Cervix insufficiëntie : etiologie en diagnostiek

De hoofdfunctie van de baarmoedermond tijdens de zwangerschap is de baarmoeder afgesloten te houden tot het kind levensvatbaar is. Bij het falen van deze sluitfunctie zakt het zwangerschapsprodukt er voortijdig uit. Medisch gezien is er dan sprake van congenitale of verworven cervixinsufficiëntie. Het klinische beeld waaronder deze vroeggeboorte hoort plaats te vinden wordt gekenmerkt door een aantal in definities vastgelegde voorwaarden. Deze in het verleden opgestelde definities zijn niet eensluidend (Hoofdstuk III), maar het komt er veelal op neer dat de zwangere vrouw in kwestie niet mag merken dat er ontsluiting plaatsvindt, doch hiermee pas geconfronteerd wordt, als onverwacht de foetus geboren wordt. Deze situatie moet zich bij voorkeur, en bij herhaling, in het tweede trimester voordoen en er moet een normale en levende foetus geboren zijn (Roddick e . a . 1961, Danforth 1947 en 1980, Ranney 1963, FrieJmann 1980). Indien de vrouw wel weeën bemerkt en dit ook aangeeft, of als er bij buikpijn of krampen uteruscontracties aantoonbaar zijn, wordt niet voldaan aan de in de definities gestelde voorwaarden. Als reden voor de premature geboorte wordt in deze gevallen dan veelal de te vroeg opgetreden weeënactiviteit genoemd en de daardoor ontstane ontsluiting. De oorzaak van de weeënactiv iteit blijft dan onduidelijk. Indien een premature geboorte begint met het voortijdig breken van de vliezen wordt ook niet aan de in de klassieke definitie voor cerv ixinsufficientie gestelde voorwaarden voldaan. Als reden voor de vroeggeboorte wordt dan het voortijdig breken van de vliezen opgegeven met het hierdoor in partu komen. De oorzaak van het vroegtijdig breken van de vliezen blijft echter onduidelijk. Het niet stellen van de juiste diagnose van de oorzaak van een partus immaturus of praematurus bij de individuele patiente heeft in het verleden tot recidiveren hiervan geleid. De oorzaken van een geboorte geruime tijd voor de à terme datum, die zijn terug te voeren op cervixinsufficiëntie of samenhangen met het stellen van de diagnose hiervan, hebben onze speciale belangstelling en vormen het onderwerp van ons onderzoek

Abdi Ibrahim t. Noorwegen (EHRM, 15379/16): Permanente uithuisplaatsingen en een steeds strengere toets van het EHRM

EHRMEHRC 2022-0002Effective Protection of Fundamental Rights in a pluralist worl

Graminees du Cameroun

The grasses are one of the most important plant families of Cameroon. The dry savanas of the North and the mountainous areas of central and western Cameroon are extensive grass areas which are of utmost importance for cattle and fauna in general.Several of the importantant traditional agricultural crops such as sorghum, maize and rice are members of the grass family.For botanical education and research of plant communities and grasslands the knowledge of grasses is of great importance. At the Cameroonian universities and the Garoua wildlife school there was a great need of a practical grass flora of Cameroon in the french language.The first part of the grasses of Cameroon deals with the geology, topography, soils and climate. Next is a discussion of the phytogeography of the grasses and thereafter an overview is given of the prairies and their use by cattle and wildlife.Three more or less clear defined plant geographical vegetation zones are distinguished, each of them can be further subdivided: the Soudanian zone (North, and the lower part of the uplands), the Afro-Montaneous zone (the mountains above 2000 m) and the Congo-Guinean zone (forest zone), each with its typical species and genera. The northern slope of the Adamaoua plateau is a clear boundary within the Soudanian zone. The uplands are the richest in species diversity of grasses.The open vegetations of Cameroun are often dominated by the grasses, and specimens of these areas are well represented in plant collections. The presence of the Garoua wildlife school has stimulated the knowledge of the vegetation of northern Cameroon. Also around Bamenda (research station Bambui) and on Mt Cameroon many grasses have been collected.In the rain forest area of Cameroon the grasses are poorly represented in the collections because of the little importance forest botanists attach to grasses. They generally look upwards instead of downwards and think of grasses as secondary species. However, next to the typical shade-species there are quite a few species typical for the open patches in the forest, in particular along the streams and rivers.Of the flora the Andropogoneae are the most striking savana-group and often very dominating. More to the North the Eragrostideae and Aristideae become more important. The Paniceae occur everywhere but are less dominating. A number of smaller bamboo-like groups are shade-tolerant and occur in the rain forest.The bend to the south of the vegetation zones as is so obvious in the western Sahel, hardly find expression in Cameroon. Andropogon gayanus is a very clear indicator species in this respect. Although the extreme north of Cameroon has suffered seriously from the drought and the vegetation is very degradated, compared with a few decennia ago no obvious modification of the location of the vegetation zones is visible.Grasses are well adapted to fire. Frequent burning causes grasses to dominate. This annual burning is of importance for the cattle as fresh grass becomes available each year. When fires are prevented, the vegetation gets more and more dominated by woody species.The wildlife has a more mixed and broader utilisation of the vegetation. More emphasis should be given to a better and sustainable exploitation of this wildlife.In the appendix a fist of species is given with notes on the distribution in Cameroon, in Africa and worldwide, and of the most important vegetation types they occur in.The second volume of the flore (the Flora) treats the 19 tribes of the grasses, occurring in Cameroon. The lay-out follows the model of the Flore du Cameroun.The grass flora of Cameroon is very rich. There are 433 species of grasses, in 125 genera and 19 tribes. Two species new to science are described in the appendix and two new combinations are given.Two identification keys are presented, one leading to the tribes and the other to the genera. For each of the tribes and genera keys are provided, leading to the species. For each species there is a description of the general habit, with leaf shape, details on the inflorescences and the spikelets. After the type-indication particulars are given about the habitat, the vernacular names and the uses. There are 120 plates with drawings of 244 species. The microfiches in the back present the herbarium specimens examined. Details include geographic locality and indication where the specimens are lodged with the usual herbarium acronyms (K, L, P, WAG, etc.)

Out of home, out of right? Rechten van minderjarigen bij uithuisplaatsing

De bescherming van fundamentele rechten in een integrerend Europ

Sample transformation in online separations:how chemical conversion advances analytical technology

While the advent of modern analytical technology has allowed scientists to determine the complexity of mixtures, it also spurred the demand to understand these sophisticated mixtures better. Chemical transformation can be used to provide insights into properties of complex samples such as degradation pathways or molecular heterogeneity that are otherwise unaccessible. In this article, we explore how sample transformation is exploited across different application fields to empower analytical methods. Transformation mechanisms include molecular-weight reduction, controlled degradation, and derivatization. Both offline and online transformation methods have been explored. The covered studies show that sample transformation facilitates faster reactions (e.g. several hours to minutes), reduces sample complexity, unlocks new sample dimensions (e.g. functional groups), provides correlations between multiple sample dimensions, and improves detectability. The article highlights the state-of-the-art and future prospects, focusing in particular on the characterization of protein and nucleic-acid therapeutics, nanoparticles, synthetic polymers, and small molecules

Antibiotics for otitis media with effusion in children

BACKGROUND: Otitis media with effusion (OME) is characterised by an accumulation of fluid in the middle ear behind an intact tympanic membrane, without the symptoms or signs of acute infection. Since most cases of OME will resolve spontaneously, only children with persistent middle ear effusion and associated hearing loss potentially require treatment. Previous Cochrane reviews have focused on the effectiveness of ventilation tube insertion, adenoidectomy, nasal autoinflation, antihistamines, decongestants and corticosteroids in OME. This review, focusing on the effectiveness of antibiotics in children with OME, is an update of a Cochrane review published in 2012. OBJECTIVES: To assess the benefits and harms of oral antibiotics in children up to 18 years with OME. SEARCH METHODS: The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 3); PubMed; Ovid EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 April 2016. SELECTION CRITERIA: Randomised controlled trials comparing oral antibiotics with placebo, no treatment or therapy of unproven effectiveness in children with OME. DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by Cochrane. MAIN RESULTS: Twenty-five trials (3663 children) were eligible for inclusion. Two trials did not report on any of the outcomes of interest, leaving 23 trials (3258 children) covering a range of antibiotics, participants, outcome measures and time points for evaluation. Overall, we assessed most studies as being at low to moderate risk of bias. We found moderate quality evidence (six trials including 484 children) that children treated with oral antibiotics are more likely to have complete resolution at two to three months post-randomisation (primary outcome) than those allocated to the control treatment (risk ratio (RR) 2.00, 95% confidence interval (CI) 1.58 to 2.53; number needed to treat to benefit (NNTB) 5). However, there is evidence (albeit of low quality; five trials, 742 children) indicating that children treated with oral antibiotics are more likely to experience diarrhoea, vomiting or skin rash (primary outcome) than those allocated to control treatment (RR 2.15, 95% CI 1.29 to 3.60; number needed to treat to harm (NNTH) 20). In respect of the secondary outcome of complete resolution at any time point, we found low to moderate quality evidence from five meta-analyses, including between two and 14 trials, of a beneficial effect of antibiotics, with a NNTB ranging from 3 to 7. Time periods ranged from 10 to 14 days to six months. In terms of other secondary outcomes, only two trials (849 children) reported on hearing levels at two to four weeks and found conflicting results. None of the trials reported data on speech, language and cognitive development or quality of life. Low quality evidence did not show that oral antibiotics were associated with a decrease in the rate of ventilation tube insertion (two trials, 121 children) or in tympanic membrane sequelae (one trial, 103 children), while low quality evidence indicated that children treated with antibiotics were less likely to have acute otitis media episodes within four to eight weeks (five trials, 1086 children; NNTB 18) and within six months post-randomisation (two trials, 199 children; NNTB 5). It should, however, be noted that the beneficial effect of oral antibiotics on acute otitis media episodes within four to eight weeks was no longer significant when we excluded studies with high risk of bias. AUTHORS' CONCLUSIONS: This review presents evidence of both benefits and harms associated with the use of oral antibiotics to treat children up to 16 years with OME. Although evidence indicates that oral antibiotics are associated with an increased chance of complete resolution of OME at various time points, we also found evidence that these children are more likely to experience diarrhoea, vomiting or skin rash. The impact of antibiotics on short-term hearing is uncertain and low quality evidence did not show that oral antibiotics were associated with fewer ventilation tube insertions. Furthermore, we found no data on the impact of antibiotics on other important outcomes such as speech, language and cognitive development or quality of life. Even in situations where clear and relevant benefits of oral antibiotics have been demonstrated, these must always be carefully balanced against adverse effects and the emergence of bacterial resistance. This has specifically been linked to the widespread use of antibiotics for common conditions such as otitis media

Motor performance and functional ability in preschool- and early school-aged children with Juvenile Idiopathic Arthritis: a cross-sectional study

<p>Abstract</p> <p>Objective</p> <p>To describe the level of motor performance and functional skills in young children with JIA.</p> <p>Methods</p> <p>In a cross-sectional study in 56 preschool-aged (PSA) and early school- aged children (ESA) with JIA according to ILAR classification, motor performance was measured with the Bayley Scales of Infant Development II (BSID₂) and the Movement Assessment Battery for Children (M-ABC). Functional skills were measured with the Pediatric Evaluation of Disability Inventory (PEDI). Disease outcome was measured with a joint count on swelling/range of joint motion, functional ability and joint pain.</p> <p>Results</p> <p>Twenty two PSA children (mean age 2.1 years) with a mean Developmental Index of the BSID₂of 77.9 indicating a delayed motor performance; 45% of PSA children showed a severe delayed motor performance. Mean PEDI scores were normal, 38% of PSA scored below -2 SD in one or more domains of the PEDI. Thirty four ESA children (mean age 5.2 years) with a mean M-ABC 42.7, indicating a normal motor performance, 12% of ESA children had an abnormal score. Mean PEDI scores showed impaired mobility skills, 70% of ESA children scored below -2 SD in one or more domains of the PEDI. Disease outcome in both age groups demonstrated low to moderate scores. Significant correlations were found between age at disease onset, disease duration and BSID₂or M-ABC and between disease outcome and PEDI in both age cohorts.</p> <p>Conclusion</p> <p>More PSA children have more impaired motor performance than impaired functional skills, while ESA children have more impairment in functional skills. Disease onset and disease duration are correlated with motor performance in both groups. Impaired motor performance and delayed functional skills is primarily found in children with a polyarticular disease course. Clinical follow up and rehabilitation programs should also focus on motor performance and functional skills development in young children with JIA.</p