Fetal growth after preterm premature rupture of membranes: is it related to amniotic fluid volume?

OBJECTIVE: Preterm premature rupture of membranes (PPROM) has been associated with an increased rate of fetal growth restriction (FGR). It is unknown whether impairment of fetal growth is mediated through external compression from decreased amniotic fluid volume or (an)other mechanism(s). METHODS: Over a three-year period all patients with singleton pregnancies experiencing PPROM at <37 weeks lasting greater than 10 days, and who underwent serial sonograms to assess fetal biometry after PPROM, were included in the study. Patients were excluded for congenital anomalies or other inherent risk factors for abnormal fetal growth. Fetal abdominal circumference (AC) percentiles were compared between the first sonographic exam after PPROM and the last exam before delivery. The median amniotic fluid index between PPROM and delivery was correlated with the change in AC percentiles while controlling for the duration of PPROM. Statistical analysis utilized one-way analysis of variance and correlation; a p value of <0.05 was considered significant. RESULTS: Twenty-two patients met our inclusion criteria with a mean duration (+/-SD) of PPROM of 58 days (+/-46). The median AFI during the PPROM period was not correlated with the change in AC percentiles after controlling for duration of PPROM (p = 0.49). CONCLUSIONS: The residual amniotic fluid volume after PPROM does not appear to correlate with fetal growth suggesting that the increased rate of FGR in PPROM is not secondary to oligohydramnios. We hypothesize that the intrauterine pathologic processes responsible for membrane rupture may also interfere with fetal growth.     

Prospective evaluation of contracted sockets.

Aims: To establish a correct method of evaluation and management of contracted sockets Results: Anopthalmic socket were frequently seen in orbit and Oculoplasty clinic of Aravind Eye Hospital, Madurai, South India. Prospective evaluation of Anophthalmic Sockets was done in this study. Anophthalmic Socket which can not support prosthetic eye is called contracted socket.4,5,14. These sockets were graded as congenital and acquired, which were managed using single, combined and multiple procedures. Surgical outcome of each case were analyzed. Key words: Anophthalmos, contracted sockets, prosthesis, conformer, volume deficit.     

Influence of women's autonomy on infant mortality in Nepal

Background  

Nepalese women lag behind men in many areas, such as educational attainment, participation in decision-making and health service utilization, all of which have an impact on reproductive health outcomes. This paper aims to examine the factors influencing infant mortality, specifically, whether women's autonomy has an impact on infant mortality in the Nepali context.     

Phosphoinositides from human foetal brain during development

An attempt has been made in the present study to look for the activity of the enzymes which catalyse the breakdown of phosphorylated metabolites both in acidic and alkaline pH from human foetal brain, in different gestational ages during development in 18 foetal samples. It was revealed that phosphatases were distributed throughout the brain and were operative from the onset of development. There was a tendency of increment of specific activity of enzymes with respect to the advancement of gestational period. This observation should be accounted as a prerequisite criteria for understanding phosphate meatabolism in human foetal organs primarily associated with glycolytic and gluconeogenic pathways.     

Visual defects in Nepalese children with Down syndrome

Background: Down syndrome (DS) is a common chromosomal anomaly. People with this syndrome have recognisable physical characteristics and limited intellectual abilities. The aim of this study was to determine visual defects, especially refractive error and binocular anomalies, in a sample of Nepalese children with DS. Methods: Thirty‐six children with DS (19 boys and 17 girls) from the Kathmandu valley, aged from four months to 18 years, underwent detailed optometric examination. Cycloplegic refraction was performed on all subjects. Vision on presentation of all the children was assessed with preferential looking cards, the Kay picture cards, the Bailey‐Lovie logMAR chart or the Snellen chart. Binocular function was assessed with cover test, Hirschberg or Bruckner test. Results: Cycloplegic refraction of the children revealed that 80 per cent of the children had significant refractive error. Most of them had hyperopia (55 per cent), followed by astigmatism (44 per cent), myopia (25 per cent) and anisometropia (19 per cent). Only two (5.6 per cent) children were strabismic and both of them were alternating esotropes. Nystagmus was present in 10 (28 per cent). Other ocular findings were upward slanting palpebral fissures, blepharitis, congenital nasolacrimal duct obstruction, blepharoconjunctivitis, chalazion and lenticular opacities. Conclusion: Nepalese children with DS have a high prevalence of refractive error and nystagmus. Regular eye examinations are indicated for these children to enable early diagnosis and appropriate management of ocular disorders to improve their vision and quality of life.     

Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up?

Computer navigation assistance in total knee arthroplasty (TKA) results in consistently accurate alignment of prostheses. We aimed to compare the outcome of computer-navigated and conventional TKA and to analyse the radiologically malaligned knees. We analysed 637 primary TKA, carried out by a single surgeon, over five consecutive years and divided them into two cohorts: group 1 = STA (standard instrumentation) and group 2  = CAS (computer-assisted surgery). There was no significant difference between the average Oxford Knee Scores (OKS) of the two groups at any time from one to five years. However, the malaligned TKA at three years had a worse OKS. At medium term there is no difference in clinical outcome measures that can be attributed to the surgeon having used computer-assisted navigation for TKA. But group 1, having a higher proportion of malaligned TKA, might show worsening of OKS at long term.     

Vertebral Fracture Risk in Diabetic Elderly Men: The MrOS Study

Type 2 diabetes (T2DM) is associated with a significant increase in risk of nonvertebral fractures, but information on risk of vertebral fractures (VFs) in subjects with T2DM, particularly among men, is lacking. Furthermore, it is not known whether spine bone mineral density (BMD) can predict the risk of VF in T2DM. We sought to examine the effect of diabetes status on prevalent and incident vertebral fracture, and to estimate the effect of lumbar spine BMD (areal and volumetric) as a risk factor for prevalent and incident morphometric vertebral fracture in T2DM (n = 875) and nondiabetic men (n = 4679). We used data from the Osteoporotic Fractures in Men (MrOS) Study, which enrolled men aged ≥65 years. Lumbar spine areal BMD (aBMD) was measured with dual‐energy X‐ray absorptiometry (DXA), and volumetric BMD (vBMD) by quantitative computed tomography (QCT). Prevalence (7.0% versus 7.7%) and incidence (4.4% versus 4.5%) of VFs were not higher in T2DM versus nondiabetic men. The risk of prevalent (OR, 1.05; 95% CI, 0.78 to 1.40) or incident vertebral‐fracture (OR, 1.28; 95% CI, 0.81 to 2.00) was not higher in T2DM versus nondiabetic men in models adjusted for age, clinic site, race, BMI, and aBMD. Higher spine aBMD was associated with lower risk of prevalent VF in T2DM (OR, 0.55; 95% CI, 0.48 to 0.63) and nondiabetic men (OR, 0.66; 95% CI, 0.5 to 0.88) (p for interaction = 0.24) and of incident VF in T2DM (OR, 0.50; 95% CI, 0.41 to 0.60) and nondiabetic men (OR, 0.54; 95% CI, 0.33 to 0.88) (p for interaction = 0.77). Results were similar for vBMD. In conclusion, T2DM was not associated with higher prevalent or incident VF in older men, even after adjustment for BMI and BMD. Higher spine aBMD and vBMD are associated with lower prevalence and incidence of VF in T2DM as well as nondiabetic men. © 2017 American Society for Bone and Mineral Research.     

A study of ABO incompatibility and neonatal jaundice in Black South African newborn infants

In order to establish the role of fetomaternal ABO incompatibility as a cause of overall neonatal jaundice, its relationship to the degree of jaundice, and its etiologic contribution to severe jaundice necessitating exchange transfusion in South African blacks, a retrospective analysis of both laboratory and clinical data was undertaken. Two thousand forty-two blood samples were submitted for laboratory investigation from mothers and their jaundiced newborn infants and categorized according to ABO blood groups and levels of serum bilirubin. At levels of serum bilirubin below 301 mumol/l, ABO incompatible combinations occurred as frequently as ABO compatible combinations. However, at serum bilirubins above 301 mumol/l, ABO incompatibility was a major cause of jaundice in almost 58 per cent of infants. In the nursery-based clinical studies, ABO incompatibility accounted for 41.7 per cent of those severely jaundiced (greater than 301 mumol/l) and 44.4 per cent of newborn infants who had exchange transfusions. ABO incompatible combinations however did not assume a significant role in the cause of overall neonatal jaundice. Both laboratory and clinical findings therefore confirm the importance of fetomaternal ABO incompatibility as a cause of severe jaundice and an unimportant cause of overall jaundice in newborn black babies.