Weapons injuries during and after periods of conflict: retrospective analysis.

OBJECTIVE: To assess the relative frequency of weapon injuries during conflict and after periods of conflict in the absence of disarmament. DESIGN: Retrospective analysis of a database of war wounds. SETTING: Region with a protracted conflict between rival combatant groups and a subsequent transition to the uncontested military authority of a single power. SUBJECTS: 2332 people who received weapons injuries during the conflict or post-conflict periods and were admitted to hospital within 24 hours of injury. MAIN OUTCOME MEASURES: Percentage change in mean monthly admission rate by weapon type between conflict and post-conflict periods; annual incidence of injury by weapon type during conflict and post-conflict periods; percentage change in annual incidence by weapon type between conflict and post-conflict periods. RESULTS: Mean monthly admission rates for injuries from fragmentation munitions decreased by 8% between conflict and post-conflict periods and by 23% for injuries from mines and 32% for gunshot injuries. The decline in admissions for all injuries was 23%. After adjustment for population growth over the study period, declines in annual incidence were 22% for fragmentation munitions injuries, 34% for mine injuries, and 40% for gunshot injuries. The decline in incidence for all injuries was 33%. In-hospital mortality from weapons related injuries increased from 2.5% to 6.1% (P < 0.001) between conflict and post-conflict periods. CONCLUSIONS: In this setting, continued availability of weapons is associated with increased mortality and a level of injuries from weapons that is only somewhat reduced from that observed during a period of conflict.     

A multi-endpoint matched molecular pair (MMP) analysis of 6-membered heterocycles

Aromatic rings, ubiquitous in pharmaceutical compounds, are often exchanged with another ring during the optimization process of drug discovery. Inevitably, the preferred ring system for one endpoint may prove detrimental to another, thus necessitating a holistic, multiple endpoint optimization approach for finding the ideal replacement. Accordingly, we conducted an extensive matched molecular pair (MMP) analysis of common 6-membered aromatic rings across 4 endpoints critical for drug discovery (log D lipophilicity, microsomal metabolism, P-gp efflux and passive permeability). We also investigated the effect of context by considering the connecting atom. Heat maps were created as a simple yet comprehensive way to view and analyze the vast amount of interrelated data. Paired difference statistical tests were used to identify transforms with changes that were significantly different from zero. We conclude that the heat maps of transforms provide a unique and powerful approach for multiparameter optimization.     

Intrathoracic versus Cervical Anastomosis after Resection of Esophageal Cancer: A matched pair analysis of 72 patients in a single center study

ABSTRACT: BACKGROUND: The aim of this study was to analyze the early postoperative outcome of esophageal cancer treated by subtotal esophageal resection, gastric interposition and either intrathoracic or cervical anastomosis in a single center study. METHODS: 72 patients who received either a cervical or intrathoracic anastomosis after esophageal resection for esophageal cancer were matched by age and tumor stage. Collected data from these patients were analyzed retrospectively regarding morbidity and mortality rates. RESULTS: Anastomotic leakage rate was significantly lower in the intrathoracic anastomosis group than in the cervical anastomosis group (4 of 36 patients (11 %) vs. 11 of 36 patients (31 %); p = 0.040). The hospital stay was significantly shorter in the intrathoracic anastomosis group compared to the cervical anastomosis group (14 (range 10-110) vs. 26 days (range 12 - 105); p = 0.012). Wound infection and temporary paresis of the recurrent laryngeal nerve occurred significantly more often in the cervical anastomosis group compared to the intrathoracic anastomosis group (28 % vs. 0 %; p = 0.002 and 11 % vs. 0 %; p = 0.046). The overall Inhospital mortality rate was 6 % (4 of 72 patients) without any differences between the study groups. CONCLUSIONS: The present data support the assumption that the transthoracic approach with an intrathoracic anastomosis compared to a cervical esophagogastrostomy is the safer and more beneficial procedure in patients with carcinoma of the lower and middle third of the esophagus due to a significant reduction of anastomotic leakage, wound infection, paresis of the recurrent laryngeal nerve and shorter hospital stay.     

Accuracy of mothers' retrospective reports of smoking during pregnancy: comparison with twin sister informant ratings.

Retrospective assessment of maternal smoking or substance use during pregnancy is sometimes unavoidable. The unusually close relationship of twin sister pairs permits comparison of self-report data versus co-twin informant data on substance use during pregnancy. Information about smoking during pregnancy has been gathered from a series of mothers from an Australian volunteer twin panel (576 women reporting on 995 pregnancies), supplemented in many cases by independent ratings of their smoking by twin sister informants (821 pregnancies). Estimates of the proportion of women who had never smoked regularly (56-58%), who had smoked but did not smoke during a particular pregnancy (16-21%), or who smoked throughout the pregnancy (16-18%), were in good agreement whether based on self-report or twin sister informant data. However, informants underreported cases who smoked during the first trimester but then quit (1-3% versus 7-9% by self-report). Women who smoked throughout pregnancy (by informant report) rarely denied a history of regular smoking (< 1%), although a small proportion of apparent false negative cases were identified where they either denied smoking during a pregnancy (9%) or denied smoking beyond the first trimester (10%). We conclude that retrospective smoking data can safely be used to identify potential associations of later child outcomes with maternal smoking during pregnancy.     

False positive results of tests for syphilis and outcome of pregnancy: a retrospective case-control study.

In a retrospective case-control study 64 women yielding a false positive result to a test for syphilis in pregnancy were compared with 128 controls individually matched for age, parity, hospital of delivery, and year of delivery. There were significantly more unsuccessful pregnancies, mainly spontaneous abortions during the first and second trimesters, among women with persistent false positive results. There was no significant difference between groups in the mean birth weights of liveborn infants. The antibodies responsible for the false positive result may indicate the presence of an immunological disturbance. Women who give a false positive result should be carefully managed throughout their pregnancy.     

Blastomycosis during pregnancy.

Disseminated blastomycosis with extensive involvement of the lungs, skin and bones was diagnosed in a 31-year-old woman who was 36 weeks pregnant. No antifungal treatment had been given while she was pregnant, and she gave birth shortly after admission to hospital. The child was healthy and uninfected, and there were no signs of inflammation or infection in the placenta. Post partum the mother was treated with 2 g of amphotericin B, with resolution of her symptoms. A literature review suggested that blastomycosis and other systemic fungal infections are more likely to occur during pregnancy because of immunosuppression and that disseminated blastomycosis in pregnant women should be treated with amphotericin B.     

Rh isoimmunization during pregnancy: antenatal prophylaxis.

Of 3533 Rh-negative women who began a pregnancy without detectable Rh antibodies, 62 (1.8%) demonstrated evidence of Rh isoimmunization during pregnancy or within 3 days after delivery. All denied transfusions as well as abortions or previous pregnancies not followed by the administration of Rh immune globulin. Rh isoimmunization during pregnancy or within 3 days after delivery, which will not be prevented by the administration of Rh immune globulin after delivery, is the most important cause of residual Rh isoimmunization. A clinical trial of antenatal administration of Rh immune globulin, initially at 34 weeks''s and subsequently at 28 and 34 weeks'' gestation, in 1357 Rh-negative pregnant women who were delivered of Rh-positive babies, was effective in preventing the development of Rh isoimmunization during pregnancy or within 3 days after delivery. Antenatal prophylaxis with Rh immune globulin will be necessary if the incidence of Rh isoimmunization is to be reduced to its lowest possible level. Antenatal prophylaxis at 28 weeks'' gestation is now an insured service in Manitoba.     

Zinc supplementation during pregnancy: a double blind randomised controlled trial.

OBJECTIVE--To see whether zinc supplementation during pregnancy improves maternal and fetal outcome. DESIGN--Prospective study started at booking and continued till discharge of mother and baby from the maternity hospital. Mothers were randomly assigned to receive zinc supplementation or placebo in a double blind trial. SETTING--Mothers booking at one hospital. PATIENTS--Women booking before 20 weeks of gestation who agreed to take part in the study. 494 Mothers were followed up till the end of pregnancy. There was no difference between the groups given zinc and placebo in their social or medical backgrounds. INTERVENTIONS--Mothers in the active treatment group received one capsule of 20 mg elemental zinc daily and those in the placebo treated group a capsule identical in appearance and taste with the active capsule but which contained inert substances. MAIN OUTCOME MEASURE--Various adverse outcomes were tested, including maternal bleeding, hypertension, complications of labour and delivery, gestational age, Apgar scores, and neonatal abnormalities. The main outcome measure was birth weight. RESULTS--There were no differences whatsoever between mothers given a zinc supplement and those given a placebo. CONCLUSION--Zinc supplementation in pregnancy in the United Kingdom does not seem to offer any benefits to the mother or her fetus.     

Raptors rehabilitated in Iowa during 1986 and 1987: a retrospective study

A retrospective study was conducted on 60 raptors representing 13 species treated at the Iowa State University College of Veterinary Medicine during 1986-1987. Eight species (31 individuals) were Falconiformes and five species (29 individuals) were Strigiformes. Seventy-five percent of all injuries were due to trauma and 65% of these were injuries arising from human activity, including car collisions (28%), shooting (17%) and trapping (11%). Thirty-four percent of all raptors admitted were treated and released, 25% were permanently crippled and 41% died during treatment or were euthanized. Data from this study implicate trauma resulting from human activity as a major reason for injury in free-ranging raptors presented for treatment in Iowa.