A life threatening uterine inversion and massive post partum hemorrhage caused by placenta accrete during Caesarean section in a primigravida: a case report

Epoxide hydrolases catalyze the cofactor-independent hydrolysis of reactive and toxic epoxides. They play an essential role in the detoxification of various xenobiotics in higher organisms and in the bacterial degradation of several environmental pollutants. The first x-ray structure of one of these, from Agrobacterium radiobacter AD1, has been determined by isomorphous replacement at 2.1-Å resolution. The enzyme shows a two-domain structure with the core having the α/β hydrolase-fold topology. The catalytic residues, Asp107 and His275, are located in a predominantly hydrophobic environment between the two domains. A tunnel connects the back of the active-site cavity with the surface of the enzyme and provides access to the active site for the catalytic water molecule, which in the crystal structure, has been found at hydrogen bond distance to His275. Because of a crystallographic contact, the active site has become accessible for the Gln134 side chain, which occupies a position mimicking a bound substrate. The structure suggests Tyr152/Tyr215 as the residues involved in substrate binding, stabilization of the transition state, and possibly protonation of the epoxide oxygen.

Second-trimester amniotic fluid proteins changes in subsequent spontaneous preterm birth

IntroductionThe global sequence of the pathogenesis of preterm labor remains unclear. This study aimed to compare amniotic fluid concentrations of extracellular matrix-related proteins (procollagen, osteopontin and IL-33), and of cytokines (IL-19, IL-6, IL-20, TNF alpha, TGF beta, and IL-1 beta) in asymptomatic women with and without subsequent spontaneous preterm delivery. Material and methodsWe used amniotic fluid samples of singleton pregnancy, collected by amniocentesis between 16 and 20 weeks' gestation, without stigmata of infection (i.e., all amniotic fluid samples were tested with broad-range 16 S rDNA PCR to distinguish samples with evidence of past bacterial infection from sterile ones), during a randomized, double-blind, placebo-controlled trial to perform a nested case-control laboratory study. Cases were women with a spontaneous delivery before 37 weeks of gestation (preterm group). Controls were women who gave birth at or after 39 weeks (full term group). Amniotic fluid concentrations of the extracellular matrix-related proteins and cytokines measured by immunoassays were compared for two study groups. : NCT00718705. ResultsBetween July 2008 and July 2011, in 12 maternal-fetal medicine centers in France, 166 women with available PCR-negative amniotic fluid samples were retained for the analysis. Concentrations of procollagen, osteopontin, IL-19, IL-6, IL-20, IL-33, TNF alpha, TGF beta, and IL-1 beta were compared between the 37 who gave birth preterm and the 129 women with full-term delivery. Amniotic fluid levels of procollagen, osteopontin, IL-19, IL-33, and TNF alpha were significantly higher in the preterm than the full-term group. IL-6, IL-20, TGF beta, and IL-1 beta levels did not differ between the groups. ConclusionsIn amniotic fluid 16 S rDNA PCR negative samples obtained during second-trimester amniocentesis, extracellular matrix-related protein concentrations (procollagen, osteopontin and IL-33), together with IL-19 and TNF alpha, were observed higher at this time in cases of later spontaneous preterm birth

On the challenge of adopting standard EHR systems in developing countries

Electronic health record (EHR) systems are a popular mechanism for accessing health records in the developed world and have contributed towards improved and cost-effective health care management. However, the development of appropriate and scalable EHR systems in developing countries has been difficult to achieve because of certain limitations inherent in the technological infrastructure. In this paper, we present a comparative study of 19 EHR systems in terms of the security and usability of these systems within the context of the developing world. Our aim was to investigate whether online health services designed for developed countries can be adopted for EHR systems in developing countries. The investigation was based on a number of dimensions such as development environment, system platform, type and access control standards found in the National Institute for Standard and Technology (NIST) and Certification Commission for Health Information Technology (CCHIT). Our research indicates that all the systems evaluated require online access control decisions. Solely relying on an online access control system is limiting, particularly in developing countries where access to the server can be disrupted by a number of disastrous events

Self-Protecting Access Control: On Mitigating Privacy Violations with Fault Tolerance

Self-protecting access control mechanisms can be described as an approach to enforcing security in a manner that automatically protects against violations of access control rules. In this chapter, we present a comparative analysis of standard Cryptographic Access Control (CAC) schemes in relation to privacy enforcement on the Web. We postulate that to mitigate privacy violations, self-protecting CAC mechanisms need to be supported by fault-tolerance. As an example of how one might to do this, we present two solutions that are inspired by the autonomic computing paradigm1. Our solutions are centered on how CAC schemes can be extended to protect against privacy violations that might arise from key updates and collusion attacks

Efficient enforcement of dynamic cryptographic access control policies for outsourced data

Outsourcing of their data to third-party service providers is a cost-effective data management strategy for many organizations. Outsourcing, however, introduces new challenges with respect to ensuring the security and the privacy of the data. In addition to the need for standard access control policies, organizations must now be concerned with the privacy of their data and so hiding the data from the service provider is important. Simply encrypting the data before it is transmitted to the service provider is inefficient and vulnerable to security attacks when the access control policies change. Approaches based on two layers of encryption alleviate the privacy concern but still require re-encryption of the data when policies change. This paper presents a novel and efficient solution that employs two layers of encryption of the data and an encrypted data object containing the second access key. Changes to the access control policies are handled by re-encrypting the object containing the affected key, which is an efficient operation. The paper presents our key management approach, a security analysis of our approach, and an evaluation of the performance of a proof of concept implementation of our approach

The impact of chorionicity on pregnancy outcome and neurodevelopment at 2 years old among twins born preterm: the EPIPAGE-2 cohort study

OBJECTIVE To compare the short‐ and mid‐term outcomes of preterm twins by chorionicity of pregnancy. DESIGN Prospective nationwide population‐based EPIPAGE‐2 cohort study. SETTING 546 maternity units in France, between March and December 2011. POPULATION A total of 1700 twin neonates born between 24 and 34 weeks of gestation. METHODS The association of chorionicity with outcomes was analysed using multivariate regression models. MAIN OUTCOME MEASURES First, survival at 2‐year corrected age with or without neurosensory impairment, and second, perinatal, short‐, and mid‐term outcomes (survival at discharge, survival at discharge without severe morbidity) were described and compared by chorionicity. RESULTS In the EPIPAGE 2 cohort, 1700 preterm births were included (850 twin pregnancies). In all, 1220 (71.8%) were from dichorionic (DC) pregnancies and 480 from monochorionic (MC) pregnancies. MC pregnancies had three times more medical terminations than DC pregnancies (1.67 versus 0.51%, P < 0.001), whereas there were three times more stillbirths in MC than in DC pregnancies (10.09 versus 3.78%, P < 0.001). Both twins were alive at birth in 86.6% of DC pregnancies compared with 80.0% among MC pregnancies (P = 0.008). No significant difference according to chorionicity was found regarding neonatal deaths and morbidities. Likewise, for children born earlier than 32 weeks, the 2‐year follow‐up neurodevelopmental results were not significantly different between DC and MC twins. CONCLUSIONS This study confirms that MC pregnancies have a higher risk of adverse outcomes. However, the outcomes among preterm twins admitted to neonatal intensive care units are similar irrespective of chorionicity

Placenta increta causing hemoperitoneum in the 26th week of pregnancy: a case report

Abstract Introduction Placenta increta is a serious complication of pregnancy. We describe a case leading to uterine rupture associated with massive intra-abdominal hemorrhage. Case presentation A 34-year-old Caucasian Albanian woman, gravida 2, para 1, was admitted to the emergency department of our hospital for acute abdominal pain associated with profound secondary anemia. An anatomopathological diagnosis of placenta increta destruens was made. An urgent hysterectomy was performed after resuscitation procedures, applied due to the severe anemia and the abdominal drama accompanying the case. Intra-operatively, a uterus-saving procedure was found to be impossible, and hysterectomy remained the only surgical option. The uterine structures were sent for further microscopic evaluation. On histological examination, deep trophoblastic infiltration of the uterine wall was observed, justifying the surgeon's decision. Our patient received blood transfusions and antibiotics. Her sutures were removed on the eighth postoperative day and she was discharged the following day in a stable condition. Conclusion This case, describing a patient with uterine rupture and massive hemorrhage, illustrates a serious and potentially fatal complication of placenta previa. In such cases, surgery is essential, and hysterectomy may be the only viable option.</p

Brazilian multicenter study on prevalence of preterm birth and associated factors

<p>Abstract</p> <p>Background</p> <p>The occurrence of preterm birth remains a complex public health condition. It is considered the main cause of neonatal morbidity and mortality, resulting in a high likelihood of sequelae in surviving children. With variable incidence in several countries, it has grown markedly in the last decades. In Brazil, however, there are still difficulties to estimate its real occurrence. Therefore, it is essential to establish the prevalence and causes of this condition in order to propose prevention actions. This study intend to collect information from hospitals nationwide on the prevalence of preterm births, their associated socioeconomic and environmental factors, diagnostic and treatment methods resulting from causes such as spontaneous preterm labor, prelabor rupture of membranes, and therapeutic preterm birth, as well as neonatal results.</p> <p>Methods/Design</p> <p>This proposal is a multicenter cross-sectional study plus a nested case-control study, to be implemented in 27 reference obstetric centers in several regions of Brazil (North: 1; Northeast: 10; Central-west: 1; Southeast: 13; South: 2). For the cross sectional component, the participating centers should perform, during a period of six months, a prospective surveillance of all patients hospitalized to give birth, in order to identify preterm birth cases and their main causes. In the first three months of the study, an analysis of the factors associated with preterm birth will also be carried out, comparing women who have preterm birth with those who deliver at term. For the prevalence study, 37,000 births will be evaluated (at term and preterm), corresponding to approximately half the deliveries of all participating centers in 12 months. For the case-control study component, the estimated sample size is 1,055 women in each group (cases and controls). The total number of preterm births estimated to be followed in both components of the study is around 3,600. Data will be collected through a questionnaire all patients will answer after delivery. The data will then be encoded in an electronic form and sent online by internet to a central database. The data analysis will be carried out by subgroups according to gestational age at preterm birth, its probable causes, therapeutic management, and neonatal outcomes. Then, the respective rates, ratios and relative risks will be estimated for the possible predictors.</p> <p>Discussion</p> <p>These findings will provide information on preterm births in Brazil and their main social and biological risk factors, supporting health policies and the implementation of clinical trials on preterm birth prevention and treatment strategies, a condition with many physical and emotional consequences to children and their families.</p