Bulging amniotic membranes at 26 weeks with hindwater leakage. Amnioreduction, rescue double cervical cerclage, subsequent frank membrane rupture and severe oligohydramnios

A 39-year-old, gravida 3 para 0+2 presented at 26+4 weeks gestation with a clear vaginal discharge which upon speculum examination revealed prominent bulging amniotic membranes and a pool of clear amniotic fluid in the vagina. Abdominal ultrasound showed a single viable fetus in longitudinal lie, cephalic presentation and fetal heart rate (FHR) 150 beats per minute, regular. Estimated fetal weight 863g. The past history included 2 previous missed miscarriages. A diagnosis of pre-term premature hind water rupture of membranes was made. Intravenous antibiotics, magnesium sulphate, intramuscular progesterone and antenatal steroids were administered and emergency (double) cervical cerclage was performed after amnioreduction. The next day, the patient showed features of frank rupture of membranes and severe oligohydramnios on ultrasound. Six weeks after cerclage (32+4) considering the persistent amniotic fluid leakage with severe oligohydramnios, planned Caesarean section delivery was performed and a male fetus, weighing 1790 grams was delivered with APGAR scores of 7 and 8 at 1 and 5 minutes respectively. NICU care included invasive volume targeted ventilation, double dose surfactant administration and management of neonatal sepsis with β-haemolytic streptococci. Echocardiographic assessment was normal and feeds were initiated after 3 days of oral immune therapy using colostrum. After 14 days of NICU stay, the neonate was discharged

2,2'-(Ethane-1,2-diyl)bis(4-chlorophenol)

The X-ray structure of the title compound, obtained as a byproduct in a natural product synthesis, has been determined and shows an unusual pattern featuring chains of molecules with both intra- and intermolecular hydrogen bonding of the OH groups.Publisher PDFPeer reviewe

7-Phenyl­sulfonyl-7H-benzofurano[2,3-b]carbazole

In the title compound, C24H15NO3S, the dihedral angle between the phenyl ring and the carbozole system is 74.91 (6)°. The S atom exhibits a distorted tetra­hedral geometry [N—S—C = 104.85 (8)°; O—S—O = 119.59 (9)°]. The crystal structure is established by weak inter­molecular π–π inter­actions [centroid–centroid distances = 3.583 (2)–3.782 (2) Å]

7H-1-Benzofuro[2,3-b]carbazole

In the title compound, C18H11NO, the carbazole and benzofuran rings are almost co-planar, making a dihedral angle of 3.31 (3)°. The crystal structure is stabilized by weak C—H⋯π inter­actions

Addressing ethical challenges in the Genetics Substudy of the National Eye Survey of Trinidad and Tobago (GSNESTT).

BACKGROUND: The conduct of international collaborative genomics research raises distinct ethical challenges that require special consideration, especially if conducted in settings that are research-naïve or resource-limited. Although there is considerable literature on these issues, there is a dearth of literature chronicling approaches taken to address these issues in the field. Additionally no previous ethical guidelines have been developed to support similar research in Trinidad and Tobago. METHODS: A literature review was undertaken to identify strategies used to address common ethical issues relevant to human genetics and genomics research in research-naïve or resource-limited settings. Strategies identified were combined with novel approaches to develop a culturally appropriate, multifaceted strategy to address potential challenges in the Genetics Substudy of the National Eye Survey of Trinidad and Tobago (GSNESTT). RESULTS: Regarding the protection of study participants, we report a decision to exclude children as participants; the use of a Community Engagement and Sensitization Strategy to increase the genetic literacy of the target population; the involvement of local expertise to ensure cultural sensitivity and to address potential comprehension barriers in informed consent; and an audit of the informed consent process to ensure valid consent. Concerning the regulation of the research, we report on ethics approvals from relevant authorities; a Materials Transfer Agreement to guide sample ownership and export; and a Sample Governance Committee to oversee data use and data access. Finally regarding the protection of the interests of scientists from the host country, we report on capacity building efforts to ensure that local scientists have access to data collected through the project and appropriate recognition of their contributions in future publications. CONCLUSION: This paper outlines an ethical framework for the conduct of population-based genetics and genomics research in Trinidad and Tobago; highlights common issues arising in the field and strategies to address these

The National Eye Survey of Trinidad and Tobago (NESTT): Rationale, objectives and methodology

Purpose: This paper describes the rationale, study design and procedures of the National Eye Survey of Trinidad and Tobago (NESTT). The main objective of this survey is to obtain prevalence estimates of vision impairment and blindness for planning and policy development. Methods: A population-based, cross-sectional survey was undertaken using random multistage cluster sampling, with probability-proportionate-to-size methods. Eligible participants aged 5 years and older were sampled from the non-institutional population in each of 120 cluster segments. Presenting distance and near visual acuity were screened in their communities. People aged 40 years and older, and selected younger people, were invited for comprehensive clinic assessment. The interview included information on potential risk factors for vision loss, associated costs and quality of life. The examination included measurement of anthropometrics, blood glucose, refraction, ocular biometry, corneal hysteresis, and detailed assessment of the anterior and posterior segments, with photography and optical coherence tomography imaging. Adult participants were invited to donate saliva samples for DNA extraction and storage. Results: The fieldwork was conducted over 13 months in 2013–2014. A representative sample of 10,651 individuals in 3410 households within 120 cluster segments identified 9913 people who were eligible for recruitment. Conclusion: The study methodology was robust and adequate to provide the first population-based estimates of the prevalence and causes of visual impairment and blindness in Trinidad and Tobago. Information was also gathered on risk factors, costs and quality of life associated with vision loss, and on normal ocular parameters for the population aged 40 years and older

Health risk behaviours among adolescents in the English-speaking Caribbean: a review

<p>Abstract</p> <p>Background</p> <p>The aim of this paper was to review and summarize research on prevalence of health risk behaviours, their outcomes as well as risk and protective factors among adolescents in the English-speaking Caribbean.</p> <p>Methods</p> <p>Searching of online databases and the World Wide Web as well as hand searching of the <it>West Indian Medical Journal </it>were conducted. Papers on research done on adolescents aged 10 – 19 years old and published during the period 1980 – 2005 were included.</p> <p>Results</p> <p>Ninety-five relevant papers were located. Five papers were published in the 1980s, 47 in the 1990s, and from 2000–2005, 43 papers. Health risk behaviours and outcomes were divided into seven themes. Prevalence data obtained for these, included lifetime prevalence of <b>substance use</b>: cigarettes-24% and marijuana-17%; <b>high risk sexual behaviour</b>: initiation of sexual activity ≤ 10 years old-19% and those having more than six partners-19%; <b>teenage pregnancy</b>: teens account for 15–20% of all pregnancies and one-fifth of these teens were in their second pregnancy; <b>Sexually-Transmitted Infections (STIs)</b>: population prevalence of gonorrhoea and/or chlamydia in 18–21 year-olds was 26%; <b>mental health</b>: severe depression in the adolescent age group was 9%, and attempted suicide-12%; <b>violence and juvenile delinquency</b>: carrying a weapon to school in the last 30 days-10% and almost always wanting to kill or injure someone-5%; <b>eating disorders and obesity</b>: overweight-11%, and obesity-7%. Many of the risk behaviours in adolescents were shown to be related to the adolescent's family of origin, home environment and parent-child relationships. Also, the protective effects of family and school connectedness as well as increased religiosity noted in studies from the United States were also applicable in the Caribbean.</p> <p>Conclusion</p> <p>There is a substantial body of literature on Caribbean adolescents documenting prevalence and correlates of health risk behaviours. Future research should emphasize the designing and testing of interventions to alleviate this burden.</p

The X-ray Structure of 5-Chlorosalicylaldehyde

5-Chlorosalicylaldehyde [monoclinic, a = 3.800(2), b = 5.595(4), c = 15.174(11) Å, β = 93.221(17)°, space group P21] exhibits an unusual crystal structure with both intramolecular and intermolecular OH to CH=O hydrogen bonding, the latter leading to chains of molecules aligned along the b axis. A survey of previous substituted salicylaldehyde structures shows three main hydrogen bonding patterns: intramolecular only (14), intramolecular and intermolecular dimeric (5), and intramolecular and intermolecular polymeric (3)