Clinical chorioamnionitis at term X: Microbiology, clinical signs, placental pathology, and neonatal bacteremia - Implications for clinical care

Objectives: Clinical chorioamnionitis at term is considered the most common infection-related diagnosis in labor and delivery units worldwide. The syndrome affects 5-12% of all term pregnancies and is a leading cause of maternal morbidity and mortality as well as neonatal death and sepsis. The objectives of this study were to determine the (1) amniotic fluid microbiology using cultivation and molecular microbiologic techniques; (2) diagnostic accuracy of the clinical criteria used to identify patients with intraamniotic infection; (3) relationship between acute inflammatory lesions of the placenta (maternal and fetal inflammatory responses) and amniotic fluid microbiology and inflammatory markers; and (4) frequency of neonatal bacteremia. Methods: This retrospective cross-sectional study included 43 women with the diagnosis of clinical chorioamnionitis at term. The presence of microorganisms in the amniotic cavity was determined through the analysis of amniotic fluid samples by cultivation for aerobes, anaerobes, and genital mycoplasmas. A broad-range polymerase chain reaction coupled with electrospray ionization mass spectrometry was also used to detect bacteria, select viruses, and fungi. Intra-amniotic inflammation was defined as an elevated amniotic fluid interleukin-6 (IL-6) concentration ≥2.6 ng/mL. Results: (1) Intra-amniotic infection (defined as the combination of microorganisms detected in amniotic fluid and an elevated IL-6 concentration) was present in 63% (27/43) of cases; (2) the most common microorganisms found in the amniotic fluid samples were Ureaplasma species, followed by Gardnerella vaginalis; (3) sterile intra-amniotic inflammation (elevated IL-6 in amniotic fluid but without detectable microorganisms) was present in 5% (2/43) of cases; (4) 26% of patients with the diagnosis of clinical chorioamnionitis had no evidence of intra-amniotic infection or intra-amniotic inflammation; (5) intra-amniotic infection was more common when the membranes were ruptured than when they were intact (78% [21/27] vs. 38% [6/16]; p=0.01); (6) the traditional criteria for the diagnosis of clinical chorioamnionitis had poor diagnostic performance in identifying proven intra-amniotic infection (overall accuracy, 40-58%); (7) neonatal bacteremia was diagnosed in 4.9% (2/41) of cases; and (8) a fetal inflammatory response defined as the presence of severe acute funisitis was observed in 33% (9/27) of cases. Conclusions: Clinical chorioamnionitis at term, a syndrome that can result from intra-amniotic infection, was diagnosed in approximately 63% of cases and sterile intra-amniotic inflammation in 5% of cases. However, a substantial number of patients had no evidence of intra-amniotic infection or intra-amniotic inflammation. Evidence of the fetal inflammatory response syndrome was frequently present, but microorganisms were detected in only 4.9% of cases based on cultures of aerobic and anaerobic bacteria in neonatal blood

CXCL10 and ILâ 6: Markers of two different forms of intraâ amniotic inflammation in preterm labor

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137580/1/aji12685_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137580/2/aji12685.pd

The link between social work education and the social worker's reported ability to respond to the needs of anglophone and allophone clients directly or indirectly affected by substance abuse /

Statistics corroborate the substantial and deleterious impact of substance abuse to both client and client systems. Social workers are regularly exposed to clients who are directly or indirectly affected by substance abuse. A random survey of social workers working with Anglophone and Allophone populations on the island of Montreal was conducted to evaluate the workers perceived ability to recognize and respond to the needs of this client group. Links were drawn to the various ways in which social workers developed their knowledge about addiction and to the worker's formal social work education. The study demonstrates the inadequacy of the formal social work program to address the problem of substance abuse. The implications for schools of social work and the need to develop core curriculum as well as specializations in substance abuse are presented

Paradoxes, Double Blinds, and Reflexive Loops: An Alternative Theoretical Perspective

This article presents a new theory of refiexivity in systems of social meaning and action. It is argued that Russell\u27s Theory of Logical Types, which formed the basis of the early work of the Palo Alto group, rests upon an inappropriate and largely outdated epistemology. The theory offered here rejects the assumption that reflexivity and paradox are coterminous. It is further argued that reflexivity is a natural and necessary feature of human systems of meaning. New analytic tools are offered for discerning problematic from nonproblematic reflexive loops. The new tools take the form of a symbol system that can be used to represent the rules that organize reflexive relationships. The theory also contains a set of statements designed to delimit conditions under which problematic reflexive loops have ramifications for persons\u27 mental health