Evaluation of Obstetricians' Opinion of Thrombocytopenia in Pregnancy: A Cross-Sectional Study.

BACKGROUND: Thrombocytopenia occurs in about 8-10% of pregnancies. Thrombocytopenia may be incidental in pregnancy and could point to medical or gestational conditions that may pose a morbidity and mortality risk to both mother and foetus. AIM: To determine Obstetricians' view/opinion about thrombocytopenia in pregnancy. METHODS: A pre-tested structured questionnaire was distributed amongst consultant and resident obstetricians during their antenatal clinics in 3 tertiary hospitals over a period of one month. Analysis was descriptive and results were expressed as frequencies in words, tables and charts. RESULTS: A total of 91 responders were studied of which 24 were consultants (26.4%), 57 (62.6%) senior registrars and 10 (11%) were registrars. There were 20 (22.7%) responders who were unaware of incidental thrombocytopenia in pregnancy. Most obstetricians (n=83, 91.2%) requested for only packed cell volume (PCV) at antenatal booking, only 2 (2.9%) routinely requested for full blood count (FBC). At booking; only 10 (11.1%) obstetricians asked for a history of thrombocytopenia. Majority (n=87, 98.9%) never requested for platelet counts. If they encountered thrombocytopenia, up to 89 (97.8%) would investigate further with a repeat FBC (n=77, 86.5%), coagulation screen (n=54, 61.4%) or bone marrow aspiration (n=20, 24.7%). Most of the obstetricians (n=82, 96.5%) would transfuse patients with thrombocytopenia and 34 (43.6%) of them would do so when the count is <50 X 109/L. CONCLUSION: Obstetricians have the capacity to investigate symptomatic thrombocytopenia in pregnancy but do not routinely screen for asymptomatic thrombocytopenia. Routine FBC if done at booking may identify missed cases of asymptomatic thrombo-cytopenia for adequate management.

CONTEXTE: La thrombocytopénie survient dans environ 8 à 10 % des grossesses. La thrombocytopénie peut être fortuite pendant la grossesse et peut indiquer une condition médicale ou gestationnelle qui peuvent poser un risque de morbidité et de mortalité pour la mère et le fœtus. OBJECTIF: Déterminer le point de vue/opinion des obstétriciens concernant la thrombocytopénie pendant la grossesse. MÉTHODES: Un questionnaire structuré et pré-testé a été distribué parmi les obstétriciens consultants et résidents lors de leurs consultations prénatales dans trois hôpitaux tertiaires sur une période d'un mois. L'analyse descriptive et les résultats ont été exprimés sous forme de fréquences en mots, tableaux et graphiques. RÉSULTATS: Au total, 91 répondants ont été étudiés, dont 24 étaient Les conseillers(26,4 %), 57 (62,6 %) des chefs de clinique et 10 (11 %) des titulaires. Il y' avait Vingt (22,7 %) des répondants n'étaient pas au courant de la présence de thrombocytopénie fortuite pendant la grossesse. La plupart des obstétriciens (n=83, 91,2 %) demandaient uniquement un volume globulaire (VGP) lors de la consultation anténatale, seuls 2 (2,9 %) demandaient systématiquement une formule sanguine complète (FBC). Lors de la réservation, seuls 10 obstétriciens (11,1 %) ont demandé des antécédents de thrombocytopénie. La majorité (n=87, 98,9 %) n'a jamais demandé de numération plaquettaire. S'ils rencontraient une thrombocytopénie, jusqu'à 89 (97,8 %) poursuivaient les investigations en répétant la numération formule sanguine (n=77, 86,5%), un test de coagulation (n=54, 61,4%) ou une ponction de moelle osseuse (n=20, 24.7%). La plupart des obstétriciens (n=82, 96,5 %) transfuseraient des patients atteints de thrombocytopénie et 34 (43,6%) d'entre eux le feraient lorsque la numération est <50 X 109/L. CONCLUSION: Les obstétriciens ont la capacité d'investiguer la thrombopénie symptomatique pendant la grossesse, mais ne procèdent pas systématiquement au dépistage systématique de la thrombocytopénie asymptomatique. La FBC de routine, si elle est effectuée peut identifier les cas manqués de thrombocytopénie asymptomatique pour une prise en charge adéquate. Mots clés: Thrombocytopénie, grossesse, obstétriciens.

Kinetic changes during a six-week minimal footwear and gait-retraining intervention in runners.

An evaluation of a six-week Combined minimal footwear transition and gait-retraining combination vs. gait retraining only on impact characteristics and leg stiffness. Twenty-four trained male runners were randomly assigned to either (1) Minimalist footwear transition Combined with gait-retraining over a six-week period ("Combined" group; n = 12) examined in both footwear, or (2) a gait-retraining group only with no minimalist footwear exposure ("Control"; n = 12). Participants were assessed for loading rate, impact peak, vertical, knee and ankle stiffness, and foot-strike using 3D and kinetic analysis. Loading rate was significantly higher in the Combined group in minimal shoes in pre-tests compared to a Control (P ≤ 0.001), reduced significantly in the Combined group over time (P ≤ 0.001), and was not different to the Control group in post-tests (P = 0.16). The impact peak (P = 0.056) and ankle stiffness reduced in both groups (P = 0.006). Loading rate and vertical stiffness was higher in minimalist footwear than conventional running shoes both pre (P ≤ 0.001) and post (P = 0.046) the intervention. There has a higher tendency to non-rearfoot strike in both interventions, but more acute changes in the minimalist footwear. A Combined intervention can potentially reduce impact variables. However, higher loading rate initially in minimalist footwear may increase the risk of injury in this condition.

In vitro adherence of Staphylococcus epidermidis to silicone punctual plugs and collagen implants.

PURPOSE: To evaluate in vitro adherence of Staphylococcus epidermidis to silicone punctal plugs and collagen implants. SETTING: Loyola University Medical Center, Maywood, Illinois, USA. METHODS: Silicone punctal plugs and collagen implants were exposed to S epidermidis (3 x 10(8) colony forming units/mL) for 0, 5, 30, and 60 minutes, rinsed in sterile saline, and processed for light, scanning (SEM), and transmission (TEM) electron microscopy. Scanning electron microscopy (x2000) was used to quantify bacteria/mm2 adhering to the devices. RESULTS: The mean S epidermidis/mm2 +/- (SD) adhering to each device were as follows: baseline, silicone punctal plug, 1593 +/- 899, and collagen implant, 7168 +/- 2895 (P =.000, paired Student t test); 5 minutes, silicone punctal plug, 3833 +/- 537, and collagen implant, 6571 +/- 2240 (P =.008); 30 minutes, silicone punctal plug, 13 988 +/- 9076, and collagen implant, 10 404 +/- 1731 (P =.2616); and 60 minutes, silicone punctal plug, 12 644 +/- 10 402, and collagen implant, 11 748 +/- 2685 (P =.8056). CONCLUSIONS: Staphylococcus epidermidis adhered significantly more to collagen implants than to silicone punctal plugs at 0 and 5 minutes. No significant difference in bacterial adherence was seen at 30 and 60 minutes. For both devices, bacterial adherence increased with increasing exposure.