Osteoporosis in clinical practice – bone densitometry and fracture risk

Osteoporosis is a condition of decreased bone mass and bone density associated with an increase in fracture risk. Bone mineral density (BMD) of the lumbar spine and femur can be reliably measured by double-beam X-ray absorptiometry (DEXA), which provides a measure of bone strength. Reduction in BMD is a continuum and is associated with a progressive increase in fracture risk. The diagnosis of osteoporosis is based on BMD relative to that of healthy young adults and criteria for diagnosis are arbritary. The original 'normal' BMD data published by some manufacturers were relatively high, leading to a relative overdiagnosis of osteoporosis. Revised normative BMD values of the spine and femur and revised criteria using degrees of severity are proposed and may provide a better basis for diagnosis and for the management of patients with osteoporosis. The. indications for BMD measurement, the age at which BMD is measured, and number of measurements, depends upon the purpose of the measurement and how the result will affect the management of each patient in clinical practice

The place of isotopic placentography in the management of antepartum haemorrhage

No Abstract

Foetal distress - is the paediatrician necessary?

No Abstrac

The incidence and significance of clinical foetal distress in labour

No Abstract

Intensive care in labour: A preliminary appraisal

This is a preliminary investigation into the value, function and practicability of an intensive care labour unit for highrisk cases. All the equipment necessary can be mounted on two standard theatre trolleys which can be moved to the patient's bedside, but there is no place at present for this equipment outside a teaching unit. The investigation reports on continuous foetal heart monitoring of 36 patients and simultaneous foetal scalp pH estimations on 16 of them. A high proportion of babies with low Apgar scores showed one of two (or both) characteristic foetal heart patterns during labour: (a) the well-known type 2 dip, (b) a steppe pattern not previously described as such. The latter is of importance because it is impossible to detect using only clinical methods. There was poor correlation between foetal pH values and Apgar rating, and between foetal pH values and monitor patterns. Moreover, the pH values of foetal scalp blood and foetal umbilical arterial and venous blood samples bore varying relations to one another. However, for practical purposes, a foetal scalp blood of pH less than 7·20 when associated with a maternofoetal pH difference of 0·250 or more should be regarded with anxiety. The place and value of intensive care are discussed

Indoramin pregnancy in the treatment hypertension of A placebo-controlled trial comparing the efficacy of indoramin with alpha-methyldopa

A placebo-controlled trial was used to assess the antihypertensive efficacy of indoramin in the management of pregnancy hypertension. Sixty patients were recruited into the study and only 17 attained satisfactory blood pressure control. In the doses of drugs administered indoramin was not shown to be more effective than alpha-methyldopa

Using Genetic Variation to Explore the Causal Effect of Maternal Pregnancy Adiposity on Future Offspring Adiposity: A Mendelian Randomisation Study

Background: It has been suggested that greater maternal adiposity during pregnancy affects lifelong risk of offspring fatness via intrauterine mechanisms. Our aim was to use Mendelian randomisation (MR) to investigate the causal effect of intrauterine exposure to greater maternal body mass index (BMI) on offspring BMI and fat mass from childhood to early adulthood. Methods and Findings: We used maternal genetic variants as instrumental variables (IVs) to test the causal effect of maternal BMI in pregnancy on offspring fatness (BMI and dual-energy X-ray absorptiometry [DXA] determined fat mass index [FMI]) in a MR approach. This was investigated, with repeat measurements, from ages 7 to 18 in the Avon Longitudinal Study of Parents and Children (ALSPAC; n = 2,521 to 3,720 for different ages). We then sought to replicate findings with results for BMI at age 6 in Generation R (n = 2,337 for replication sample; n = 6,057 for total pooled sample). In confounder-adjusted multivariable regression in ALSPAC, a 1 standard deviation (SD, equivalent of 3.7 kg/m2) increase in maternal BMI was associated with a 0.25 SD (95% CI 0.21–0.29) increase in offspring BMI at age 7, with similar results at later ages and when FMI was used as the outcome. A weighted genetic risk score was generated from 32 genetic variants robus

The dependence of the EIT wave velocity on the magnetic field strength

"EIT waves" are a wavelike phenomenon propagating in the corona, which were initially observed in the extreme ultraviolet (EUV) wavelength by the EUV Imaging Telescope (EIT). Their nature is still elusive, with the debate between fast-mode wave model and non-wave model. In order to distinguish between these models, we investigate the relation between the EIT wave velocity and the local magnetic field in the corona. It is found that the two parameters show significant negative correlation in most of the EIT wave fronts, {\it i.e.}, EIT wave propagates more slowly in the regions of stronger magnetic field. Such a result poses a big challenge to the fast-mode wave model, which would predict a strong positive correlation between the two parameters. However, it is demonstrated that such a result can be explained by the fieldline stretching model, \emph{i.e.,} that "EIT waves" are apparently-propagating brightenings, which are generated by successive stretching of closed magnetic field lines pushed by the erupting flux rope during coronal mass ejections (CMEs).Comment: 11 pages, 8 figures, accepted for publication in Solar Phy

One-year risk of stroke after transient ischemic attack or minor stroke in Hunter New England, Australia (INSIST Study)

Background: One-year risk of stroke in transient ischemic attack and minor stroke (TIAMS) managed in secondary care settings has been reported as 5–8%. However, evidence for the outcomes of TIAMS in community care settings is limited. Methods: The INternational comparison of Systems of care and patient outcomes In minor Stroke and TIA (INSIST) study was a prospective inception cohort community-based study of patients of 16 general practices in the Hunter–Manning region (New South Wales, Australia). Possible-TIAMS patients were recruited from 2012 to 2016 and followed-up for 12 months post-index event. Adjudication as TIAMS or TIAMS-mimics was by an expert panel. We established 7-days, 90-days, and 1-year risk of stroke, TIA, myocardial infarction (MI), coronary or carotid revascularization procedure and death; and medications use at 24 h post-index event. Results: Of 613 participants (mean age; 70 ± 12 years), 298 (49%) were adjudicated as TIAMS. TIAMS-group participants had ischemic strokes at 7-days, 90-days, and 1-year, at Kaplan-Meier (KM) rates of 1% (95% confidence interval; 0.3, 3.1), 2.1% (0.9, 4.6), and 3.2% (1.7, 6.1), respectively, compared to 0.3, 0.3, and 0.6% of TIAMS-mimic-group participants. At one year, TIAMS-group-participants had twenty-five TIA events (KM rate: 8.8%), two MI events (0.6%), four coronary revascularizations (1.5%), eleven carotid revascularizations (3.9%), and three deaths (1.1%), compared to 1.6, 0.6, 1.0, 0.3, and 0.6% of TIAMS-mimic-group participants. Of 167 TIAMS-group participants who commenced or received enhanced therapies, 95 (57%) were treated within 24 h post-index event. For TIAMS-group participants who commenced or received enhanced therapies, time from symptom onset to treatment was median 9.5 h [IQR 1.8–89.9]. Conclusion: One-year risk of stroke in TIAMS participants was lower than reported in previous studies. Early implementation of antiplatelet/anticoagulant therapies may have contributed to the low stroke recurrence

Large-scale Bright Fronts in the Solar Corona: A Review of "EIT waves"

``EIT waves" are large-scale coronal bright fronts (CBFs) that were first observed in 195 \AA\ images obtained using the Extreme-ultraviolet Imaging Telescope (EIT) onboard the \emph{Solar and Heliospheric Observatory (SOHO)}. Commonly called ``EIT waves", CBFs typically appear as diffuse fronts that propagate pseudo-radially across the solar disk at velocities of 100--700 km s$^{-1}$ with front widths of 50-100 Mm. As their speed is greater than the quiet coronal sound speed ($c_s\leq$200 km s$^{-1}$) and comparable to the local Alfv\'{e}n speed ($v_A\leq$1000 km s$^{-1}$), they were initially interpreted as fast-mode magnetoacoustic waves ($v_{f}=(c_s^2 + v_A^2)^{1/2}$). Their propagation is now known to be modified by regions where the magnetosonic sound speed varies, such as active regions and coronal holes, but there is also evidence for stationary CBFs at coronal hole boundaries. The latter has led to the suggestion that they may be a manifestation of a processes such as Joule heating or magnetic reconnection, rather than a wave-related phenomena. While the general morphological and kinematic properties of CBFs and their association with coronal mass ejections have now been well described, there are many questions regarding their excitation and propagation. In particular, the theoretical interpretation of these enigmatic events as magnetohydrodynamic waves or due to changes in magnetic topology remains the topic of much debate.Comment: 34 pages, 19 figure