Perspectives on anticipated quality-of-life and recommendations for neonatal intensive care: a survey of neonatal providers

Objective: Explore associations between neonatal providers’ perspectives on survival, quality of life (QOL) and treatment recommendations.

Methods: Providers attending a workshop on neonatal viability were surveyed about survival, perceived QOL and treatment recommendations for marginally viable infants. We assessed associations between estimated survival and perceived QOL and treatment recommendations.

Results: In the 44 included surveys, estimates of survival and QOL varied widely. Maximum care was recommended 80% of the time when anticipated QOL was high, versus 20% when anticipated QOL was low (p?<?0.001). Adjusted for confounders, odds of recommending maximum intervention were 4.4 times higher when anticipated QOL was high (95% CI 1.9 – 10.2, p?=?0.001).

Conclusions: The perspectives of practitioners who provide care to critically ill neonates regarding potential survival and QOL vary dramatically and are associated with the treatments those practitioners recommend. Practitioners should take care to avoid basing treatment recommendations on their own perspectives if they are not well aligned with those of the parents.     

Crystal structure of the FRP and identification of the active site for modulation of OCP-mediated photoprotection in cyanobacteria

Photosynthetic reaction centers are sensitive to high light conditions, which can cause damage because of the formation of reactive oxygen species. To prevent high-light induced damage, cyanobacteria have developed photoprotective mechanisms. One involves a photoactive carotenoid protein that decreases the transfer of excess energy to the reaction centers. This protein, the orange carotenoid protein (OCP), is present in most cyanobacterial strains; it is activated by high light conditions and able to dissipate excess energy at the site of the light-harvesting antennae, the phycobilisomes. Restoration of normal antenna capacity involves the fluorescence recovery protein (FRP). The FRP acts to dissociate the OCP from the phycobilisomes by accelerating the conversion of the active red OCP to the inactive orange form. We have determined the 3D crystal structure of the FRP at 2.5 Å resolution. Remarkably, the FRP is found in two very different conformational and oligomeric states in the same crystal. Based on amino acid conservation analysis, activity assays of FRP mutants, FRP:OCP docking simulations, and coimmunoprecipitation experiments, we conclude that the dimer is the active form. The second form, a tetramer, may be an inactive form of FRP. In addition, we have identified a surface patch of highly conserved residues and shown that those residues are essential to FRP activity.     

子宫破裂20例临床分析

目的：探讨妊娠子宫破裂的原因及预防方法。方法：对1998年8月－2000年3月,也门南方阿特戈医院收治的20例子宫破裂的临床资料进行回顾性分析。结果：18例为完全性子宫破裂,2例为不完全性子宫破裂。3例合并膀胱损伤,1例同时合并膀胱及输尿管损伤,1例单纯合并输尿管损伤。4例感染严重,无继续生育要求行子宫次全切除术,16例行修补术。2例产妇死亡,病死率10％,围产儿19例死亡,病死率95％。结论：严密观察产程、严禁滥用缩宫素和前列腺素、严格掌握阴道助产指征,是预防子宫破裂的关键;术中应仔细检查有否合并泌尿道损伤,及时发现,及时修补,减少术后并发症。     

The oldest gravidas: a review of pregnancy risks in women over 45

As a result of delayed childbearing and increasingly sophisticated assisted reproductive technologies, pregnancy in women aged ≥45 years is becoming more common. Women in this age-group should receive thorough preconception evaluation and counseling about their specific risks in pregnancy. Although many pregnancies in women >45 years old are achieved via assisted reproductive technologies with associated preconception counseling, as many as 45% may be spontaneously conceived. It is therefore important for obstetrician-gynecologists to incorporate education for older women about the risks of pregnancy into routine office visits, and to ask women in this age-group about pregnancy planning. Additionally, many pregnancies in women aged >45 years may be safely managed in a nontertiary care center, avoiding the need for referral and transfer of care to an unfamiliar setting. This review addresses preconception evaluation and counseling, real and perceived risks in older mothers, common pregnancy complications and management of pregnancy in women >45 years old. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be better able to counsel women about the risks of pregnancy for women aged ≥45, evaluate older women for common risk factors that may further increase risk in pregnancy, assess pregnancy complications that are more common in women aged >45, and manage otherwise uncomplicated pregnancies in women in this age-group.     

Mutagenicity and induction of sister chromatid exchange by optically active enantiomers of secondary butyl methanesulfonate

This report describes experiments in which a chiral alkyl methanesulfonate was used to investigate possible mechanisms by which alkylating agents cause their mutagenic, cytotoxic, and clastogenic effects. Optically active enantiomers and the racemic mixture of 2-butyl methanesulfonate (2-BMS) were cytotoxic and mutagenic in Chinese hamster V79 cells and in AS52 cells and mutagenic in Salmonella typhimurium strains TA100 and TA1535 (without the addition of exogenous metabolizing systems). Within the experimental uncertainties, the cytotoxicity and mutagenicity curves were the same for the R and S enantiomers and for the racemic mixture. The 2-BMS isomers were cytotoxic and induced sister chromatid exchanges (SCE) in CHO-K1-BH4 cells. The cytotoxicity curve was similar to that observed with V79 and AS52 cells. The induction of SCE was linear between 1 and 6 mM 2-BMS with no differences discernable between the isomers. The results can be interpreted two ways. The first interpretation is that 2-BMS reacts via a carbocation, and the second interpretation involves an SN2 reaction of 2-BMS with DNA. The latter interpretation suggests that the mechanisms of mutagenesis, cytotoxicity, or the induction of SCE cannot distinguish between small (four-carbon) optically active DNA adducts. We favor the second interpretation because of solvolysis experiments showing the complete inversion of configuration of optically active 2-octyl methanesulfonate (2-OMS, Weiner and Sneen: J American Chemical Society 87:287-291, 1965). While we assume that optically active 2-BMS will react using the same mechanism as chiral 2-OMS, we cannot exclude the possibility that 2-BMS reacts via a carbocation intermediate.     

Gestational Diabetes Testing: Making Sense of the Controversy

Evidence has demonstrated that even mild increases in maternal blood sugar are associated with worsening pregnancy outcomes, particularly macrosomia, and that reducing blood sugar improves outcomes. Euglycemia can often be achieved with dietary modification and exercise without a need for medication. Despite this evidence, there continues to be controversy over exactly who, when, and how to test for gestational diabetes mellitus (GDM), with various professional organizations and experts in the field suggesting different strategies or not making specific recommendations at all. Potential sources of this controversy may include differences in opinion about the clinical importance of the consequences of GDM and the benefits of available interventions. Further, dichotomously diagnosing disease when the disease‐defining characteristic is linear requires drawing a somewhat arbitrary line in the sand for diagnosis, which is likely to fall in a different place for different providers. Finally, given the resources and effort needed by both women and providers to address GDM, the availability of resources is likely to impact providers’ perspectives on the ideal testing strategy. Given the differences among patient characteristics and available resources that exist in different health care settings, identifying one best strategy for GDM testing is not necessarily appropriate. However, given the potential benefits of identifying pregnant women with hyperglycemia, providers should use the most sensitive testing strategy that their patient population and resources allow.     

Evaluation of community pharmacists’ knowledge about drug–drug interaction in Central Saudi Arabia

IntroductionAlthough all implemented and ongoing initiatives, drug-drug interactions (DDIs) are still a global problem. Most published studies about DDIs in Saudi Arabia are carried out in hospital settings. In addition, assessing the knowledge of drug interactions in Saudi Arabia is limited. The aim of our study is to evaluate the knowledge of potential common drug-drug interactions among community pharmacists particularly in Saudi Arabia.MethodologyA crosses-sectional study utilizing a self- administered questionnaire was conducted among community pharmacy in Riyadh city Saudi Arabia. DDIs' knowledge was assessed by 26 drug pairs. Community pharmacists were asked to select the DDIs as “contraindication”, “may be used together with monitoring”, “no interaction” and “not sure”.ResultsA total of 283 of community pharmacists completed the survey with response rate of 80.9%. Among the 26 drug pairs only 5 of them were identified correctly by most of the participants. To add more 3 out of the 5 pairs had a cutoff of less than 10% between the correct and wrong answer, meaning there still a majority that couldn't identify the correct answer. All the 26 pairs had a statistically significant difference between the correct and incorrect answer.ConclusionThe results of this study showed that knowledge of community pharmacists about DDIs was inadequate. Community pharmacist should have specific courses in drug interactions to cover the most possible interactions that can be seen in this setting.