Emergency obstetrics care in a Nigerian tertiary hospital: a 20 year review of umblical cord prolapse

Context: Umbilical cord prolapse is an obstetric emergency associated with high perinatal morbidity and mortality unless prompt delivery by the fastest and safest route is carried out. Objectives: To determine the incidence ofumbilical cord prolapse, predisposing factors, and fetal outcome. Study design, setting and subjects: A20 year retrospective study of all women who presented with umbilical cord prolapse atUniversity of MaiduguriTeachingHospital,Maiduguri.North-EasternNgeria. Results: During the study period there were 27,753 deliveries and 75 women had cord prolapse, giving the incidence of 1 in 370 deliveries (0.27%). Significantly more patients with non vertex presentation, twins and preterm delivery had cord prolapse. The highest occurrence was in those with unengaged presenting part(65.2%), spontaneous rupture of membrances(62.1%) and grandmultiparous women(57.6%). Caeserean section was carried out in 50% of cases, with mean decision-delivery interval of 77.1+- 21.7 minutes and 28/33(84.9%) of babies deliveredwithin 60minute had normalApgar scores. The Knee-chest position was most commonly used method of alleviating cord compression while arrangement for caesarean section was being made.The perinatalmortalitywas 27.3%. Conclusion: umbilical cord prolapse is a brisk obstetric emergency with high perinatalmorbidity andmortality unless prompt delivery is undertaken. Better communication and prompt response to emergency by the theatre teamto reduce the decision-delivery intervalwould improve the perinatal outcome.Keywords: Umblical cord, grandmultiparous, Apgar, asphyxia, perinatal mortality and perinatal outcom

Maternal and fetal determinants of perinatal transmission of HIV among HIV positive mothers attending ANC at a northern Nigerian tertiary health institution

Objective: To ascertain the major determinants of perinatal transmission of HIV among HIV positive women attending ANC and delivery at the University of Maiduguri Teaching Hospital, Maiduguri.Patients and methods: A prospective case control study of 52 HIV positive pregnant women who were attending ANC and delivery at university of Maiduguri Teaching Hospital (UMTH) was carried out. Known HIV positive mothers sent from the adult HIV clinic and those found during ANC HIV screening and diagnosis using rapid tests were recruited, while Fetal diagnosis of HIV was done using polymerase chain reaction (PCR) technique at 6 and/or at 12 weeks of birth age. Socio demographic and obstetrics history were obtained and analyzed using SPSS version 11 and test of significance was carried out using chi square tests.Results: Of the 52 women that were found to be HIV positive, the perinatal transmission rate was 11.5%. Elective caesarean section (ELCS) was offered to 11(21.2%) and all the babies delivered through ELCS were negative for HIV. Advanced maternal age (X2 =33.53 P <0.001), Low CD4 count (X2 =15.58 P =0.016), high maternal viral load (X2 =21.85 P =0.005), prematurity (X2 = 9.872 P= 0.007), low birth weight (X2 = 63.80 P < 0.001) and birth asphyxia(X2 = 24.149 P< 0.001) were the major determinants of perinatal transmission of HIV infection in this study.Conclusion: The perinatal transmission of HIV is high. Prompt identification of both maternal and fetal risks' factors and Effective interventions aim at minimizing the impact of these factors before or during pregnancy will help to lower some of the preventable determinants of perinatal transmission.Recommendations: A prenatal and antenatal risks reduction strategy should be advocated. All effort should be geared toward identifying those positive and minimized or modify risks factors through behavior change, prompt initiation of treatment and prophylaxis for those found positive with a view to reduce the incidence of perinatal transmission.Key Words: perinatal transmission, HIV, maternal, fetal determinants, Maidugur

Carbon uptake by mature Amazon forests has mitigated Amazon nations' carbon emissions

Background: Several independent lines of evidence suggest that Amazon forests have provided a significant carbon sink service, and also that the Amazon carbon sink in intact, mature forests may now be threatened as a result of different processes. There has however been no work done to quantify non-land-use-change forest carbon fluxes on a national basis within Amazonia, or to place these national fluxes and their possible changes in the context of the major anthropogenic carbon fluxes in the region. Here we present a first attempt to interpret results from groundbased monitoring of mature forest carbon fluxes in a biogeographically, politically, and temporally differentiated way. Specifically, using results from a large long-term network of forest plots, we estimate the Amazon biomass carbon balance over the last three decades for the different regions and nine nations of Amazonia, and evaluate the magnitude and trajectory of these differentiated balances in relation to major national anthropogenic carbon emissions. Results: The sink of carbon into mature forests has been remarkably geographically ubiquitous across Amazonia, being substantial and persistent in each of the five biogeographic regions within Amazonia. Between 1980 and 2010, it has more than mitigated the fossil fuel emissions of every single national economy, except that of Venezuela. For most nations (Bolivia, Colombia, Ecuador, French Guiana, Guyana, Peru, Suriname) the sink has probably additionally mitigated all anthropogenic carbon emissions due to Amazon deforestation and other land use change. While the sink has weakened in some regions since 2000, our analysis suggests that Amazon nations which are able to conserve large areas of natural and semi-natural landscape still contribute globally-significant carbon sequestration. Conclusions: Mature forests across all of Amazonia have contributed significantly to mitigating climate change for decades. Yet Amazon nations have not directly benefited from providing this global scale ecosystem service. We suggest that better monitoring and reporting of the carbon fluxes within mature forests, and understanding the drivers of changes in their balance, must become national, as well as international, priorities

Carbon uptake by mature Amazon forests has mitigated Amazon nations' carbon emissions

BACKGROUND: Several independent lines of evidence suggest that Amazon forests have provided a significant carbon sink service, and also that the Amazon carbon sink in intact, mature forests may now be threatened as a result of different processes. There has however been no work done to quantify non-land-use-change forest carbon fluxes on a national basis within Amazonia, or to place these national fluxes and their possible changes in the context of the major anthropogenic carbon fluxes in the region. Here we present a first attempt to interpret results from ground-based monitoring of mature forest carbon fluxes in a biogeographically, politically, and temporally differentiated way. Specifically, using results from a large long-term network of forest plots, we estimate the Amazon biomass carbon balance over the last three decades for the different regions and nine nations of Amazonia, and evaluate the magnitude and trajectory of these differentiated balances in relation to major national anthropogenic carbon emissions. RESULTS: The sink of carbon into mature forests has been remarkably geographically ubiquitous across Amazonia, being substantial and persistent in each of the five biogeographic regions within Amazonia. Between 1980 and 2010, it has more than mitigated the fossil fuel emissions of every single national economy, except that of Venezuela. For most nations (Bolivia, Colombia, Ecuador, French Guiana, Guyana, Peru, Suriname) the sink has probably additionally mitigated all anthropogenic carbon emissions due to Amazon deforestation and other land use change. While the sink has weakened in some regions since 2000, our analysis suggests that Amazon nations which are able to conserve large areas of natural and semi-natural landscape still contribute globally-significant carbon sequestration. CONCLUSIONS: Mature forests across all of Amazonia have contributed significantly to mitigating climate change for decades. Yet Amazon nations have not directly benefited from providing this global scale ecosystem service. We suggest that better monitoring and reporting of the carbon fluxes within mature forests, and understanding the drivers of changes in their balance, must become national, as well as international, priorities

Seasonal drought limits tree species across the Neotropics

Within the tropics, the species richness of tree communities is strongly and positively associated with precipitation. Previous research has suggested that this macroecological pattern is driven by the negative effect of water-stress on the physiological processes of most tree species. This process implies that the range limits of taxa are defined by their ability to occur under dry conditions, and thus in terms of species distributions it predicts a nested pattern of taxa distribution from wet to dry areas. However, this ‘dry-tolerance’ hypothesis has yet to be adequately tested at large spatial and taxonomic scales. Here, using a dataset of 531 inventory plots of closed canopy forest distributed across the Western Neotropics we investigated how precipitation, evaluated both as mean annual precipitation and as the maximum climatological water deficit, influences the distribution of tropical tree species, genera and families. We find that the distributions of tree taxa are indeed nested along precipitation gradients in the western Neotropics. Taxa tolerant to seasonal drought are disproportionally widespread across the precipitation gradient, with most reaching even the wettest climates sampled; however, most taxa analysed are restricted to wet areas. Our results suggest that the ‘dry tolerance’ hypothesis has broad applicability in the world's most species-rich forests. In addition, the large number of species restricted to wetter conditions strongly indicates that an increased frequency of drought could severely threaten biodiversity in this region. Overall, this study establishes a baseline for exploring how tropical forest tree composition may change in response to current and future environmental changes in this region

Seasonal drought limits tree species across the Neotropics

AcceptedArticle in Press© 2016 Nordic Society Oikos.Within the tropics, the species richness of tree communities is strongly and positively associated with precipitation. Previous research has suggested that this macroecological pattern is driven by the negative effect of water-stress on the physiological processes of most tree species. This implies that the range limits of taxa are defined by their ability to occur under dry conditions, and thus in terms of species distributions predicts a nested pattern of taxa distribution from wet to dry areas. However, this 'dry-tolerance' hypothesis has yet to be adequately tested at large spatial and taxonomic scales. Here, using a dataset of 531 inventory plots of closed canopy forest distributed across the western Neotropics we investigated how precipitation, evaluated both as mean annual precipitation and as the maximum climatological water deficit, influences the distribution of tropical tree species, genera and families. We find that the distributions of tree taxa are indeed nested along precipitation gradients in the western Neotropics. Taxa tolerant to seasonal drought are disproportionally widespread across the precipitation gradient, with most reaching even the wettest climates sampled; however, most taxa analysed are restricted to wet areas. Our results suggest that the 'dry tolerance' hypothesis has broad applicability in the world's most species-rich forests. In addition, the large number of species restricted to wetter conditions strongly indicates that an increased frequency of drought could severely threaten biodiversity in this region. Overall, this study establishes a baseline for exploring how tropical forest tree composition may change in response to current and future environmental changes in this region.This paper is a product of the RAINFOR and ATDN networks and of ForestPlots.net researchers (http://www.forestplots.net). RAINFOR and ForestPlots have been supported by a Gordon and Betty Moore Foundation grant, the European Union’s Seventh Framework Programme (283080, ‘GEOCARBON’; 282664, ‘AMAZALERT’); European Research Council (ERC) grant ‘Tropical Forests in the Changing Earth System’ (T-FORCES), and Natural Environment Research Council (NERC) Urgency Grant and NERC Consortium Grants ‘AMAZONICA’ (NE/F005806/1) and ‘TROBIT’ (NE/D005590/1). Additional funding for fieldwork was provided by Tropical Ecology Assessment and Monitoring (TEAM) Network, a collaboration among Conservation International, the Missouri Botanical Garden, the Smithsonian Institution, and the Wildlife Conservation Society. A.E.M. receives a PhD scholarship from the T-FORCES ERC grant. O.L.P. is supported by an ERC Advanced Grant and a Royal Society Wolfson Research Merit Award. We thank Jon J. Lloyd, Chronis Tzedakis, David Galbraith, and two anonymous reviewers for helpful comments and Dylan Young for helping with the analyses. This study would not be possible without the extensive contributions of numerous field assistants and rural communities in the Neotropical forests. Alfredo Alarcón, Patricia Alvarez Loayza, Plínio Barbosa Camargo, Juan Carlos Licona, Alvaro Cogollo, Massiel Corrales Medina, Jose Daniel Soto, Gloria Gutierrez, Nestor Jaramillo Jarama, Laura Jessica Viscarra, Irina Mendoza Polo, Alexander Parada Gutierrez, Guido Pardo, Lourens Poorter, Adriana Prieto, Freddy Ramirez Arevalo, Agustín Rudas, Rebeca Sibler and Javier Silva Espejo additionally contributed data to this study though their RAINFOR participations. We further thank those colleagues no longer with us, Jean Pierre Veillon, Samuel Almeida, Sandra Patiño and Raimundo Saraiva. Many data come from Alwyn Gentry, whose example has inspired new generations to investigate the diversity of the Neotropics

Long-term decline of the Amazon carbon sink

Atmospheric carbon dioxide records indicate that the land surface has acted as a strong global carbon sink over recent decades1, 2, with a substantial fraction of this sink probably located in the tropics3, particularly in the Amazon4. Nevertheless, it is unclear how the terrestrial carbon sink will evolve as climate and atmospheric composition continue to change. Here we analyse the historical evolution of the biomass dynamics of the Amazon rainforest over three decades using a distributed network of 321 plots. While this analysis confirms that Amazon forests have acted as a long-term net biomass sink, we find a long-term decreasing trend of carbon accumulation. Rates of net increase in above-ground biomass declined by one-third during the past decade compared to the 1990s. This is a consequence of growth rate increases levelling off recently, while biomass mortality persistently increased throughout, leading to a shortening of carbon residence times. Potential drivers for the mortality increase include greater climate variability, and feedbacks of faster growth on mortality, resulting in shortened tree longevity5. The observed decline of the Amazon sink diverges markedly from the recent increase in terrestrial carbon uptake at the global scale1, 2, and is contrary to expectations based on models6

Male reproduction in spinal muscular atrophy (SMA) and the potential impact of oral survival of motor neuron 2 (SMN2) pre-mRNA splicing modifiers

Spinal muscular atrophy (SMA) is a neuromuscular disease caused by deletions or mutations in the survival of motor neuron 1 (SMN1) gene resulting in reduced levels of SMN protein. SMN protein is produced by cells throughout the body, and evidence suggests that low SMN protein can have systemic implications, including in male reproductive organs. However, a paucity of research exists on this important topic. This article will discuss findings from non-clinical studies on the role of SMN in the male reproductive system; additionally, real-world observational reports of individuals with SMA will be examined. Furthermore, we will review the non-clinical reproductive findings of risdiplam, a small-molecule SMN2 splicing modifier approved for the treatment of SMA, which has widespread distribution in both the central nervous system and peripheral organs. Specifically, the available non-clinical evidence of the effect of risdiplam on male reproductive organs and spermatogenesis is examined. Lastly, the article will highlight available capabilities to assess male fertility as well as the advanced reproductive technologies utilized to treat male infertility. This article demonstrates the need for further research to better understand the impacts of SMA on male fertility and reproduction

Patient-reported reasons for stopping care or switching clinics in Zambia: A multisite, regionally representative estimate using a multistage sampling-based approach in Zambia

BACKGROUND: Understanding patient-reported reasons for lapses of retention in human immunodeficiency virus (HIV) treatment can drive improvements in the care cascade. A systematic assessment of outcomes among a random sample of patients lost to follow-up (LTFU) from 32 clinics in Zambia to understand the reasons for silent transfers and disengagement from care was undertaken. METHODS: We traced a simple random sample of LTFU patients (\u3e90 days from last scheduled visit) as determined from clinic-based electronic medical records from a probability sample of facilities. Among patients found in person, we solicited reasons for either stopping or switching care and predictors for re-engagement. We coded reasons into structural, psychosocial, and clinic-based barriers. RESULTS: Among 1751 LTFU patients traced and found alive, 31% of patients starting antiretroviral therapy (ART) between 1 July 2013 and 31 July 2015 silently transferred or were disengaged (40% male; median age, 35 years; median CD4 level, 239 cells/μL); median time on ART at LTFU was 480 days (interquartile range, 110-1295). Among the 544 patients not in care, median prevalences for patient-reported structural, psychosocial, and clinic-level barriers were 27.3%, 13.9%, and 13.4%, respectively, and were highly variable across facilities. Structural reasons, including, relocated to a new place were mostly cited among 289 patients who silently transferred (35.5%). We found that men were less likely to re-engage in care than women (odds ratio, .39; 95% confidence interval, .22-.67; P = .001). CONCLUSIONS: Efforts to improve retention of patients on ART may need to be tailored at the facility level to address patient-reported barriers

Investigation of Malaria Parasitemia among Asymptomatic Individuals in Designated Districts of Central and Muchinga Provinces of Zambia – A Cross Sectional Study

The aim of the study was to investigate asymptomatic malaria in health-conscious population across four selected districts. Malaria is a life-threatening disease caused by Plasmodium spp. transmitted through bites of infected female Anopheles mosquitoes. Asymptomatic malaria refers to the presence of malaria parasites in vivo without symptoms, which usually provides a reservoir for the disease transmission.Materials and methods. Blood collected in EDTA underwent testing through RDT (SD Bioline one-step malaria antigen P.f. (HRP-II) rapid test kits), while thin and thick blood smears Giemsa stained were microscopically examined.Results and discussion. Out of 385 individuals examined, 84 people (21.8 %) tested positive for malaria using RDT and 101/385 (26.2 %) – through microscopy. Microscopic examination further identified 27 individuals (7.0 %) with gametocytes and 74 (19.2 %) – with trophozoites. Intriguingly, 17 (4.4 %) samples showed negative results in RDT but exhibited trophozoites and gametocytes upon smear examination. District-wise analysis demonstrated the highest malaria positivity rate in Kanchibiya district, with 32 cases (8.3 %) detected by RDT and 35 (8.5 %) – through microscopy. Chitambo district followed closely: with RDT and microscopy values of 25 (6.5 %) and 33 (8.4 %), respectively; while Mpika and Serenje districts had 13 (3.4 %) and 14 (3.6 %) prevalence, respectively, with RDT and microscopy at 12 (3.1 %) in both districts [x2 =16.3, p-value=0.0118]. The study also revealed that 365/385 (95 %) of the participants demonstrated knowledge and positive attitudes toward malaria. Our findings accentuate the presence of asymptomatic malaria, encompassing trophozoites and gametocytes, among seemingly healthy individuals which poses a health risk to the community. Therefore, it is imperative to implement preventive chemotherapy and strengthen vector control efforts against malaria in order to reduce the infection rate