively, were used in an enzyme-linked immunosorbent assay (ELISA) to quantitate the level of IgG antibodies in samples of 169 sera obtained in India from 75 patients with pulmonary tuberculosis and from 94 controls. The results of the two ELISA tests were integrated using defined criteria. All the controls were correctly classified by this dual-ELISA approach and only two patients were categorized as false negatives. The method has a specificity of 1.00 and a sensitivity of 0.974, while the gain in the certainty of diagnosis was 1.974, only slightly less than the ideal value of 2.00.