The full blood count in screening asymptomatic infants for early-onset sepsis: A cross-sectional study.

AIM: The full blood count (FBC) is commonly measured as part of a partial septic work-up in asymptomatic infants at increased risk of early-onset neonatal sepsis (EOS). To determine the impact of FBC parameters on infants' subsequent management a retrospective cross-sectional study was performed. METHODS: Infants, born at ≥34 weeks gestation, asymptomatic at birth, undergoing a partial septic work-up and receiving prophylactic antibiotics due to increased risk of EOS in a single centre over a 2-year period, were included. The primary outcome measure was frequency of FBC result impacting on duration of antibiotic therapy. Secondary outcome measures included frequency of FBC parameters outside of the reference range and incidental diagnoses. RESULTS: In total, 16 726 live-born infants were delivered during the study period. A total of 802 (4.8%) were included. Thirteen infants (1.6%) received a prolonged course of antibiotics due to suspicion for EOS. Two of these infants had elevated white cell counts. All had normal neutrophil counts. In no case did the FBC result influence the decision to prolong the antibiotic course. CONCLUSION: In a cohort of 802 infants, asymptomatic at birth and at increased risk of EOS, the FBC result did not impact on the decision to prolong the course of antibiotics for suspicion of EOS.

Haematological parameters and coagulation in umbilical cord blood following COVID-19 infection in pregnancy.

OBJECTIVE: The aim of this study was to evaluate infants, born to women with SARS-CoV-2 detected during pregnancy, for evidence of haematological abnormalities or hypercoagulability in umbilical cord blood. STUDY DESIGN: This was a prospective observational case-control study of infants born to women who had SARS-CoV-2 RNA detected by PCR at any time during their pregnancy (n = 15). The study was carried out in a Tertiary University Maternity Hospital (8,500 deliveries/year) in Ireland. This study was approved by the Hospital Research Ethics Committee and written consent was obtained. Umbilical cord blood samples were collected at delivery, full blood count and Calibrated Automated Thrombography were performed. Demographics and clinical outcomes were recorded. Healthy term infants, previously recruited as controls to a larger study prior to the outbreak of COVID-19, were the historical control population (n = 10). RESULTS: Infants born to women with SARS-CoV-2 had similar growth parameters (birth weight 3600 g v 3680 g, p = 0.83) and clinical outcomes to healthy controls, such as need for resuscitation at birth (2 (13.3%) v 1 (10%), p = 1.0) and NICU admission (1 (6.7%) v 2 (20%), p = 0.54). Haematological parameters (Haemoglobin, platelet, white cell and lymphocyte counts) in the COVID-19 group were all within normal neonatal reference ranges. Calibrated Automated Thrombography revealed no differences in any thrombin generation parameters (lag time (p = 0.92), endogenous thrombin potential (p = 0.24), peak thrombin (p = 0.44), time to peak thrombin (p = 0.94)) between the two groups. CONCLUSION: In this prospective study including eligible cases in a very large population of approximately 1500 women, there was no evidence of derangement of the haematological parameters or hypercoagulability in umbilical cord blood due to COVID-19. Further research is required to investigate the pathological placental changes, particularly COVID-19 placentitis and the impact of different strains of SARS-CoV-2 (particularly the B.1.1.7 and the emerging Delta variant) and the severity and timing of infection on the developing fetus.

Predicting bacteraemia in maternity patients using full blood count parameters: A supervised machine learning algorithm approach.

INTRODUCTION: Bacteraemia in pregnancy and the post-partum period can lead to maternal and newborn morbidly. The purpose of this study was to use machine learning tools to identify if bacteraemia in pregnant or post-partum women could be predicted by full blood count (FBC) parameters other than the white cell count. METHODS: The study was performed on 129 women with a positive blood culture (BC) for a clinically significant organism, who had a FBC taken at the same time. They were matched with controls who had a negative BC taken at the same time as a FBC. The data were split in to a training (70%) and test (30%) data set. Machine learning techniques such as recursive partitioning and classification and regression trees were used. RESULTS: A neutrophil/lymphocyte ratio (NLR) of >20 was found to be the most clinically relevant and interpretable construct of the FBC result to predict bacteraemia. The diagnostic accuracy of NLR >20 to predict bacteraemia was then examined. Thirty-six of the 129 bacteraemia patients had a NLR >20, while only 223 of the 3830 controls had a NLR >20. This gave a sensitivity of 27.9% (95% CI 20.3-36.4), specificity of 94.1% (93.3-94.8), positive predictive value of 13.9% (10.6-17.9) and a negative predictive value (NPV) of 97.4% (97.2-97.7) when the prevalence of bacteraemia was 3%. CONCLUSION: The NLR should be considered for use in routine clinical practice when assessing the FBC result in patients with suspected bacteraemia during pregnancy or in the post-partum period.

Directions for Research on Climate and Conflict.

The potential links between climate and conflict are well studied, yet disagreement about the specific mechanisms and their significance for societies persists. Here, we build on assessment of the relationship between climate and organized armed conflict to define crosscutting priorities for future directions of research. They include (1) deepening insight into climate-conflict linkages and conditions under which they manifest, (2) ambitiously integrating research designs, (3) systematically exploring future risks and response options, responsive to ongoing decision-making, and (4) evaluating the effectiveness of interventions to manage climate-conflict links. The implications of this expanding scientific domain unfold in real time.

Climate as a risk factor for armed conflict.

Research findings on the relationship between climate and conflict are diverse and contested. Here we assess the current understanding of the relationship between climate and conflict, based on the structured judgments of experts from diverse disciplines. These experts agree that climate has affected organized armed conflict within countries. However, other drivers, such as low socioeconomic development and low capabilities of the state, are judged to be substantially more influential, and the mechanisms of climate-conflict linkages remain a key uncertainty. Intensifying climate change is estimated to increase future risks of conflict.

Effects of temperature and precipitation variability on the risk of violence in sub-Saharan Africa, 1980-2012.

Ongoing debates in the academic community and in the public policy arena continue without clear resolution about the significance of global climate change for the risk of increased conflict. Sub-Saharan Africa is generally agreed to be the region most vulnerable to such climate impacts. Using a large database of conflict events and detailed climatological data covering the period 1980-2012, we apply a multilevel modeling technique that allows for a more nuanced understanding of a climate-conflict link than has been seen heretofore. In the aggregate, high temperature extremes are associated with more conflict; however, different types of conflict and different subregions do not show consistent relationship with temperature deviations. Precipitation deviations, both high and low, are generally not significant. The location and timing of violence are influenced less by climate anomalies (temperature or precipitation variations from normal) than by key political, economic, and geographic factors. We find important distinctions in the relationship between temperature extremes and conflict by using multiple methods of analysis and by exploiting our time-series cross-sectional dataset for disaggregated analyses.

Training high: a clinical skills initiative for families and staff.

During the past 50 years the care of children and young people who are unwell in the UK has shifted out of the hospital environment and into the community and has become more complex, requiring the development among families and care staff of corresponding clinical skills. The ongoing initiative Training High aims to meet this need by offering appropriate training programmes to families and professional carers so they can safely undertake certain procedures. This article describes the success of one training project in England.

Climate variability and conflict risk in East Africa, 1990-2009.

Recent studies concerning the possible relationship between climate trends and the risks of violent conflict have yielded contradictory results, partly because of choices of conflict measures and modeling design. In this study, we examine climate-conflict relationships using a geographically disaggregated approach. We consider the effects of climate change to be both local and national in character, and we use a conflict database that contains 16,359 individual geolocated violent events for East Africa from 1990 to 2009. Unlike previous studies that relied exclusively on political and economic controls, we analyze the many geographical factors that have been shown to be important in understanding the distribution and causes of violence while also considering yearly and country fixed effects. For our main climate indicators at gridded 1° resolution (~100 km), wetter deviations from the precipitation norms decrease the risk of violence, whereas drier and normal periods show no effects. The relationship between temperature and conflict shows that much warmer than normal temperatures raise the risk of violence, whereas average and cooler temperatures have no effect. These precipitation and temperature effects are statistically significant but have modest influence in terms of predictive power in a model with political, economic, and physical geographic predictors. Large variations in the climate-conflict relationships are evident between the nine countries of the study region and across time periods.

Safety, tolerability, and pharmacokinetics of SPL7013 gel (VivaGel): a dose ranging, phase I study.

OBJECTIVES: To evaluate safety, tolerability and systemic pharmacokinetics of escalating doses of SPL7013 Gel in healthy women. DESIGN: : Randomized, double-blind, placebo-controlled dose-escalation trial. METHODS: Thirty-seven healthy women were randomized to receive 3.5 g of 0.5% (N = 8), 1% (N = 8), or 3% (N = 9) SPL7013 Gel or placebo gel (N = 12), applied vaginally once daily for 7 consecutive days. Genital toxicity was determined by interview, physical examination, assessment of vaginal microflora and colposcopy. Systemic toxicity was determined by nongenital adverse events (AEs) and laboratory assessments. Plasma was collected for pharmacokinetic analysis. RESULTS: Genital AEs considered potentially product-related were all mild and reported by 5 (20%) women receiving SPL7013 Gel and 2 (17%) women receiving placebo gel. The most common were abdominal pain or discomfort, with no reports of vaginal burning or malodour, or genital-tract pain. There were no clinically significant colposcopic findings, including of genital inflammation or epithelial disruption. Lower concentrations of normal lactobacillary flora occurred during SPL7013 Gel and placebo gel use, with a decrease in anaerobes in the SPL7013 Gel groups. There were no reported cases of bacterial vaginosis, and lactobacilli returned to predose levels in most women after treatment. All nongenital AEs were of mild or moderate severity, expect for a severe tension headache in a woman receiving placebo. There was no absorption of SPL7013 into the systemic circulation. CONCLUSIONS: SPL7013 Gel applied vaginally once daily for 7 days at concentrations of 0.5% to 3% was safe and well tolerated in healthy, sexually abstinent women, with no evidence of systemic toxicity or absorption.

Asma bronquial: tratamiento / Bronchial asthma: treatment

El tratamiento tradicional para el asma bronquial - aire puro y ejercici vigoroso- tiene su razon de ser, porque al alejarse de los agente causales algunos pacientes asmaticos obtienen alivio. Sin embargo, hoy en dia el medico dispone de muchos medios farmacologicos que permiten detener los episodios asmaticos agudos y mantener los sintomas cronicos bajo control en aquellos casos en que es imposible determinar o eliminar la causa. El articulo describe los agentes antiasmaticos de uso actual y las posologias que ofrecen la mayor eficacia terapeutica