Urban and rural comparison of vitamin D status in Pakistani pregnant women and neonates.

We undertook a cross-sectional study in rural Jehlum and urban Karachi to evaluate the prevalence of vitamin D deficiency in Pakistani pregnant women and neonates and to assess any association of serum 25(OH) vitamin D [25(OH)D] concentration with vitamin D binding protein (Gc) genotypes. Altogether, 390 women and 266 neonates were recruited from urban and rural sites, respectively. Serum 25(OH)D was measured by an immunoassay, while Gc genotypes were identified using polymerase chain reaction followed by restriction fragment length polymorphism or PCR-RFLP. One-way analysis of variance or ANOVA and linear regression were used for statistical analysis. In urban Karachi, 99.5% of women and 97.3% of neonates were vitamin D deficient (< 50 nmol/L), while 89% of women and 82% of neonates were deficient in rural Jehlum. Gc genotypes were not associated with serum 25(OH)D concentrations in both women and their neonates. We conclude that vitamin D deficiency is highly prevalent in Pakistani women and their neonates, and Gc genotypes are not associated with serum 25(OH)D concentrations.

Microbial epidemiology and clinical risk factors of carbapenemase-producing Enterobacterales amongst Irish patients from first detection in 2009 until 2020.

Background: Carbapenemase producing Enterobacterales (CPE) are major public health threats. Aim: To review microbial epidemiology of CPE, as well as clinical risk factors and infections, amongst CPE positive patients over 12 years in an Irish tertiary hospital. Methods: Retrospective observational study of data extracted from a laboratory CPE database, electronic healthcare records and manual review of patient charts. Common risk factors, treatment regimens for all CPE related infections, and clinical outcomes were ascertained. Findings: Among CPE strains isolated from 460 patients, Klebsiella pneumoniae carbapenemase (KPC) was the carbapenemase most frequently detected, accounting for 87.4% (459) of all CPE enzymes. Citrobacter species 177 (33.7%) were the most common species harbouring this enzyme. 428 CPE positive patients (93%) were identified in the acute hospital setting; the most common risk factor for CPE acquisition was history of hospitalisation, observed in 305 (66%) cases. Thirty patients (6.5%) had confirmed infections post-acquisition, of which four were bloodstream infections. There were 19 subsequent episodes of non CPE-related bacteraemia in this cohort. All causal mortality at 30 days was 41 patients (8.9%). However, clinical review determined that CPE was an indirect associative factor in 8 patient deaths. Conclusions: In this tertiary hospital setting, microbial epidemiology is changing; with both OXA-48 enzymes and KPC-producing Citrobacter species becoming more prevalent. Whilst the burden of CPE related infections, especially bacteraemia, was low over the study period, it remains critical that basic infection prevention and control practices are adhered to lest the observed changes in epidemiology result in an increase in clinical manifestations.

PIERS proteinuria: relationship with adverse maternal and perinatal outcome.

OBJECTIVE: To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot urine protein:creatinine ratio [Pr/Cr], and 24-hour urine collection) to predict adverse pregnancy outcomes. METHODS: We performed a prospective multicentre cohort study, PIERS (Preeclampsia Integrated Estimate of RiSk), in seven academic tertiary maternity centres practising expectant management of preeclampsia remote from term in Canada, New Zealand, and Australia. Eligible women were those admitted with preeclampsia who had at least one antenatal proteinuria assessment by urinary dipstick, spot urine Pr/Cr ratio, and/or 24-hour urine collection. Proteinuria assessment was done either visually at the bedside (by dipstick) or by hospital clinical laboratories for spot urine Pr/Cr and 24-hour urine collection. We calculated receiver operating characteristic area under the curve (95% CI) for each proteinuria method and each of the combined adverse maternal outcomes (within 48 hours) or adverse perinatal outcomes (at any time). Models with AUC ≥ 0.70 were considered of interest. Analyses were run for all women who had each type of proteinuria assessment and for a cohort of women ("ALL measures") who had all three proteinuria assessments. RESULTS: More women were proteinuric by urinary dipstick (≥ 2+, 61.4%) than by spot urine Pr/Cr (≥ 30 g/mol, 50.4%) or 24-hour urine collection (≥ 0.3g/d, 34.7%). Each proteinuria measure evaluated had some discriminative power, and dipstick proteinuria (categorical) performed as well as other methods. No single method was predictive of adverse perinatal outcome. CONCLUSION: The measured amount of proteinuria should not be used in isolation for decision-making in women with preeclampsia. Dipstick proteinuria performs as well as other methods of assessing proteinuria for prediction of adverse events.

Pregnancy following cardiac surgery.

OBJECTIVE: To determine the pregnancy outcome in women with cardiac disease who have undergone cardiac surgery. DESIGN AND SETTING: Prospective study in a tertiary care hospital. POPULATION: One hundred and thirteen pregnant women who had cardiac surgery due to valvular disease (commisurotomy as well as valve replacement), or other cardiac defects. These women were followed up in 170 pregnancies between January 1990 and December 1999. RESULTS: Rheumatic heart disease (91%) affecting the mitral valve, was the commonest indication for cardiac surgery (89%). Valve replacement with mechanical prostheses followed by anticoagulant therapy was carried out in 45%. There was no maternal death. Maternal morbidity from complications included pulmonary oedema (16%), cardiac arrythmias (4%), postpartum haemorrhage (3.5%). Other bleeding complications included epistaxis and haematoma at episiotomy site (2%). Impaired functioning of prosthesis (4%), severe pregnancy induced hypertension (2%) and thromboembolism (0.6%) were also observed. The abortion rate was 10.6%. There were 3 stillbirths (2%), another 6.7% babies were born preterm and 28% were lighter than appropriate for the period of gestation. There were no neonatal deaths. Coumarin derivatives were not associated with obvious foetal malformation. CONCLUSION: With appropriate care, the outcome of pregnancy in women who have had cardiac surgery is favourable, if their functional class is good.

Management of complicated hemangiomas with vincristine/vinblastine: Quantitative response to therapy using MRI.

PURPOSE: To quantify the efficacy of vincristine and vinblastine in the treatment of complicated hemangiomas. DESIGN: Retrospective review. METHODS: Charts were reviewed to identify patients treated with vincristine or vinblastine for complicated hemangiomas from August 2002 to October 2007. Only patients who received both a pre and post-treatment magnetic resonance imaging (MRI) were considered. A database was created which includes patient gender, age at treatment initiation, rationale for treatment, hemangioma location, number of cycles of chemotherapy received, and complications of treatment. A single pediatric radiologist calculated lesion volumes from both pre and post-treatment MRI which were compared to quantify treatment response. RESULTS: Seven patients (2 male, 5 female) met criteria. Mean age at treatment initiation was 20 weeks (median 14, range 5-60). Rationale for treatment included four patients (57%) with proptosis/orbital compromise and one patient each (14%) with heart failure, airway compression, and hemangiomatosis with rapid growth of multiple lesions. Patients received a mean of 2.86 cycles of chemotherapy (median 3, range 1-5). Twelve lesions were identified and analyzed for pre and post-treatment volume on MRI in the seven patients. Eleven of twelve (92%) lesions decreased in size after treatment. The mean volume ratio of hemangiomas at the conclusion of chemotherapy was 0.45 compared to pre-treatment size (median 0.18, range 0-2.19) Orbital compromise, airway compression, and cardiac failure either improved or resolved in all patients. Three complications of treatment were seen in seven patients (42%) including bacteremia with anemia, peripheral neuropathy and motor delay. All complications resolved after cessation of chemotherapy. CONCLUSIONS: Treatment of complicated hemangiomas with vincristine or vinblastine can control growth and improve symptoms in the majority of patients. Treatment often requires multiple cycles of chemotherapy. Complications of treatment are common, but reversible.