High dose gonadotrophin-releasing hormone antagonist (ganirelix) may prevent ovarian hyperstimulation syndrome caused by ovarian stimulation for in-vitro fertilization

This case report describes the first attempt to treat imminent ovarian hyperstimulation syndrome (OHSS) by using a gonadotrophin-releasing hormone (GnRH) antagonist. A 33 year old, normo-ovulatory woman undergoing in-vitro fertilization received daily subcutaneous injections of 150 IU of recombinant follicle-stimulating hormone (recFSH) from cycle day 2, together with GnRH antagonist (ganirelix) 0.125 mg from cycle day 7 onwards. On cycle day 10 the patient was found to have a serum oestradiol concentration of 16 500 pmol/l and, on ultrasound examination, four preovulatory (>16 mm) and nine intermediate sized (10-16 mm) follicles. RecFSH injections were discontinued, human chorionic gonadotrophin (HCG) withheld, whereas the ganirelix dose was increased to 2 mg/d. This regimen led to a rapid decrease in serum oestradiol concentrations and the decrease in ovarian size on ultrasound. Since GnRH antagonists will become clinically available for in-vitro fertilization programmes in the near future this suggested regimen might have a role in preventing severe OHSS.      

Localization of a gene for Mobius syndrome to chromosome 3q by linkage analysis in a Dutch family

Mobius syndrome (MIM no. 157900) consists of a congenital paresis or paralysis of the VIIth cranial nerve, frequently accompanied by paralysis of other cranial nerves, orofacial and limb malformations, defects of the musculoskeletal system and mental retardation. Although most patients are sporadic cases, familial recurrence is not rare. Different pedigrees suggest different modes of inheritance. We performed linkage analysis in a large family with autosomal dominantly inherited Mobius syndrome, consisting essentially of asymmetric bilateral facial pareses. After exclusion of the candidate region for Mobius syndrome on 13q12.2-q13, we localized the gene to chromosome 3q21-22, indicating genetic heterogeneity of Mobius syndrome. This heterogeneity is further proven by the exclusion of both loci in a second family with Mobius syndrome.      

Social Implications of Obstetric Fistula: An Integrative Review

Obstetric fistula is a devastating complication of obstructed labor that affects more than two million women in developing countries, with at least 75,000 new cases every year. Prolonged pressure of the infant's skull against the tissues of the birth canal leads to ischemia and tissue death. The woman is left with a hole between her vagina and bladder (vesicovaginal) or vagina and rectum (rectovaginal) or both, and has uncontrollable leakage of urine or feces or both. It is widely reported in scientific publications and the media that women with obstetric fistula suffer devastating social consequences, but these claims are rarely supported with evidence. Therefore, the true prevalence and nature of the social implications of obstetric fistula are unknown. An integrative review was undertaken to determine the current state of the science on social implications of obstetric fistula in sub‐Saharan Africa.     

Findings From the Analysis of the American College of Nurse‐Midwives' Membership Surveys: 2006–2008

Introduction : The American College of Nurse‐Midwives (ACNM) Core Data Survey is an annual membership survey that collects demographic and selected workforce data about certified nurse‐midwives (CNMs), certified midwives (CMs), and students enrolled in midwifery education programs accredited by the Accreditation Commission for Midwifery Education, who are members of the organization. This article presents findings from the analysis of membership data for the years 2006 to 2008. Methods : An e‐mail invitation to participate in the online survey was sent to all ACNM members who provided ACNM with an e‐mail address. A paper copy of the survey was available upon request. The survey instrument for the years 2006 to 2008 focused on five categories: demographics, certification, education, employment, and licensure. Results : ACNM member respondents continue to remain predominantly white and female. The average age of CNMs/CMs for 2008 is 51 years, and the majority holds a master's degree as their highest degree. Discussion : Very few advances have been made in the effort to increase the diversity of ACNM membership. The number of CNMs earning doctoral degrees (including the doctor of nursing practice degree) is increasing. A majority of CNMs/CMs continue to identify a broad domain of clinical midwifery practice as their primary responsibility in their primary employment, and hospitals and physician practices remain the largest employers of midwives. Salaries for midwifery‐related work are rising, but it is unclear if midwives are earning more because salaries are higher or because the higher salaries reflect market wage adjustments that occur over time.     

Pregnancy‐Associated Stroke

Cerebrovascular accident, or stroke, is the fourth leading cause of death for all women and the eighth leading cause of pregnancy‐associated death. The physiologic changes of pregnancy increase the risk of cerebrovascular accident for women. With current incidence rates, a facility with 3300 births per year can anticipate caring for one woman with a pregnancy‐related stroke at least every 2 years. All maternity care providers must be able to assess women experiencing stroke‐like symptoms and initiate timely care to mitigate brain tissue damage, decrease long‐term morbidity, and prevent mortality. The 2 main types of stroke, ischemic and hemorrhagic, have similar presenting symptoms but very different pathophysiology and treatment. This article reviews assessment and initial treatment of pregnant and postpartum women experiencing stroke and provides guidance for subsequent maternity and primary care to assist front‐line perinatal care providers who may be the first to treat affected women or may resume primary care after diagnosis.     

Six month tracking of microbial growth in a metalworking fluid after system cleaning and recharging

Large volumes of metalworking fluids (MWFs) are used in manufacturing industries for cooling and lubrication of metal pieces and tools during machining. MWFs accumulate microbial growth through continuous recirculation and reuse. We studied the progression of microbial contamination for 6 months after dumping, cleaning and recharging (DCR) of a large semi-synthetic MWF system managed with several biocides. Fresh, uncontaminated fluid was added to the system after extensive cleaning. The following samples were collected and analyzed: pre-DCR fluid (before system cleaning); neat fluid diluted to 6% with water; in use MWF 12 h and 1, 3 and 6 months post-DCR. Samples were analyzed for total microorganism concentrations by direct counting using fluorescence microscopy and by plate counting on various media (R2A, BHI, Middlebrooks and rose bengal under aerobic conditions). In addition, PCR was performed for the detection of mycobacteria. There was a rapid progression in the total bacterial counts as determined by fluorescence microscopy: 5.7 x 10(7) cells/ml in the pre-DCR used fluid, no measurable bacteria in the neat fluid, 6.9 x 10(6) cells/ml after 12 h and 2.2 x 10(6), 3.6 x 10(8) and 6.1 x 10(8) cells/ml after 1, 3 and 6 months, respectively. On average, only 0.2% of the direct count organisms were quantified on R2A cultures. PCR showed the presence of mycobacteria in the used MWF at 3 and 6 months. Mycobacteria were also identified from cultures on Middlebrooks and R2A. This study demonstrates that standard methods for cleaning MWF systems are inadequate since residual bacteria in the system can rapidly repopulate the newly charged MWF.     

CARIDIAC TRANSPLANTATION IN PATIENTS OVER 60 YEARS OLD

Objective To reevaluate the age limit for heart transplantation ( HTX) and the long-term outcomes in el derly patients. Methods From Oct. 1984 to Dec. 1996, 161 cases of HTX were performed in Hartford Hospital, with 35 pa tients aged 60～68 years (mean: 63.5±2.7, group A) and 126 under 60 years (mean: 47.6±11.3, group B). The causes of HTX for group A and group B were ischemic : 60% vs 48%, idiopathic: 29% vs 45%, valvular: 6% vs 4 %, congenital: 0 vs 2%, and graft failure : 6 % vs1% . Results The operative mortality (within 30d) were5.7%(2/35) in group A , and1. 6% (2/126) in group B. The overall late death were 13 (37%) in group A, and 50(40% ) in group B. The main causes of dea th were ( group A vs group B) infection: 46 % vs 24 %, rejection: 0 vs 28 % (P<0.05), malignancy: 23 % vs 8 %, multi-or gan system failure:23% vs 2%, cardiac events:8% vs 10%. The 1-,3-,5- ,8- and 10- year survival rate in group A and group B was 74% vs 88%, 67% vs 77%, 60% vs 65%, 49% vs 43%, and 49% vs 34% respectively. The quality of life for both groups was improved remarkably. Conclusion The survival rate for patients over 60 is as good as that of the younger group. HTX could be successfully performed in patients around 65 years old.     

A systematic review of components of community‐based organisation engagement

Community‐based organisations (CBOs) are important for eliminating health disparities globally and translating research findings to inform interventions. Engagement is an integral part of partnerships between CBOs and community health researchers and impacts the quality and quantity of any desired outcome. Despite the acknowledged benefits of community‐based organisation engagement (CBOE), there are variations in its operationalisation and paucity in the understanding of its use in community‐scientific partnerships. To further understand CBOE, the aim of this study was to synthesise published literature relevant to the definitions and applications of CBOE and identify its key components. A systematic search was conducted in March 2017, and updated in June 2017. Keywords were varied to account for international differences in spelling and word usage. Five major databases, MEDLINE, PubMed, CINAHL, PsycINFO and Google Scholar, were used to identify potential research studies. A total of 32 studies were included in this review. Following the analysis of the literature, four salient themes emerged as components of CBOE: (1) Need (a consensus between all the parties in a partnership on the importance of a specified project and its proposed benefits to a target community); (2) Partnership Dynamics (the workings of a relationship between a CBO and a scientific/academic stakeholder); (3) Resources (include but are not limited to: personnel, money, work space, expertise and equipment); and (4) Outcomes (products of the partnership). This review provides a foundation for future research in applying CBOE to translational research and interventions. This analysis will assist community health researchers in planning partnerships with CBOs, and make necessary adjustments to improve study outcomes. Appropriate application of the components of CBOE in partnerships will assist researchers in addressing health disparities.