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Urolithiasis is one of the most frequently occurring diseases worldwide. Its management is related on investigation of concretion composition which helps to assess the current therapy. Fourier-transform infrared (FTIR) spectrometry gains significant importance because of its ability to determine concretion composition. Presented review shows the use of FTIR spectroscopy in detection of the very rare urinary stones including cyanoacrylate and pyrophosphate. Infrared spectroscopy made possible to identify the nature of the concretions and helped in management of urolithiasis. [ABSTRACT FROM AUTHOR]

Background: Rates of gestational diabetes are reported to be increasing in many jurisdictions, but the reasons for this are poorly understood. We sought to evaluate the relative contribution of screening practices for gestational diabetes (including completion and methods of screening) and population characteristics to risk of gestational diabetes in British Columbia, Canada, from 2005 to 2019. Methods: We used a population-based cohort from a provincial registry of perinatal data, linked to laboratory billing records. We used data on screening completion, screening method (1-step 75-g glucose test or 2-step approach of 50-g glucose screening test, followed by a diagnostic test for patients who screen positive) and demographic risk factors. We modelled predicted annual risk for gestational diabetes, sequentially adjusted for screening completion, screening method and risk factors. Results: We included 551 457 pregnancies in the study cohort. The incidence of gestational diabetes more than doubled over the study period, from 7.2% in 2005 to 14.7% in 2019. Screening completion increased from 87.2% in 2005 to 95.5% in 2019. Use of 1-step screening methods increased from 0.0% in 2005 to 39.5% in 2019 among those who were screened. Unadjusted models estimated a 2.04 (95% confidence interval [CI] 1.94–2.13) increased risk of gestational diabetes in 2019 (v. 2005). This increase was 1.89 (95% CI 1.81–1.98) after accounting for the rise in screening completion and 1.34 (95% CI 1.28–1.40) after accounting for changes in screening methods. Further accounting for demographic risk factors (e.g., age, body mass index, prenatal care) had a small impact (increase of 1.25, 95% CI 1.19–1.31). Interpretation: Most of the observed increase in the incidence of gestational diabetes was attributable to changes in screening practices (primarily changes in screening methods) rather than changing population factors. Our findings highlight the importance of understanding variation in screening practices when monitoring incidence rates for gestational diabetes. [ABSTRACT FROM AUTHOR]

Twenty-three different autoantibodies were screened in 38 CVID patients receiving IRT (baseline characteristics in Supplementary table 1) and in the immunoglobulin solutions used for IRT (Supplementary table 2). We identified a high prevalence of anti-TPO autoantibodies and anti-GAD autoantibodies in the majority of the screened CVID patients receiving IRT. Despite the markedly impaired antibody production, diseases hallmarked by the presence of autoantibodies, such as autoimmune hemolytic anemia (AIHA) or immune thrombocytopenic purpura (ITP), are among the most commonly diagnosed autoimmune complications in CVID patients [[2]]. [Extracted from the article]

Based on prediction models and expert opinion, most obstetric venous thromboembolism guidelines recommend low-molecular-weight heparin for many postpartum women, including most delivering by caesarean. Scrutiny reveals major oversights: prediction models are based on studies that report asymptomatic deep vein thrombosis; risk estimates are not adjusted for time exposure; and harm caused by heparin has been overlooked. The benefits of heparin are exaggerated and its harms are under-appreciated. Estimates of the numbers-needed-to-treat and harm are universally lacking. This paper critically reviews the evidence and quantifies the benefit and harm from low-molecular-weight heparin in postpartum women with common risk factors.Funding: This work was unsponsored and unfunded.Tweetable Abstract: Randomised trials should demonstrate more benefit than harm before widespread postpartum low-molecular-weight heparin is recommended. [ABSTRACT FROM AUTHOR]

The article offers information on improvement in the communication between clinicians and patients along with harm reduction when women refuses recommended care. Topics discussed include impact of ethical tension between autonomy, beneficence, and nonmaleficence on women and caregivers; need to maintain therapeutic alliance; and right to decline medical procedure violating bodily integrity of patient.

Accordingly, this study shows that women with treated mycoplasma, ureaplasma or bacterial vaginosis do not have an increased incidence of preterm birth; however, no comment can be made on whether untreated infection causes preterm birth. Ethically, investigators may be able to demonstrate research equipoise: that we do not yet know whether treatment reduces preterm birth associated with mycoplasma infection. [Extracted from the article]

Clinical practice guidelines hope to offer unbiased, evidence-based guidance for clinicians. This paper examines levels of evidence contained within the guidelines of the Society of Obstetricians and Gynaecologists of Canada and compares classification of the recommendation (CoR) A/B/C/D/E/L (derived from evidence and consensus) versus quality of evidence assessment (QoEA) I-III. 1250 recommendations were analysed and 43% of recommendations were graded as “good” evidence, the highest grade of CoR, while just 24.6% of recommendations were based on the highest level of QoEA (level I). The paper discusses possible reasons for this discrepancy. The authors hope that this analysis promotes greater transparency in evidence-based medicine ultimately leading to using the best quality of evidence available yet taking into account any areas of scientific uncertainty. This will enhance respectful care of patients, while taking into account their autonomy and furthering the cause of patient centre care. [ABSTRACT FROM PUBLISHER]

Background: The aim of the study was to investigate serum NT-proBNP levels in adult patients with transposition of the great arteries (d-TGA) corrected by atrial switch procedures (Mustard or Senning) operation and to assess the relationship with ventricular impairment and NYHA class. Methods: Serum NT-proBNP levels were measured in a group of 81 consecutive adult patients (59 males, mean age 27 years and 22 females, mean age 28 years) with transposition of the great arteries (TGA) after surgical correction in childhood, and in a control group of 25 healthy individuals (16 males, mean age 32 years, and 9 females, mean age 29 years). Age-matched correlation of NT-proBNP concentrations in TGA patients after Mustard or Senning correction was performed, but this correlation was considered not significant (p = 0.08). Results: Concentrations of NT-proBNP in patients with TGA were significantly elevated compared to the control group of healthy individuals (203 ng/L vs. 41 ng/L, p < 0.0001). Patients after the Mustard repair had significantly higher NT-proBNP values than patients after the Senning operation (234 ng/L vs. 148 ng/L, p = 0.0023). NT-proBNP correlated negatively with the systemic right ventricular ejection fraction with the greatest significance in patients after Mustard correction (r = -0.32, p < 0.0001). The concentration of NT-proBNP was also associated with NYHA functional class (p = 0.0035) with the greatest significance in patients with Mustard correction (p = 0.028). Conclusions: Elevated levels of NT-proBNP appear to be a useful tool in assessing heart failure in patients with transposition of the great arteries after atrial switch correction. [ABSTRACT FROM AUTHOR]

The Landon et al and the Crowther et al papers are both prospective trials comparing planned vaginal birth after a previous cesarean section ( VBAC) with elective cesarean section in women eligible for a trial of labor. With 33,000 women, the cohort studied by Landon et al in conjunction with the National Institute of Child Health and Human Development ( NICHHD) spawned multiple publications, giving estimates of VBAC risks and success relevant to women in a wide variety of clinical situations. Data abstraction was careful and outcomes were hard and verified. With 2,300 women, the study by Crowther et al, was 6 percent the size of the Landon- NICHHD study. Although it claimed 'increased risk of both fetal death or liveborn infant death prior to discharge or serious infant outcome,' there were only 2 perinatal deaths-both stillbirths prior to 39 weeks' gestation and unrelated to mode of delivery. Of the 28 infants with 'serious neonatal morbidity,' only three could have resulted from uterine rupture; prior experience with this outcome indicates all three will likely escape long-term morbidity. Pseudorandomization and erroneous adherence to an intention-to-treat principle seriously hinder the study's internal validity, attributing outcomes for one quarter of women undergoing elective cesarean section to the planned VBAC group. The study by Landon and NICHHD is over 10 times larger and of much higher quality than the study by Crowther et al. The Landon- NICHHD publications should be used to help women make decisions about planned mode of delivery after cesarean. ( BIRTH 39:4 December 2012) [ABSTRACT FROM AUTHOR]

The stories in this Roundtable Discussion are related by two women whose babies were born recently in Canadian hospitals. Each woman had undergone a cesarean delivery for her first child, and whereas Sophia delivered her second baby by vaginal birth after a cesarean (VBAC), Marie was unable to find a practitioner or hospital that would allow her to have a VBAC for her second birth. The women describe how they feel about their choices and experiences. Their two accounts and the issues that they raise are discussed in commentaries by a family physician, midwife, doula, and obstetrician. (BIRTH 37:3 September 2010) [ABSTRACT FROM AUTHOR]

The stories in this Roundtable Discussion are related by two women whose babies were born recently in Canadian hospitals. Each woman had undergone a cesarean delivery for her first child, and whereas Sophia delivered her second baby by vaginal birth after a cesarean (VBAC), Marie was unable to find a practitioner or hospital that would allow her to have a VBAC for her second birth. The women describe how they feel about their choices and experiences. Their two accounts and the issues that they raise are discussed in commentaries by a family physician, midwife, doula, and obstetrician. (BIRTH 37:3 September 2010) [ABSTRACT FROM AUTHOR]

A letter to the editor is presented related to need for a coordinated approach for harmonisation of the laboratory testing process.

Objectives: To review the physiology of breech birth; to discern the risks and benefits of a trial of labour versus planned Caesarean section; and to recommend to obstetricians, family physicians, midwives, obstetrical nurses, anaesthesiologists, pediatricians, and other health care providers selection criteria, intrapartum management parameters, and delivery techniques for a trial of vaginal breech birth.Options: Trial of labour in an appropriate setting or delivery by pre-emptive Caesarean section for women with a singleton breech fetus at term.Outcomes: Reduced perinatal mortality, short-term neonatal morbidity, longterm infant morbidity, and short- and long-term maternal morbidity and mortality.Evidence: Medline was searched for randomized trials, prospective cohort studies, and selected retrospective cohort studies comparing planned Caesarean section with a planned trial of labour; selected epidemiological studies comparing delivery by Caesarean section with vaginal breech delivery; and studies comparing long-term outcomes in breech infants born vaginally or by Caesarean section. Additional articles were identified through bibliography tracing up to June 1, 2008.Values: The evidence collected was reviewed by the Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the criteria and classifications of the Canadian Task Force on Preventive Health Care.Validation: This guideline was compared with the 2006 American College of Obstetrician's Committee Opinion on the mode of term singleton breech delivery and with the 2006 Royal College of Obstetrician and Gynaecologists Green Top Guideline: The Management of Breech Presentation. The document was reviewed by Canadian and International clinicians with particular expertise in breech vaginal delivery. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To review the physiology of breech birth; to discern the risks and benefits of a trial of labour versus planned Caesarean section; and to recommend to obstetricians, family physicians, midwives, obstetrical nurses, anaesthesiologists, pediatricians, and other health care providers selection criteria, intrapartum management parameters, and delivery techniques for a trial of vaginal breech birth. Options: Trial of labour in an appropriate setting or delivery by pre-emptive Caesarean section for women with a singleton breech fetus at term. Outcomes: Reduced perinatal mortality, short-term neonatal morbidity, long-term infant morbidity, and short- and long-term maternal morbidity and mortality. Evidence: Medline was searched for randomized trials, prospective cohort studies, and selected retrospective cohort studies comparing planned Caesarean section with a planned trial of labour; selected epidemiological studies comparing delivery by Caesarean section with vaginal breech delivery; and studies comparing long-term outcomes in breech infants born vaginally or by Caesarean section. Additional articles were identified through bibliography tracing up to June 1, 2008. Values: The evidence collected was reviewed by the Maternal Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada (SOGC) and quantified using the criteria and classifications of the Canadian Task Force on Preventive Health Care. Validation: This guideline was compared with the 2006 American College of Obstetrician''s Committee Opinion on the mode of term singleton breech delivery and with the 2006 Royal College of Obstetrician and Gynaecologists Green Top Guideline: The Management of Breech Presentation. The document was reviewed by Canadian and International clinicians with particular expertise in breech vaginal delivery. Sponsors: The Society of Obstetricians and Gynaecologists of Canada. [Copyright &y& Elsevier]

Background and objective: Monitoring of renal function in cystic fibrosis (CF) patients is essential. The dosage regimen of amikacin is regularly modified according to the patient’s glomerular filtration rate (GFR). The aim of the study was to evaluate the use of cystatin C (CyC) for monitoring amikacin therapy along with other markers of renal tubular and glomerular function, and damage [ N-acetyl-β- d glucosaminidase (NAG), creatinine level and creatinine clearance]. Methods: We compared the GFR, estimated from the serum concentrations of creatinine (Cockcroft–Gault formula) and CyC (Grubb’s formula). Seventy-one patients (mean age 12 years; range 4–28 years) with CF were treated by intermittent intravenous infusion of amikacin. Tubular nephrotoxicity was investigated by measurement of urine NAG/urine creatinine ratio (U-NAG/U-creatinine). Concentrations of all markers were measured before starting amikacin therapy and at days 3, 5, 7, 10 and 12. Fluorescence polarization analysis, turbidimetry, enzymatic phototometric creatinine deaminase method and fluorimetry were used for determination of serum amikacin, serum CyC, creatinine and urine NAG activity. Receiver operating characteristic (ROC) analysis was performed to assess the influence of GFR estimated from serum creatinine and serum CyC for the prediction of amikacin clearance during aminoglycoside therapy. Results: Significant differences in the rate of U-NAG/U-creatinine were noted before and after treatment with amikacin ( P < 0·001). Serum creatinine levels and creatinine clearance at the end of amikacin therapy (12th day) did not show any significant differences in comparison with the levels measured before the start of therapy (0th day). At days 5, 7, 10 and 12, serum CyC levels showed a significant elevation ( P < 0·001), and CyC clearance showed a significant decrease ( P < 0·001) in comparison with the levels measured at day 0. The ratio of amikacin clearance/creatinine clearance decreased with therapy whereas the amikacin clearance/CyC and amikacin clearance/CyC clearance increased. Conclusion: We showed that the rate of U-NAG/U-creatinine is a suitable marker for monitoring tubular nephrotoxicity in CF patients. Serum creatinine and estimated creatinine clearance are modest predictors of GFR in CF patients. CyC appears to be a better marker of GFR than serum creatinine concentration or creatinine clearance in our study. Serum CyC levels and CyC clearance showed greater ability to predict amikacin clearance during therapy than creatinine clearance. [ABSTRACT FROM AUTHOR]

In 2001 the term breech trial led the American and Royal Colleges of Obstetricians and Gynecologists (ACOG and RCOG) to issue black-and-white 'cookbook' guidelines condemning vaginal breech birth. Since then, women have been coerced, both overtly and covertly, into having cesarean sections. New evidence and a better understanding of the limitations of the term breech trial have led both the ACOG and RCOG to replace their 2001 guidelines with new ones that re-open the door for planned vaginal breech birth, acknowledge the evolving understanding of the nature of evidence, and emphasize the importance of external validity in the evaluation of complex phenomena. Parturient choice and clinical judgment are re-introduced. [ABSTRACT FROM AUTHOR]

In 2001 the term breech trial led the American and Royal Colleges of Obstetricians and Gynecologists (ACOG and RCOG) to issue black-and-white “cookbook” guidelines condemning vaginal breech birth. Since then, women have been coerced, both overtly and covertly, into having cesarean sections. New evidence and a better understanding of the limitations of the term breech trial have led both the ACOG and RCOG to replace their 2001 guidelines with new ones that re-open the door for planned vaginal breech birth, acknowledge the evolving understanding of the nature of evidence, and emphasize the importance of external validity in the evaluation of complex phenomena. Parturient choice and clinical judgment are re-introduced. (BIRTH 34:2 June 2007) [ABSTRACT FROM AUTHOR]

Critiques the use of randomized trials in evidence-based medicine guidelines for treating complex conditions. View that differences between patients and complexity of conditions limit the usefulness of randomized trials in clinical decision making; Discussion of the management of vaginal breech deliveries in obstetric care; Critique of a study which used clinical trial results to advise treatments; Potential for randomized trials to portray an inaccurate picture of a patient's risks; Comments on the limitations of evidence-based medicine practices.

Background: Cervical Papanicolaou (Pap) smear screening is an effective method of detecting cytological changes in the cervix before they lead to cervical cancer. However, the quality of a Pap smear can be compromised by inflammatory exudate, inadequate cellularity or failure to sample the transformation zone. We evaluated the effect of routine cervical cleaning on Pap smear quality. Methods: In a primary care setting, we compared the quality of Pap smears obtained after cervical cleaning (with a dry, oversized cotton swab) with the quality of historical control slides obtained from the same women without prior cervical cleaning. The results for both groups were then compared with statistical averages for the province of British Columbia. Results: Inflammatory exudate was reported in 1 (0.3%) of the 334 study smears and 72 (11.0%) of the 652 control smears (p<0.001). Inadequate endocervical or metaplastic squamous cells were reported in 11 (3.3%) of the study smears and 90 (13.8%) of the control smears (p<0.001). Inadequate cellularity was reported in 13 (3.9%) of the study smears and 9 (1.4%) of the control smears (p = 0.01). There were similar statistical differences between the study group and provincial averages. The results for the control group did not differ significantly from provincial averages (inflammatory exudate, 11.3%; inadequate endocervical cells, 14.7%; and poor cellularity, 2.7%). Interpretation: Prior cervical cleaning with an oversized cotton swab was associated with a lower frequency of smears with inflammatory exudate or inadequate endocervical cells and, to a lesser degree, a higher frequency of smears with inadequate cellularity. [ABSTRACT FROM AUTHOR]

PREFACE: This “In the Literature” column has a different genesis from previous columns. It emanates from a discussion that began on the Maternity Care Discussion Group (MCDG), an online group of more than 600 family physicians, obstetricians, midwives, nurses, and doulas that has been hosted on the College of Family Physicians of Canada website for 20 years. Although mainly a Canadian list, international participants are welcome to join in the struggle to improve maternity care and support those who provide it. To join the MCDG List, send an e-mail to . [ABSTRACT FROM AUTHOR]

A majority of deep vein thromboses identified in screening studies of hospitalized patients remain clinically insignificant. Guidelines based on these studies markedly overestimate the risk of clinical venous thromboembolism (VTE) and the benefit of heparin prophylaxis. Accordingly, in 2012, the American College of Chest Physicians (ACCP) removed screening studies from the 9th edition of its Antithrombotic and Thrombolytic Therapy guideline (AT9), and downgraded recommendations. Involvement of authors of the 8th edition (AT8) was restricted due to financial and intellectual conflicts of interest. However, the first author of AT8 subsequently wrote a "Getting Started Kit," widely distributed to help Canadian hospitals develop VTE protocols. Based on screening studies reporting asymptomatic VTE, it lacks estimates of the magnitudes of benefit or harm from low molecular weight heparin (LMWH), yet advises prophylaxis in almost all hospitalized patients. Most Canadian hospitals have implemented guidelines based on this kit. Guidelines from the U. K National Institute for Health and Care Excellence and the U.S. Agency for Healthcare Research and Quality recommend a similar approach. However, a critical review of evidence reveals that most hospitalized patients have a risk of clinical VTE equal to or lower than the bleeding risk from LMWH. Most hospitalized patients should not receive LMWH until and unless randomized trials show more benefit than harm. Guidelines recommending liberal LMWH prophylaxis in hospitalized patients are not evidence based and should be critically re-examined. [ABSTRACT FROM AUTHOR]

In this article the author reflects on the 2001 breech guidelines of the American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG). It notes that the guidelines were poor because they accepted the term breech trial without sufficient scientific skepticism and have ignored external validity and parturient autonomy. It implies that clinicians should be aware of the limitations of guidelines to keep care patient- and woman-centered.

Cardiovascular complications associated with methamphetamine (MAP) abuse have increasingly been reported. However, chronic cardiotoxicity of methamphetamine is not experimentally well documented. In this study, MAP (5 mg/kg/day) was subcutaneously injected into 5-week-old male Wistar rats (n=6) for 30 days. Age-and sex-matched Wistar rats served as controls (n=6). Cardiotoxicity was evaluated by electron microscopy and analysis of biochemical markers of cardiac injury (creatine kinase -- CK, myoglobin, interleukin-6, and high senstitive cardiac troponin I -- cTn1). The body and heart weights were lower in MAP group. There were no significant differences in relative right and left ventricles weights between control and MAP group. Electron microscopy revealed swelling and irregular mitochondrias with disrupted cristaes in MAP group. Lesions of the mitochondria were relatively mild. Injury of intracellular membrane system was also found. Spotty fibrosis were patchily distributed throughout the myocardium in most of rats. Concentration of IL-6 was 63.8±19.9 pg/mL in MAP treated rats whereas all values in control rats were under detection limit (≤16 pg/mL). The administration of MAP resulted in a increase of cTn1 levels (0.171±0.123 vs. 1.2124±0.598 ng/mL). Compared to control animals, higher levels of CK (24.4±2.9 vs. 29.1±2.9 µkat/L) and myoglobin (16.1±1.2 vs. 20.14±2.0 µg/L) were observed in the MAP rats. These findings suggest that methamphetamine may have direct and indirect toxic effects on adult rat myocytes. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article "Force, failure and trauma with vacuum extractor devices," is presented.

In this article the author reflects on modern cesarean section for breech pregnancy. It presents cases of maternal death from complications of cesarean and neonatal death after unattended breech birth. It notes that the cases illustrate parous women with sufficient grown nonfootling breech fetuses at term who were not given a trial of labor. It implies that complications and neonatal death would have been avoided if there were basic obstetrical or midwifery attendance and neonatal resuscitation.

Presents a reply by Andrew Kotaska to letters to the editor about his article "Inappropriate use of randomised trials to evaluate complex phenomena: case study of vaginal breech delivery," in the October 30, 2004 issue.