Gross presentation and histomorphological changes of placentae in patients presenting with intrauterine foetal death at Kenyatta national hospital

Background: There are 3.2 million annual stillbirths, at least 98% occur in low-/middle income countries, and on average, as many as two-thirds of these stillbirths are thought to occur antenatally, prior to labour. The most useful test towards a diagnosis after stillbirth is pathological examination of the placenta and the foetus. However, this pathological examination is done in less than half of the placentae after cases of stillbirth.Objective: To determine gross presentation and histomorphological changes of placentae in patients presenting with intrauterine foetal death as compared to live births.Design: A case control study.Setting: The Kenyatta National Hospital’s labour ward and the Department of Human Pathology, University of Nairobi.Subjects: The cases were mothers who presented with IUFD at a gestation of 28 weeks and above. The controls were a comparative group of mothers who delivered live babies at the hospital and were matched for age.Results: Reduction of the mass of functioning villi was present in 11.8% of placenta in the stillbirth group compared to 2% in the live birth group (p-value 0.002). There was significant presence of other placental abnormalities in the stillbirth group (22.5%) compared to the live birth group (9.8%) (p-value-0.002).Conclusion: This study revealed that histological examination of placenta is useful in identifying some causes of stillbirths. This knowledge may lead to preventive measures which would lower perinatal mortality

Distribution and origin of suspended matter and organic carbon pools in the Tana River Basin, Kenya

We studied patterns in organic carbon pools and their origin in the Tana River Basin (Kenya), in February 2008 (dry season), September–November 2009 (wet season), and June–July 2010 (end of wet season), covering the full continuum from headwater streams to lowland mainstream sites. A consistent downstream increase in total suspended matter (TSM, 0.6 to 7058 mg l−1) and particulate organic carbon (POC, 0.23 to 119.8 mg l−1) was observed during all three sampling campaigns, particularly pronounced below 1000m above sea level, indicating that most particulate matter exported towards the coastal zone originated from the mid and low altitude zones rather than from headwater regions. This indicates that the cascade of hydroelectrical reservoirs act as an extremely efficient particle trap. Although 7Be / 210Pbxs ratios/age of suspended sediment do not show clear seasonal variation, the gradual downstream increase of suspended matter during end of wet season suggests its origin is caused by inputs of older sediments from bank erosion and/or river sediment resuspension. During wet season, higher TSM concentrations correspond with relatively young suspended matter, suggesting a contribution from recently eroded material.With the exception of reservoir waters, POC was predominantly of terrestrial origin as indicated by generally high POC : chlorophyll a (POC : Chl a) ratios (up to 41 000). Stable isotope signatures of POC ( 13CPOC) ranged between −32 and −20‰and increased downstream, reflecting an increasing contribution of C4-derived carbon in combination with an expected shift in 13C for C3 vegetation towards the more semi-arid lowlands. 13C values in sediments from the main reservoir (−19.5 to −15.7 ‰) were higher than those found in any of the riverine samples, indicating selective retention of particles associated with C4 fraction. Dissolved organic carbon (DOC) concentrations were highest during the end of wet season (2.1 to 6.9 mg l−1), with stable isotope signatures generally between −28 and −22 ‰. A consistent downstream decrease in % organic carbon (%OC) was observed for soils, riverine sediments, and suspended matter. This was likely due to better preservation of the organic fraction in colder high altitude regions, with loss of carbon during downstream spiraling. 13C values for soil and sediment did not exhibit clear altitudinal patterns, but values reflect the full spectrum from C3-dominated to C4-dominated sites. Very low ratios of organic carbon to mineral surface area (OC : SA) were found in reservoir sediments and suspended matter in the lower Tana River, indicating that these are stable OC pools which have undergone extensive degradation. Overall, our study demonstrates that substantial differences occur in both the quantities and origin of suspended sediments and organic carbon along the river profile in this tropical river basin, as well as seasonal differences in the mechanisms causing such variations.Peer reviewe

Perturbations in the carbon budget of the tropics

The carbon budget of the tropics has been perturbed as a result of human influences. Here, we attempt to construct a ‘bottom-up’ analysis of the biological components of the budget as they are affected by human activities. There are major uncertainties in the extent and carbon content of different vegetation types, the rates of land-use change and forest degradation, but recent developments in satellite remote sensing have gone far towards reducing these uncertainties. Stocks of carbon as biomass in tropical forests and woodlands add up to 271 ± 16 Pg with an even greater quantity of carbon as soil organic matter. Carbon loss from deforestation, degradation, harvesting and peat fires is estimated as 2.01 ± 1.1 Pg annum(−1); while carbon gain from forest and woodland growth is 1.85 ± 0.09 Pg annum(−1). We conclude that tropical lands are on average a small carbon source to the atmosphere, a result that is consistent with the ‘top-down’ result from measurements in the atmosphere. If they were to be conserved, they would be a substantial carbon sink. Release of carbon as carbon dioxide from fossil fuel burning in the tropics is 0.74 Pg annum(−1) or 0.57 MgC person(−1) annum(−1), much lower than the corresponding figures from developed regions of the world

Antiretroviral Drugs Protect Against HIV-1 Infection in Heterosexuals

BackgroundAntiretroviral preexposure prophylaxis is a promising approach for preventing human immunodeficiency virus type 1 (HIV-1) infection in heterosexual populations.MethodsWe conducted a randomized trial of oral antiretroviral therapy for use as preexposure prophylaxis among HIV-1-serodiscordant heterosexual couples from Kenya and Uganda. The HIV-1-seronegative partner in each couple was randomly assigned to one of three study regimens--once-daily tenofovir (TDF), combination tenofovir-emtricitabine (TDF-FTC), or matching placebo--and followed monthly for up to 36 months. At enrollment, the HIV-1-seropositive partners were not eligible for antiretroviral therapy, according to national guidelines. All couples received standard HIV-1 treatment and prevention services.ResultsWe enrolled 4758 couples, of whom 4747 were followed: 1584 randomly assigned to TDF, 1579 to TDF-FTC, and 1584 to placebo. For 62% of the couples followed, the HIV-1-seronegative partner was male. Among HIV-1-seropositive participants, the median CD4 count was 495 cells per cubic millimeter (interquartile range, 375 to 662). A total of 82 HIV-1 infections occurred in seronegative participants during the study, 17 in the TDF group (incidence, 0.65 per 100 person-years), 13 in the TDF-FTC group (incidence, 0.50 per 100 person-years), and 52 in the placebo group (incidence, 1.99 per 100 person-years), indicating a relative reduction of 67% in the incidence of HIV-1 with TDF (95% confidence interval [CI], 44 to 81; P<0.001) and of 75% with TDF-FTC (95% CI, 55 to 87; P<0.001). Protective effects of TDF-FTC and TDF alone against HIV-1 were not significantly different (P=0.23), and both study medications significantly reduced the HIV-1 incidence among both men and women. The rate of serious adverse events was similar across the study groups. Eight participants receiving active treatment were found to have been infected with HIV-1 at baseline, and among these eight, antiretroviral resistance developed in two during the study.ConclusionsOral TDF and TDF-FTC both protect against HIV-1 infection in heterosexual men and women. (Funded by the Bill and Melinda Gates Foundation; Partners PrEP ClinicalTrials.gov number, NCT00557245.)

Global patterns of nitrate isotope composition in rivers and adjacent aquifers reveal reactive nitrogen cascading

Remediation of nitrate pollution of Earth’s rivers and aquifers is hampered by cumulative biogeochemical processes and nitrogen sources. Isotopes (δ15N, δ18O) help unravel spatiotemporal nitrogen(N)-cycling of aquatic nitrate (NO3−). We synthesized nitrate isotope data (n = ~5200) for global rivers and shallow aquifers for common patterns and processes. Rivers had lower median NO3− (0.3 ± 0.2 mg L−1, n = 2902) compared to aquifers (5.5 ± 5.1 mg L−1, n = 2291) and slightly lower δ15N values (+7.1 ± 3.8‰, n = 2902 vs +7.7 ± 4.5‰, n = 2291), but were indistinguishable in δ18O (+2.3 ± 6.2‰, n = 2790 vs +2.3 ± 5.4‰, n = 2235). The isotope composition of NO3− was correlated with water temperature revealing enhanced N-cascading in warmer climates. Seasonal analyses revealed higher δ15N and δ18O values in wintertime, suggesting waste-related N-source signals are better preserved in the cold seasons. Isotopic assays of nitrate biogeochemical transformations are key to understanding nitrate pollution and to inform beneficial agricultural and land management strategies