Pregnancy after bariatric surgery: Consensus recommendations for periconception,antenatal and postnatal care

The objective of the study is to provide evidence‐based guidance on nutritional management and optimal care for pregnancy after bariatric surgery. A consensus meeting of international and multidisciplinary experts was held to identify relevant research questions in relation to pregnancy after bariatric surgery. A systematic search of available literature was performed, and the ADAPTE protocol for guideline development followed. All available evidence was graded and further discussed during group meetings to formulate recommendations. Where evidence of sufficient quality was lacking, the group made consensus recommendations based on expert clinical experience. The main outcome measures are timing of pregnancy, contraceptive choice, nutritional advice and supplementation, clinical follow‐up of pregnancy, and breastfeeding. We provide recommendations for periconception, antenatal, and postnatal care for women following surgery. These recommendations are summarized in a table and print‐friendly format. Women of reproductive age with a history of bariatric surgery should receive specialized care regarding their reproductive health. Many recommendations are not supported by high‐quality evidence and warrant further research. These areas are highlighted in the paper.     

Developing vaccinology expertise for Africa: six years and counting

There exists high quality evidence showing that interactive educational meetings and workshops can improve healthcare worker performance. This evidence formed the basis for establishing the annual African Vaccinology Course in 2005 at the University of Cape Town in South Africa. The course, which is designed to develop vaccinology expertise for Africa, covers relevant basic sciences pertaining to vaccine-preventable diseases such as epidemiology, immunology and microbiology; discusses specific vaccine-preventable diseases; provides information on vaccine safety, vaccination strategies and evaluation of vaccines; discusses new vaccines in the pipeline; and promotes vaccine advocacy. We hope that course alumni would become strong advocates for childhood immunisation in their respective countries. Such dedicated advocacy should contribute to reducing the time gap between the development of new vaccines and the formulation of policies enabling their introduction in African countries, as well as contributing to more equitable increase in immunisation coverage in our continent.     

Three-dimensional analysis of temporomandibular joint in Chinese adults with normal occlusion and harmonious skeleton

Oral Radiology - This study aimed to analyze the detailed three-dimensional measurements of temporomandibular joint (TMJ) in Chinese adults with normal occlusion and harmonious skeleton. In 51...     

Anticipated and unanticipated complications of severe dengue in a primigravida

As the incidence of dengue is rising among adults more cases of dengue fever are being reported during pregnancy. Physiological changes of pregnancy mask the pathognomonic features of severe dengue such as increased hematocrit, thrombocytopenia, and leukopenia and a high index of suspicion are required in endemic areas. Massive hemorrhage may complicate operative deliveries in unsuspected patients. World Health Organization recommends that all patients with severe dengue should be admitted to a hospital with access to intensive care facilities and blood transfusion. We present the successful management of hemorrhage and unanticipated complications of severe dengue in a young primigravida admitted to the Intensive Care Unit after an emergency cesarean section.     

Alteration of Glial Fibrillary Acidic Proteins Immunoreactivity in Astrocytes of the Spinal Cord Diabetic Rats

Diabetes affects retinal and nervous glial cells, especially the astrocytes. A key indicator of this response is the alteration in the level of intermediate filament glial fibrillary acidic protein (GFAP) and number of GFAP‐immunoreactive astrocytes. To date, no study has investigated the effect of diabetes on the distribution of GFAP‐immunoreactive astrocytes in the spinal cord. Therefore, the present study investigated the effect of diabetes on the number of GFAP‐immunoreactive astrocytes in the gray matter of the spinal cord of streptozotocin‐induced diabetic Wistar rats. Animals were divided into six groups (n = 7); 6 weeks and 12 weeks diabetic duration groups and their respective age‐matched normal control and sham control groups. Our results demonstrated a significant (P < 0.001) decrease in the number of GFAP‐immunoreactive astrocytes in different areas of the spinal cord sections of the 6 weeks and 12 weeks long diabetic rats when compared with the spinal cord of normal and sham control groups of comparable age. The mean percentage in total number of GFAP‐immunoreactive astrocytes in the whole gray matter areas of the spinal cord of the 6 and 12 weeks diabetic groups were approximately 28% and 41% less than control groups. Furthermore, the 12 weeks diabetic group showed a significant (P < 0.001) reduction in the number of GFAP‐immunoreactive astrocytes when compared with the 6 weeks diabetic animals. These results suggest that the induction of diabetes is associated with a reduction in GFAP‐positive astrocytes in the spinal cord, which may affect the functional support and role of astrocytic cells in the nervous tissue. This in turn may contribute to the pathological changes associated with diabetic state in the central nervous system. Anat Rec, 291:390–399, 2008. © 2008 Wiley‐Liss, Inc.