Sheepskin Effects in the Returns to Education by Ethnic Group: Evidence from Northeastern Brazil

This paper examines the relative magnitudes of "sheepskin effects" in the returns to education for the three main ethnic groups in the Metropolitan Region of Salvador (MRS), Bahia state, in Northeastern Brazil, and ascertains whether their pattern is consistent with a simple signalling model. We show that failure to account for the strong signal furnished by admission to university, which is subject to a rigorous entrance exam in Bahia state, artificially inflates the estimated rate of return to an additional year of university education and results in downward bias in the estimated sheepskin effect of completing a four-year university degree. This is especially true for blacks. Moreover, our empirical results suggest that sheepskin effects take the traditional form of an additional return to the completion of a diploma for whites, whereas for blacks the additional return stems entirely from the sheepskin-like effect associated with admission to university.Brazil., discrimination, sheepskin effects, returns to education

Study of maternal and fetal outcomes in patients with gestational diabetes mellitus

Background: Diabetes mellitus is the commonest medical problem complicating pregnancy, with possibility of grave consequences. With the present study, incidence, management and perinatal outcomes in the cases of GDM were studied.Methods: All the pregnant patients attending antenatal clinic at the study centre during study period of three years were studied. Those with positive history were screened for GDM as early as possible and rest screened at 24-28 weeks gestation. Carpenter and Coustan criteria were used for the diagnosis of gestational diabetes mellitus. All the diagnosed cases of gestational diabetes mellitus were followed up throughout the course of gestation and complications, if any, recorded.Results: A total of 39 patients were diagnosed as GDM. Majority were multigravida (69.3%, 27) and weighed over 75 kg (56%, 22). Patients were mostly diagnosed at the gestational age of 31-35 weeks (n-15) and 21-25 weeks (n-11). Fifteen patients (38.4%) had HbA1c values between 6-7%, 14 patients (35.8%) between 7-8% and 3 patients had HBA1c levels more than 10%. Twenty-three percent (9) patients had PIH, 13% (5) polyhydramnios and 7.6% (3) had PROM. Three mothers had babies suffering from IUGR. Sixteen (41%) had full term normal delivery while 2 (5.1%) patients had preterm labor and delivered normally. Twenty-one mothers (53.84%) had LSCS, out of which 3 had preterm LSCS.Conclusions: Diabetes during pregnancy is associated with risk factors as well as high maternal and foetal morbidity. GDM has good maternal and foetal outcomes depending upon how well the blood sugar levels are controlled

A study of evaluation of unhealthy cervix by various diagnostic modalities

Background: This study was carried out to evaluate cases of unhealthy cervix by using Pap (Papanicolaou) smear, colposcopy and cervical biopsy and to arrive at a definitive diagnosis. It correlated the findings of Pap smear, colposcopy and histopathology. It is important to strictly implement the screening program and spread awareness of the disease symptoms and its management to reduce the overall incidence of morbidity and mortality reported due to cervical cancer.Methods: A total 120 patients satisfying the inclusion/exclusion criteria were recruited for the study and informed consent was taken from all the participants. Pap smear was taken for all the cases. Then cases were subjected to colposcopy followed by biopsy. All the findings were correlated and analyzed. The findings of Pap smear and colposcopy were correlated with the gold standard of histopathology.Results: The sensitivity and specificity of Pap smear and colposcopy with respect to cervical biopsy were 53.1% and 98.7%, 87.87% and 72.72% respectively. Colposcopy had higher sensitivity and lower specificity than Pap smear for screening of cancer cervix.Conclusions: Cervical cancer is one of the preventable and highly curable conditions when diagnosed in the precancerous stage. The incidence of deaths resulting from cervical cancer can be brought down with adequate cervical cancer screening. Colposcopy and colposcopy directed biopsy should be done along with Pap smear in screening for early detection of cervical cancer since the accuracy of detection of cervical abnormalities is higher when these two methods are used complementarily

A prospective study of the study of maternal and perinatal outcome in cases of eclampsia

Background: This is an observational analytical study carried out in the department of obstetrics and gynecology, in a tertiary care center to determine the factors influencing fetal and maternal outcome, prognosis and complications in booked and unbooked eclamptic cases.Methods: The present study is a prospective study of perinatal and maternal outcome in 50 cases of eclampsia, above 32 weeks of gestation, from 1st May 2013 to 30th April 2014. Patients with medical complications like anemia, preexisting hypertension, diabetes, vascular or renal disease, multiple gestation, polyhydraminos, etc. are excluded from the study. Detailed history, physical examinations were carried out and appropriate management instituted as per individual patient need. Follow-up of mothers up to 6weeks postpartum and neonates in the early neonatal period was done.                Results: Incidence of eclampsia is 0.64%, incidence of maternal mortality is 0.4% and perinatal mortality is 24%. 36% of patients developed complications. Maternal mortality was significantly high in patients with 6 or more episodes of convulsions. The most common cause of perinatal mortality is prematurity. Antepartum eclampsia with gestational age less than 36 weeks, BP >160/100, preterm births, low birth weight babies, low apgar scores influenced adverse perinatal outcome.Conclusions: Eclampsia still remains a major problem in developing countries. It is one of the important causes of maternal and perinatal morbidity and mortality due to lack of proper ANC, low socio-economic status and lack of education

P300: avaliação do potencial evocado cognitivo em crianças com e sem TDAH

This study presents the result of the investigation of methylphenidate effect in the latency and amplitude of P300 in children with TDAH. It also investigated the cognitive potential P300 in children with TDAH in comparison with a control group. Two studies were developed: the first, considered almost experimental, of analytical character, only in individuals with TDAH, esteemed the latency and amplitude of P300 in function of methylphenidate use. The second, a descriptive study, of exploratory character, esteemed the latency and amplitude of P300 in cases (TDAH) and controls (without TDAH). The results shows that Ritalina LI reduces the latency of P300 in children with TDAH, with significant results just in the group of age between 11 to 16 years. The amplitudes was not sensitive as a parameter for evaluation of Ritalina in P300, the results presented a great variability in the answers. It was observed, also, that the children with TDAH have larger latencies and reduced amplitudes when compared to the control group, it was verified statistical significance, once again, just in the group of age between 11 to 16 years. Individuals in the age from 7 to 10 years present larger latencies and reduced amplitudes, independent of the use of Ritalina, that those in the age from 10 to 16 years. This study allow us to infer that the use of Ritalina improves the attention process favoring the hearing discrimination and the power of decision.Este estudo apresenta o resultado da investigação do potencial cognitivo P300 em crianças com TDAH, em comparação com um grupo de crianças sem TDAH. Trata-se de um estudo descritivo, de caráter exploratório, que estimou a latência e a amplitude do P300 em crianças portadoras de TDAH, em comparação com crianças sem sintomas de TDAH. A casuística foi composta por 56 indivíduos na faixa etária de 7 a 16 anos, 25 dos quais pertenciam ao grupo com diagnóstico de TDAH e 31 sem sintomas de TDAH Todos os participantes, representados pelos pais ou responsáveis legais, responderam a um questionário para levantamento de dados sociodemográficos, dados de saúde geral, queixas específicas e desempenho escolar. As crianças foram submetidas a testes para avaliação da audição periférica e potencial evocado cognitivo (P300). Foi observado que os portadores de TDAH possuem latências maiores e amplitude menores, quando comparados com as crianças do grupo de controle, verificando-se significância estatística apenas para o grupo de maior faixa-etária (11 a 16 anos)

Reminiscencia

Ese día estaba sentada recibiendo una extensa y pesada clase de pediatría sobre cómo tratar la diarrea. De repente, tu mejor amigo, tu hermano, salió corriendo desesperadamente. No pude concentrarme más ni estar tranquila en esa clase, sentía que todo el mundo me miraba como queriéndome decir algo, pero era como si nadie se atreviera a hacerlo. El celular vibró y lo miré de reojo: alguien había mandado un mensaje que decía “Tenemos que hablar.”. Mi preocupación aumentaba, mi intuición me decía que algo te había pasado, que lo que me fuera a decir tenía que ver contigo

The burden of sickle cell disease in Cape Town

Background. South Africa has a low incidence of sickle cell disease (SCD). However, its demographics are changing because of immigration from sub-Saharan African countries where SCD is prevalent.Objectives. We aimed to determine the frequency of SCD presenting to the Haematology/Oncology Service at Red Cross War Memorial Children’s Hospital in Cape Town and to measure the associated disease burden.Methods. This was a retrospective cross-sectional study of patients first attending the Haematology Service between January 2001 and June 2010.Results. A total of 58 SCD patients were indentified, with an annual frequency that increased over the study period by 300 -400%. Up to 93.1% (n=54) were originally from other African countries, mainly the Democratic Republic of Congo (62.1%, n=36). One patient had sickle D-Punjab genotype, and all the other patients had the homozygous sickle cell anaemia genotype (Hb SS). Their haematological parameters  demonstrated a normocytic anaemia with high white cell counts. The mean number of clinic visits per patient per year was 22.2 (range 0 - 64), and the mean number of hospital admissions per patient per year was 1.2 (range 0 - 5). All the patients were on antibiotic prophylaxis. The majorityhad at least one blood transfusion (65.5%, n=38), and a significantproportion required intravenous analgesia on admission (29.3%, n=17) and hydroxyurea treatment (36.2%, n=21).Conclusions. Over the past 10 years the frequency of SCD has increased considerably, imposing a significant burden and new challenges to the health services in Cape Town

Time to shift from contemporary to high-sensitivity cardiac troponin in diagnosis of acute coronary syndromes

AbstractEarly rule-in and rule-out of non-ST-segment elevation myocardial infarction (NSTEMI) is a challenge. In patients with inconclusive findings on ECG, cardiac biomarkers play a crucial role in the diagnosis. The introduction of the new high-sensitive cardiac troponin test (hs-TnI assay) has changed the landscape of NSTEMI diagnosis.The new hs-TnI assay can detect troponin values at a lower level compared with a contemporary cardiac troponin (cTn) assay. The hs-cTnI assay has a coefficient of variation of ≤10%, well below the 99th percentile value. It reduces the time to diagnose acute myocardial infarction from 6h to 3h. A recent study has demonstrated that hs-cTnI can further reduce the time to 1h in 70% of all patients with chest pain.The European Society of Cardiology 2015 guidelines recommend including a second sample of hs-cTnI within 3h of presentation This increases the sensitivity of the hs-TnI assay from 82.3% (at admission) to 98.2% and negative predictive value from 94.7% (at admission) to 99.4%. Combining the 99th percentile at admission with serial changes in troponin increases the positive predictive value to rule in acute coronary syndrome from 75.1% at admission to 95.8% after 3h.The 2015 ESC Guidelines recommend the use of a rapid rule out protocol (0h and 1h) when hs-cTnI with a validated 0 to1h algorithm is available.Training and displaying the clinical algorithm depicting the role of hs-TnI assay in acute cardiac care units and in EDs are an efficient way to deliver the new standard of care to patients. Compared with contemporary troponin assays, the hs-cTn assay accelerates the diagnostic pathway to 0–1h, thus reducing the time for diagnosis of NSTEMI and hence, its management