Social class inequalities in perinatal outcomes: Scotland 1980–2000

Objective: To examine social class inequalities in adverse perinatal events in Scotland between 1980 and 2000 and how these were influenced by other maternal risk factors. Design: Population based study using routine maternity discharge data. Setting: Scotland. Participants: All women who gave birth to a live singleton baby in Scottish hospitals between 1980 and 2000 (n = 1 282 172). Main outcome measures: Low birth weight (LBW), preterm birth, and small for gestational age (SGA). Results: The distribution of social class changed over time, with the proportion of mothers with undetermined social class increasing from 3.9% in 1980–84 to 14.8% in 1995–2000. The relative index of inequality (RII) decreased during the 1980s for all outcomes. The RII then increased between the early and late 1990s (LBW from 2.09 (95%CI 1.97, 2.22) to 2.43 (2.29, 2.58), preterm from 1.52 (1.44, 1.61) to 1.75 (1.65, 1.86), and SGA from 2.28 (2.14, 2.42) to 2.49 (2.34, 2.66) respectively). Inequalities were greatest in married mothers, mothers aged over 35, mothers taller than 164 cm, and mothers with a parity of one or more. Inequalities were also greater by the end of the 1990s than at the start of the 1980s for women of parity one or more and for mothers who were not married. Conclusion: Despite decreasing during the 1980s, inequalities in adverse perinatal outcomes increased during the 1990s in all strata defined by maternal characteristics

A case report of iatrogenic gas gangrene post colonoscopy successfully treated with conservative management- is surgery always necessary?

Background: Colonoscopy is a routine procedure in diagnosis and treatment of colonic disease. While generally regarded as a safe procedure, potentially fatal complications can occur. Gas gangrene is one such complication, with very high mortality. There are few cases of gas gangrene occurring after colonoscopy, making it one of the rarer complications of this procedure. There have been no previously reported cases of a patient surviving such an infection and the optimal treatment strategy is contentious. This report describes a case of intramural gas gangrene of the colon, treated conservatively with antibiotic therapy in which the patient survived with full recovery. Case presentation: A 71-year-old, previously healthy male presented 6 h post apparently uncomplicated colonoscopic polypectomy with rigors, nausea, vomiting and right upper quadrant pain. At presentation he was febrile at 40.1 °C but hemodynamically stable. Abdominal computed tomography revealed substantial colonic thickening and several focal intramural gas bubbles (pneumatosis intestinalis) surrounding the polypectomy site. Within 24 h post procedure he became hypotensive and was admitted to ICU in frank septic shock requiring inotropes, and with demonstrable septic myocardial depression. Bloods showed multi-organ derangement with leukocytosis, lactic acidosis, haemolytic anaemia and hyperbilirubinemia. A diagnosis of presumed Clostridial gas gangrene was made, and treatment was initiated with benzylpenicillin, clindamycin, metronidazole and vancomycin. After 4 days in ICU he was stepped down, and discharged after a further 10 days with no surgical or endoscopic interventions. At three-month review he reported being back to full health. Conclusions: This case demonstrates that gas gangrene infection is a possible complication of colonoscopic polypectomy. This is a cause of rapid deterioration in post-colonoscopy patients and has been misdiagnosed as colonic perforation in previously reported cases of retroperitoneal gas gangrene. Such misdiagnosis delays antibiotic therapy, which likely plays a role in the high mortality of this condition. Early diagnosis and initiation of antibiotic therapy with benzylpenicillin and clindamycin as seen in this case is essential for patient survival. While surgery is typically performed, non-operative management of pneumatosis intestinalis, and potentially gas gangrene is becoming more common and was utilized effectively in this patient

Discovery of a very X-ray luminous galaxy cluster at z=0.89 in the WARPS survey

We report the discovery of the galaxy cluster ClJ1226.9+3332 in the Wide Angle ROSAT Pointed Survey (WARPS). At z=0.888 and L_X=1.1e45 erg/s (0.5-2.0 keV, h_0=0.5) ClJ1226.9+3332 is the most distant X-ray luminous cluster currently known. The mere existence of this system represents a huge problem for Omega_0=1 world models. At the modest (off-axis) resolution of the ROSAT PSPC observation in which the system was detected, ClJ1226.9+3332 appears relaxed; an off-axis HRI observation confirms this impression and rules out significant contamination from point sources. However, in moderately deep optical images (R and I band) the cluster exhibits signs of substructure in its apparent galaxy distribution. A first crude estimate of the velocity dispersion of the cluster galaxies based on six redshifts yields a high value of 1650 km/s, indicative of a very massive cluster and/or the presence of substructure along the line of sight. While a more accurate assessment of the dynamical state of this system requires much better data at both optical and X-ray wavelengths, the high mass of the cluster has already been unambiguously confirmed by a very strong detection of the Sunyaev-Zel'dovich effect in its direction (Joy et al. 2001). Using ClJ1226.9+3332 and ClJ0152.7-1357 (z=0.835), the second-most distant X-ray luminous cluster currently known and also a WARPS discovery, we obtain a first estimate of the cluster X-ray luminosity function at 0.8<z<1.4 and L_X>5e44 erg/s. Using the best currently available data, we find the comoving space density of very distant, massive clusters to be in excellent agreement with the value measured locally (z<0.3), and conclude that negative evolution is not required at these luminosities out to z~1. (truncated)Comment: accepted for publication in ApJ Letters, 6 pages, 2 figures, uses emulateapj.st

The sources, impact and management of car park runoff pollution: a review

Traffic emissions contribute significantly to the build-up of diffuse pollution loads on urban surfaces with their subsequent mobilisation and direct discharge posing problems for receiving water quality. This review focuses on the impact and mitigation of solids, metals, nutrients and organic pollutants in the runoff deriving from car parks. Variabilities in the discharged pollutant levels and in the potentials for pollutant mitigation complicate an impact assessment of car park runoff. The different available stormwater best management practices and proprietary devices are reported to be capable of reductions of between 20% and almost 100% for both suspended solids and a range of metals. This review contributes to prioritising the treatment options which can achieve the appropriate pollutant reductions whilst conforming to the site requirements of a typical car park. By applying different treatment scenarios to the runoff from a hypothetical car park, it is shown that optimal performance, in terms of ecological benefits for the receiving water, can be achieved using a treatment train incorporating permeable paving and bioretention systems. The review identifies existing research gaps and emphasises the pertinent management practices as well as design issues which are relevant to the mitigation of car park pollution

An assay for argininosuccinate synthetase in Neurospora

An assay for argininosuccinate synthetase in Neurospor

The WARPS survey - IV: The X-ray luminosity-temperature relation of high redshift galaxy clusters

We present a measurement of the cluster X-ray luminosity-temperature relation out to high redshift (z~0.8). Combined ROSAT PSPC spectra of 91 galaxy clusters detected in the Wide Angle ROSAT Pointed Survey (WARPS) are simultaneously fit in redshift and luminosity bins. The resulting temperature and luminosity measurements of these bins, which occupy a region of the high redshift L-T relation not previously sampled, are compared to existing measurements at low redshift in order to constrain the evolution of the L-T relation. We find a best fit to low redshift (z1 keV, to be L proportional to T^(3.15\pm0.06). Our data are consistent with no evolution in the normalisation of the L-T relation up to z~0.8. Combining our results with ASCA measurements taken from the literature, we find eta=0.19\pm0.38 (for Omega_0=1, with 1 sigma errors) where L_Bol is proportional to (1 + z)^eta T^3.15, or eta=0.60\pm0.38 for Omega_0=0.3. This lack of evolution is considered in terms of the entropy-driven evolution of clusters. Further implications for cosmological constraints are also discussed.Comment: 11 pages, 7 figures, accepted for publication in MNRA

Mortality Rate of Bullous Pemphigoid in a US Medical Center

All patients at the Medical College of Wisconsin Affiliated Hospitals with a new diagnosis of bullous pemphigoid (BP) between May 1, 1997 and September 1, 2002 were included in this study. The age at onset, date of death or date of last follow-up visit, mode of treatment, co-morbidities, and initial and follow-up hospitalizations were noted. Thirty-eight new patients were identified and complete follow-up data were obtained on 37 of the patients. Patients were followed a minimum of 1 y or until the time of death. The mean duration of follow-up was 20 mo. Kaplan–Meier analysis of our population indicated a 1-y survival probability of 88.96% (standard error 5.21%), with a 95% confidence interval (75.6%, 94.2%). This survival rate was considerably higher than that recently reported in several studies from Europe (29%–41% first year mortality). Although the age at onset and co-morbidities of our patients were similar to those in the European studies, the rate of hospitalization of our patients was much lower than that of patients from Europe (1.5 d per patient vs 11–25 d per patient). This study suggests that differences in practice patterns may be an important factor in the reduced mortality rate in US BP patients compared with Europe