Predicting birth weight in fetuses with gastroschisis

OBJECTIVE

To determine the accuracy of commonly utilized ultrasound formulas for estimating birth weight (BW) in fetuses with gastroschisis.

STUDY DESIGN

A retrospective review was conducted of all inborn pregnancies with gastroschisis within the five institutions of the University of California Fetal Consortium (UCfC) between 2007 and 2012. Infants delivered at ⩾28 weeks who had an ultrasound within 21 days before delivery were included. Prediction of BW was evaluated for each of the five ultrasound formulas: Hadlock 1 (abdominal circumference (AC), biparietal diameter (BPD), femur length (FL) and head circumference (HC)) and Hadlock 2 (AC, BPD and FL), Shepard (AC and BPD), Honarvar (FL) and Siemer (BPD, occipitofrontal diameter (OFD), and FL) using Pearson's correlation, mean difference and percent error and Bland-Altman analysis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the ultrasound diagnosis of intrauterine growth restriction (IUGR) were assessed.

RESULTS

We identified 191 neonates born with gastroschisis within the UCfC, with 111 neonates meeting the inclusion criteria. The mean gestational age at delivery was 36.3±1.7 weeks and the mean BW was 2448±460 g. Hadlock (1) formula was found to have the best correlation (r=0.81), the lowest mean difference (8±306 g) and the lowest mean percent error (1.4±13%). The Honarvar and Siemer formulas performed significantly worse when compared with Hadlock 1, with a 13.7% (P<0.001) and 3.9% (P=0.03) difference, respectively, between estimated and actual BW. This was supported by Bland-Altman plots. For Hadlock 1 and 2, sensitivity was 80% with a NPV of 91%.

CONCLUSION

The widely used Hadlock (1) and (2) formulas provided the best estimated BW in infants with gastroschisis despite its inclusion of abdominal circumference. Furthermore, this formula performs well with diagnosis of IUGR.

Safety and effectiveness of antireflux surgery in obese patients

Introduction The incidence of gastro-oesophageal reflux disease and obesity has increased significantly in recent years. The number of antireflux procedures being carried out on people with a higher body mass index (BMI) has been rising. Evidence is conflicting for outcomes of antireflux surgery in obese patients in terms of its safety and efficacy. Given the contradictory reports, this meta-analysis was undertaken to establish the outcomes of antireflux surgery (ARS) in obese patients and its associated safety. Methods A systematic electronic search was conducted using the PubMed, MEDLINE®, Ovid®, Cochrane Library and Google Scholar™ databases to identify studies that analysed the effect of BMI on the outcomes of ARS. A meta-analysis was performed using the random effects model. The intraoperative and postoperative outcomes that were examined included operative time, conversion to an open procedure, mean length of hospital stay, recurrence of acid reflux requiring reoperation and wrap migration. Results A total of 3,772 patients were included in 13 studies. There was no significant difference in procedure conversion rate, recurrence of reflux requiring reoperation or wrap migration between obese and non-obese patients. However, both the mean operative time and mean length of stay were longer for obese patients. Conclusions ARS in obese patients with gastro-oesophageal reflux disease is safe and outcomes are comparable with those in patients with a BMI in the normal range. A high BMI should therefore not be a deterrent to considering ARS for appropriate patients.

Data collection using open access technology in multicentre operational research involving patient interviews

Conducting multicentre operational research is challenging due to issues related to the logistics of travel, training, supervision, monitoring and troubleshooting support. This is even more burdensome in resource-constrained settings and if the research includes patient interviews. In this article, we describe an innovative model that uses open access tools such as Dropbox, TeamViewer and CamScanner for efficient, quality-assured data collection in an ongoing multicentre operational research study involving record review and patient interviews. The tools used for data collection have been shared for adaptation and use by other researchers.

Qualitative profile of degummed guar (Cyamopsis tetragonoloba L.) seeds grown in a Mediterranean area for use as animal feed

Guar (Cyamopsis tetragonoloba L.) is an interesting summer legume multipurpose crop used for the extraction of seed gum, due to its galactomannan content, and the high-protein by-product, (germ and hull) used for animal feed. The aim of this study was to assess qualitative traits of degummed seeds, named guar meal, of six guar varieties from India, South Africa and USA, grown in a Mediterranean environment (Sicily, Southern Italy), in order to explore their suitability for livestock, and comparing them with the marketed Indian products of guar meals, Churi and Korma. After harvest, seeds were manually degummed and proximate composition was analysed using the official method of analyses, total phenols and tannins by UV spectrophotometry and fatty acids by GC-FID. Qualitative profile of degummed guar seeds (DGS) was significantly (p < .05) influenced by the genotype. Among DGS, Matador showed a high (p < .05) content of protein (518 g/kg), lipids (59.4 g/kg) and the lowest (p < .05) NDF level (181 g/kg) compared to the other varieties. Total phenol content of DGS showed similar values among varieties (2.57 mg gallic acid/g, on average) and with those of guar meal Korma 50%-53% (2.89 mg gallic acid/g) and Korma 56%-58% (2.94 mg gallic acid/g). Tannins were below the instrumental limit of quantification (1.5 mg/g of catechin equivalents) in DGS, as well as in the marketed products. Fatty acid composition was significantly influenced (p < .05) by the genotype. Matador showed the significant highest content of polyunsaturated fatty acids (PUFA) of the n6 series (45.2 g/100 g), whereas India showed the significant (p < .05) highest content of PUFA of the n3 series (3.55 g/100 g), and the significant (p < .05) highest level of n3/n6 PUFA ratio (0.08), and the best (p < .05) Atherogenic Index (0.19) and Thrombogenic Index (0.46). This study shows the interesting nutritional characteristics of degummed guar seeds, underlining that, if the future of the guar gum industries depends largely on the utilization of guar seed meal, this product can be considered a valuable feed resource and a way to increase the income of guar production.

Activity of Catmint (Nepeta cataria) essential oil against Anisakis larvae

Nepeta cataria L.,commonly known as Catnip, is an aromatic plant belonging to the mint family, Limiaceae. Nematicidal activity of Catnip essential oil (CEO), was assayed in vitro against L3 larvae of Anisakis type 1. Anisakidosis is one of the most important fishborne zoonotic diseases related to the ingestion of nematode larvae belonging to the genus Anisakis, Contraceacum and more rarely Pseudoterranova and Hysterothylacium. In vitro tests revealed a complete inactivation of parasites after 6 and 12 h of treatment, at 10 and 5% respectively, in saline solution. In marinating solution a complete inactivation of parasites was observed after 12 and 18 hours at 10 and 5% concentrations respectively. The data obtained showing a significant activity against Anisakis larvae and suggest further investigations on CEO as a larvicidal agent.

Decidual CD56+ Natural Killer Cells in Spontaneous Early Pregnancy Loss- An Immunohistochemical Study

INTRODUCTION

Natural killer cells are believed to promote placental and trophoblastic growth and provide immune- modulation at maternal-fetal interface in pregnancy and their role in reproductive failure has been a matter of discussion.

AIM

To study CD56+ Natural killer cells in spontaneous pregnancy loss.

MATERIALS AND METHODS

In this prospective observational study, formalin-fixed paraffin embedded sections from products of conception from twenty women each with spontaneous early pregnancy loss (test group) and elective pregnancy termination (control group). Immunohistochemical staining with CD 56 monoclonal antibody was done by avidin-biotin peroxidase technique. CD56+ cells in decidua were counted under light microscopy by two independent observers in ten high power fields (40X) and mean cell count taken. Student's paired 't'-test was used to statistically compare CD56+ NK cell population between the test and control groups.

RESULTS

The mean number of CD56+ NK cells was higher in the decidual tissue of women who had spontaneous early pregnancy loss (mean±SD, 57.55±1.79) as compared to the mean number of CD56+ NK cells in the decidual tissue from women who underwent elective termination (mean±SD, 50.9±3.46). The difference was statistically significant (difference of 6.65 with 95% confidence interval of 4.76 to 8.54, p-value <0.0001).

CONCLUSION

This could imply that CD56+ NK cells have a role in the pathogenesis of spontaneous early pregnancy loss and further large scale studies can throw more light on the mechanism and designing of appropriate therapy.

Mathematical modeling of the circadian dynamics of the neuroendocrine-immune network in experimentally induced arthritis

The circadian dynamics of important neuroendocrine-immune mediators have been implicated in progression of rheumatoid arthritis pathophysiology, both clinically as well as in animal models. We present a mathematical model that describes the circadian interactions between mediators of the hypothalamic-pituitary-adrenal (HPA) axis and the proinflammatory cytokines. Model predictions demonstrate that chronically elevated cytokine expression results in the development of adrenal insufficiency and circadian variability in paw edema. Notably, our model also predicts that an increase in mean secretion of corticosterone (CST) after the induction of the disease is accompanied by a decrease in the amplitude of the CST oscillation. Furthermore, alterations in the phase of circadian oscillation of both cytokines and HPA axis mediators are observed. Therefore, by incorporating the circadian interactions between the neuroendocrine-immune mediators, our model is able to simulate important features of rheumatoid arthritis pathophysiology.

Cutaneous Sarcoidosis Misdiagnosed as Leprosy. Report of Two Cases and Review of Literature

Cutaneous sarcoidosis may occasionally be mistaken and treated for leprosy. We present two cases of sarcoidosis of the skin which were initially treated as leprosy based on the histopathological features. Histological study in one patient showed perineural and perivascular granuloma adding on to the diagnostic confusion. It is very important for the clinicians to consider sarcoidosis as a possible diagnosis in a patient with clinical features that are not typical of leprosy. Histopathology along with appropriate in -situ techniques can help in arriving at an appropriate diagnosis.

The STRokE DOC Trial Technique: ‘Video Clip, Drip, and/or Ship’

Rationale

To describe the clinical trial methods of a site-independent telemedicine system used in stroke.

Aims

A lack of readily available stroke expertise may partly explain the low rate of rt-PA use in acute stroke. Although telemedicine systems can reliably augment expertise available to rural settings, and may increase rt-PA use, point-to-point systems do require fixed base stations. Site-independent systems may minimize delay. The STRokE DOC trial assesses whether site-independent telemedicine effectively and efficiently brings rt-PA to a remote population.

Design

STRokE DOC is a 5–year, 400–participant, noninvasive trial, comparing two consultative techniques at four remote sites. Participants are randomized to acute ‘STRokE DOC telemedicine’ or ‘telephone’ consultations. Treatment decision accuracy is adjudicated at two time points, using three levels of data availability and an independent auditor.

Study outcomes

The primary outcome measure is whether there was a ‘correct decision to treat or not to treat using rt-PA’ at each of three adjudication levels (primarily at Level #2). Secondary outcomes include the number of thrombolytic recommendations, intracerebral hemorrhage, and 90–day outcomes. Using the STRokE DOC system (or telephone evaluation), medical history, neurologic scales, CT interpretations, and recommendations have been completed on over 200 participants to date. Of the initial 11, nonrandomized, ‘run-in’ patients, six (65%) were evaluated wirelessly, and five (45%) were evaluated with a site-independent LAN or cable modem. Three (27%) received rt-PA. The adjudication methodology was able to show both agreements and disagreements in these 11 cases. It is feasible to perform site-independent stroke consultations, and adjudicate those cases, using the STRokE DOC system and trial design. Telemedicine efficacy remains to be proven.

Prebiotic-supplemented partially hydrolysed cow's milk formula for the prevention of eczema in high-risk infants: a randomized controlled trial

Background

Prevention guidelines for infants at high risk of allergic disease recommend hydrolysed formula if formula is introduced before 6 months, but evidence is mixed. Adding specific oligosaccharides may improve outcomes.

Objective

To evaluate whether partially hydrolysed whey formula containing oligosaccharides (0.8 g/100 ml) (pHF‐OS) can prevent eczema in high‐risk infants [ISRCTN65195597].

Methods

We conducted a parallel‐group, multicentre, randomized double‐blind controlled trial of pHF‐OS vs standard cow's milk formula. Infants with a family history of allergic disease were randomized (stratified by centre/maternal allergy) to active (n = 432) or control (n = 431) formula until 6 months of age if formula was introduced before 18 weeks. Primary outcome was cumulative incidence of eczema by 12 months in infants randomized at 0–4 weeks (375 pHF‐OS, 383 control). Secondary outcomes were cumulative incidence of eczema by 12 or 18 months in all infants randomized, immune markers at 6 months and adverse events.

Results

Eczema occurred by 12 months in 84/293 (28.7%) infants allocated to pHF‐OS at 0‐4 weeks of age, vs 93/324 (28.7%) control (OR 0.98 95% CI 0.68, 1.40; P = 0.90), and 107/347 (30.8%) pHF‐OS vs 112/370 (30.3%) control in all infants randomized (OR 0.99 95% CI 0.71, 1.37; P = 0.94). pHF‐OS did not change most immune markers including total/specific IgE; however, pHF‐OS reduced cow's milk‐specific IgG1 (P < 0.0001) and increased regulatory T‐cell and plasmacytoid dendritic cell percentages. There was no group difference in adverse events.

Conclusion

pHF‐OS does not prevent eczema in the first year in high‐risk infants. The immunological changes found require confirmation in a separate cohort.

Diminished growth and lower adiposity in hyperglycemic very low birth weight neonates at 4 months corrected age

OBJECTIVE

Characterize the relationship between neonatal hyperglycemia and growth and body composition at 4 months corrected age (CA) in very low birth weight (VLBW) preterm infants.

STUDY DESIGN

A prospective study of VLBW appropriate-for-gestation infants (N=53). All blood glucose measurements in the first 14 days and nutritional intake and illness markers until discharge were recorded. Standard anthropometrics and body composition via air displacement plethysmography were measured near term CA and 4 months CA. Relationships between hyperglycemia and anthropometrics and body composition were examined using multivariate linear regression.

RESULTS

Infants with >5 days of hyperglycemia were lighter (5345 vs 6455 g, P⩽0.001), shorter (57.9 vs 60.9 cm, P⩽0.01), had smaller occipital-frontal head circumference (39.4 vs 42.0 cm, P⩽0.05) and were leaner (percent body fat 15.0 vs 23.8, P⩽0.01) at 4 months CA than those who did not have hyperglycemia, including after correcting for nutritional and illness factors.

CONCLUSIONS

Neonatal hyperglycemia in VLBW infants is associated with decreased body size and lower adiposity at 4 months CA independent of nutritional deficit, insulin use and illness. Downregulation of the growth hormone axis may be responsible. These changes may influence long-term growth and cognitive development.