First trimester examination of fetal anatomy: clinical practice guideline by the World Association of Perinatal Medicine (WAPM) and the Perinatal Medicine Foundation (PMF)

This recommendation document follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation. We aim to bring together groups and individuals throughout the world for precise standardization to implement the ultrasound evaluation of the fetus in the first trimester of pregnancy and improve the early detection of anomalies and the clinical management of the pregnancy. The aim is to present a document that includes statements and recommendations on the standard evaluation of the fetal anatomy in the first trimester, based on quality evidence in the peer-reviewed literature as well as the experience of perinatal experts around the world.

The use of antenatal corticosteroids for fetal maturation: clinical practice guideline by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine foundation

This practice guideline follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world, with the goal of improving the use of antenatal corticosteroids (ACS) for fetal maturation. In fact, this document provides further guidance for healthcare practitioners on the appropriate use of ACS with the aim to increase the timely administration and avoid unnecessary or excessive use. Therefore, it is not intended to establish a legal standard of care. This document is based on consensus among perinatal experts throughout the world and serves as a guideline for use in clinical practice.

The use of antenatal corticosteroids for fetal maturation in COVID-19: clinical practice statement by WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation

This statement follows the mission of the World Association of Perinatal Medicine in collaboration with the Perinatal Medicine Foundation, bringing together groups and individuals throughout the world with the goal of improving the use of antenatal corticosteroids (ACS) for fetal maturation in Coronavirus Disease 2019 (COVID-19). Pregnant women with COVID-19 are at increased risk of hospitalization, admission to intensive care unit and mechanical ventilation compared to non-pregnant patients. Thus, obstetricians may face the dilemma of initiating maternal corticosteroid therapy for maternal indication while weighing its potential adverse effects on the fetus. As there is no evidence on the effect of betamethasone in pregnant women with COVID-19, dexamethasone should be preferably used for fetal maturation, if available. As a recommendation, for pregnant women with COVID-19 who are oxygen dependent or under mechanical ventilation and meet the criteria for ACS, the usual doses of dexamethasone should be administered, followed by oral prednisolone 40 mg OD or intravenous hydrocortisone 80 mg BD for up to 10 days.

The use of antenatal corticosteroids for fetal maturation: clinical practice guideline by the WAPM-World Association of Perinatal Medicine and the PMF-Perinatal Medicine Foundation

This practice guideline follows the mission of the World Association of Perinatal Medicine (WAPM) in collaboration with the Perinatal Medicine Foundation (PMF), bringing together groups and individuals throughout the world with the goal of improving the use of antenatal corticosteroids (ACS) for fetal maturation. In fact, this document provides further guidance for healthcare practitioners on the appropriate use of ACS with the aim to increase the timely administration and avoid unnecessary or excessive use. Therefore, it is not intended to establish a legal standard of care. This document is based on consensus among perinatal experts throughout the world and also serves as a guideline for use in clinical practice.

First trimester examination of fetal anatomy: clinical practice guideline by the World Association of Perinatal Medicine (WAPM) and the Perinatal Medicine Foundation (PMF)

This recommendation document follows the mission of the World Association of Perinatal Medicine (WAPM) in collaboration with the Perinatal Medicine Foundation (PMF). We aim to bring together groups and individuals throughout the world for precise standardization to implement the ultrasound evaluation of the fetus in the first trimester of pregnancy and improve the early detection of anomalies and the clinical management of the pregnancy. The aim is to present a document that includes statements and recommendations on the standard evaluation of the fetal anatomy in the first trimester, based on quality evidence in the peer-reviewed literature as well as the experience of perinatal experts around the world.

Maternal and perinatal outcomes in high compared to low risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection (phase 2): the World Association of Perinatal Medicine working group on coronavirus disease 2019

BACKGROUND

It has still to be ascertained whether severe acute respiratory syndrome coronavirus 2 infection in pregnancy is associated with worse maternal and fetal outcomes compared to low risk gestations.

OBJECTIVE

This study aimed to evaluate maternal and perinatal outcomes in high- and low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.

STUDY DESIGN

This was a multinational retrospective cohort study involving women with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection from 76 centers from 25 countries in Europe, the United States, South America, Asia, and Australia from April 4, 2020, to October 28, 2020. The primary outcome was a composite measure of maternal mortality and morbidity, including admission to the intensive care unit, use of mechanical ventilation, or death. The secondary outcome was a composite measure of adverse perinatal outcome, including miscarriage, fetal loss, neonatal and perinatal death, and admission to the neonatal intensive care unit. All outcomes were assessed in high- and low-risk pregnancies. Pregnancies were considered high risk in case of either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy. The Fisher exact test and logistic regression analysis were used to analyze the data.

RESULTS

A total of 887 singleton pregnancies who tested positive for severe acute respiratory syndrome coronavirus 2 infection using reverse transcription-polymerase chain reaction of nasal and pharyngeal swab specimens were included in the study. The risk of composite adverse maternal outcomes was higher in high-risk pregnancies than in low-risk pregnancies (odds ratio, 1.52; 95% confidence interval, 1.03-2.24; P=.035). In addition, women carrying high-risk pregnancies were at higher risk of hospital admission (odds ratio, 1.48; 95% confidence interval, 1.07-2.04; P=.002), presence of severe respiratory symptoms (odds ratio, 2.13; 95% confidence interval, 0.41-3.21; P=.001), admission to the intensive care unit (odds ratio, 2.63; 95% confidence interval, 1.42-4.88), and invasive mechanical ventilation (odds ratio, 2.65; 95% confidence interval, 1.19-5.94; P=.002). When exploring perinatal outcomes, high-risk pregnancies were at high risk of adverse perinatal outcomes (odds ratio, 1.78; 95% confidence interval, 0.15-2.72; P=.009). However, such association was mainly because of the higher incidence of miscarriage in high-risk pregnancies compared with that in low-risk pregnancies (5.3% vs 1.6%, P=.008); furthermore, there was no difference in other explored outcomes between the 2 study groups. At logistic regression analysis, maternal age (odds ratio, 1.12; 95% confidence interval, 1.02-1.22; P=.023) and high-risk pregnancy (odds ratio, 4.21; 95% confidence interval, 3.90-5.11; P<.001) were independently associated with adverse maternal outcomes.

CONCLUSION

High-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection were at higher risk of adverse maternal outcomes than low-risk pregnancies complicated by severe acute respiratory syndrome coronavirus 2 infection.

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.

Tracking the dynamic ecological history of a tropical urban estuary as it responds to human pressures

Coastal cities in tropical areas are often low-lying and vulnerable to the effects of flooding and storms. San Juan, Puerto Rico is a good example of this. It is built around a lagoon-channel complex called the San Juan Bay Estuary (SJBE). A critical channel in the estuary, the Caño Martín Peña, has filled in and now frequently floods the surrounding communities with sewage-enriched waters, causing a series of human health and ecological problems. Sediment core analyses indicate that portions of the SJBE now function as settling basins. High urban and sewage runoff to the Caño contributes nitrogen (N), but stable isotope and sediment nutrient analyses indicate that this runoff may also enhance conditions for coupled sulfate reduction-nitrogen fixation. The amount of 'new' bioavailable N created from inert atmospheric N₂ gas may meet or exceed that from the runoff into the Caño Martín Peña. The ecological consequences of this appear to extend beyond the ponded channel, potentially contributing to the poor water quality of the SJBE, greater than contaminated runoff alone.

Adult-onset hypothyroidism increases ethanol consumption

RATIONALE

Only in Europe it can be estimated that more than 20 million of people would be affected by hypothyroidism in some moment of their life. Given that ethanol consumption is so frequent, it would be reasonable to ask what the consequences of ethanol consumption in those individuals affected by hypothyroidism are.

OBJECTIVES

To study the interaction between hypothyroidism and ethanol consumption.

METHODS

We study ethanol consumption in a rat model of methyl-mercaptoimidazole-induced-adult-onset hypothyroidism and thyroid T4/T3 hormone supplementation. Also, we studied the effects of ethanol on motor activity, memory, and anxiety.

RESULTS

We found that hypothyroidism increased the voluntary ethanol consumption and that this was enhanced by thyroid hormone supplementation. Hypothyroidism was associated with motor hyperactivity which was prevented either by T4/T3 supplementation or ethanol. The relationship between hypothyroidism, ethanol, and anxiety was more complex. In an anxiogenic context, hypothyroidism and T4/T3 supplementation would increase immobility, an anxiety-like behavior, while in a less anxiogenic context would decrease rearing, a behavior related to anxiety. Regarding memory, acute ethanol administration did not alter episodic-like memory in hypothyroid rats. Gene expression of enzymes involved in the metabolism of ethanol, i.e., Adh1 and Aldh2, were altered by hypothyroidism and T4/T3 supplementation.

CONCLUSIONS

Our results suggest that hypothyroid patients would need personalized attention in terms of ethanol consumption. In addition, they point that it would be useful to embrace the thyroid axis in the study of ethanol addiction, including as a possible therapeutic target for the treatment of alcoholism and its comorbid disorders.

A MSFD complementary approach for the assessment of pressures, knowledge and data gaps in Southern European Seas: The PERSEUS experience

PERSEUS project aims to identify the most relevant pressures exerted on the ecosystems of the Southern European Seas (SES), highlighting knowledge and data gaps that endanger the achievement of SES Good Environmental Status (GES) as mandated by the Marine Strategy Framework Directive (MSFD). A complementary approach has been adopted, by a meta-analysis of existing literature on pressure/impact/knowledge gaps summarized in tables related to the MSFD descriptors, discriminating open waters from coastal areas. A comparative assessment of the Initial Assessments (IAs) for five SES countries has been also independently performed. The comparison between meta-analysis results and IAs shows similarities for coastal areas only. Major knowledge gaps have been detected for the biodiversity, marine food web, marine litter and underwater noise descriptors. The meta-analysis also allowed the identification of additional research themes targeting research topics that are requested to the achievement of GES.

Incidence of eclampsia with HELLP syndrome and associated mortality in Latin America

OBJECTIVE

To describe the maternal outcome among women with eclampsia with and without HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count).

METHODS

A cross-sectional study of women with eclampsia was undertaken in 14 maternity units in Latin America between January 1 and December 31, 2012. Outcomes were compared between women with and without concomitant HELLP syndrome. Logistic regression analysis was performed to identify independent risk factors of maternal mortality.

RESULTS

There were 196 eclampsia cases among 115 038 deliveries; 142 (72.4%) women had eclampsia alone and 54 (27.6%) women had concomitant HELLP syndrome. Severe systolic hypertension (≥160 mm Hg), severe diastolic hypertension (≥110 mm Hg), and hypertensive encephalopathy were significantly more common among women with HELLP than among those with eclampsia alone (P=0.01 for all). There were 8 (4.1%) maternal deaths, all in the group with HELLP syndrome, and 18 (9.1%) perinatal deaths. In a multivariate regression model, maternal mortality was significantly associated with low platelet count and severe systolic hypertension (P<0.05).

CONCLUSION

Eclampsia with HELLP syndrome is a dangerous complication associated with pregnancy. Low platelet count secondary to HELLP syndrome and severe systolic hypertension were independently associated with maternal mortality from eclampsia.

Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth

BACKGROUND

When a woman has had a previous caesarean birth, there are two options for her care in a subsequent pregnancy: planned elective repeat caesarean or planned vaginal birth. While there are risks and benefits for both planned elective repeat caesarean birth and planned vaginal birth after caesarean (VBAC), current sources of information are limited to non-randomised cohort studies. Studies designed in this way have significant potential for bias and consequently conclusions based on these results are limited in their reliability and should be interpreted with caution.

OBJECTIVES

To assess, using the best available evidence, the benefits and harms of a policy of planned elective repeat caesarean section with a policy of planned VBAC for women with a previous caesarean birth.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2013) and reference lists of retrieved studies.

SELECTION CRITERIA

Randomised controlled trials with reported data that compared outcomes in mothers and babies who planned a repeat elective caesarean section with outcomes in women who planned a vaginal birth, where a previous birth had been by caesarean.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trial quality and extracted data.

MAIN RESULTS

Two randomised trials involving 320 women and their infants were included. However, data for maternal and infant clinical outcomes were available from one trial with very low event rates, involving 22 women only.For the primary outcomes maternal death or serious morbidity (one study; 22 women; risk ratio (RR) not estimable), and infant death or serious morbidity (one study; 22 women; RR not estimable), there were no statistically significant differences between planned caesarean birth and planned vaginal birth identified.

AUTHORS' CONCLUSIONS

Planned elective repeat caesarean section and planned VBAC for women with a prior caesarean birth are both associated with benefits and harms. Evidence for these care practices is largely drawn from non-randomised studies, associated with potential bias. Any results and conclusions must therefore be interpreted with caution. Randomised controlled trials are required to provide the most reliable evidence regarding the benefits and harms of both planned elective repeat caesarean section and planned vaginal birth for women with a previous caesarean birth.

Discordancia entre cultivos de vellosidades coriónicas, de corto y largo plazo. Presentación de un caso y revisión del tema

Presentamos un caso de diagnóstico prenatal en el que se halló un resultado falso negativo en un cultivo a largo plazo de vellosidades coriónicas, discordante con los resultados del cultivo a corto plazo, que mostraba trisomía 21. Se discute las posibles causas de discrepancia en éste y otros casos similares, y la mejor manera de proceder para asegurar el diagnóstico correcto.

Displasia mesenquimal placentaria

La displasia mesenquimal placentaria es una rara condición de placentomegalia y vellosidades coriales anormales, con frecuencia confundida clínicamente como mola hidatidiforme parcial. Sin embargo, es clínica y patológicamente distinta, con alta incidencia de restricción de crecimiento intrauterino y muerte fetal. Se presenta la evolución clínica de una gestante portadora de una displasia mesenquimal placentaria, el primer caso diagnosticado en el Instituto Nacional Materno Perinatal. Se describe el problema, para sospechar el diagnóstico y el manejo de la gestación. Hubo necesidad de realizar cesárea a las 27 semanas de gestación, obteniéndose una recién nacida mujer de 1 048 gramos, con Ápgar 8 al minuto y 9 a los 5 minutos, líquido amniótico sanguinolento en regular cantidad y placentomegalia. La paciente evolucionó satisfactoriamente y salió de alta al tercer día. En el neonato se confirmó una tumoración abdominal hepática y tuvo que ser intervenido quirúrgicamente, previa ganancia ponderal, determinándose el diagnóstico anatomopatológico de hamartoma mesenquimal de hígado.

C957T polymorphism of the dopamine D2 receptor gene is associated with motor learning and heart rate

Genetic variants that are related to the dopaminergic system have been frequently found to be associated with various neurological and mental disorders. Here, we studied the relationships between some of these genetic variants and some cognitive and psychophysiological processes that are implicated in such disorders. Two single nucleotide polymorphisms were chosen: one in the dopamine D2 receptor gene (rs6277-C957T) and one in the catechol-O-methyltransferase gene (rs4680-Val158Met), which is involved in the metabolic degradation of dopamine. The performance of participants on two long-term memory tasks was assessed: free recall (declarative memory) and mirror drawing (procedural motor learning). Heart rate (HR) was also monitored during the initial trials of the mirror-drawing task, which is considered to be a laboratory middle-stress generator (moderate stress), and during a rest period (low stress). Data were collected from 213 healthy Caucasian university students. The C957T C homozygous participants showed more rapid learning than the T allele carriers in the procedural motor learning task and smaller differences in HR between the moderate- and the low-stress conditions. These results provide useful information regarding phenotypic variance in both healthy individuals and patients.

Combined metallothioneins and p53 proteins expression as a prognostic marker in patients with Dukes stage B and C colorectal cancer

Our study aimed to evaluate metallothionein and p53 expression in colorectal cancer and to correlate their combined expression with selected clinical and pathologic variables of the disease, to define their prognostic significance. Colorectal cancer specimens from 99 patients were retrospectively analyzed by immunohistochemistry for metallothionein and p53 expression. Survival curves were generated according to the Kaplan-Meier method, and univariate survival distributions were compared with the use of the log-rank test. Multivariate models were computed using Cox proportional hazards regression. This research was approved by the institutional review boards of all centers. Tumors showing concomitant high metallothionein expression and negative p53 (metallothionein(H)/p53(-)) were significantly inversely related to depth of invasion, frequency of nodal metastasis, and Dukes stage (P < .01). In univariate analysis, patients with metallothionein(H)/p53(-) phenotype showed a better overall survival (hazard ratio [HR], 2.83; P < .05) and disease-free survival (HR, 2.03; P < .05). In multivariate analysis, considering staging, metallothionein, and metallothionein + p53 variables, in 83 patients with Dukes stages B and C, metallothionein(H)/p53(-) combination was the sole factor showing an independent prognostic value for overall survival (HR, 3.88; P < .1) and disease-free survival (HR, 2.56; P < .1). In conclusion, the combined analysis of metallothionein and p53 may enhance the prognostic power of each individual marker by predicting the progression of the disease and contributing to a better identification of patients at low risk for mortality, especially for those with Dukes stage B and C colorectal cancer.

Perinatal outcomes after sonographic detection of isolated short femur in the second trimester

PURPOSE

To determine the association of fetal isolated short femur in the second-trimester ultrasound (US) examination with perinatal outcomes such as small-for-gestational age (SGA) and low-birth weight (LBW) neonates.

METHODS

This is a retrospective cohort study in fetuses routinely assessed by US examination at 18 to 24 weeks during 2006-2009. A fetal isolated short femur was defined as femur length below the 5th percentile and with no chromosomal or structural abnormalities. Fetuses with abdominal circumference below the 5th percentile at the time of US examination were excluded. Each case of short femur was matched with three controls according to gestational age at the time of the US examination.

RESULTS

Sixty-one fetuses met the inclusion criteria. Both the group of women carrying a fetus with isolated short femur and that of women carrying a fetus with normal femur length had similar general and obstetric characteristics. Women carrying a fetus with isolated short femur were significantly more likely to deliver a SGA neonate (19.7% versus 8.7%, p < 0.05) and a LBW neonate (19.7% versus 7.1%, p < 0.05) than women carrying a fetus with normal femur length. Logistic regression analysis found odds ratios for SGA and LBW of 2.6 (95% confidence interval, 1.1-5.9) and 2.9 (95% confidence interval, 1.2-7.1), respectively.

CONCLUSIONS

Isolated short femur in the second-trimester US examination is associated with a subsequent delivery of SGA and LBW neonates.

Síndrome de costillas cortas y polidactilia: displasia esquelética fetal incompatible con la vida

<span style="font-family: Verdana; font-size: x-small;">El síndrome costillas cortas polidactilia es una categoría descriptiva para un grupo de displasias esqueléticas incompatibles con la vida, caracterizadas por tórax estrecho, costillas extremadamente pequeñas, micromelia, polidactilia y anomalías viscerales. Las 4 variantes establecidas son SRPS I (tipo Saldino-Noonan), SRPS II (tipo Majewski), SRPS III (tipo Verma-Naumoff) y SRPS IV (tipo Beemer-Langer). Se piensa que todas las variantes son heredadas en forma autosómica recesiva. Debido a la frecuente superposición fenotípica, existe controversia si las variantes son debidas a expresión variable o a heterogeneidad genética. Presentamos un caso de un feto masculino, con signos ecográficos característicos de displasia esquelética, tales como micromelia, tórax estrecho en forma de campana, hipertelorismo, implantación baja de las orejas y polidactilia, que nació de parto vaginal y falleció a los 2 días de vida, producto de insuficiencia respiratoria, la cual presentó desde el nacimiento.</span>

Prenatal sonographic diagnosis of duplicated middle cerebral artery

We report a fetus scanned by color Doppler ultrasound at 37 weeks for suspicion of growth restriction with an extremely rare variation of duplicated middle cerebral artery. Three-dimensional color power Doppler and tomographic ultrasound imaging enhanced our incidental finding.

The D2 dopamine receptor gene variant C957T affects human fear conditioning and aversive priming

Polymorphisms of DRD2 and ANKK1 have been associated with psychiatric syndromes where there is believed to be an underlying learning process deficit such as addiction, post-traumatic stress disorder and psychopathy. We investigated the effects of the DRD2 C957T and ANKK1 TaqIA single nucleotide polymorphism (SNP), which have been associated with psychopathic traits in alcoholic patients, on fear conditioning and aversive priming in healthy volunteers. We found that the DRD2 C957T SNP, but not the ANKK1 TaqIA SNP, was associated with both differential conditioning of the skin conductance response and the aversive priming effect. There were no differences between the genotype groups with respect to the extinction of the skin-conductance conditioned response. These results suggest that the C957T SNP could be related to learning differences associated with the risk of developing psychiatric disorders in individuals that are carriers of the C homozygous genotype. Our genetic data raise the possibility that the dopaminergic system functional variations determined by this SNP could affect fear learning.

DRD2 and ANKK1 genotype in alcohol-dependent patients with psychopathic traits: association and interaction study

BACKGROUND

The TaqI-A polymorphism of the ANKK1 gene, adjacent to the DRD2 gene, has been associated with alcoholism and other psychiatric conditions, although other DRD2 gene variants, such as the C957T polymorphism, could be related to these phenotypic traits.

AIMS

To investigate the contribution of the TaqI-A and the C957T polymorphisms to the presence of psychopathic traits in patients with alcoholism.

METHOD

We performed association and interaction analyses of the polymorphisms in 150 controls and 176 male alcohol-dependent patients assessed for the presence of dissocial personal disorder, using the Psychopathy Checklist-Revised (PCL-R).

RESULTS

There was a significant association of the TaqI-A and C957T polymorphisms when both genotypes were present, with PCL-R scores of F(1-171=0.13) (P=0.01) and a frequency of dissocial personal disorder OR=10.52, P<0.001.

CONCLUSIONS

The TaqI-A of the ANKK1 gene and the C957T of the DRD2 gene are epistatically associated with psychopathic traits in alcohol-dependent patients.

Wastewater reclamation through a combination of natural systems (infiltration-percolation and constructed wetlands): a solution for small communities

The decision on technologies used for reclaiming wastewater appears as important as a consequence of the implications on the economic, environmental and health conditions of societies. The problem arises when deciding how to deal with wastewater in small communities, because the costs of implementing and operating small, intensive wastewater treatment plants are unacceptable and can lead to financing and operation problems. Extensive treatment systems can be a good solution, where space is available. This paper presents the combination of two soft technologies (infiltration-percolation and constructed wetlands) to treat and reclaim wastewater. The obtained results show that the infiltration-percolation effluent presents a quality enough to be reused for irrigation of industrial crops, nurseries, fodder, cereals and oleaginous seeds, ornamental flower production; industrial cooling; impoundments, water bodies, and streams for recreational use in which the public's contact with the water is not permitted; and irrigation of forested areas, landscape areas and restricted access areas. Moreover, the combination of infiltration-percolation and constructed wetlands increases the list of final reclamation to the following: irrigation of pasture for milk or meat animals, crops for canning industry, crops not raw-consumed, fruit trees except by sprinkling, aquaculture; and aquifer recharge by localised percolation through the soil.

Wastewater infiltration percolation for water reuse and receiving body protection: thirteen years' experience in Spain

Infiltration percolation (IP) is an extensive technology to treat primary or secondary effluents of small and middle size communities before reuse or disposal to sensitive receiving bodies. Thirteen years of implementation of IP in Spain has highlighted the necessity to abide by defined design and construction rules and operation conditions in order to achieve consistently the treatment objectives and guarantee a long lasting treatment capacity. From this experience, high care should be taken of (i) the characteristics of the sand constituting the filter, (ii) the drainage conditions, (iii) the influent spreading over the infiltration surface and (iv) the risks related to recurrent overloading. Simple monitoring measures are suggested in order to improve the reliability of IP plants.

Wastewater reclamation systems in small communities

The demands established in the rules and regulations by the administration in Catalonia seem to exclude small communities from wastewater reclamation and reuse, due to the comparatively high costs associated with the practice at small scale. In the framework of the DRAC project (Demonstration on Wastewater Reclamation and Reuse in Catalonia) two different pre-treatment systems, one extensive (infiltration-percolation) and another intensive (ring filter), each one followed by chlorine dioxide disinfection, were tested in order to be applied for small communities wastewater reclamation and reuse. The results of this study show that infiltration-percolation systems remove very efficiently physico-chemical contaminants and microorganisms. The ring filter system does not show a significant removal rate of contaminants, The use of infiltration-percolation as a pre-treatment for advanced chemical disinfection allows reducing the dose of disinfectant and the contact time needed to achieve a specific water quality, and diminishes disinfection byproducts (DBPs) generation. Therefore, this reclamation line is suitable for small communities due to its efficiency and low cost. However, further studies are needed in relation to the removal mechanisms of microorganisms, organic compounds in IP systems and the possible DBPs formation using chlorine dioxide.

Surgical salvage of pelvic recurrences from colorectal tumors

13580

Background: The morbidity of pelvic recurrences from colorectal tumors (PRCT) represents a challenge for the oncology multidisciplinary team. Surgical treatment is the best option for palliation and in several series it offers long term local control in 30% of the cases. Objective: To perform a retrospective analysis of patients (pts) surgically resected for PRCT in terms of: time to progression after surgical salvage (TP) and specific suvival (SS). Correlatives studies were performed with clinic and pathologic factors, surgical procedures (SP), and postoperative complications in terms of TP and SS. Methods: 64 pts treated (June 1994 - February 2005) were identified (women: 30), median age 63 years, site of the primary: rectum 48, sigmoid 16; Median number of resected nodes: 8 (r: 2 - 20) in pts with negative nodes and 15 (r: 6 - 42) in pts with positive nodes; primary treatment: surgery (S): 22 pts, S + chemotherapy (CT): 18, S + radiotherapy (RT): 4, S + CT/RT: 17, CT + S: 2 pts, QT/RT + CX: 1; in 7/64 a Miles procedure was performed as primary therapy, median disease free interval: 15 months; site of initial recurrence: locoregional 58 (90%), locoregional + systemic 10%. Pain and bleeding were the most frecuent symptoms. Results: The strategy in PRCT was: S: 29 pts, S + RT: 15, S + CT/RT: 9, CT/RT + S: 7, S + CT: 2, CT + S: 1, RT + S:1; IORT: 18/64; external beam RT: 17/64, 6 pts required Miles; type of resection: R0: 50/64 (78%), R1: 8/64 (12%), R2: 3/64 (5%) and 3 (5%) unknown. Median duration of surgery: 4 hours, abscesses and fistulas were the complications most frequently observed. Median time to progression (TP): 12 months, site of recurrence (56/64 pts) post salvage surgery: pelvic: 22 pts, extrapelvic: 6 pts, combined: 10 and unknown 18. Eleven pts are free of disease. In 16 pts more than one surgical salvage was perfomed. The specific survival was 21 months (IC 95% 37 - 61 m). Conclusions: In this serie surgical salvage of PRCT showed one year of local control disease, even in pts with R2 and with moderate morbidity. The surgical decision must be individualized and in the context of a trained surgical team.

No significant financial relationships to disclose.

Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth

BACKGROUND

When a woman has had a previous caesarean birth, there are two options for her care in a subsequent pregnancy: planned elective repeat caesarean or planned vaginal birth. While there are risks and benefits for both planned elective repeat caesarean birth and planned vaginal birth after caesarean, current sources of information are limited to non-randomised cohort studies. Studies designed in this way have significant potential for bias and consequently conclusions based on these results are limited in their reliability and should be interpreted with caution.

OBJECTIVES

To assess, using the best available evidence, the benefits and harms of a policy of planned elective repeat caesarean section with a policy of planned vaginal birth after caesarean section for women with a previous caesarean birth.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group trials register (24 June 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2004), and PubMed (1966 to 24 June 2004).

SELECTION CRITERIA

Randomised controlled trials with reported data that compared outcomes in mothers and babies who planned a repeat elective caesarean section with outcomes in women who planned a vaginal birth, where a previous birth had been by caesarean.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data.

MAIN RESULTS

There were no randomised controlled trials identified.

REVIEWERS' CONCLUSIONS

Planned elective repeat caesarean section and planned vaginal birth after caesarean section for women with a prior caesarean birth are both associated with benefits and harms. Evidence for these care practices is drawn from non-randomised studies, associated with potential bias. Any results and conclusions must therefore be interpreted with caution. Randomised controlled trials are required to provide the most reliable evidence regarding the benefits and harms of both planned elective repeat caesarean section and planned vaginal birth for women with a previous caesarean birth.

Unintended consequences of using an oral HIV test on HIV knowledge

This study assessed the effects of oral HIV testing on the belief that HIV can be transmitted in saliva and on overall AIDS knowledge. A sample of current or former street drug users (N = 155) was recruited to complete a survey of HIV risk behaviour at two points in time. The survey included three items that assessed beliefs in the possible transmission of HIV through saliva. Among the 80 participants who received oral HIV testing at baseline, accuracy on the three saliva items decreased at follow-up and, among the 75 participants who did not receive oral HIV testing, accuracy on these items increased at follow-up. This pattern of change was statistically significant. Oral HIV testing has been a significant advance. However, unintended effects may include increased belief in the transmission of HIV through saliva. This problematic outcome suggests the importance of enhanced HIV counselling among participants in oral HIV testing.

Field evaluation of a simplified unit-dose syringe for administration of measles vaccine

Ezeject is a plungerless syringe prefilled with lyophilized measles vaccine. Ezeject syringes were compared with standard 3-cc syringes and 10-dose measles vaccine vials in the vaccination of 884 Guatemalan infants 8-23 months of age. Vaccination was performed by experienced vaccinators and by individuals without prior vaccination experience who received 2.5-3 hours of training. The overall seroconversion rate following administration was 96%, regardless of the type of syringe used or of the experience of the vaccinator. No significant adverse events were observed in children vaccinated with the new syringes. Although incomplete emptying was noted in 87% of the Ezeject syringes used, this had no effect on the serologic response to measles vaccine. Aspiration for detection of blood before injection of the vaccine was performed significantly (P less than .001) less frequently with Ezeject than with 3-cc syringes by both experienced and inexperienced personnel. Inexperienced vaccinators administered measles vaccine significantly faster (P less than .001) with Ezeject than with 3-cc syringes, but the times were similar for experienced vaccinators. Ezeject is an acceptable alternative to standard syringes for the administration of measles vaccine. Several design modifications that would improve the handling of the device and eliminate the possibility of its reuse have been suggested.