Interaction of chorioamnionitis at term with maternal, fetal and obstetrical factors as predictors of neonatal mortality: a population-based cohort study.

BACKGROUND: Chorioamnionitis is a frequent complication of pregnancy and is known to be associated with serious adverse post-natal outcomes including death. However, the assessment of fetal well-being in labor in the context of chorioamnionitis is often challenging because of fetal tachycardia. Identifying specific risk factors for adverse neonatal outcomes in the context of chorioamnionitis could therefore be of paramount importance. This study aimed to determine if maternal and fetal risk factors for increased neonatal mortality and early neonatal mortality are modified in the context of chorioamnionitis in term pregnancies. METHODS: A retrospective population-based cohort study using the United States birth/infant death public file from 2011 to 2013 was performed, including all live births at 37 weeks gestation and beyond. Interaction between chorioamnionitis and maternal demographic variables as well as labor and delivery potential risk factors were analyzed for association with neonatal death (< 28 days) and early neonatal death (< 7 days) using multivariate logistic regressions. RESULTS: Among 9,034,428 live births, the prevalence of chorioamionitis was 1.29% (95% CI 1.28-1.30%). The incidence of neonatal death and early neonatal death were 0.09 and 0.06% in the chorioamnionitis group versus 0.06 and 0.04% in the no chorioamnionitis group (p = 0.0003 and < 0.0001), respectively. Smoking was significantly associated with neonatal death and early neonatal death in the context of chorioamnionitis (OR 2.44, CI:1.34-4.43/ 2.36 CI:1.11-5.01) but was either less strongly or not associated in the absence of chorioamnionitis (OR 1.24, CI:1.14-1.35/0.93, CI:0.82-1.05). The association between gestational age (37 weeks compared to 39 weeks) and neonatal death was more important in the context of chorioamnionitis (OR = 3.19, CI: 1.75-5.82 versus 1.63, CI: 1.49-1.79). Multivariate analysis identified the following risk factors for neonatal death and/or early neonatal death: low maternal education, extreme maternal age, obesity (BMI > 35 kg/m2), late or no prenatal care, diabetes, meconium-stained amniotic fluid, gestational ages other than 39 weeks, neonatal weight < 2500 g and delivery by vacuum or caesarian. CONCLUSIONS: Smoking as well as early term have a positive interaction with chorioamnionitis for the risk of neonatal mortality. This should be taken into account when counseling pregnant women and managing laboring pregnant women with suspected chorioamnionitis.

Evaluation of antagonistic actinomycetes isolates as biocontrol agents against wastewater-associated bacteria.

In wastewater treatment plants the antagonistic activities of actinomycetes could be contributing significantly in microbe-removing mechanisms, which are a combination of different factors. For this purpose, out of 58 actinomycetes isolates from a wastewater treatment plant in Al-Fayoum Governorate, Egypt, only 36 different morphological isolates were selected for further studies. Although 35 isolates (97.23%) were active against one or more of tested bacteria, WD5 isolate had broad-spectrum antagonistic activity against both Gram-negative and Gram-positive tested bacteria. WD5 ethyl acetate extract recorded the highest antibacterial activity against Staphylococcus aureus MTCC 96 (23 mm) and the lowest antibacterial activity against Pseudomonas aeruginosa MTCC 2453 (11 mm). Gas chromatography-mass spectrometry analysis of extract using available NIST (National Institute of Standards and Technology) library data identified seven bioactive compounds: 2-methylbutyl acetate, 3',5'-dinitrobenzoic acid, 1-octadecene, tetradecane, dodecane, docosane, and methylamine,N,N-bis(N.-decyl). Many earlier studies mentioned the antibacterial activity of all above seven compounds. The 16S rRNA sequence of WD5 was recorded in GenBank under the accession number MK491056 and confirmed by comparing it with the known 16S rRNA sequences in GenBank as Streptomyces sp. These results indicated antagonistic activity of actinomycetes in the removal of wastewater-associated bacteria.

Infections in children with simple obesity: The relation to phagocytic function and serum leptin.

INTRODUCTION: There is a possible association between obesity and infections. We sought to investigate phagocytic functions in obese children and their relation to serum leptin levels. METHODS: A cross sectional, controlled study was conducted, comprising 40 cases with simple visceral-type obesity. Subjects were evaluated for percentage of caloric intake, frequency and type of infections, body mass index (BMI) z score, in addition to complete blood counting, serum leptin assay (ELISA) and Dihydrorhodamine (DHR) flowcytometry. RESULTS: Cases were 21 males (52.5%) and 19 females (47.5%) with mean age 7.14 years±2.73 SD with median duration of obesity 4.2 years (IQR: 2-6). Cases had higher frequency of infections compared with controls (p<0.001). Serum leptin was significantly higher among cases (t=-12.391, p<0.001), while DHR results were comparable in the studied groups (p=0.067). Among cases, absolute lymphocytic count (ALC) correlated negatively with percentage of total caloric intake (p=0.045). Leptin levels correlated positively with frequency of infections (p=0.019) but negatively with ALC (p=0.043). DHR results showed weak negative correlations with serum leptin (p=0.177) and with BMI Z score (p=0.109). CONCLUSION: Obese children are posed at increased risk of infections and have higher serum leptin levels with possible negative effects of leptin on phagocytic functions.

Pelvic floor muscle training as a treatment for genitourinary syndrome of menopause: A single-arm feasibility study.

OBJECTIVES: Treatments for genitourinary syndrome of menopause (GSM) may not be suitable for all women, may not be completely effective, and may cause adverse effects. Therefore, there is a need to explore new treatment approaches. The objectives were to evaluate the feasibility of using a pelvic floor muscle training (PFMT) program in postmenopausal women with GSM, and to investigate its effect on symptoms, signs, activities of daily living (ADL), quality of life (QoL) and sexual function. STUDY DESIGN: Postmenopausal women with GSM participated in a single-arm feasibility study embedded in a randomized controlled trial (RCT) on PFMT for urinary incontinence. This substudy was composed of two pre-intervention evaluations, a 12-week PFMT program and a post-intervention evaluation. MAIN OUTCOME MEASURES: Feasibility was defined as study completion and participation in physiotherapy sessions and in-home exercises. The effects of the PFMT program were assessed by measuring GSM symptoms ('Most Bothersome Symptom' approach, ICIQ-UI SF), GSM signs (Vaginal Health assessment scale), GSM's impact on ADL (Atrophy Symptom questionnaire), QoL and sexual function (ICIQ-VS, ICIQ-FLUTSsex) and leakage episodes. RESULTS: Thirty-two women participated. The study completion rate was high (91%), as was participation in treatment sessions (96%) and in-home exercises (95%). Post-intervention, there were significant reductions in GSM symptoms and signs (p < 0.01) as well as in its impacts on ADL, QoL and sexual function (p < 0.05). CONCLUSIONS: A study including a PFMT program is feasible, and the outcomes indicate PFMT to be an effective treatment approach for postmenopausal women with GSM and urinary incontinence. This intervention should be assessed through a RCT.

Assessment of Allergic Rhinitis among Children after Low-Level Laser Therapy.

BACKGROUND: Allergic rhinitis (AR) represents one of the most common global health problems with seriously increasing incidence over the last decades. The goal of the treatment of rhinitis is to prevent or reduce the symptoms caused by the inflammation of affected tissues. Intranasal steroids and oral antihistamines are recommended as first lines of treatment. Acupuncture had reported a significant improvement in daily symptoms and an increase of symptom-free days in many studies enrolling adults' patients. AIM: This study aimed to evaluate the laser acupuncture effect on the treatment of children AR in comparison to the effect of the medication and to assess the anti-inflammatory effect of laser acupuncture through measurement of serum inflammatory marker (hs-CRP). METHODS: Sixty patients with allergic rhinitis their age group ranged from 4 to 18 years were divided randomly into two groups. Group 1 enrolled 30 patient that received AR in the form of intranasal steroids, antihistaminic, leukotriene antagonists while group2 thirty patients received 12 laser acupuncture sessions (2 sessions a \ week) on specific traditional Chinese acupuncture points. RESULTS: There was a significant improvement in the severity score symptoms in both groups through and by the end of the study. High Significant improvement in the levels of the inflammatory marker in both groups, especially in the group which receive laser acupuncture sessions. CONCLUSION: Laser acupuncture is a reliable, painless and non-invasive successful technique, which may be used as a complementary treatment for pediatric allergic rhinitis.