Laparoscopic reconstructive tubal surgery in a tertiary referral centre - a review of 177 cases

Objectives. To establish the pregnancy rate (PR) following endoscopic reconstructive tubal surgery in patients with tubal disease presenting to the Reproductive Medicine Unit at Groote Schuur Hospital between January 1994 and December 1997.Design. A prospective descriptive study utilising the Hulka classification system of tubal disease scored at the time of surgery and correlating the findings and procedures carried out with the pregnancy outcome.Setting and subjects. Patients with infertility referred from level 1 and 2 health care facilities in the Western Cape to the Reproductive Medicine Unit in the Department of Obstetrics and Gynaecology at Groote Schuur Hospital.Outcome measures. The main outcome measure was the PR following reconstructive surgery. Secondary outcome measures included the number of patients undergoing assisted reproductive techniques (ART) and the outcome of in vitro fertilisation and embryo transfer (IVFlET).Results. The results of 177 patients were analysed. The spontaneous PR for these patients was 13.6% per patient, with a live birth rate of 9%. The spontaneous extra-uterine pregnancy rate was 3.4% per patient and accounted for 25% of all spontaneous conceptions. Twenty-five patients (14% of the study population) underwent IVFlET resulting in a PR of 36% per patient and 33.3% per-embryo transfer.Conclusions. The poor PR following endoscopic tubal reconstruction is predominantly attributed to the severity of tubal damage in the study population. Patients undergoing IVFlET had a favourable PR - indicating that most of these couples are highly fertile but for the mechanical obstruction. The results of our study support ART as first-line therapy in the majority of patients with tubal factor infertility in the setting of this study

Peripheral T cell lymphopenia in COVID-19: potential mechanisms and impact

Immunopathogenesis involving T lymphocytes, which play a key role in defence against viral infection, could contribute to the spectrum of COVID-19 disease and provide an avenue for treatment. To address this question, are view of clinical observational studies and autopsy data in English and Chinese languages was conducted with a search of registered clinical trials. Peripheral lymphopenia affecting CD4 and CD8 T cells was a striking feature of severe COVID-19 compared with non-severe disease. Autopsy data demonstrated infiltration of T cells into organs, particularly the lung. 74 clinical trials are on-going that could target T cell-related pathogenesis, particularly IL-6 pathways. SARS-CoV-2 infection interrupts T cell circulation in patients with severe COVID-19. This could be due to redistribution of T cells into infected organs, activation induced exhaustion, apoptosis or pyroptosis. Measuring T cell dynamics during COVID-19 will inform clinical risk-stratification of hospitalised patients and could identify those who would benefit most from 66treatments that target T cell

A decade of horizontal deformation from great earthquakes

The 21st Century has seen the occurrence of 17 great earthquakes (Mw >8), including some of the largest earthquakes ever recorded. Numerical modeling of the earthquakes shows that nearly half of the Earth's surface has undergone horizontal coseismic defo

Respiratory viral infection alters the gut microbiota by inducing inappetence

ABSTRACT Respiratory viral infections are extremely common, but their impacts on the composition and function of the gut microbiota are poorly understood. We previously observed a significant change in the gut microbiota after viral lung infection. Here, we show that weight loss during respiratory syncytial virus (RSV) or influenza virus infection was due to decreased food consumption, and that the fasting of mice altered gut microbiota composition independently of infection. While the acute phase tumor necrosis factor alpha (TNF-α) response drove early weight loss and inappetence during RSV infection, this was not sufficient to induce changes in the gut microbiota. However, the depletion of CD8+ cells increased food intake and prevented weight loss, resulting in a reversal of the gut microbiota changes normally observed during RSV infection. Viral infection also led to changes in the fecal gut metabolome, with a significant shift in lipid metabolism. Sphingolipids, polyunsaturated fatty acids (PUFAs), and the short-chain fatty acid (SCFA) valerate were all increased in abundance in the fecal metabolome following RSV infection. Whether this and the impact of infection-induced anorexia on the gut microbiota are part of a protective anti-inflammatory response during respiratory viral infections remains to be determined. IMPORTANCE The gut microbiota has an important role in health and disease: gut bacteria can generate metabolites that alter the function of immune cells systemically. Understanding the factors that can lead to changes in the gut microbiome may help to inform therapeutic interventions. This is the first study to systematically dissect the pathway of events from viral lung infection to changes in gut microbiota. We show that the cellular immune response to viral lung infection induces inappetence, which in turn alters the gut microbiome and metabolome. Strikingly, there was an increase in lipids that have been associated with the resolution of disease. This opens up new paths of investigation: first, what is the (presumably secreted) factor made by the T cells that can induce inappetence? Second, is inappetence an adaptation that accelerates recovery from infection, and if so, does the microbiome play a role in this

Intranasal immunisation with Outer Membrane Vesicles (OMV) protects against airway colonisation and systemic infection with Acinetobacter baumannii.

OBJECTIVES: The multi-drug resistant bacteria Acinetobacter baumannii is a major cause of hospital associated infection; a vaccine could significantly reduce this burden. The aim was to develop a clinically relevant model of A. baumannii respiratory tract infection and to test the impact of different immunisation routes on protective immunity provided by an outer membrane vesicle (OMV) vaccine. METHODS: BALB/c mice were intranasally challenged with isolates of oxa23-positive global clone GC2 A. baumannii from the lungs of patients with ventilator associated pneumonia. Mice were immunised with OMVs by the intramuscular, subcutaneous or intranasal routes; protection was determined by measuring local and systemic bacterial load. RESULTS: Infection with A. baumannii clinical isolates led to a more disseminated infection than the prototype A. baumannii strain ATCC17978; with bacteria detectable in upper and lower airways and the spleen. Intramuscular immunisation induced an antibody response but did not protect against bacterial infection. However, intranasal immunisation significantly reduced airway colonisation and prevented systemic bacterial dissemination. CONCLUSION: Use of clinically relevant isolates of A. baumannii provides stringent model for vaccine development. Intranasal immunisation with OMVs was an effective route for providing protection, demonstrating that local immunity is important in preventing A. baumannii infection

A New Facility to Enhance Australian GPS-geodetic Research

The Australian Research Council recently awarded a grant to a consortium of five Australian universities to purchase ten geodetic-quality GPS receivers and peripherals. This cooperative approach will enhance new and existing GPS-geodetic research opportunities for Australian academic geodesists. These research projects include the monitoring of deformation of man-made structures and natural features, global and regional plate tectonics, measurement of sea-level change, mapping of Antarctic ice sheets and their flow, sounding of the Earth's atmosphere, and experiments in kinematic and rapid-static GPS-geodesy

Tropical cyclones and the ecohydrology of Australia's recent continental-scale drought

The Big Dry, a recent drought over southeast Australia, began around 1997 and continued until 2011. We show that between 2002-2010, instead of a localized drought, there was a continent-wide reduction in water storage, vegetation and rainfall, spanning the northwest to the southeast of Australia. Trends in water storage and vegetation were assessed using Gravity Recovery and Climate Experiment (GRACE) and Normalized Difference Vegetation Index (NDVI) data. Water storage and NDVI are shown to be significantly correlated across the continent and the greatest losses of water storage occurred over northwest Australia. The frequency of tropical cyclones over northwest Australia peaked just prior to the launch of the GRACE mission in 2002. Indeed, since 1981, decade-scale fluctuations in tropical cyclone numbers coincide with similar variation in rainfall and vegetation over northwest Australia. Rainfall and vegetation in southeast Australia trended oppositely to the northwest prior to 2001. Despite differences between the northwest and southeast droughts, there is reason to believe that continental droughts may occur when the respective climate drivers align

Antibodies to Chlamydia trachomatis in patients presenting with ectopic pregnancy at Groote Schuur hospital

Objectives. To detennine the prevalence of antibodies to Chlamydia trachomatis in women presenting with ectopic pregnancies to Groote Schuur Hospital.Methods. C. trachomatis antibody titres were measured using a modified micro-immunofluorescence test in women presenting with ectopic pregnancy. Control subjects were drawn from women with term pregnancies and an uneventful reproductive history.Results. Seventy-four patients and controls were studied. Demographic variables were controlled for at time of entry into the study. A significant association between the number of lifetime sexual partners and exposure to C. trachomatis was noted (P = 0.001). Patients with ectopic pregnancies had significantly higher antibody titres than control subjects (P = 0.001), and in both groups the prevalence of background antichlamydial antibody was high (ectopic pregnancies 59%, pregnant controls 32%).Conclusions. While the role of C. trachomatis infection in women who develop ectopic pregnancies needs to be explored further, it seems wise to treat them all with empirical antibiotics at the time of presentation