Spontaneous broad ligament haematoma following a normal vaginal delivery: a case report

Broad ligament haematoma is a rare complication following a normal vaginal delivery. We report one such case of a woman who developed this complication within 3 hrs of normal vaginal delivery. She is G2P1L1, 38 wks GA, in active labour. Pt was allowed for spontaneous progression of labour, following which she delivered vaginally. Within 3 hrs patient looked clinically very pale with vitals being deranged and complains of inability to void urine, severe perineal pain. On basis of clinical examination and transabdominal ultrasound features a diagnosis of right sided broad ligament haematoma was made. Based on patients haemodynamic instability surgical management in the form of obstetric hysterectomy was done

Mems Tabanlı Kuvvet Algılayıcıları İle Mikro Newton Mertebesinde Ölçüm

Konferans Bildirisi -- Teorik ve Uygulamalı Mekanik Türk Milli Komitesi, 2013Conference Paper -- Theoretical and Applied Mechanical Turkish National Committee, 2013Nanoteknolojideki gelişmeler sayesinde mikro ve nano seviyesindeki küçük ölçeklerde kuvvet üretimi ve üretilen kuvvetin ölçülmesi hem endüstrinin hem de akademinin ilgi alanına girmektedir. Bu çalışmada önerilen kuvvet ölçümü sistemi, yekpare olarak üretilmiş bir yay sistemi ve üçlü algılayıcı elektrot geometrisinden meydana gelmektedir. Bu elektrot kümelerinden ikisi sabit, birisi hareketli durumdadır. Dış bir kuvvetten uygulanan tahrik sonucunda oluşan yer değiştirme, hareketli elektrot kümesinin sabit kümelere göre yer değiştirmesine sebep olur. Bunun sonucunda sistemde oluşan sığa değişimi, sabit elektrot kümelerine uygulanan ve 1800 faz farkına sahip olan AC gerilimi neticesinde hareketli plakadan DC gerilimi olarak okunur. Bu çalışmada en fazla 30 N kuvveti okuyabilen bir kuvvet algılayıcı tasarımı gerçekleştirildi. Tasarım kriterlerini kontrol etmek amacıyla sonlu elemanlar yazılımı ile yöntem doğrulaması sağlandı. Bir sonraki adım olarak, tasarımı yapılan kuvvet algılayıcı, mikro-üretim yöntemleri kullanılarak imal edilecektir.With the continuous advances in the field of nanotechnology, both force generation and force measurement techniques at micro and nano scales are widely employed in industry and academia. The proposed force measurement system of this work consists of a monolithic flexural part and a sensor with the three-electrode geometry, namely “tri-plate geometry”, for capacitive displacement sensing. One of these sets of electrodes is movable, whereas the remaining two are fixed. Displacement of the movable set of electrodes induced by an external source results in a capacitive difference in between movable and fixed set of electrodes. This displacement is then sensed on the movable stack as a DC voltage output by applying an AC voltage of 1800 phase difference to the two fixed electrode sets. In this study, we propose a design of a force sensor which is able to detect a maximum force of 30 N. To verify the design, finite element simulations are carried out and shown to be in agreement with the design criteria. As a final step, fabrication of the force sensor will be carried out

Field effect transistors for terahertz detection - silicon versus III–V material issue

International audienceResonant frequencies of the two-dimensional plasma in FETs reach the THz range for nanometer transistor channels. Non-linear properties of the electron plasma are responsible for detection of THz radiation with FETs. Resonant excitation of plasma waves with sub-THz and THz radiation was demonstrated for short gate transistors at cryogenic temperatures. At room temperature, plasma oscillations are usually over-damped, but the FETs can still operate as efficient broadband THz detectors. The paper presents the main theoretical and experimental results on detection with FETs stressing their possible THz imaging applications. We discuss advantages and disadvantages of application of III-V GaAs and GaN HEMTs and silicon MOSFETs

Unified reconstruction and motion estimation in cardiac perfusion MRI

ABSTRACT We introduce a novel unifying approach to jointly estimate the motion and the dynamic images in first pass cardiac perfusion MR imaging. We formulate the recovery as an energy minimization scheme using a unified objective function that combines data consistency, spatial smoothness, motion and contrast dynamics penalties. We introduce a variable splitting strategy to simplify the objective function into multiple sub problems, which are solved using simple algorithms. These sub-problems are solved in an iterative manner using efficient continuation strategies. Preliminary validation using a numerical phantom and in-vivo perfusion data demonstrate the utility of the proposed scheme in recovering the perfusion images from considerably under-sampled data

Patients' perspectives on taking warfarin: qualitative study in family practice

BACKGROUND: Despite the well-documented benefits of using warfarin to prevent stroke, physicians remain reluctant to initiate therapy, and especially so with the elderly owing to the higher risk of hemorrhage. Prior research suggests that patients are more accepting of the risk of bleeding than are physicians, although there have been few qualitative studies. The aim of this study was to employ qualitative methods to investigate the experience and perspective of individuals taking warfarin. METHODS: We conducted face-to-face interviews with 21 older patients (12 male, 9 female) who had been taking warfarin for a minimum of six months. Participants were patients at a family practice clinic situated in a large, tertiary care teaching hospital. We used a semistructured interview guide with four main thematic areas: decision-making, knowledge/education, impact, and satisfaction. Data were analysed according to the principles of content analysis. RESULTS AND DISCUSSION: Participants tended to have minimal input into the decision to initiate warfarin therapy, instead relying in great part on physicians' expertise. There appeared to be low retention of information received regarding the therapy; half the patients in our sample possessed only a superficial level of understanding of the risks and benefits. This notwithstanding, participants reported a high level of satisfaction with the care provided and a low level of impact on their day-to-day lives. CONCLUSIONS: Minimal patient involvement in the initial decision and modest knowledge did not appear to diminish satisfaction with warfarin management. At the same time, care providers exert a tremendous influence on the initiation of warfarin therapy and should strive to incorporate patient preferences and expectations into the decision-making process

Educational intervention improves anticoagulation control in atrial fibrillation patients:the TREAT randomised trial

Background: Stroke prevention in atrial fibrillation (AF), most commonly with warfarin, requires maintenance of a narrow therapeutic target (INR 2.0 to 3.0) and is often poorly controlled in practice. Poor patient-understanding surrounding AF and its’ treatment may contribute to patient’s willingness to adhere to recommendations. Method: A theory-driven intervention, developed using patient interviews and focus groups, consisting of a one-off group session (1-6 patients) utilising an ‘expert-patient’ focussed DVD, educational booklet, self-monitoring diary and worksheet, was compared in a randomised controlled trial (ISRCTN93952605) against usual care, with patient postal follow-ups at 1, 2, 6, and 12-months. Ninety-seven warfarin-naïve AF patients were randomised to intervention (n=46, mean age (SD) 72.0 (8.2), 67.4% men), or usual care (n=51, mean age (SD) 73.7 (8.1), 62.7% men), stratified by age, sex, and recruitment centre. Primary endpoint was time within therapeutic range (TTR); secondary endpoints included knowledge, quality of life, anxiety/depression, beliefs about medication, and illness perceptions. Main findings: Intervention patients had significantly higher TTR than usual care at 6-months (76.2% vs. 71.3%; p=0.035); at 12-months these differences were not significant (76.0% vs. 70.0%; p=0.44). Knowledge increased significantly across time (F (3, 47) = 6.4; p<0.01), but there were no differences between groups (F (1, 47) = 3.3; p = 0.07). At 6-months, knowledge scores predicted TTR (r=0.245; p=0.04). Patients’ scores on subscales representing their perception of the general harm and overuse of medication, as well as the perceived necessity of their AF specific medications predicted TTR at 6- and 12-months. Conclusions: A theory-driven educational intervention significantly improves TTR in AF patients initiating warfarin during the first 6-months. Adverse clinical outcomes may potentially be reduced by improving patients’ understanding of the necessity of warfarin and reducing their perception of treatment harm. Improving education provision for AF patients is essential to ensure efficacious and safe treatment

Immune system deregulation in hypertensive patients chronically RAS suppressed developing albuminuria

Albuminuria development in hypertensive patients is an indicator of higher cardiovascular (CV) risk and renal damage. Chronic renin-angiotensin system (RAS) suppression facilitates blood pressure control but it does not prevent from albuminuria development. We pursued the identification of protein indicators in urine behind albuminuria development in hypertensive patients under RAS suppression. Urine was collected from 100 patients classified in three groups according to albuminuria development: (a) patients with persistent normoalbuminuria; (b) patients developing de novo albuminuria; (c) patients with maintained albuminuria. Quantitative analysis was performed in a first discovery cohort by isobaric labeling methodology. Alterations of proteins of interest were confirmed by target mass spectrometry analysis in an independent cohort. A total of 2416 proteins and 1223 functional categories (coordinated protein responses) were identified. Immune response, adhesion of immune and blood cells, and phagocytosis were found significantly altered in patients with albuminuria compared to normoalbuminuric individuals. The complement system C3 increases, while Annexin A1, CD44, S100A8 and S100A9 proteins showed significant diminishment in their urinary levels when albuminuria is present. This study reveals specific links between immune response and controlled hypertension in patients who develop albuminuria, pointing to potential protein targets for novel and future therapeutic interventions.Sin financiación4.122 JCR (2017) Q1, 12/64 Multidisciplinary Sciences0.809 SJR (2017) Q2, 4/10 OptometryNo data IDR 2017UE

Correction: Pulsed moxifloxacin for the prevention of exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial

BACKGROUND: Acute exacerbations contribute to the morbidity and mortality associated with chronic obstructive pulmonary disease (COPD). This proof-of-concept study evaluates whether intermittent pulsed moxifloxacin treatment could reduce the frequency of these exacerbations. METHODS: Stable patients with COPD were randomized in a double-blind, placebo-controlled trial to receive moxifloxacin 400 mg PO once daily (N = 573) or placebo (N = 584) once a day for 5 days. Treatment was repeated every 8 weeks for a total of six courses. Patients were repeatedly assessed clinically and microbiologically during the 48-week treatment period, and for a further 24 weeks' follow-up. RESULTS: At 48 weeks the odds ratio (OR) for suffering an exacerbation favoured moxifloxacin: per-protocol (PP) population (N = 738, OR 0.75, 95% confidence interval (CI) 0.565-0.994, p = 0.046), intent-to-treat (ITT) population (N = 1149, OR 0.81, 95% CI 0.645-1.008, p = 0.059), and a post-hoc analysis of per-protocol (PP) patients with purulent/mucopurulent sputum production at baseline (N = 323, OR 0.55, 95% CI 0.36-0.84, p = 0.006).There were no significant differences between moxifloxacin and placebo in any pre-specified efficacy subgroup analyses or in hospitalization rates, mortality rates, lung function or changes in St George's Respiratory Questionnaire (SGRQ) total scores. There was, however, a significant difference in favour of moxifloxacin in the SGRQ symptom domain (ITT: -8.2 vs -3.8, p = 0.009; PP: -8.8 vs -4.4, p = 0.006). Moxifloxacin treatment was not associated with consistent changes in moxifloxacin susceptibility. There were more treatment-emergent, drug related adverse events with moxifloxacin vs placebo (p < 0.001) largely due to gastrointestinal events (4.7% vs 0.7%). CONCLUSIONS: Intermittent pulsed therapy with moxifloxacin reduced the odds of exacerbation by 20% in the ITT population, by 25% among the PP population and by 45% in PP patients with purulent/mucopurulent sputum at baseline. There were no unexpected adverse events and there was no evidence of resistance development. TRIAL REGISTRATION: ClinicalTrials.gov number, NCT00473460 (ClincalTrials.gov)