Olfactory and gustatory sensory changes to tobacco smoke in pregnant smokers

Models of smoking behavior change include addiction, social, and behavioral concepts. The purpose of this study was to explore the prevalence of two biologic factors, olfactory and gustatory responses to tobacco smoke, as potentially powerful contributors to smoking behavior change among pregnant women. Data were obtained from 209 pregnant smokers. The majority of women reported olfactory (62%) and gustatory (53%) aversions to tobacco. Aversions first appeared during the first trimester of pregnancy. Women who experienced olfactory aversions were more likely also to experience gustatory aversions. Olfactory aversions were associated with women smoking less. Aversions to tobacco smoke are common among pregnant smokers, are associated with women smoking less, and could help explain pregnant women's smoking patterns.

Preterm premature rupture of membrane management--inpatient versus outpatient: a retrospective review

The purpose of this study was to evaluate the outcome of patients with preterm premature rupture of membranes (PPROM) managed as inpatients who would have been candidates for outpatient management by prior published criteria. A retrospective review of medical records of PPROM subjects enrolled in a prospective cohort study was performed. Similar criteria to those established in a randomized trial for home management of PPROM by Carlan et al were applied. Assuming local residence, 65 subjects met the criteria for outpatient management. Demographic and delivery information were collected. Of the 65 subjects, 12 (18%) delivered <2 hours from the sentinel event. Adverse outcomes in these 12 subjects could have been devastating had they been managed as outpatients. Given the susceptibility of these subjects to obstetric emergencies, patients with PPROM at a viable gestational age should be considered for management as inpatients in a tertiary-care facility.

Nicotine replacement and behavioral therapy for smoking cessation in pregnancy

BACKGROUND

This study examines whether adding nicotine replacement therapy (NRT) to cognitive-behavioral therapy (CBT) for pregnant smokers increases rates of smoking cessation.

METHODS

An open-label randomized trial (Baby Steps, n=181) of CBT-only versus CBT+NRT (choice of patch, gum, or lozenge; 1:2 randomization) was used. Data were collected from 2003 through 2005; analyses were conducted in 2006 and 2007. Outcomes were biochemically validated self-reported smoking status at 7 weeks post-randomization, 38 weeks gestation, and 3 months postpartum.

RESULTS

Women in the CBT+NRT arm were almost three times more likely than women in the CBT-only arm to have biochemically validated cessation at both pregnancy time points (after 7 weeks: 24% vs 8%, p=0.02; at 38 weeks gestation: 18% vs 7%, p=0.04), but not at 3 months postpartum (20% vs 14%, p=0.55). Recruitment was suspended early by an Independent Data and Safety Monitoring Board when an interim analysis found a higher rate of negative birth outcomes in the CBT+NRT arm than in the CBT-only arm. In the final analysis, the difference between the arms in rate of negative birth outcomes was 0.09 (p=0.26), when adjusted for previous history of preterm birth.

CONCLUSIONS

The addition of NRT to CBT promoted smoking cessation in pregnant women. This effect did not persist postpartum. More data are needed to determine safety parameters and to confirm the efficacy of NRT use during pregnancy.

Maternal Serum Cytokines in Preterm Premature Rupture of Membranes

OBJECTIVE

To estimate whether maternal serum interleukin (IL)-6 or granulocyte colony-stimulating factor (G-CSF) obtained daily are elevated in women with preterm premature rupture of membranes who develop funisitis.

METHODS

Daily blood samples were obtained from women with preterm premature rupture of membranes and analyzed for IL-6 and G-CSF by enzyme-linked immunosorbent assay. Funisitis was determined by placental examination. Observations were stratified based on the presence or absence of funisitis and analyzed. Proportional hazards models were used to evaluate time-to-delivery on the basis of diagnostic IL-6 and G-CSF levels, determined by receiver operating characteristic curve analysis.

RESULTS

Of the 107 patients available for analysis, 54 (50%) had evidence of funisitis after delivery. Patients with funisitis were more likely to deliver at an earlier gestational age (28.5 weeks compared with 31.5 weeks, P<.001) and have Medicaid insurance (57% compared with 39%, P=.04). Serum IL-6 and G-CSF were elevated 24 to 48 hours before delivery in women with preterm premature rupture of membranes with funisitis compared with those without funisitis (IL-6, 7.5 compared with 2.8 pg/mL, P<.001; G-CSF, 121.7 compared with 56.9 pg/mL, P=.002). Using values identified by the receiver operating characteristic curve, elevated serum IL-6 in the interval 24-72 hours before delivery was significantly associated with funisitis (P<.03), even after controlling for gestational age and insurance status.

CONCLUSION

Maternal serum IL-6 and G-CSF appear to be biomarkers in the identification of women with preterm premature rupture of membranes likely to develop funisitis.

LEVEL OF EVIDENCE

II.

Association of maternal IL-1 receptor antagonist intron 2 gene polymorphism and preterm birth

OBJECTIVE

This study was undertaken to determine whether the interleukin-1 receptor antagonist (IL-1RN) variable number tandem repeat polymorphism is associated with preterm birth.

STUDY DESIGN

A case-control study was performed. Cases (n = 95) delivered before 37 weeks after preterm labor (PTL) or preterm premature rupture of membranes (PPROM) and controls (n = 105) delivered after 37 weeks. Maternal DNA was genotyped by polymerase chain reaction for a length polymorphism in intron 2 of the IL-1RN gene.

RESULTS

There was no significant difference in maternal age, ethnicity, insurance status, or parity between groups. Allele and genotype frequencies did not differ significantly from that expected under Hardy-Weinberg equilibrium (P = .59) in the total group as well as study groups. Of the 95 cases, 26.8% had at least 1 copy of allele 2 present compared with 12.4% in the control group (P < .0004).

CONCLUSION

Maternal carriage of at least 1 copy of the IL-1RN allele 2 appears to be associated with increased risk of preterm birth.

Challenges and solutions for recruiting pregnant smokers into a nicotine replacement therapy trial

Improvements in smoking cessation interventions for pregnant smokers are needed. One major step is to examine the potential effectiveness of nicotine replacement therapy (NRT). The potential benefits of providing pregnant women with NRT to help them quit smoking are still unknown; early interventions to test the effectiveness and efficacy are vital to advancing the field. This paper describes recruitment efforts for a multiclinic trial to test the effectiveness of NRT use in addition to behavioral therapy in promoting cessation during pregnancy. The biggest challenge is recruiting sufficient numbers of pregnant women. This paper discusses specific obstacles for recruitment and solutions. Knowing the potential pitfalls to recruiting pregnant women into these trials can lead to better studies and thus improved outcomes.

Historical evidences on medicolegal autopsy and toxicological descriptions in Kautilya's Arthaśăstra

Kautilya's Arthaśăstra deals mainly the art of government, duties of Kings, ministers, officials and methods of diplomacy. It also deals with branches of internal and foreign policies, civil, military, commercial, fiscal, judicial etc. By name and popularity of the book, scholars believe this as seed of political science and Economics. Surprisingly, it also has the descriptions of many Ayurvĕda herbs, metals, herbomineral preparations and poisonous substances. This book also deals with medico legal autopsy and Toxicology. The main aim of this article is to highlight the descriptions of forensic medicines and toxicology.

Acute myocardial infarction in pregnancy: a United States population-based study

BACKGROUND

The purpose of this study was to determine the incidence, mortality, and risk factors for pregnancy-related acute myocardial infarction in the United States.

METHODS AND RESULTS

The Nationwide Inpatient Sample for the years 2000 to 2002 was queried for all pregnancy-related discharges. A total of 859 discharges included a diagnosis of acute myocardial infarction, for a rate of 6.2 (95% confidence interval [CI] 3.0 to 9.4) per 100,000 deliveries. Among these, there were 44 deaths, for a case fatality rate of 5.1%. The odds of acute myocardial infarction were 30-fold higher for women aged 40 years and older than for women <20 years of age. Single independent variables that were statistically and clinically significant, including age, race, and certain medical conditions and obstetric complications, were entered into a multivariable logistic regression model. Hypertension (odds ratio [OR] 21.7, 95% CI 6.8 to 69.1), thrombophilia (OR 25.6, 95% CI 9.2 to 71.2), diabetes mellitus (OR 3.6, 95% CI 1.5 to 8.3), smoking (OR 8.4, 95% CI 5.4 to 12.9), transfusion (OR 5.1, 95% CI 2.0 to 12.7), postpartum infection (OR 3.2, 95% CI 1.2 to 10.1), and age 30 years and older remained as significant risk factors for pregnancy-related acute myocardial infarction. Black race was eliminated as a risk factor in the multivariable analysis, which suggests that the increased incidence among black women is explained by an increased prevalence of other cardiovascular risk factors.

CONCLUSIONS

Although acute myocardial infarction is a rare event in women of reproductive age, pregnancy increases the risk 3- to 4-fold. Certain medical conditions and complications of pregnancy increase the risk further and are potentially modifiable risk factors.

Vandhyatva--a medico historical study

As per Ayurvĕda, important factors for conception are considered as rtu (fertile period), Kşĕtra (uterus and reproductive organs), Ambu (Proper nutrient fluid) and Bĭja (sukra-sŏnita) and also normalcy of Hŗdaya (Psychology). Abnormality of properly functioning Văyu and Satbhavăs (mătŗja, pitŗja, atma, satva, sătmaya and Rasa), any one of these causes infertility (Vandhyatva). From the time immemorial the phenomenon of infertility was prevalent through out the world and this may persist till the human race exists. Every human being has inherent, intense desire to continue his (one's) own race; to become a mother is one of the most cherished desires of every woman. Failure to achieve conception by a couple of mature age, having normal coitus during appropriate period of menstrual cycle regularly, at least for one year of their conjugal is termed as infertility. The historical importance of strĭ vandhyatva and a comparative study regarding its Nidăna, Samprăpti, Lakşaņa, Chikitsă etc compiled from various Granthăs are being presented in this paper.

Vŗkşăyurvĕda of parăśara--an ancient treatise on plant science

Vŗkşăyurvĕda of Parăśara is a great contribution to the Botany in ancient India. N.N. Sircar and Roma sarkar edited this text with English translation. Notes with comparative references of modern botany were added. This book can be placed in all probability in between 1st century B.C to 4th century A.D by its linguistic style. Many scientific branches of Botany including origin of life, ecology, distribution of forests, morphology, classification, nomenclature, histology and physiology were dealt in this ancient work. Though it is presumed that this book was written by Parăśara to teach Botany to preparatory to Ayurvĕda studies to ancient Ayurvĕda students, it is true to the Ayurvĕda personals and other disciplines related to Botany of present day as well. Aim of this article is to attract the attention of all scholars who are related to Ayurvĕda and Botany and to feel the depth of the knowledge of ancient Indian botany.

Clinical utility of fetal fibronectin for predicting preterm birth

OBJECTIVE

To determine if fetal fibronectin can be used in a clinical setting to predict preterm birth and guide clinical management.

STUDY DESIGN

We implemented a clinical protocol using the rapid fetal fibronectin test for patients presenting with symptoms of preterm labor. Adherence to the clinical pathway was at the discretion of the practitioner. Subjects who met the inclusion criteria (n = 404) were divided into 2 groups based on the fetal fibronectin result. Outcomes included time until delivery, gestational age at delivery and use of therapeutic interventions. Univariate and multivariate statistical analyses were performed.

RESULTS

The 46 subjects (11.4%) with positive fetal fibronectin were more likely to deliver within 7 days, within 14 days, prior to 32 weeks' gestation and prior to 37 weeks' gestation (RR 22.0, 22.0, 12.3 and 5.1, respectively). For delivery within 7 days, the sensitivity, specificity, positive predictive value and negative predictive value were 67%, 92%, 30% and 98%, respectively. Time until delivery and gestational age at delivery were lower in women with a positive test, while the frequency of therapeutic interventions was higher (p < 0.01).

CONCLUSION

A positive fetal fibronectin test is predictive of preterm birth in a clinical setting. A negative fetal fibronectin test can be used to avoid unnecessary, potentially harmful interventions.

A literary review of Arśas (haemorrhoids)

The disease Arśas (hemorrhoids), an ano-rectal disorder is as old as mankind. Suśrta farther of surgery described the Arśas under heading of 'Mahagadas' (eight major diseases). Due to inconsistency of human diet and social obligations, a large proportion of the population is suffering from hemorrhoids. As per Ayurveda, the etiological factors are broadly classified as Sămănya (Non-specific) and Viśĕsa (Specific). Viśĕsa again sub divided in to Sahaja and Janmottara. Suśrta classified this disease on the basis of clinical manifestations in to six types, where as Caraka and Văgbhata classified in to two according to discharging nature and causative factors respectively.