Isolated tricuspid stenosis in a patient with history of scleroderma

Isolated tricuspid stenosis (TS) is a very uncommon finding. There are some reports of isolated TS in the setting of systemic lupus erythematous, but its presence in scleroderma has never been reported before. We report a 48-year- old female with isolated TS with a background of scleroderma, diagnosed by echocardiography

Effects of L-asparginase administration on anticoagulant proteins and platelet function in patients with acute lymphoblastic leukemia

Introduction: Acute lymphoblastic leukemia is one the most common malignancies in children and adolescents. L-asparginase (L-ASP) is one of the leading medications in treatment of ALL. L.ASP interferes with the synthesis of some coagulation proteins and therefore causing disturbance in normal coagulation. In this study, the effects of L-ASP on anticoagulant proteins (protein C, protein S, and antithrombin III) and platelet function were assessed. Material and methods: This was a before-after study on 41 patients with ALL who refered to Mahak hospital (Tehran, Iran). Before and after the injection of L.ASP, a bleeding time test was performed based on Ivy method. Protein C and protein S performance was assessed by turbidometry and antithrombin III performance was evaluated by chromogenic method. Results: 48.8 of patients were female. Mean (±SD) of age was 4.0±7.2. A significant reduction in the mean amount of protein C, antithrombin III and bleeding time was recorded. However, the reduction in protein S was not significant. No patient showed the symptoms of thrombosis. Conclusion: The results of this study showed that L. ASP drug reduced coagulation proteins (except the protein S). This decrease along with other concomitant genetic factors can lead to thrombosis in some patients with ALL during induction therapy

The study of establishment of rainbow trout culture and hatchery farms on Zayanderood’s River region in Caharmahal and Bakhtiyari Province

The aim of this study was to find the best location for establishment of rainbow trout culture and hatcheries farms on Zayanderood’s river region in Charmahal and Bakhtiyari province. This survey carried out over ten station along Zayanderood’s river. The result of physical and chemical analysis showd that the annual average of air temperature varied from 9.5oC - 10oC where the pH annual average value were between 7.5 and 8.8. the dissolve oxygen concentration in stations except in rainbow trout farm effluent were above 10 mg/l. the other chemical , pollutant as well as pesticides levels were under the limiting concentration for rainbow trout culture and Hatcheries activity. The plankton survey showed that the Bacillurophyta were the dominant group of phytoplankton where protozoa constituted the most abundant group of zooplankton the Benthic organisms sensitive to pollutant in particular Epirus were dominant group in all stations. In regard to fishes presence in river, five species of Ciprinidae, one species from Balitoridae and one species from salmonidae families were identified. The capacity for development of rainbow trout culture for tow phase period in Zayanderood’s river region with respect to self purification potential (self purification potential were determined from the oxidation of the effluent of the only active trout farm of the river region), minimum of 10 L/s water requirement for production of trout in concrete canal and pond system and 1 L/S water need for production in semi circular closed system were estimated to be 5202 metric tons

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention