Asunto(s)
Mortalidad Infantil , Pobreza/estadística & datos numéricos , Resultado del Embarazo/epidemiología , Adulto , Estudios de Casos y Controles , Escolaridad , Emigración e Inmigración/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/normas , Vivienda/estadística & datos numéricos , Humanos , Recién Nacido , Kuwait/epidemiología , Servicios de Salud Materna/normas , Vigilancia de la Población , Embarazo , Características de la Residencia/estadística & datos numéricos , Factores de RiesgoRESUMEN
This study is the first of its kind in Kuwait. It evaluates various risk factors associated with perinatal mortality (PNM) in the Al-Jahra district hospital during the period January 1995-December 1997. Risks associated with PNM were age above 30, parity above 8, history of abortion or perinatal death, lack of antenatal care, presence of chronic maternal disease, hydramnios, antepartum haemorrhage, breech presentation and low Apgar scores. The effect of the appropriate preventative programmes involving highlighting women at risk of perinatal mortality and probable intervention are discussed.
RESUMEN
The purpose of this study was to determine the clinical characteristics of chronic renal failure patients who developed hand ischemia in the limb carrying the dialysis angioaccess. A retrospective review of the charts of 352 patients who underwent 409 upper extremity arteriovenous access, and who were subsequently diagnosed as steal syndrome, was performed at the Emory University Hospital between February 1992 and January 1997. Hand ischemia occurred after 13 of 299 arteriovenous grafts (4.3%) and after 2 of 110 direct forearm arteriovenous fistulas (1.8%). Six patients developed ischemic manifestations immediately postoperatively, 2 in the first week, 4 after 1 month, and 1 after 1 year. Thirteen occurred in association with the primary access procedure. Two cases occurred following graft thrombectomy and outflow dilatation. Seven patients were mildly symptomatic with dialysis-induced pain, coldness, or numbness; 8 patients developed severe ischemic manifestations in the form of sensory loss in 3, severe intolerable pain with impalpable pulse in 3, and digital gangrene and amputation in 2, one of whom developed an unhealed amputation stump and required a higher amputation level with satisfactory healing of the revised stump. Three patients were treated conservatively, 6 by banding, 4 by ligation, 1 by embolization, and 1 by distal ligation and bypass operation. Clinical characteristics of patients with hand ischemia included long-standing insulin-dependent diabetes (10), chronic hypertension (12), peripheral arterial disease (14; 93.3%), coronary artery disease (8), and systemic lupus erythematosis (1). Severe peripheral arterial diseases are commonly found and may be markers for risk of hand ischemia after access surgery.
Asunto(s)
Derivación Arteriovenosa Quirúrgica/efectos adversos , Mano/irrigación sanguínea , Isquemia/etiología , Diálisis Renal/efectos adversos , Amputación Quirúrgica , Catéteres de Permanencia/efectos adversos , Humanos , Isquemia/diagnóstico por imagen , Isquemia/cirugía , Enfermedades Vasculares Periféricas/complicaciones , Pronóstico , Radiografía , Factores de TiempoRESUMEN
OBJECTIVE: To assess the efficacy and safety of labetalol compared with methyldopa in the management of mild and moderate cases of pregnancy-induced hypertension (PIH). METHODS: One hundred four primigravidas with PIH were randomly allocated to receive either labetalol (group A) or methyldopa (group B). The dose of the drugs was doubled every 48 h to maintain a mean arterial blood pressure < or = 103.6 mmHg. Clinico-biochemical effects and frequency of side effects were studied. The statistical level of significance was taken at P < 0.05. RESULTS: Ten patients in group B (18.5%) developed significant proteinuria (> 30 mg/dl) whereas none developed proteinuria in group A. Labetalol was quicker and more efficient at controlling blood pressure, having a beneficial effect on renal functions and causing fewer side effects compared with methyldopa. The rate of induction of labor and rate of cesarean section for uncontrolled PIH was less in group A (48% and 1%, respectively) compared with group B (63.0% and 5.6%, respectively). Moreover a higher Bishop score at induction of labor was noticed in group A. CONCLUSIONS: Labetalol is better tolerated than methyldopa, gives more efficient control of blood pressure and may have a ripening effect on the uterine cervix.
Asunto(s)
Hipertensión/tratamiento farmacológico , Labetalol/uso terapéutico , Metildopa/uso terapéutico , Preeclampsia/tratamiento farmacológico , Complicaciones Cardiovasculares del Embarazo/tratamiento farmacológico , Adulto , Presión Sanguínea/efectos de los fármacos , Cesárea , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Humanos , Hipertensión/diagnóstico , Recién Nacido , Kuwait , Labetalol/efectos adversos , Trabajo de Parto Inducido , Metildopa/efectos adversos , Preeclampsia/diagnóstico , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnósticoRESUMEN
We report a 27-year-old XY female who presented with abdominal pain due to hemoperitoneum from a ruptured abdominal mass. Gonadoblastoma overgrown by endodermal sinus tumor and dysgerminoma was detected. The risk of neoplasia in such cases is discussed.