Missed abortion, and later spontaneous abortion, in pregnancies clinically normal at 7–12 wk

One thousand nine hundred and thirty-eight mothers were examined by ultrasound at 7–12 wk gestation. Eighty-three (4.28%) were found to have a dead fetus or an empty gestation sac. Twenty-five (1.29%) had a live fetus at that scan but spontaneously aborted 1–13 wk later. The earlier in pregnancy the ultrasound was carried out the more likely was the pregnancy to be dead or subsequently to abort. Mothers aged 35 or over were more likely than other women to have dead pregnancies at the initial ultrasound or subsequently to abort: those of 19 or less were less likely than other age groups to have a missed abortion but they had a rate of spontaneous abortion similar to those of 35 or more.     

Salicylate inhibition of Acanthamoeba attachment to contact lenses: a model to reduce risk of infection

PURPOSE: Acanthamoeba attachment (adsorption) to hydrogel contact lenses is enhanced by Pseudomonas aeruginosa biofilm. The effect of sodium salicylate on Acanthamoeba attachment to biofilm-coated and uncoated hydrogel lenses was investigated. DESIGN: Experimental study. PARTICIPANTS AND CONTROLS: A minimum of 16 replicates were used for each test condition; a control condition using clean lenses without biofilm was included. METHODS: Four groups of hydrogel contact lenses (etafilcon A) were pretreated with P. aeruginosa to form a biofilm. In addition, two more groups remained untreated. Quartered lenses of all six groups were then incubated in a suspension of A. castellanii trophozoites. Two batches of lenses had either 3 or 30 mM sodium salicylate added to the bacterial suspension (stage 1 intervention). Two other batches of lenses had salicylate added to the amoebal suspension (stage 2 intervention). One of the batches, which had a stage 1 intervention, had salicylate added at the second stage as well. The remaining batches received no salicylate exposure and included lenses with and without biofilm coating. MAIN OUTCOME MEASURE: The outcome measure in this study was the number of Acanthamoeba trophozoites attached, per square centimeter, to the hydrogel surfaces. RESULTS: Biofilm coating from P. aeruginosa gave a significantly increased attachment of A. castellanii trophozoites to the contact lens. When introduced at a first (biofilm) stage, second (trophozoite attachment) stage, or with intervention at both stages, 30 mM sodium salicylate reduced amoebal attachment to the hydrogel lens. When applied to both stages and when applied at stage 2 to the biofilm coated contact lenses, 3 mM sodium salicylate reduced amoebal attachment. The 3 mM concentration was not effective for the lower level of amoebae attachment to uncoated (nonbiofilm) lenses. CONCLUSIONS: Sodium salicylate successfully reduced amoebal trophozoite attachment to hydrogel lenses. This was the result of one of the following possibilities or a combination thereof: inhibition of biofilm formation; a direct effect on the amoebae; an alteration in the biofilm-amoebal attachment and resulting modification of the hydrogel lens surface. The results of this study suggest the major action is at stage 2 (on amoebal attachment to lenses) and favors alteration of the biofilm-amoebal attachment mechanism. This study demonstrates salicylate's potential benefit as a component of contact lens care solutions, designed to reduce microbial attachment and the risk of infection.     

Concentrations of hypoxanthine, xanthine, uridine and urate in amniotic fluid at caesarean section and the association of raised levels with prenatal risk factors and fetal distress

Samples of amniotic fluid were obtained at caesarean section from 33 of 80 consecutive unselected patients in whom the membranes were intact. Concentrations of the ATP metabolites, hypoxanthine and xanthine, as well as uridine and urate were determined using high pressure liquid chromatography. Independent 'clinical' factors associated with reduced fetal growth and well-being were identified and the patients were assigned to one of three groups: those with no recognized risk, those with moderate risk and a small group of four patients with high risk. The mean hypoxanthine concentration was higher in the moderate-risk group than in the group with no risk. Two of the three patients with proteinuric hypertension in the high-risk group had normal hypoxanthine concentrations. There were seven patients with fetal distress, and concentrations of hypoxanthine, xanthine, uridine and urate were significantly higher in the three patients who had meconium stained amniotic fluid in addition to abnormal fetal heart rate tracings than in the remaining four who had fetal heart rate abnormalities only. It is suggested that fetal distress at emergency caesarean sections might be quantitated by such analysis.     

Emphysema in the renal allograft

Two diabetic patients in whom emphysematous pyelonephritis developed after renal transplantation are described. Clinical recognition of this unusual and serious infection is masked by the effects of immunosuppression. Abdominal radiographic, ultrasound, and computed tomography findings are discussed. The clinical presentation includes urinary tract infection, sepsis, and acute tubular malfunction of the allograft in insulin-dependent diabetics.     

Missed opportunities: emergency contraception utilisation by young south African women

Although contraceptives, including emergency contraceptives, are widely available free at public health facilities in South Africa, rates of teenage and unintended pregnancy are high. This paper analyses awareness and utilisation of emergency contraception amongst 193 young women (aged 15-24 years) attending public sector health facilities. Structured interviews were held at 17 and 14 primary health clinics in an urban and a rural area respectively. Respondents were asked about their knowledge of contraceptive methods and use, and specifically about emergency contraceptive utilisation. More sexually active young urban women (76%) were currently using a method of contraception, compared to the young rural women (53%). Only 17% had ever heard of emergency contraception, although significantly more in the urban area (p = 0.005) had heard of it. Only one woman from each site had ever used emergency contraception, although 39% had had unprotected intercourse in the previous year when they did not wish to conceive. Young South African women should be the focus of interventions aimed at improving awareness of the availability of emergency contraception and knowledge about its correct utilisation.