Sarmina Hassan

Accuracy and reliability of fetal heart rate monitoring using maternal abdominal surface electrodes.

Objective. Compare the accuracy and reliability of fetal heart rate identification from maternal abdominal fetal electrocardiogram signals (ECG) and Doppler ultrasound with a fetal scalp electrode. Design. Prospective open method equivalence study. Setting. Three urban teaching hospitals in the Northeast United States. Sample. 75 women with normal pregnancies in labor at >37 weeks of gestation. Methods. Three fetal heart rate detection methods were used simultaneously in 75 parturients. The fetal scalp electrode was the standard against which abdominal fetal ECG and ultrasound were judged. Main outcome measures. The positive percent agreement with the fetal scalp electrode indicated reliability. Bland–Altman analysis determined accuracy. The confusion rate indicated how frequently the devices tracked the maternal heart rate. Results. Positive percent agreement was 81.7 and 73% for the abdominal fetal ECG and ultrasound, respectively (p = 0.002). The abdominal fetal ECG had a lower root mean square error than ultrasound (5.2 vs. 10.6 bpm, p < 0.001). The confusion rate for ultrasound was 20‐fold higher than for abdominal ECG (8.9 vs. 0.4%, respectively, p < 0.001). Conclusion. Compared with the fetal scalp electrode, fetal heart rate detection using abdominal fetal ECG was more reliable and accurate than ultrasound, and abdominal fetal ECG was less likely than ultrasound to display the maternal heart rate in place of the fetal heart rate.

CardioClasp: a new passive device to reshape cardiac enlargement.

In dilated heart failure, geometric distortions place an extra load on the myocardial cells. If this extra burden can be eliminated, the myocardial wall stress would decrease leading to improved systolic ventricular performance. In a dilated heart failure model, we wanted to see whether the CardioClasp™ (which uses two indenting bars to reshape the left ventricle [LV] as two widely communicating “lobes” of reduced radius) could improve systolic performance by passively reshaping the LV and reducing the wall stress.In mongrel dogs (n = 7; 25–27 kg), rapid ventricular pacing (210 ppm 1st week to 240 ppm 4th week) induced dilated heart failure. After 4 weeks, LV performance was evaluated at baseline and with the CardioClasp™ by measuring LV end-diastolic and peak LV systolic pressure, LV +dP/dt, LV −dP/dt, and cardiac output. With the Clasp on, LV wall stress was reduced to 58.6 ± 3.5 from 108.3 ± 8.2 g/cm2. The fractional area of contraction (FAC) with the Clasp on (28.4 ± 4.4) was significantly increased (p < 0.05) from baseline (20.8 ± 4.6) and consistent with improved systolic performance. Cardiac output, LV peak systolic and end-diastolic pressures, and regional myocardial blood flow were unaltered.The Clasp was able to acutely reshape the left ventricle, while preserving the contractile mass, and reduced the tension on the myocardial cells and increased the fractional area of contraction without decreasing the systolic blood pressure.

Accuracy and Reliability of Uterine Contraction Identification Using Abdominal Surface Electrodes

Objective: To compare the accuracy and reliability of uterine contraction identification from maternal abdominal electrohysterogram and tocodynamometer with an intrauterine pressure transducer. Methods: Seventy-four term parturients had uterine contractions monitored simultaneously with electrohysterography, tocodynamometry, and intrauterine pressure measurement. Results: Electrohysterography was more reliable than tocodynamometry when compared to the intrauterine method (97.1 versus 60.9 positive percent agreement; P < 0.001). The root mean square error was lower for electrohysterography than tocodynamometry in the first stage (0.88 versus 1.22 contractions/10 minutes; P < 0.001), and equivalent to tocodynamometry in the second. The positive predictive values for tocodynamometry and electrohysterography (84.1% versus 78.7%) were not significantly different, nor were the false positive rates (21.3% versus 15.9%; P = 0.052). The sensitivity of electrohysterography was superior to that of tocodynamometry (86.0 versus 73.6%; P < 0.001). Conclusion: The electrohysterographic technique was more reliable and similar in accuracy to tocodynamometry in detecting intrapartum uterine contractions.

Douching With Water Works Device for Perceived Vaginal Odor With or Without Complaints of Discharge in Women With No Infectious Cause of Vaginitis: A Pilot Study

Objective. To determine if douching with Water Works device for 1 month can (1) lower or eliminate perceived vaginal odor by subject; (2) have any effects on vaginal ecosystem. Methods. Ten women with perceived vaginal odor with or without discharge, douched every day for 4 weeks in an open-label, nonrandomized pilot study. Primary outcome measures included perceived vaginal odor by subject, lactobacilli score from Nugent slide, and acceptance of the Water Works douching system. Secondary outcome included the safety of using this douching device. Results. At week 4, there was improvement in vaginal odor (P = .0006) and there was no significant change in lactobacilli score. Conclusion. Douching with Water Works device is associated with reduction or elimination of vaginal odor without adversely affecting the vaginal ecosystem.

CardioClasp Changes Left Ventricular Shape Acutely in Enlarged Canine Heart

Abstract Background: In dilated cardiomyopathy (DCM), eliminating or reducing extra‐geometric burden to the myocardial cells would directly reduce myocardial wall stress leading to improved LV systolic performance. In acute experiments, we tested whether a passive non‐blood contacting CardioClasp™ device, which employs two indenting bars to reshape the left ventricle (LV), could reduce extra‐geometric burden, LV wall stress (LVWS) and improve LV systolic function and contractility without decreasing arterial blood pressure. Methods: In mongrel dogs (n = 5), 4 weeks of right ventricular pacing (210–220–230–240 ppm) induced DCM with severe heart failure. After placing the CardioClasp™ device, LV performance was evaluated immediately by measuring hemodynamics, echocardiography, and Sonometrics® crystal data. Eleven sonometric crystals were placed into endocardial positions (8 in anterior, posterior, mid‐anterior, mid‐posterior, apex, base, free and septal wall) and in myocardial (2 as regional) and epicardial (1) positions to assess the LV end‐systolic pressure‐segment length relationships (ESPSR) and cross‐sectional area (ESPAR) relationship. Results: CardioClasp™ decreased the LV end‐diastolic anterior‐posterior (A‐P) dimensions at two levels (15% and 25%). With CardioClasp™, LVWS decreased from 93.1 ± 7.2 to 59.1 ± 3.2  g/cm2 (P < 0.05) and fractional area of contraction (FAC) increased from 27.6 ± 3.8 to 33.1 ± 3.7% (P < 0.01). Peak LV and arterial pressures, LV +dP/dt, LV −dP/dt, and cardiac output were unaltered with CardioClasp™. CardioClasp™ placement significantly increased the slopes of LV pressure versus anterior‐posterior segment relationship from 7.3 ± 0.6 to 15.8 ± 1.8 mmHg/mm and septal‐free wall segment relationship from 6.3 ± 0.9 to 9.8 ± 0.5 mmHg/mm. At both 15% and 25% LV A‐P dimension reductions, the slopes of ESPAR showed significant steepening and increased from 10.1 ± 0.7 (baseline) to 15.5 ± 1.7 (15% reduction) and 19.0 ± 1.4 mmHg/cm2 (25% reduction). The larger the reduction, the greater was the steepening of the slopes of ESPSR and ESPAR. Conclusions: CardioClasp™ reduced LV diameter and thereby decreased LVWS and increased FAC. CardioClasp™ was able to reshape the left ventricle, while preserving the contractile mass, which increased the slopes of ESPSR and ESPAR. This reshaping was associated with maintained systolic pressures, cardiac output, and increased contractility. (J Card Surg 2003;18(Suppl 2):S49‐S60)

Douching for perceived vaginal odor with no infectious cause of vaginitis: a randomized controlled trial.

Objective. To demonstrate the effectiveness of medical-grade stainless steel Water Works Douching Device for treating abnormal vaginal odor in comparison with a commercially available over-the-counter plastic douching device. Materials and Methods. In a multicenter study, 140 women with perceived vaginal odor with no vaginal infection were randomized to either Water Works or control group in a 1:1 ratio and were douched daily for 4 weeks. A visual analog scale (VAS) was used to assess the intensity of vaginal odor. Primary outcome included subject assessment of odor improvement and Nugent Gram stain score of vaginal secretions. Secondary outcome compared the efficacy and safety of Water Works with control douching device. Each patient underwent baseline, week 2, and week 4 visits. Results. The final analytic sample consisted of 96 women. Success score at 4 weeks was 78% for the Water Works group and 38.5% for the control group. Mean VAS was significantly reduced, and Nugent and Lactobacillus scores were maintained in both groups. In the Water Works group, VAS was reduced from 7.3 ± 0.3 to 1.8 ± 0.6 (p < .001) after 4 weeks. In the control group, baseline versus 4 weeks VAS was 7.2 ± 0.3 and 3.4 ± 0.8 (p < .003). Conclusions. Women reported significant reduction of vaginal odor after douching with water for 4 weeks without any alteration of vaginal flora. The Water Works Douching Device was superior to over- the-counter device in reducing vaginal odor.

Can latissimus dorsi muscle stimulation benefit heart during training period after vascular delay

We hypothesized that a two-stage vascular delay procedure followed by 5 weeks of conditioning of the latissimus dorsi muscle (LDM) could benefit the heart during the training period and greatly increase cardiac assistance when examined with maximum potential. In mongrel dogs (n = 10), left ventricle (LV) dysfunction was induced by intracoronary injections of latex microspheres [90 ± 2 &mgr; diameter]. Vascular delay of the LDM was performed in one group (n = 6), whereas the other group (control, n = 4) did not undergo vascular delay. After 2 weeks, CMP was performed in all animals followed by LDM conditioning. After 5 weeks of muscle training, we examined left ventricular function at 20 Hz-4 volts, 33 Hz-4 volts, and 50 Hz-10 volts stimulation by assessing peak aortic pressure (AoP), left ventricular pressure (LVP), maximum LV +dP/dt, stroke volume (SV), stroke work (SW), stroke power (SP), and aortic flow. LDM assisted beats were compared with nonstimulated beats. LDM stimulation caused significant increases in pressure and flow in the vascular delay group. At 20 Hz-4 volts, absolute increases were LVP (10.2 ± 0.6) mm Hg, AoP (9.8 ± 1.7) mm Hg, SV (1.8 ± 0.4) ml, SW (5.3 ± 1.0) gm·m, SP (40.8 ± 12.7) gm·m/sec, max LV dP/dt (104.8 ± 53.2) mm Hg/sec, and peak aortic flow (0.9 ± 0.3) L/min. At 33 Hz-4 volts, the absolute increases were LVP (13.6 ± 1.3) mm Hg, AoP (12.1 ± 2.4) mm Hg, SV (2.7 ± 0.7) ml, SW (7.4 ± 1.4) gm·m, SP (72.7 ± 16.5) gm·m/sec, max LV dP/dt (294 ± 19) mm Hg/sec, and peak aortic flow (1.8 ± 0.5) L/min. At 50 Hz-10 volts, the absolute increases were LVP (17.7 ± 0.7) mm Hg, AoP (21.1 ± 1.9) mm Hg, SV (6.0 ± 1.1) ml, SW (14.6 ± 2.2) gm·m, SP (128.2 ± 15.3) gm·m/sec, max LV dP/dt (352 ± 62) mm Hg/sec, and peak aortic flow (3.3 ± 0.4) l/min (p < 0.05). The percentage increases were significantly larger in the vascular delay group compared with controls at 50 Hz-10 volts LDM stimulation. By using a two-stage vascular delay procedure, LDM stimulation can provide meaningful cardiac assistance during training periods. Furthermore, brief periods of maximal potential benefit (demand cardiomyoplasty) can be achieved during the training period.