Obstetric outcome with low molecular weight heparin therapy during pregnancy

This was a prospective study of women attending a combined haematology/obstetric antenatal clinic in the National Maternity Hospital (2002-2008). Obstetric outcome in mothers treated with low molecular weight heparin (LMWH) was compared to the general obstetric population of 2006. There were 133 pregnancies in 105 women. 85 (63.9%) received prophylactic LMWH and 38 (28.6%) received therapeutic LMWH in pregnancy. 10 (7.5%) received postpartum prophylaxis only. The perinatal mortality rate was 7.6/1000 births. 14 (11.3%) women delivered preterm which is significantly higher than the hospital population rate (5.7%, p<0.05). Despite significantly higher labour induction rates (50% vs 29.2% p<0.01), there was no difference in CS rates compared to the general hospital population (15.4% vs 18.9%, NS). If carefully managed, these high-risk women can achieve similar vaginal delivery rates as the general obstetric population.

Is laparoscopic appendicectomy a safe procedure for trainees in the peripheral hospital setting?

Laparoscopic appendicectomy has become standard in the treatment of acute appendicitis in most hospitals in Ireland. Studies have shown that it is a safe procedure for trainees to perform. However, these studies were conducted in university teaching hospitals whereas a significant proportion of training in Ireland takes place in peripheral hospitals which provide a different training environment. The aim of this study was to determine whether laparoscopic appendicectomy is a safe procedure for surgical trainees to perform in a peripheral hospital setting. A retrospective analysis was performed of appendicectomies carried out at a peripheral hospital over a 12 month period. Comparisons were made between consultant surgeons and trainees for a variety of outcomes. Of 155 appendicectomies, 129 (83.2%) were performed laparoscopically, of which 10 (7.75%) were converted to open. Consultants performed 99 (77%) laparoscopic appendicectomies. There were no statistically significant differences between consultants and trainees in complication rates (19 (19.2%) vs. 4 (13.3%), p = 0.46), mean length of hospital stay (4.7 +/- 4.0 vs. 3.4 +/- 3.3 days, p = 0.13), or rate of conversion to open operation (9 (9.1%) vs. 1 (3.3%), p = 0.45). For cases of complicated appendicitis there were no significant differences between consultants and trainees in complication rates (12 vs. 2, p = 0.40) or length of hospital stay (6.4 +/- 3.9 vs. 4.7 +/- 5.6 days, p = 0.27). We conclude that laparoscopic appendicectomy is a safe procedure for trainees to perform in the peripheral hospital setting and should be incorporated into surgical training programs at an early stage of training.

First Report of Bacterial Wilt in Mandevilla (= Dipladenia) splendens 'Red Riding Hood' in the United States Caused by Ralstonia solanacearum Biovar 3

In November of 2007, 6-inch rooted cuttings of Mandevilla (= Dipladenia) splendens 'Red Riding Hood' were submitted from a greenhouse in Indiana to the Purdue Plant and Pest Diagnostic Lab. Plants exhibited leaf dieback, wilting, and reduced top growth. Microscopic observation revealed no fungal structures within the roots, stems, and leaves; however bacterial streaming was observed from the cut edge of stem and root tissue using ×100 magnification with phase contrast. A Ralstonia solanacearum ImmunoStrip test (Agdia Inc., Elkhart, IN) was used to determine that the samples (roots and stem) were positive for R. solanacearum, the causal agent of southern wilt. A bacterial suspension was prepared from infected tissue and streaked onto King's Medium B (KB). Gram-negative, nonfluorescent, oxidase-positive bacteria were consistently isolated from the diseased tissues and determined as R. solanacearum by BIOLOG (Hayward, CA) carbohydrate utilization. A culture of R. solanacearum and infected plant material were submitted to USDA APHIS PPQ as per select agent protocol. (3) CPHST NPGBL generated pure cultures and together with submitted plant materials they tested positive for R. solanacearum using Agdia ImmunoStrips. Culture and plant material tested positive for R. solanacearum and negative for biovar 2 using the Fegan conventional PCR (1) and the Central Science Lab (CSL, York, UK) real-time PCR (4). Pure cultures were determined to be negative for biovar 2 but positive for biovar 3 using the biovar carbohydrate utilization plate assay (2). On the basis of these results, the bacteria were identified as R. solanacearum biovar 3 and not as the select agent R. solanacearum race 3 biovar 2. Koch's postulates confirmed pathogenicity of the isolated bacteria on tomato, a susceptible host. Three 6-week-old plants were mechanically inoculated with a bacterial suspension of approximately 1 × 10⁸ CFU/ml prepared from cultures grown on KB for 2 days at 28°C. Inoculum (0.1ml of bacterial suspension) was injected into stem axils with a 22-gauge hypodermic needle. Three 6-week-old control plants were inoculated with sterile water. Plants were kept at 24°C with supplemental 400W high-pressure sodium light. Within 5 days, all three inoculated plants exhibited wilt symptoms. No symptoms were observed in control plants. Bacteria were reisolated from symptomatic plants on KB medium as described above, and gram negative, nonfluorescent, oxidase-positive bacteria were obtained. Reisolated strains were identical to R. solanacearum using BIOLOG carbohydrate utilization testing, confirming the causal agent of the disease. Personal correspondence with other diagnosticians also confirms the presence of R. solanacearum biovar 3 in Mandevilla in Ohio, Michigan, and Minnesota. To our knowledge, this is the first documented report in the world of R. solanacearum biovar 3 on Mandevilla. References: (1) M. Fegan et al. Page 34 in: Bacterial Wilt Disease Molecular and Ecological Aspects. P. Prior et al., eds. INRA Editions-Springer. Verlag, Germany, 1998. (2) E. R. French et al. Fitopatologia 30:126, 1995. (3) USDA/APHIS/PPQ New Pest Response Guidelines. Ralstonia Solanacearum race3 biovar 2, from http://www.aphis.usda.gov/import_export/plants/manuals/emergency/ downloads/nprg-ralstonia.pdf , retrieved May 2008. (4) S. A. Weller et al. Appl Environ. Microbiol. 7:2853, 2000.

Qualitative accounts of needle and syringe cleaning techniques among people who inject drugs in Sydney, Australia

INTRODUCTION AND AIMS

Cleaning needles/syringes is an important second-line harm reduction strategy, yet there is limited information on practices employed by people who inject drugs in Australia. This study attempts to identify and assess cleaning practices in terms of the techniques involved and the social contexts in which cleaning takes place.

DESIGN AND METHODS

As part of an exploratory qualitative study in south-west Sydney, in-depth interviews and simulated cleaning exercises were conducted with 12 people who inject drugs. Interviews were digitally recorded and transcribed verbatim. Open coding was used to inductively classify data into themes, and data were examined for patterns and variations in the relationships within and between themes.

RESULTS

Data indicate that cleaning and reuse of needles/syringes was common in this small sample. The most frequently utilised reagent was cool water. While all participants reported cleaning and reusing only their own equipment, none of the techniques demonstrated would have been sufficient to deactivate human immunodeficiency virus or hepatitis C virus.

DISCUSSION AND CONCLUSIONS

Results suggest that even where cleaning of needles and syringes is widespread, people who inject drugs may not engage in efficacious cleaning. The combination of the complexity of current cleaning messages and a lack of accurate information about efficacious techniques are likely to contribute to poor cleaning practice. Australia could benefit from the development of a nationally consistent cleaning message; however, the evidence would suggest that this would need to be accompanied by strategies designed to simplify and disseminate this information in order to increase the uptake of efficacious cleaning methods by people who inject drugs.

Detecting soluble clusterin in in-vitro and in-vivo models of prostate cancer

PSA, the only relevant marker for prostate cancer, has a low predictive value; moreover its low threshold leads to unnecessary biopsies with associated complications. Identification of prognostic factors is an important goal in prostate cancer. In the search for new markers, clusterin, has some potential as it is closely linked with cancer progression and resistance to apoptosis. We looked at the expression of secreted clusterin (sCLU) in prostate cells to determine correlations with progression and drug resistance. The plasmatic expression of sCLU was also investigated in order to use it as a potential marker for prostate cancer. sCLU expression was studied using Western blotting on cultured prostate cells, PWR-1E, PC3 and PC3 Docetaxel resistant cells in the cytosol and culture medium. An inhouse ELISA test was developed to determine sCLU expression in culture media and plasma samples. A patient cohort was identified from the Prostate Cancer Research Consortium Bio-Resource and plasmatic expression of sCLU was studied using western blotting and the inhouse ELISA test. Only the fully processed form of sCLU was identified in the medium of cells with increased expression associated with increased progression of disease and resistance to docetaxel. Plasmatic expression of sCLU was significantly higher in the plasma of patients with high grade prostate cancer with extracapsular extension than in the plasma of prostate cancer patients without extracapsular extension. Plasmatic sCLU may be an effective prognostic marker of prostate cancer and needs to be tested in a multimarker approach.

Three generations of matrilineal excess of birth defects in Irish families with neural tube defects

BACKGROUND

Neural tube defects (NTDs) and birth defects overall are more likely to occur among maternal compared to paternal relatives in two generations (uncles/aunts and first cousins) of Irish families where an individual has been born with an NTD.

AIMS

The aim of this study was to determine if the matrilineal excess persisted into the third generation.

METHODS

First cousins were interviewed about their pregnancy outcomes and their offsprings' health.

RESULTS

Maternal first cousins once removed (FCOR) were more likely to have birth defects than paternal FCOR: 6.7 versus 3.5% (adjusted odds ratio 1.49, 95% CI 0.57, 3.89). No NTDs occurred. Folic acid supplementation significantly reduced the risk of birth defects (P = 0.04).

CONCLUSIONS

This study demonstrates an excess of birth defects among maternal relatives in three consecutive generations of NTD families, and supports the hypothesis that an underlying mechanism links distant maternal relatives in at least some NTD families.

First Report of Gymnosporangium sabinae, European Pear Rust, on Bradford Pear in Michigan

Bradford pear, Pyrus calleryana Decne., is well known as an ornamental plant for its flowers, leaf color in fall, and disease resistance, making it desirable as a street tree. In August and October of 2008, the aecial stage of Gymnosporangium sabinae (Dicks.) G. Winter was collected from leaves of P. calleryana in Farmington, MI (Oakland County). The one tree had foliage that was severely affected by the rust fungus. Using published descriptions of G. sabinae as the synonym of G. fuscum, type of the genus Gymnosporangium (1-4), the Michigan specimen was identified and confirmed by comparison with previously reported European and U.S. specimens (BPI 118736 and BPI 856578). The diagnostic characteristics of G. sabinae include: spermagonia epiphyllous; aecia hypophyllous, roestelioid, 3 to 6 mm high; peridium balanoid (acorn shaped), becoming elongated at maturity, pale yellow, sides opening with lateral slits but remaining attached at light brown, pointed apex; peridial cells elongated, 51 to 68 μm long, outer walls smooth, inner walls and side walls sparsely echinulate; aeciospores globose to broadly ellipsoid, somewhat angular, surface slightly coronate, 22 to 32 × 22 to 36 μm, walls orange, 3.5 to 5.5 μm thick. This species is distinguished from other species of Gymnosporangium on Pyrus by the balanoid (acorn-shaped) peridium and the late season maturation of the aecial stage (4). Telia and teliospores of G. sabinae are produced on the alternate host, various species of Juniperus sect. Sabinae, but were not observed in Michigan. The specimen from Michigan is deposited in the U.S. National Fungus Collections (BPI 878928). G. sabinae is widely distributed in Europe, extending to Asia and North Africa, but is rarely reported in North America. It was accidentally introduced into California in the aecial stage on P. communis L. and the telial stage on Juniperus chinensis L. (2), as well as introduced into Canada (British Columbia) (3,4). The only previous report of G. sabinae on P. calleryana is in Germany (1). G. sabinae is known to attack commercial pear and ornamental juniper plants in Europe, thus it seems important to prevent the further spread of this fungus in North America. References: (1) U. Braun. Feddes Repert. Beih. 93:213, 1982. (2) G. Laundon. Mycotaxon 3:133, 1975. (3) A. H. McCain and D. Y. Rosenberg. Calif. Dep. Agric. Bull. 50:13, 1961. (4) J. A. Parmelee. Fungi Canadensis No. 43. Gymnosporangium fuscum, 1974.