Modeling maternal mortality in Bangladesh: the role of misoprostol in postpartum hemorrhage prevention.

BackgroundBangladesh is one of the few countries that may actually achieve the fifth Millennium Development Goal (MDG) in time, despite skilled birth attendance remaining low. The purpose of this paper is to examine the potential role misoprostol can play in the decline of maternal deaths attributed to postpartum hemorrhage (PPH) in Bangladesh.MethodsUsing data from a misoprostol and blood loss measurement tool feasibility study in Bangladesh, observed cause specific maternal mortality ratios (MMRs) were estimated and contrasted with expected ratios using estimates from the Bangladesh Maternal Mortality Survey (BMMS) data. Using Crystal Ball 7 we employ Monte Carlo simulation techniques to estimate maternal deaths in four scenarios, each with different levels of misoprostol coverage. These scenarios include project level misoprostol coverage (69%), no (0%), low (40%), and high (80%) misoprostol coverage. Data on receipt of clean delivery kit, use of misoprostol, experience of PPH, and cause of death were used in model assumptions.ResultsUsing project level misoprostol coverage (69%), the mean number of PPH deaths expected was 40 (standard deviation = 8.01) per 100,000 live births. Assuming no misoprostol coverage (0%), the mean number of PPH deaths expected was 51 (standard deviation = 9.30) per 100,000 live births. For low misoprostol coverage (40%), the mean number of PPH deaths expected was 45 (standard deviation = 8.26) per 100,000 live births, and for high misoprostol coverage (80%), the mean number of PPH deaths expected was 38 (standard deviation = 7.04) per 100,000 live births.ConclusionThis theoretical exercise hypothesizes that prophylactic use of misoprostol at home births may contribute to a reduction in the risk of death due to PPH, in addition to reducing the incidence of PPH. If findings from this modeling exercise are accurate and uterotonics can prevent maternal death, misoprostol could be the tool countries need to further reduce maternal mortality at home births

A Case Presentation of Pericarditis Associated with Haemophilus Influenzae Bacteremia

Acute pericarditis, or inflammation of the pericardial sac, is a clinical condition which can often be attributed to a variety of underlying etiologies, including infection, autoimmune disease, trauma, and malignancy. While viral infections are commonly implicated in the etiology of pericarditis, bacteria known to be associated with pericarditis include staphylococcus species, streptococcal species, tuberculosis, and in children, Haemophilus influenzae.1 Here we present a rare case of pericarditis in an adult male patient which occurred in association with Haemophilus influenzae bacteremia

Novel partial anomalous pulmonary venous connection associated with brain abscess.

BACKGROUND: Right-to-left vascular shunts are associated with brain abscess. CASE REPORT: We present a 47-year-old female with a cryptogenic left thalamic abscess on which Streptococcus mitis grew upon aspiration. Computed tomography of the chest with contrast agent revealed an anomalous connection between the left superior pulmonary and brachiocephalic veins. A right-to-left shunt was confirmed in a transthoracic echocardiogram study in which bubbles were injected into the left arm; this shunt had not previously been noted upon right-arm injection. CONCLUSIONS: We recommend aggressive evaluation for right-to-left shunts in patients who present with cryptogenic brain abscesses. In addition to imaging, this should include a bubble-based study with left-arm saline injection

From the Editors

We are honored to present the 24th Annual edition of The Medicine Forum to the Jefferson community. Over the years, it has been remarkable to see the quality and diversity of projects submitted to this forum, and this year is no exception. The Medicine Forum aims to celebrate the scholarly activity among physicians in training at our institution. We hope that this year\u27s edition will continue to honor this long standing tradition. Despite the uncertainties and stressors that are inherent to working in a hospital, our authors have found the time to produce scholarly work that will diversify and further medical knowledge. For this, we thank them. We also want to thank our supporters for making this journal possible and our readers for their continued interest. Editorial Board Harrison Bell, MD Akash Patel, DO Benjamin Tasevac, MD Editorial Staff Katherine Duffey, MD Michael Joseph, DO Louis Kishfy, MD Mark Mallozzi, MD Lindsey Morris, MD Jason Ojeda, MD Tal Zivan, MD Friends of the Forum Mark S. Berger, M

Effects of inundation period and tillage option on field performance of self-propelled rice transplanter

Manual transplanting of rice seedlings in puddling condition is a common method of crop establishment in the irrigated rice systems of Asia though it is time consuming. Rice transplanters are outmost need to overcome the labor crisis in the peak transplanting periods. But, self-propelled transplanter requires an ideal field conditions to obtain better performance. Hence, a self-propelled rice transplanter (Model: DP480 and S3-680) was evaluated in clay loam (CLS), loam (LS) and sandy loam soil (SLS) during the irrigated dry season (Boro) of 2012-13 and 2013-14 under three inundation periods of 12, 18 and 24 hrs and three tillage options as strip tillage (ST), zero tillage (ZT) and conventional tillage (CT) to identify a suitable inundation period and tillage option. Soil penetration resistance decreased with the increased of inundation period in both the seasons and in three soil types. In CLS and SLS, CT showed lower penetration. In LS, ST gave higher resistance in strip compared to ZT and CT. 2-way interaction of tillage and inundation period as well as single effect of inundation period showed significant outcome in SLS during Boro/2013-14 where 18 hr inundation period for ST and CT and 24 hr for ZT gave significantly higher rate of area coverage. Average of two seasons, ST gave more rate of area coverage for 18 hrs inundation period irrespective of soil types whereas ZT gave more for 24, 18 and 24 hrs inundation period in CLS, LS and SLS respectively. ST and ZT saved 22 to 13% and 8 to 13% fuel requirement for transplanting in CLS and SLS compared to CT, respectively whereas CT saved fuel requirement by 2 to 7% over ST and ZT in LS. Contrary, ST reduced the percentage of missing hills (9.7%) compared to ZT (13.0%) and CT (10.7%) while percentage of missing hills reduced (13.7 to 9.2%) with the increased of inundation periods irrespective of seasons and soil types. Highest percentage of picker missing hills was observed for ZT in LS (4.8%) and SLS (4.6%) while 12 hrs inundation periods in SLS gave the highest and 18 and 24 hrs inundation periods in CLS and 24 hrs inundation periods in SLS gave the lowest picker missing hills. Damage hills increased in ZT from 2.6 to 3.0% compared to CT (1.0 to 1.6%) and ST (1.6 to 2.1%). Damage hills also increased in 12 hrs inundation period (2.4%) followed by 24 hrs (1.8%) and 18 hrs (1.7%) inundation periods. Highest floating hills were also observed for ZT followed by ST. Floating hills decreased with inundation periods in all types of soil. CT increased the buried hills significantly during the both seasons. However, highest percentages of buried hills were observed for 12 hrs inundation periods (2.6%) while lowest for 24 hrs inundation periods (1.6%). ST gave higher grain yield of rice compared to ZT and CT in both seasons under clay loam, loam and sandy loam soils except CLS during Boro 2012-13 seasons where ZT gave higher yield. Averaged over two seasons and three soil types, 24 hrs inundation periods gave higher yield followed by 18 hrs inundation periods. However, ST, ZT and CT gave higher yield for 18 (6.1 t/ha), 24 (6.0 t/ha) and 24 hrs (5.9 t/ha) inundation periods followed by 24 (5.9 t/ha), 18 (5.6 t/ha) and 18 hrs (5.7 t/ha), respectively. Finally, it can be stated that unpuddled minimum tillage is a resource saving technique of rice production while 18 hrs inundation prior to transplanting for strip and 24 hrs inundation for zero and conventional tillage showed more benefited for rice production

A complementary relation between classical bits and randomness in local part in simulating singlet state

Recently Leggett's proposal of non-local model generates new interest in simulating the statistics of singlet state. Singlet state statistics can be simulated by 1 bit of classical communication without using any further nonlocal correlation. But, interestingly, singlet state statistics can also be simulated with no classical cost if a non-local box is used. In the first case, the output is completely unbiased whereas in second case outputs are completely random. We suggest a new (possibly) signaling correlation resource which successfully simulates singlet statistics and this result suggests a new complementary relation between required classical bits and randomness in local output when the classical communication is limited by 1 cbit. This result reproduces the above two models of simulation as extreme cases. This also explains why Leggett's non-local model and the model presented by Branciard et.al. should fail to reproduce the statistics of a singlet.Comment: v3: Typos corrected, few changed notations, some extensions to earlier write-u

DC fault protection of multi-terminal HVDC systems using DC network partition and DC circuit breakers

This paper concentrates on using fast acting DC Circuit Breakers (DCCBs) at strategic locations to allow the entire Multi-terminal HVDC (MTDC) system to be operated interconnected but partitioned into islanded DC network zones following faults. This configuration uses least number of DCCBs in order to minimise the capital cost and power loss while retaining the benefit of system interconnection. The proposed concept has greater flexibility during normal operating condition and reduces the need for pre-fault partitioning of the system. During a DC fault, the DCCBs at the strategic cable connections that link the different DC network partitions are opened such that the faulty DC section is quickly isolated from the remaining of the MTDC system. Thus, the healthy DC network zone can recover and power transmission can be restored quickly. The faulty DC section can be protected using slow AC circuit breakers. MATLAB/SIMULINK simulations are presented to demonstrate satisfactory system behaviour during DC faults

Cerebral Arteriovenous Malformations: Evaluation and Management.

There has been increased detection of incidental AVMs as result of the frequent use of advanced imaging techniques. The natural history of AVM is poorly understood and its management is controversial. This review provides an overview of the epidemiology, pathophysiology, natural history, clinical presentation, diagnosis, and management of AVMs. The authors discussed the imaging techniques available for detecting AVMs with regard to the advantages and disadvantages of each imaging modality. Furthermore, this review paper discusses the factors that must be considered for the most appropriate management strategy (based on the current evidence in the literature) and the risks and benefits of each management option