87,364 research outputs found
Iatrogenic late preterm birth : when is it recommended? A Delphi survey promoted by the Italian Society of Perinatal Medicine
No full textBackground: The rate of iatrogenic Late Preterm (LP) Birth varies in different settings. This is due to the lack of strong evidence/guidelines on the management of the different maternal, fetal and placental complications affecting pregnancy in the LP window. Steroid prophylaxis is also under discussion. Aim: To build recommendations about the management of main medical complications (pregestational diabetes, placenta previa, preeclampsia, cholestasis, p-PROM, intrauterine growth restriction -IUGR-) occurring in the LP period to reduce clinical heterogeneity. Methods: A group of Italian Perinatal experts were identified by Scientific Societies. A Delphi consensus methodology was used to reach agreement on different clinical sceneries. Two rounds of consultation by using a purpose built on-line survey and a third open panel discussion were performed. Results: The panel of 50 experts reached agreement for the vast majority of clinical sceneries (Placenta Previa, Preeclampsia, Diabetes, Cholestasis). Overall, there was agreement to be conservative at 34 weeks and in favor of delivery at 36 weeks. The management of p-PROM and mostly of IUGR were characterized by a minor degree of consensus. Corticosteroids were found necessary at the 34th week and unnecessary at the 36th week. Conclusions: Besides providing some guidance on clinical indications for LP iatrogenic delivery, these results represent a stimulus for designing future trials investigating the grey areas in this field
Mandatory examinations to understand causes of stillbirth: the key role of autopsy and placental analysis
No full textIntrapartum stillbirth for sepsis complicating Arabin cervical pessary placement in a twin pregnancy
No full textThere is little evidence regarding the best treatment in case of dilated cervix and exposed membranes in twins. Current options for its management include vaginal progesterone, cervical cerclage and cervical pessary, but none of them had shown effectiveness compared to expectant management. We presented a case of twin pregnancy at 22 6/7 weeks gestation admitted to the hospital because of cervical insufficiency with bulging of membranes. An Arabin pessary was positioned after a failed attempt of cervical cerclage and no antibiotic was given in absence of signs of infection. Cesarean delivery was performed at 24 weeks gestation because of spontaneous preterm labor and spontaneous rupture of membranes with the first baby in a transverse lie position. At the uterus section, the first baby was stillborn, with Arabin pessary strictly adherent to his ecchymotic head, while the second baby was born alive. After diagnostic histopathological and microbiological investigations, we hypothesized that the first twin died for funisitis/sepsis and mechanical insult due to the strict adhesion of the pessary to the fetal head. We concluded that in case of bulging membranes and dilated cervix, antibiotic treatment should be evaluated, also in absence of signs/symptoms of infection or suspicion of rupture of the membranes, and pessary insertion should be avoided, namely at second trimester, because of the risk of its dislocation inside the uterus when contractions start and potential hurt to extremely preterm fetus
The intermolecular electrostatic and magnetic effects of the carbonyl group on the shielding constant of proton
No full textThe intermolecular effects of a carbonyl group on the shielding constant of proton are analysed. An experimental evaluation of the contribution to chemical shift is suggested on the basis of bond distances for hydrogen bonding determined by CNDO/2. The reliability of the McConnell and Musher-Buckingham equations is tested and discussed
New chiral pyridine-based Eu(III) complexes: Study of the relationship between the nature of the ligands and the D-5(0) luminescence spectra
No full textIn this paper a new family of imines [N,N'-bis(2-pyridylmethylidene)-1,2-(R,S)-cyclohexanediamine (ligand 1); N,N'-bis(2-pyridylmethylidene)-1,2-(R,S)-cyclohexanediamine (ligand 3)] and amines [N,N'-bis(2-pyridylmethylene)- 1,2-(R,R + S,S)-cyclohexanediamine (ligand 2); N,N'-bis(2-pyridylmethylene)-1,2-(R,S)-cyclohexanediamine (ligand 4)] pyridine-based chiral ligands and their chiral nitrate Eu(III) complexes is presented. Combination of structural and spectroscopic evidences in the solid state, reveals that the Eu(III) ion environment is characterized by a low symmetry for all the complexes. The D-5(0) -> F-7(0) Eu(III) emission intensity reflects the degree of distortion of the metal surroundings, that is higher in the case of cis isomer of amine-based complex. This new family of Eu(III) chiral complexes are promising candidates for applications in the sensing field as probes in solution of the nitrate anion and of chiral molecules. (C) 2011 Elsevier B.V. All rights reserved
Potentially preventable antepartum stillbirths in a high-resource setting: a prospective audit-based study
No full textObjectives: The primary objective was the identification of sub-standard care in antepartum stillbirths in Emilia-Romagna Region (Italy), hence the number of potentially preventable cases. Secondly, we seek to evaluate any association between inadequate care and either risk factors for stillbirth or causes of death. Study Design: This study was based on prospectively-collected data in an institutional stillbirth audit project, involving all 29 hospital with a maternity unit in Emilia-Romagna Region. For each stillbirth occurred in the area from 2014 to the first semester of 2019 the same diagnostic workup was performed and a clinical record with data about mother and stillborn was completed. Every case was discussed in a multidisciplinary local audit to assess both the cause of death and the quality of care. Two aspects of care quality were evaluated: clinical management and women's access to care. Data were then reviewed by the Regional Audit Group. Results: Elements of inadequate care were identified in 56 out of 524 (10.7 %) fetal deaths. Non-Italian women and pregnancies with fetal growth restriction had double the risk of having received inadequate care during pregnancy, compared to Italian women (aOR 2.0, 95 % CI 1.1–3.6) and a normally developing fetus (aOR 2.0, 95 % CI 1.1–4.1), respectively. Women whose stillbirth was caused by maternal disorders were at higher risk for inadequate care compared to women who had stillbirth explained by other cause (aOR 5.89, 95 %CI 2.2–15.4). Sub-optimal clinical management and barriers to access to care were observed to equal extents. Inappropriate ultrasound monitoring was the most frequent suboptimal care element. Conclusions: About one out of ten stillbirths was potentially preventable. Interventions to reduce stillbirth occurrence in our high-resource setting should focus on appropriate diagnosis and management of maternal disorders and fetal growth restriction, as well as improving access to antenatal care
Psoriatic uveitis is not an exploded myth
No full textPsoriatic uveitis, a distinct clinical entity quoted for 7% to 25% in psoriatic ophthalmic patients with spondyloarthritis, and for 25.,% +/- 2,3 in meta-analysis of rheumatic patients with a prevalence of HLA-B27 quoted as for 40%-50%, is often misdiagnosed. The model proposed by Conti & Coll. [Clinical Dermatology 2017;5(1):30-36]merits also to drive attention of Dermatologist, Radiologist, General Practitioner to submit those psoriatic patients to an ophthalmological screening
Discussion of "How to find an appropriate clustering for mixed-type variables with application to socio-economic stratification" by Christian Hennig and Tim F. Liao
No full textA Middle Jurassic bivalve and gastropod fauna from Umbria (Central Italy)
No full textFossil bivalves and gastropods originating from a neptunian dike infilling are described from Central Italy. The fauna of Middle Jurassic age is composed of hundred of specimens. Among them we acknowledged 26 species from 19 genera. Parallelodon apenninicus, P. carsulanus and P. maxiai among bivalves are described as new. Among the gastropods the following new genera and species are erected: Proconulus (Laeviconulus) keratomorphus, Odoardia, O. prosornata, Fischeriella, F. umbra, Naticopsis (Marmolatella) esui, Neritoma (Neridomus) riettii, Crossostoma macerinoi, Planicollonia, P. macrostoma, Allocosmia geometrica. The family Crossostomatidae Cox, 1960 is also emended
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