Inferior Vena Cava Filter Placement During Pregnancy: an Adjuvant Option When Medical Therapy Fails

The authors present a case of a 27-year-old multiparous woman, with multiple thrombophilia, whose pregnancy was complicated with deep venous thrombosis requiring placement of a vena cava filter. At 15th week of gestation, following an acute deep venous thrombosis of the right inferior limb, anticoagulant therapy with low-molecular-weight heparin (LMWH) was instituted without improvement in her clinical status. Subsequently, at 18 weeks of pregnancy, LMWH was switched to warfarin. At 30th week of gestation, the maintenance of high thrombotic risk was the premise for placement of an inferior vena cava filter for prophylaxis of pulmonary embolism during childbirth and postpartum. There were no complications and a vaginal delivery was accomplished at 37 weeks of gestation. Venal placement of inferior vena cava filters is an attractive option as prophylaxis for pulmonary embolism during pregnancy.

Factor V Leiden and Prothrombin G20210A in Portuguese Women with Recurrent Miscarriage: Is it Worthwhile to Investigate?

OBJECTIVE: To compare the prevalence of factor V Leiden (FVL) and prothrombin (PT) G20210A mutations in Portuguese women with unexplained recurrent miscarriage (RM) and a control group of parous women. MATERIALS AND METHODS: FVL and PT G20210A analysis were carried out in 100 women with three or more consecutive miscarriages and 100 controls with no history of pregnancy losses. Secondary analysis was made regarding gestational age at miscarriage (embryonic and fetal losses). RESULTS: Overall, the prevalence of FVL and PT G20210A was similar in women with RM (5 and 3%) compared with controls (5 and 1%) OR 1.36 (CI 95% 0.45-4.08). In RM embryonic subgroup, PT G20210A was observed in 1.3% of women and FVL prevalence (2.6%) was inclusively lesser than that of controls. Both polymorphisms were more prevalent in women with fetal losses than in controls, although statistical significance was not reached due to the small size of the >10 weeks' subgroup. CONCLUSION: These data indicate that neither FVL nor PT G20210A is associated with RM prior to 10 weeks of gestation. Therefore, its screening is not indicated as an initial approach in Portuguese women with embryonic RM and negative personal thromboembolic history.

Estudo do Aborto Recorrente. Ainda há Lugar para a Histerossalpingografia?

Overview and Aims: The investigation of recurrent miscarriage includes the study of uterine morphology. 3D ultrasound allows the evaluation of the morphology (cavity and outer contour), reducing the need for invasive tests such as hystero - salpingography (HSG), hysteroscopy and laparoscopy. We evaluated the diagnostic agreement between HSG and 3D ultrasound in the study of the uterine cavity morphology. Study Design: Prospective study. Population: A total of 34 women referred to our institution with a history of recurrent miscarriage. Methods: To compare the results of 3D ultrasound and HSG, all women underwent both exams. 3D scans were performed by the same operator and HSG were evaluated by the same clinician. The concordance study was performed using the Kappa coefficient. Results: With 3D ultrasound and HSG, uterine anomalies were diagnosed in 52.9% (18/34) and 47% (16/34) of the cases and congenital malformations were the most frequent findings. The agreement between the two techniques was excellent(K = 0.825). The three cases of diagnostic disagreement were analyzed. Conclusion: A high level of diagnostic agreement was observed between HSG and 3D ultrasound. The 3D ultrasound, a low cost and well tolerated technique, when performed by an experienced operator, is the first line exam to study the uterine morphology in women with recurrent miscarriage.

Diabetes Gestacional e Hemoglobina A1c

Introdução: Há estudos que revelam que a Hemoglobina A1c (HbA1c) é um indicador confiável do controlo glicémico em grávidas com diabetes gestacional (DG). Objetivo: Relacionar os níveis de HbA1c no terceiro trimestre e o prognóstico materno-fetal. Tipo de estudo: Retrospetivo. População: Quatrocentos e setenta e quatro mulheres vigiadas na consulta de diabetes e gravidez com o diagnóstico de DG. Métodos: Dividiu-se a população em dois grupos: HbA1c <6% (grupo um) e HbA1c ≥6% (grupo dois). Foram avaliados: fatores de risco para diabetes gestacional, ganho de peso na gravidez, idade gestacional (IG) do diagnóstico, complicações na gravidez, administração de insulina, IG no parto, peso ao nascer e resultado do rastreio pós-parto. Resultados: No grupo um obteve-se 420 mulheres e no grupo dois 54. O grupo dois havia mulheres com maior IMC (27 vs 29 kg / cm2; p-value 0,007), história pessoal de diabetes gestacional(14,3% vs 27,6%; p-value 0,004) e macrossomia prévia (7,6% vs 14,8%; p-value 0,039). Neste mesmo grupo uma maior percentagem de grávidas efetuou insulina (28,6% vs 48,1%; p-value 0,005) e apresentou maior ganho de peso durante a gravidez (24,8% vs 55,6%; p-value 0,000). Verificou-se um maior número de casos de recém-nascidos grandes para a IG (6,7% vs 20,4%; p-value = 0,002) e uma maior percentagem de mulheres apresentou alteração no rastreio pós-parto (15,8% vs 47,5%; p-value = 0,000). Conclusões: As mulheres com valores de HbA1c ≥6% são mais pesadas, com história pessoal de DG e macrossomia prévia, mais frequentemente necessitaram de terapêutica com insulina e apresentam maior ganho de peso. Verificou-se um maior número de casos de recém-nascidos grandes para a IG e uma maior percentagem de mulheres apresentou alteração no rastreio pós-parto.

Pré-Eclâmpsia de Causa Vascular: Será Possível a sua Profilaxia com Extracto de Ginkgo Biloba? Fundamentos Teóricos

O autor começa por descrever os aspectos normais do processo de placentação que se encontram alterados na pré-eclâmpsia. Os efeitos desse defeito reflectem-se no aumento da resistência vascular das artérias uterinas e que pode ser detectado ecograficamente (é assumido como possível método de rastreio às 23 semanas de gestação). São analisadas relações entre pré-eclâmpsia e síndroma de HELLP, síndroma dos anticorpos anti-fosfolípidos (SAAF) e atraso de crescimento intra-uterino (ACIU). Comentam-se as tentativas de prevenção de pré-eclâmpsia com ácido acetil salicílico (AAS) e com cálcio. São analisados os efeitos de vários agentes anti-hipertensivos na hemodinâmica uterina e fetal. É feita uma introdução da Ginkgo biloba, dos motivos que levam a escolhê-la como um bom candidato à terapêutica preventiva do desenvolvimento da pré-eclâmpsia, analisando os seus mecanismos de acção, a farmacodinâmica, as doses habitualmente utilizadas e a sua segurança. Por fim sugerem-se alguns critérios para investigar clinicamente os efeitos do extracto de Ginkgo biloba (EGB 761).

Implant Site Nexplanon Reaction?

Nexplanon (Schering-Plough Limited/Merck Sharp & Dohme Limited (MSD)) is a long active reversible contraceptive method that provides effective contraception for 3 years. It consists of a single, flexible, rod-shaped implant, containing 68 mg etonogestrel. It is 4 cm long, consists of an ethylene vinyl acetate copolymer, a non-absorbable material, and also contains 15 mg of barium sulfate, which makes it visible by X-ray. We describe a case of a 39-year-old woman who experienced a local reaction to the barium sulfate in Nexplanon. She was given medical treatment, but only the removal of the implant resolved the symptoms. After removal there was gradual improvement and 72 h later the patient was asymptomatic. Allergic reaction to barium sulfate is extremely rare: until now, there have only been two cases associated with Nexplanon described in the literature.

BANMAC: an opportunistic MAC protocol for reliable communications in body area networks

We consider reliable communications in Body Area Networks (BAN), where a set of nodes placed on human body are connected using wireless links. In order to keep the Specific Absorption Rate (SAR) as low as possible for health safety reasons, these networks operate in low transmit power regime, which however, is known to be error prone. It has been observed that the fluctuations of the Received Signal Strength (RSS) at the nodes of a BAN on a moving person show certain regularities and that the magnitude of these fluctuations are significant (5 - 20 dB). In this paper, we present BANMAC, a MAC protocol that monitors and predicts the channel fluctuations and schedules transmissions opportunistically when the RSS is likely to be higher. The MAC protocol is capable of providing differentiated service and resolves co-channel interference in the event of multiple co-located BANs in a vicinity. We report the design and implementation details of BANMAC integrated with the IEEE 802.15.4 protocol stack. We present experimental data which show that the packet loss rate (PLR) of BANMAC is significantly lower as compared to that of the IEEE 802.15.4 MAC. For comparable PLR, the power consumption of BANMAC is also significantly lower than that of the IEEE 802.15.4. For co-located networks, the convergence time to find a conflict-free channel allocation was approximately 1 s for the centralized coordination mechanism and was approximately 4 s for the distributed coordination mechanism.

Using a prioritized MAC protocol to execute the database operation join in networked embedded computer systems

Database query languages on relations (for example SQL) make it possible to join two relations. This operation is very common in desktop/server database systems but unfortunately query processing systems in networked embedded computer systems currently do not support this operation; specifically, the query processing systems TAG, TinyDB, Cougar do not support this. We show how a prioritized medium access control (MAC) protocol can be used to efficiently execute the database operation join for networked embedded computer systems where all computer nodes are in a single broadcast domain.

Exploiting a prioritized MAC protocol to efficiently compute min and max in multihop networks

Consider a wireless sensor network (WSN) where a broadcast from a sensor node does not reach all sensor nodes in the network; such networks are often called multihop networks. Sensor nodes take sensor readings but individual sensor readings are not very important. It is important however to compute aggregated quantities of these sensor readings. The minimum and maximum of all sensor readings at an instant are often interesting because they indicate abnormal behavior, for example if the maximum temperature is very high then it may be that a fire has broken out. We propose an algorithm for computing the min or max of sensor reading in a multihop network. This algorithm has the particularly interesting property of having a time complexity that does not depend on the number of sensor nodes; only the network diameter and the range of the value domain of sensor readings matter.

Exploiting a prioritized MAC protocol to efficiently compute interpolations

Consider a network where all nodes share a single broadcast domain such as a wired broadcast network. Nodes take sensor readings but individual sensor readings are not the most important pieces of data in the system. Instead, we are interested in aggregated quantities of the sensor readings such as minimum and maximum values, the number of nodes and the median among a set of sensor readings on different nodes. In this paper we show that a prioritized medium access control (MAC) protocol may advantageously be exploited to efficiently compute aggregated quantities of sensor readings. In this context, we propose a distributed algorithm that has a very low time and message-complexity for computing certain aggregated quantities. Importantly, we show that if every sensor node knows its geographical location, then sensor data can be interpolated with our novel distributed algorithm, and the message-complexity of the algorithm is independent of the number of nodes. Such an interpolation of sensor data can be used to compute any desired function; for example the temperature gradient in a room (e.g., industrial plant) densely populated with sensor nodes, or the gas concentration gradient within a pipeline or traffic tunnel.

Improving the IEEE 802.15.4 Slotted CSMA/CA MAC for time-critical events in wireless sensor networks

In beacon-enabled mode, IEEE 802.15.4 is ruled by the slotted CSMA/CA Medium Access Control (MAC) protocol. The standard slotted CSMA/CA mechanism does not provide any means of differentiated services to improve the quality of service for timecritical events (such as alarms, time slot reservation, PAN management messages etc.). In this paper, we present and discuss practical service differentiation mechanisms to improve the performance of slotted CSMA/CA for time-critical events, with only minor add-ons to the protocol. The contribution of our proposal is more practical than theoretical since our initial requirement is to leave the original algorithm of the slotted CSMA/CA unchanged, but rather tuning its parameters adequately according to the criticality of the messages. We present a simulation study based on an accurate model of the IEEE 802.15.4 MAC protocol, to evaluate the differentiated service strategies. Four scenarios with different settings of the slotted CSMA/CA parameters are defined. Each scenario is evaluated for FIFO and Priority Queuing. The impact of the hiddennode problem is also analyzed, and a solution to mitigate it is proposed.

Using a prioritized MAC protocol to efficiently compute aggregated quantities

Consider a distributed computer system such that every computer node can perform a wireless broadcast and when it does so, all other nodes receive this message. The computer nodes take sensor readings but individual sensor readings are not very important. It is important however to compute the aggregated quantities of these sensor readings. We show that a prioritized medium access control (MAC) protocol for wireless broadcast can compute simple aggregated quantities in a single transaction, and more complex quantities with many (but still a small number of) transactions. This leads to significant improvements in the time-complexity and as a consequence also similar reduction in energy “consumption”.

Protocolo Mac para acesso multi-modo em redes de sensores sem fios móveis

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para a obtenção do grau de Mestre em Engenharia Electrotécnica e de Computadores

Use of MAC-ELISA for evaluation of yellow fever vaccination

An evaluation of the IgM antibody immune response against yellow fever using strain 17D was carried out by MAC-ELISA and PRNT. The results showed an agreement of 97% between both tests and the authors conclude that MAC-ELISA can be used as a specific and sensitive asssay to replace the PRNT for detecting yellow fever antibodies in human sera, after vaccination programs.