Prevalence of maternal urinary ketones in pregnancy in overweight and obese women.

BACKGROUND: Ketonuria may be associated with adverse fetal outcomes. This study aimed to determine the prevalence of ketonuria at three time points in pregnancy and to assess whether ketonuria correlates with a clinical indication for performing a urine test. METHODS: Women had fasting urinary ketone levels measured at 16 and 28 weeks gestation and random ketone levels measured close to 36 weeks gestation. All ketone levels in the third trimester were recorded along with the clinical indication for the test. RESULTS: One hundred and eighty-seven women were included in the study. Twenty-two per cent of women had ketonuria at either 16 or 28 weeks gestation and 8% at 36 weeks gestation. Ketonuria was significantly more likely if a test was performed for a clinical indication (p = 0.0002). CONCLUSION: Ketonuria in pregnancy is common affecting at least one in five women. Ketonuria is more common in women who have a clinical indication for performing a urine test.

SOMANZ guidelines for the investigation and management sepsis in pregnancy.

SOMANZ (Society of Obstetric Medicine Australia and New Zealand) has written a guideline to provide evidence-based guidance for the investigation and care of women with sepsis in pregnancy or the postpartum period. The guideline is evidence-based and incorporates recent changes in the definition of sepsis. The etiology, investigation and treatment of bacterial, viral and non-infective causes of sepsis are discussed. Obstetric considerations relevant to anaesthetic and intensive care treatment in sepsis are also addressed. A multi-disciplinary group of clinicians with experience in all aspects of the care of pregnant women have contributed to the development of the guidelines. This is an executive summary of the guidelines.

Poor compliance with community-acquired pneumonia antibiotic guidelines in a large Australian private hospital emergency department.

AIMS: This study evaluated guideline concordance and time to administration of antibiotics in community-acquired pneumonia (CAP) in a private Australian emergency department (ED). Two key components in the management of CAP are timely administration and appropriate choice of antibiotic therapy. The use of antibiotics outside of guidelines can potentially increase rates of antibiotic resistance. Previous studies that evaluate guideline concordance have largely been conducted in Australian public hospitals; however, private hospitals comprise a significant portion of Australian health care. METHODS: One hundred and thirty patients admitted to a private Brisbane hospital between 01/01/2011 and 28/03/2012 with an admission diagnosis of CAP were included. Data were collected on administration time and choice of antibiotic therapy in the ED. This was compared with local and national CAP guidelines. RESULTS: Concordance with antibiotic guidelines was low (6.9%). Antibiotics with broader spectrum of action than that recommended in guidelines were frequently prescribed. Eighty-one percent of patients received their first antibiotic within 4 hours of arriving in the ED. Mortality was low at 0.9% in a cohort where 31% of patients were aged under 65. CONCLUSIONS: We found low rates of concordance with CAP antibiotic guidelines and high use of broad-spectrum antibiotics. This has the potential to lead to increased rates of antibiotic resistance. A subtle alteration to the restrictions within the pharmaceutical benefit scheme formulary could potentially decrease the high usage of broad-spectrum antibiotics. However, the low mortality rate, nontoxic nature of these antibiotics, and the ease of their administration pose a challenge to convincing clinicians to alter their practice.

Role of granule-bound starch synthase in determination of amylopectin structure and starch granule morphology in potato.

Reductions in activity of SSIII, the major isoform of starch synthase responsible for amylopectin synthesis in the potato tuber, result in fissuring of the starch granules. To discover the causes of the fissuring, and thus to shed light on factors that influence starch granule morphology in general, SSIII antisense lines were compared with lines with reductions in the major granule-bound isoform of starch synthase (GBSS) and lines with reductions in activity of both SSIII and GBSS (SSIII/GBSS antisense lines). This revealed that fissuring resulted from the activity of GBSS in the SSIII antisense background. Control (untransformed) lines and GBSS and SSIII/GBSS antisense lines had unfissured granules. Starch analyses showed that granules from SSIII antisense tubers had a greater number of long glucan chains than did granules from the other lines, in the form of larger amylose molecules and a unique fraction of very long amylopectin chains. These are likely to result from increased flux through GBSS in SSIII antisense tubers, in response to the elevated content of ADP-glucose in these tubers. It is proposed that the long glucan chains disrupt organization of the semi-crystalline parts of the matrix, setting up stresses in the matrix that lead to fissuring.