Comparison of active vs. expectant management of the third stage of labor in women with low risk of postpartum hemorrhage: a randomized controlled trial

Objectives: To compare the ‘strictly’ active management protocol in women with low risk of postpartum hemorrhage using the expectant management protocol with respect to changes in hematologic parameters, uterotonics, blood transfusions, or additional interventions. Material and methods: A randomized controlled prospective trial in which 934 singleton parturients enrolled; 654 were randomly assigned to the active and mixed management groups. The primary outcome parameter was the reduction in hemoglobin concentrations due to delivery, and the secondary outcome parameters were changes in hemoglobin of more than 3 g/dL (ΔHb ≥ 3 g/dL), durations of the third stage of labor, need for additional uterotonic agents, blood transfusions, manual removal of the placenta, and surgical evacuation of retained products of conception. Results: The mean postpartum hemoglobin concentration was significantly higher (P = 0.04) in the active management group with a significantly lower reduction (P = 0.03). Falls of hemoglobin levels of more than 3 g/dL (ΔHb ≥ 3g/dL) were less common in the active management group though not significantly (P = 0.32). The mean duration of the third stage of labor was significantly (P < 0.001) shorter in the active management group. There was no significant difference between the two groups with regard to the need for additional uterotonic agents, uterine atony, blood transfusion, manual removal of the placenta, surgical evacuation of retained products of conception, and prolonged third stage of labor. Conclusions: Although active management of the third stage of labor was associated with higher postpartum hemoglobin levels, it did not influence the risk of ‘severe postpartum hemorrhage’ in women with low risk of postpartum hemorrhage

“New Alien Mediterranean Biodiversity Records” (November 2021)

This Collective Article includes records of 29 alien and cryptogenic species in the Mediterranean Sea, belonging to eight Phyla (Rhodophyta, Ochrophyta, Cnidaria, Annelida, Mollusca, Arthropoda, Echinodermata, and Chordata) and coming from 11 countries. Notes published here can be divided into three different categories: occupancy estimation for wide areas, new records for the Mediterranean Sea, and new records of species expanding within the Mediterranean Sea. The first category includes a visual survey held along the coastline of Peloponnese (Greece), which yielded records of 15 species. The second category includes the first Mediterranean records of the Coho salmon Oncorhynchus kisutch (Greece) and of the Arabian monocle bream Scolopsis ghanam (Tunisia). The third category includes new records for countries (Ganonema farinosum in Malta, Cassiopea andromeda in Libya, Cingulina isseli in Greece, Okenia picoensis in Italy, Callinectes sapidus in Slovenia, Charybdis cf. hellerii in Malta, Urocaridella pulchella in Cyprus, Ablennes hians and Aluterus monoceros in Lebanon, and Fistularia petimba in Greece and Lebanon), new records for MSFD areas or regional seas (Septifer cumingii in the Greek Ionian Sea and F. petimba in the Marmara Sea), and confirmation of old, doubtful, or spurious records/statements (Branchiomma luctuosum in Tunisia, Thalamita poissonii in the Saronikos Gulf, and Pterois miles in Albania). Noteworthy, the three new records of F. petimba suggest that it may soon spread further in the Mediterranean Sea, as already happened for its congeneric Fistularia commersonii. Distributional data reported here will help tracing colonization routes of alien species in the basin and may facilitate the development of mitigation measures

Türkiye’de bulunan yoğun bakımlarda sabun, kağıt havlu ve alkol bazlı el dezenfektanı yeterli mi?: Phokai çalışması sonuçları

Introduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products.Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016).Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p<0.0001, p<0.0001) while the number of hand disinfectant units with alcohol-based disinfectant was significantly higher (p<0.0001).Conclusion: There should be adequate and accessible hand hygiene materials for effective hand hygiene. In this study, we found that soap and paper towels were inadequate on the observation days in 3-11% and 10-18% of units, respectively. Attention should be paid on soap and paper towel supply at weekends as well

Swimming pool, respiratory health, and childhood asthma: should we change our beliefs? [

Swimming is often recommended as a sport because of its several benefits to health. It is also recommended in asthmatic children as a sport with a lower potential for prompting exercise-induced asthma. However, there is growing interest in the potentially harmful effects of repeated respiratory tract exposure to chlorinated products and the problem of possible swimming-related health hazards is gaining importance at international level. It is already known that acute exposure to chlorine gas as in swimming pool accidents causes lung damage and also that elite swimmers may have increased airway inflammation and bronchial hyperreactivity, probably as a result of repeated exposure to chlorine derivatives. Recently some studies have been conducted to investigate whether repeated exposure to chlorine by-products in recreational swimmers might also lead to lung damage. In addition, some studies have been lately published on the even more debated issue of the possible harmful effects of baby swimming on respiratory health. This article reviews and discusses data from the literature on the effects of chlorine derivatives in different categories of people routinely attending swimming pools. The need for longitudinal studies is emphasized to definitely clarify any role of chlorinated swimming pool attendance in the development of asthma in recreational swimmers