https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(03)12323-9.pdf

Neuroanatomical abnormalities before and after onset of psychosis: a cross-sectional and longitudinal MRI comparison.

Peter G. Pappas, John H. Rex, Jack D. Sobel, Scott G. Filler, William E. Dismukes, Thomas J. Walsh, and John E. Edwards Division of Infectious Diseases, University of Alabama at Birmingham, Alabama; AstraZeneca Pharmaceuticals, Manchester, Great Britain; Wayne State University School of Medicine, Detroit, Michigan; Harbor–University of California-Los Angeles Medical Center, Torrance, California; and Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland

/pdf/guidelines-for-treatment-of-candidiasis-4yqbm9hcop.pdf

Guidelines for Treatment of Candidiasis

https://idph.iowa.gov/Portals/1/userfiles/35/Factors%20that%20May%20Contribute%20to%20Stillbirth.pdf

Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis

Retinopathy of prematurity

Summary Background Stillbirth rates in high-income countries have shown little or no improvement over the past two decades. Prevention strategies that target risk factors could be important in rate reduction. This systematic review and meta-analysis was done to identify priority areas for stillbirth prevention relevant to those countries. Methods Population-based studies addressing risk factors for stillbirth were identified through database searches. The factors most frequently reported were identified and selected according to whether they could potentially be reduced through lifestyle or medical intervention. The numbers attributable to modifiable risk factors were calculated from data relating to the five high-income countries with the highest numbers of stillbirths and where all the data required for analysis were available. Odds ratios were calculated for selected risk factors, from which population-attributable risk (PAR) values were calculated. Findings Of 6963 studies initially identified, 96 population-based studies were included. Maternal overweight and obesity (body-mass index >25 kg/m 2 ) was the highest ranking modifiable risk factor, with PARs of 8–18% across the five countries and contributing to around 8000 stillbirths (≥22 weeks' gestation) annually across all high-income countries. Advanced maternal age (>35 years) and maternal smoking yielded PARs of 7–11% and 4–7%, respectively, and each year contribute to more than 4200 and 2800 stillbirths, respectively, across all high-income countries. In disadvantaged populations maternal smoking could contribute to 20% of stillbirths. Primiparity contributes to around 15% of stillbirths. Of the pregnancy disorders, small size for gestational age and abruption are the highest PARs (23% and 15%, respectively), which highlights the notable role of placental pathology in stillbirth. Pre-existing diabetes and hypertension remain important contributors to stillbirth in such countries. Interpretation The raising of awareness and implementation of effective interventions for modifiable risk factors, such as overweight, obesity, maternal age, and smoking, are priorities for stillbirth prevention in high-income countries. Funding The Stillbirth Foundation Australia, the Department of Health and Ageing, Canberra, Australia, and the Mater Foundation, Brisbane, Australia.

Major risk factors for stillbirth in high-income countries: A systematic review and meta-analysis

Background. A prospective study was performed to elucidate the etiology of intrauterine fetal death and to evaluate diagnostic procedures.Methods. Sixty-six stillbirth cases with a gestational age of more than 25 complete weeks were studied. using an extensive test protocol. The validity of the cause of death was classified as certain. probable, possible and unexplained. The extent to which the diagnostic measures had been performed was classified: patients in whom none or only a few tests were performed, patients partially tested and patients completely tested.Results. The cause of death was certain in 57%, probable in 20%, and possible in 11% of the cases. In only 12% of the cases did the cause of death remain entirely unexplained. The principal causes of IUFD were infections, including premature rupture of the membranes (15%). anomalies (11%), preeclampsia-associated conditions (9%) and intrauterine growth retardation of unknown etiology (8%). In this series, less well-known conditions, such as circula...

Sixty-six cases of intrauterine fetal death. A prospective study with an extensive test protocol.

The metabolic profiles of urinary bile acids in pregnant women in the last trimester and patients with recurrent intrahepatic cholestasis of pregnancy (RCP) were studied. Following separation according to mode of conjugation, about thirty different bile acids were quantitatively analysed by gas chromatography-mass spectrometry. In all patients the sulphate fraction comprised 50--90% of the total bile acids. In RCP a shift from glycine to taurine conjugation was noted to together with a slight relative increase in sulphation. A ten- to hundred-fold increase in cholic and chenodeoxycholic acids was seen in RCP, the increase being mainly in the sulphate fraction. Tetrahydroxylated bile acids, tentatively regarded as 1- and 6-hydroxylated products of cholic acid, were quantitatively important in patients with RCP. The relative amounts of the secondary bile acids, deoxycholic and lithocholic acids, decreased with increasing cholestasis. Metabolites hydroxylated at C-6 were common, and the excretion of hydroxylated at C-6 were common, and the excretion of hyocholic acid was positively correlated to that of chenodeoxycholic acid. An increase in the excretion of 5 alpha-configurated bile acids in RCP was noted. A positive correlation between the excretion of 3 beta-hydroxy-5-cholenoic acid and 3 beta,12 alpha-dihydroxy-5-cholenoic acid indicates a metabolic relationship between the two compounds. Because of the relatively small amounts of lithocholic and 3 beta-hydroxy-5-cholenoic acids in patients with RCP, these compounds do not seem to be of pathogenetic importance in this type of cholestasis.

Urinary bile acids in late pregnancy and in recurrent cholestasis of pregnancy.

Background. The aim of the study was to investigate maternal risk factors for retinopathy of prematurity (ROP) and also to describe risk factors for prematurity per se in our population. Design. A retrospective, population-based study.Material and methods. The study group included the mothers (identified with the help of a National Birth Register) of 202 single-born preterm infants with a birth weight of 1500 grams or less, from a previous population-based study. From the same register we also received information on 307 mothers of full term pregnancies for description of risk factors for preterm birth. Data from antenatal clinics, labor rooms and neonatal units were studied.Results. Univariate analysis of maternal risk factors for ROP revealed a few positive findings. In a further logistic multiple regression analysis, apart from gestational age at birth and birth weight, only essential hypertension prior to pregnancy was a predicting risk factor (odds/ ratio 8.36, 95% confidence interval 1.62-43.0).Conc...

Maternal risk factors for retinopathy of prematurity – a population‐based study

Background. During the last decade there has been a significant reduction in early neonatal mortality. The rate of late fetal death, however, has not changed significantly despite improvements in antenatal care. This study evaluated the years 1984 and 1991 as to possible changes in well known risk factors for late fetal death. Methods. We studied all single births during 1984 and 1991 recorded in the Swedish Medical Birth Register. In 1984, there were 94,270 births; of these, 381 were late fetal deaths. In 1991, there were 124,201 births and 464 late fetal deaths. The risk factors analyzed included maternal age, parity, smoking, birth weight, birth weight deviation, plurality, hypertension, diabetes, placental complications and previous late fetal death. Some of these variables were assessed in a cohort design and others in a case-control design. Results. The small reduction in the late fetal death rate between 1984 and 1991 (4.0/1000 vs. 3.7/1000 births) may be explained by changes in maternal age and parity. However, it seems more likely that changes have occurred in the various risk factors, but the net result did not affect the late fetal death rate. Although the number of mothers who smoked decreased from 30% to 24%, this habit increased as a risk factor, especially when it was >=10 cig/day (odds ratio 1.24 vs. 1.97). Infants <2500g showed a significant decrease in the risk of late fetal death. No significant change in the latter risk was found among infants small for gestational age. Conclusions. Demographic changes may entirely explain the small decrease in late fetal death rate between 1984 and 1991. Despite all the improvements in the care of pregnant women between these years, the net gain, in terms of a decreasing number of late fetal deaths, is small, which most likely is due to shifts in the fetal death risks between the risk factors. Further significant decreases in the number of late fetal deaths may be difficult to obtain through improvements in the Maternal Health Care Service.

https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1034/j.1600-0412.1999.780512.x

The changing panorama of late fetal death in Sweden between 1984 and 1991

A syndrome of deep pain in the breast during and immediately after lactation has been ascribed to an infection with Candida albicans. A series of 20 patients with deep pain, another 20 with superficial infection and 20 healthy women were compared with respect to the growth of bacteria and fungi. C. albicans was found twice as often in the milk of women with superficial lesions compared to those with deep pain. Bacteria were often found on the nipple and in the milk of those complaining of deep pain. Thus, if the deep pain syndrome is caused by microbes, this study points to a pathogenic role of bacteria rather than fungi.

Breast-feeding, pain and infection.

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