Maternal early warning criteria predict postpartum severe maternal morbidity and mortality after delivery hospitalization discharge: a case-control study.

BACKGROUND: The predictors of postpartum severe maternal morbidity and mortality have not been well-described using patient-level data. OBJECTIVE: This study aimed to evaluate the application of maternal early warning criteria in the postpartum period and generate a preliminary predictive model for severe maternal morbidity and mortality occurring after delivery hospitalization discharge until 42 days postpartum. STUDY DESIGN: A retrospective case-control study was conducted from January 2013 to September 2020. Cases were identified from electronic medical records using the International Classification of Diseases, Tenth Revision codes for Centers for Disease Control and Prevention-defined severe maternal morbidity. Patients meeting the criteria for severe maternal morbidity and mortality from delivery hospitalization discharge until 42 days postpartum were matched for delivery hospital and year with the controls in an approximate 1:2 fashion. The objective was to identify the demographic and clinical risk factors during the antepartum through postpartum periods for postpartum severe maternal morbidity and mortality. Multivariable logistic regression was performed to estimate the risks, and a receiver operating characteristic curve was derived to evaluate the model. RESULTS: Ninety cases of postpartum severe maternal morbidity and mortality that occurred following delivery hospitalization discharge were identified. These were matched with 175 controls. Women with postpartum severe maternal morbidity and mortality had more postpartum assessments (mean: 1.7 vs 1.4, P=.005) and a higher frequency of maternal early warning criteria (58% [52/90] vs 2% [3/175]; P<.001) preceding the diagnosis of severe maternal morbidity and mortality than controls. Black women had higher odds of postpartum severe maternal morbidity and mortality than White women (odds ratio, 1.93; 95% confidence interval, 1.14-3.27). Women with maternal early warning criteria during postpartum assessments were more likely to experience subsequent postpartum severe maternal morbidity and mortality (odds ratio, 67.2; 95% confidence interval, 21.3-211.6) than women with no maternal early warning criteria. Although the point estimate was different in Black women (odds ratio, 161.8; 95% confidence interval, 8.9 to >999) than White women (odds ratio, 47.9; 95% confidence interval, 13.8-167.1), the effect modification between the maternal early warning criteria and race was not statistically significant (P=.93). In a multivariable model, race, body mass index, cesarean delivery, and maternal early warning criteria at postpartum assessments were associated with subsequent severe maternal morbidity and mortality, with an area under the curve of 0.905 (95% confidence interval, 0.864-0.946). CONCLUSION: Maternal early warning criteria are associated with increased odds of postpartum severe maternal morbidity and mortality. A straightforward model that includes race, body mass index, cesarean delivery, and presence of maternal early warning criteria appears to be a promising tool to identify those at risk for postpartum severe maternal morbidity and mortality following delivery hospitalization discharge. This is an important first step in improving the ability to recognize and respond to conditions preceding postpartum severe maternal morbidity. These findings should be validated in a prospective cohort.

Clinical audit of referrals for sexual abuse among females ages 13–19 years attending the Agape Family Medicine Clinic, Nassau, Bahamas, 2011–2015

OBJECTIVE: To evaluate the adequacy of the documentation of referrals for sexually abused females ages 13–19 years directed to the Agape Family Medicine Clinic for interim management. SUBJECTS AND METHODS: An approved review was performed on 123 referral forms regarding sexually abused females 13–19 years old who attended Agape’s Sexual Assault Follow-up and Evaluation (SAFE) clinic, Nassau, Bahamas. The exercise focussed on documentation adequacy based on a scoring system developed by the researchers: > 50% was assessed to be adequate, and recording disposition, date of incident and sexually transmitted infection (STI) screening was considered vital for adequacy. A current version of Statistical Package for the Social Sciences (IBM SPSS, v 21) generated descriptive and inferential statistics. RESULTS: Participants’ median age was 14 (IQR: 13, 15) years old. Of 63.4% (n = 78) with documented nationality, 88.5% (n = 69) were Bahamian and 11.5% (n = 9) Haitian. Documentation status did not differ statistically significantly by nationality. Regarding documentation, 74% (n =91) recorded school, 59.3% (n = 73) recorded knowing the assailant and 17.9% (n = 22) indicated not knowing. Approximately two-thirds (65.9%; n = 81) indicated penetration type; 18.7% recorded disposition, 29.8% (n =36) incident date and 60.2% STI screening; 7.3% (n = 9) documented all three and 22.8% (n = 28) two. Among public health clinics (PHCs), 45.3% (n = 29) did not indicate any of the three vital variables versus 7.8% (n = 4) for Accident and Emergency (A&E) referrals. Mean percent documentation for vital variables was 49.3 (± 3.6)%for A&E versus 30.5 (± 4.0)% for PHCs (p = 0.001). CONCLUSION: The deficient documentation status of referral forms demands the need for reform. Complete, consistent documentation is required.

Surface Study of Lithium-Air Battery Oxygen Cathodes in Different Solvent-Electrolyte pairs.

The O2/Li2O2 electrode reaction has been studied on low surface area Au electrodes in three solvent-electrolyte pairs (0.1 M LiPF6/DMSO, LiPF6/ACN, and LiBF4/ACN) using an electrochemical cell coupled to UHV XPS spectrometer, EQCM, AFM, and DEMS. The XPS spectra of the surfaces after treatment at selected electrode potentials for the O2 reduction and reoxidation of the surface show the presence of C and S from solvent decomposition and of F and P from electrolyte decomposition. Furthermore, Li 1s and O 1s peaks due to Li2O2 and decomposition products such as carbonate, organics, LiF, high oxidation sulfur, and phosphorus compounds were also observed. Using ACN instead of DMSO results in less solvent decomposition, whereas using LiBF4 results in less electrolyte decomposition. XPS, AFM, and EQCM show that O2 reduction products removal only takes place at very high overpotentials. In agreement with XPS which shows removal of carbonate surface species, DEMS confirms evolution of CO2 and consumption of O2 at 4.5 V, but LiF cannot be removed completely in a round trip of the Li-O2 battery cathode.

KIR genes polymorphism in Argentinean Caucasoid and Amerindian populations.

In natural killer cells, killer immunoglobulin-like receptors (KIRs) loci code for either inhibitory or activating receptors, and according to the number of genes present in each individual, it is possible to identify a high rate of polymorphism in the populations. We performed KIR typing by polymerase chain reaction-sequence-specific oligonucleotide probing in 402 Argentinean Caucasoid and in two Amerindian populations (101 Wichis and 54 Chiriguanos) from the North of Argentina. KIR2DL4, KIR3DL2, KIR3DL3 and KIR3DP1 were always present, whereas the frequencies of KIR2DL1, KIR2DL3, KIR2DS4, KIR3DL1 and KIR2DP1 ranged between 84% and 96%. The frequencies of KIR2DS2, KIR2DL2, KIR2DL5, KIR2DS5, KIR2DS1 and KIR3DS1 ranged between 41% and 62%. The KIR2DS3 with a frequency of 29% in Argentinean Caucasoid population was present at a very low frequency in Amerindian populations. Haplotype segregation studies performed in 10 Wichi families showed the presence of only three haplotypes: A, B5 and B1. The Amerindian populations showed several similarities to Asian but not to Caucasoid populations with regard to the frequency of KIR2DS3, full-length KIR2DS4 gene and KIR2DL4 alleles.

Increased frequencies of activating natural killer receptors are associated with liver injury in individuals who do not eliminate hepatitis C virus.

This study was designed to investigate the role of killer immunoglobulin-like receptor (KIR) genes in the outcome of hepatitis C virus (HCV) infection. In patients who cleared the virus (HCV RNA-) we found a decrease of 2DL2 (P= 0.04), and 2DS2 (P= 0.014) accompanied by an increase of 2DS5 (P= 0.04). Those RNA+ patients with elevated levels of hepatic transaminases (HCV RNA+ elevated alanine aminotransferase) showed an increased frequency of 2DS3 (P= 0.018). Additionally, in cirrhotic patients we found an increased frequency of individuals having two copies of 3DS1 and HLA-Bw4 (P= 0.016). We conclude that higher natural killer cytotoxicity might be associated with a worse progression of the HCV infection.

KIR receptors and HLA-C in the maintenance of pregnancy.

The present study demonstrated that patients who have recurrent spontaneous abortions (RSA) presented a decreased number of killer immunoglobulin-like inhibitory receptors (KIR), in particular KIR2DL2. The KIR AA genotype was found increased in comparison with controls. Individuals AA will also be homozygous for 2DL3, which in contrast to 2DL2, show a weaker interaction with C1 ligands and therefore a weaker inhibition. The present study might support that in RSA patients, the balance between inhibitory and activating receptors present in natural killer cells is inclined toward an activating state that may contribute to pregnancy loss.

Characterisation of a new HLA-B allele, HLA-B*0720, identified in the Cuban population.

The HLA class I genes display significant levels of polymorphism, which is principally due to hypervariable regions located in the second and third exons. To date, 286 HLA-B alleles have been identified and characterised. We describe a new HLA-B*07 allele present in a Cuban Caucasoid individual, which has been officially named HLA-B*0720.

Sistema de vigilancia especializado de enfermedades diarréica agudas en el área de salud Nº11 de Pedro Vicente Maldonado / System of monitoring specialized of acute diseases diarréica in the area of health Nº11 de Pedro Vicente Maldonado

El Área de Salud Nº11 de Pedro Vicente Maldonado de la Provincia de Pichincha, de reciente creación (finales 1998), perteneciente al Ministerio de Salud se encuentra ubicado en el Noroccidente de la Provincia de Pichincha a 116 Km. de la ciudad capital Quito y comprende los cantones de San Miguel de los Bancos, Pedro Vicente Maldonado y Puerto Quito.El perfil epidemiológico del áea de Salud Nº11, definido por el autor se basa en dos componentes: Diez primeras causas de morbilidad y las enfermedades de alto riesgo (EPI-2)

Analysis of the distribution of HLA-A alleles in populations from five continents.

The variation and frequency of HLA-A genotypes were established by PCR-SSOP typing in diverse geographically distributed populations: Brazilian, Colombian Kogui, Cuban, Mexican, Omani, Singapore Chinese, and South African Zulu. HLA-A allelic families with only one allele were identified for HLA-A*01, -A*23, -A*25, -A*31, -A*32, -A*36, -A*43, -A*69, -A*80; and with two alleles for HLA-A*03, -A*11, -A*26, -A*29, -A*33, -A*34, and -A*66. Greater variation was detected for HLA-A*02, -A*24, and -A*68 allele families. Colombian Kogui and Mexican Seris showed the least diversity with respect to HLA-A alleles, albeit with small numbers tested, with only four and five HLA-A alleles identified, respectively. It would appear by their presence in all populations studied, either rural or indigenous, that certain alleles are very important in pathogen peptide presentation.

Molecular analysis of HLA class I alleles in the Mexican Seri Indians: implications for their origin.

The molecular analysis of HLA class I loci has demonstrated that, although, the genetic profile is restricted in Amerindians, several micropolymorphisms may be important in conferring a biological advantage. We analyzed the HLA-A and B genetic profile of Seris, a Mexican Indian tribe living in northwestern Mexico in the state of Sonora. There are presently only 619 individuals. Our study included 100 Seris belonging to nine families. HLA-A and -B loci typing was performed by polymerase chain reaction using an amplification refractory mutation system (PCR-ARMS) on a select group of samples; all of them were typed by polymerase chain reaction using sequence-specific oliogonuoleotide probes (PCR-SSOP) at a low-intermediate resolution level. The correlation between the techniques was 100%. Only five HLA-A alleles and seven HLA-B alleles were found. A*0201, A*68, A*31, A*24, B*3501, B*40, B*51, B*3512 and B*15 were present in over 5% of the individuals. B*27052 was detected in 2%. B27 is absent in any other Mexican Indian groups previously studied. The presence of B27 may be the result of a founder effect due to different waves of southward migrations. The B-locus is more diverse and the prevalent haplotypes were: A*0201-B*3501, A*0201-B*40, A*0201-B*3512, A*31-B*51, A*68-B*3501 and A*68-B*40. This genetic profile is different from the pattern of other Mexicans. The phylogenetic tree suggests that Seris are more closely related to the Warao Indians from Venezuela, who live in a similar ecosystem, and to some groups of Argentina, than they are to the Mexican Lacandones who live in the jungle. These data emphasize the relevance of the interaction between genes and environment.

A seven-year field trial of two typhoid vaccines in Guyana

In 1960 about 72,000 Guyanese schoolchildren, aged five to fifteen years, were divided into three similar groups, one of which acted as a control and was given tetanus toxoid, the second was given an acetone-killed typhoid vaccine, and the third a heat-killed-phenolised typhoid vaccine. Two subcutaneous doses of 0.5ml. of reconstituted vaccines were given five weeks apart. An additional 10,000 children received one dose only. The incidence of typhoid fever, diagnosed by the bacteriological isolation of Salmonella typhi, was followed for seven years after vaccination. In those given two doses, 146 cases of typhoid occurred in the control group and 16 and 49 in the acetone and heat-phenol typhoid vaccine groups, showing protection-rates of 88 percent and 65 percent , respectively. In those given one dose of vaccine the protection was somewhat greater, 22 cases occurring in the control group and 1 and 4 in the groups given acetone and heat-phenol vaccines, respectively. Protection showed little diminution until the fifth year after vaccination. (Summary)

Tropical eosinophilia in British Guiana: a preliminary report

This is a report on the clinical aspects of 72 cases of tropical eosinophilia seen at the Georgetown Hospital, British Guiana. The x-ray appearances of these 72 cases plus a further 78 are described. A case that came to post-mortem is described. The report is preceded by a brief review of the history and clinical pathological features of the condition, as well as a suggestion concerning its possible aetiology (AU)