Monoamniotic twin pregnancy: is there a need for frequent fetal-doppler surveillance?

Monoamniotic twin pregnancy is a rare type of twin pregnancy which poses risk of cord entanglement and sudden death of either one or both fetuses. The role of antenatal surveillance by Ultrasound Doppler for umbilical cord and ultrasonic evidence of cord entanglement or knotting may predict the pregnancy outcome but yet unavoidable. The discussion will include antenatal surveillance in this rare type of pregnanc

Syringomyelia in pregnancy - is caesarean section the best option for delivery - a case report

Syringomyelia is a rare neurological disease, which is characterized by the formation of a cyst in the spinal cord. The aetiology of the disease still remains controversial. The damage to the spinal cord results in headache, weakness, stiffness and numbness on both lower and upper limbs. Only few a cases of syringomyelia in pregnancy have been reported thus far. As such, there is no standard management of intrapartum care. We present a case of symptomatic syringomyelia in pregnancy, its management and literature review. The mode of delivery with risks for vaginal route is discussed

Chemical and functional properties of bovine and porcine skin gelatin

The ability to compare bovine and porcine skin gelatin based on their amino acid composition, polypeptides pattern, bloom strength, turbidity and foaming properties were investigated. Amino acid composition of both gelatin showed that the content of glycine, proline and arginine in porcine gelatin were higher than bovine gelatin. However, the polypeptides pattern between both gelatin is closely similar. The bloom strength of porcine gelatin was higher than bovine gelatin from pH 3 to pH 10. Both gelatin possessed highest bloom strength at pH 9. The lowest bloom strength of bovine gelatin was at pH 3 while porcine gelatin at pH 5. The highest turbidity of bovine gelatin obtained at pH 7 while porcine gelatin at pH 9. Foam expansion and foam stability of bovine gelatin were higher than porcine gelatin at all concentrations

A psychologist-led educational intervention results in a sustained reduction in neonatal intensive care unit infections

Even though in the corporateworld psychological science has been widely used, the formal use of evidence-based psychology in important areas of clinical medicine has been scanty at best. It was the aim of this study to determine the efficacy of a psychologist-led 2-week nurse educator training on the infection rate in the neonatal intensive care unit (NICU). Materials and methods: In 2007, six senior neonatal nurses underwent a training course focusing on the retrieval of evidence and knowledge of psychological principles that would allow them to share the evidence in such a way that evidence is effectively brought into practice.The course was led by a psychologist.The nurses created and delivered their own teaching modules, all focused on infection control. The rates of bacteremia, 2 years prior to intervention were analyzed and compared with the rate following the intervention for 3 years

The outcome of singleton breech delivery

Breech presentations and breech births are reported to have increased morbidity and mortality when compared to cephalic presentation Hall and Kohl 1956 stated that the type of breech influenced the perinatal morbidity and the risk of cord prolapse with non-frank breech increased by six folds There was also increased intrapartum and neonatal deaths with non-frank breech presentation . The concept of elective caesarean section in all primigravida term frank breech needed in some to be reviewed Caesarean section is absolutely necessary if the biparietal diameter exceeds 10 centimetres with hyperextended head and where inadequacy of pelvis is suspected However caesarean delivery is not associated with a lower risk of either perinatal mortality or intraventricular haemorrhage in very low birth weight infants weighing less than 1500g Denise M Martin et al 1983 It was noted that no significant differences found in the incidence of lower Apgar scores traumatic birth injury or requirement for neonatal resuscitation between those infants delivered via caesarean section and vaginal delivery

Middle cerebral artery doppler and umbilical artery doppler as predictors Of perinatal outcome in small for gestational age fetuses in Hospital USM, Kubang Kerian, Kelantan

Small for gestational age babies are prone to get adverse perinatal outcome. They have increased risk of perinatal mortality, morbidity and neuro-developmental impairment.Doppler studies help to assess the condition of these babies in-utero, thus help to plan and ensure a better outcome of small fetuses. Monitoring and assessment provide a better collaboration between the pediatric team and the obstetric team. Such a collaboration help to reduce the neonatal intensive care unit stay and avoid delivery of severely premature fetuses without prior planning for post-delivery back up. It is hoped that the analysis of this study will help the obstetricians to decide and counsel patients on timing of delivery, and make necessary preparations before the delivery of these high risk fetuses

Increased circulating oxidised low-density lipoprotein and antibodies to oxidised low-density lipoprotein in preeclampsia

Enhanced oxidative stress is involved in the pathogenesis of endothelial dysfunction in preeclampsia (PE). Circulating oxidised LDL (oxLDL) and antibodies to oxLDL (Ab-oxLDL) have been found to be associated with atherosclerosis. The objectives of this study were to investigate the association of oxLDL and Ab-oxLDL with PE and to assess the association between oxLDL and Ab-oxLDL. The levels of oxLDL and Ab-oxLDL were measured by enzyme-linked immunoassay in 78 women with preeclampsia (PE group) and 78 women with normal pregnancy (control group). The PE group had higher oxLDL and Ab-oxLDL levels than the control group (485.1vs.145.9 ng/ml, p < .001) and (578.7 vs 216.2 mU/ml, p < .001), respectively. However, Ab-oxLDL levels were not associated with the levels of oxLDL, age, BMI, gestational age, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both the groups. In conclusion, our study showed that PE was associated with increased oxLDL and Ab-oxLDL, which may reflect the enhanced oxidative stress in PE.Impact Statement Preeclampsia (PE) is a potentially life-threatening condition and both maternal and foetal complications can develop if it is not monitored appropriately. The pathogenesis of endothelial dysfunction in PE is related to the enhanced oxidative stress and oxidation of LDL. However, more studies were required as previous studies had not shown a consistent association of oxLDL and Ab-oxLDL with PE. Our study showed significant association of oxLDL and Ab-oxLDL with PE, indicating that their levels may be reliable indicators of oxidation stress and of the risk of PE. Levels of oxidative stress markers may have implications for clinical practice, such as their association with intrauterine growth restriction (IUGR), HELLP syndrome or eclampsia, foetal birth weight and premature delivery. Further research is still needed, ideally as a prospective cohort study to investigate the association of oxLDL and Ab-oxLDL with such outcome parameters

Comparison of bovine and porcine skin gelatin based on amino acid composition, polypeptide pattern and gel strength

The ability to compare bovine skin gelatin (BSG) and porcine skin gelatin (PSG) based on their amino acid content, polypeptide pattern and Bloom strength were investigated. Amino acid composition analysis of the two types of gelatin showed that the content of glycine, proline and arginine in PSG were higher than BSG. In the other hand, the Bloom strength of PSG and BSG was determined in different pH value ranging from pH 3 to pH 10. Within this pH range, PSG confer higher Bloom strength as compared to BSG. Both gelatins have the highest Bloom strength at pH 9 while the lowest Bloom strength of BSG and PSG was at pH 3 and pH 5 respectively. However, there is no difference of polypeptide pattern between PSG and BSG as both of them consists of α and β chains

A psychologist-led educational intervention results in a sustained reduction in neonatal intensive care unit infections

Even though in the corporate world psychological science has been widely used, the formal use of evidence- based psychology in important areas of clinical medicine has been scanty at best. It was the aim of this study to determine the efficacy of a psychologist-led two-week nurse educator training on the infection rate in the NICU. Materials and methods: Six senior neonatal nurses underwent in 2007 a training course covering the retrieval of evidence and knowledge of psychological principles that would allow them to share the evidence in such a way that evidence is effectively brought into practice. The course was led by a psychologist. The nurses created and delivered their own teaching modules, all focused on infection control. The rates of bacteraemia, 2 years prior to intervention were analyzed and compared with the rate following the intervention for three years.Results: The immediate output of the course included three teaching modules (hand washing, sterile procedures, general measures to control infection). These modules were subsequently administered to the NICU nurses in structured and regular continuous nursing education (CNE) sessions. The psychological techniques taught in the course were applied. Bacteraemia in the NICU significantly decreased in the year of the course and the subsequent years when compared to previous years.Conclusion: This study suggests that a psychologist-led course, followed by a structured CNE can lead to a sustainable reduction in infection rates in a NICU. <br/