New architectural design of delivery room reduces morbidity in preterm neonates: a prospective cohort study

Background: A multidisciplinary committee composed of a panel of experts, including a member of the American Academy of Pediatrics and American Institute of Architects, has suggested that the delivery room (DR) and the neonatal intensive care units (NICU) room should be directly interconnected. We aimed to investigate the impact of the architectural design of the DR and the NICU on neonatal outcome. Methods: Two cohorts of preterm neonates born at < 32weeks of gestational age, consecutively observed during 2years, were compared prospectively before (Cohort 1: "conventional DR") and after architectural renovation of the DR realized in accordance with specific standards (Cohort 2: "new concept of DR"). In Cohort 1, neonates were initially cared for a conventional resuscitation area, situated in the DR, and then transferred to the NICU, located on a separate floor of the same hospital. In Cohort 2 neonates were assisted at birth directly in the NICU room, which was directly connected to the DR via a pass-through door. The primary outcome of the study was morbidity, defined by the proportion of neonates with at least one complication of prematurity (i.e., late-onset sepsis, patent ductus arteriosus, intraventricular hemorrhage, periventricular leukomalacia, bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis). Secondary outcomes were mortality and duration of hospitalization. Statistical analysis was performed using standard methods by SPSS software. Results: We enrolled 106 neonates (56 in Cohort 1 and 50 in Cohort 2). The main clinical and demographic characteristics of the 2cohorts were similar. Moderate hypothermia (body temperature ≤ 35.9° C) was more frequent in Cohort 1 (57%) compared with Cohort 2 (24%, p = 0.001). Morbidity was increased in Cohort 1 (73%) compared with Cohort 2 (44%, p = 0.002). No statistically significant differences in mortality and median duration of hospitalization were observed between the 2 cohorts of the study. Conclusions: If realized according to the proposed architectural standards, renovation of DR and NICU may represent an opportunity to reduce morbidity in preterm neonates

Effect of chemical resistance inducers on the control of Monosporascus root rot and vine decline of melon

The effect of the resistance inducers methyl jasmonate (MeJA), acybenzolar-S-methyl (BTH) anddipotassium hydrogenphosphate (K2HPO4) was tested by seed soaking and by foliar application to determine whether these resistance inducers controlled root rot and vine decline of melon caused by Monosporascus cannonballus. Tests were carried out in pots and under field conditions in a two-year trial. Application of MeJA to melon seed significantly reduced symptoms of melon root rot and vine decline in soil artificially inoculated with M. cannonballus, and seeds treated with BTH and K2HPO4 produced plants with a slightly greater resistance to the pathogen. Greenhouse experiments in soil naturally infected with M. cannonballus in 2006 showed that MeJA treatments by seed soaking followed by foliar applications decreased the severity of the disease. In 2007, both MeJA and BTH significantly reduced root rot and vine decline, but K2HPO4 was ineffective. The resistance inducers differentially induced the synthesis of a number of pathogenesis related (PR) protein isoenzymes, markers of induced resistance in the root system. Using MeJA to induce resistance to root rot and vine decline of melon caused by M. cannonballus may provide a practical supplement to an environmentally friendly disease management when it is combined with appropriate integrated agronomic practices.&nbsp

Organizzazione, strutture e qualità dell'assistenza al parto.

L'Autore illustra in dettaglio gli eventi nei quali si possono creare condizioni di rischi feto-neonatale, dall'accettazione della gestante al trasporto del neonato, e i fattori condizionanti il possibile rischio feto-neonatale: personale medico e paramedico, strutture ambientali, fattori igienici, attrezzature diagnostiche e di monitoraggio, strumentario chirurgico, attrezzature di rianimazione e di trasporto del neonato. Tutti questi fattori possono in qualche modo contribuire allo stato di sofferenza fetale se non addirittura alla morte.Pertanto, il riscontro autoptico diventa di primaria importanza per identificare l'esatta causa di morte e il patologo deve essere in possesso dei dati clinici e di laboratorio, delle caratteristiche tecnico-organizzative delle strutture in cui è avvenuto il travaglio e dell'assistenza al neonato, per espletare le sue indagini nel modo più esauriente e soprattutto efficace per la profilassi futura

Use of the GnRH-agonist (GnRH-A) in gynaecology.

GnRH-agonist therapy is used in the management of many gynaecological pathologies: uterine fibroids, endometriosis, ovarian cystic pathology, breast cancer, dysfunctional uterine bleeding and, in males, prostatic cancer. In the case of uterine fibroids, this therapy can be used as a pre-treatment before conservative or demolitive surgery or as an alternative to hysterectomy. At the Centre for Therapy of Uterine Pathologies (I Institute of Obstetrics and Gynaecology of the University of Rome "La Sapienza") the use of Gn-RH-A therapy in uterine fibroids has been investigated and results consistent with those of many other groups of study have been obtained. The two most important results are: 1. the decrease of both the myoma's size and the uterine volume; 2. the block of menometrorrhagiae symptoms, with improvement of the haematic crasis and possibility to convert a demolitive surgery to a conservative surgery. GnRH-agonists can represent a definitive treatment for patients with symptomatic uterine fibroids and in perimenopausal age

The impact of the Factor V Leiden mutation on pregnancy

A resistance to the anticoagulant activity of activated protein C (APC), most frequently due to a point mutation in the Factor V gene (the Leiden mutation), represents the most common genetic cause of thrombophilia, The Leiden mutation has been significantly related to pregnancy complications associated with hypercoagulation, e.g. deep vein thrombosis during pregnancy (8-fold increased risk), pre-eclampsia (prevalence of the mutation up to 26%), placental infarction extending to >10% of the placenta (10-fold increased risk), abruptio placentae (prevalence of the mutation up to 29.6%), and second- and third-trimester pregnancy failure (prevalence of the mutation up to 31.3%), An association of the maternal mutation with recurrent first-trimester miscarriage does not emerge from the literature, although fetal mutation (frequency higher than twice compared with that of the general population) has been related to early spontaneous miscarriage. Although some evidence suggests an association between APC resistance and intrauterine growth retardation, no significant relationship emerges currently from the literature. Screening for the Leiden mutation would seem advisable in women with previous pregnancy complications amongst those associated with APC resistance. Carriers of the mutation should be given appropriate counselling. The screening of asymptomatic women is not recommended at present

The evolution of estroprogestative contraception: Analysis on the reduction or suppression of side-effects

The advances achieved by scientific research about contraception estroprogestinic contraception have lead to a better knowledgeof the risk factors connected to the use of oral contraceptives (O.C.) and trough the years, the change of their hormonal components dosesand of the type of progestin. These advances, together with the selection and monitoring of the patients who can use the pill have been accompanied by an evolution of its riskk. O.C. risks basically include neoplastic, cardiovascular, metabolic, and reproductive risks. This article presents a review of the most important studies conducted about such possible relations. The Authors conclude that the progress achieved in the hotmonal contraception has allowed to reduce greatly and, in some cases, to annul its risks. therefore, proper information is needed to explain that the pill, administered under medical control, is a safe drug and that many fears for its uses are no more justified