Observation of the pulse oximeter trace to estimate systolic blood pressure during spinal anaesthesia for Caesarean section: the effect of body mass index

Background: The estimation of systolic blood pressure by disappearance and reappearance of the pulse oximeter trace during cuff inflation and deflation was compared with non-invasive blood pressure (NIBP) measurement, across the range of body mass index (BMI), during spinal anaesthesia for Caesarean section.Methods: Seventy-five parturients were recruited, with BMI of < 30 (Group 1), 30–40 (Group 2), and > 40 kg/m2 ((morbidly obese, Group 3). A non-invasive blood pressure monitor was used with the pulse oximeter probe on the ipsilateral arm. Estimations were done before induction and 5 min after induction of spinal anaesthesia, during cuff inflation and deflation. Bland and Altman analysis was performed and the concordance correlation coefficient (r) estimated.Results: For estimation of systolic blood pressure during cuff inflation under spinal anaesthesia in Groups 1, 2 and 3: r = 0.57, 0.74 and 0.91; bias = –0.4, –2.9 and 0.8 mmHg, and limits of agreement = –27.7 to 26.9, –27.7 to 21.9, and –15.9 to 17.5 mmHg respectively. The mean (SD) time saved by estimation during inflation compared with measurement in Groups 1, 2 and 3 was 22.8 (13.2) s, 30.0 (11.6) s and 33.0 (15.6) s respectively. In Group 3, the percentage error was ± 13% of mean systolic blood pressure.Conclusions: Estimation of systolic blood pressure during cuff inflation under spinal anaesthesia in the morbidly obese is more precise than in lower BMI parturients. Time to estimation is relevantly shorter than measurement. This could improve patient safety by rapid and accurate identification of hypotension in these high-risk patients. This estimation method is associated with limits of agreement that may be clinically significant even in morbidly obese patients, and should not be considered a replacement for subsequent NIBP measurement.Keywords: body mass index, Caesarean section, pulse oximeter trace, spinal anaesthesia, systolic blood pressur

Association Between Smoking and Tuberculosis Infection: A Population Survey in a High Tuberculosis Incidence Area

Associations between smoking and tuberculosis disease including death from tuberculosis have been reported, but there are few reports on the influence of smoking on the risk of developing Mycobacterium tuberculosis infection. The aim of this study was to determine the association between smoking and M tuberculosis infection. In a cross sectional population survey, data on smoking and tuberculin skin test (TST) results of 2401 adults aged >15 years were compared. A total of 1832 (76%) subjects had a positive TST (>10 mm induration). Of 1309 current smokers or ex-smokers, 1070 (82%) had a positive TST. This was significantly higher than for never smokers (unadjusted OR 1.99, 95% confidence interval (CI) 1.62 to 2.45). A positive relationship with pack-years was observed, with those smoking more than 15 pack-years having the highest risk (adjusted OR 1.90,95% CI 1.28 to 2.81). Smoking may increase the risk of M tuberculosis infection.\u

Supplemented low-protein diets - are they superior in chronic renal failure?

No Abstract

Risk factors for the development of osteoporosis in a South African population: A prospective analysis

Despite the vast number of risk factors that apparently predispose to the development ofosteoporosis (OP), they have not been accurately identified and given relative priority. In order to analyse possible risk factors prospectively in a local patient population with overt OP (histomorphometrically confirmed and characterised) and compare it with an appropriately matched non-OP control group (with normal bone mass on dualenergy X-ray absorptiometry), a detailed general history, risk factor analysis, dietary history and anthropometric data were obtained from 56 OP and 125 non-OP subjects. In females a positive family history of OP (P =0,002), a fair complexion (P =0,009), lower body mass (P =0,02) and height (P =0,03), no breast-feeding of babies (P =0,006), a history of smoking (P =0,001) and fat distribution around the waist (P =0,009) were identified as risk factors. In males lack of exercise (P =0,008), a history of smoking (P =0,01), lower body mass (P = 0,04) and height (P = 0,04), a preference for salty food (P =0,02) and fat distribution around the waist (P =0,002) appeared to predispose. Dietary calcium, phosphorus, protein and caffeine intakes were similar in OP and control subjects, but alcohol consumption was clearly higher in both OP males (P = 0,001) and females (P = 0,01)

Factors affecting pregnancy outcome in a gamete intrafallopian transfer (GIFT) programme

Objective. To identify the factors that most significantly affected pregnancy rates in a gamete intrafallopian transfer (GIFT) programme.Methods. A total of 863 GIFT cycles were analysed retrospectively. The variables found to be associated significantly with pregnancy were then used to obtain multivariate analysis using logistical regression.Results. Overall and ongoing pregnancy rates were significantly better in patients ≤ 38 years than in patients > 38 years (37.3% and 28.4% v. 23.7% and 11.0% respectively), and age was positively associated with success after GIFT (odds ratio (OR) 1.87, 95% confidence interval (CI): 1.22- 2.85). Metaphase I (MI) oocytes were negatively associated with pregnancy (OR 1.54, 95% CI: 0.28 - 1.04). The highest pregnancy rates occurred when 3 metaphase II (MII) oocytes were transferred (39.8%, OR 7.51, 95% CI: 1.74 - 32.42). With regard to sperm morphology, overall pregnancy rates of 25.5% (≤ 4% normal forms) and 37.2% (> 4% normal forms) were obtained. Morphology of > 4% normal forms was positively associated with pregnancy (OR 1.58, 95% CI: 1.04 - 2.42).Conclusion. The results of this study suggest that the most important factors influencing pregnancy rates in a GIFT programme are the woman's age and those factors pertaining to the characteristics of the gametes. Considering the emotional and financial costs it is important to relate this information to all prospective participants in a GIFT programme

Management of incomplete abortions at South African public hospitals

Objective. The objective of this report was to review and describe the management of incomplete abortion by public sector hospitals.Design. A descriptive study in which data were collected prospectively from routine hospital records on all women admitted with incomplete abortion to a stratified random sample of hospitals between 14 and 28 September 1994.Setting. Public sector hospitals in South Africa.Patients. Women with incomplete abortions.Main outcome measures. Length of hospital stay, details of medical management, details of surgical management, determinants of the above.Main results. Data were collected on 803 patients from the 56 participating hospitals. Of these, 767 (95.9%) were in hospital for 1 day or more, and 753 (95.3%) women underwent evacuation of the uterus. Sharp curettage wasthe method employed in 726 (96.9%) and general anaesthesia was used for 601 (88%) of the women requiring uterine evacuation. Antibiotics were prescribed for 396 (49.5%) and blood transfusions were administered to 125 (17%) women. Statistical analysis showed length of stay to be longer in small hospitals (under 500 beds) and when the medical condition was more severe. Antibiotic  usage and blood transfusion were more common with increasing severity and a low haemoglobin level on admission. However, some inappropriate management was identified with regard to both.Main conclusions. It is suggested that uncomplicated incomplete abortion can be more effectively and safely managed using the manual vacuum aspiration technique with sedation/analgesia as an outpatient procedure. Attention should be directed at the introduction of this management routine at all types of hospital and to the ensuring of appropriate management of women with complicated abortion

The incidence of melanoma in South Africa : an exploratory analysis of national cancer registry data from 2005 to 2013 with a specific focus on melanoma in black Africans

BACKGROUND. Melanoma is an aggressive skin cancer with poor survival when diagnosed late. There are important differences in clinical and histological features of melanoma and disease outcomes in people with darker skin types. METHODS. A retrospective review of data captured by the National Cancer Registry (NCR) of South Africa (SA) was performed for 2005 - 2013. Data on patient numbers, demography, location and biological features were analysed for all records. Closer analysis of melanoma of the limbs reported in black Africans was done after manually collecting this information from original reports. RESULTS. With 11 784 invasive melanomas reported to the NCR, the overall incidence of melanoma for SA was 2.7 per 100 000. Males (51%), individuals aged ≥60 years (48%) and the anatomical sites of lower limb (36%) and trunk (27%) were most commonly affected. Melanoma incidences in the white and black populations were 23.2 and 0.5 per 100 000, respectively. Most cases were diagnosed at private pathology laboratories (73%). Superficial spreading melanoma (47%) and nodular melanoma (20%) predominated. Among 878 black Africans diagnosed in the public sector with melanoma of the limbs, females (68%) and individuals aged ≥60 years (61%) were most commonly affected. Lower-limb lesions (91%) and acral lentiginous melanoma (65%) predominated, with 74% of cases affecting the foot and 62% of cases presenting with a Breslow depth >4 mm. CONCLUSIONS. This study provides up-to-date NCR incidence and demographic data on melanoma and highlights the neglected research gaps in relation to melanoma in black Africans to provide evidence needed to address health disparities in overlooked population groups.CYW receives funding from the South African Medical Research Council and the National Research Foundation of South Africa.http://www.samj.org.zaam2019Geography, Geoinformatics and Meteorolog

How magic is the magic 68Ni nucleus?

We calculate the B(E2) strength in 68Ni and other nickel isotopes using several theoretical approaches. We find that in 68Ni the gamma transition to the first 2+ state exhausts only a fraction of the total B(E2) strength, which is mainly collected in excited states around 5 MeV. This effect is sensitive to the energy splitting between the fp shell and the g_{9/2}orbital. We argue that the small experimental B(E2) value is not strong evidence for the double-magic character of 68Ni.Comment: 4 pages, 4 figure

Area of hock hair loss in dairy cows : risk factors and correlation to a categorical scale

Data from 3691 dairy cows from 76 farms were used to investigate the risk factors associated with area of hair loss over the lateral aspect of the hock, and the correlation between the area of hair loss as calculated using a hock map and hock lesion scores determined using a pre-existing categorical scale. Six factors were associated with a greater area of hair loss, including cows with locomotion score 3, a cleanliness score (10-18/28), high daily milk yield (25.1 - 58.1 kg), poor body condition score (1-1.5), duration of winter housing (≥41 days) and some combinations of cubicle base and bedding materials. Compared with cows housed in cubicles with a concrete base and whole straw or rape straw bedding, cows housed in cubicles with concrete bases with sand or chopped straw bedding had smaller areas of hair loss and cows housed on a mattress base with whole straw or rape straw bedding had a larger area of hair loss. Area of hair loss, as measured on hock maps, was not significantly different between cows with score 1 (median=23.6 cm2) and score 2 (median=20.3 cm2) on the categorical scale for hock lesions. This suggests that the categorical scale was not reflecting the extent of hair loss and that hock maps are a good alternative for studying the dynamics of hock lesions over time. Further work is required to explore the aetiology of hock lesions and find better ways to control this common condition. Keywords: Hock lesions; Hair loss; Dairy cow; Welfare; Hock map