A regional audit system for stillbirth: A way to better understand the phenomenon

Background: Implementation of high-quality national audits for perinatal mortality are needed to improve the registration of all perinatal deaths and the identification of the causes of death. This study aims to evaluate the implementation of a Regional Audit System for Stillbirth in Emilia-Romagna Region, Italy. Methods: For each stillbirth ( 65 22 weeks of gestation, 65 500 g) occurred between January 1, 2014 to December 1, 2016 (n = 332), the same diagnostic workup was performed and a clinical record with data about mother and stillborn was completed. Every case was discussed in a multidisciplinary local audit to assess both the cause of death (ReCoDe classification) and the quality of care. Data were reviewed by the Regional Audit Group. Stillbirth rates, causes of death and the quality of care were established for each case. Results: Total stillbirth rate was 3.09 per 1000 births (332/107,528). Late stillbirth rate was 2.3 per 1000 (251/107,087). Sixteen stillbirths were not registered by the Regional Birth Register. The most prevalent cause of death was placental disorder (33.3%), followed by fetal (17.6%), cord (14.2%) and maternal disorders (7.6%). Unexplained cases were 14%. Compared to local audits, the regional group attributed different causes of death in 17% of cases. At multivariate analysis, infections were associated with early stillbirths (OR 3.38, CI95% 1.62-7.03) and intrapartum cases (OR 6.64, CI95% 2.61-17.02). Placental disorders were related to growth restriction (OR 1.89, CI95% 1.06-3.36) and were more frequent before term (OR 1.86, CI95% 1.11-3.15). Stillbirths judged possibly/probably preventable with a different management (10.9%) occurred more frequently in non-Italian women and were mainly related to maternal disorders (OR 6.64, CI95% 2.61-17.02). Conclusions: Regional Audit System for Stillbirth improves the registration of stillbirth and allows to define the causes of death. Moreover, sub-optimal care was recognized, allowing to identify populations which could benefit from preventive measures

Current preventive strategies and management of Epstein-Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey

There is limited clinical evidence on the utility of the monitoring of Epstein-Barr virus (EBV) DNAemia in the pre-emptive management of post-transplant lymphoproliferative disease (PTLD) in solid organ transplant (SOT) recipients. We investigated current preventive measures against EBV-related PTLD through a web-based questionnaire sent to 669 SOT programmes in 35 European countries. This study was performed on behalf of the ESGICH study group from the European Society of Clinical Microbiology and Infectious Diseases. A total of 71 SOT programmes from 15 European countries participated in the study. EBV serostatus of the recipient is routinely obtained in 69/71 centres (97%) and 64 (90%) have access to EBV DNAemia assays. EBV monitoring is routinely used in 85.9% of the programmes and 77.4% reported performing pre-emptive treatment for patients with significant EBV DNAemia levels. Pre-emptive treatment for EBV DNAemia included reduction of immunosuppression in 50.9%, switch to mammalian target of rapamycin inhibitors in 30.9%, and use of rituximab in 14.5% of programmes. Imaging by whole-body 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) is used in 60.9% of centres to rule out PTLD and complemented computer tomography is used in 50%. In 10.9% of centres, FDG-PET is included in the first-line diagnostic workup in patients with high-risk EBV DNAemia. Despite the lack of definitive evidence, EBV load measurements are frequently used in Europe to guide diagnostic workup and pre-emptive reduction of immunosuppression. We need prospective and controlled studies to define the impact of EBV monitoring in reducing the risk of PTLD in SOT recipients

X-ray diffraction and self condensation reaction of thionicotinamide S-oxide

Thiobenzamide and thionicotnamide S-oxide were prepared as intermediates in the dimerization of corresponding thioamides to 1,2,4-thiadiazoles and the X-ray crystal structure of thionicotinamide S-oxide water solvate was determined. Crystals belong to orthorhombic Pbca space group with a = 14.129(3), b = 7.299(2), c = 15.277(3)Angstrom, and Z = 8. The geometry of the molecule accords well with that found in similar compounds; an intramolecular N-H ... O hydrogen bond is present, while the packing is mainly determined by the hydrogen bond system involving the water molecule and the side-chain of the organic molecule. The contacts between pyridine moieties, stacked along the [010] axis, complete the packing

Condensation of thiourea derivatives with carbonyl compounds: one-pot synthesis of N-alkyl-1,3-thiazol-2-amines and of 3-alkyl-1,3-thiazolimines

The reactions of ketones and N-substituted thioureas, in the presence of HCl (or HBr) and DMSO afford mixtures of the title compounds which are easily separated on a silica gel column. This method avoids the classical use of alpha-haloketones. The mechanism of these reactions involves the enolization of ketones and the activation of thiourea sulfur, probably by oxygen transfer from DMSO

Radical intermediates in the peroxidation of indoles

2-Substituted and 1,2-disubstituted indoles react with m-chloroperbenzoic acid and hydrogen peroxide in the presence of acid or calcium chloride affording 2- and 3-(3-oxoindol-2-yl)indoles; whereas 2,3-disubstituted indoles, reacting with the same oxidants, lead to the formation of products typical of pentaatomic ring opening. The reaction mechanisms are discussed in terms of electron transfer processes based on the redox potentials of the reagents, the Marcus theory and the reaction products distribution. The reactions of 1-hydroxy-2-phenylindole, which yield 2-phenylisatogen (2-phenyl-3-oxo-3H-indole 1-oxide), bisnitrone and 3-(3-oxoindol-2-yl)indole are also explained by an electron transfer mechanism depending on the oxidant and on the conditions of the reaction, The structures of 2- and 3-(3-oxoindol-2-yl)indoles have been elucidated by X-ray analysis

Tautomerism in some Acetamido Derivatives of Nitrogen-containing Heterocycles: X-ray Structural Analysis of 2-Amino and 2-Imino Forms of Benzothiazole Derivatives

Amide and acylimine derivatives of nitrogen-containing heterocycles have been investigated by X-ray diffraction and IR and UV-VIS spectroscopy. X-Ray crystal diffraction indicated that the product of the reaction between 2-aminobenzothiazole and alpha-chloropropionyl chloride is in the amide form, whereas the product of the reaction between 2-aminobenzothiazole and trichloroacetyl chloride is in the acylimine form. The UV-VIS spectroscopic data define the position of the tautomeric equilibrium; the previously reported quantitative method to evaluate the position of the tautomeric equilibrium without the direct use of parameters arising from fixed parents is suitable for the compounds considered. Medium polarity, electron-withdrawing power of the acyl group, acidity of the exocyclic N-H bond, and ring size and aromaticity of the heterocyclic moiety were the main starting points for investigating the tautomeric properties in potential prototropic systems