- HIV Infection and risk of postpartum infection, complications and mortality in rural Uganda. [Journal Article]
- ACAIDS Care 2018 Feb 16; :1-11
- HIV infection may increase risk of postpartum infection and infection-related mortality. We hypothesized that postpartum infection incidence and attributable mortality in Mbarara, Uganda would be hig...
HIV infection may increase risk of postpartum infection and infection-related mortality. We hypothesized that postpartum infection incidence and attributable mortality in Mbarara, Uganda would be higher in HIV-infected than HIV-uninfected women. We performed a prospective cohort study of 4231 women presenting to a regional referral hospital in 2015 for delivery or postpartum care. All febrile or hypothermic women, and a subset of randomly selected normothermic women were followed during hospitalization and with 6-week postpartum phone interviews. The primary outcome was in-hospital postpartum infection. Secondary outcomes included in-hospital complications (mortality, re-operation, intensive care unit transfer, need for imaging or blood transfusion) and 6-week mortality. We performed multivariable regression analyses to estimate adjusted differences in each outcome by HIV serostatus. Mean age was 25.2 years and 481 participants (11%) were HIV-infected. Median CD4+ count was 487 (IQR 325, 696) cells/mm3, and 90% of HIV-infected women (193/215 selected for in-depth survey) were on antiretroviral therapy. Overall, 5% (205/4231) of women developed fever or hypothermia. Cumulative in-hospital postpartum infection incidence was 2.0% and did not differ by HIV status (aOR 1.4, 95% CI 0.6-3.3, P = 0.49). However, more HIV-infected women developed postpartum complications (4.4% vs. 1.2%, P = 0.001). In-hospital mortality was rare (2/1768, 0.1%), and remained so at 6 weeks (4/1526, 0.3%), without differences by HIV serostatus (P = 1.0 and 0.31, respectively). For women in rural Uganda with high rates of antiretroviral therapy coverage, HIV infection did not predict postpartum infection or mortality, but was associated with increased risk of postpartum complications.
- The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature. [Journal Article]
- JEJ Emerg Med 2018 Jan 20
- CONCLUSIONS: The most common etiologic agents are Staphylococcus aureus and Streptococcus pyogenes. Sources of TSS include postsurgical wounds, postpartum, postabortion, burns, soft tissue injuries, pharyngitis, and focal infections. Symptoms are due to toxin production and infection focus. Early symptoms include fever, chills, malaise, rash, vomiting, diarrhea, and hypotension. Diffuse erythema and desquamation may occur later in the disease course. Laboratory assessment may demonstrate anemia, thrombocytopenia, elevated liver enzymes, and abnormal coagulation studies. Diagnostic criteria are available to facilitate the diagnosis, but they should not be relied on for definitive diagnosis. Rather, specific situations should trigger consideration of this disease process. Treatment involves intravenous fluids, source control, and antibiotics. Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus prevalent areas) along with either clindamycin or linezolid.TSS is a potentially deadly disease requiring prompt recognition and treatment. Focused history, physical examination, and laboratory testing are important for the diagnosis and management of this disease. Understanding the evaluation and treatment of TSS can assist providers with effectively managing these patients.
- Implementation of vaginal cleansing prior to cesarean delivery to decrease endometritis rates. [Journal Article]
- JMJ Matern Fetal Neonatal Med 2018 Jan 17; :1-6
- CONCLUSIONS: Implementation of a protocol for vaginal cleansing prior to cesarean delivery in women with ruptured membranes or in labor has high uptake, but in almost a third of eligible women it was not performed. The implementation, has led to a clinical, although not statistical, decrease in postoperative endometritis. Continued research is needed to explore how to improve uptake of this quality improvement measure.
- Methanol extract of Guettarda speciosa Linn. inhibits the production of inflammatory mediators through the inactivation of Syk and JNK in macrophages. [Journal Article]
- IJInt J Mol Med 2018; 41(3):1783-1791
- Guettarda speciosa Linn. (G. speciosa, Rubiaceae) has been used as a traditional medicinal plant in Asia for the treatment of various inflammatory conditions, including cough, fever and maternal post...
Guettarda speciosa Linn. (G. speciosa, Rubiaceae) has been used as a traditional medicinal plant in Asia for the treatment of various inflammatory conditions, including cough, fever and maternal postpartum infection. However, the mechanisms underlying the anti‑inflammatory action of G. speciosa extracts have remained elusive. In the present study, the anti‑inflammatory effects of the methanol extract of G. speciosa (MGS) were investigated in murine macrophages by measuring the production of inflammatory mediators and the underlying mechanisms of action by performing immunoblotting analysis of proteins that are potentially involved. MGS reduced nitric oxide (NO) production through regulation of the expression of inducible NO synthase (iNOS) in lipopolysaccharide‑activated RAW 264.7 cells; however, cyclooxygenase‑2, the enzyme responsible for prostaglandin E2 production, was not affected at the mRNA or protein level. MGS reduced interleukin‑6 (IL‑6) production, but had no effect on tumor necrosis factor (TNF)‑α production. In addition, MGS suppressed the transcription of IL‑6, but not that of IL‑1β and TNF‑α. The effect of MGS on proinflammatory mediators resulted from the inhibition of the activation of spleen tyrosine kinase and c‑Jun N‑terminal kinase. In conclusion, the present study suggested that MGS may be a potential candidate for development as a therapeutic for alleviating inflammation.
- Milk fever in dairy cows is preceded by activation of innate immunity and alterations in carbohydrate metabolism prior to disease occurrence. [Journal Article]
- RVRes Vet Sci 2017 Dec 19; 117:167-177
- The objective of this study was to search for potential alterations in innate immunity reactants and carbohydrate and lipid metabolism in the blood of transition dairy cows before, during, and after ...
The objective of this study was to search for potential alterations in innate immunity reactants and carbohydrate and lipid metabolism in the blood of transition dairy cows before, during, and after clinical occurrence of milk fever (MF) and identify potential predictive biomarkers of disease. One hundred pregnant multiparous Holstein dairy cows were involved in the study starting from -8wks before the expected day of parturition until +8wks postpartum as part of a large retrospective longitudinal study. Health status, DMI, milk yield, and milk composition were monitored during the whole experimental period. Six healthy cows (CON) and 6 cows that showed clinical signs of MF were selected for blood analyses. Serum concentrations of lactate, non-esterified fatty acids (NEFA), β-hydroxybutyric acid (BHBA), interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor (TNF), haptoglobin (Hp), and serum amyloid A (SAA) were determined. Results indicated that concentrations of serum lactate, IL-6, TNF, SAA, and Hp were greater in cows with MF than those in the CON group at different time points. Moreover, serum lactate, TNF, SAA, and Hp were greater in cows with MF starting at -8 and -4wks prior to parturition. Both principal component analysis (PCA) and partial least squares - discriminant analysis (PLS-DA) showed separated clusters between MF and CON cows at -8, -4, and disease diagnosis weeks. Overall DMI and milk production were lower in MF-affected cows. Additionally milk fat and fat:protein ratio were greater in MF. In conclusion, cows affected by MF showed alterations in some of the innate immunity reactants and metabolites related to carbohydrate metabolism several weeks prior to appearance of clinical signs of MF. Variable importance in projection plots demonstrated that TNF and SAA in the serum were the strongest discriminators between MF cows and CON ones, which might be useful as predictive biomarkers of the disease.
- Mortality Among Confirmed Lassa Fever Cases During the 2015-2016 Outbreak in Nigeria. [Journal Article]
- AJAm J Public Health 2018; 108(2):262-264
- CONCLUSIONS: Effective, coordinated response reduces mortality from public health events. Attention to vulnerable groups during disasters is essential. Public Health Implications. Activating an incident command system improves the outcome of disasters in resource-constrained settings.
- [Miliary tuberculosis]. [Journal Article]
- RPRev Pneumol Clin 2018; 74(1):28-34
- CONCLUSIONS: We insist on this work on the severity of the tuberculous miliary and the need for early and urgent therapeutic management.
- Multifaceted spiral suture: A hemostatic technique in managing placenta praevia or accrete: A retrospective study. [Journal Article]
- MMedicine (Baltimore) 2017; 96(49):e9101
- Patients with total placenta previa and past history of cesarean delivery often experience overwhelming hemorrhage during childbirth. In order to control intraoperative and postoperative bleeding, we...
Patients with total placenta previa and past history of cesarean delivery often experience overwhelming hemorrhage during childbirth. In order to control intraoperative and postoperative bleeding, we propose a novel multifaceted spiral suture of the lower uterine segment which directly sutures the bleeding site.To evaluate the efficacy and safety of multifaceted spiral suture, a retrospective study was conducted using data from 33 patients with total placenta praevia and caesarean history.All participants underwent multifaceted spiral suture and no patient experienced uncontrollable bleeding or underwent hysterectomy.The average blood loss of all patients involved was 1327.3 ± 1244.1 mL. Five patients reported blood loss exceeding 3000 mL (15.15%), and the highest reached to 4000 mL. No complications such as fever, pyometra, synechiae, or uterine necrosis were observed. Three cases (3/33, 9.09%) reported hematuria in the first 3 days following surgery and spontaneous resolution were observed within 3 to 7 days following insertion of indwelling catheters. No complaints were received during 6-month follow-up visits.These findings suggest that multifaceted spiral suture is a practical, feasible, and promising technique in potentially minimizing postpartum bleeding and avoiding hysterectomy for patients with placenta praevia or accrete.
- Diagnosis and management of postpartum ovarian vein thrombosis. [Review]
- HAHematology Am Soc Hematol Educ Program 2017 Dec 08; 2017(1):168-171
- A 26-year-old woman experienced persistent fever (39.5°C), chills, and right-lower-quadrant tenderness 3 days after caesarean delivery. A computed tomography (CT) scan of the abdomen and pelvis with ...
A 26-year-old woman experienced persistent fever (39.5°C), chills, and right-lower-quadrant tenderness 3 days after caesarean delivery. A computed tomography (CT) scan of the abdomen and pelvis with contrast revealed enlargement of her right ovarian vein with an associated intraluminal filling defect. What is the best treatment of this patient?
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- Acute disseminated melioidosis giving rise to pneumonia and renal abscesses complicated with thrombotic thrombocytopenic purpura in a post partum woman: a case report. [Journal Article]
- BRBMC Res Notes 2017 Nov 29; 10(1):653
- CONCLUSIONS: This case was challenging as it was an atypical presentation of melioidosis during postpartum leading to a diagnostic conundrum. This highlights the need to look into the effect of pregnancy and postpartum as added risk factors. High index of suspicion is necessary to avoid diagnostic delays.