Repeated-batch ethanol fermentation from sweet sorghum juice by free cells of Saccharomyces cerevisiae NP 01

Low-cost inoculum preparation (IP) media for ethanol production were developed. It was found that sweet sorghum juice (SSJ) containing 100 g l-1 of total sugar without nutrient supplement could be used as the low-cost IP medium instead of the typical IP medium or yeast extract malt extract (YM) medium. Ethanol production from the SSJ (total soluble solids of 24 °Bx) by the inoculum of Saccharomyces cerevisiae NP 01 in batch and repeated-batch fermentations was then investigated. The fermentations were carried out under static condition in 500 ml air-locked Erlenmeyer flasks at 30°C and the initial yeast cell concentration was 1×108 cells ml-1. In the batch fermentation, the concentration (P), productivity (Qp) and yield (Yp/s) of ethanol were 110.09 ± 0.81 g l-1, 2.29 ± 0.01 g l-1 h-1 and 0.51 ± 0.02, respectively. In the repeated-batch fermentation, the yeasts could be used at least eight successive batches without a marked decrease in ethanol production. The repeated-batch fermentation with fill and drain volume at 75% of the working volume gave higher ethanol production efficiencies than those at 50% of the working volume in terms of total ethanol production rate (g h-1). The average P, Qp and Yp/s of the eight successive batches at 75% fill and drain volume in a 2 L bioreactor at the agitation rate of 100 rev min-1 were 93.30 ± 9.44 g l-1, 1.21 ± 0.43 g l-1 h-1 and 0.48 ± 0.03, respectively.Key words: Repeated-batch, ethanol fermentation, low-cost nutrient, sweet sorghum juice, Saccharomyces cerevisiae

Improvement of gas chromatographic analysis for organic acids and solvents in acetone-butanolethanol fermentation from sweet sorghum juice

Modern development for gas chromatographic peak recognition of organic acids and organic solvents in acetone-butanol-ethanol (ABE) fermentation was investigated under different temperature programmes. Either propanol or iso-butanol was used as an internal standard. The results showed that short retention time and fair recognition peak of the compounds were obtained under the following column temperature programme: 10 min at 150°C, 15°C/min to 180°C and 20 min at 180°C. The appearance of the chromatograms showed that iso-butanol allowed higher resolution and satisfactory peak shape for the tested compounds than propanol. Calibration curve between ratios of standard peak area per internal standard peak area and concentrations of the organic acids and organic solvents under these conditions had a good linear correlation with R2 ≥ 0.998. When ABE fermentation by Clostridium beijerinckii JCM1390 from sweet sorghum juice was carried out in a 2-L fermenter, the highest butanol concentration was 7.56 g/l with the butanol yield of 0.33 g/g sugar utilized.Key words: Acetone-butanol-ethanol fermentation, column temperature programme, gas chromatography, sweet sorghum juice

Pregnancy and childbirth outcomes among adolescent mothers: A World Health Organization multicountry study

Tuvo como objetivo investigar el riesgo de resultados adversos del embarazo entre adolescentes en 29 países. El diseño utilizado fue un análisis secundario utilizando datos transversales basados en instalaciones de la Encuesta multipaís sobre salud materna y neonatal de la Organización Mundial de la Salud. Se tomó el análisis de veintinueve países de África, América Latina, Asia y Oriente Medio. La población estimada fue de mujeres ingresadas para el parto de 359 centros de salud durante 2 a 4 meses entre 2010 y 2011. Se utilizaron modelos de regresión logística multinivel para estimar la asociación entre la edad materna joven y los resultados adversos del embarazo. Se analizaron un total de 124 446 madres de ≤24 años y sus bebés. En comparación con las madres de 20 a 24 años, las madres adolescentes de 10 a 19 años tenían mayores riesgos de eclampsia, endometritis puerperal, infecciones sistémicas, bajo peso al nacer, parto prematuro y afecciones neonatales graves. El mayor riesgo de muerte neonatal temprana intrahospitalaria entre los bebés nacidos de madres adolescentes se redujo y fue estadísticamente insignificante después del ajuste por edad gestacional y peso al nacer, además de las características maternas, el modo de parto y la malformación congénita. La cobertura de los uterotónicos profilácticos, los antibióticos profilácticos para la cesárea y los corticosteroides prenatales para el parto prematuro a las 26 - 34 semanas fue significativamente menor entre las madres adolescentes. El embarazo adolescente se asoció con mayores riesgos de resultados adversos del embarazo. Las estrategias de prevención del embarazo y la mejora de las intervenciones de atención médica son cruciales para reducir los resultados adversos del embarazo entre las mujeres adolescentes en países de bajos y medianos ingresos

Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study

Objective: To investigate the risk of adverse pregnancy outcomes among adolescents in 29 countries. Design: Secondary analysis using facility-based cross-sectional data of the World Health Organization Multicountry Survey on Maternal and Newborn Health. Setting: Twenty-nine countries in Africa, Latin America, Asia and the Middle East. Population: Women admitted for delivery in 359 health facilities during 2–4 months between 2010 and 2011. Methods: Multilevel logistic regression models were used to estimate the association between young maternal age and adverse pregnancy outcomes. Main outcome measures: Risk of adverse pregnancy outcomes among adolescent mothers. Results: A total of 124 446 mothers aged ≤24 years and their infants were analysed. Compared with mothers aged 20–24 years, adolescent mothers aged 10–19 years had higher risks of eclampsia, puerperal endometritis, systemic infections, low birthweight, preterm delivery and severe neonatal conditions. The increased risk of intra-hospital early neonatal death among infants born to adolescent mothers was reduced and statistically insignificant after adjustment for gestational age and birthweight, in addition to maternal characteristics, mode of delivery and congenital malformation. The coverage of prophylactic uterotonics, prophylactic antibiotics for caesarean section and antenatal corticosteroids for preterm delivery at 26–34 weeks was significantly lower among adolescent mothers. Conclusions: Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low- and middle-income countries

Use of antenatal corticosteroids and tocolytic drugs in preterm births in 29 countries: an analysis of the WHO Multicountry Survey on Maternal and Newborn Health

Background: Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries. Methods: WHOMCS is a facility-based, cross-sectional survey database of birth outcomes in 359 facilities in 29 countries, with data collected prospectively from May 1, 2010, to Dec 31, 2011. For this analysis, we included deliveries after 22 weeks’ gestation and we excluded births that occurred outside a facility or quicker than 3 h after arrival. We calculated use of antenatal corticosteroids in women who gave birth between 26 and 34 weeks’ gestation, when antenatal corticosteroids are known to be most beneficial. We also calculated use in women at 22–25 weeks’ and 34–36 weeks’ gestation. We assessed tocolytic drug use, with and without antenatal corticosteroids, in spontaneous, uncomplicated preterm deliveries at 26–34 weeks’ gestation. Findings: Of 303 842 recorded deliveries after 22 weeks’ gestation, 17 705 (6%) were preterm. 3900 (52%) of 7547 women who gave birth at 26–34 weeks’ gestation, 94 (19%) of 497 women who gave birth at 22–25 weeks’ gestation, and 2276 (24%) of 9661 women who gave birth at 35–36 weeks’ gestation received antenatal corticosteroids. Rates of antenatal corticosteroid use varied between countries (median 54%, range 16–91%; IQR 30–68%). Of 4677 women who were potentially eligible for tocolysis drugs, 1276 (27%) were treated with bed rest or hydration and 2248 (48%) received no treatment. β-agonists alone (n=346, 7%) were the most frequently used tocolytic drug. Only 848 (18%) of potentially eligible women received both a tocolytic drug and antenatal corticosteroids. Interpretation: Use of interventions was generally poor, despite evidence for their benefit for newborn babies. A substantial proportion of antenatal corticosteroid use occurred at gestational ages at which benefit is controversial, and use of less effective or potentially harmful tocolytic drugs was common. Implementation research and contextualised health policies are needed to improve drug availability and increase compliance with best obstetric practice

Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health

<p>Abstract</p> <p>Background</p> <p>There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes.</p> <p>Methods</p> <p>This is a multicountry, facility-based survey that used a stratified multistage cluster sampling design to obtain a sample of countries and health institutions worldwide. A total of 24 countries and 373 health facilities participated in this study. Data collection took place during 2004 and 2005 in Africa and the Americas and during 2007 and 2008 in Asia. All women giving birth at the facility during the study period were included and had their medical records reviewed before discharge from the hospital. Univariate and multilevel analysis were performed to study the association between each group's mode of delivery and the severe maternal and perinatal outcome.</p> <p>Results</p> <p>A total of 286,565 deliveries were analysed. The overall caesarean section rate was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections without medical indications, either due to maternal request or in the absence of other recorded indications. Compared to spontaneous vaginal delivery, all other modes of delivery presented an association with the increased risk of death, admission to ICU, blood transfusion and hysterectomy, including antepartum caesarean section without medical indications (Adjusted Odds Ratio (Adj OR), 5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In addition, this association is stronger in Africa, compared to Asia and Latin America.</p> <p>Conclusions</p> <p>Caesarean sections were associated with an intrinsic risk of increased severe maternal outcomes. We conclude that caesarean sections should be performed when a clear benefit is anticipated, a benefit that might compensate for the higher costs and additional risks associated with this operation.</p

Maternal and perinatal guideline development in hospitals in South East Asia: the experience of the SEA-ORCHID project

<p>Abstract</p> <p>Background</p> <p>Clinical practice guidelines (CPGs) are commonly used to support practitioners to improve practice. However many studies have raised concerns about guideline quality. The reasons why guidelines are not developed following the established development methods are not clear.</p> <p>The SEA-ORCHID project aims to increase the generation and use of locally relevant research and improve clinical practice in maternal and perinatal care in four countries in South East Asia. Baseline data highlighted that development of evidence-based CPGs according to recommended processes was very rare in the SEA-ORCHID hospitals. The project investigators suggested that there were aspects of the recommended development process that made it very difficult in the participating hospitals.</p> <p>We therefore aimed to explore the experience of guideline development and particularly the enablers of and barriers to developing evidence-based guidelines in the nine hospitals in South East Asia participating in the SEA-ORCHID project, so as to better understand how evidence-based guideline development could be facilitated in these settings.</p> <p>Methods</p> <p>Semi-structured, face-to-face interviews were undertaken with senior and junior healthcare providers (nurses, midwives, doctors) from the maternal and neonatal services at each of the nine participating hospitals. Interviews were audio-recorded, transcribed and a thematic analysis undertaken.</p> <p>Results</p> <p>Seventy-five individual, 25 pair and eleven group interviews were conducted. Participants clearly valued evidence-based guidelines. However they also identified several major barriers to guideline development including time, lack of awareness of process, difficulties searching for evidence and arranging guideline development group meetings, issues with achieving multi-disciplinarity and consumer involvement. They also highlighted the central importance of keeping guidelines up-to-date.</p> <p>Conclusion</p> <p>Healthcare providers in the SEA-ORCHID hospitals face a series of barriers to developing evidence-based guidelines. At present, in many hospitals, several of these barriers are insurmountable, and as a result, rigorous, evidence-based guidelines are not being developed. Given the acknowledged benefits of evidence-based guidelines, perhaps a new approach to supporting their development in these contexts is needed.</p

Use of antenatal corticosteroids prior to preterm birth in four South East Asian countries within the SEA-ORCHID project

BackgroundThere is strong evidence supporting the use of antenatal corticosteroids in women at risk of preterm birth to promote fetal lung maturation and reduce neonatal mortality and morbidity. This audit aimed to assess the use of antenatal corticosteroids prior to preterm birth in the nine hospitals in four South East Asian countries participating in the South East Asia Optimising Reproductive Health in Developing Countries (SEA-ORCHID) Project.MethodWe reviewed the medical records of 9550 women (9665 infants including 111 twins and two triplets) admitted to the labour wards of nine hospitals in four South East Asian countries during 2005. For women who gave birth before 34 weeks gestation we collected information on women's demographic and pregnancy background, the type, dose and use of corticosteroids, and key birth and infant outcomes.ResultsAdministration of antenatal corticosteroids to women who gave birth before 34 weeks gestation varied widely between countries (9% to 73%) and also between hospitals within countries (0% to 86%). Antenatal corticosteroids were most commonly given when women were between 28 and 34 weeks gestation (80%). Overall 6% of women received repeat doses of corticosteroids. Dexamethasone was the only type of antenatal corticosteroid used. Women receiving antenatal corticosteroids compared with those not given antenatal corticosteroids were less likely to have had a previous pregnancy and to be booked for birth at the hospital and almost three times as likely to have a current multiple pregnancy. Exposed women were less likely to be induced and almost twice as likely to have a caesarean section, a primary postpartum haemorrhage and postpartum pyrexia. Infants exposed to antenatal corticosteroids compared with infants not exposed were less likely to die. Live born exposed infants were less likely to have Apgar scores of ConclusionIn this survey the use of antenatal corticosteroids prior to preterm birth varied between countries and hospitals. Evaluation of the enablers and barriers to the uptake of this effective antenatal intervention at individual hospitals is needed.Pattanittum P, Ewens MR, Laopaiboon M, Lumbiganon P, McDonald SJ, Crowther CA and The SEA-ORCHID Study Grou

Prevalence of early initiation of breastfeeding and determinants of delayed initiation of breastfeeding: secondary analysis of the WHO Global Survey

Early initiation of breastfeeding (EIBF) within 1 hour of birth can decrease neonatal death. However, the prevalence of EIBF is approximately 50% in many developing countries, and data remains unavailable for some countries. We conducted a secondary analysis using the WHO Global Survey on Maternal and Perinatal Health to identify factors hampering EIBF. We described the coverage of EIBF among 373 health facilities for singleton neonates for whom breastfeeding was initiated after birth. Maternal and facility characteristics of EIBF were compared to those of breastfeeding >1 hour after birth, and multiple logistic regression analysis was performed. In total, 244,569 singleton live births without severe adverse outcomes were analysed. The EIBF prevalence varied widely among countries and ranged from 17.7% to 98.4% (average, 57.6%). There was less intra-country variation for BFI <24 hours. After adjustment, EIBF was significantly lower among women with complications during pregnancy and caesarean delivery. Globally, EIBF varied considerably across countries. Maternal complications during pregnancy, caesarean delivery and absence of postnatal/neonatal care guidelines at hospitals may affect EIBF. Our findings suggest that to better promote EIBF, special support for breastfeeding promotion is needed for women with complications during pregnancy and those who deliver by caesarean section

Hemorrhage associated with hepatic artery pseudoaneurysms after regional chemotherapy with floxuridine: case report

Pseudoaneurysms of the hepatic artery are a rare complication in patients with primary or secondary liver tumors treated with intra-arterial chemotherapy. We present two patients who developed this complication after placement of a catheter system into the gastroduodenal artery and initiation of regional chemotherapy with floxuridine. Diagnosis was made after symptomatic bleeding occurred, necessitating emergency angiography with coil embolization. Pseudoaneurysms usually occur after mechanical damage of the vessel wall, but the chemical toxicity of floxuridine may add to the development of vascular impairment