Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy.

Cervical cerclage is a well-known surgical procedure carried out during pregnancy. It involves positioning of a suture (stitch) around the neck of the womb (cervix), aiming to give mechanical support to the cervix and thereby reduce risk of preterm birth. The effectiveness and safety of this procedure remains controversial. This is an update of a review last published in 2012.To assess whether the use of cervical stitch in singleton pregnancy at high risk of pregnancy loss based on woman's history and/or ultrasound finding of 'short cervix' and/or physical exam improves subsequent obstetric care and fetal outcome.We searched Cochrane Pregnancy and Childbirth's Trials Register (30 June 2016) and reference lists of identified studies.We included all randomised trials of cervical suturing in singleton pregnancies. Cervical stitch was carried out when the pregnancy was considered to be of sufficiently high risk due to a woman's history, a finding of short cervix on ultrasound or other indication determined by physical exam. We included any study that compared cerclage with either no treatment or any alternative intervention. We planned to include cluster-randomised studies but not cross-over trials. We excluded quasi-randomised studies. We included studies reported in abstract form only.Three review authors independently assessed trials for inclusion. Two review authors independently assessed risk of bias and extracted data. We resolved discrepancies by discussion. Data were checked for accuracy. The quality of the evidence was assessed using the GRADE approach.This updated review includes a total of 15 trials (3490 women); three trials were added for this update (152 women). Cerclage versus no cerclageOverall, cerclage probably leads to a reduced risk of perinatal death when compared with no cerclage, although the confidence interval (CI) crosses the line of no effect (RR 0.82, 95% CI 0.65 to 1.04; 10 studies, 2927 women; moderate quality evidence). Considering stillbirths and neonatal deaths separately reduced the numbers of events and sample size. Although the relative effect of cerclage is similar, estimates were less reliable with fewer data and assessed as of low quality (stillbirths RR 0.89, 95% CI 0.45 to 1.75; 5 studies, 1803 women; low quality evidence; neonatal deaths before discharge RR 0.85, 95% CI 0.53 to 1.39; 6 studies, 1714 women; low quality evidence). Serious neonatal morbidity was similar with and without cerclage (RR 0.80, 95% CI 0.55 to 1.18; 6 studies, 883 women; low-quality evidence). Pregnant women with and without cerclage were equally likely to have a baby discharged home healthy (RR 1.02, 95% CI 0.97 to 1.06; 4 studies, 657 women; moderate quality evidence).Pregnant women with cerclage were less likely to have preterm births compared to controls before 37, 34 (average RR 0.77, 95% CI 0.66 to 0.89; 9 studies, 2415 women; high quality evidence) and 28 completed weeks of gestation.Five subgroups based on clinical indication provided data for analysis (history-indicated; short cervix based on one-off ultrasound in high risk women; short cervix found by serial scans in high risk women; physical exam-indicated; and short cervix found on scan in low risk or mixed populations). There were too few trials in these clinical subgroups to make meaningful conclusions and no evidence of differential effects. Cerclage versus progesteroneTwo trials (129 women) compared cerclage to prevention with vaginal progesterone in high risk women with short cervix on ultrasound; these trials were too small to detect reliable, clinically important differences for any review outcome. One included trial compared cerclage with intramuscular progesterone (75 women) which lacked power to detect group differences. History indicated cerclage versus ultrasound indicated cerclageEvidence from two trials (344 women) was too limited to establish differences for clinically important outcomes.Cervical cerclage reduces the risk of preterm birth in women at high-risk of preterm birth and probably reduces risk of perinatal deaths. There was no evidence of any differential effect of cerclage based on previous obstetric history or short cervix indications, but data were limited for all clinical groups. The question of whether cerclage is more or less effective than other preventative treatments, particularly vaginal progesterone, remains unanswered

Frequency of factor II G20210A, factor V Leiden, MTHFR C677T and PAI-1 5G/4G polymorphism in patients with venous thromboembolism: Croatian case-control study

Introduction: Venous thromboembolic disease is one of the leading causes of morbidity and mortality in the developed world. Identification of hereditary factors of thrombophilia is contributing to a better understanding of the etiology and disease prevention. The aim of this study was to assess the prevalence of factor IIG20210A, factor V Leiden, MTHFR (methylenetetrahydrofolate reductase) C677T and PAI-1 (plasminogen activator inhibitor-1) 5G/4G polymorphisms in healthy Croatian subjects and patients with thromboembolism. Materials and methods: This prospective study included 100 thromboembolic patients consecutively admitted to the Intensive Care Unit, Sestre Milosrdnice University Hospital and 106 healthy subjects. Genotyping of factor IIG20210A, factor V Leiden, MTHFR C677T and PAI-1 5G/4G polymorphisms was done using melting curve analysis on Light Cycler 1.2 analyzer. Results: Heterozygotes for Factor V Leiden polymorphism were more frequent in the group of patients with the thromboembolic disease (16%) than in the control healthy subjects (2.9%), OR (95% CI) = 6.41 (1.81-22.8); P = 0.004. Allele and genotype frequencies of other studied polymorphisms did not differ between cases and controls. Conclusion: This study confirmed the association of factor V Leiden polymorphism with the thromboembolic disease in Croatian population

Understanding and responding to the regional perceptions of the global economic crisis: towards the ”low-tech” knowledge-based approach

In this paper, authors apply the 'sense-and-respond' model to understanding and modeling reactions of customers in the wider South-East European (SEE) region to the actual economic crisis. As results of the previous research indicate that the role of contemporary knowledge-based tools can serve as a complement, rather as a replacement for the 'traditional' research methodology, the role of universities and other knowledge providers to the business community in responding to the economic crisis is also critically examined. The paper suggests that development and the use of a modified 'sense-and-response' model at the industry/cluster level could assist all economic and social actors in relieving the consequences of the economic crisis/recession, as well as affirm the role of the university in the process[1].  

Big Data Transforms Discovery-Utilization Therapeutics Continuum.

Enabling omic technologies adopt a holistic view to produce unprecedented insights into the molecular underpinnings of health and disease, in part, by generating massive high-dimensional biological data. Leveraging these systems-level insights as an engine driving the healthcare evolution is maximized through integration with medical, demographic, and environmental datasets from individuals to populations. Big data analytics has accordingly emerged to add value to the technical aspects of storage, transfer, and analysis required for merging vast arrays of omic-, clinical-, and eco-datasets. In turn, this new field at the interface of biology, medicine, and information science is systematically transforming modern therapeutics across discovery, development, regulation, and utilization

Severe primary immune thrombocytopenia in Pregnancy UK Obstetric Surveillance System (UKOSS) Study

This is the largest reported population cohort of severe ITP in pregnancy. Current incidence of severe ITP in the UK is approximately 0.1/1000 pregnancies. With current treatment strategies the incidence of serious maternal and neonatal outcomes is extremely low

Pharmacogenetics and pharmacogenomics: practical applications in routine medical practice

A report of the 3rd joint European Science Foundation and University of Barcelona Conference in Biomedicine, San Feliu de Guixols, Catalonia, Spain, 6-11 June 2010

Cost effectiveness analysis of HLA-B*58:01 genotyping prior to initiation of allopurinol for gout

Objective. To determine whether prospective testing forHLA-B*58:01, as a strategy to prevent seriousadverse reactions to allopurinol in patients with gout, is cost-effective from the perspective of the NationalHealth Service in the UK. Methods. A systematic review and meta-analysis for the association ofHLA-B*58:01with cutaneous andhypersensitivity adverse drug reactions informed a decision analytic and Markov model to estimate lifetimecosts and outcomes associated with testingvsstandard care (with febuxostat prescribed for patients whotest positive). Scenario analyses assessed alternative treatment assumptions and patient populations. Results. The number of patients needed to test to prevent one case of adverse drug reaction was 11 286(95% central range (CR): 2573, 53 594). Cost and quality-adjusted life-year (QALY) gains were small, £103(95% CR: £98, £106) and 0.0023 (95% CR: 0.0006, 0.0055), respectively, resulting in an incrementalcost-effectiveness ratio (ICER) of £44 954 per QALY gained. The probability of testing being cost-effectiveat a threshold of £30 000 per QALY was 0.25. Reduced costs of testing or febuxostat resulted in an ICERbelow £30 000 per QALY gained. The ICER for patients with chronic renal insufficiency was £38 478 perQALY gained. Conclusion. Routine testing forHLA-B*58:01in order to reduce the incidence of adverse drug reactions inpatients being prescribed allopurinol for gout is unlikely to be cost-effective in the UK; however testing isexpected to become cost-effective with reductions in the cost of genotyping, and with the future avail-ability of cheaper, generic febuxosta