Use of a simple duodenal capsule to study upper intestinal microflora.

The upper intestinal microflora was studied in 10 malnourished Indonesian children using the paediatric Enterotest Capsules. Trophozoites of Giardia lamblia were found in 2 specimens, profuse fungal mycelia in 3, and ascaris worms and eggs in 1. In 9 patients an abnormally profuse small intestinal bacterial flora was found. Provided precautions are taken to exclude artefactual contamination of the line on its withdrawal, this is a safe and simple method for studying the upper gut flora which could be applied to field conditions since it does not require radiological facilities.     

Importance of Adopting BMI Classifications Using Public Health Action Points to Delineate Obstetric Risk Factors Resulting in Worsening Obstetric Outcomes Among Asian Population

Aims

The aim of this study is to compare obstetric outcomes between overweight and class 1 obesity among pregnant women in their first pregnancy based on WHO’s BMI cut-offs and the potential public health action points identified by WHO expert consultations specific for high-risk population such as Asians.

Methods

This is a retrospective cohort review of data obtained from the Malaysian National Obstetrics and Gynaecology Registry between the year 2010 and year 2012. All women in their first pregnancy with a booking BMI in their first trimester were included in this study. The association between BMI classifications as defined by the WHO cut-offs and the potential public health action points identified by WHO expert consultations towards adverse obstetric outcomes was compared.

Results

A total of 88,837 pregnant women were included in this study. We noted that the risk of adverse obstetric outcomes was significantly higher using the public health action points identified by WHO expert consultations even among the overweight group as the risk of stillbirths was (OR 1.2; 95% CI 1.0,1.4), shoulder dystocia (OR 1.9; 95% CI 1.2,2.9), foetal macrosomia (OR 1.8; 95% CI 1.6,2.0), caesarean section (OR 1.9; 95% CI 1.8,2.0) and assisted conception (OR 1.9; 95% CI 1.6,2.1).

Conclusion

A specifically lower BMI references based on the potential public health action points for BMI classifications were a more sensitive predictor of adverse obstetric outcomes, and we recommend the use of these references in pregnancy especially among Asian population.

     

Inhibin B and anti-Mullerian hormone: markers of ovarian response in IVF/ICSI patients?

OBJECTIVE: The objective of this study was to investigate whether follicle stimulating hormone (FSH), anti-Mullerian hormone (AMH) and inhibin B could be useful in predicting the ovarian response to gonadotrophin stimulation in assisted reproduction patients who are considered to be poor responders. DESIGN: Prospective study. SETTING: Fertility unit. SAMPLE: Blood samples were collected on day five or six in the early follicular phase of an untreated menstrual cycle. Samples were collected from 69 patients. METHODS: Serum samples were assayed for FSH, AMH and inhibin B using commercial immunoassay kits. MAIN OUTCOME MEASURES: Response to gonadotrophin stimulation and number of eggs collected. RESULTS: Among the 69 patients, 52 patients completed an IVF cycle and 17 patients had to cancel the cycle because of poor ovarian response to gonadotrophin stimulation. Mean FSH levels were significantly higher (P < 0.05) in the cancelled group (10.69 +/- 2.27 mIU/mL) compared with the cycle-completed group (7.89 +/- 0.78 mIU/mL). Mean AMH levels were significantly lower (P < 0.01) in the cancelled group (0.175 +/- 0.04 ng/mL) compared with the cycle-completed group (1.13 +/- 0.2 ng/mL). Mean inhibin B levels were significantly lower (P < 0.001) in the cancelled group (70 +/- 12.79 pg/mL) compared with the completed group (126.9 +/- 8.8 pg/mL). Predictive statistics show that AMH is the best single marker and that the combination of FSH, AMH and inhibin B is modestly better than the single marker. Linear regression analysis in the cycle completed patients shows that although FSH (r= 0.25, P < 0.05) and inhibin B (r= 0.35, P < 0.05) have a significant linear association with the number of eggs collected, AMH has the greatest association (r= 0.69, P < 0.001) with the number of eggs collected among the parameters measured. CONCLUSION: In this particular group of IVF patients, AMH is the best single marker of ovarian response to gonadotrophin stimulation. The combined markers modestly improved the prediction.     

The stomach in malnutrition

Basal gastric acid output was reduced in 9 out of 14 infants and young children with malnutrition compared with 21 age-matched controls. In all the patients the response of the gastric mucosa to stimulation by pentagastrin was impaired, and gastritis of variable severity was present in 8 out of the 9 patients in who biopsies were performed. Impaired gastric acid secretion probably contributes towards bacterial overgrowth and diarrhoeal diseases in malnourished children.     

The stomach in malnutrition.

Basal gastric acid output was reduced in 9 out of 14 infants and young children with malnutrition compared with 21 age-matched controls. In all the patients the response of the gastric mucosa to stimulation by pentagastrin was impaired, and gastritis of variable severity was present in 8 out of the 9 patients in who biopsies were performed. Impaired gastric acid secretion probably contributes towards bacterial overgrowth and diarrhoeal diseases in malnourished children.     

Use of a simple duodenal capsule to study upper intestinal microflora

The upper intestinal microflora was studied in 10 malnourished Indonesian children using the paediatric Enterotest Capsules. Trophozoites of Giardia lamblia were found in 2 specimens, profuse fungal mycelia in 3, and ascaris worms and eggs in 1. In 9 patients an abnormally profuse small intestinal bacterial flora was found. Provided precautions are taken to exclude artefactual contamination of the line on its withdrawal, this is a safe and simple method for studying the upper gut flora which could be applied to field conditions since it does not require radiological facilities.     

Serum anti-Müllerian hormone and inhibin B in disorders of spermatogenesis

This study investigates circulating concentrations of AMH and inhibin B in men with azoospermia. Serum AMH and inhibin B are significantly lower in the men with nonobstructive azoospermia compared to the controls and the men with obstructive azoospermia, suggesting that these hormones could be markers of nonobstructive azoospermia.     

Identification of the human cytochromes P450 catalysing the rate-limiting pathways of gliclazide elimination

AIMS: To identify the human cytochrome P450 (CYP) enzymes responsible for the formation of the 6beta-hydroxy (6beta-OHGz), 7beta-hydroxy (7beta-OHGz) and hydroxymethyl (MeOH-Gz) metabolites of gliclizide (Gz). METHODS: 6beta-OHGz, 7beta-OHGz and MeOH-Gz formation by human liver microsomes and a panel of recombinant human P450s was measured using a high-performance liquid chromatography procedure, and the kinetics of metabolite formation was determined for each pathway. Effects of prototypic CYP enzyme selective inhibitors were characterized for each of the microsomal metabolic pathways. RESULTS: Microsomes from six human livers converted Gz to its 6beta-OHGz, 7beta-OHGz, and MeOH-Gz metabolites, with respective mean (+/- SD) K(m) values of 461 +/- 139, 404 +/- 143 and 334 +/- 75 microm and mean V(max) values of 130 +/- 55, 82 +/- 31 and 268 +/- 115 pmol min(-1) mg(-1), respectively. V(max)/K(m) ratios for the microsomal reactions parallelled relative metabolite formation in vivo. Sulfaphenazole inhibited microsomal 6beta-OHGz, 7beta-OHGz and MeOH-Gz formation by 87, 83 and 64%, respectively, whereas S-mephenytoin caused significant inhibition (48%) of only MeOH-Gz formation. Recombinant CYP2C9, CYP2C18 and CYP2C19 catalysed all hydroxylation pathways, whereas CYP2C8 formed only 6beta-OHGz and 7beta-OHGz. CONCLUSION: Taken together, the results indicate that CYP2C9 is the major contributor to Gz metabolic clearance, although CYP2C19 may also be involved in MeOH-Gz formation (the major metabolic pathway). Factors known to influence CYP2C9 activity will provide the main source of variability in Gz pharmacokinetics.     

Carbetocin versus oxytocin for the prevention of postpartum hemorrhage: A meta-analysis of randomized controlled trials in cesarean deliveries

Objective

Postpartum hemorrhage remains the leading cause of maternal mortality in developing countries and a significant proportion of these cases are attributable to uterine atony. In contrast to the advances made in the treatment of postpartum hemorrhage, there has been few novel prophylactic agents. This study was undertaken to analyze the effectiveness of carbetocin compared to oxytocin for the prevention of postpartum hemorrhage, in the context of cesarean deliveries.