Recurrence of fetal growth restriction in singleton and twin gestations

Objective.?Patterns of recurrence of restricted fetal growth provide important insights to understand the relative contributions of genetic versus environmental influences. Although there is evidence of increased tendency of small for gestational age (SGA) births to recur, whether similar patterns of recurrence in twins among women that delivered a prior singleton SGA birth remains poorly studied.

Methods.?We used Missouri's maternally-linked data (1978–1997), and restricted the analysis to women that delivered their first two consecutive live births. SGA (birthweight <10th and <5th centile for gestational age) recurrence was examined in two distinct analyses: women that delivered their first two singleton live births (n = 305,654) and those that delivered their first singleton live birth followed by twin live births (n = 8594). Sib–sib pairwise odds ratio (pOR) were estimated from bivariate logistic regression with robust variance estimation after adjustments for confounders.

Results.?Risks of SGA were 24.3% and 6.1% in the second singleton birth among women with and without a previous singleton SGA, respectively (pOR 3.9, 95% CI 3.7–4.0). The corresponding risks among twins with and without a previous singleton SGA birth were 16.9% and 6.7%, respectively (pOR 2.3, 95% CI 1.8–2.8). In the singleton–singleton cohort, the highest recurrence risk for SGA occurred around the same gestational age window as the first singleton SGA birth. These associations were stronger for more severe forms of SGA (<5th centile).

Conclusions.?The likelihood of SGA to recur within sibships is strong, with varying magnitude of risks between singleton–singleton and singleton–twin births.     

PS2-13: Trends in Elective Labor Induction at 7 US Health Plans, 2001-2007

Background/Aims Elective induction of labor is controversial and has been linked to adverse pregnancy outcomes including higher rates of cesarean delivery. Many institutions have implemented measures to limit this practice. Our aim was to describe recent trends in the prevalence of elective induction. Methods A trend analysis was performed using data from 7 health plans participating in the Medication Exposure in Pregnancy Risk Evaluation Program, which includes linked health plan and state birth certificate data. Participating health plans represented 6 states within 3 US regions and a range of health care delivery models. We included deliveries from 2001 to 2007 and required that women be enrolled for the last trimester of pregnancy or longer. Induction was identified from birth certificate and health plan data and was defined as elective if neither source revealed an accepted indication for induction (e.g. diabetes, preeclampsia, and others). We compared induction prevalence across sites and over time, both unadjusted and also adjusted for health plan, gestational age, maternal age, and parity. Adjusted rates were estimated by marginal standardization using logistic regression. Results These analyses include 524,730 deliveries. Induction for any indication occurred in 27% (19,582/73,553) in 2001, rising to 32% (23,366/73,958) in 2005 and then declining to 29% (22,561/77,063) in 2007. Elective induction occurred in 10% (7,152/73,553) in 2001, rising to 13% in 2005 (9,924/73,958) and 2006 (9,937/78,357) and then declining slightly to 12% (8,877/77,063) in 2007. The lowest prevalence for elective induction at any site in any year was 7% (2,029/27,107) and the highest, 18% (454/2,480). At only one site did the prevalence of elective induction increase every year of the study period: from 10% to 15% (p<0.01 for trend). Adjusted results were similar. Discussion The prevalence of elective induction was highest in 2005-2006 and slightly lower in 2007. While there was considerable variation in prevalence across sites, elective induction continued to increase at only one site after 2005. Our data suggest that overall, in this setting, elective induction may have plateaued or even begun to decline.     

Knowledge of the Therapeutic Goals of Diabetes Care among Patients with Type 2 Diabetes at a Tertiary Hospital in Ethiopia

BackgroundA comprehensive cardiovascular risk control reduces diabetes-associated complications but achieving the triplet goals (blood glucose, blood pressure (BP), and low-density lipoprotein (LDL-C)) remains a clinical challenge. Patients'' knowledge of these diabetes therapeutic goals has been shown to improve glycemic control. However, this is not well studied in Ethiopia.MethodsA cross-sectional study was conducted from March to June 2020 in Tikur Anbessa Specialized Hospital among randomly selected 419 patients with type 2 diabetes. Data was collected using a pretested, structured questionnaire. A multivariable binary logistic regression was fitted to identify determinants of knowledge.ResultsThe mean age (±SD) of study participants was 57.4 (±10.8) years and the median duration (IQR) of diabetes was 12 (7, 20) years. A quarter of them achieved fasting glycemic control, a fifth of them attained the A1c goal and only 3% achieved the triple targets. Patients who reported knowing their target goals for BP, fasting blood sugar (FBS), A1C, and LDL-C were 79.5, 77.3, 11.7, and 7.2% respectively. The factors associated with knowledge of the therapeutic goals were longer diabetes duration, increased household income, age, being divorced as compared to married, having no formal education, and primary education.ConclusionThe majority of participants knew their BP and FBS targets while only a minority understood their A1c and LDL-C targets. It highlighted the need for the provision of patient-centered diabetes education to improve knowledge of the therapeutic targets.     

Bacteraemia among severely malnourished children in jimma university hospital, ethiopia

Background

Sever acute malnutrition severely suppresses every component of the immune system leading to increased susceptibility and severity to infection. However, symptoms and signs of infections are often unapparent making prompt clinical diagnosis and early treatment very difficult. The aim of the study was to determine the magnitude of bacteraemia and antimicrobial sensitivity among severely malnourished children.

Methods

Severely malnourished children admitted in Jimma University Specialized Hospital were enrolled between October, 2009 to May, 2010. Blood samples were collected, processed and bacterial isolates were identified using standard bacteriological procedures. Then, antibiotic susceptibility pattern of the isolates was determined by using Kirby-Bauer technique.

Results

Bacteraemia was seen in 35 (20.6%) of the 170 study subjects. There were a total of 35 bacterial isolates, Gram positive bacteria constitute 24(68.6%) of the isolates, where Staphylococcus aureus was the leading Gram positive isolate while Klebsiella species were the dominant Gram negative isolates. Twelve (7.1%) children died and 4 (33.3%) of them had bacteraemia. While susceptibility was more than 80% to Gentamicin, Ciprofloxacin and Ceftriaxone, increased level of resistance was documented to commonly used antibiotics, such as Amoxycillin, Co-trimoxazole and Chloramphenicol.

Conclusion

High prevalence of bacteraemia with predominating Gram positive isolates and increased level of resistance to commonly used antibiotics was shown among severely malnourished children in Jimma. Further studies are required to revise the current guideline for antibiotic choice.     

Prevalence of paralytic poliomyelitis in rural and urban populations in Ethiopia: report of a house-to-house survey

A house-to-house survey was carried out to determine the prevalence of poliomyelitis. During the survey 37,219 households were visited and 17,941 children 5-9 years old were found. Of 231 lame children, lameness compatible with paralytic poliomyelitis was found in 131, of these 91% had their condition before the age of 3 years. Nineteen percent needed a stick support for walking while 12% were unable to walk even with support. This problem was more common in rural populations. The prevalence of paralytic poliomyelitis was 7.3/1,000 children 5-9 years old.     

Prenatal screening for anticardiolipin antibody

Anticardiolipin antibodies, immunoglobulin G, and M (IgG, IgM) have been associated with recurrent abortion and with maternal death. This study tested whether anticardiolipin titers would be a useful prenatal screening test to determine high-risk pregnancies. Titers were obtained at the first clinic visit in 686 patients, mean gestation, 20 weeks. The outcome variables were taken from a medical records computer data base. IgG anticardiolipin correlated inversely with birthweight (p less than 0.025), but not with gestation. IgM anticardiolipin correlated strongly with the inverse of patient age (p less than 0.0002) and with chronic hypertension (p less than 0.01), but not with preeclampsia. There was a weak correlation with the 1-minute Apgar score (p less than 0.05). Thirty-seven patients had titers of IgG or IgM greater than 3 standard deviations above the mean for nonpregnant patients. Sixteen of these patients were studied for antinuclear antibody and coagulopathy (prothrombin time, partial thromboplastin time, viper venom time) and all were normal. Six of eight patients tested had low range elevated antibody titers to double-stranded DNA. Ten placentas were examined and showed no infarctions. None of the correlations were of practical clinical utility. The biologic basis of the correlations found is of further interest. The value of anticardiolipin titers with lupus erythematosus, or with coagulopathy, was not tested.