Journals

Severity of Retinopathy Parallels the Degree of Parasite Sequestration in Eye and Brain in Malawian Children with Fatal Cerebral Malaria.

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Severity of Retinopathy Parallels the Degree of Parasite Sequestration in Eye and Brain in Malawian Children with Fatal Cerebral Malaria.

J Infect Dis. 2014 Oct 28;

Authors: Barrera V, Hiscott PS, Craig AG, White VA, Milner DA, Beare NA, MacCormick IJ, Kamiza S, Taylor TE, Molyneux ME, Harding SP

Abstract

BACKGROUND:  Malarial retinopathy (MR) has diagnostic and prognostic value in children with Plasmodium falciparum cerebral malaria (CM). A clinicopathological correlation between observed retinal changes during life and the degree of sequestration of parasitized red blood cells was investigated in ocular and cerebral vessels at autopsy.

METHODS:  In 18 Malawian children who died from clinically-defined CM, we studied the intensity of sequestration and the maturity of sequestered parasites in the retina, in non-retinal ocular tissues and in the brain.

RESULTS:  Five children with clinically-defined CM during life had other causes of death identified at autopsy, no MR, and scanty intracerebral sequestration. Thirteen children had MR, and died of CM. MR severity correlated with percentage of microvessels parasitized in retina, brain and non-retinal tissues with some neuroectodermal components (all p<0.01). In moderate/severe MR cases (n=8) vascular congestion was more intense (ρ=0.841, p<0.001), sequestered parasites were more mature and the quantity of extraerythrocytic hemozoin was higher, than in mild MR cases (n=5).

CONCLUSIONS:  These data provide a histopathological basis for the known correlation between degrees of retinopathy and cerebral dysfunction in CM. In addition to being a valuable tool for clinical diagnosis, retinal observations give important information about neurovascular pathophysiology in pediatric CM.

PMID: 25351204 [PubMed - as supplied by publisher]

EU appoints Ebola coordinator.

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EU appoints Ebola coordinator.

BMJ. 2014;349:g6497

Authors: Watson R

PMID: 25351197 [PubMed - in process]

Doctors’ leaders back call for greater investment in NHS in England.

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Doctors’ leaders back call for greater investment in NHS in England.

BMJ. 2014;349:g6506

Authors: Iacobucci G

PMID: 25351367 [PubMed - in process]

Defending the sophisticated consent attack.

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Defending the sophisticated consent attack.

BMJ. 2014;349:g6432

Authors: Sokol DK

PMID: 25351423 [PubMed - in process]

Milk intake and risk of mortality and fractures in women and men: cohort studies.

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Milk intake and risk of mortality and fractures in women and men: cohort studies.

BMJ. 2014;349:g6015

Authors: Michaëlsson K, Wolk A, Langenskiöld S, Basu S, Warensjö Lemming E, Melhus H, Byberg L

Abstract

OBJECTIVE: To examine whether high milk consumption is associated with mortality and fractures in women and men.

DESIGN: Cohort studies.

SETTING: Three counties in central Sweden.

PARTICIPANTS: Two large Swedish cohorts, one with 61 433 women (39-74 years at baseline 1987-90) and one with 45 339 men (45-79 years at baseline 1997), were administered food frequency questionnaires. The women responded to a second food frequency questionnaire in 1997.

MAIN OUTCOME MEASURE: Multivariable survival models were applied to determine the association between milk consumption and time to mortality or fracture.

RESULTS: During a mean follow-up of 20.1 years, 15 541 women died and 17 252 had a fracture, of whom 4259 had a hip fracture. In the male cohort with a mean follow-up of 11.2 years, 10 112 men died and 5066 had a fracture, with 1166 hip fracture cases. In women the adjusted mortality hazard ratio for three or more glasses of milk a day compared with less than one glass a day was 1.93 (95% confidence interval 1.80 to 2.06). For every glass of milk, the adjusted hazard ratio of all cause mortality was 1.15 (1.13 to 1.17) in women and 1.03 (1.01 to 1.04) in men. For every glass of milk in women no reduction was observed in fracture risk with higher milk consumption for any fracture (1.02, 1.00 to 1.04) or for hip fracture (1.09, 1.05 to 1.13). The corresponding adjusted hazard ratios in men were 1.01 (0.99 to 1.03) and 1.03 (0.99 to 1.07). In subsamples of two additional cohorts, one in males and one in females, a positive association was seen between milk intake and both urine 8-iso-PGF2α (a biomarker of oxidative stress) and serum interleukin 6 (a main inflammatory biomarker).

CONCLUSIONS: High milk intake was associated with higher mortality in one cohort of women and in another cohort of men, and with higher fracture incidence in women. Given the observational study designs with the inherent possibility of residual confounding and reverse causation phenomena, a cautious interpretation of the results is recommended.

PMID: 25352269 [PubMed - in process]

Milk and mortality.

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Milk and mortality.

BMJ. 2014;349:g6205

Authors: Schooling CM

PMID: 25352270 [PubMed - in process]

Fire the Medical Schools Council if you want more GPs.

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Fire the Medical Schools Council if you want more GPs.

BMJ. 2014;349:g6245

Authors: Wakeford R

PMID: 25352271 [PubMed - in process]

One in eight GP training posts vacant, despite unprecedented third round of recruitment.

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One in eight GP training posts vacant, despite unprecedented third round of recruitment.

BMJ. 2014;349:g6478

Authors: Rimmer A

PMID: 25352357 [PubMed - in process]

Scotland to bring in tougher drink driving law.

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Scotland to bring in tougher drink driving law.

BMJ. 2014;349:g6474

Authors: Christie B

PMID: 25352444 [PubMed - in process]

Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis.

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Fertility and early pregnancy outcomes after treatment for cervical intraepithelial neoplasia: systematic review and meta-analysis.

BMJ. 2014;349:g6192

Authors: Kyrgiou M, Mitra A, Arbyn M, Stasinou SM, Martin-Hirsch P, Bennett P, Paraskevaidis E

Abstract

OBJECTIVE: To determine the impact of cervical excision for cervical intraepithelial neoplasia on fertility and early pregnancy outcomes.

DESIGN: Systematic review and meta-analysis of cohort studies.

DATA SOURCES: Medline and Embase.

ELIGIBILITY CRITERIA: Studies assessing fertility and early pregnancy outcomes in women with a history of treatment for cervical intraepithelial neoplasia versus untreated women. We classified the included studies according to treatment type and fertility or early pregnancy endpoint.

ANALYSIS: Pooled relative risks and 95% confidence intervals using a random effect model, and interstudy heterogeneity with I(2) statistics.

RESULTS: 15 studies fulfilled the inclusion criteria and were included. The meta-analysis did not provide any evidence that treatment for cervical intraepithelial neoplasia adversely affected the chances of conception. The overall pregnancy rate was higher for treated women than for untreated women (four studies; 43% v 38%, pooled relative risk 1.29, 95% confidence interval 1.02 to 1.64), although the heterogeneity between studies was high (P<0.0001). Pregnancy rates did not differ between women with an intention to conceive (two studies; 88% v 95%, 0.93, 0.80 to 1.08) and the number requiring more than 12 months to conceive (three studies, 15% v 9%, 1.45, 0.89 to 2.37). Although the rates for total miscarriages (10 studies; 4.6% v 2.8%, 1.04, 0.90 to 1.21) and miscarriage in the first trimester (four studies; 9.8% v 8.4%, 1.16, 0.80 to 1.69) was similar for treated and untreated women, cervical treatment was associated with a significantly increased risk of miscarriage in the second trimester. The rate was higher for treated women than for untreated women (eight studies; 1.6% v 0.4%, 16 558 women; 2.60, 1.45 to 4.67). The number of ectopic pregnancies (1.6% v 0.8%; 1.89, 1.50 to 2.39) and terminations (12.2% v 7.4%; 1.71, 1.31 to 2.22) was also higher for treated women.

CONCLUSION: There is no evidence suggesting that treatment for cervical intraepithelial neoplasia adversely affects fertility, although treatment was associated with a significantly increased risk of miscarriages in the second trimester. Research should explore mechanisms that may explain this increase in risk and stratify the impact that treatment may have on fertility and early pregnancy outcomes by the size of excision and treatment method used.

PMID: 25352501 [PubMed - in process]