Safety classification of herbal medicines used in pregnancy in a multinational study.

BACKGROUND: The use of herbal medicines for health prevention and ailments is an increasing trend worldwide. Women in pregnancy are no exception; the reported prevalence of herbal medicine use in pregnancy ranges from 1 to 60 %. Despite a common perception of safety, herbal medicines may have potent pharmacological actions, and historically, have been used for this reason. METHODS: A multinational, cross-sectional study on how women treat disease and pregnancy-related health ailments was conducted between October 2011 and February 2012 in Europe, North America, and Australia. This study's primary aim was to evaluate and classify the herbal medicines used according to their safety in pregnancy and, secondly, to investigate risk factors associated with the use of contraindicated herbal medicines during pregnancy. RESULTS: In total, 29.3 % of the women (n = 2673) reported the use of herbal medicines in pregnancy; of which we were able to identify 126 specific herbal medicines used by 2379 women (89.0 %). Twenty seven out of 126 herbal medicines were classified as contraindicated in pregnancy, and were used by 476 women (20.0 %). Twenty-eight were classified as safe for use in pregnancy and used by the largest number of women (n = 1128, 47.4 %). The greatest number was classified as requiring caution in pregnancy; these sixty herbal medicines were used by 751 women (31.6 %). Maternal factors associated with the use of contraindicated herbal medicines in pregnancy were found to be working in the home, having a university education, not using folic acid, and consuming alcohol. Interestingly, the recommendation to take a contraindicated herbal medicine was three times more likely to be from a healthcare practitioner (HCP) than an informal source. CONCLUSION: Based on the current literature the majority of women in this study used an herbal medicine that was classified as safe for use in pregnancy. Women who reported taking a contraindicated herb were more likely to have been recommended it use by an HCP rather than informal source(s), indicating an urgent need for more education among HCPs. The paucity of human studies on herbal medicines safety in pregnancy stands in stark contrast to the widespread use of these products among pregnant women.

Using quantitative disease dynamics as a tool for guiding response to avian influenza in poultry in the United States of America.

Wild birds are the primary source of genetic diversity for influenza A viruses that eventually emerge in poultry and humans. Much progress has been made in the descriptive ecology of avian influenza viruses (AIVs), but contributions are less evident from quantitative studies (e.g., those including disease dynamic models). Transmission between host species, individuals and flocks has not been measured with sufficient accuracy to allow robust quantitative evaluation of alternate control protocols. We focused on the United States of America (USA) as a case study for determining the state of our quantitative knowledge of potential AIV emergence processes from wild hosts to poultry. We identified priorities for quantitative research that would build on existing tools for responding to AIV in poultry and concluded that the following knowledge gaps can be addressed with current empirical data: (1) quantification of the spatio-temporal relationships between AIV prevalence in wild hosts and poultry populations, (2) understanding how the structure of different poultry sectors impacts within-flock transmission, (3) determining mechanisms and rates of between-farm spread, and (4) validating current policy-decision tools with data. The modeling studies we recommend will improve our mechanistic understanding of potential AIV transmission patterns in USA poultry, leading to improved measures of accuracy and reduced uncertainty when evaluating alternative control strategies.

Lead exposure, gestational hypertension and pre-eclampsia: a systematic review of cause and effect.

The association between lead and hypertension in adults was first identified in the early 1980's and it has since been proposed that lead may also have a role in gestational hypertension (GH). This systematic review investigates whether lead may be associated with the development of GH or pre-eclampsia. MEDLINE, Embase and Web of Science were searched from inception to August 2011, using the terms: blood lead levels, pregnancy, pregnancy induced hypertension, gestational hypertension and pre-eclampsia. Nine papers were found. Positive associations between lead and GH or pre-eclampsia were found in six studies. The development of GH or pre-eclampsia may serve as a signal to assess blood lead concentrations in pregnant women, as even low lead concentrations have been shown to negatively impact the neurodevelopment and cognitive abilities of children. Adequate calcium intake throughout the pregnancy and lactation period may assist with reducing lead exposure levels.

Home antipyretic use in children brought to the emergency department.

OBJECTIVE: To determine how often children with a complaint of fever receive antipyretics at home and if any demographic factors are associated with correct dosing. METHODS: A prospective, descriptive study of children 3 to 36 months old presenting with complaint of fever was conducted. Caregivers were questioned about demographics and antipyretic given. The ability of demographics to predict proper dosing was tested first individually and then with a regression model. The effect of proper home dosing on presence of fever and height of fever was also analyzed. A total of 138 children were analyzed. RESULTS: Of the 118 (86%) who received antipyretics at home, only 47% had been given a proper dose. No demographic variable predicted proper dosing. CONCLUSION: Reported antipyretic dose at home did not predict presence of fever or height of temperature measured in the emergency department.

Microbiological safety cabinets: selection, installation, testing and use.

In the last quarter of the 20th century, there was much confusion and uncertainty amongst microbiologists and managers about the choice, installation, testing and use of the various types of microbiological safety cabinet. This review clarifies these issues, with reference to the latest standards and safe procedures.

Evolution of microbiological safety cabinets.

Microbiological safety cabinets have had a chequered history, often being confused with chemical fume cupboards and cabinets intended to protect cultures from contamination rather than workers from infection. They have suffered from incorrect and inapt names. Much work has been required to determine the levels of air flow necessary to contain infectious particles and to prevent the exhaust of those particles to the environment, and this is considered in historical sequence. Warnings are given about the shortcomings of portable and home-made cabinets. This review traces the evolution of these cabinets, from the time of Robert Koch to the development of good national standards.

Infiltrating ductal carcinoma of the vulva.

The eleventh case of primary infiltrating ductal carcinoma of the vulva is reported with a review of the literature. The infiltrating tumor is associated with an intraductal component as well as noninvolved mammary-like glandular tissue (ectopic breast tissue) and metastases to inguinal lymph nodes. Estrogen receptor and progesterone receptor immunohistochemical staining is negative utilizing the HSCORE method. The treatment regimen is patterned after approach to node-positive breast carcinoma.

Pregnancy-related fibroadenoma of ectopic breast tissue in the vulva.

BACKGROUND: Pregnancy-related vulvar fibroadenoma of ectopic breast tissue is rare. Management involves diagnosing the mass as a fibroadenoma by physical examination and delaying excision until the postpartum period. CASE: A 31-year-old multigravid woman at 29 weeks' gestation had a right labial mass that was increasing in size. Physical examination showed accessory breast tissue in the left axilla and three vulvar masses, the largest vulvar mass measuring 4 × 5 cm. Suspicion of malignancy was low, so the patient was serially examined during the pregnancy and the vulvar masses were excised during the postpartum period. The final diagnosis was fibroadenoma of ectopic breast tissue. CONCLUSION: Fibroadenoma of ectopic breast tissue can occur during pregnancy. Diagnosis and serial physical examinations are the appropriate course of management during pregnancy. A fine-needle aspiration biopsy can be performed during pregnancy to confirm the diagnosis. The tumors seldom regress spontaneously and so should be removed during the postpartum period.

Reperfusion of ischemic skeletal muscle causes erythrocyte hemolysis and decreases subsequent oxidant-mediated lung injury.

A prior transient hindlimb ischemia/reperfusion (I/R) insult decreased acute lung injury in rats subsequently treated with cobra venom factor. I/R-mediated protection was associated with erythrocyte hemolysis, increased plasma catalase activity, and increased plasma hydrogen peroxide scavenging activity. In contrast, hindlimb I/R did not increase lung catalase activity, and large amounts of injected catalase were required to increase lung catalase activity. The results suggest that limited I/R in one organ can induce systemic processes that may decrease a subsequent O2 metabolite-mediated injury in another distant organ. The mechanism may involve release of catalase from hemolyzed erythrocytes at levels that are not sufficient to measurably increase total lung catalase activity.

Posttraining D1 receptor blockade impairs odor conditioning in neonatal rats.

Rat pups that were exposed to a novel anise odor paired with tactile stimulation (stroking the skin with a paint brush) received injections of either saline or the dopamine D1 receptor antagonist (+/-)-SKF 83566 (0.1 mg/kg) before conditioning or immediately after conditioning. Animals that received the drug either before or after training showed less approach to the conditioned odor during the testing period 24 hr later than did animals that received the vehicle. Posttraining administration of the D2 receptor antagonist spiperone (0.1 mg/kg) did not affect subsequent approach to the conditioned odor, suggesting a selective effect of D1 receptor blockade. The impairment in learning by the administration of (+/-)-SKF 83566 before conditioning was reversed by the injection of the dopamine receptor agonist apomorphine (0.1 mg/kg) immediately after conditioning. Posttraining D1 receptor activation appears necessary for normal odor conditioning in rat pups.

Protocol for the evaluation of automated blood coagulation instruments (coagulometers) for determination of the international normalised ratio.

Results of prothrombin time tests for the control of oral anticoagulant therapy, when using automated blood coagulation instruments (coagulometers), may not be the same as those obtained when using manual methods, and variation in coagulometer performance may affect clinical interpretation of data. The haematology advisory committee of the Institute of Medical Laboratory Sciences has recommended that coagulometers should be used for determination of prothrombin times only if it can be demonstrated that the results are valid when compared with those of a standardised manual method. A protocol for the evaluation of coagulometers, and details of the procedures, are given in this report, the main emphasis of which is on the assessment of instruments for determination of the International Normalised Ratio. Guidelines are also provided for the general use of machines of this type and for the assessment of safety. The principles of the protocol are applicable to other automated tests of blood coagulation.

Clinical laboratory environmental contamination: use of a fluorescence/bacterial tracer.

A "Centrifichem" centrifugal analyser was found using a double fluorescence/bacterial tracer method to be a source of airborne and surface contamination in the laboratory. The airborne contamination was controlled by a modification incorporating a filter. Ubiquitous surface contamination generally accompanied the processing of simulated patients' sera. Double tracer samples could be used in laboratories to assess the quality of hygiene practices in the same way as quality control samples are currently used to assess the quality of analytical performance. The findings indicated a lack of understanding of basic hygiene practices in the laboratory.

Needlestick injuries: mechanisms and control.

Consideration of a linear model for venepuncture and patterns that emerge from the literature can help to understand the occurrence of occupational needlestick injuries which are common in healthcare workers. A systematic approach can also help in evaluation of potential control measures and in cost-benefit analysis.

Urinary excretion of cyclic nucleotides, creatinine prostaglandin E2 and thromboxane B2 from mice exposed to whole-body irradiation from an enhanced neutron field.

Urine volume and excretion of cyclic AMP, cyclic GMP, prostaglandin E2 (PGE2), thromboxane B2 (TxB2) and creatinine were evaluated as potential indicators of radiation damage in mice given 2-5 Gy to the whole body from an enhanced neutron field. In general, urinary cyclic AMP, cyclic GMP, creatinine and urine volumes were positively correlated across time postexposure, for each radiation dose. TxB2 levels positively correlated with urine volume and cyclic AMP excretion only in animals given 2.0 Gy. None of these parameters suggests their use as a prognostic indicator of the extent of radiation damage. Urinary excretion of PGE2 was negatively correlated with other urinary parameters. Biphasic increases in urinary PGE2 were also observed. The initial transient elevation 2-3 days postexposure was not correlated with the dose (2-5 Gy). The second elevation of PGE2 excretion occurred at 6-10 days. The magnitude of the latter increase suggests that urinary PGE2 excretion may be a useful indicator of whole-body or kidney exposure to neutron fields.

Prostaglandin-mediated suppression of delayed-type hypersensitivity to infected erythrocytes during Babesia microti infection in mice.

The mechanism of suppression of delayed-type hypersensitivity (DTH) to intraerythrocytic Babesia microti which occurs during infection in mice was examined. The suppression was not specific for anti-parasite DTH; infected mice immunized and challenged with sheep red blood cells had a similar depression of anti-sheep red blood cell DTH. Sublethal or lethal irradiation did not significantly alter the suppression of the DTH response, and cyclophosphamide pretreatment of infected mice also had no effect on suppression. Multiple passive transfer experiments using serum or regional lymph node cells from immunized or infected and immunized (suppressed) donor animals failed to demonstrate any ability to transfer suppression of DTH. Adherent cells from the spleens or peritoneal exudates of suppressed mice, however, did significantly depress the ability of immunized mice to express a DTH response. The cells responsible for this suppression were Thy 1- and nonspecific esterase+. Treatment of suppressive cell populations with 10 micrograms/ml indomethacin for 24 hr in vitro abrogated their suppressive ability, and in vivo administration of indomethacin to suppressed mice also restored DTH to normal levels. By examining levels of prostaglandin E2 (PGE2) in supernates of cultured peritoneal exudate cells from immune or suppressed mice, it was shown that infected mice had peritoneal exudate cells which produced significantly more PGE2 than similar cells from immune mice. These data suggest that B. microti infection elicits synthesis of PGE2 by macrophage-like cells which results in suppression of DTH to parasite as well as heterologous antigens.