Comparing the safety and effectiveness of various umbilical cord milking techniques and delayed cord clamping in full-term and preterm infants: A systematic review and meta-analysis.

We compare the hematocrit, hemoglobin, need for transfusion, recurrent phototherapy, serum bilirubin level, and serum ferritin at different time frames for the umbilical cord milking (UCM) and delayed cord clamping (DCC) in both full-term and preterm infants. A comprehensive search through various databases aimed to compare UCM and DCC studies until May 2nd, 2023. Cochrane and NIH tools assessed RCTs and cohorts, respectively. Meta-analysis employed Review Manager 5.4 software, calculating MD and RR with 95% CIs for continuous and dichotomous data. We included 20 studies with a total of 5189 infants. Regarding preterm infants, hematocrit level showed no significant difference between intact Umbilical Cord Milking (iUCM) compared to DCC (MD = -0.24, 95% CI [-1.11, 0.64]). Moreover, Neonatal death incidence was significantly higher with the UCM technique in comparison to DCC (RR = 1.28, 95% CI [1.01 to 1.62]). Regarding term and late preterm infants, Hematocrit level showed no significant difference between the iUCM or cUCM techniques compared to DCC (MD = 0.21, 95% CI [-1.28 to 1.69]), (MD = 0.96, 95% CI [-1.02 to 2.95]), respectively. UCM led to a higher risk of neonatal death in preterm infants compared to DCC. However, the incidence of polycythemia was lower in the UCM group. Additionally, UCM was associated with higher rates of severe IVH events. Based on these findings, DCC may be preferred due to its lower incidence of severe IVH and neonatal death.

Nous comparons l'hématocrite, l'hémoglobine, le besoin de transfusion, la photothérapie récurrente, le taux de bilirubine sérique et la ferritine sérique à différentes périodes pour la traite du cordon ombilical (UCM) et le clampage retardé du cordon (DCC) chez les nourrissons nés à terme et prématurés. Une recherche complète dans diverses bases de données visait à comparer les études UCM et DCC jusqu'au 2 mai 2023. Les outils Cochrane et NIH ont évalué les ECR et les cohortes, respectivement. La méta-analyse a utilisé le logiciel Review Manager 5.4, calculant le MD et le RR avec des IC à 95 % pour les données continues et dichotomiques. Nous avons inclus 20 études portant sur un total de 5 189 nourrissons. Concernant les nourrissons prématurés, le niveau d'hématocrite n'a montré aucune différence significative entre la traite du cordon ombilical intact (iUCM) et la DCC (DM = -0,24, IC à 95 % [-1,11, 0,64]). De plus, l'incidence des décès néonatals était significativement plus élevée avec la technique UCM qu'avec la technique DCC (RR = 1,28, IC à 95 % [1,01 à 1,62]). Concernant les nourrissons à terme et peu prématurés, le niveau = 0,21, IC à 95 % [-1,28 à 1,69]), (DM = 0,96, IC à 95 % [-1,02 à 2,95]), respectivement. L'UCM a entraîné un risque plus élevé de décès néonatal chez les nourrissons prématurés par rapport au DCC. Cependant, l'incidence de la polyglobulie était plus faible dans le groupe UCM. De plus, l'UCM était associée à des taux plus élevés d'événements IVH graves. Sur la base de ces résultats, le DCC peut être préféré en raison de sa plus faible incidence d'IVH grave et de décès néonatals. d'hématocrite n'a montré aucune différence significative entre les techniques iUCM ou cUCM par rapport à la technique DCC (DM.

Efficacy of warm compresses in preserving perineal integrity and decreasing pain during normal labor: A systematic review and meta-Analysis.

The objective of the study was to assess the effect of warm compresses in preserving perineal integrity in women who delivered a single baby vaginally with cephalic presentation. We searched PubMed, Scopus, and the ISI Web of Science databases. Two researchers worked independently and conducted the study's search, selection, and extraction. We calculated the pooled risk ratio (R.R.)- for our categorical outcomes- and mean difference (M.D.)-for our continuous outcomes- using random or fixed-effect meta-analysis according to heterogenicity status. I2 test was used to detect heterogenicity. Studies were assessed for methodological quality using the Cochrane risk of bias assessment tool. Our study analyzed 13 controlled trials (n= 3947) to compare warm compresses versus not using it during vaginal delivery. The analysis revealed that warm compresses group had better outcomes regarding episiotomy, degree of perineal trauma (third and fourth degree), perineal trauma requiring suturing, and also in behavioral pain scales (severe muscle tense, being very restless, and constant grimacing) with the following R.R. and confidence intervals: (R.R.= 0.56, 95% C.I.[0.23, 1.37]), (R.R.= 0.69, 95% C.I.[0.54, 0.89], p= 0.004),( (R.R.= 0.37, 95% C.I.[0.18, 0.77], p= 0.004), and ( (R.R.= 0.42, 95% C.I.[0.23, 0.78], p= 0.006) respectively. We conclude that among primiparous women, warm compresses group showed better outcome in improving perineal comfort than a the good of women who did not receive warm compresses after delivery.

External validity and clinical usefulness of a risk prediction model for 30 day unplanned hospitalization in patients receiving outpatient parenteral antimicrobial therapy.

OBJECTIVES: Outpatient parenteral antimicrobial therapy (OPAT) is increasingly used to treat a variety of infections. However, hospital readmissions remain relatively common. We examined the external validity and clinical usefulness of a previously derived risk prediction model for 30 day unplanned hospitalization in patients receiving OPAT. METHODS: A retrospective cohort study was conducted at two large teaching hospitals in the UK. The design comprised quasi-external temporal validation on patients from the same OPAT setting as the model development, and broader external validation on patients from a different setting. The model predictors were age, prior hospitalizations in the preceding 12 months, Charlson comorbidity score, concurrent IV antimicrobial therapy, type of infection and mode of OPAT treatment. Discriminative ability, calibration and clinical usefulness were assessed. RESULTS: Data from 2578 OPAT patients were analysed. The rates of 30 day unplanned hospitalization were 11.5% (123/1073), 12.9% (140/1087) and 25.4% (106/418) in the model derivation, temporal validation and broader external validation cohorts, respectively. The discriminative ability of the prediction model was adequate on temporal validation (c-statistic 0.75; 95% CI: 0.71-0.79) and acceptable on broader validation (c-statistic 0.67; 95% CI: 0.61-0.73). In both external cohorts, the model displayed excellent calibration between observed and predicted probabilities. Decision curve analysis showed increased net benefit across a range of meaningful risk thresholds. CONCLUSIONS: A simple risk prediction model for unplanned readmission in OPAT patients demonstrated reproducible predictive performance, broad clinical transportability and clinical usefulness. This model may help improve OPAT outcomes through better identification of high-risk patients and provision of tailored care.

Callus Induction and Plant Regeneration from Immature Embryos of Sweet Sorghum (Sorghum bicolor Moench).

BACKGROUND AND OBJECTIVE: Regeneration of plant through tissue culture technique is a critical process in transformation of plants. This study sought to establish the effect of genotype and auxin concentration on callus induction from different sweet sorghum genotypes (IESV92008DL, IESV92001DL, IESV92021DL, ICSV700 and ICSV93048). MATERIALS AND METHODS: In this study, MS medium supplemented with five levels of the hormone 2,4-D (0, 1, 2, 4 and 6 mg L-1) to assess the effect of the hormone 2,4-D on callus induction and regeneration was used. RESULTS: The highest callus induction frequency was observed at 2 mg L-1 2,4-D for all the genotypes, IESV92008 gave the highest callus induction frequency among all the genotypes at 2 mg L-1 2,4-D. The lowest callus induction frequency was observed 0 and 6 mg L-1 for all the genotypes, the two genotypes ICSV700 and IESV92021 were observed to give the lowest callus induction frequency among all the genotypes used in this study. Embryogenic callus induction frequency was observed to be higher at 2 mg L-1 2,4-D and the genotype IESV92008 gave the highest callus induction frequency among all the genotypes used. Induction of shoots was achieved in MS medium supplemented with 3 mg L-1 6BA and 1 mg L-1 IAA, the highest regeneration efficiency was obtained from the three genotypes ICSV93048, IESV92008 and IESV92001, respectively. CONCLUSION: This study discovers the importance of the auxin 2,4-D on callus induction and regeneration of sweet sorghum and this will help the researcher to develop protocols for transformation of sweet sorghum.

Comparison of oral and video debriefing and its effect on knowledge acquisition following simulation-based learning.

Introduction: Learning from simulation takes place to a large extent in debriefing; however, there is still sparse knowledge about the advantages and disadvantages of debriefing methods. 2 common forms are video-assisted and oral only debriefing. We set out to determine if there is increased knowledge acquisition for candidates undergoing video, rather than oral debriefing. Methods: Second year doctors were randomised to a training day with oral or video feedback. Candidates underwent an emergency clinical scenario followed by feedback. The candidates completed 30 multiple choice questions related to managing common clinical emergencies presimulation and postsimulation training. Results: There was no significant difference in the postscore mean for the oral debriefing (128.3, SD 5.16) and video-assisted debriefing group (127.1, SD=5.96). There was significant interaction between precourse and postcourse scores with superior knowledge acquisition for candidates with lower precourse scores (p=0.008). The candidates with lowest precourse score showed significant improvement in the orally debriefed group in comparison to video debriefed group. Discussion: Our results showed that video debriefing has equivocal effect to oral debriefing. Oral debriefing provides superior knowledge acquisition to learners with lower precourse test scores.

Downregulation of transcription factor aflR in Aspergillus flavus confers reduction to aflatoxin accumulation in transgenic maize with alteration of host plant architecture.

KEY MESSAGE: We report success of host-induced gene silencing in downregulation of aflatoxin biosynthesis in Aspergillus flavus infecting maize transformed with a hairpin construct targeting transcription factor aflR. Infestation of crops by aflatoxin-producing fungi results in economic losses as well as negative human and animal health effects. Currently, the control strategies against aflatoxin accumulation are not effective to the small holder farming systems in Africa and this has led to widespread aflatoxin exposure especially in rural populations of sub-Saharan Africa that rely on maize as a staple food crop. A recent strategy called host-induced gene silencing holds great potential for developing aflatoxin-resistant plant germplasm for the African context where farmers are unable to make further investments other than access to the germplasm. We transformed maize with a hairpin construct targeting the aflatoxin biosynthesis transcription factor aflR. The developed transgenic maize were challenged with an aflatoxigenic Aspergillus flavus strain from Eastern Kenya, a region endemic to aflatoxin outbreaks. Our results indicated that aflR was downregulated in A. flavus colonizing transgenic maize. Further, maize kernels from transgenic plants accumulated significantly lower levels of aflatoxins (14-fold) than those from wild type plants. Interestingly, we observed that our silencing cassette caused stunting and reduced kernel placement in the transgenic maize. This could have been due to "off-target" silencing of unintended genes in transformed plants by aflR siRNAs. Overall, this work indicates that host-induced gene silencing has potential in developing aflatoxin-resistant germplasm.

A new double right border binary vector for producing marker-free transgenic plants.

BACKGROUND: Once a transgenic plant is developed, the selectable marker gene (SMG) becomes unnecessary in the plant. In fact, the continued presence of the SMG in the transgenic plant may cause unexpected pleiotropic effects as well as environmental or biosafety issues. Several methods for removal of SMGs that have been reported remain inaccessible due to protection by patents, while development of new ones is expensive and cost prohibitive. Here, we describe the development of a new vector for producing marker-free plants by simply adapting an ordinary binary vector to the double right border (DRB) vector design using conventional cloning procedures. FINDINGS: We developed the DRB vector pMarkfree5.0 by placing the bar gene (representing genes of interest) between two copies of T-DNA right border sequences. The ß-glucuronidase (gus) and nptII genes (representing the selectable marker gene) were cloned next followed by one copy of the left border sequence. When tested in a model species (tobacco), this vector system enabled the generation of 55.6% kanamycin-resistant plants by Agrobacterium-mediated transformation. The frequency of cotransformation of the nptII and bar transgenes using the vector was 66.7%. Using the leaf bleach and Basta assays, we confirmed that the nptII and bar transgenes were coexpressed and segregated independently in the transgenic plants. This enable separation of the transgenes in plants cotransformed using pMarkfree5.0. CONCLUSIONS: The results suggest that the DRB system developed here is a practical and effective approach for separation of gene(s) of interest from a SMG and production of SMG-free plants. Therefore this system could be instrumental in production of "clean" plants containing genes of agronomic importance.

The effect of qat chewing and other factors on breast-feeding and child survival in a Yemeni society.

In a survey conducted in Dammar, Republic of Yemen, 755 mothers were interviewed to investigate the patterns and factors affecting childhood feeding practices. It was found that full breast-feeding rate (41.8%) and timely introduction of complementary feeding rate (57.4%) were low, bottle-feeding rate (25.1%) was high and timely first suckling rate was zero. It was also found that the more educated and older mothers tended to wean their children earlier than illiterate and younger mothers. A significant association between regular frequent qat chewing and history of child death was observed. The implications of these findings were discussed.