bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative study of four candidate strategies to detect cervical cancer in different health care settings
Authors: Kamal Meherbano M. , Sapkal Rekha U. , Sarodey Chhaya S. , Munshi Maitreyee M. , Alsi Yamini D. , Chande Mrudul A. , Hingway Sneha R. , Dandige Seema , Kane Utpala S. , Kshirsagar Ragini , Tangsale Madhvi , Zodpey Sanjay , Patel Archana B. , Mamtani Manju , Kulkarni Hemant
Published: August 2007

Aim:  Considering the differing but potentially supplementary properties of visual inspection of the cervix with acetic acid (VIA) and the cytological examination (CYTO) of cervical smears for the screening of cervical cancers, we examined the performance of these two tests and their combinations for the screening of cervical cancer in different health care settings.

Methods:  In this cross‐sectional diagnostic test performance evaluation study of 4235 female subjects in the reproductive age group, we assessed the screening performance of four strategies: VIA alone, CYTO alone, VIA and CYTO combined in a parallel fashion, and VIA and CYTO combined in tandem. Subjects were recruited from three settings: Hospital, Urban Community and Rural Community. Colposcopy was used as the reference standard. Screening performance was assessed using sensitivity, specificity, post‐test probabilities and likelihood ratios (LR), diagnostic odds, area under receiver operating characteristic curve and LR χ2.

Results:  Both VIA and CYTO when used alone had a low sensitivity but high specificity, especially in the Rural Community setting. A combination of the results of VIA and CYTO improved the diagnostic accuracy but the strategy using a parallel combination of VIA and CYTO was the most accurate. In general, all screening strategies using VIA and CYTO showed a modest screening performance.

Conclusions:  In the settings of varying levels of health care and low resources, caution is needed for a generalized use of VIA for cervical cancer screening. Further evaluation of the cost‐effective ways of combining VIA and CYTO is needed in these circumstances.
Does a change in obstetric management influence the incidence of traumatic birth lesions in mature, otherwise healthy newborn infants?
Authors: Zeck Willibald , Haas Josef , Rossegger Helfried , Bjelic Vesna , Schöll Wolfgang
Published: August 2007

Aim:  The incidence of lesions due to birth trauma can be generally regarded as a characteristic of obstetric management; since obstetric management has changed through the years, one might expect a decrease or increase of lesions due to birth trauma in mature newborn infants.

Methods:  In a retrospective study, the incidence of lesions due to birth trauma was recorded in the year 2000. In 1989, an identical study had already been carried out in the same department, employing the same criteria. The new findings were compared with the historical data.

Results:  In the year 1989 24.6% and in 2000 13.2% showed lesions due to obstetric trauma. The episiotomy rate and lesions due to birth trauma had significantly decreased. A decline regarding the traumas per se was noticed in caput succedaneum traumas, in hematomas due to birth trauma and in clavicle fracture. The cesarean section rate among the study group increased. The cesarean section rate among the traumatized newborns decreased.

Conclusion:  Episiotomy does not prevent newborns from traumatic lesions. Gestational age and birthweight have not significantly changed throughout the years; therefore an increase in the cesarean section rate must have contributed to the decrease of birth traumas. Even during abdominal operative delivery, obstetric traumas in newborns do occur. However, an increase in cesarean sections alone can not thoroughly explain the reduction of birth lesion among newborns. Improvement in prenatal diagnostic tools and procedures, respectively, and a goal‐oriented use of labor induction might also play a major role.
Surgical morbidity associated with total laparoscopic hysterectomy in women with prior diagnostic excision of the cervix
Authors: Phongnarisorn Chailert , Srisomboon Jatupol
Published: August 2007

Aims:  To evaluate the feasibility, safety, and complications of total laparoscopic hysterectomy (TLH) in women undergoing prior diagnostic excision of the cervix.

Methods:  A retrospective study (Canadian Task Force classification II‐2) was conducted in a tertiary care university hospital. The medical records of women undergoing TLH between June 2003 and September 2004 were reviewed.

Results:  Twenty‐six women with stage IA1 cervical cancer (19) and persistent high grade cervical neoplasia (7) underwent TLH after diagnostic cervical excision. The operation was successfully performed in all cases without conversion to laparotomy. The mean age of the patients was 47.0 ± 8.64 years (95% CI 43.5–50.5). 19 patients had previous loop electrosurgical excision procedure (LEEP), one had cold knife conization. Six patients underwent repeated LEEP for positive endocervical margin. The mean operating time was 253.0 ± 66.7 min (95% CI 226.0–279.9). The median blood loss was 300 mL (range 50–1000 mL). Only one patient needed 1 unit of blood transfusion. The median post‐operative hospital stay was 3 days (range 2–6 days). All hysterectomy specimens had negative surgical margins. Two patients had major complications, one with bladder injury requiring laparoscopic repair. The remaining one had ureteral injury detected 9 days after the operation requiring subsequent ureteroneocystostomy. Both complications occurred in the first four cases of this series. No significant morbidity was noted in 2 years of follow‐up.

Conclusion:  TLH appears to be feasible and safe in patients with prior diagnostic excision of the cervix. Careful separation of the bladder from the cervix and identification of both ureters are recommended to minimize morbidity associated with this operation.
Cytokine profiles in serum and peritoneal fluid from infertile women with and without endometriosis
Authors: Kalu Emmanuel , Sumar Nazira , Giannopoulos Theodoros , Patel Pinika , Croucher Carolyn , Sherriff Elizabeth , Bansal Amolak
Published: August 2007

Objective:  To study the serum and peritoneal fluid cytokine profiles in infertile women with minimal/mild active endometriosis.

Methods:  Fifty‐seven consecutive infertile women undergoing laparoscopy for unexplained infertility had peritoneal fluid and serum samples obtained at the time of laparoscopy. The levels of interleukin‐6 (IL‐6), interleukin‐8 (IL‐8), interleukin‐1 beta (IL‐1 β), vascular endothelial growth factor (VEGF), tumor necrosis factor‐alpha (TNF‐α), monocyte chemotatic protein‐1 (MCP‐1), RANTES, platelet derived growth factor (PDGF), soluble Fas (sFas), and soluble Fas Ligand (sFasL) in peritoneal fluid and serum were measured to compare the concentration in both biological fluids, in women who have minimal/mild red endometriosis using women with no endometriosis as controls.

Results:  Peritoneal fluid levels of MCP‐1, IL‐8 and IL‐6 were significantly higher in the endometriosis group (P < 0.012, P = 0.003, and P = 0.015, respectively). There was no significant difference in the peritoneal fluid levels of IL‐1 β, TNF‐α, RANTES, VEGF, PDGF, sFas and sFasL in the two groups. Although serum levels of IL‐8 were higher in women with endometriosis, the difference was not significant (P = 0.07). Serum levels of PDGF, IL‐6, RANTES, IL‐1 β, TNF‐α, and sFas, were not significantly different in the two groups.

Conclusion:  The elevated levels of MCP‐1, IL‐6, and IL‐8 in peritoneal fluid but not serum may indicate the importance of local macrophage activating factors in the pathogenesis of endometriosis.
Massive pericardial effusion in an early gestational fetus having intrapericardial diaphragmatic hernia
Authors: Hara Kikue , Kikuchi Akihiko , Takagi Kimiyo , Kaneko Sachie , Yasukochi Satoshi , Ogiso Yoshifumi
Published: August 2007

Intrapericardial diaphragmatic hernia is a very rare phenotype of congenital diaphragmatic hernia. Twelve cases of this condition have been reported under the age of 1 year since 1981, and in only four cases were abnormal findings observed antenatally. We report a case of a fetus with this disease in which pericardial effusion was noted in an earlier gestational age than any other previously reported cases. A 35‐year‐old pregnant woman was referred to our center at 16 weeks' gestation. Ultrasound revealed that the bilateral lungs of the fetus were very small due to the compression by massive pericardial effusion. Pregnancy was terminated at 18 weeks, and autopsy of the stillborn baby revealed intrapericardial diaphragmatic hernia and cardiac aneurysm of the right ventricle. In conclusion, when pericardial effusion is observed in a fetus, intrapericardial diaphragmatic hernia, a very rare type of congenital diaphragmatic hernia, must be included in a differential diagnosis.
Dichorionic twin fetuses with VACTERL association
Authors: Sunagawa Sorahiro , Kikuchi Akihiko , Yoshida Shiro , Miyashita Susumu , Takagi Kimiyo , Kawame Hiroshi , Kondo Yoshiaki , Nakamura Tomohiko
Published: August 2007

Although prenatal diagnosis of VACTERL (vertebral defects, anal atresia, cardiac anomaly, tracheal‐esophageal fistula with esophageal atresia, renal defects, and radial limb dysplasia) association is not always possible, ultrasonography and magnetic resonance imaging can visualize some of the characteristic findings of this condition. Because infants with this condition usually require significant surgical treatment and care, prenatal detection with those imaging modalities should assist in proper planning for delivery and anticipated care of the neonate. In this report, we present dichorionic twin fetuses, both of whom were found postnatally to have this condition, and suggest the possible relationship between this disorder and intracytoplasmic sperm injection. As far as we know, this is the first report of twin fetuses affected by VACTERL association.
Nitric oxide donor isosorbide mononitrate for pre‐induction cervical ripening at 41 weeks' gestation: A randomized controlled trial
Authors: Rameez Mohamed Furukan Mohamed , Goonewardene Indra Malik Rodrigo
Published: August 2007

Objective:  Nitric oxide donors have been shown to cause cervical ripening. The aim of this study was to determine whether sustained release isosorbide mononitrate (ISMN‐SR) 60 mg administered vaginally is effective for pre induction cervical ripening at 41 weeks' gestation.

Methods:  A double‐blind randomised controlled trial was carried out at the University Obstetric Unit, Galle, Sri Lanka for a period of 9 months, commencing 1st August 2003. One hundred and fifty‐six consecutive women with uncomplicated singleton pregnancies at 41 weeks' gestation with a modified Bishop Score <5 were allocated by stratified (primip/multip) block randomization to receive either ISMN‐SR 60 mg (n = 78) or vitamin C 100 mg (n = 78) vaginally. Modified Bishop Score at 41 weeks + 2 days' gestation and the proportions establishing spontaneous labor or becoming favorable for induction of labor (IOL) by 41 weeks + 2 days' gestation were evaluated in each group.

Results:  At the commencement of the study there were no differences between the mean age, parity or modified Bishop Score of the two groups. In the ISMN‐SR group, there was a marked increase in the proportion establishing spontaneous labor (28% vs 7.5%, P < 0.01) and being favorable for IOL (40% vs 9% P < 0.001), 2 days after therapy. In the ISMN‐SR group, there was a significantly higher increase in the mean modified Bishop Score (3.8, 95% CI 2.3–5.3 vs 1.3, 95% CI 0.3–2.2, P < 0.01) and a marked decrease in the proportion of subjects requiring further ripening of the cervix with a Foley catheter. (32% vs 79%, P < 0.001). The cesarean section rates were similar in both groups.

Conclusion:  Sustained release ISMN administered vaginally is effective for preinduction cervical ripening.
Mixed epithelial and stromal tumor of the kidney in a puerperal woman
Authors: Sharma Jai Bhagwan , Aruna Janaki , Mittal Suneeta , Sharma Meher Chand
Published: August 2007

Puerperal pyrexia is still rampant, especially in third world countries, and is usually due to puerperal sepsis, urinary tract infections, upper respiratory infection, and breast infection. Rarely, in third world countries like India, it may be due to tuberculosis, malaria, typhoid, and so on, which are also rampant in the general population. Mixed epithelial and stromal tumor of the kidney (MESTK) is a recently recognized subset of renal tumors composed mainly of smooth muscle cells in which epithelial structures are embedded. It usually occurs in middle aged and older women. In the present case report, a 36‐year‐old woman presented with puerperal pyrexia, possibly due to tuberculosis and with an incidental mixed epithelial and stromal tumor of the kidney causing complex ascitis and fever, which required nephrectomy that was followed by full recovery. This case report highlights the importance of keeping MESTK in mind even in younger women with asymptomatic renal mass. It also highlights the importance of keeping renal tumors in mind as a possibility and to perform proper investigations for adequate treatment and recovery.
Total vaginal reconstruction with combined ‘Split Labia Minora Flaps’ and full‐thickness skin grafts
Authors: Baytekin Caghan , Menderes Adnan , Mola Fahri , Balik Ozan , Tayfur Volkan , Vayvada Haluk
Published: August 2007

Purpose:  Vaginal reconstruction with split‐thickness skin grafts is the most common method for total vaginal reconstruction. Although it has disadvantages like contraction of the graft, foreshortening, donor site morbidity and long‐lasting periods of vaginal standing; its easy surgical technique makes it popular. A new method using split labia minora (LM) flaps and full‐thickness skin graft is discussed in this study.

Method:  A 19‐year‐old female was presented with amenorrhea. A total absence of vagina was present and the patient underwent a total vaginal reconstruction for possible sexual intercourse.

Results:  We observed no contraction and no foreshortening with a patent vaginal cavity up to 11 cm and 4.5 cm width. The need for continuous standing period was as short as 4 weeks and for intermittent standing up to 4 months. Sexual intercourse was encouraged after 4 weeks. During sexual intercourse no external lubrication was reported to be needed. There was no need for further reconstructive intervention.

Conclusion:  Vaginal reconstruction in congenital vaginal agenesis with split LM flaps and full‐thickness skin grafts is a simple and effective method, which shortens the standing period and decreases the contraction in neovagina. Total vaginal reconstruction with split LM flaps could also be possible; to achieve this goal, expansion of LM flaps could be a further alternative.
Retrospective study of the success rates and complications associated with total laparoscopic hysterectomy
Authors: Ng Christopher C. M. , Chern Bernard S. M. , Siow Anthony Y. M.
Published: August 2007

Aims:  Laparoscopic techniques are being used increasingly more in gynecologic surgery and the introduction of modern laparoscopic instruments has allowed complex operations to be performed laparoscopically. The aim of this study is to evaluate our surgical technique with regard to the success of total laparoscopic hysterectomy (TLH) for the removal of the uterus, by analyzing its intraoperative and postoperative surgical outcomes and complications in the hope of reducing their occurrence.

Methods:  A retrospective observational study was carried out at KK Hospital, Singapore, based on TLH operations performed from January 2001 to June 2005. The KOH Colpotomizer System and the RUMI Uterine Manipulator were the surgical methods used.

Results:  435 women consented for a TLH. 427 women (98.2%) had a successful TLH with three mini‐laparotomy and five laparotomy conversions (1.8% failure rate). Injuries included bowel injury (four), bladder base bleeding (one), uterine perforation (one), uterovaginal fistula (one) and vaginal laceration (four). 21 women (4.8%) encountered major complications (defined as laparotomy conversion, excessive bleeding requiring blood transfusion, hemorrhage ≥1000 mL, ureteric injury, bowel injury and pulmonary embolus), which compares favorably with previous reports (4.0–11.0%) of laparoscopic hysterectomy. Our mean operating time, mean estimated blood loss, mean hospital stay and readmission rate are similarly comparable.

Conclusion:  TLH is associated with a high success rate, and low morbidity with few complications.
Hypersensitivity to aeroallergens in patients with recurrent vulvovaginitis of undetermined etiology
Authors: Ozturk Sami , Caliskaner Zafer , Karaayvaz Mehmet , Dede Murat , Gulec Mustafa
Published: August 2007

Aim:  Recent findings show that the vaginal mucosa can develop an allergic response to environmental allergens and there is a strong association between atopy and some recurrent vulvovaginal infections. In this study, we investigated prospectively the rate of atopy in patients with recurrent vulvovaginitis of undetermined etiology (RVV).

Material and Methods:  After being investigated by a gynecologist, 35 patients with RVV who were considered as undetermined etiology formed the study group. The control group consisted of 150 healthy females. Study and control groups were investigated for atopy by means of skin prick test for common aeroallergens. Associated allergic disease and familial atopy history of the subjects were recorded.

Results:  The rate of atopy (11/35; 31.4% vs 9/150; 6%) was significantly higher (P < 0.001) in the study group than in the controls. Familial history of atopy was significantly more frequent in the study group than in the controls (10/35; 28.6% vs 8/150; 5.3%, P < 0.05). RVV in atopics is more associated with seasonal rhinitis than in nonatopics (5/11; 45.4% vs 2/24; 8.3%, P < 0.05).

Conclusion:  We concluded that a significant number of RVV is associated with atopy. Although the exact mechanism(s) of this relationship remains to be investigated atopy might be a causative and/or contributing factor in the pathogenesis of RVV.
Ligneous inflammation involving the female genital tract
Authors: Karaer Abdullah , Mert Ismail , Akınsu Filiz , Tug Mengu , Tefs Katrin , Schuster Volker , Mollamahmutoglu Leyla
Published: August 2007

Ligneous inflammation is a rare disease characterized by progressive growth of ligneous plaques on mucosal surfaces. Involvement of the female genital tract is an unusual condition. We present a patient with multifocal ligneous inflammation involving her genital tract, oral mucosa and conjunctiva. Plasminogen functional activity was 18% of normal (reference: 55–145%). Molecular analysis exhibited that her genetic status is homozygous for a combination of three polymorphisms. But no true mutation could be found in all 19 exons of the plasminogen gene. We did not observe any clinical changes, although plasminogen activity has improved in the course of 5 months of oral contraceptive therapy Most gynecologists are unfamiliar with this diagnosis and pathologists with wide experience in gynecology are unaware of this disease. However, the histology of lesions is characteristic and a diagnosis can be made quite easily once it has been considered.
Impact of use of combined oral contraceptive pill on the quality of life of Japanese women
Authors: Matsumoto Yasuyo , Yamabe Shingo , Ideta Kazuhisa , Kawabata Masato
Published: August 2007

Aim:  To evaluate the impact of combined oral contraceptive pill (OC) use on quality of life (QOL) among Japanese women, we performed a prospective study using the Japanese version of the World Health Organization Quality of Life (WHOQOL) questionnaire.

Methods:  Women who consulted Chayamachi Lady's Clinic to get a prescription for OC for the first time were recruited for our questionnaire study and asked to complete the WHOQOL questionnaire twice, before taking OC and more than 3 months after beginning OC use. Two hundred and seventeen women responded to our questionnaire before taking OC and 110 patients completed the questionnaire. The patients were divided into six groups based on the reason they wanted to take OC: contraception, relaxation of dysmenorrhea, regulation of menstrual cycles, improvement of acne, remission of menorrhagia, and improvement of premenstrual tension syndrome (PMS).

Results:  WHOQOL scores showed significant improvement in all domains of the dysmenorrhea group, all domains but the social of over all participants, the social and overall domain of the irregular cycle group, physical, environmental, and overall domain of the acne group, and psychological and overall domain of the PMS group. The WHOQOL score worsened in the social domain of the contraception group; however, the score in the overall domain of that group improved.

Conclusions:  These results indicate that OC can provide higher QOL for women with problems involving menstrual pain and/or hormonal abnormalities. However, those using OC for contraception only were found to be unsatisfied with taking OC in a relationship with their partners.
Re‐evaluation of the true rate of hepatitis C virus mother‐to‐child transmission and its novel risk factors based on our two prospective studies
Authors: Hayashida Ayako , Inaba Noriyuki , Oshima Kyoko , Nishikawa Masayoshi , Shoda Akiko , Hayashida Shihou , Negishi Masami , Inaba Fujiyuki , Inaba Michiyo , Fukasawa Ichio , Watanabe Hiroshi , Takamizawa Hiroyoshi
Published: August 2007

Objective:  To re‐evaluate the true hepatitis C virus (HCV) mother‐to‐child transmission (MTCT) rate and its novel risk factors.

Study Design:  A comparative study based on our own two prospective studies done during the two periods, ‘early’ (1989–1994) and ‘recent’ (1995–2004).

Results:  All carrier infants became HCV RNA‐positive within 3 months after birth. The MTCT and de‐carrier rates were, respectively, higher (14.2%) and lower (16.7%) in the recent period, although liver dysfunction of carrier infants was found very frequently (66.7%) in both groups. MTCT occurred significantly when the maternal viral load, serum alanine aminotransferase (sALT) levels and blood loss at delivery were, respectively, more than 105 copies/mL, 110 IU/L, and 500 g. No MTCT was found when elective cesarean section was done.

Conclusions:  The true HCV MTCT and de‐carrier rates were found to be much higher and lower than those reported previously. The maternal liver dysfunction (sALT ≥110 IU/mL) and blood loss (≥500 g) at delivery are the next risk factors to maternal viral load (≥105 copies/mL) for MTCT.
Implementation of the Uniform Donor History Questionnaire across the American Red Cross Blood Services: increased deferral among repeat presenters but no measurable impact on blood safety
Authors: Zou Shimian , Eder Anne F. , Musavi Fatemeh , Notari Iv Edward P. , Fang Chyang T. , Dodd Roger Y. ,   ARCNET Study Group
Published: August 2007

BACKGROUND: The Uniform Donor History Questionnaire (UDHQ) was implemented across the American Red Cross Blood Services in 2005. This study assessed the potential impact of changes inherent in UDHQ implementation on deferral and on prevalence of infectious disease markers among donated units.

STUDY DESIGN AND METHODS: Deferral and donation records were extracted and analyzed for the period of April 1, 2005, to September 30, 2005, after the implementation of the UDHQ and for the same period in the previous year. For comparison, most of the questions in the UDHQ were aligned with corresponding questions in the previous questionnaire, although such alignment could not be exact because of changes in the wording and organization of the questions.

RESULTS: From 2004 (1 year previously) to 2005 (UDHQ), significant changes in deferral rate were observed for different groups of deferral questions, with the largest being +99.2 percent for “man who had sex with another man” and +92.0 percent for “receipt of blood, tissue, organ, or clotting factor concentrates or a bleeding condition or a blood disease” among repeat presenters. Changes to the educational material and the wording of questions, elimination of compound questions, and other concurrent changes could have contributed to the changed deferral rates. There was no significant change in prevalence rates of major infectious disease markers.

CONCLUSIONS: Implementation of the UDHQ impacted on donor deferral, including increased deferral among repeat presenters. No significant impact was observed for infectious disease marker rates. Further monitoring for longer‐term trends is recommended.
Review of dyspnoea quantification in the emergency department: Is a rating scale for breathlessness suitable for use as an admission prediction tool?
Authors: Saracino Amanda
Published: August 2007

Acute shortness of breath is a potential marker of serious cardiopulmonary disease and requires rapid assessment. In our current health‐care system, increasing pressure on the ED to limit costs and waiting times has resulted in the development of many clinical decision aids and admission prediction tools designed to assist ED physicians in meeting these demands. However, most of these tools are disease specific, and none are currently available for application to patients presenting to the ED with shortness of breath. Although somewhat limited, current evidence supports the utilization of a simple dyspnoea rating scale, to assist in the streamlining of clinical severity assessments and urgency evaluations, and to potentially provide useful information to facilitate rapid and accurate site‐of‐care decisions in this setting.
Investigation of the rate of meningitis in association with urinary tract infection in infants 90 days of age or younger
Authors: Vuillermin Peter J , Starr Mike
Published: August 2007

Objective:  To test the hypothesis that urinary tract infections (UTI) in young infants are rarely associated with meningitis.

Methods:  We undertook a review of the laboratory results from 322 infants, 90 days of age or younger, with an admission or discharge diagnosis of UTI or meningitis. The study was conducted in a tertiary paediatric hospital. The primary outcome measure was the incidence of coexisting urinary tract and cerebrospinal fluid sepsis.

Results:  In total, 161 of the 322 (50%) infants with an admission or discharge diagnosis of UTI or meningitis were subsequently shown to have a culture‐proven UTI. Of the children with a culture‐proven UTI, 75 (47%) had cerebrospinal fluid obtained. We detected one case of probable bacterial meningitis in association with UTI.

Conclusion:  UTI is rarely associated with meningitis in infants 90 days of age or younger.
Identifying severe community‐acquired pneumonia in the emergency department: A simple clinical prediction tool
Authors: Buising Kirsty L , Thursky Karin A , Black James F , MacGregor Lachlan , Street Alan C , Kennedy Marcus P , Brown Graham V
Published: August 2007

Objective:  To identify independent predictors of severe pneumonia in a local population, and create a simple severity score that would be useful in the ED.

Methods:  Data on the clinical features of patients presenting to hospital with community‐acquired pneumonia were collected. Multivariate logistic regression was used to identify independent predictors of death, requirement for ventilatory or inotropic support, and these combined. These predictors were used to modify an existing severity score, and its performance was tested in a second cohort of patients.

Results:  A total of 392 patients in the derivation, and 330 in the validation cohorts. Independent predictors of ‘death and/or requirement for ventilatory or inotropic support’ were: systolic blood pressure (BP) <90 mmHg (OR 3.49 [95% CI 1.12–10.38]); acute confusion (OR 5.48 [95% CI 2.74–10.99]); oxygen saturations ≤90% (OR 3.49 [95% CI 1.77–6.89]); and respiratory rate ≥30/min (OR 2.65 [95% CI 1.35–5.21]). Age >65 years was not an independent predictor in this patient group (OR 0.52 [95% CI 0.23–1.16]). This information was used to propose that severe pneumonia could be predicted by two or more of: acute confusion; oxygen saturations ≤90%; respiratory rate ≥30/min; and either systolic BP <90 mmHg; or diastolic BP ≤60 mmHg. In a separate cohort, the performance of this score was similar to other tools.

Conclusion:  This provides a practical tool that can be used to ‘flag’ impending patient demise. Its advantages are that it is simple, uses predictive variables, does not require invasive testing, and removes bias regarding patient age. Like other tools, its accuracy is not perfect, and it should only be used to augment clinical judgement.
Accuracy of ECG electrode placement by emergency department clinicians
Authors: McCann Kelly , Holdgate Anna , Mahammad Rima , Waddington Adam
Published: August 2007

Objectives:  Misplaced ECG electrodes can cause changes in ECG recordings, which could have an impact on clinical decisions. We aimed to determine the inter‐rater reliability of ECG electrode placement by senior clinical staff in the ED.

Methods:  A prospective observational study was conducted in adult patients undergoing an ECG as part of their routine ED care. Adhesive electrodes were left in place after an ECG had been performed by the treating nurse, and subsequently each patient was assessed by two of the three investigators. Each investigator independently recorded the location of the chest electrodes relative to the recommended standard positions. Displacement of the electrodes from the standard positions was measured in the vertical and horizontal planes. The age, sex, weight, height and chest circumference was also recorded. Comparisons were made between investigators to determine variability in assessment of the standard positions.

Results:  Measurement of horizontal and vertical displacement for each of the six chest leads in the 77 patients resulted in 924 paired measurements. There was substantial inter‐rater variation in the measurement of both vertical (mean 13.5 mm, range 0–105 mm) and horizontal (mean 16.5 mm, range 0–120 mm) displacement. This variation was greater in the lateral chest leads and was more marked in women than in men, especially in the vertical plane (lead V6: men 14.5 mm vs women 27.0 mm, P < 0.01).

Conclusion:  Among clinical ‘experts’, there is wide variation in the identification of the correct location for electrode placement, particularly in the lateral leads and in women. This has significant implications when comparing ECG in which electrodes have been placed by different clinicians.
Trauma team radiation exposure: The potential need for dosimetry monitoring
Authors: Ittimani Mana , Goozée Gary , Manovel Alvaro , Holdgate Anna
Published: August 2007

Objectives:  Australian radiation regulations require routine monitoring of health‐care workers who might receive a whole‐body effective radiation dose in excess of 1 mSv/year. In Australian hospitals, routine monitoring with a dosimeter is recommended for levels beyond 300 μSv/year. We aimed to determine the potential radiation exposure to trauma team members and whether routine personal radiation dosimetry should be recommended.

Method:  An anthropomorphic mannequin with a radiation detector was placed at five locations around the resuscitation bed. Three sets of standard trauma‐series X‐rays were performed, and the exposure was measured and averaged at each location. These data were then extrapolated to estimate the potential radiation equivalence at the level of the thyroid gland for staff working in each of the locations over a 1 year period with and without personal protective equipment.

Results:  The total dose ranged from 1.2 to 20.5 μSv for a single trauma patient. The highest recorded dose was at the location of the circulation doctor during pelvic X‐ray. Based on these data, it would take only 15 trauma patients per year for a team member to be potentially exposed to the level at which routine dosimetry is usually recommended, should no personal protective equipment be used. The use of a lead gown and a lead gown with a thyroid collar reduced exposure by four‐ and ninefold, respectively.

Conclusions:  We have demonstrated the possibility of significant ionizing radiation exposure for unprotected trauma team members. Dosimeter use by trauma team personnel needs to be reviewed based on local protocols and patient numbers.
Follow‐up phone calls increase nutrient intake estimated by three‐day food diaries in 13‐year‐old participants of the Raine study
Authors: CANDILO Kathryn D.I. , ODDY Wendy , MILLER Margaret , SLOAN Nick , KENDALL Garth , KLERK Nicholas D.E.
Published: August 2007

Aim:  Our primary objective was to determine the effect of follow‐up phone calls on estimated nutrient intakes obtained by three‐day food diaries from 13‐year‐old adolescents.

Methods:  Food diaries were recorded using household measures and entered into a dietary analysis software program, before and after follow up by telephone. A sample of 340 participants aged 13 years born into the Western Australian Pregnancy Cohort (Raine) Study, a population‐based longitudinal cohort followed from 16 to 20 weeks' gestation to 13 years of age (current follow up). After face‐to‐face instruction, participants completed three‐day food diaries at home and returned them by post. Follow‐up telephone calls were made to each participant to improve data collection response and to verify missing details in the food diaries. Nutrient intakes before and after telephone follow up were compared using Student's t‐tests in spss. Results were also compared with those of the Child and Adolescent Physical Activity and Nutrition survey.

Results:  Follow‐up phone calls significantly increased the estimated intake of total kilojoules, water, total carbohydrates, sugars and magnesium (P < 0.05).

Conclusion:  These results indicate the importance of follow‐up phone calls to obtain missing details in three‐day food diaries completed by adolescents.
Deficiencies in nutritional intake in patients admitted with diabetes‐related foot complications
Authors: PITT Sarah , MAY Kerry , COLMAN Peter , WRAIGHT Paul
Published: August 2007

Aim:  Adequate nutritional intake is an essential component for timely wound healing. The present research aimed to identify the frequency of inadequate dietary intake, including the specific nutritional elements most frequently lacking, in a group of patients admitted with diabetes‐related foot complications.

Methods:  Consecutive patients admitted to a diabetic foot unit underwent a dietary assessment, which included the retrospective collection of a seven‐day food history for the period just prior to admission. The collected data were entered into FoodWorks, and comparisons were made with recommendations made by national guidelines.

Results:  Thirty‐five patients underwent nutritional assessment, 74% male and 26% having impaired renal function. Protein consumption was in excess of daily recommended intake, and although the overall fat intake as a percentage of total calories consumed was in keeping with national guidelines, the intake of saturated fat was inappropriately high. Of the 12 micronutrients assessed, niacin and vitamin C were appropriately consumed by all; average intake of potassium, phosphorus and thiamine approached recommended levels, while the intake of magnesium, calcium, zinc, riboflavin, folate and vitamin A all fell short of recommended daily requirements. No dietary differences were identified between individuals with normal and abnormal renal function, but deficiencies in calcium and iron were identified only in women.

Conclusion:  Dietary deficiencies of macronutrients were not identified in individuals admitted with diabetes‐related foot complications, but many patients were found to be consuming well below the daily recommended daily intake of one or more of the micronutrients deemed necessary for normal wound healing.
Body mass and fatness of Japanese college women and relationship to place of residence
Authors: SUZUKI Masatoshi , MURASHIMA Megumi , HOERR Sharon L.
Published: August 2007

Aim:  The objectives of the present study are to examine prevalence of overweight, underweight, and overfat and underfat in Japanese college women and to determine if and how living arrangements during college were related.

Methods:  During 1997–2004, 1757 female college students (18–23 years) in an urban city in Japan were measured for height, weight and body fatness. They completed a demographic questionnaire identifying place of residence.

Results:  Nearly three times as many women were underweight as were overweight from 1997 to 2004, but 33.8% were overfat and only 1.8% underfat. The mean percentage body fat (25.6 ± 5.2%) was similar to that of other similarly aged Japanese college women, but exceeded that of Japanese teenagers and young adults in several other studies. Despite no difference in BMI by place of residence, those students who lived alone in an apartment or lived in a dormitory had significantly higher percentage of body fatness (n = 493, 26.1 ± 5.6% vs. n = 577, 25.7 ± 5.1%, respectively) compared with those living with their family (n = 524, 24.8 ± 4.7%).

Conclusions:  The high prevalence of underweight in college women concurrent with increasing body fatness might be cause for concern. Women who lived alone had the highest adiposity.
Mini Nutritional Assessment in geriatric rehabilitation: Inter‐rater reliability and relationship to body composition and nutritional biochemistry
Authors: NEUMANN Sonja A. , MILLER Michelle D. , DANIELS Lynne A. , AHERN Michael , CROTTY Maria
Published: August 2007

Aim:  To determine the inter‐rater reliability of the Mini Nutritional Assessment (MNA) and relationship with body composition and nutritional biochemistry among older Australians undergoing rehabilitation.

Methods:  Thirty‐eight adults aged ≥65 years were prospectively and consecutively recruited from an Australian rehabilitation ward. Two dietitians independently administered the 18‐item MNA to determine inter‐rater reliability. MNA classifications (well nourished, at risk of malnutrition, malnourished) were compared with body composition (using dual‐energy X‐ray absorptiometry) and serum albumin. These analyses were also performed for the short‐form version of the MNA (six items).

Results:  In this cross‐sectional study, inter‐rater reliability of the 18‐item MNA score, estimated by the intraclass correlation coefficient, was 0.833, while inter‐rater reliability estimated by the weighted kappa index was 0.53. The two raters reached agreement on MNA classification for 26 of 38 cases (68%). Women classified as malnourished/at risk of malnutrition using the 18‐item MNA had lower total body fat (11 kg vs 29 kg, P < 0.01) and per cent body fat (25% vs 40%, P < 0.01), compared with women classified as well nourished. Similar findings were not apparent for men, although men classified as malnourished/at risk of malnutrition had lower serum albumin (32 g/L vs 36 g/L, P = 0.04) compared with men classified as well nourished. Similar findings were evident for the short‐form version of the MNA.

Conclusion:  The MNA was found to be useful for identifying older women with lower body fat in the Australian rehabilitation setting. The 18‐item MNA score has substantial inter‐rater reliability, and fair inter‐rater reliability when used according to the classifications. Inclusion of subjective and self‐reported items in surveys can be problematic for optimal reliability as can the use of such items in a subject population that is experiencing rapid progress in recovery.
Central obesity is common in renal transplant recipients and is associated with increased prevalence of cardiovascular risk factors
Authors: ORAZIO Linda , ARMSTRONG Kirsty , BANKS Merrilyn , JOHNSON David , ISBEL Nikky , HICKMAN Ingrid
Published: August 2007

Aim:  Obesity following renal transplantation is common and may be associated with cardiovascular disease. We sought to investigate the prevalence of central obesity in renal transplant recipients (RTR) and its association with cardiovascular risk factors.

Methods:  Weight, height, body mass index (BMI), waist and hip circumference, and biochemical cardiovascular risk factors were prospectively measured in 199 RTR, and were compared against published data from the Australian general population.

Results:  When obesity was defined by BMI, there was no difference between RTR and the Australian population irrespective of age. Significantly more female RTR had central obesity (defined as waist circumference ≥90 cm for men and ≥80 cm for women) when compared with the general population, and this was apparent at a younger age. In younger women (<45 years), 76% of RTR had central obesity compared with 17% of women from the general population (P < 0.0001). This trend was also seen in older female RTR. Younger male RTR (<45 years) had a greater prevalence of central obesity than aged‐matched men in the general population (66% vs 44%, respectively, P < 0.001). This trend was not seen in older male RTR. Centrally obese RTR gained significantly more weight post transplant than those who were lean (9.5 kg vs 2.4 kg, respectively, P < 0.0001), and were more likely to have a history of childhood obesity (P = 0.04). On multivariate analysis, central obesity was independently associated with weight gain post transplant (P < 0.001), a history of hyperlipidaemia (P = 0.01) and a history of hypertension (P = 0.02).

Conclusion:  Central obesity is a common problem for all RTR, particularly women and men aged below 45 years. Measures of central obesity should be used for RTR in clinical practice. BMI is not a suitable measure to determine central obesity. Central obesity is associated with cardiovascular risk factors, and further studies targeting multidisciplinary lifestyle interventions are recommended.
Child feeding practices and perceptions of childhood overweight and childhood obesity risk among mothers of preschool children
Authors: CROUCH Patrick , O'DEA Jennifer A. , BATTISTI Robert
Published: August 2007

Aim:  The present study assessed the relationship between maternal attitudes, beliefs and child feeding practices. It was hypothesised that: (i) maternal control over feeding would increase when mothers perceived their children as over‐ or underweight and were concerned about the weight status of their children; and (ii) mothers would express more concern about their daughters' weight, and report higher levels of control over feeding as a result.

Methods:  Participants included 112 mothers and their children aged 2–6 years who were attending swim lessons at a Central Coast swim school. Mothers completed the Child Feeding Questionnaire to assess maternal attitudes, beliefs and control over child feeding. Child and maternal body mass indexes were measured. Correlational analyses, t‐tests and multiple regression analyses were performed.

Results:  Mothers reported a high overall level of control in child feeding, and a low level of concern for child weight. Child overweight and obesity were marginally lower than reported in previous studies. Mothers reported more concern for their daughters' weight, but did not report increased control over feeding based on child gender. Pressure to eat was negatively associated with maternal education, suggesting a link between socioeconomic status and child feeding practices. Mothers displayed higher levels of parental control over obese than normal‐weight children, suggesting that they accurately assessed the weight status at the obese level.

Conclusion:  Mothers may be able to detect obesity in their children, but not overweight. Mothers may also be unconcerned about their sons' weight, and this discrepancy should be investigated in clinical and educational settings. Nutrition education and child obesity prevention and treatment programs should take maternal attitudes, perceptions and child feeding practices into account when planning interventions.
Hepatic encephalopathy in a pregnant mare: identification of histopathological changes in the brain of a mare and fetus
Authors: Johns IC , Del Piero F , Wilkins PA
Published: August 2007

An 11‐year‐old Thoroughbred broodmare was evaluated for suspected hepatic dysfunction. Clinical signs of hepatic encephalopathy were evident at admission. Hepatic ultrasonographic evaluation revealed an increase in hepatic size, rounded borders and normal echogenicity. There was no evidence of cholelithiasis or bile duct distention. Increased activity of hepatic enzymes, increased bile acid and bilirubin concentration and an increased ammonia concentration were supportive of a diagnosis of hepatic disease and hepatic encephalopathy. Histopathological evaluation of a liver biopsy specimen was consistent with chronic active hepatitis. The mare was treated with intravenous fluids and antimicrobials, pentoxyfilline, branched‐chain amino acids and dietary manipulation. Clinical improvement was observed initially, however, 3 weeks later, deterioration in the mare's condition necessitated euthanasia. Pathological lesions at necropsy were restricted to the liver and brain. The liver was diffusely firm with a prominent reticular pattern on the cut surface. A large choledocholith was present in the main bile duct of the left liver lobe. Histopathological examination of the liver revealed severe fibrosis, with hyperplastic bile ducts and mononuclear and neutrophilic inflammation. Pathological changes consistent with hepatic encephalopathy, (Alzheimer type II cells), were evident in the cerebrum of both the mare and the fetus.
Bilateral correction of metatarsal rotation in a dog using circular external skeletal fixation
Authors: Nelligan MR , Wheeler JL , Lewis DD , Thompson MS
Published: August 2007

An 8‐month‐old castrated male Saint Bernard was evaluated for bilateral hind limb lameness. Lameness was ascribed to bilateral metatarsal rotational abnormalities on the basis of the physical examination and radiographic evaluations. Staged, bilateral deformity correction and tarsometatarsal arthrodeses were performed using circular external skeletal fixators. The dog's gait improved following surgery and the fixators were removed 3 (left hind paw) and 4 (right hind paw) months following surgery. Twenty months after the initial surgery, the owner reported that the dog was walking well without apparent lameness. Previous reports suggest that metatarsal rotation is untreatable; however, our results suggest that surgical correction of this deformity can substantially improve limb function in dogs affected with metatarsal rotation.
Feedlot entry characteristics and climate: their relationship with cattle growth rate, bovine respiratory disease and mortality
Authors: Cusack PMV , McMeniman NP , Lean IJ
Published: August 2007

Objective  To examine the relationship between the feedlot entry characteristics of breed, gender, entry weight and the presence or absence of permanent incisors, with growth rate, the incidence of bovine respiratory disease (BRD), and mortalities of cattle destined for the Australian domestic market. The relationship between climate data and the occurrence of BRD was also investigated.

Design  Two thousand four hundred and sixty eight cattle were individually identified at feedlot entry, and lot number, body weight, property identification code, breed, gender, and the presence or absence of permanent incisors were recorded for each animal. Daily climate data were collected for the duration of the experiment. Univariate correlations, multivariate analysis and survival analysis techniques were used to examine the relationship between these feedlot entry characteristics and the outcomes of BRD and growth rate.

Results  The feedlot entry description of breed had a significant effect on average daily gain. The presence of permanent incisors at feedlot entry was associated with an increase in average daily gain of 0.1 kg/animal/d. Growth rate decreased by 0.702 kg/animal/d in cattle treated for BRD and by 0.302 kg/animal/d in cattle identified with anorexia. Treatment for BRD was ten times more likely with Hereford cattle. There was a moderate correlation between minimum daily temperature and the occurrence of BRD.

Conclusions  This study indicates that breed can affect growth rate and health, specifically the occurrence of BRD, in Australian domestic feedlot cattle. The moderate correlation between minimum daily temperature and the occurrence of BRD indicates potential associations between climate and BRD incidence in Australian feedlots.