Do improvements in clinical practice guidelines alter pregnancy outcomes in asthmatic women? A single-center retrospective cohort study.

OBJECTIVE: Asthma occurs in ∼17% of Australian pregnancies and is associated with adverse perinatal outcomes, which worsen with poor asthma control. Consequently, the South Australian 'Asthma in Pregnancy' perinatal guidelines were revised in 2012 to address management according to severity. This study investigated if these revised guidelines reduced the impact of maternal asthma on risks of adverse perinatal outcomes before (Epoch 1, 2006-2011) and after the revision (Epoch 2, 2013-2018). METHODS: Routinely collected perinatal and neonatal datasets from the Women's and Children's Hospital (Adelaide, Australia) were linked. Maternal asthma (prevalence:7.5%) was defined as asthma medication use or symptoms described to midwives. In imputation (n = 59131) and complete case datasets (n = 49594), analyses were conducted by inverse proportional weighting and multivariate logistic regression, accounting for confounders. RESULTS: Overall, maternal asthma was associated with increased risks of any antenatal corticosteroid treatment for threatened preterm birth (aOR 1.319, 95% CI 1.078-1.614), any Cesarean section (aOR 1.196, 95% CI 1.059-1.351), Cesarean section without labor (aOR 1.241, 95% CI 1.067-1.444), intrauterine growth restriction (IUGR, aOR 1.285, 95% CI 1.026-1.61), and small for gestational age (aOR 1.324, 95% CI 1.136-1.542). After guideline revision, asthma-associated risks of any Cesarean section (p < 0.001), any antenatal corticosteroids (p = 0.041), and small for gestational age (p = 0.050), but not IUGR and Cesarean section without labor, were reduced. CONCLUSIONS: Clinical practice guidelines based on the latest evidence do not guarantee clinical efficacy. Since adverse perinatal outcomes did not all improve, this work highlights the need to evaluate the ongoing impact of guidelines on clinical outcomes.

CD4 count and risk of anti-tuberculosis drug-associated cutaneous reactions in HIV-infected Thai patients.

OBJECTIVES: Tuberculosis (TB) is a major cause of morbidity and mortality in human immunodeficiency virus (HIV) infected patients. However, anti-tuberculosis drugs can cause cutaneous adverse drug reactions (CADRs). This study was conducted to evaluate differences in CADR incidence between low and high CD4 cell count in patients with low and high CD4 cell count and to identify other risk factors for CADR in HIV-TB co-infected patients. DESIGN: In a retrospective cohort of adult HIV-TB co-infected patients receiving standard anti-tuberculosis treatment between January 2008 and December 2015 at Vajira Hospital, Bangkok, Thailand, baseline demographic, clinical characteristics and factors associated with CADRs, including CD4 cell count status, were collected. RESULTS: Of 307 patients enrolled, CADRs occurred in 48 during the 6-month period of anti-tuberculosis treatment (incidence rate 0.41 events/person-year). Maculopapular rash was the most prevalent CADR. Low CD4 cell count was not associated with CADRs. Cox regression analysis revealed that moderate decrease in the glomerular filtration rate, history of drug hypersensitivity and concomitant cotrimoxazole use were all associated with CADRs. Concomitant antiretroviral therapy use was associated with lower risk of CADRs. No difference in the time to CADRs between patients with lower and higher CD4 cell count could be demonstrated. CONCLUSION: CADRs are common in HIV-TB co-infected patients. Early recognition and prompt withdrawal of the offending agent can prevent complications and improve TB care.

The highly abundant urinary metabolite urobilin interferes with the bicinchoninic acid assay.

Estimation of total protein concentration is an essential step in any protein- or peptide-centric analysis pipeline. This study demonstrates that urobilin, a breakdown product of heme and a major constituent of urine, interferes considerably with the bicinchoninic acid (BCA) assay. This interference is probably due to the propensity of urobilin to reduce cupric ions (Cu(2+)) to cuprous ions (Cu(1+)), thus mimicking the reduction of copper by proteins, which the assay was designed to do. In addition, it is demonstrated that the Bradford assay is more resistant to the influence of urobilin and other small molecules. As such, urobilin has a strong confounding effect on the estimate of total protein concentrations obtained by BCA assay and thus this assay should not be used for urinary protein quantification. It is recommended that the Bradford assay be used instead.

A public perception of access to NHS dentistry.

OBJECTIVE: To quantify the level of unmet dental access need which had been reported locally and to provide information about the perceived need for dental treatment with particular reference to those not registered for continuing NHS care. DESIGN: A postal survey of adults resident in Aylesbury Vale, Buckinghamshire was carried out toward the end of 1994. SUBJECTS AND METHODS: 2000 adults aged between 35 and 54 years were randomly selected: RESULTS: A response rate of 68% matched well with the population under study. 16% of people were unable to access any regular dental care and this group had the highest treatment need, with more experience of broken fillings and toothache within the previous year. 15% thought they were registered with an NHS dentist, but were not. Only 28% of all respondents were confirmed registered with an NHS dentist. 27% said they received private care, and one-third of these said it was because they had been unable to find an NHS dentist. In total, 74% of the population under study thought they were receiving regular dental care and only 6% did not want regular care. More than one-third of respondents volunteered comments about dental services. The majority were supportive of dentists but critical of the lack of NHS provision. CONCLUSIONS: This survey indicates a substantial unmet perceived need in Aylesbury Vale, with more than one-third of this population unable to access continuing NHS dental services which they prefer. There is also a need for emergency and occasional dental treatment for a small proportion of this population. It is likely that a similar situation exists elsewhere in England.