Time for global scale-up, not randomized trials, of uterine balloon tamponade for postpartum hemorrhage.

Maternal death is the greatest health disparity globally, with postpartum hemorrhage the most common cause. As senior leaders in obstetrics and maternal health from Bolivia, Canada, Colombia, Côte d'Ivoire, Honduras, India, Kenya, Nepal, Niger, Norway, Peru, Tanzania, the UK, the USA, and Zambia, we are deeply disturbed by recent calls for randomized controlled trials (RCTs) of uterine balloon tamponade (UBT) in women with uncontrolled postpartum hemorrhage (PPH). Our collective experience, in combination with mounting evidence, unequivocally supports the effectiveness of commercial and condom UBTs in averting death and disability from PPH associated with atonic uterus. We believe it would be highly unethical to embark on an RCT of UBT, now or in the future, unless compared with a proven equivalent intervention. This article is protected by copyright. All rights reserved

BSS Plus compared to the vitreous of non-diabetics and diabetics

Letter to the EditorAbstract not availableJan Kokavec, Saban Horo, Weng Onn Chan, San H Min, Mei H Tan, John Grigg, Jagjit S Gilhotra, Henry S Newland, Shane R Durkin and Robert J Casso

A Trial of Early Antiretrovirals and Isoniazid Preventive Therapy in Africa

BACKGROUND: In sub-Saharan Africa, the burden of human immunodeficiency virus (HIV)-associated tuberculosis is high. We conducted a trial with a 2-by-2 factorial design to assess the benefits of early antiretroviral therapy (ART), 6-month isoniazid preventive therapy (IPT), or both among HIV-infected adults with high CD4+ cell counts in Ivory Coast. METHODS: We included participants who had HIV type 1 infection and a CD4+ count of less than 800 cells per cubic millimeter and who met no criteria for starting ART according to World Health Organization (WHO) guidelines. Participants were randomly assigned to one of four treatment groups: deferred ART (ART initiation according to WHO criteria), deferred ART plus IPT, early ART (immediate ART initiation), or early ART plus IPT. The primary end point was a composite of diseases included in the case definition of the acquired immunodeficiency syndrome (AIDS), non-AIDS-defining cancer, non-AIDS-defining invasive bacterial disease, or death from any cause at 30 months. We used Cox proportional models to compare outcomes between the deferred-ART and early-ART strategies and between the IPT and no-IPT strategies. RESULTS: A total of 2056 patients (41% with a baseline CD4+ count of ≥500 cells per cubic millimeter) were followed for 4757 patient-years. A total of 204 primary end-point events were observed (3.8 events per 100 person-years; 95% confidence interval [CI], 3.3 to 4.4), including 68 in patients with a baseline CD4+ count of at least 500 cells per cubic millimeter (3.2 events per 100 person-years; 95% CI, 2.4 to 4.0). Tuberculosis and invasive bacterial diseases accounted for 42% and 27% of primary end-point events, respectively. The risk of death or severe HIV-related illness was lower with early ART than with deferred ART (adjusted hazard ratio, 0.56; 95% CI, 0.41 to 0.76; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.56; 95% CI, 0.33 to 0.94) and lower with IPT than with no IPT (adjusted hazard ratio, 0.65; 95% CI, 0.48 to 0.88; adjusted hazard ratio among patients with a baseline CD4+ count of ≥500 cells per cubic millimeter, 0.61; 95% CI, 0.36 to 1.01). The 30-month probability of grade 3 or 4 adverse events did not differ significantly among the strategies. CONCLUSIONS: In this African country, immediate ART and 6 months of IPT independently led to lower rates of severe illness than did deferred ART and no IPT, both overall and among patients with CD4+ counts of at least 500 cells per cubic millimeter. (Funded by the French National Agency for Research on AIDS and Viral Hepatitis; TEMPRANO ANRS 12136 ClinicalTrials.gov number, NCT00495651.)

Low temperature coefficient of resistivity Ag-Cd and Ag-Sn alloys - structure and transport

The microstructure vis-a-vis electrical transport behavior of Ag-Cd and Ag-Sn binary alloys in the temperature range 70-300 K has been studied. The 22.2 wt.% Cd and 29.4 wt.% Cd alloys were both found to have a single-phase structure made of solid solution of Ag. The lattice parameter however increased with increasing Cd content in the alloy. The microstructure of 17.7 wt.% Sn and 23.5 wt.% Sn alloys however is made of two phases Ag4Sn and Ag3Sn. The resistivity of Ag-Cd alloys increased with increasing Cd content and the temperature coefficient of resistivity (TCR) decreased to 1560 ppm K-1 for the 29.4 wt.% Cd alloy compared to 4100 ppm K-1 for pure Ag. The lowest TCR however was obtained for the 17.7 wt.% Sn alloy, 375 ppm K-1, which has a room temperature resistivity of 23.93 RQ cm. (C) 200

Bilateral choroidal metastasis from carcinoma of the submandibular gland

Metastatic tumor is the most common uveal malignancy. However, choroidal metastasis from a salivary gland neoplasm is extremely rare. We report a case of bilateral, multifocal choroidal metastasis from carcinoma of the submandibular gland

Spain and European Union constitution building

The broad objective of this paper is to better understand how national governments form their policy position on the Draft Constitutional proposal by analysing developments in Spain. It examines the Spanish position on various parts of the European Convention based on data from expert interviews carried out in November 2003. It then evaluates the internal coordination process, focusing on the few domestic-level actors (from the Prime Ministers’ Office and the Ministries of Foreign Affairs and Economy) that have been most influential in shaping Spain’s position. Finally, it ponders the potential shift in the Spanish position given the recent Socialist victory in March 2004