Monitoring intracranial pressure, perfusion and metabolism

Cerebral monitoring is important for management of severe headinjury. It is also used in subarachnoid haemorrhage, stroke,intracerebral haematoma, meningitis, encephalopathies, hepaticfailure, after neurosurgery and in patients undergoing carotidartery surgery. This article provides an overview of cerebralmonitoring techniques available in clinical practice.     

Early Childhood Growth Parameters in South African Children with Exposure to Maternal HIV Infection and Placental Insufficiency

Maternal HIV exposure and intrauterine growth restriction (IUGR) due to placental insufficiency both carry major risks to early child growth. We compared the growth outcomes of children aged 18 months who had abnormal umbilical artery resistance indices (UmA-RI), as a marker of placental insufficiency, with a comparator group of children with normal UmA-RI during pregnancy, as mediated by maternal HIV infection. The cross-sectional study included 271 children, grouped into four subgroups based on HIV exposure and history of normal/abnormal UmA-RI, using available pregnancy and birth information. Standard procedures were followed to collect anthropometric data, and z-scores computed as per World Health Organization growth standards. Lower length-for-age z-scores (LAZ) were observed in children who were HIV-exposed-uninfected (CHEU) (−0.71 ± 1.23; p = 0.004) and who had abnormal UmA-RI findings (−0.68 ± 1.53; p < 0.001). CHEU with abnormal UmA-RI had lower LAZ (−1.3 ± 1.3; p < 0.001) and weight-for-age z-scores (WAZ) (−0.64 ± 0.92; p = 0.014) compared to the control group. The prevalence of stunting was 40.0% in CHEU with abnormal UmA-RI and 16.0% in CHEU with normal UmA-RI (p < 0.001; p = 0.016, respectively). In conclusion, maternal HIV exposure and placental insufficiency are independent risk factors for childhood stunting, with this risk potentiated when these two risk factors overlap.     

Effectiveness of first and second COVID‐19 mRNA vaccine monovalent booster doses during a period of circulation of Omicron variant sublineages: December 2021–July 2022

BackgroundUS recommendations for COVID‐19 vaccine boosters have expanded in terms of age groups covered and numbers of doses recommended, whereas evolution of Omicron sublineages raises questions about ongoing vaccine effectiveness.MethodsWe estimated effectiveness of monovalent COVID‐19 mRNA booster vaccination versus two‐dose primary series during a period of Omicron variant virus circulation in a community cohort with active illness surveillance. Hazard ratios comparing SARS‐CoV‐2 infection between booster versus primary series vaccinated individuals were estimated using Cox proportional hazards models with time‐varying booster status. Models were adjusted for age and prior SARS‐CoV‐2 infection. The effectiveness of a second booster among adults ≥50 years of age was similarly estimated.ResultsThe analysis included 883 participants ranging in age, from 5 to >90 years. Relative effectiveness was 51% (95% CI: 34%, 64%) favoring the booster compared with primary series vaccination and did not vary by prior infection status. Relative effectiveness was 74% (95% CI: 57%, 84%) at 15 to 90 days after booster receipt, but declined to 42% (95% CI: 16%, 61%) after 91 to 180 days, and to 36% (95% CI: 3%, 58%) after 180 days. The relative effectiveness of a second booster compared to a single booster was 24% (95% CI: −40% to 61%).ConclusionsAn mRNA vaccine booster dose added significant protection against SARS‐CoV‐2 infection, but protection decreased over time. A second booster did not add significant protection for adults ≥50 years of age. Uptake of recommended bivalent boosters should be encouraged to increase protection against Omicron BA.4/BA.5 sublineages.     

Total perinatal-related wastage in twin pregnancies

The primary obstetric cause of total perinatal-related wastage (TPRW) in twin pregnancy was studied in a clearly defined population over a 3-year period. There were 77 deaths from 204 pairs of twins; the perinatal mortality rate (PMR) was 51/1,000 and TPRW was 189/1,000. Of the 77 deaths 52% were late abortions, 14% stillbirths, 10% early neonatal deaths, 18% late neonatal deaths and 5% perinatal-related infant deaths. The major obstetric factors leading to TPRW were spontaneous preterm labour (32%), antepartum haemorrhage (30%), infection (16%), unexplained intra-uterine death (10%) and hypertension (8%). The major factors responsible for perinatal-related loss in twin pregnancies are similar to the major factors in singleton pregnancies, but occur earlier in pregnancy. Rather than considering the primary causes of loss in twin pregnancies as a separate entity, we should direct our attention to solving the same obstetric factors responsible for initiating loss in both twin and singleton pregnancies.     

Outcome study using an administrative database: terminal salpingostomy, physician case load and live birth rates

Information on the outcome following salpingostomy performedfor infertility in everyday practice is needed to counsel patients,determine the best approach to this condition and clarify whetherthe outcome is superior when surgery is performed by a physicianwho maintains a high volume of ongoing experience. A total of547 consecutive subjects were identified over a 5 year periodusing the Alberta Health Care Claims Database. Their claimshistory was analysed over a follow-up of 2–7 years, toidentify pregnancy-related events, loss to follow-up and eventswhich would result in sterility. Pregnancies were crosscheckedwith the only in-vitro fertilization programme serving the region.The overall cumulative live birth and tubal pregnancy rateswere 11.7 and 7.2% respectively. Live birth rates were significantlyhigher when practitioners had performed >10 procedures withinthe study period. Live birth rates would appear to be substantiallylower hi everyday practice than following surgery performedby acknowledged experts. A high volume of ongoing experienceappears to be associated with superior live birth rates. Itis unclear whether this association relates to case selection,surgical expertise or both variables.     

The effect of ethanol on enzyme synthesis and secretion in isolated rat pancreatic lobules

This study investigates the effect of ethanol on enzyme synthesis and secretion in rat pancreatic lobules. Ethanol caused a dose-dependent inhibition of 3H-leucine incorporation into total protein. Examination of the time dependence showed that ethanol inhibited protein synthesis at each time point. Removal of ethanol partially reversed this inhibition. An autoradiograph of the newly synthesized proteins separated on SDS-PAGE showed that ethanol inhibited synthesis of all proteins. 14C-cycloleucine uptake was not altered by ethanol, excluding inhibition of amino acid uptake as the mechanism for the decreased protein synthesis induced by ethanol. Electron microscopy revealed no ultrastructural damage. Ethanol had no effect on the stimulated release of (i) amylase from zymogen granules nor (ii) newly synthesized pulse labelled enzymes. Acetaldehyde had no inhibitory effect on enzyme synthesis or secretion indicating that ethanol per se and not its metabolite is inhibitory. The decreased synthesis after acute exposure to ethanol with preservation of exocytosis would limit the autodigestive potential of pancreatic tissue. This may explain why isolated toxic doses of ethanol are rarely if ever associated with pancreatitis.     

PREPARING THE MALE URETHRA FOR TRANSURETHRAL PROCEDURES

SUMMARY The antiseptic and analgesic effectiveness of different preparations of lignocaine gel used prior to flexible cystoscopy were studied in patients recruited over a 12-month period. This random study involved 106 patients in four groups. There appeared to be no difference in bacterial colonisation of the urethra between the groups. Urethral analgesia was improved when higher volumes of gel were used. It was concluded that high-volume gel preparations (>20 ml) with no antiseptic provided optimal conditions for flexible cystoscopy.