Adverse Pregnancy Outcomes in Sickle Cell Trait: a Prospective Cohort Study Evaluating Clinical and Haematological Parameters in Postpartum Mothers and Newborns.

Background: Sickle cell trait (SCT) is a congenital condition caused by the inheritance of a single allele of the abnormal haemoglobin beta gene, HbS. Carriers of SCT are generally asymptomatic, and they do not manifest the clinical and haematological abnormalities of sickle cell anaemia (SCA). However, there is evidence that they display some symptoms in stressful situations. Pregnancy is a stressful physiological event, and it is not clear if SCT adversely affects pregnancy outcomes, particularly in those from developing countries where people regularly suffer from nutritional insufficiency. Objective: This study aims to investigate pregnancy outcomes in Sudanese women with SCT. Subjects and methods: Pregnant women with (HbAS, n=34) and without (HbAA, n=60) SCT were recruited during their first trimester at El Obeid Hospital, Kordofan, Western Sudan. Following appropriate ethical approval and informed consent from the participants, detailed anthropometric, clinical, haematological, obstetric, and birth outcome data were registered. In addition, blood samples were collected at enrolment and at delivery. Results: At enrolment in the first trimester, the SCT group did not manifest SCA symptoms, and there was no difference in the haematological parameters between the SCT and control groups. However, at delivery, the women with SCT, compared with the control group, had lower levels of hemoglobin (Hb, p=0.000), packed cell volume (PCV, p=0.000), mean corpuscular haemoglobin (MCH, p=0.002) and neutrophil counts (p=0.045) and higher mean corpuscular volume (MCV, p=0.000) and platelet counts (p=0.000). Similarly, at delivery, the babies of SCT women had lower birth weight (p=0.000), lower Hb (p=0.045), PCV (p=0.000), MCH (p=0.000), and higher neutrophil (p=0.004) and platelet counts (p=0.000) than the babies of the healthy control group. Additionally, there were more miscarriages, stillbirths, and admissions to the Special Care Baby Unit (SCBU) in the SCT group. Conclusions: The study revealed that SCT is associated with adverse pregnancy outcomes, including maternal and neonatal anaemia, low birth weight, and increased risk of stillbirth, miscarriage, and admission to SCBU. Therefore, pregnant women with SCT should be given appropriate pre-conceptual advice and multidisciplinary antenatal and postnatal care.

De la conjonctivite à l'ulcère de Mooren : errance diagnostique ou insuffisance des spécialistes

Nous rapportons une observation d'un homme âgé de 25 ans, mélanoderme sans antécédent médico-chirurgical connu, qui a consulté pour douleur oculaire,larmoiement, baisse de l'acuité visuelle, photophobie évoluant depuis environ huit mois, l'examen ophtalmologique note une hyperhémie conjonctivale, une ulcération cornéenne marginale compliquée de perforation cornéenne avec hernie de l'iris rongeant la moitié de la cornée, une excavation papillaire asymétrique.Le diagnostic d'ulcère de Mooren bilatéral est fortement suspecté, puis retenu sur la base d'argument épidémiologique ; clinique ophtalmologique (kératite ulcéreuse chronique inflammatoire qui affecte initialement la périphérie de la cornée, avec progression circonférentielle et centrale, puis perforation) ; paraclinique (la négativité de tous les examens complémentaires : les facteurs rhumatoïdes, les sérologies de l'hépatite B, C, VIH et de la syphilis, l'examen parasitologique des selles, la protéinurie de 24 h …) mais aussi après avoir exclu un certain nombre de diagnostics,notamment les maladies systémiques, les maladies infectieuses, les atteintes traumatiques des yeux.La collaboration entre ophtalmologiste et interniste a abouti à la mise en route immédiate d'un traitement à base de corticothérapie locale, d'antibiothérapie et des topiques locaux. L'évolution a été favorable avec récupération progressive de l'acuité visuelle au niveau des deux yeux deux semaines après la mise en route du traitement

Recurrent pancreatitis after unremarkable colonoscopy, temporalised by CT imaging: an unusual case.

Acute pancreatitis is a common surgical presentation, frequently caused by gallstones and alcohol. Here we present an unusual case of a recurrent episode of pancreatitis after an unremarkable colonoscopy, in a patient with several pre-existing risk factors for pancreatitis. Before and after abdominal CT scans clearly demonstrate the acute inflammatory process affecting the pancreas and temporalise its development. Early resuscitation and appropriate involvement of high dependency care is advocated by all current guidelines to improve patient outcome. We consider possible aetiology and how early diagnosis and recognition of possible high-risk situations can expedite its investigation and management, helping to provide the best possible care.

Understanding the emergence of ebola virus disease in sierra leone: stalking the virus in the threatening wake of emergence.

Since Ebola Virus Disease (EVD) was first identified in 1976 in what is now the Democratic Republic of Congo, and despite the numerous outbreaks recorded to date, rarely has an epidemic origin been identified. Indeed, among the twenty-one most documented EVD outbreaks in Africa, an index case has been identified four times, and hypothesized in only two other instances. The initial steps of emergence and spread of a virus are critical in the development of a potential outbreak and need to be thoroughly dissected and understood in order to improve on preventative strategies. In the current West African outbreak of EVD, a unique index case has been identified, pinpointing the geographical origin of the epidemic in Guinea. Herein, we provide an accounting of events that serve as the footprint of EVD emergence in Sierra Leone and a road map for risk mitigation fueled by lessons learned.

Middle East respiratory syndrome coronavirus (MERS-CoV) RNA and neutralising antibodies in milk collected according to local customs from dromedary camels, Qatar, April 2014.

Antibodies to Middle East respiratory syndrome coronavirus (MERS-CoV) were detected in serum and milk collected according to local customs from 33 camels in Qatar, April 2014. At one location, evidence for active virus shedding in nasal secretions and/or faeces was observed for 7/12 camels; viral RNA was detected in milk of five of these seven camels. The presence of MERS-CoV RNA in milk of camels actively shedding the virus warrants measures to prevent putative food-borne transmission of MERS-CoV.

Using indirect ELISA to assess different antigens for the serodiagnosis of Fasciola gigantica infection in cattle, sheep and donkeys.

An indirect enzyme-linked immunosorbent assay (iELISA) was evaluated for its diagnostic capability in detecting antibodies against Fasciola gigantica infection in cattle, sheep and donkeys sera using crude worm, excretory-secretory and glutathione S-transferase antigens prepared from adult liver fluke. Presence of F. gigantica worms at post-mortem examination of cattle, sheep and donkey's livers was taken as a gold standard for the evaluation of the assay. The diagnostic sensitivity, specificity and accuracy percentages of iELISA were determined for each antigen. Excretory-secretory antigen gave the best results for the serodiagnosis of F. gigantica infection in cattle, sheep and donkeys using iELISA with diagnostic sensitivity percentages of 93.3%, 94.9% and 93.3%, respectively, while the specificity percentages were 96.7%, 97.2% and 96.3%, respectively, whereas the accuracy percentages were 95%, 96% and 95.7%, respectively. The diagnostic sensitivity percentages of iELISA using crude worm antigen were 96.7%, 100% and 93.3%, respectively, while the specificity percentages were 80%, 83.3% and 85.2%, respectively, whereas the accuracy percentages were 88.3%, 86.7% and 87%, respectively. The diagnostic sensitivity percentages of iELISA using glutathione S-transferase antigen were 66.7%, 71.8% and 60%, respectively, while the specificity percentages were 70%, 77.8% and 77.8%, respectively, whereas the accuracy percentages were 68.3%, 74.7% and 73.9%, respectively. Conclusively, excretory-secretory antigen dependent iELISA can be used as a reliable serodiagnostic test for F. gigantica infection in cattle, sheep and donkeys.

Detection of Brucella melitensis in semen using the polymerase chain reaction assay.

An evaluation of the polymerase chain reaction (PCR) for detection of Brucella melitensis DNA in bovine and ovine semen was performed. Since semen contains different components that inhibit PCR amplification, a protocol was used to purify Brucella-DNA from bovine and ovine semen samples prior to conducting amplification of the targeted DNA. When separated fractions of naturally Brucella contaminated semen were analyzed by the PCR, most of B. melitensis DNA were present in the seminal fluid and non-sperm fractions. The PCR examination results for detection of B. melitensis DNA in different semen fractions were compared with the results for traditional cultural methods of Brucella from semen. The PCR was more sensitive than the traditional cultural methods since it detected Brucella-DNA in 12 (10%) out of 120 semen samples while direct culture detected only 7 (5.8%) in the same semen samples. The limit of detection by PCR was 100 CFU/ml of semen. In addition, the results of PCR were available in one day, whereas isolation and identification of Brucella organisms required days or even weeks. The PCR may be used as a supplementary test for detection of B. melitensis in semen.

Fine-needle aspiration of the thyroid.

BACKGROUND: Although fine-needle aspiration (FNA) of the thyroid is the key preoperative investigation of thyroid lesions, there are overlaps in the criteria for diagnosis of certain lesions, particularly important among which are those for follicular neoplasms. A proposal for a 5-category working system for thyroid FNA diagnosis is presented, devised using clearly defined diagnostic guidelines with a prospective 2-year evaluation in 1 center. METHODS: The results of FNA of 156 patients with nodular thyroid lesions are presented. All patients were observed over a 2-year period in a multidisciplinary thyroid clinic. In some cases, the aspirates were repeated before excision of the lesion. The results of the FNA are classified by worst category for each patient, according to a 5-category scheme: THY1: inadequate; THY2: benign; THY3: indeterminate; THY4: suspicious lesion; THY5: malignant. RESULTS: Seventy-five of the 156 patients (48.1%) proceeded to excision, of these 50 (67%) showed multinodular goiter or adenomatoid nodule within a goiter, 7 (9.3%) showed evidence of Hashimoto thyroiditis or lymphocytic thyroiditis alone, 1 (1.3%) showed evidence of Reidel thyroiditis, and 1 (1.3%) showed evidence of a parathyroid cyst. Eight patients (11%) showed evidence of follicular adenoma, and 5 patients (6.6%) showed papillary carcinoma; 1 (1.3%) showed follicular carcinoma, and 2 (2.7%) showed lymphoproliferative disease. There was a significant difference in the number of benign as compared with neoplastic thyroid lesions excised in the indeterminate (THY3) (2 of 13 [15%]) as compared with the suspicious categories (THY4) (10 of 24 [42%]), (P = 0.05). Although no false-negative FNAs were identified in this series, there was 1 false-positive (THY5) FNA. CONCLUSIONS: The use of an indeterminate (THY3) category is helpful because it improves the diagnostic efficacy of thyroid FNA. The indeterminate (THY3) category is clinically useful and may markedly reduce or eliminate false-negative FNA in many patients with thyroid nodules. Cancer (Cancer Cytopathol)

A comparative study between planar Ga-67, Tl-201 images, chest x-ray, and x-ray CT in inoperable non-small cell carcinoma of the lung.

Seventy patients with newly diagnosed, pathologically proven inoperable non-small cell lung cancer (NSCLC) had planar Ga-67, Tl-201, chest x-ray, and chest CT imaging performed. Tumor/Normal tissue background (T/B) ratio was calculated for 62 Ga-67 and 55 Tl-201 scintigraphy studies and comparisons were made between Ga-67 and Tl-201 imaging results regarding T/B ratios, site of lesion, and histologic type. The impact of the images on the initial knowledge of the extent of the tumor and on the radiotherapy (RT) planning was evaluated for each patient. For primary lesions, Ga-67 imaging results were positive in 94% (66 of 70 patients) versus 71% (50 of 70 patients) for Tl-201 scans (P < 0.005) and the T/B ratio was > 1.5 in 74% (46 of 62 patients) for Ga-67 versus 36% (20 of 55 patients) for Tl-201 (P < 0.0001). For centrally located lesions, sensitivity for Ga-67 was 100% (53 of 53 patients) versus 74% (39 of 53 patients) for Tl-201 (P < 0.0005) and the T/B ratio > 1.5 in 84% (38 of 45 patients) for Ga-67 versus 38% (15 of 40 patients) for Tl-201 (P > 0.001). For peripheral lesions, sensitivity of Ga-67 was 76% (13 of 17 patients) versus 64% (11 of 17) for Tl-201 (P > 0.05) and the T/B ratio was > 1.5 in 47% (8 of 17 patients) for Ga-67 versus 33% (5 of 15 patients) for Tl-201 (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

B-mode ultrasonography of the bovine udder and teat.

The udders and teats of cows were examined by brightness mode (B-mode) ultrasonography. A 5-MHz linear array transducer and a 5-MHz or 10-MHz mechanical sector transducer were used in the examinations. In lactating animals, the teat sinus, gland sinus, and lactiferous ducts were imaged easily. The scans also allowed visualization of the layers of the teat wall. The annular fold and the folding of the mucosa at the junction of the teat sinus and the papillary duct were seen best with the 5-MHz and 10-MHz mechanical sector transducers. In one cow lacking milk flow from one quarter, a mass at the junction of the papillary duct and the teat sinus was observed ultrasonographically. Surgical removal of the mass resulted in a return of milk flow from that quarter.

Tectonics of the Middle America trench offshore Guatemala

A geophysical and geological survey conducted over the landward slope of the Middle America Trench offshore Guatemala has revealed lanward - dipping reflectors which are associated with high compressional wave velocities, large magnetic anomalies, and basic/ultrabasic rock. Multifold seismic reflection data reveal that the edge of the continental shelf is a structural high on which Cretaceous and younger sediments of the shelf basin onlap and pinch out. The upper part of the continental slope is covered in most places by a 0.5 to 1.0 km thick sediment apron with seismic velocities of 1.8 to 2.6 km/sec. Immediately beneath the sediment apron an irregular surface is the top of an interval with velocities of 4.3 to 4.7 km/sec. Within this interval landward - dipping reflections are traced to about 6 km below sea level. Above this zone of dipping reflectors two positive magnetic anomalies are observed as well as a positive gree - air gravity anomaly reported by other workers (AU)