Getting to the Heart of the Matter: Epidemiology of Cyanotic Heart Defects

Congenital heart defects (CHDs) are the most common type of birth defect, making significant contributions to infant morbidity and mortality, but not all CHDs contribute equally to such outcomes. Although cyanotic CHDs constitute some of the most serious CHDs, its epidemiology is poorly understood. We present a comprehensive systematic review of the literature on the epidemiology of cyanotic CHD, with emphasis on the most current knowledge on identified risk/etiologic factors. Literature for this review was identified by searching the PubMed database from the National Center for Biotechnology Information at the US National Library of Medicine as well as bibliographies of identified papers. The 100 reports that contributed to this review describe risk factors such as infant sex, race, and ethnicity, environmental exposures, and maternal and paternal age. Several studies reported differences in prevalence rates by race and ethnicity and elevated sex ratios, and they identified some risk factors, including advanced maternal age. Investigators have made significant progress in the effort to describe the etiology of cyanotic CHDs, but discrepancies, such as the variation in prevalence rates by race and ethnicity and the impact of environmental exposures, still need to be addressed.     

Impact of sickle cell disease and thalassemias in infants on birth outcomes

Objective

The contribution of sickle cell disease (SCD) and other common thalassemias in infants to adverse birth outcomes is under-studied. We therefore sought to compare adverse birth outcomes in infants with and without hemoglobinopathy.

Study design

Retrospective cohort study utilizing a population-based dataset from Florida (1998–2007, n = 1,564,038). The primary outcomes were low birthweight (LBW), very low birthweight (VLBW), preterm birth (PTB), very preterm birth (VPTB) and small for gestational age (SGA). We used propensity scores to match infants with hemoglobinopathy to those without hemoglobinopathy on selected variables. To approximate relative risks, we generated adjusted odds ratios (AOR) and 95% confidence intervals (CI) from logistic regression models and accounted for the matched design using generalized estimating equations framework.

Results

Infants with SCD or thalassemia had a heightened risk for LBW (AOR = 1.58, 95% CI: 1.29–1.93), VLBW (AOR = 3.01, 95% CI: 2.12–4.25), PTB (AOR = 1.36, 95% CI: 1.12–1.65), VPTB (AOR = 2.70, 95% CI: 1.93–3.78), and neurological conditions (AOR = 2.04, 95% CI: 1.48–2.81) compared to infants without hemoglobinopathy.

Conclusion

Infants with SCD or thalassemia experience considerably higher risks for multiple infant morbidities. Our findings are potentially important in prenatal counseling, as well as for targeted care of affected pregnancies in the prenatal period.     

6‐Gingerol‐rich fraction prevents disruption of histomorphometry and marker enzymes of testicular function in carbendazim‐treated rats

Previous investigations demonstrated that 6‐gingerol‐rich fraction (6‐GRF) prevented testicular toxicity via inhibition of oxidative stress and endocrine disruption in CBZ‐treated rats. The influence of 6‐GRF on alterations in histomorphometry and marker enzymes of testicular function in CBZ‐treated rats which hitherto has not been reported was investigated in this study. The animals were orally administered either CBZ (50 mg/kg) alone or in combination with 6‐GRF (50, 100 and 200 mg/kg) for 14 consecutive days. Histomorphormetric analysis demonstrated that 6‐GRF significantly prevented CBZ‐mediated increase in the organo‐somatic index of the testes and seminiferous tubular diameter as well as the reduction in epithelium height and tubular length of testes in the rats. Similarly, 6‐GRF ameliorated CBZ‐induced disruption in the epithelium height as well as in the proportion of tubule and interstitium of the epididymis the treated rats. Furthermore, 6‐GRF prevented CBZ‐mediated increase in testicular acid phosphatase activity and the decrease in testicular alkaline phosphatase, aminotransferases, glucose‐6‐phosphate dehydrogenase and lactate dehydrogenase activities. Moreover, 6‐GRF ameliorated CBZ‐induced reduction in the testicular and epididymal sperm count and sperm motility in the treated rats. Conclusively, 6‐GRF enhances key functional enzymes involve in spermatogenesis and maintains histo‐architecture of testes and epididymis in CBZ‐treated rats.     

The impact of previous cesarean section on the success of future fetal programming pattern

Purpose  

The purpose of this study is to examine whether cesarean section in the first pregnancy is associated with the success or failure of programmed fetal growth phenotypes or patterns in the subsequent pregnancy.     

Rhinometry: Spectrum of nasal profile among Nigerian Africans

Nasal parameters measurements are useful in anthropology to distinguish people into racial and ethnic groups.Materials and methodsA cross-sectional survey among Nigerians aged 18 to 70 years of Nigerian parentage randomly selected at the ENT Clinic of the University of Ilorin teaching hospital (U.I.T.H.), Ilorin, Nigeria without gender discrimination had measurement of their nasal parameters done using a sliding caliper: Nasal height, width, tip protrusion, alar thickness, nasal septal thickness and nares diameter.Results105 subjects were seen, the age range 18 to 70 years (mean of 28.63 + 13.06 years). There was 58 males and 47 females with a male/female ratio of 1.2:1. The mean nasal width/height (Nasal index -NI) was 90.7 in males and 88.2 in females. Males had a higher NI compared to female (p < 0.03). The commonest type of nasal variability is Type A (70.5%), Platyrrhine nose, Type B (26.7%) especially in females (mesorrhine) and Type C (leptorrhine) (2.8%).ConclusionsThere is significant association between the sex of an individual and type of Nose. Platyrrhine nose, among males and mesorrhine among females, only 2.8% being leptorrhine. The nasal indices were higher in males than in females.     

Prenatal smoking and risk of intrapartum stillbirth

The purpose of this study was to examine the association between prenatal smoking and intrapartum stillbirth by the use of a cohort of singleton births in Missouri from 1978 through 1997. Overall, the authors identified a total of 7,325 counts of stillbirth, yielding a stillbirth rate of 4.4 per 1,000. The timing of the occurrence of the stillbirth to onset of labor was specified in 85.6% (n = 6,273). Of these, 1,070 (17.0%) occurred intrapartum. Smoking mothers were 50% more likely to experience intrapartum fetal death as compared with nonsmoking gravidas (adjusted hazard ratio = 1.5; 95% confidence interval = 1.3-1.7). Women who smoked 10 to 19 cigarettes per day were at the highest risk of experiencing intrapartum stillbirth (adjusted hazard ratio = 1.7 [95% confidence interval = 1.4-2.0]). Our findings underscore the need for increased smoking-cessation education efforts targeted toward pregnant women.     

The Florida Investigation of Primary Late Preterm and Cesarean Delivery: The accuracy of the birth certificate and hospital discharge records

(1) Assess the accuracy of public health data sources used to investigate primary late preterm cesarean delivery (PLPCD) and (2) compare differences in data accuracy by hospital PLPCD rate classification. This analysis uses data from the Florida Investigation of Late Preterm and Cesarean Delivery (FILPCD), an investigation of singleton, PLPCD’s that occurred from 2006 to 2007 in hospitals classified with either a low or high PLPCD rate (high rate 39.4–58.3 %, low rate 11.9–25.1 %). Three data sources were validated with maternal medical records: birth certificates, hospital discharge data, and combined birth certificate and hospital discharge data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa values were calculated. A summary measure of kappa values was compared by hospital PLPCD rate classification using the paired sample Wilcoxon signed rank test. Large variations in accuracy of data elements were found by hospital PLPCD rate classification, with low PLPCD rate hospitals demonstrating higher overall data accuracy. The summary measure of agreement was significantly higher for low PLPCD rate hospitals compared to high PLPCD rate hospitals (0.60 vs. 0.50, p < 0.01). Accurate estimates of CD and late preterm birth are vital for public health practitioners and policy makers who seek to address the growing concern over recent increases in CD and late preterm birth. Understanding the potential for systematic differences in reporting accuracy by hospital PLPCD rate is important to data quality improvement efforts.