Specialist antenatal clinics for severely obese mums-to-be can help cut rates of pregnancy complications, research has found.
Women who received the specialist care were eight times less likely to have a stillbirth.
Health experts say the clinic helps them to spot signs of complications sooner, so that women can be given appropriate treatment. It also helps them to pinpoint those who need to be induced early or undergo an elective caesarean to avoid problems during labour.
The team tracked more than 1000 pregnant women classed as being severely obese during pregnancy because they had a body mass index (BMI) of 40 or above.
Around half of the women attended a specialist obesity clinic while the others received standard antenatal care.
Those that attended the obesity clinic were treated by a team that included obstetricians, specialist midwives, dieticians and other clinical experts.  They were given tailored advice about healthy eating and weight management during pregnancy, and were tested for diseases such as gestational diabetes.
Women who developed a complication could be treated in one visit, rather than being referred to a separate specialist clinic at a later date.
Around one in five pregnant women in the UK is obese and one in 50 is classed as severely obese.

University of Edinburgh
www.ed.ac.uk/news/2017/clinics-cut-pregnancy-risks-for-obese-women

One change to field triage guidelines for emergency medical services (EMS) responding to older adults with head trauma could make a ‘clinically important improvement over usual care,’ according to a study and accompanying editorial published earlier this month.

‘Adding a question about the use of blood thinners in older adults to our field triage criteria could save lives,’ said the editorial’s writer, Craig Newgard, MD, MPH, of Oregon Health & Science University in Portland, Ore. ‘Older patients suffering head trauma who are taking blood thinners are more likely to suffer from bleeding in the brain that requires time-sensitive surgery at a major trauma centre. Current EMS triage criteria do not include that question but this study suggests that maybe they should.’

Researchers analysed charts for 2,100 patients who were 55 or older with head trauma who were transported to the hospital by EMS. Using standard field triage criteria, 19.8 percent of those patients were correctly identified as suffering traumatic intracranial haemorrhage, or bleeding in the brain. Adding a fourth question – whether the patient is on anti-coagulant therapy – improved the sensitivity for intracranial haemorrhage to 59.5 percent.

‘Use of steps one to three triage criteria is not sufficient for identifying intracranial haemorrhage and death or neurosurgery for older patients who suffer head trauma,’ said the lead author of the study, Daniel K. Nishijima, MD, MAS, of the University of California Davis School of Medicine in Sacramento, Calif. ‘While we wait for other studies to confirm our research, we strongly urge patients to make their medication history available and known to their families and EMS providers, especially for situations that may arise where they cannot speak for themselves. Knowledge of their use of blood thinners may help in getting these patients to the right hospital.’

American College of Emergency Physicians newsroom.acep.org/news_releases?item=122825

Chemists at The University of Texas at Austin have developed a material that holds the key to cheap, fast and portable new sensors for a wide range of chemicals that right now cost government and industries large sums to detect. The innovation could lead to major public health gains, as it holds the potential to drastically reduce the costs associated with cleaning-up accidental chemical spills, remediating old industrial sites, detecting radioactive contamination in drinking water, and operating medical and research imaging devices.

‘A company with an abandoned chemical plant that has barrels of unlabelled solvents or a public utility concerned its water supply has been contaminated today face a cumbersome process of identifying the chemicals before they can start clean-up,’ said Simon Humphrey, associate professor of chemistry who led the research. ‘It’s costly and can take two or three days. We can now do that with a rapid, on-site method – and that difference could improve people’s health and reduce pollution a lot more efficiently.’

Humphrey envisions disposable paper dipsticks coated with the new material. A user would dip one into an uncharacterized substance and stick it into an ultraviolet (UV) reader. Based on the colours of light emitted, the device would indicate what components, such as organic solvents, fluoride, mercury and heavy metals, are in the substance.

The material, called PCM-22 is a crystal made of lanthanide ions and triphenylphosphine. When a chemical bonds to the material and a UV light shines on it, the material emits specific colours of visible light. Each chemical produces a unique eight-factor signature of colour and brightness that can be used to identify and quantify it in an uncharacterized sample.

Once scientists calibrate the sensor on known samples to create a catalogue of fingerprints that can be used to identify the components of uncharacterized samples, the dipstick-type sensors would be relatively simple to produce, Humphrey said. He and UT Austin share joint patents on the sensor material and on the process of analysing results, and UT Austin’s Office of Technology Commercialization has already begun work to license the technology to companies.

Another beneficial feature of PCM-22 is that it can distinguish between two types of water -the ordinary water (H2O) that we experience in everyday life and so-called heavy water (D2O), used in the operation of medical and research imaging.

With D2O, hydrogen atoms are replaced by deuterium atoms, but the two types of water are notoriously hard to tell apart because they look and, in most cases, behave the same chemically. It normally requires a costly test with a sophisticated piece of laboratory equipment called a laser spectrometer to tell the two apart.

Because the new material makes distinguishing between the two types of water simpler, it could become much easier for government agencies to detect the presence of radioactive contamination in drinking water or other bodies of water such as lakes and rivers. When ordinary water interacts with radioactive material, such as uranium, some of it is converted to heavy water, so elevated levels of heavy water give an early warning of contamination with radioactive material.

The ability to detect and quantify the two forms of water quickly, cheaply and at the point of need also would pave the way for more affordable and reliable medical and research imaging, such as nuclear magnetic resonance spectroscopy (NMR), which requires heavy water to operate. For NMR to function properly, this heavy water has to be very pure, but it is easily contaminated with ordinary water from moisture in the atmosphere.

‘When you buy heavy water from a manufacturer it starts out ultrapure,’ Humphrey said. ‘But as soon as you unscrew the bottle, hydrogen atoms from the air start swapping with deuterium atoms. A week later, all of the H’s have become scrambled with the D’s and it effectively ruins the heavy water. It’s an exchange that you can’t stop.’

The new material, which is sensitive enough to detect concentrations of ordinary water as low as 10 parts per million in a solution of heavy water, could make it cheaper and faster to verify the purity of this important reagent.

University of Texas at Austin news.utexas.edu/2017/04/13/universal-chemical-sensor-could-help-boost-public-health

In a large population study that was the first of its kind, researchers found that an experimental technique known as three-dimensional vascular ultrasound (3DVUS) estimated the quantification of plaque burden (in cubic millimeters) as an important addition to conventional risk factor profile in addressing patient risk stratification.
At an average age of 45 years, they found that the plaque burden in subjects was more than twice as high in men as in women (63.4 cubic millimeters vs. 25.7), and higher in the femoral arteries, and with increasing age.
Researchers explored the bilateral carotid and femoral arteries of 3,860 middle aged participants without prior cardiovascular disease who were employees of the Banco de Santander in Madrid, Spain.  This is an ongoing observational prospective cohort study where participants are being followed up for 10 years. The 3DVUS examinations were performed using a new Phillips iU22 ultrasound system equipped with a VL13-5 3D volume–linear array transducer. This equipment will be available in the near future for routine patient care.
The clinical application of 3DVUS techniques is still at the research and development stage, but there are now a number of clinically promising areas including the measurement of plaque. Direct quantification of atherosclerotic plaque volume by 3DVUS is more reproducible than two-dimensional techniques.
“3DVUS is a feasible, reproducible, and novel imaging technique for quantifying early carotid and femoral atherosclerotic burden in large populations,” said the study’s lead author, Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital. “This novel method is valid for imaging superficial peripheral atherosclerosis burden from early to advanced stages of disease and can be applied to identification of individuals at risk, targeting or monitoring treatment. Further studies are needed, however, to assess the cost utility of this method compared with others when used in large-scale practice settings and population-based epidemiological studies.”

Icahn School of Medicine at Mount Sinai
icahn.mssm.edu/about-us/news-and-events/mount-sinai-researchers-find-the-significance-of-plaque-burden-using-3d-vascular-ultrasound-in-estimating-cardiovascular-risk

At-risk patients, such as those with HIV or transplant recipients, could benefit from potentially life-saving study carried out by a University of Surrey led group of international researchers.

The research, led by Professor Vince Emery, Senior Vice-President (Global Strategy and Engagement) and Professor of Translational Virology at the University of Surrey, has developed a model that will provide vital insight into how best to help patients with Cytomegalovirus (CMV) infection, particularly those who have undergone organ transplantation.

CMV can be serious if the patient’s immune system is not fully functioning, as in transplant patients on immune-suppressant drugs, or for HIV patients in the advanced stages of AIDS. In these cases, CMV can cause major health problems, affecting a range of organs and contributing to early death, which obviously makes it vital to understand how to control the virus.

The mainstay of therapy for CMV has been an antiviral drug called Ganciclovir, which mimics the building blocks of DNA and stops the virus from replicating.

In the current study, the researchers used information from a large clinical trial of Ganciclovir for the treatment of CMV disease in patients who had undergone solid organ transplantation, to assess the patterns of viral responses seen following therapy.

This is the first time that a comprehensive model has been developed which explains the full range of post-therapy virus decline patterns. It provides vital insight into how to best help patients with CMV infection, especially after solid organ transplants and is potentially extendable to stem cell transplant patients.

The researchers have identified four unique patterns of response and have then used this to develop a sophisticated mathematical model which can accurately account for these patterns of decline.

The researchers’ work also benefits patients by leading the way forward to personalised medicine, and will make it possible to predict the likely duration of therapy needed for a patient with CMV infection to clear the virus.

Professor Emery said: ‘I am very proud to have led this vital research, as it will improve the health and quality of life of patients with CMV infection. CMV is a member of the herpes virus family and related to the virus that causes cold sores; these viruses are widespread and usually harmless.

‘But in some at risk cases, such as when the patients’ immune system is not fully functioning, it could mean the difference between life and death.

University of Surrey www.surrey.ac.uk/mediacentre/press/2017/research-uncovers-life-saving-benefits-battle-against-viruses