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PubMed2001

Iron therapy for improving psychomotor development and cognitive function in children under the age of three with iron deficiency anaemia.

BACKGROUND: Iron deficiency and iron deficiency anaemia (IDA) are common in young children. It has been suggested that the lack of iron may have important effects on children's psychomotor development and cognitive function. OBJECTIVES: To determine the effects of iron therapy on psychomotor development and cognitive function in iron deficient children less than 3 years of age. SEARCH STRATEGY: The following databases were searched: COCHRANE LIBRARY (2000 ISSUE 4) MEDLINE (1966-August 2000) EMBASE (1980-August 2000) Latin American Database (LILACS) PsycLIT Journal articles (1974-August 2000) PsycLIT Chapters and Books (1987-August 2000) The references of identified trials and of important review articles were scrutinised. Citation searches on trials from the primary search were performed within the Science Citation Index. Key authors were contacted. SELECTION CRITERIA: Studies were included if children less than 3 years of age with evidence of iron deficiency anaemia were randomly allocated to iron or iron and vitamin C versus a placebo or vitamin C alone and assessment of developmental status or cognitive function was carried out using standardised tests by observers blind to treatment allocation. DATA COLLECTION AND ANALYSIS: Abstracts and titles of studies identified on searches of electronic databases were read to determine whether they might meet the inclusion criteria. Full copies of those possibly meeting these criteria from electronic or other searches were assessed by two independent reviewers. Differences of opinion about suitability for inclusion were resolved by discussion. Data were analysed separately depending on whether participants had iron assessments were performed within one month of beginning iron therapy or later. MAIN RESULTS: Five trials, including 180 children with IDA, examined the effects of iron therapy on measures of psychomotor development between 5 and 11 days of commencement of therapy. Data from four trials could be pooled. The pooled difference in pre to post treatment change in Bayley Scale PDI between iron treated and placebo groups was -3.2 (95%CI -7.24, 0.85) and in Bayley Scale MDI, 0.55 (95% CI -2.84, 1.75). Two studies, including 160 randomised children with IDA, examined the effects of iron therapy on measures of psychomotor development more than 30 days after commencement of therapy. Aukett et al reported the mean number of skills gained after two months of iron therapy, using the Denver test. The intervention group gained 0.8 (95% CI -0.18, 1.78) more skills on average than the control group. Idjrandinata et al reported that the difference in pre to post treatment change in Bayley Scale PDI between iron treated and placebo groups after 4 months was 18.40 (95%CI 10.16, 26.64) and in Bayley Scale MDI, 18.80 (95% CI 10.19, 27.41). REVIEWER'S CONCLUSIONS: There is no convincing evidence that iron treatment of young children with IDA has an effect on psychomotor development discernable within 5-11 days. The effect of longer term treatment remains unclear but the data would be compatible with clinically significant benefit. There is urgent need for further randomised controlled trials with long term follow up.

Anemia, Iron-Deficiency↗
PubMed2003

Oral sumatriptan for acute migraine.

BACKGROUND: Migraine is a common neurovascular disorder characterized by recurrent episodes of disabling headache, autonomic nervous system dysfunction, and, in some patients, neurological aura symptoms. Sumatriptan is one of a class of selective serotonin 5-hydroxytryptamine (5-HT1B/1D) agonists (triptans) thought to relieve migraine attacks by several mechanisms, including cranial vasoconstriction and peripheral and central neural inhibition. OBJECTIVES: To describe and assess the evidence from randomized controlled trials (RCTs) concerning the efficacy and tolerability of oral sumatriptan for the treatment of a single acute attack of migraine in adults. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (Cochrane Library, Issue 4, 2001), MEDLINE (1966 through November 2001), and reference lists of articles and books. SELECTION CRITERIA: We included double-blind RCTs comparing oral sumatriptan (100 mg, 50 mg, 25 mg) with placebo, no intervention, other drug treatments, behavioral therapy, or physical therapy for the treatment of an acute attack of migraine in adults. Trials comparing different doses of sumatriptan or dosing regimens were also included. Outcomes considered were: 2-hour pain-free response, headache relief/headache intensity, and functional disability; headache recurrence; and adverse events. DATA COLLECTION AND ANALYSIS: Data were abstracted by one reviewer and over-read by the other. The two reviewers independently assessed trial quality. Information on adverse events was collected from trial reports. MAIN RESULTS: Twenty-five trials involving 16,200 participants were included. Methodological quality was generally good. Sixteen trials were placebo comparisons and showed that sumatriptan in doses of 100 mg (14 trials), 50 mg (five trials), and 25 mg (three trials) provided significantly better pain-free response (100 mg and 25 mg only), headache relief, and relief of disability at 2 hours. Numbers-needed-to-treat (NNTs) for pain-free response at 2 hours were 5.1 (3.9 to 7.1) for the 100-mg dose (n = 2221) and 7.5 (2.7 to 142) for the 25-mg dose (n = 131); there was no significant difference between the 50-mg dose and placebo for this outcome (n = 127). For headache relief at 2 hours, NNTs were 3.4 (3.0 to 4.0), 3.2 (2.4 to 5.1), and 3.4 (2.3 to 6.6) for sumatriptan 100 mg (n = 2940), 50 mg (n = 420), and 25 mg (n = 226), respectively. Precise estimates of the efficacy of the 50- and 25-mg doses relative to the 100-mg dose could not be obtained. Adverse events were more common with sumatriptan 100 mg than with placebo (risk difference [RD] = 0.14 [0.09 to 0.20]; number-needed-to-harm [NNH] = 7.1 [5.0 to 11.1]; n = 3172). RDs for the 50- and 25-mg vs. placebo comparisons were not statistically significant. REVIEWER'S CONCLUSIONS: Oral sumatriptan has been shown to be an effective drug for the treatment of a single acute attack of migraine. It is well tolerated, though minor adverse events were not uncommon in the included trials. Other triptans were generally similar in efficacy and adverse events. Among non-triptan drugs, ergotamine + caffeine was significantly less effective than sumatriptan, and other drugs have been insufficiently studied to draw firm conclusions.

Administration, Oral↗
PubMed2004

Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and pneumonia with consolidation on x-ray in children under two years of age.

BACKGROUND: Pneumonia, most commonly caused by Streptococcus pneumoniae (Pnc), is a major cause of morbidity and mortality among young children especially in developing countries. Recently, the prevalence of antibiotic-resistant Pnc has increased worldwide such that the effectiveness of preventive strategies, like the new pneumococcal conjugate vaccines (PCV) on rates of invasive pneumococcal disease (IPD) and pneumonia, needs to be evaluated. OBJECTIVES: To determine the efficacy of PCV in reducing the incidence of IPD due to vaccine serotypes (VT) and x-ray confirmed pneumonia with consolidation of unspecified etiology in children who received PCV before 12 months of age. SEARCH STRATEGY: We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 1 2004), MEDLINE (1990 to March 2004) and EMBASE (1990 to December 2003). Reference list of articles, and books of abstracts of relevant symposia, were hand searched. Researchers in the field were also contacted. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing PCV with placebo, or another vaccine, among children below two years with IPD and clinical/radiographic pneumonia as outcomes. DATA COLLECTION AND ANALYSIS: Two reviewers independently identified eligible studies, assessed trial quality, and extracted data. Differences were resolved by discussion. The inverse variance method was used to pool effect sizes. MAIN RESULTS: We identified four trials assessing the efficacy of PCV in reducing the incidence of IPD, two on x-ray confirmed pneumonia as outcome, and one on clinical pneumonia, with or without x-ray confirmation. Results from pooling HIV-1 negative children from the South African study with the other studies were as follows: the pooled vaccine efficacy (VE) for vaccine-type IPD was 88% (95% confidence interval (CI) 73% to 94%; fixed effect and random effects models), the effect measure was statistically significant (p <0.00001) and there was no heterogeneity (p = 0.77I2 0%); the pooled VE for all-serotype IPD was 66% (95% CI 46% to 79%; fixed effect model), the effect measure was statistically significant (p <0.00001) and there was no statistical heterogeneity (p = 0.09, I2 51%); the pooled VE for x-ray confirmed pneumonia was 22% (95% CI 11% to 31%; both fixed effect and random effects models) and there was no statistical heterogeneity (p = 0.80, I2 0%). Analyses that included all the children in the South African study (HIV-1 negative and HIV-1 positive children) and pooled with data from the other studies gave very similar results. REVIEWERS' CONCLUSIONS: PCV is effective in reducing the incidence of IPD from all serotypes but exerts a greater effect in reducing VT IPD. Although PCV is also effective in reducing the incidence of x-ray confirmed pneumonia, there are still uncertainties about the definition of this outcome. Additional randomised controlled trials are currently in progress.

Humans↗
PubMed1995

The influence of social class on health status: American and British research on health inequalities.

PURPOSE: To summarize recent and past American and British studies on the relationship of social class and health status. DATA SOURCES: A systematic review of the pertinent British and American literature, including references identified from bibliographies of books and recent articles. STUDY SELECTION: Published English-language studies that report original or summary data describing socioeconomic status and mortality/morbidity are emphasized. DATA SYNTHESIS: Social class, whether measured by occupation, income, or education, has a marked effect on mortality and morbidity. Use of British and American standardized mortality ratios (SMRs) shows that the gap between the advantaged upper socioeconomic classes and the disadvantaged lower classes has become wider from 1930 to 1980. Explanations for this inequality in health status by socioeconomic status point to four factors: artefact, social selection, culture/behavior, and material/structural conditions. A synthesis of existing literature suggests that material deprivation and social deprivation are the most important factors contributing to this association, although data from longitudinal studies implicate social hierarchy. CONCLUSION: The reviewed studies point to growing inequalities in health status between those of lower and those of higher socioeconomic status. Clinicians and teachers in internal medicine should incorporate this knowledge in assessing patients and adopt a perspective that takes account of socioeconomic factors in diagnostic and management decisions.

Female↗
PubMed2000

Cognitive disorders in patients with occlusive disease of the carotid artery: a systematic review of the literature.

We present a systematic review of the literature on the prevalence, nature, severity, course, and causes of cognitive deficits in patients with occlusive disease of the carotid artery prior to surgery (if surgery was under discussion). Searches were carried out on Medline and Psychlit from 1980 to 1999 using neurovascular and psychological index terms, and papers and books were checked for further references. Studies describing neuropsychological assessment of groups of patients with carotid obstruction were included. Eighteen studies were found. We extracted from the papers data on study design, demographic characteristics of patients, clinical diagnosis, carotid obstruction, cerebral imaging, time interval between ischemic episode and neuropsychological assessment, neuropsychological assessment procedures, integration and interpretation of test performances, and conclusions of authors. Fourteen studies concluded that there are cognitive deficits both in patients with symptomatic and in those with asymptomatic carotid obstruction; four studies denied cognitive impairment. There were no differences in patient characteristics, study design, or neuropsychological assessment procedures between the 14 studies that found deficits and the 4 that did not. There are indications for a mild, diffuse detrimental effect of carotid occlusive disease on cognitive functioning. However, methodological problems prevent a definitive conclusion. Further research is needed to confirm these findings and to ascertain the neurovascular risk factors for and the natural course of cognitive impairment in patients with carotid occlusive disease.

Adult↗
PubMedDate not supplied

Transforming the traditional discharge planning manual.

Discharge planning resources change frequently, and keeping them current, available, and accessible to case management (CM) staff and others is a challenge. Given the time-consuming and labor-intensive nature of updating, many organizations revise them in preparation for the tri-annual survey or when they are hopelessly out-of-date. The reality is that CM staff and others involved with discharges have their own personal "little black book" of resources. Those personal reference tools are treated with reverence and guarded like the family Bible. Organizations are challenged to have up-to-date resources available and accessible for staff in all areas. One approach is to transform the traditional paper-based manual into an electronic document and make it available on the organization's intranet. This approach means that each page of the current paper-based manual must be in electronic format, ending the use of overcopied resources that become difficult to read and "grandfathered in" to each successive edition of the paper manual. This option permits easy and rapid updates when resources and information change.

Academic Medical Centers↗
PubMed2002

Single session debriefing after psychological trauma: a meta-analysis.

BACKGROUND: Despite conflicting research findings and uncertain efficacy, single session debriefing is standard clinical practice after traumatic events. We aimed to assess the efficacy of this intervention in prevention of chronic symptoms of post-traumatic stress disorder and other disorders after trauma. METHODS: In a meta-analysis, we selected appropriate studies from databases (Medline Advanced, PsychINFO, and PubMed), the Journal of Traumatic Stress, and reference lists of articles and book chapters. Inclusion criteria were that single session debriefing had been done within 1 month after trauma, symptoms were assessed with widely accepted clinical outcome measures, and data from psychological assessments that had been done before (pretest data) and after (post-test data) interventions and were essential for calculation of effect sizes had been reported. We included seven studies in final analyses, in which there were five critical incident stress debriefing (CISD) interventions, three non-CISD interventions, and six no-intervention controls. FINDINGS: Non-CISD interventions and no intervention improved symptoms of post-traumatic stress disorder, but CISD did not improve symptoms (weighted mean effect sizes 0.65 [95% CI 0.14-1.16], 0.47 [0.28-0.66], and 0.13 [-0.29 to 0.55], respectively). CISD did not improve natural recovery from other trauma-related disorders (0.12 [-0.22 to 0.47]). INTERPRETATION: CISD and non-CISD interventions do not improve natural recovery from psychological trauma.

Adult↗
PubMed2001

Cultural aspects of dementia.

This paper critically reviews current knowledge regarding culture and dementia in order to identify unanswered questions in the field. Medline was searched from 1993-2000. One hundred nine articles were identified, of which 59 were critically reviewed, augmented by additional references from experts and by books. Limited research evidence was identified in four areas: 1) the recognition of dementia across cultures 2) cultural specificity of screening tools 3) identification of differences in risk factors, incidence, onset and prevalence across culture 4) culturally related issues in decision making about management. Implications for research and practice are described.

Aged↗
PubMed2000

Outcome of pregnancy following renal transplantation.

Fertility is restored following renal transplantation, and the potential for motherhood can be realised. This retrospective study reviews the outcome of 53 pregnancies, in 24 patients, between 1988 and 1995. All patients underwent transplant surgery, and received antenatal care at a single centre. The mean age at first conception was 27.6 years, and graft function, as assessed by serum creatinine at the time of antenatal booking, was good. Patients were referred early, seen regularly, and had both obstetrician and nephrologist involved in management. The main maternal complication was hypertension, affecting 50% of patients. Seven patients had a worsening of pre-existing hypertension, whilst four patients developed hypertension for the first time during pregnancy. Graft function was, for the most part, well maintained. Four patients required delivery because of declining renal function, two of these went on to develop frank rejection, necessitating a return to dialysis within 3 months of delivery. These figures however are not higher than have been reported in the non-pregnant population. The overall pregnancy loss was 26%. There were a total of 39 live births. Premature birth was higher than that of the general population, with 57% of infants in the study delivering before 37 weeks' gestation (average 34 weeks' gestation) Of the 39 infants born alive 27% were growth retarded. Congenital abnormalities were, reassuringly, no higher than that in the general population, despite the need to take immunosuppressive drugs. Delivery was by caesarean section in 64% of cases, which may reflect a high degree of clinical caution in this group of patients. The study concludes that, whilst risks are recognised, for both the mother and infant, with a careful, multidisciplinary approach, the outcome is generally good.

Journal Article↗
PubMedDate not supplied

The acute effects of noninvasive ventilatory support during exercise on exercise endurance and dyspnea in patients with chronic obstructive pulmonary disease: a systematic review.

PURPOSE: The objective of this study was to review studies systematically, in which the acute effects of noninvasive ventilatory support (NIVS) during exercise were evaluated in patients with chronic obstructive pulmonary disease (COPD). In addition, a quantitative analysis was performed on the effects of NIVS on exertional dyspnea and exercise endurance. METHODS: Literature was searched in electronic databases, and by scanning lists of references of studies and abstract books of annual congresses of the American Thoracic Society and European Respiratory Society. Preliminary data of a study by our own group into the effects of NIVS on exercise endurance in patients with COPD were added. The systematic review was carried out on the basis of a validated methodological screening list. For the quantitative analysis, Glass delta of individual studies were pooled to aggregate a summary effect size. RESULTS: Fifteen studies were identified. Seven of these studies met the inclusion criteria, including a total of 65 patients with COPD. The methodological quality of the included studies varied from 31% to 54% of the maximum score of 13 points. Statistically significant summary effect sizes were found in the analysis of exertional dyspnea (P <.05) as well as in the analysis of exercise endurance (P <.001), indicating improvements in these outcomes in favor of NIVS. CONCLUSIONS: The present systematic review suggests that NIVS during exercise may acutely reduce exertional dyspnea and improve exercise endurance, in patients with COPD.

Chi-Square Distribution↗
PubMed2002

Information: needs for the future.

The four central questions surrounding the use of information are: where to find it; how to find it; how to present it; and how to maintain information availability and information literacy. It is usually assumed that the main source of information for most scientists is the peer-reviewed journal literature. Traditional journal publishing is beset with a number of problems. Although electronic publishing might possibly solve some of these, it in turn introduces new problems. Further problems arise with respect to secondary sources which, in some cases, are being supplemented by electronic archives of full-text documents. One fundamental question that arises when considering any large collection of documents or of records about documents is whether or not to index them, and how to index them. The pros and cons of free-text searching versus the use of controlled vocabularies are discussed, as is the importance of harmonising the Three Rs-related terminology of existing and proposed thesauri. However, there is a further problem that documents pertinent to the Three Rs are not always indexed from this point of view. Authors need to be made aware that, if the information is not provided in the abstract, there is no easy way to identify and retrieve this document from a database. Small specialised databases on the Three Rs in relation to specific subject areas could provide a further solution, especially if they provide references to conference proceedings and book chapters, which are not usually found in the large bibliographical databases. The provision of training in the use of information resources, and the establishment and maintenance of these resources require investment of money and professional skills. Finally, the future of Three Rs information depends on a recognition that this in an important topic which deserves more than lip service.

Animal Testing Alternatives↗
PubMed1994

Traditional methods used for controlling animal diseases in Iran.

In ancient times in Iran, infectious diseases of animals and human beings were referred to as choleraic diseases. Rhazes (9th century), followed by Avicenna (10th century), Jorjani (11th century) and others, had specific opinions on the cause and effect relationship in these diseases, which recall the fermentation theory of Louis Pasteur. In ancient Iran, the methods adopted for veterinary procedures were those of general theoretical and practical medicine, including the humoral theory, accurate diagnosis, signs and symptoms, and the prescription of herbal and mineral medicines or substances of animal origin. If herbal treatment failed, cauterisation and surgery were used. When refractory and contagious infectious diseases occurred, animals were evacuated from the infected region, in order to preserve their health, with resort to the mercy of Allah (God) as a final remedy. Iranian scientists of ancient times had interesting views on rabies. A kind of serotherapy was used for treating persons bitten by rabid dogs. Vaccination was performed many centuries ago by using dried smallpox lesions. In Baluchistan (Iran), infants were encouraged to play with and touch the teats of cows affected with cowpox, in order to immunise the children against smallpox, and this was centuries before the discovery of smallpox vaccine by Edward Jenner. Camelpox was also used for human immunisation. In the case of caprine pleuropneumonia, an extract or juice was obtained from the lungs of affected animals and was inactivated by treatment with certain herbal medicines which had a disinfectant effect. A thread coated with this extract was passed through the ear of healthy goats to render them immune. The author lists various diseases and their treatment. This work forms part of detailed research by the author with reference to some 2,200 books and many ancient manuscripts on the history of veterinary science in Iran.

Animal Diseases↗
PubMed2004

[Breastfeeding and maternal medications].

OBJECTIVE: To contribute with information about the adequate administration of drugs during breastfeeding. SOURCES OF DATA: MEDLINE articles from 1993 to 2004, and Lilacs articles from 1995 to 2004 were selected in Portuguese, Spanish and English, by including the following keywords: breastfeeding, lactation, drugs and medicines. Other updated references found in articles and books were also included in this review, in order to provide additional information. SUMMARY OF THE FINDINGS: Most of the drugs are compatible with breastfeeding. Few were considered inadequate, such as antineoplastic drugs, radiopharmaceuticals and drugs of abuse. Some drugs require concern, as they may cause adverse effects in breastfed babies or reduce the mother's breast milk volume. However, further knowledge on some medicines during lactation is required. CONCLUSION: The fundamental principle in the prescription of medicines for lactating mothers is mostly based on the concept of risk and benefit. The option must be, as much as possible, for a drug that has already been studied, which is little released in the maternal milk or that does not mean an apparent risk for the infant's health. Medicines that reduce the mother's production of milk should be avoided during the lactation period. The use of galactogogos is reserved for particular situations. Therefore, only safety drugs should be administered during breastfeeding, which should rarely be discouraged or discontinued in such cases.

Breast Feeding↗
PubMed2003

Rapid and non-rapid cycling bipolar disorder: a meta-analysis of clinical studies.

BACKGROUND: Rapid cycling, defined as 4 or more mood episodes per year, is a course specifier of bipolar disorder associated with relative treatment resistance. Several risk factors have been suggested to be associated with rapid cycling. The purpose of this meta-analysis was to compare clinical studies for the evidence of discriminating factors between rapid and non-rapid cycling. DATA SOURCES AND SELECTION: We searched MEDLINE and reference lists of articles and book chapters and selected all of the clinical studies published from 1974 to 2002 comparing subjects with rapid and non-rapid cycling bipolar disorder. Prevalence rates and mean random effect sizes for 18 potential risk factors that were reported by at least 3 studies were calculated. In addition, we differentiated between current and lifetime diagnoses of rapid cycling. DATA SYNTHESIS: Twenty studies were identified. Rapid cycling was present in 16.3% of 2054 bipolar patients in 8 studies that included patients who were consecutively admitted to an inpatient or outpatient facility, without a priori selection of rapid cyclers and without matching the numbers of rapid cyclers to non-rapid cycling controls. Female gender and bipolar II subtype both had a small, but statistically significant, effect (p <.000 for female gender, p <.001 for bipolar II subtype). The further absence of recurrences with lithium prophylaxis was reported in 34% of rapid cyclers compared with 47% of non-rapid cyclers, a nearly significant difference, and a partial response was present in 59% and 65% of patients, respectively. The effect of hypothyroidism was significant (p <.01) in studies using current, but not lifetime, definitions of rapid cycling. In 46% of cases, a rapid cycling course was preceded by treatment with antidepressants, but systematic data on their causal role are lacking. CONCLUSION: Rapid cycling is slightly more prevalent in women and in patients with bipolar II subtype. In contrast to common opinion, lithium prophylaxis has at least partial efficacy in a considerable number of rapid cyclers, especially when antidepressants are avoided. Hypothyroidism may be associated with mood destabilization in vulnerable patients.

Bipolar Disorder↗
PubMed2006

Psychiatry and psychology in medieval Persia.

OBJECTIVE: The history of psychological sciences and especially the ways in which related disorders were treated in medieval Persia are not well known in the West. The main objective of this article is to review the clinical approaches to psychological disorders used by practitioners in medieval Persia. DATA SOURCES: Several documents still exist from which the clinical data on different psychological syndromes in medieval Persia can be ascertained. Data for this review were identified by searches of MEDLINE, Current Contents, the Internet, references from relevant articles and books, the Astan-e-Ghods Razavi Library, the Tehran University Library, the Mashhad University Library, and the files of the authors. Search terms included psychiatry, psychology, Persian, medieval, Avicenna, and pharmacotherapy. DISCUSSION: The medieval practitioners defined various signs and symptoms, apparent causes, and hygienic and dietary rules for prevention of these disorders. Medieval Persian medical writings encouraged the treatment of psychological disorders by tackling the conditions that cause or contribute to the disorder and through the use of electrical-shock therapy, phlebotomy, psychotherapy, music and color therapy, and especially prescription of long lists of medicaments. CONCLUSION: Some of the approaches of doctors in medieval Persia are accepted today, although most remain largely unexamined. With further research, more of these treatments may be shown to be of use to modern medicine.

History, Medieval↗
PubMed2005

[Practical training in gastrointestinal endoscopy].

In this paper, we describe a practical approach to the gastrointestinal endoscopy. We comment on the basic clinical education, endoscopy training with static models, basic courses with animals, as well as a reference to audiovisual media as books, journals, videotapes and CDs. Also we deal with the computer simulation. We describe the strategies for the interventional endoscopy training, as well as the education in the future developments. At the end, we introduce a structured training in gastrointestinal endoscopy.

Endoscopy, Gastrointestinal↗
PubMed1993

[Transylvanian refugees and the plague in 1708-1709].

Owing to the overwhelming military power of the Habsburg forces Transylvanian sympathizers fled twice to Hungary during the Rákóczi uprising (1704-1711): first in 1704-1706 and then in 1707-1711. In the autumn of 1707 they numbered as much as ten thousand people, and according to the decrees of the diet at Kisvárda, they were settled down in smaller units in around Szabolcs, Szatmár, Bereg, Ung, Ugocsa and Máramaros counties. Though always short of money, the leaders of the ukprising created a system that satisfied the basic needs of these refugees. By the end of the rebellion, nevertheless, as the territory controlled by Rákóczi's armies decreased considerably, the refugees were forced to move on and on, which certainly led to a corruption of their food supplies, accommodation and hygienic conditions. The worst among all came with the plague. The author examines the effects of the epidemic and the counter-measures taken by the individual and the authorities of the uprising. Kis has consulted the main Hungarian books of that age that referred to black death (among others Anna Zay's Herbarium [1719], Samuel Köleséri's Pestis Daicae, György Komáromi Csipkés's Pestis pestise, Ferenc Pápai Páriz's Pax Corporis and A [estos betegség etc., and Máté Tsanaki's A Döghalálról, etc.), as well as many archival papers (the correspondence of Count Sándor Károlyi with his wife Krisztina Barkóczy, thos of General Bercsényi to his wife and Prince Rákóczi, and some doctors' reports, etc.). His main source, however, is Zsigmond Szaniszló's diary. Szaniszló was a former fobiró (chief-sheriff) of the Transsylvanian Torda city, an Anti-Trinitarian stronghold, and remained a leader of his people during the emigration. According to his notes, which the author has compared with the data given by the others, there were hardly any measures taken against plague in this community. Although Szaniszló gives detailed descriptions about the everyday life of the refugees he almost entirely omits to mention anything that could be considered as anti-plague measure, except, perhaps, turning to the Almighty. This unreasonable conduct is often supposed to be the manifestation of fanaticism. Kis, however, prefers another explanation, because, as he argues, in lack of an elaborated knowledge of the mentalité of the Transsylvanian Anti-Trinitarian communities, and according to the insufficient number of original sources it would be unsafe to reason this striking phenomenon exclusively by unquestioning faith. So, Kis concludes that it was caused rather by the fact that plague had been virtually unknown in the remote cityof Torda, therefore these refugees did not know any sort of counter-measures that could have been taken. For them the epidemic was unexpected, uncontrollably fast and devastating. As a consequence, having but the last refuge, all they could do was praying.

Emigration and Immigration↗
PubMed2002

Hemorrhagic shock.

OBJECTIVE: To review the clinical aspects of hemorrhagic shock and provide recommendations for therapy. OPTIONS: Early recognition of hemorrhagic shock and prompt systematic intervention will help avoid poor outcomes. OUTCOMES: Establish guidelines to assist in early recognition of hemorrhagic shock and to conduct resuscitation in an organized and evidence-based manner. EVIDENCE: Medline references were sought using the MeSH term "hemorrhagic shock." All articles published in the disciplines of obstetrics and gynaecology, surgery, trauma, critical care, anesthesia, pharmacology, and hematology between 1 January 1990 and 31 August 2000 were reviewed, as well as core textbooks from these fields. Selected references from these articles and book chapters were also obtained and reviewed. The level of evidence has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS: 1. Clinicians should be familiar with the clinical signs of hemorrhagic shock. (III-B) 2. Clinicians should be familiar with the stages of hemorrhagic shock. (III-B) 3. Clinicians should assess each woman's risk for hemorrhagic shock and prepare for the procedure accordingly. (III-B) 4. Resuscitation from hemorrhagic shock should include adequate oxygenation. (II-3A) 5. Resuscitation from hemorrhagic shock should include restoration of circulating volume by placement of two large-bore IVs, and rapid infusion of a balanced crystalloid solution. (I-A) 6. Isotonic crystalloid or colloid solutions can be used for volume replacement in hemorrhagic shock (I-B). There is no place for hypotonic dextrose solutions in the management of hemorrhagic shock (I-E). 7. Blood component transfusion is indicated when deficiencies have been documented by clinical assessment or hematological investigations (II-2B). They should be warmed and infused through filtered lines with normal saline, free of additives and drugs (II-3B). 8. Vasoactive agents are rarely indicated in the management of hemorrhagic shock and should be considered only when volume replacement is complete, hemorrhage is arrested, and hypotension continues. They should be administered in a critical care setting with the assistance of a multidisciplinary team. (III-B) 9. Appropriate resuscitation requires ongoing evaluation of response to therapy, including clinical evaluation, and hematological, biochemical, and metabolic assessments. (III-B) 10. In hemorrhagic shock, prompt recognition and arrest of the source of hemorrhage, while implementing resuscitative measures, is recommended. (III-B)VALIDATION: These guidelines have been reviewed by the Clinical Practice Obstetrics Committee and approved by Executive and Council of the Society of Obstetricians and Gynaecologists of Canada. SPONSORS: The Society of Obstetricians and Gynaecologists of Canada.

Blood Transfusion↗