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European Journal of Epidemiology May 2022We aimed to review Semmelweis's complete work on puerperal sepsis mortality in maternity wards in relation to exposure to cadavers and chlorine handwashing and other... (Review)
Review
We aimed to review Semmelweis's complete work on puerperal sepsis mortality in maternity wards in relation to exposure to cadavers and chlorine handwashing and other factors from the perspective of modern epidemiological methods. We reviewed Semmelweis' complete work and data as published by von Györy 1905 according to current standards. We paid particular attention to Semmelweis's definition of mortality in and of itself, to concepts of modern epidemiology that were already recognizable in Semmelweis's work, and to bias sources. We did several quantitative bias analyses to address selection bias and information bias from outcome measurement error. Semmelweis addressed biases that have become known to modern epidemiology, such as confounding, selection bias and bias from outcome misclassification. Our bias analysis shows that differential loss to follow-up is an unlikely explanation for his results. Bias due to outcome misclassification would only be relevant if misclassification differed between time periods. Confounding by health status was likely but could not be quantitatively addressed. Semmelweis was aware that cause-specific mortality is a function of incidence and prognosis. He reasoned in potential outcome terms to estimate the reduced number of deaths from an intervention. He advanced a hypothesis of clinic overcrowding as a risk factor for puerperal sepsis mortality that turns out to be wrong. Semmelweis' data provide a great pool for illustrating the logic of scientific discovery by use of the numerical method. The explanatory power of his work was strong and Semmelweis was able to refute several previous causal explanations.
Topics: Causality; Female; History, 19th Century; Humans; Hungary; Male; Pregnancy; Puerperal Infection; Risk Factors; Selection Bias; Sepsis
PubMed: 35486338
DOI: 10.1007/s10654-022-00871-8 -
Biomolecules Apr 2022Louis Pasteur is the most internationally known French scientist. He discovered molecular chirality, and he contributed to the understanding of the process of... (Review)
Review
Louis Pasteur is the most internationally known French scientist. He discovered molecular chirality, and he contributed to the understanding of the process of fermentation, helping brewers and winemakers to improve their beverages. He proposed a process, known as pasteurization, for the sterilization of wines. He established the germ theory of infectious diseases that allowed Joseph Lister to develop his antiseptic practice in surgery. He solved the problem of silkworm disease, although he had refuted the idea of Antoine Béchamp, who first considered it was a microbial infection. He created four vaccines (fowl cholera, anthrax, pig erysipelas, and rabies) in the paths of his precursors, Henri Toussaint (anthrax vaccine) and Pierre Victor Galtier (rabies vaccine). He generalized the word "vaccination" coined by Richard Dunning, Edward Jenner's friend. Robert Koch, his most famous opponent, pointed out the great ambiguity of Pasteur's approach to preparing his vaccines. Analysis of his laboratory notebooks has allowed historians to discern the differences between the legend built by his hagiographers and reality. In this review, we revisit his career, his undeniable achievements, and tell the truth about a hero who made every effort to build his own fame.
Topics: Animals; Fermentation; Swine; Vaccination; Vaccines; Wine
PubMed: 35454184
DOI: 10.3390/biom12040596 -
Veterinary Sciences Apr 2022() forms part of the intestinal microbiome, but is also a known pathogen in histotoxic infections. The significance of the pathogen as a cause of uterine infections in...
() forms part of the intestinal microbiome, but is also a known pathogen in histotoxic infections. The significance of the pathogen as a cause of uterine infections in cattle has been little studied so far. Here, we analyzed the association between a pathological puerperium in cattle and the detection of in a prospective longitudinal study. were only found in vaginal and uterine samples of diseased cattle, and were absent in healthy controls. Isolates ( = 21) were tested for the production of major toxins (alpha-, beta-, epsilon-toxin) by ELISA and for the potential of production of major (alpha-, beta-, iota-toxin) and minor toxins (beta2 toxin) by PCR. Furthermore, antimicrobial susceptibility was also tested phenotypically by microdilution. Despite the frequent use of tetracycline treatment in cows suffering from puerperal disorders, no isolate showed phenotypic tetracycline resistance. Most isolates did not release major amounts of toxin. The strict association of with puerperal disease, together with the absence of major toxins might hint towards a major role of other or unknown clostridial virulence factors in uterine disease.
PubMed: 35448671
DOI: 10.3390/vetsci9040173 -
PeerJ 2022It is unclear whether weight management is still effective for pregnant women with excessive weight gain in the second or third trimester in China. This study adopted... (Randomized Controlled Trial)
Randomized Controlled Trial Clinical Trial
It is unclear whether weight management is still effective for pregnant women with excessive weight gain in the second or third trimester in China. This study adopted individualized weight management intervention for pregnant women with abnormal weight gain in the second or third trimester, to analyze the effect of intervention by observing the gestational weight gain and perinatal outcomes. This randomized controlled trial was performed at Aerospace Center Hospital. The obstetrician determined whether the pregnant women gained too much weight in the second or third trimester according to the Institute of Medicine guidelines, and randomly divided the pregnant women who gained too much weight in the second or third trimester into the intervention group or the control group according to the inclusion and exclusion criteria. The pregnant women in the intervention group and in the control group all received routine prenatal examination and diet nutrition education by the doctors in the Department of Obstetrics and Gynecology. The intervention group underwent individualized weight management, including individualized diet, exercise, psychological assessment, cognitive intervention and continuous communication, the whole process is tracked and managed by professional nutritionists. The obstetrician collected the prenatal examination data and pregnancy outcome data of all enrolled pregnant women. The primary outcome measure was weight gain during pregnancy. A generalized linear model and a logistic regression model were used to compare the outcomes between the two groups. In total, 348 pregnant women participated in this study with 203 in the intervention group and 145 in the control group. The whole gestational weight gain in the intervention group (15.8 ± 5.4 Kg) was lower than that in the control group (17.5 ± 3.6 Kg; adjusted = - 1.644; 95% CI [-2.660--0.627]; = 0.002). The percent of pregnant women with excessive weight gainbefore delivery was 54.2% (110/203) in the intervention group, which was lower than 69.7% (101/145) in the control group (adjusted RR = 0.468; 95% CI [0.284-0.769] = 0.003). The pregnant women given the individualized weight management intervention from the second to the third trimester experienced less weight gain than that from the third trimester (15.5 ± 5.6 Kg 16.2 ± 5.2 Kg), but without significant difference ( = 0.338). Lower rates of GDM, preeclampsia and gestational hypertension, higher rates of fetal distress and puerperal infection were observed in the intervention group than in the control group (all < 0.05). Individualized weight management during the second or third trimesters is still beneficial for pregnant women who gain excessive weight and can decrease the associated adverse outcomes.
Topics: United States; Pregnancy; Female; Humans; Gestational Weight Gain; Body Mass Index; Weight Gain; Pregnancy Outcome; Pregnancy Trimester, Third
PubMed: 35282280
DOI: 10.7717/peerj.13067 -
Annals of Translational Medicine Jan 2022Low-lying placenta is a special form of placenta previa and a major cause of postpartum hemorrhage (PPH). As an important hemostatic tool, the Bakri balloon is widely...
BACKGROUND
Low-lying placenta is a special form of placenta previa and a major cause of postpartum hemorrhage (PPH). As an important hemostatic tool, the Bakri balloon is widely used in the prevention and treatment of PPH caused by placenta previa. Few studies have paid attention to the effect of Bakri balloon after vaginal delivery in women with low-lying placenta. The aim of this study is to evaluate the efficacy and safety of prophylactic Bakri balloon tamponade (BBT) after vaginal delivery in women with low-lying placenta based on a retrospective cohort study.
METHODS
Singleton pregnant women with low-lying placenta who had vaginal deliveries at our hospital between January 2015 to December 2020 were enrolled. Women who received prophylactic balloon tamponade immediately after vaginal delivery were defined as the BBT group, while women who underwent routine procedures after vaginal delivery except immediate balloon tamponade were defined as the non-BBT group. The maternal clinical characteristics and outcomes of the two groups were collected and analyzed retrospectively.
RESULTS
A total of 118 women with low-lying placenta were included in the study, with 47 in the BBT group and 71 in the non-BBT group. The postpartum bleeding amount was 339.19±102.94 mL at 2 hours and 418.11±90.73 mL at 24 hours in the BBT group, while in the non-BBT group the postpartum bleeding amount was 421.55±106.37 mL at 2 hours and 505.11±94.51 mL at 24 hours, with significant differences between the two groups (P<0.05). However, there were no significant differences in the postpartum length of hospital stay (P=0.085) and the incidence of puerperal infection (P=0.244) between the two groups.
CONCLUSIONS
Routine use of prophylactic BBT after vaginal delivery can significantly reduce the postpartum bleeding amount in women with low-lying placenta and does not increase the incidence of puerperal infection and the postpartum length of hospital stay.
PubMed: 35282069
DOI: 10.21037/atm-22-68 -
Social History of Medicine : the... Feb 2022By introducing compulsory antiseptic measures in 1881, the Austrian Empire became a trendsetter in European midwifery legislation. Starting with the focus on puerperal...
By introducing compulsory antiseptic measures in 1881, the Austrian Empire became a trendsetter in European midwifery legislation. Starting with the focus on puerperal infection in the 1870s, this article investigates the process from the first proposal of antiseptic regimes within a clinical setting to the dissemination of antiseptic knowledge among the midwifery profession. Competition between the leading medical men throughout the Austrian territories played a major role and influenced the way in which antiseptic measures were propagated. The article identifies the antiseptic collectives active at the leading universities of Prague and Vienna. As practical instruction during midwifery education was not regarded as sufficient, the late 1870s and 1880s saw the emergence of several instruction textbooks. Changing birth attendance routines and the innovative materials that entered midwifery practice are explored and discussed, based on these manuals, alongside evidence of midwives' reactions as published in the Austrian Midwifery Newspaper.
PubMed: 35264903
DOI: 10.1093/shm/hkab097 -
Nutrients Feb 2022Anemia is a very common occurrence during pregnancy, with important variations during each trimester. Anemia was also considered as a risk factor for severity and...
Anemia is a very common occurrence during pregnancy, with important variations during each trimester. Anemia was also considered as a risk factor for severity and negative outcomes in patients with SARS-CoV-2 infection. As the COVID-19 pandemic poses a significant threat for pregnant women in terms of infection risk and access to care, we developed a study to determine the impact of nutritional supplementation for iron deficiency anemia in correlation with the status of SARS-CoV-2 infection. In a case-control design, we identified 446 pregnancies that matched our inclusion criteria from the hospital database. The cases and controls were stratified by SARS-CoV-2 infection history to observe the association between exposure and outcomes in both the mother and the newborn. A total of 95 pregnant women were diagnosed with COVID-19, having a significantly higher proportion of iron deficiency anemia. Low birth weight, prematurity, and lower APGAR scores were statistically more often occurring in the COVID-19 group. Birth weight showed a wide variation by nutritional supplementation during pregnancy. A daily combination of iron and folate was the optimal choice to normalize the weight at birth. The complete blood count and laboratory studies for iron deficiency showed significantly decreased levels in association with SARS-CoV-2 exposure. Puerperal infection, emergency c-section, and small for gestational age were strongly associated with anemia in patients with COVID-19. It is imperative to screen for iron and folate deficiency in pregnancies at risk for complications, and it is recommended to supplement the nutritional intake of these two to promote the normal development and growth of the newborn and avoid multiple complications during pregnancy in the COVID-19 pandemic setting.
Topics: Anemia; Anemia, Iron-Deficiency; COVID-19; Dietary Supplements; Female; Humans; Infant, Newborn; Iron Deficiencies; Pandemics; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; SARS-CoV-2
PubMed: 35215486
DOI: 10.3390/nu14040836 -
Diagnostics (Basel, Switzerland) Feb 2022Interferon-gamma release assays (IGRAs) are widely used in the diagnosis of () infection by detecting interferon-γ released by previously sensitized T-cells in-vitro.... (Review)
Review
Interferon-gamma release assays (IGRAs) are widely used in the diagnosis of () infection by detecting interferon-γ released by previously sensitized T-cells in-vitro. Currently, there are two assays based on either enzyme-linked immunosorbent assay (ELISA) or enzyme-linked immunospot (ELISPOT) technology, with several generations of products available. The diagnostic value of IGRAs in the immunocompromised population is significantly different from that in the immunocompetent population because their results are strongly affected by the host immune function. Both physiological and pathological factors can lead to an immunocompromised situation. We summarized the diagnostic value and clinical recommendations of IGRAs for different immunocompromised populations, including peoplewith physiological factors (pregnant and puerperal women, children, and older people), as well as people with pathological factors (solid organ transplantation recipients, combination with human immunodeficiency virus infection, diabetes mellitus, end-stage renal disease, end-stage liver disease, and chronic immune-mediated inflammatory diseases). Though the performance of IGRAs is not perfect and often requires a combination with other diagnostic strategies, it still has some value in the immunocompromised population. Hopefully, the newly developed IGRAs could better target this population.
PubMed: 35204544
DOI: 10.3390/diagnostics12020453 -
Journal of Dairy Science Apr 2022Although puerperal metritis (PM) is a common infectious disease in dairy cattle, there are currently discrepancies between clinical case definitions within and between... (Review)
Review
Although puerperal metritis (PM) is a common infectious disease in dairy cattle, there are currently discrepancies between clinical case definitions within and between available peer-reviewed literature and on-farms practices. The inconsistent use of PM criteria across studies and on-farms practices can result in disparities related to recommendations for treating cows, affecting judicious use of antimicrobials. The objective of this study was to systematically review the peer-reviewed literature for clinical signs used for case definition of PM. The criteria used included local (e.g., vaginal discharge) and systemic clinical signs of infection (e.g., fever, drop in milk). The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews protocols were used to screen commonly used databases. Following this protocol, one reviewer screened title and abstract for eligibility (n = 2,096), followed by full-text screening of selected articles (n = 396) by 2 reviewers to confirm eligible articles (n = 174). The most frequently cited reference article (37.5%) for the definition of PM was published in 2006, followed by articles published between 1998 and 2009 (13%). In 40.2% of articles, no reference was provided for definition of PM; vaginal discharge was described in terms of color, odor, and viscosity when related to the PM definition. Terms used for description of vaginal discharge color were red-brown (61.4%), red (5.1%), brown (8.6%), chocolate (4%), white (1.7%), yellow (0.5%), pink (5.7%), or gray (0.5%); vaginal discharge color was not reported in 24.1% articles. The vaginal discharge odor was described as fetid (75.8%), putrid (5.1%), foul (10.3%), or other (5.7%; e.g., abnormal, malodorous, odoriferous); odor was not mentioned in 7.4% of articles. The vaginal discharge viscosity was described as watery (74.1%), purulent (27%), mucopurulent (8.6%), thin (4%), serous (2.8%), or abnormal (2.3%) and was not mentioned in 11.5% of articles. Fever was included in 59.7% of articles as a criterion for PM diagnosis. The most used rectal temperature threshold was ≥39.5°C (56.8%), followed by ≥39.2°C (2.8%). Approaches used for vaginal discharge evaluation included rectal palpation (37.3%), intravaginal exploration with a gloved hand (18.4%), Metricheck (9.8%), or speculum (5.7%); and in 28.7% of articles, diagnostic tools used were not mentioned. Many of the color and odor vaginal discharge descriptions observed in the literature, used synonymous words to describe the same vaginal discharge sample, highlighting a lack of terminology consensus that could result in disagreements, especially due to the subjective character of these clinical evaluations of vaginal discharge color and odor. Although select consensus articles are available, it is common for studies to disregard a reference when defining PM cases. Furthermore, our findings highlight the need for a robust and clear consensus on criteria and terminology used to diagnose PM.
Topics: Animals; Cattle; Cattle Diseases; Endometritis; Female; Milk; Postpartum Period; Vaginal Discharge
PubMed: 35151476
DOI: 10.3168/jds.2021-21203 -
PloS One 2022Severe post-partum anemia is an important cause of maternal deaths and severe morbidity in sub-Saharan Africa. In Tanzania, little information is available to guide...
BACKGROUND
Severe post-partum anemia is an important cause of maternal deaths and severe morbidity in sub-Saharan Africa. In Tanzania, little information is available to guide health care professionals in ensuring good health of women after delivery. The objective of our study was to determine the prevalence of post-partum anemia and associated factors among women attending public primary health care facilities.
MATERIALS AND METHODS
An institutional based cross sectional study was carried out. Women in post-partum period (the period from child birth to six weeks after delivery) attending the public primary health care facilities from October to December 2019 for children vaccination were recruited. The prick method was used to obtain blood for haemoglobin estimation. Post-partum anemia was defined as a haemoglobin level of less than 11g/dl. Participants found anaemic were asked to undertake malaria and helminths parasites tests from blood and stool samples respectively. The samples were examined by an experienced laboratory scientist on study sites according to the Tanzania national standard for medical laboratories protocols.
RESULTS
A total of 424 women were enrolled with mean age of 27.8 years (SD 5.93). Most of the participants 234(55.2%) had primary education and nearly half 198(46.7%) of them were house wives. The overall prevalence of post-partum anemia was 145(34.2%). Among the anaemic participants, 34(23.5%) had positive blood slide for malaria parasite while 15(10.3%) had positive test for stool helminths infection. Delivery by vaginal route and low parity were protective against post-partum anemia (p<0.001).Other factors that were associated with post-partum anemia included absence of a marital partner (p<0.001) and inter pregnancy interval of less than two years (p<0.001). The risk of post-partum anemia in women with less than two years interval between their last two pregnancies was about 18 times more as compared to women with more than two years interval between their last two pregnancies, (COR = 18; 95% CI 8.617-38.617).Women without marital partners were 10 times more likely to get anemia as compared to married women, (COR = 10; 01.910-54.935).
CONCLUSIONS
The prevalence of anaemia among post-partum women found in this study points to a situation of public health problem according to WHO cut-off values for the public health significance of anaemia. Inter pregnancy interval of less than two years and absence of a marital partner were associated with post-partum anemia while delivery by vaginal route and low parity were protective against post-partum anemia. Strategies should therefore be put in place to encourage thorough health education and promotion programs among both pregnant and post-partum women.
Topics: Adolescent; Adult; Anemia; Birth Intervals; Cross-Sectional Studies; Female; Hemoglobins; Humans; Malaria; Maternal-Child Health Services; Parity; Postpartum Period; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Complications, Parasitic; Prevalence; Primary Health Care; Public Health; Puerperal Disorders; Tanzania; Young Adult
PubMed: 35113955
DOI: 10.1371/journal.pone.0263501