Heart diseasae in pregnancy

A series of two hundred and twenty -five patients with heart disease is reviewed, showing its incidence in pregnancy to be 0.8 per cent, and its mortality 3.1 per cent.With better obstetrics and fewer deaths from sepsis, heart disease is occupying a relatively more prominent position as a cause of maternal deaths, being the fourth most common cause in this series, and accounting for 11.6 per cent of all maternal deaths.Rheumatic fever was responsible for 93 per cent of cases, and the mitral valve was the site of the lesion in all but a few.Observation of patients with heart disease at weekly intervals is recommended, owing to the danger of their condition deteriorating and in order immediately to observe any adverse change: and it is recommended that all patients should be admitted for one week about the twenty- eighth week, for rest and assessment, and again seven to ten days before full term. Antenatal care is one of the major factors in lowering the mortality rate, and each visit of the patient should include careful medical examination, especially of her lung bases for the early crepitations, close questioning as to her daily routine and an assurance that she keeps within the limits of her cardiac reserve. It is possible that the more frequent examination and earlier advice and treatment of the Group II patients may be the key to the avoidance of the occasional failure in this group.Respiratory infections, however trivial, have to be treated seriously, as they have a tendency to resist ordinary treatment and may precipitate.heart failure; anaemia, too, should be avoided, and, if marked, a careful look-out kept for signs which might suggest subacute endocarditis, and the patient should be advised to report should she develop any new symptom.The functional heart grouping of the American Heart Association gives a good indication of the cardiac reserve, and offers a common nomenclature for reporting results.Some additional factors in assessment in individual cases, as suggested by Lamb (1934), may help to lessen the dangers of cardiac decompensation and, towards this end, the co- operation between the cardiologist and the obstetrician is essential.A history of previous failure is a bad prognosti sign, and, although there is an apparent recovery, such patients should be regarded as group IV cases. It may, in fact, be advisable, as regards the obstetric treatment, to place the patient in the least favourable group to which she may have reached, no matter what the improvement obtained with treatment, or what more favourable group she may later occupy during pregnancy.Spontaneous labour, aided, if necessary, by forceps, would seem to be the best mode of delivery, and is possible in the vast majority of cases; Caesarean section being reserved for the presence of other obstetrical complications, or, in some cases, where surgical termination of the pregnancy is indicated.It has been noted in this series, that patients with heart disease do not stand up well to prolonged labour or to accouchement force, and, if these are anticipated, a Caesarean section may be less of a risk to the patient. Observation of the pulse and respiration rates during the first stage of labour, as recommended by Mendelson and Pardee (1942), and immediate digitalisation, if necessary, may serve to prevent decompensation developing.The anaesthetic which is best advised is morphia for the first stage and pudendal block for the second stage of labour, supplemented by a light gas and oxygen and episiotomy when forceps are used.There is a definite place for therapeutic abortion in the group III and IV patients; and in others, rho have given a history of previous heart failure, it is assessed individually.The selection of bad-risk cardiac patients should be one at cardiac clinics, where they should be advised against becoming pregnant: and this precaution together with careful choosing of patients who are to proceed with pregnancy and avoid decompensation, with its attendant risks, can serve greatly to lower the mortality rate. Gilchrist and Murray Lyon (1933) say that one or two pregnancies do not shorten the expectation of life in the cardiac: and Jones (1944) advises against a third pregnancy. These observations have shown, however, that, altho pregnancy may not induce heart failure, it may leave the heart severely crippled. It has been shown in this series that patients who have changed to a less favourable functional heart group during pregnancy are more liable to show these adverse effects in later years. No difference, however, in the age of death has been shown in nulliparous and parous women.Of congenital lesions, unless there is persistent cyanosis, which would justify advising against pregnancy, or securing an early termination, the patient is treated as for other heart lesions: the exception being in those lesions where excess straining must be avoided and when, therefore, a Caesarean section should be performed.A guarded prognosis has to be given until the end of the puerperium, since the majority of fatalities occur then, and additional rest in hospital should be advised for patients at this time.Before the patient leaves hospital, to assume the extensive burdens of the care of her child, a full opportunity should be taken to discuss with her the domestic responsibilities which she has to meet: and if indicated, as it is in most cases, arrangements made whereby she may have the assistance of a Home-help, such as is now available from most local Authority Departments. Finally, a date is given to the patient for attendance at a Cardiological clinic for future advice and guidance

Combined antiapoptotic and antioxidant approach to acute neuroprotection for stroke in hypertensive rats

We hypothesized that targeting key points in the ischemic cascade with combined neuroglobin (Ngb) overexpression and c-jun N-terminal kinase (JNK) inhibition (SP600125) would offer greater neuroprotection than single treatment after in vitro hypoxia/reoxygenation and in a randomized, blinded in vivo experimental stroke study using a clinically relevant rat strain. Male spontaneously hypertensive stroke-prone rats underwent transient middle cerebral artery occlusion (tMCAO) and were divided into the following groups: tMCAO; tMCAO+control GFP-expressing canine adenovirus-2, CAVGFP; tMCAO+Ngb-expressing CAV-2, CAVNgb; tMCAO+SP600125; tMCAO+CAVNgb+SP600125; or sham procedure. Rats were assessed till day 14 for neurologic outcome before infarct determination. In vitro, combined lentivirus-mediated Ngb overexpression+SP600125 significantly reduced oxidative stress and apoptosis compared with single treatment(s) after hypoxia/reoxygenation in B50 cells. In vivo, infarct volume was significantly reduced by CAVNgb, SP600125, and further by CAVNgb+SP600125. The number of Ngb-positive cells in the peri-infarct cortex and striatum was significantly increased 14 days after tMCAO in animals receiving CAVNgb. Neurologic outcome, measured using a 32-point neurologic score, significantly improved with CAVNgb+SP600125 compared with single treatments at 14 days after tMCAO. Combined Ngb overexpression with JNK inhibition reduced hypoxia/reoxygenation-induced oxidative stress and apoptosis in cultured neurons and reduced infarct and improved neurologic outcome more than single therapy after in vivo experimental stroke in hypertensive rats

BCKDH: the missing link in apicomplexan mitochondrial metabolism is required for full virulence of Toxoplasma gondii and Plasmodium berghei

While the apicomplexan parasites Plasmodium falciparum and Toxoplasma gondii are thought to primarily depend on glycolysis for ATP synthesis, recent studies have shown that they can fully catabolize glucose in a canonical TCA cycle. However, these parasites lack a mitochondrial isoform of pyruvate dehydrogenase and the identity of the enzyme that catalyses the conversion of pyruvate to acetyl-CoA remains enigmatic. Here we demonstrate that the mitochondrial branched chain ketoacid dehydrogenase (BCKDH) complex is the missing link, functionally replacing mitochondrial PDH in both T. gondii and P. berghei. Deletion of the E1a subunit of T. gondii and P. berghei BCKDH significantly impacted on intracellular growth and virulence of both parasites. Interestingly, disruption of the P. berghei E1a restricted parasite development to reticulocytes only and completely prevented maturation of oocysts during mosquito transmission. Overall this study highlights the importance of the molecular adaptation of BCKDH in this important class of pathogens

Year in review in Intensive Care Medicine 2012. II: Pneumonia and infection, sepsis, coagulation, hemodynamics, cardiovascular and microcirculation, critical care organization, imaging, ethics and legal issues.

Journal ArticleSCOPUS: re.jSCOPUS: re.jinfo:eu-repo/semantics/publishe

Source attribution, prevalence and enumeration of Campylobacter spp. from retail liver

Funding Information: We thank Food Standards Agency, Scotland for funding this work.Peer reviewedPreprin

2-(4-Ferrocenylphen­yl)-4,4,5,5-tetra­methyl-1,3,2-dioxaborolane

In the title compound,, [Fe(C5H5)(C17H20BO2)], the two near parallel cyclo­penta­dienyl rings of the ferrocene group are eclipsed. The benzene ring is tilted with respect to the attached cyclo­penta­diene ring by 17.0 (1)° and by 24.2 (1)° with respect to the dioxaborolane ring. The mol­ecules assemble in the crystal via C—H⋯π inter­actions between the cyclo­penta­dienyl H atoms and the benzene and cyclo­penta­dienyl rings of neighbouring mol­ecules

Efficiency of Nitrogen Use in Dairy Cows Grazing Ryegrass with Different Water Soluble Carbohydrate Concentrations

This experiment is one of a series designed to investigate the efficiency of nitrogen (N) use in Holstein-Friesian dairy cows grazing perennial ryegrass (Lolium perenne) which has been bred to express high water soluble carbohydrate (WSC) concentrations. Animals grazed either a High Sugar (HS) grass or a Control (C) variety chosen on the basis of heading date compatibility. Dry matter (DM) intakes were estimated using herbage mass. Milk yields, milk constituent concentrations and plasma concentrations of b-hydroxybutyrate, glucose, total protein, albumin and urea were also measured. Forage DM intakes were similar for the two grasses. However, because of differences in the nitrogen content of the varieties (128 vs 176 g crude protein (CP) kg-1 DM; s.e.d. 10.5; P \u3c 0.01) the animals consuming the C diet received ca. 35% more dietary N. Despite this, milk yields and outputs of milk fat, lactose and total protein were similar between treatments. These data indicate that the partition of dietary N for milk protein biosynthesis was much higher (P \u3c 0.01) in animals consuming the HS grass, which is reflected by the lower plasma urea concentrations in these animals. It is proposed that by providing grass varieties with a better match of readily available energy and protein, significant improvements in N use efficiency can be achieved

Multi-objective integer programming: An improved recursive algorithm

This paper introduces an improved recursive algorithm to generate the set of all nondominated objective vectors for the Multi-Objective Integer Programming (MOIP) problem. We significantly improve the earlier recursive algorithm of \"Ozlen and Azizo\u{g}lu by using the set of already solved subproblems and their solutions to avoid solving a large number of IPs. A numerical example is presented to explain the workings of the algorithm, and we conduct a series of computational experiments to show the savings that can be obtained. As our experiments show, the improvement becomes more significant as the problems grow larger in terms of the number of objectives.Comment: 11 pages, 6 tables; v2: added more details and a computational stud