International gestational age-specific centiles for umbilical artery Doppler indices: a longitudinal prospective cohort study of the INTERGROWTH-21st Project.

BACKGROUND: Reference values for umbilical artery Doppler indices are used clinically to assess fetal well-being. However, many studies that have produced reference charts have important methodologic limitations, and these result in significant heterogeneity of reported reference ranges. OBJECTIVES: To produce international gestational age-specific centiles for umbilical artery Doppler indices based on longitudinal data and the same rigorous methodology used in the original Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project. STUDY DESIGN: In Phase II of the INTERGROWTH-21st Project (the INTERBIO-21st Study), we prospectively continued enrolling pregnant women according to the same protocol from 3 of the original populations in Pelotas (Brazil), Nairobi (Kenya), and Oxford (United Kingdom) that had participated in the Fetal Growth Longitudinal Study. Women with a singleton pregnancy were recruited at <14 weeks' gestation, confirmed by ultrasound measurement of crown-rump length, and then underwent standardized ultrasound every 5±1 weeks until delivery. From 22 weeks of gestation umbilical artery indices (pulsatility index, resistance index, and systolic/diastolic ratio) were measured in a blinded fashion, using identical equipment and a rigorously standardized protocol. Newborn size at birth was assessed using the international INTERGROWTH-21st Standards, and infants had detailed assessment of growth, nutrition, morbidity, and motor development at 1 and 2 years of age. The appropriateness of pooling data from the 3 study sites was assessed using variance component analysis and standardized site differences. Umbilical artery indices were modeled as functions of the gestational age using an exponential, normal distribution with second-degree fractional polynomial smoothing; goodness of fit for the overall models was assessed. RESULTS: Of the women enrolled at the 3 sites, 1629 were eligible for this study; 431 (27%) met the entry criteria for the construction of normative centiles, similar to the proportion seen in the original fetal growth longitudinal study. They contributed a total of 1243 Doppler measures to the analysis; 74% had 3 measures or more. The healthy low-risk status of the population was confirmed by the low rates of preterm birth (4.9%) and preeclampsia (0.7%). There were no neonatal deaths and satisfactory growth, health, and motor development of the infants at 1 and 2 years of age were documented. Only a very small proportion (2.8%-6.5%) of the variance of Doppler indices was due to between-site differences; in addition, standardized site difference estimates were marginally outside this threshold in only 1 of 27 comparisons, and this supported the decision to pool data from the 3 study sites. All 3 Doppler indices decreased with advancing gestational age. The 3rd, 5th 10th, 50th, 90th, 95th, and 97th centiles according to gestational age for each of the 3 indices are provided, as well as equations to allow calculation of any value as a centile and z scores. The mean pulsatility index according to gestational age = 1.02944 + 77.7456*(gestational age)-2 - 0.000004455*gestational age3. CONCLUSION: We present here international gestational age-specific normative centiles for umbilical artery Doppler indices produced by studying healthy, low-risk pregnant women living in environments with minimal constraints on fetal growth. The centiles complement the existing INTERGROWTH-21st Standards for assessment of fetal well-being

Telepathology Networking in VISN-12 of the Veterans Health Administration

The Veterans Integrated Service Network (VISN)-12, headquartered in Chicago, has implemented a telepathology network between the eight VISN-12 hospital laboratories and Loyola University Medical School linked by an economical, high-speed wide-area network (WAN). Implementation of the WAN has reduced monthly telecommunications costs in VISN-12 by approximately 67%. In addition to telepathology, the WAN enables real-time teleradiology (general, computer tomography, and ultrasound), telefluoroscopy, telenuclear medicine imaging, telepsychiatry, and other forms of teleconsultation. Current applications of telepathology in VISN-12 include: primary diagnosis and consultation in surgical pathology, interpretation of serum protein electrophoresis and immunofixation gels, provision of support for consolidated microbiology laboratories, review of problematic peripheral blood smears, and distance learning. We have learned a variety of lessons from telepathology. The enthusiasm and technical skill of providers are essential for success. As well, frequent communication and rapid technical support are necessary. Finally, in a supportive environment, telepathology is a tool that can help bring together clinical laboratories with shared missions and goals.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63151/1/153056200750040200.pd

PRAKTIK HIGIENE DAGING DALAM PENYEMBELIHAN HEWAN QURBAN DI KOTA KUPANG

The procedure for handling sacrificed animals has been regulated in Regulation of the Minister of Agriculture - Republic of Indonesia No. 114/Permentan/PD.410/9/2014. This research aims to describe the procedure of slaughter of qurban animals in Kupang City in relation to the provision of safe, health, intact, and halal meat (ASUH). This study is a descriptive study conducted through observation and interviews with qurban committee 1438H (2017M) at two mosques in Kupang City. Assessment is done on how to produce ASUH meat. There are fifteen aspects that are qualitatively assessed, 1 point if fulfilled and 0 if not fulfilled. Total of fulfillment points was then made in a percentage. The hygiene and sanitation practice of qurban slaughter at Al Mujahidin Mosque-Penfui and Darul Hijrah Mosque-Kolhua of Kupang City is quite good with a value of 10/15 (66.67%). Some things that need to be improved are the limitation of personnel with trained people. Meat processing facilities that need to be added is table and basket for meat storage

Promosi kesejahteraan hewan dan higiene sanitasi dalam penyembelihan hewan kurban di Kota Kupang

Tulisan mendeskripsikan pengetahuan masyarakat sasaran sosialisasi tentang implementasi kesrawan dan praktik higiene/sanitasi penyembelihan hewan qurban di Kota Kupang setelah mendapatkan penyuluhan dan pelatihan oleh tim pengabdian kepada masyarakat Universitas Nusa Cendana. Penelitian ini merupakan penelitian survey pada populasi yang diintervensi dengan penyuluhan dan pelatihan dengan menggunakan metode pre test dan post test. Peserta penyuluhan dan pelatihan kesrawan dan higiene daging qurban di Masjid Al Mujahidin Penfui dan Masjid Darul Hijrah Kolhua, Kota Kupang (masing-masing 15 orang), yaitu. Soal pretest dan posttest sebanyak 20 pertanyaan benar dan salah. Data dianalisis secara deskriptif dengan menggunakan Microsoft Excel. Kegiatan penyuluhan dan pelatihan kesrawan dan praktik higiene bagi panitia qurban di kedua masjid berhasil meningkatkan skor pemahaman peserta tentang aspek kesrawan dan praktik higiene dan sanitasi dalam menangani hewan dan daging qurban sebesar 47,5% dan 40,2%. Pemahaman tersebut penting sebagai landasan sikap dan tindakan dalam menghasilkan daging qurban yang aman, sehat, utuh dan halal

UJI SENSITIVITAS ANTIBIOTIKA TERHADAP Staphylococcus aureus YANG DIISOLASI DARI LUKA KULIT ANJING DI DESA MERBAUN, KECAMATAN AMARASI BARAT KABUPATEN KUPANG

Staphylococcus aureus is one causes of wound infection in dogs, occured as secondary infection or trauma. One of the obstacles in the treatment of Staphycoccal infection is their resistance to antibiotics. This study aims to isolate and identify the Staphylococcus aureus in the cases of dog wound as well as testing the bacterial resistance to the antibiotics namely amoxicillin, tetracycline and ampicillin. There are total of 18 samples of dog wound taken by sterile swab and put in a closed test tube containing sterile physiological NaCl and stored in a ice jar. Swab is applied to the surface on Mannitol Salt Agar and observed morphology of the bacterial colonies that grow after incubated for 24 hours at 37 0C. Furthermore, the Gram staining, hemolysis test, biochemical tests including the catalase and coagulation were also tested. Suspect Staphylococcus aureus colonies were further tested for antibiotics sensitivity test using the Kirby Bauer’s method. Results of this experiment showed 8 isolates (44.44%) were positive to Staphylococcus aureus. The isolation of Staphylococcus aureus in the culture of Blood Agar showed that 8 isolates are Beta hemolytic strain. Antibiotics sensitivity test done in duplo revealed that there are 7 isolates of Staphylococcus aureus sensitive and 1 isolate resistant to ampicillin. The sensitivity test to the antibiotic tetracycline showed that 6 isolates sensitive and 2 isolates resistant. The sensitivity test to the antibiotic amoxicillin showed that 7 isolates sensitive and 1 isolates resistant. It can be suggested that in the treatment of wound infection in the dog's skin, antibiotic sensitivity test should be done, because some strains of Staphylococcus aureus has developed resistance to antibiotics

PERBANDINGAN NILAI TOTAL PLATE COUNT (TPC) DAN CEMARAN Salmonella sp. PADA IKAN TONGKOL (Eutynnus sp.) YANG DIJUAL DI TEMPAT PELELANGAN IKAN (TPI), PASAR TRADISIONAL DAN PEDAGANG IKAN ECERAN DI KOTA KUPANG

Tuna is one of the fishery products which has a high level of consumption in the city of Kupang but are easily damaged. One of the pathogenic bacteria in fish that cause food-borne disease is Salmonella sp. The contamination of Salmonella sp. is caused by inadequate sanitation, poor hygiene and contaminated water used by the merchant. This study aims to determine both the differences in the value of TPC and whether there is the contamination of Salmonella sp. or not. Moreover, this study was to examine quantification of contamination level and different levels of Salmonella sp contamination the difference level of Salmonella sp. contamination in tuna fishes which has been sold in the fish auction place (TPI), traditional markets and retail fish market in Kupang. 54 samples of Tuna were collected from three locations. This research was also supported by the water quality testing which consisted of 15 water samples. The result showed that there was a significant difference on the TPC values with an average level of contamination from the highest to the lowest, started from the fish retailers as many as 1,35 x 105 CFU/g, followed by the traditional markets as many as 5 x 104 CFU/g and TPI as many as 3,5 x 103 CFU/g. The differences of TPC values were due to the personal higyene and sanitation, locations, the equipments as well as the materials used in the post-arrest process, the distribution and the sales. The results from TPC analysis showed that 4 samples were contaminated by the Salmonella sp. The average level of Salmonella sp contamination was from the Tuna sold by the fish relailers as many as 1,6 x 102 followed by the traditional fish markets as many as 1 x 102 and in the TPI as many as 4x10. This study also showed that based on water quality test, positive results were found in 1 sample in TPI, 3 samples in the traditional markets and 4 samples in the fish retailers. In conclusion, the Tunas sold by the fish retailers have the highest TPC value and the highest level of Salmonella sp contamination compare to the Tunas sold in the traditional markets and TPI

Clinical impact of Doppler reference charts on management of small‐for‐gestational‐age fetuses: need for standardization

Objective To assess clinical variability in the management of small‐for‐gestational‐age (SGA) fetuses according to different published Doppler reference charts for umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler indices and cerebroplacental ratio (CPR). Methods We performed a systematic search of MEDLINE, EMBASE, CINAHL and the Web of Science databases from 1954 to 2018 for studies with the sole aim of creating fetal Doppler reference values for UA, MCA and CPR. The top cited articles for each Doppler parameter were included. Variability in Doppler values at the following clinically relevant cut‐offs was assessed: UA‐pulsatility index (PI) > 95th percentile; MCA‐PI < 5th percentile; and CPR < 5th percentile. Variability was calculated for each week of gestation and expressed as the percentage difference between the highest and lowest Doppler value at the clinically relevant cut‐offs. Simulation analysis was performed in a cohort of SGA fetuses (n  = 617) to evaluate the impact of this variability on clinical management. Results From a total of 40 studies that met the inclusion criteria, 19 were analyzed (13 for UA‐PI, 10 for MCA‐PI and five for CPR). Wide discrepancies in reported Doppler reference values at clinically relevant cut‐offs were found. MCA‐PI showed the greatest variability, with differences of up to 51% in the 5th percentile value at term. Variability in the 95th percentile of UA‐PI and the 5th percentile of CPR at each gestational week ranged from 21% to 41% and 15% to 33%, respectively. As expected, on simulation analysis, these differences in Doppler cut‐off values were associated with significant variation in the clinical management of SGA fetuses, despite using the same protocol. Conclusions The choice of Doppler reference chart can result in significant variation in the clinical management of SGA fetuses, which may lead to suboptimal outcomes and inaccurate research conclusions. Therefore, an attempt to standardize fetal Doppler reference ranges is needed

Preeclampsia prediction with blood pressure measurements: A global external validation of the ALSPAC models

Objective: The prediction of preeclampsia in pregnancy has resulted in a plethora of prognostic models. Yet, very few make it past the development stage and most fail to influence clinical practice. The timely identification of high-risk pregnant women could deliver a tailored antenatal care regimen, particularly in low-resource settings. This study externally validated and calibrated previously published models that predicted the risk of preeclampsia, based on blood pressure (BP) at multiple time points in pregnancy, in a geographically diverse population. Methods: The prospective INTERBIO-21st Fetal Study included 3,391 singleton pregnancies from Brazil, Kenya, Pakistan, South Africa, Thailand and the UK, 2012–2018. Preeclampsia prediction was based on baseline characteristics, BP and deviation from the expected BP trajectory at multiple time points in pregnancy. The prediction rules from the Avon Longitudinal Study of Parents and Children (ALSPAC) were implemented in the INTERBIO-21st cohort. Results: Model discrimination was similar to the development cohort. Performance was best with baseline characteristics and a BP measurement at 34 weeks’ gestation (AUC 0.85, 95 % CI 0.80–0.90). The ALSPAC models largely overestimated the true risk of preeclampsia incidence in the INTERBIO-21st cohort. Conclusions: After recalibration, these prediction models could potentially serve as a risk stratifying tool to help identify women who might benefit from increased surveillance during pregnancy

Variants in the fetal genome near FLT1 are associated with risk of preeclampsia.

: Preeclampsia, which affects approximately 5% of pregnancies, is a leading cause of maternal and perinatal death. The causes of preeclampsia remain unclear, but there is evidence for inherited susceptibility. Genome-wide association studies (GWAS) have not identified maternal sequence variants of genome-wide significance that replicate in independent data sets. We report the first GWAS of offspring from preeclamptic pregnancies and discovery of the first genome-wide significant susceptibility locus (rs4769613; P = 5.4 × 10(-11)) in 4,380 cases and 310,238 controls. This locus is near the FLT1 gene encoding Fms-like tyrosine kinase 1, providing biological support, as a placental isoform of this protein (sFlt-1) is implicated in the pathology of preeclampsia. The association was strongest in offspring from pregnancies in which preeclampsia developed during late gestation and offspring birth weights exceeded the tenth centile. An additional nearby variant, rs12050029, associated with preeclampsia independently of rs4769613. The newly discovered locus may enhance understanding of the pathophysiology of preeclampsia and its subtypes.<br/