High Parity and Adverse Birth Outcomes: Exploring the Maze

Abstract: Background : Despite extensive literature on the topic, it is uncertain if grand (para ≥ 5) and great grand (para ≥ 10) multiparity are associated with adverse birth outcomes. We critically evaluate the evidence for and against the existence of adverse maternal and/or fetal outcomes in high parity women. Methods : An electronic search of MEDLINE and other bibliographic databases (Current Contents, EMBASE, and CAB) was conducted, and all relevant articles in English language were retrieved. Results : Findings on the association between high parity and maternal‐fetal birth outcomes are not consistent. Although the older literature tends to suggest that multiparity is a risk factor for negative birth outcomes, more recent reports are not supportive. Comparison across studies was further complicated by confounding factors like maternal age, socioeconomic status, and levels of prenatal care, as well as by variations in study designs and in the definition of parity itself. Furthermore, most studies that examined women of extreme parity (para ≥ 10) were handicapped by inadequate power. Conclusions : After accounting for quality, culture, and degrees of associations, the preponderance of evidence seems to point to possible existence of heightened risk for certain medical complications and placental pathologies among women of extreme parity. The literature also provides reasonable evidence for a higher‐than‐expected likelihood for occurrence of fetal macrosomia with advanced parity.     

Rapid detection and quantitation of hepatitis B virus DNA by real-time PCR using a new fluorescent (FRET) detection system.

BACKGROUND: The diagnosis of hepatitis B virus (HBV) has until recently been based on traditional serologic methods targeting viral antigens and antibodies to viral proteins. The development of molecular methods allowing for the quantitation of HBV DNA is proving clinically valuable for monitoring therapy and detecting early treatment failures. OBJECTIVES: Here we report a new real-time (LightCycler) quantitative PCR for the detection of HBV DNA based on sequence specific hybridisation probes (designed in-house), targeting the HBV surface antigen. STUDY DESIGN: The assay was evaluated using a 10-fold dilution series of standard HBV DNA [Eurohep standard reference 1, genotype A, HBsAg subtype adw with a unitage of 10(6) WHO. i.u./ml] and 89 clinical serum samples. The performance was measured against a quantified standard HBV DNA working reagent (NIBSC code 98/780) and the sensitivity compared with our conventional thermal-block PCR. RESULTS AND CONCLUSION: Real-time PCR detected HBV DNA in 45% (40/89) and thermal-block PCR in 16% (14/75) of clinical samples. Results for 26 samples were below the detection limit of the thermal-block PCR but could be quantified by real-time (LightCycler) PCR. The LightCycler assay was at least 5 logs more sensitive than thermal-block PCR and could detect HBV in a linear range between 5 and 10(7) i.u. per reaction. The broad generic nature of the PCR primers coupled with the enhanced sensitivity and specificity of the fluorescent hybridisation probes makes this assay potentially valuable for both routine diagnostic and epidemiological work.     

Predictors of hospital admissions in the elderly: analysis of data from the Longitudinal Study on Aging

Healthcare for the elderly population presents enormous challenges, which are further complicated by ethnicity-related socioeconomic disparities in the United States. We set out to determine the predictors of hospital admissions in the elderly by conducting a retrospective cohort analysis of a nationally representative sample of community-dwelling individuals aged 70 and older in 1984 (n = 7541). Multivariate logistic regression analysis of data from the Longitudinal Study on Aging revealed that race, health status, type of family relationship, and activities of daily living (ADL) are significant predictors of hospitalization among the elderly. Older blacks are less likely to be admitted into the hospital, compared to their white counterparts (OR 0.68, 95%CI 0.52-0.89). Elderly persons who perceive their health status as being fair or poor are three times as likely to be hospitalized than those who perceived their health status as excellent (OR 2.99, 95%CI 2.15-4.15). Those with impairment in activities of daily living are twice as likely to be confined to the hospital than those without impairment (OR 1.78, 95%CI 1.64-1.96). Elderly persons living with nonrelatives are three times as likely to be admitted for short hospital stays than those living with spouses (OR 2.90, 95%CI 1.44-5.82). Future identification of predictors of hospital admissions in the elderly may help characterize those at risk and perhaps allow for focused and timely intervention.     

Comparison of immunoblot analysis of emergent multidrug-resistant Salmonella typhimurium definitive phage type 104 with a non-multidrug-resistant definitive phage type 104 strain.

BACKGROUND AND PURPOSE: The emergent multidrug-resistant (MDR) Salmonella typhimurium definitive phage type 104 (DT104) is a public and veterinary health problem not only due to its wide host range and potential for enhanced virulence, but also the difficulty associated with its control. There is thus a need to investigate possible antigens of MDR DT104. METHODS: Using standard protocols, whole cell lysates, outer membrane extracts and cell-free ultracentrifuge supernatants of selected isolates of MDR DT104 were prepared, electrophoretically separated and tested for their antigen-antibody reactivity in comparison with a non-MDR DT104 strain. RESULTS: Protein antigens of both strain types were recognized by antibodies in chick serum in a similar manner for all methods of antigen preparation used. CONCLUSIONS: This study did not find differences between the antibody recognition of MDR DT104 and that of the non-MDR DT104 strain tested. This observation should strengthen the quest for the possible use of vaccines to control this emergent strain in poultry.     

Lactone-rich fraction from Vernonia blumeoides: antitrypanosomal activity and alleviation of the parasite-induced anemia and organ damage

The anti-Trypanosoma brucei brucei activity in vitro and in vivo of a lactone-rich fraction of Vernonia blumeoides leaves (VBLF) and its potential in alleviating trypanosome-induced anemia and organ damage were investigated. Gas chromatography–mass spectrometry (GC–MS) analysis of VBLF revealed the presence of a number of lactone-containing compounds. In an in vitro study, VBLF showed concentration-dependent activity and was further used to treat T. brucei brucei-infected rats. The VBLF treatments, especially at 300 mg/kg body weight (BW), significantly (P < 0.05) kept the parasites reduced during the entire experimental period compared with the infected untreated group. At the end of the experiment, the trypanosome-induced anemia and hepatic damage were significantly (P < 0.05) alleviated in all the VBLF treatment groups, but renal damage was only prevented in the 200 and 300 mg/kg BW treatment groups. Furthermore, the trypanosome-induced increase in the relative weights of liver, spleen and kidney were significantly (P < 0.05) alleviated by the 300 mg/kg BW VBLF treatment. It was concluded that orally administered VBLF, especially at 300 mg/kg BW, possessed antitrypanosomal activity and could alleviate parasite-induced anemia and organ damage.     

Antimicrobial Activity of the Solvent Fractions from Bulbine Natalensis Tuber

Bulbine natalensis Baker has been acclaimed to be used as an antimicrobial agent in the folklore medicine of South Africa without scientific evidence to substantiate or refute this claim. In view of this, the in vitro antimicrobial activity of solvent fractions (ethanol, ethyl acetate, n-butanol and water) from Bulbine natalensis Tuber against 4 Gram positive and 12 Gram negative bacteria as well as 3 fungal species were investigated using agar dilution. The ethanolic extract, n-butanol and ethyl acetate fractions inhibited 75, 87.5 and 100% respectively of the bacterial species in this study. The ethanolic, n-butanol and ethyl acetate fractions produced growth inhibition at MIC range of 1–10, 3–10 as well as 1 and 5 mg/ml respectively whereas the water fraction did not inhibit the growth of any of the bacterial species. Again, it was only the ethyl acetate fraction that inhibited the growth of Shigelli flexneri, Staphyloccus aureus and Escherichia coli. The ethanolic, ethyl acetate and n-butanolic fractions dose dependently inhibited the growth of Aspergillus niger and A. flavus whereas the water fraction produced 100% growth inhibition of the Aspergillus species at all the doses investigated. In contrast, no growth inhibition was produced on Candida albicans. The growth inhibition produced by the solvent fractions of B. natalensis Tuber in this study thus justifies the acclaimed use of the plant as an antimicrobial agent. The ethyl acetate fraction was the most potent.     

A game of two halves: inconsistent renal allograft function in two recipients of a split horseshoe kidney

International Urology and Nephrology -     

Effect of exchange blood transfusion on oxygen saturation of neonates with severe neonatal jaundice by pulse oximetry

Objective: To determine if there was any difference in SpO2 readings during exchange blood transfusion (EBT).Methods: A prospective cross-sectional study of neonates with severe neonatal jaundice requiring EBT was conducted. Oxygen saturation was recorded before, immediately and 15 minutes after EBT by using a pulse oximeter. Results: This study included 30 neonates with 20 males and 10 females. The age ranged from 1 to 12 days with a mean of (5.4 ± 2.9) days. Pre-EBT SpO2 ranged from 90％ to 98％ with a mean value of (94.3 ± 2.2)％; SpO2 in the end of EBT ranged from 85％ to 99％ with a mean value of (94.1 ± 3.2)％; SpO2 at 15 minutes after EBT ranged from 77％ to 99％ with a mean value of (94.8 ± 4.1)％. There was no significant difference between SpO2 values at onset of EBT and either immediately or 15 minutes after EBT (P=0.770 and 0.422, respectively). SpO2 showed no significant difference between neonates who were infused with blood of different storage times (<24 h or ≥24 h) at the onset of EBT (P=0.584), immediately (P>0.999) and 15 minutes after EBT (P=0.887). Besides, SpO2 values were compariable in neonates with hematocrit <45％ or ≥45％ at the onset of EBT (P=0.284), immediately (P=0.118) and 15 minutes after EBT (P=0.868). Conclusions: EBT does not affect SpO2 in neonates.