Birth outcomes of singleton vaginal deliveries to ART-treated,subfertile, and fertile primiparous women

Purpose

To determine whether differences in birth outcomes among assisted reproductive technology (ART)-treated, subfertile, and fertile women exist in primiparous women with, singleton, vaginal deliveries.

Methods

Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) data were linked to Massachusetts vital records and hospital discharges for deliveries between July 2004 and December 2010. Primiparous women with in-state vaginal deliveries, adequate prenatal care, and singleton birth at ≥?20 weeks (n?=?117,779) were classified as ART-treated (linked to ART data from SART CORS, n?=?3138); subfertile (not ART-treated but with indicators of subfertility, n?=?1507); or fertile (neither ART-treated nor subfertile, n?=?113,134). Outcomes of prematurity (<?37 weeks), low birthweight (<?2500 g), perinatal death (death at ≥?20 weeks to ≤?7 days), and maternal prolonged length of hospital stay (LOS >?3 days) were compared using multivariable logistic regression.

Results

Compared to fertile, higher odds were found for prematurity among ART-treated (adjusted odds ratio [AOR] 1.40, 95% confidence interval [CI] 1.25–1.50) and subfertile (AOR 1.25, 95% CI 1.03–1.50) women, low birthweight among ART-treated (AOR 1.41, 95% CI 1.23–1.62) and subfertile (AOR 1.40, 95% CI 1.15–1.71) women, perinatal death among subfertile (AOR 2.64, 95% CI 1.72–4.05), and prolonged LOS among ART-treated (AOR 1.33, 95% CI 1.19–1.48) women. Differences remained despite stratification by young age and absence of pregnancy/delivery complications.

Conclusions

Greater odds of prematurity and low birthweight in ART-treated and subfertile, and perinatal death in subfertile deliveries are evident among singleton vaginal deliveries. The data suggest that even low-risk pregnancies to ART-treated and subfertile women be managed for adverse outcomes.

     

Common variation in the ABO glycosyltransferase is associated with susceptibility to severe Plasmodium falciparum malaria

There is growing epidemiological and molecular evidence that ABO blood group affects host susceptibility to severe Plasmodium falciparum infection. The high frequency of common ABO alleles means that even modest differences in susceptibility could have a significant impact on the health of people living in malaria endemic regions. We performed an association study, the first to utilize key molecular genetic variation underlying the ABO system, genotyping >9000 individuals across three African populations. Using population- and family-based tests, we demonstrated that alleles producing functional ABO enzymes are associated with greater risk of severe malaria phenotypes (particularly malarial anemia) in comparison with the frameshift deletion underlying blood group O: case-control allelic odds ratio (OR), 1.2; 95% confidence interval (CI), 1.09-1.32; P = 0.0003; family-studies allelic OR, 1.19; 95% CI, 1.08-1.32; P = 0.001; pooled across all studies allelic OR, 1.18; 95% CI, 1.11-1.26; P = 2 x 10(-7). We found suggestive evidence of a parent-of-origin effect at the ABO locus by analyzing the family trios. Non-O haplotypes inherited from mothers, but not fathers, are significantly associated with severe malaria (likelihood ratio test of Weinberg, P = 0.046). Finally, we used HapMap data to demonstrate a region of low F(ST) (-0.001) between the three main HapMap population groups across the ABO locus, an outlier in the empirical distribution of F(ST) across chromosome 9 (approximately 99.5-99.9th centile). This low F(ST) region may be a signal of long-standing balancing selection at the ABO locus, caused by multiple infectious pathogens including P. falciparum.     

Cerebral malaria in adults at the Infectious Diseases Clinic in the Fann Hospital in Dakar, Senegal

This study aimed at describing cerebral malaria cases findings in the Fann Hospital in Dakar. Data were collected from patients files recorded from 2001 to 2005. One hundred and twenty nine cases of cerebral malaria were admitted to the clinic, accounting for 21.4% of all malaria cases. The sex-ratio M/F was 2.48 and the mean age of patients 28.24 years old +/- 13.7 [12-85 years old]. Patients presented with either coma (91.4%) or mental confusion (10.07%) along with fever (80.6%), convulsions (33.3%). Other severe malaria conditions were observed: jaundice (7 cases), severe anaemia (5 cases), acute renal failure (3 cases), and circulatory collapse (3 cases). Acute pulmonary infection (4 cases) and Salmonella bacteraemia (2 cases) occurred as complications during patient's hospitalisation. The case fatality rate was 20.2% (26 deaths). No neurological sequelae were found among survivors. Cerebral malaria lethality is still high enough to urge for the improvement of working conditions in our clinic. Together with promotion of preventive measures in the community better health care services will help to reduce malaria related morbidity and mortality.     

Experimental lumbar instability and artificial ligament

Summary This biomechanical study investigates the efficiency of a new procedure of destabilization at the L4/L5 spinal unit, as well as the effect of a new system to stabilize it.The instability is effective in backward-forward and in lateral bending (p < 0.05), and the neutral zone is increased in backward-forward and in axial rotation (p < 0.05).The artificial ligament and its wedge stabilize the cut spine, and is effective in backward-forward and in lateral bending (p < 0.05).     

Three-dimensional finite-element modelling and improvement of a bispherical intervertebral disc prosthesis

Summary The load-displacement behaviour of six fresh human cadaveric L2–L3 spinal segments was studied through in vitro testing in flexion, and torsion. The lumbar spinal units were tested firstly intact, then instrumented by the SB Charité III intervertebral disc prosthesis with respect to the surgical requirements. These experiments highlighted an increase of mobility yielded by the implantation of the prosthesis, especially in torsion. Numerical models of both the L2–L3 spinal segment and the disc prosthesis were used. Simulations were performed on an intact spinal segment model, as well as on an instrumented segment model, by reproducing the same boundary conditions as used experimentally. The results of these simulations indicated a realistic behaviour of the model when comparing numerical results to experimental ones. This allowed us to validate our numerical models and to use them to calculate compressive forces transmitted by the posterior facets. Numerical results indicated an increase of the facet loading during torsion, yielded by the implantation of the prosthesis. Three technical changes to the original design were then simulated. These changes were meant to increase the global stiffness of the implanted segment, and to reduce articular facet loading in torsion. One of the solutions reduced axial rotation in torsion without decreasing articular loading. This observation is explained through a simple mechanical model of a lumbar spinal unit in torsion. This mechanical model was used to define the last solution, which succeeded in both reducing axial rotation and intra-articular loading.     

Surveillance of Viral Encephalitis in the Context of COVID-19: A One-Year Observational Study among Hospitalized Patients in Dakar,Senegal

The burden of encephalitis and its associated viral etiology is poorly described in Africa. Moreover, neurological manifestations of COVID-19 are increasingly reported in many countries, but less so in Africa. Our prospective study aimed to characterize the main viral etiologies of patients hospitalized for encephalitis in two hospitals in Dakar. From January to December 2021, all adult patients that met the inclusion criteria for clinical infectious encephalitis were enrolled. Cerebrospinal fluids, blood, and nasopharyngeal swabs were taken and tested for 27 viruses. During the study period, 122 patients were enrolled. Viral etiology was confirmed or probable in 27 patients (22.1%), with SARS-CoV-2 (n = 8), HSV-1 (n = 7), HHV-7 (n = 5), and EBV (n = 4) being the most detected viruses. Age groups 40–49 was more likely to be positive for at least one virus with an odds ratio of 7.7. The mortality was high among infected patients, with 11 (41%) deaths notified during hospitalization. Interestingly, SARS-CoV-2 was the most prevalent virus in hospitalized patients presenting with encephalitis. Our results reveal the crucial need to establish a country-wide surveillance of encephalitis in Senegal to estimate the burden of this disease in our population and implement strategies to improve care and reduce mortality.     

Indications du lambeau du grand pectoral en carcinologie cervicofaciale: à propos de 37 cas au CHU de Dakar

Introduction: The use of pectoralis major myocutaneous flap in head and neck oncology allowed the excision of large tumors

Materials and methods

It is a retrospective study which concerns a period of 13 years in the course of which, 37 pectoralis major myocutaneous flaps were performed at the private hospital of ENT of Dakar.

Results

The mean age of our patients was 51 years with a sex ratio of 5.16. To the clinical plan, the pharyngo-laryngeal tumors prevailed in 64.87% of cases. The cancers of larynx expanding into the skin and requiring a square laryngectomy were our main indication (37.86%). It was followed by the surgical cure of pharyngostoma (18.92%). To the anatomical plan, we obtained a healing of first intention in more than half of our patients (54.05%).

Conclusion

Thanks to its qualities, the pectoralis major myocutaneous flap has already supplanted the other flaps and it finds its main use in the reconstruction after square laryngectomy.     

The effect of father’s age in fertile,subfertile, and assisted reproductive technology pregnancies: A population based cohort study

PurposeTo compare ages of mothers and of fathers at delivery in couples who are fertile, subfertile, and subfertile treated with assisted reproductive technology (ART) and to characterize birth outcomes in the ART population according to paternal age.MethodsLive birth deliveries in Massachusetts between July, 2004 and December, 2008 were identified from vital records and categorized by maternal fertility status and treatment as ART, subfertile or fertile. The ART births were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database to obtain cycle-specific treatment data. Parental ages were obtained from birth certificates. Age of mothers and fathers were compared using ANOVA for continuous measures and χ² for categories. Risks of prematurity (<37 weeks), low birthweight (<2,500 g), and low birthweight z-score (small for gestatational age, SGA) were modeled using logistic regression by categories of paternal age as adjusted odds ratios and 95 % CI.ResultsThe study population included 9,092 ART, 6,238 subfertile, and 318,816 fertile deliveries. Paternal ages in the ART and subfertile groups were similar and differed significantly from those of the fertile group. Maternal age in the ART and subfertile groups averaged 5–6 years older than their fertile counterparts and fathers averaged 4–5 years older with twice as many being older than 37. The risks for prematurity, low birthweight and SGA did not increase with increasing paternal age.ConclusionsFathers in ART- treated and subfertile couples are older than in their fertile counterparts. Older paternal age was not assoicated with increased risk for prematurity, low birthweight, or SGA.