An interesting cause of syncope

Patient with a history of repeated episodes of syncope over the preceding week

Calcium supplementation to prevent pre-eclampsia - a systematic review

Background. Calcium supplementation during pregnancy may prevent high blood pressure and preterm labour. Objective. To assess the effects of calcium supplementation during pregnancy on hypertensive disorders of pregnancy and related maternal and child adverse outcomes. Design. A systematic review of randomised trials that compared supplementation with at least 1 g calcium daily during pregnancy with placebo. Search strategy. The Cochrane Pregnancy and Childbirth Group trials register (October 2001) and the Cochrane Controlled Trials Register (Issue 3, 2001) were searched and study s were contacted. Data collection and analysis. Eligibility and trial quality were assessed. Data were extracted and analysed. Main results. There was a modest reduction in the risk of pre-eclampsia with calcium supplementation (relative risk (RR) 0.68, 95% confidence interval (CI): 0.57- 0.81). The effect was greatest for women at high risk of hypertension (RR 0.21, 95% CI: 0.11 - 0.39) and those with low baseline calcium intake (RR 0.32, 95% CI: 0.21 - 0.49). There was no overall effect on the risk of preterm delivery, although there was a reduction in risk among women at high risk of hypertension (RR 0.42, 95% CI: 0.23 - 0.78). There was no evidence of any effect of calcium supplementation on stillbirth or death before discharge from hospital. There were fewer babies with birthweight 95th percentile was reduced (RR 0.59, 95% CI: 0.39 - 0.91). Conclusions. Calcium supplementation appears to be beneficial for women at high risk of gestational hypertension and in communities with low dietary calcium intake. These benefits were confined to several rather small trials, and were not found in the largest trial to date, conducted in a low-risk population. Further research is required. (South African Medical Journal: 2003 93(3): 224-228

Pulmonary oedema after hexoprenaline administration in preterm labour A report of 4 cases

Despite the widespread use of ,a-sympathomimetic agents for preterm labour there appears to be a limited appreciation of the need for cardiovascular monitoring in the mother. Four patients in whom pulmonary oedema developed during tocolysis with hexoprenaline are described and the aetiological factors and pathogenesis of this potentially lethal complication discussed. Guidelines for the safe use of hexoprenaline in preterm labour are suggested

Assessing the preference of women for different methods of monitoring the fetal heart in labour

Objective. To assess which of three different methods of monitoring the fetal heart in labour was preferred by labouring women. Method. Ninety-nine women in the first stage of labour were enrolled into a prospective clinical study to compare their preference for fetal monitoring with a Pinard fetal stethoscope, an innovative wind-up Doppler ultrasound fetal heart rate monitor, and cardiotocography. Result. Significantly more women preferred the fetal heart rate monitor to the other two methods (p=0.001). Conclusion. Intermittent auscultation of the fetal heart during labour with a fetal monitor is more acceptable to labouring women than monitoring with a Pinard fetal stethoscope or a cardiotocograph

Geographic range extension of Speke's Hinge-back Tortoise Kinixys spekii Gray, 1863

Kinixys spekii has a wide distribution range across sub-Saharan Africa, having been reported from Angola, Botswana, Burundi, the Democratic Republic of the Congo, eSwatini, Kenya, Malawi, Mozambique, Namibia, South Africa, Tanzania, Zambia, and Zimbabwe. Kinixys spekii inhabits savannah and dry bushveld habitats and was previously considered an inland species. However, recent records suggest a more extensive geographical distribution. Here, we provide genetically verifed records for Angola, South Africa, and Mozambique, and discuss reliable sightings for Rwanda. These new records extend the range signifcantly to the east and west, and provide evidence for the occurrence of this species along the coast of the Indian Ocean in South Africa and Mozambique.© 2019 Ihlow et al. This is an open access article distributed under the terms of the Creative Commons Attribution License [Attribution 4.0 International (CC BY 4.0): https://creativecommons.org/licenses/by/4.0/], which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The official and authorized publication credit sources, which will be duly enforced, are as follows: offcial journal title Amphibian & Reptile Conservation; official journal website: amphibian-reptile-conservation.org

Children's daily travel to school in Johannesburg-Soweto, South Africa: geography and school choice in the Birth to Twenty cohort study

This paper has two aims: to explore approaches to the measurement of children’s daily travel to school in a context of limited geospatial data availability, and to provide data regarding school choice and distance travelled to school in Soweto-Johannesburg, South Africa. The paper makes use of data from the Birth to Twenty cohort study (n=1428) to explore three different approaches to estimating school choice and travel to school. Firstly, straight-line distance between home and school is calculated. Secondly, census geography is used to determine whether a child's home and school fall in the same area. Thirdly, distance data are used to determine whether a child attends the nearest school. Each of these approaches highlights a different aspect of mobility, and all provide valuable data. Overall, primary school aged children in Soweto-Johannesburg are shown to be travelling substantial distances to school on a daily basis. Over a third travel more than 3km, one-way, to school, 60% attend schools outside of the suburb in which they live, and only 18% attend their nearest school. These data provide evidence for high levels of school choice in Johannesburg-Soweto, and that families and children are making substantial investments in pursuit of high quality educational opportunities. Additionally, these data suggest that two patterns of school choice are evident: one pattern involving travel of substantial distances and requiring a higher level of financial investment, and a second pattern, involving choice between more local schools, requiring less travel and a more limited financial investment

Assessment of funnel plot asymmetry and publication bias in reproductive health meta-analyses: an analytic survey

BACKGROUND: Despite efforts to assure high methodological standards, systematic reviews may be affected by publication bias. The objective of this study was to evaluate the occurrence of publication bias in a collection of high quality systematic reviews on reproductive health. METHODS: Systematic reviews included in the Reproductive Health Library (RHL), issue No 9, were assessed. Funnel plot was used to assess meta-analyses containing 10 or more trials reporting a binary outcome. A funnel plot, the estimated number of missing studies and the adjusted combined effect size were obtained using the "trim and fill method". Meta-analyses results that were not considered to be robust due to a possible publication bias were submitted to a more detailed assessment. RESULTS: A total of 21 systematic reviews were assessed. The number of trials comprising each one ranged from 10 to 83 (median = 13), totaling 379 trials, whose results have been summarized. None of the reviews had reported any evaluation of publication bias or funnel plot asymmetry. Some degree of asymmetry in funnel plots was observed in 18 of the 21 meta-analyses evaluated (85.7%), with the estimated number of missing studies ranging from 1 to 18 (median = 3). Only for three meta-analyses, the conclusion could not be considered robust due to a possible publication bias. CONCLUSION: Asymmetry is a frequent finding in funnel plots of meta-analyses in reproductive health, but according to the present evaluation, less than 15% of meta-analyses report conclusions that would not be considered robust. Publication bias and other sources of asymmetry in funnel plots should be systematically addressed by reproductive health meta-analysts. Next amendments in Cochrane systematic reviews should include this type of evaluation. Further studies regarding the evolution of effect size and publication bias over time in systematic reviews in reproductive health are needed