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J Villar

Publications and source records attributed to J Villar.

At least 73 records · Page 4Linked to original sources
PubMed2000

Same nutrient, different hypotheses: disparities in trials of calcium supplementation during pregnancy.

Calcium supplementation during pregnancy has been provided either to increase the intake in those with a deficiency or to obtain a pharmacologic, perhaps nonnutritional, effect in individuals with an adequate calcium intake. A systematic review, including only randomized, double-blind, controlled trials of calcium supplementation during pregnancy was prepared independently for the Cochrane Library and updated by us for this paper. In view of the heterogeneity of results included in the meta-analysis, a stratified analysis by baseline dietary calcium intake (mean calcium intake in the population < or >/=900 mg/d) was conducted. On the basis of the results of the 5 randomized, controlled trials available, the risk of high blood pressure was lower in women with low baseline dietary calcium [typical relative risk (TRR): 0.49; 95% CI: 0.38, 0.62]. Of the 4 trials in which subjects had adequate dietary calcium, the TRR of high blood pressure was 0.90 (95% CI: 0.81, 0.99). The risk of preeclampsia was considerably reduced in the 6 trials conducted in populations with low-calcium diets (TRR: 0.32; 95% CI: 0.21, 0.49) but was not reduced as much in women enrolled in the 4 trials with adequate-calcium diets (TRR: 0.86; 95% CI: 0.71, 1.05). On the basis of these results, it seems clear that calcium supplementation during pregnancy for women with deficient calcium intake is a promising preventive strategy for preeclampsia. Calcium supplementation in pregnancy should be evaluated definitively in an adequately sized trial conducted in a population with a low calcium intake because this is the most likely population to benefit from such a nutritional intervention. Long-term health benefits for the offspring are also an attractive possibility.

Calcium, Dietary↗
PubMed1999

Molecular intensive care medicine.

The development of methods for the analysis of gene structure and function, referred to as recombinant DNA (deoxyribonucleic acid) technology, has created unprecedented opportunities for significantly improving the prevention or treatment of human diseases. Both practitioners working in this field and interested observers cannot fail to recognize that the remarkable progress in understanding disease pathogenesis has placed us on the threshold of a new, revolutionary era of clinical practice. In this context, molecular medicine--that is, the application of molecular biology to elucidating the causes and potential cures of disease, has become a major thrust of research at virtually all medical schools. Incorporating the techniques of molecular biology into the research arsenal of the physician should provide new opportunities to dissect out and define the reversible and irreversible intracellular processes giving rise to acute respiratory distress syndrome, sepsis, septic shock, or multiple system organ failure, the major causes of mortality in most intensive care units.

Critical Care↗
PubMed1999

Current definitions of acute lung injury and the acute respiratory distress syndrome do not reflect their true severity and outcome.

BACKGROUND: Despite intensive research, there are no universally accepted clinical definitions for acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS). A recent joint American-European Consensus Conference on ARDS formally defined the difference between ALI and ARDS based on the degree of oxygenation impairment. However, this definition may not reflect the true prevalence, severity and prognosis of these syndromes. METHODS: During a 22-month period, 56 consecutive mechanically ventilated patients who met the American-European Consensus definition for ARDS [arterial oxygen tension/fractional inspired oxygen (PaO(2)/FIO(2) </= 200 mmHg regardless of the level of positive end-expiratory pressure (PEEP), bilateral pulmonary infiltrates, and no evidence of left heart failure] were admitted into the intensive care units (ICU) of the Hospital del Pino, Las Palmas, Spain, and prospectively studied. The diagnosis of ALI and ARDS was made by a PEEP-FIO(2) trial, 24 h after patients met the Consensus inclusion criteria. Patients were classified as having ALI(-24 h) if the PaO(2)/FIO(2) was > 150 mmHg with PEEP = 5 cmH(2)O, and ARDS(-24 h) if the PaO(2) /FIO(2) was </= 150 mmHg with PEEP >/= 5 cmH(2)O. RESULTS: Overall mortality was 43 % (24 of 56). However, 24 h after inclusion, PaO(2) response to PEEP 5 cmH(2)O allowed the separation of our patients into two different groups: 31 patients met our ALI(-24 h) criteria (PaO(2)/FIO(2) > 150 mmHg) and their mortality was 22.6 %; 25 patients met our ARDS(-24 h) criteria (PaO(2)/FIO(2) </= 150 mmHg) and their mortality was 68 % (p = 0.0016). The differences in the respiratory severity index during the first 24 h of inclusion, PaO(2)/FIO(2) ratio at baseline and at 24 h, maximum plateau airway pressure, maximum level of PEEP, and number of organ system failures during the ICU stay were statistically significant. CONCLUSIONS: Since the use of PEEP in the American-European Consensus criteria for ARDS is not mandatory, that definition does not reflect the true severity of lung damage and outcome. Our data support the need for guidelines based on a specific method of evaluating oxygenation status before the American-European Consensus definition is adopted.

Adolescent↗
PubMed1999

Soluble-protein and antigenic heterogeneity in axenic Blastocystis hominis isolates: pathogenic implications.

The protein profile and the antigenic cross-reactivity of 18 axenic isolates of Blastocystis hominis obtained from symptomatic patients with chronic diarrhea (14 isolates) showing no evidence of parasitic etiology and from patients with acute diarrhea attributable in 2 cases to Salmonella spp. were analyzed. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of soluble proteins showed the existence of a common profile composed of 31 bands, with molecular weights ranging between 24 and >200 kDa, and minor differences in the proteins of 149, 118, 106, 50, 48, 47, and 30 kDa. These differences allowed us to classify the strains into three related patterns (I-III). In an indirect immunofluorescence assay, all strains were serologically identical, but two related antigenic groups (1 and 2) were found in double-immunodiffusion and Western-blot studies. The isolates of protein patterns I and II belonging to antigenic group 1 were isolated from patients with chronic diarrhea, whereas the four isolates from patients with acute diarrhea were clustered in protein pattern III and in antigenic group 2. These results confirm the protein and antigenic heterogeneity of B. hominis and the existence of demes with different pathogenic roles.

Acute Disease↗
PubMed1999

Incorporation of dietary triacylglycerols from olive oil and high-oleic sunflower oil into VLDL triacylglycerols of hypertensive patients.

OBJECTIVES: To establish whether the ingestion of diets enriched with olive oil or high-oleic sunflower oil may produce changes in the composition of VLDL triacylglycerols from hypertensive patients. It could be relevant for the uptake and metabolism of triacylglycerol-derived metabolites by extrahepatic tissues. DESIGN: Patients were assigned to the diets in a random-order sequence. SUBJECTS: The participants were 24 hypertensive patients recruited from a religious community. INTERVENTIONS: The study was conducted over two four week periods with a four week washout period between both MUFA diets. RESULTS: Dietary olive oil kept in balance the content of saturated fatty acids and decreased the content of arachidonic acid in VLDL triacylglycerols. HOSO diet reduced the content of palmitic acid and increased the content of linoleic acid. There was also a decrease in trioleate-glycerol and an increase in tripalmitate-glycerol of VLDL after the MUFA diets, but these effects were more pronounced in the HOSO group. Intake of olive oil decreased the content of disaturated triacylglycerols and increased the content of dioleate-containing triacylglycerols. A decrease in palmitate-dioleate-glycerol after dietary HOSO was observed. Olive oil (but not HOSO) promoted the presence of long-chain PUFA of n-3 family at the sn-2 position of VLDL triacylglycerols. CONCLUSIONS: Our data indicate that olive oil and HOSO, providing a similar concentration of MUFA (oleic acid), differ in the formation of VLDL triacylglycerols in hypertensive patients.

Analysis of Variance↗
PubMed1999

Misoprostol dose-related shivering and pyrexia in the third stage of labour. WHO Collaborative Trial of Misoprostol in the Management of the Third Stage of Labour.

OBJECTIVE: To select the misoprostol dose to be used in a large multicentre randomised trial comparing misoprostol with oxytocin in the routine management of the third stage of labour. DESIGN: Randomised pilot trial, double-blinded with the use of double placebos. SETTING: Two of the nine hospitals that will participate in the main multicentre trial. The hospitals were located in Johannesburg, South Africa and Khon Kaen, Thailand. POPULATION: Women during second stage of labour about to be delivered vaginally. METHODS: The trial had three arms: misoprostol 400 microg versus misoprostol 600 microg versus intramuscular oxytocin 10 IU. Each group received an injection and three tablets immediately after the birth of the baby. MAIN OUTCOME MEASURES: Shivering and pyrexia rates were the main outcome measures. Data on other side effects and characteristics of the third stage of labour were also collected. Side effects were noted as none, mild, moderate or severe. RESULTS: Both shivering and pyrexia (temperature > 38 degrees C) were most common in the 600 microg misoprostol group (28% and 7.5% for shivering and pyrexia, respectively) compared with 400 microg misoprostol (19% and 2%), and the oxytocin group (12.5% and 3%). The increase in shivering in the misoprostol 600 microg group was due primarily to a higher rate of moderate shivering. None of the women had a temperature > 40 degrees C. There were no increases in severe side effects and other adverse events in the misoprostol 600 microg group. CONCLUSIONS: When used in the management of the third stage of labour oral misoprostol is associated with an increase in the rate of moderate shivering and pyrexia which seems to be dose-related. Based on the results of this pilot trial, the Steering Committee has decided to use 600 microg misoprostol in the main trial, comparing it with oxytocin, in order to achieve higher effectiveness.

Adult↗
PubMed1999

Sodium transport kinetics, cell membrane lipid composition, neural conduction and metabolic control in type 1 diabetic patients. Changes after a low-dose n-3 fatty acid dietary intervention.

BACKGROUND: A decreased content of n-3 fatty acids in erythrocyte membrane of type 1 diabetic patients, which is inversely related to plasma levels of HbA(1c), has been reported previously. Our aim in this study was to observe the changes after a low-dose n-3 fatty acid (330 mg/day docosahexaenoic acid and 630 mg/day eicosapentanoic acid) dietary intervention in the lipid composition of cell membrane and metabolic control (measured according to plasma HbA(1c) levels). Since changes in both parameters may alter transmembrane sodium transport or influence parameters measuring target organ damage, we also studied the neural conduction quality and activity of four sodium transporters. METHODS: Eighteen type 1 diabetic patients were randomly assigned to continue their usual diet (control group) or to supplement their diet with a daily low dose of n-3 fatty acids (supplemented group). The changes between baseline and end values of the following parameters were compared: HbA(1c), lipid and phospholipid composition of cell membrane, activity of four ion carriers and neural conduction quality. RESULTS: The dietary supplementation caused statistically significant changes in membrane lipid composition, particularly an increase of C22:6 (n-3) and the total n-3 fatty acid (respectively +0.90+/-1.14% vs. -0.44+/-1.23% and +1.36+/-1.62% vs. -0.5+/-1.80%, p<0.05). After the dietary supplementation, we also observed a significant decrease of HbA(1c) (-2.00+/-1.9% vs. -0.13+/-0.48%, p<0.05), without significant changes in the dose of insulin required, an increase in the motor conduction velocity by the median nerve (+2.12 +/-1.35 m/s vs. -0.8+/-2.34 m/s, p<0.05) and a decrease of the V(max) of the Na(+)-Li(+) countertransport (-96.6+/-111.2 vs. +58.1+/-81.3 micromol/l cell/h(-1), p<0.01). CONCLUSION: A low-dose omega-3 fatty acid dietary supplementation may change the fatty acid composition of the cell membrane and improve the metabolic control of diabetes. Using this dose, we also observed a decrease of the maximal rate of Na(+)-Li(+) countertransport and a slight improvement of neural conduction.

Adolescent↗
PubMed1998

In vitro encystation of Blastocystis hominis: a kinetics and cytochemistry study.

The kinetics of in vitro encystation of Blastocystis hominis was studied over 9 days. The differentiation between trophic (TF) and cyst forms (CF) was determined by differential counts before and after treatment with distilled water. A cytochemistry study using acridine orange and Calcofluor white wet-mount preparations of CF was carried out. The growth curves of TF and CF were related because the decrease in TF was followed by an increase in CF, and vice versa. The maximum of CF counts was obtained on the 6th or 7th day. Using the differential acridine orange stain, two subpopulations of CF, yellow-orange fluorescent cells or precysts and green fluorescent cells or cysts, were detected and their curves were also related. CF was stained by Calcofluor white, which suggested the existence of beta-(1-4)-glycosyl residues in the wall cysts of B. hominis.

Acridine Orange↗
PubMed1998

Nutritional interventions for the prevention of maternal morbidity.

OBJECTIVE: To review the effectiveness of nutritional interventions to prevent maternal morbidity. METHODS: This is an overview of systematic reviews and individual randomized controlled trials (if no systematic review available) of nutritional interventions during pregnancy. For each nutrient intervention the main maternal morbidity data reported were extracted. These were pre-eclampsia/eclampsia, pregnancy-induced hypertension, hemorrhage, anemia, infection and obstructed labor. In addition, the trial settings, the number of trials and participants' characteristics were systematically extracted. RESULTS: The systematic reviews considered in this paper had only few trials that reported the selected maternal outcomes. Outcome measures are based sometimes on one trial only. Most of the interventions compared single micronutrient supplementation with placebo/no treatment and did not show significant benefits for the supplementation groups. Calcium supplementation in women at high risk of pregnancy hypertension reduced the incidence of high blood pressure (RR, 0.35; 95% CI, 0.21-0.57) and pre-eclampsia (RR, 0.22; 95% CI, 0.11-0.43). Similarly, in women with low dietary calcium intake, calcium supplementation resulted in a significant reduction in the incidence of high blood pressure (RR, 0.49; 95% CI, 0.38-0.62) and pre-eclampsia (RR, 0.32; CI, 0.21-0.49). In women at low risk of pregnancy hypertension or with adequate baseline calcium intake, the beneficial effects of calcium supplementation are small and unlikely to be of clinical significance. Both, iron and folate supplementation reduced the number of women with low pre-delivery hemoglobin. CONCLUSIONS: Routine calcium supplementation seems to be a promising intervention for pregnant women at risk of developing preeclampsia or have low calcium intake, but these findings need to be confirmed with a trial with adequate power in different settings. In populations with high incidence of nutritional anemia routine iron and folate supplementation should be recommended during ante-natal care. It is unclear at this stage if adding vitamin A to iron and folate supplementation in anemia prevalent areas provides further benefits. There is inadequate data on the benefits or harms of routine iron or folate supplementation in adequately nourished populations. With regard to other micronutrient supplementation, such as zinc, magnesium and fish oil, randomized controlled trials with sufficient power to detect clinically important differences in maternal and infant outcomes are needed.

Calcium↗
PubMed1998

The practice of antenatal care: comparing four study sites in different parts of the world participating in the WHO Antenatal Care Randomised Controlled Trial.

In the preparation of a randomised controlled trial to evaluate a new programme of antenatal care (ANC) in different parts of the world, we conducted a baseline survey of the ANC procedures in all 53 clinics participating in the trial. There were two components of this survey: (1) description of clinic characteristics and services offered: the staff of each clinic was interviewed and direct observation was made by field supervisors, and (2) the actual use of services by pregnant women attending these clinics: we reviewed a random sample of 2913 clinical histories. The clinical units surveyed were offering most of the activities, screening, laboratory tests and interventions recommended as effective according to the Cochrane Pregnancy and Childbirth Database (PCD), although some of these were not available in some sites. On the other hand, some tests and interventions that are considered not effective according to these criteria are reportedly offered. There was a difference across sites in the availability and offer to low-risk women of vaginal examination, evaluation of pelvic size, dental examination, external version for breech presentation and formal risk score classification, and a notable difference in the type of principal provider of ANC. There was a large variation in the actual use of screening and laboratory tests and interventions that should be offered to all women according to Cochrane PCD criteria: some of these are simply not available in a site; others are available, but only a fraction of women attending the clinics are receiving them. The participating sites all purport to follow the traditional 'Western' schedule for ANC, but in three sites we found that a high percentage of women initiate their ANC after the first trimester, and therefore do not have either the recommended minimum number of visits during pregnancy or the minimum first trimester evaluation. It is concluded that the variability and heterogeneity of ANC services provided in the four study sites are disturbing to the profession and cast doubts on the rationale of routine ANC.

Argentina↗
PubMed1998

Who should provide routine antenatal care for low-risk women, and how often? A systematic review of randomised controlled trials. WHO Antenatal Care Trial Research Group.

Many activities, the timing and the frequency of visits of conventional antenatal care provided to low-risk pregnant women have most often been introduced without proper scientific evaluation. Few trials, to date, have been conducted to evaluate the effectiveness of antenatal care programmes for low-risk women with varied number of antenatal visits and type of care providers. We have performed a systematic review of these randomised controlled trials. Five randomised controlled trials were identified in which the effectiveness of a schedule of reduced number of antenatal visits (n = 12,883) was compared with the existing practice (n = 9438). Four of these trials were carried out in developed countries. The difference in the number of visits between intervention and control arms of the trials was moderate. Only one trial achieved a reduction in the median number of visits, from six in the standard care to four in the intervention group, that could be considered to be of health-care relevance for the study population. No significant differences were observed in the two arms of the trials when low birthweight, small-for-gestational-age, Caesarean section, induction of labour, antepartum haemorrhage and postpartum haemorrhage were considered as outcome measures. However, there was a tendency towards an increased rate of preterm delivery in the intervention group in three of the trials. Conversely, the largest trial in Harare, Zimbabwe, demonstrated a statistically significant reduction in preterm delivery in the intervention group (relative risk [RR] 0.88; 95% confidence interval [CI] 0.80, 0.96). Neither the individual studies nor the review had the statistical power to evaluate mortality outcome variables. When perception of care was assessed, women participating in two trials expressed less satisfaction with frequency of visits in the experimental group. In the London, UK, trial, some women in the reduced number of visits group felt that their expectations were not completely fulfilled. However, an opposite trend was reflected when women were asked for their preference of the type of care for any future pregnancy. We also identified three trials that compared midwife/general practitioner-managed care vs. obstetrician/gynaecologist-led shared care. The results were indicative of similar clinical efficacy of the two groups. However, women's response regarding the continuity of care favoured midwife-led care. From the health economics perspective, there is evidence of cost reduction if antenatal care was provided by staff other than the obstetrician/gynaecologist. The available data demonstrate no significant differences in selected perinatal outcomes for low-risk women receiving care according to a reduced frequency (approximately two visits fewer) of prenatal visits vs. those following the existing practice. However, there are differences in satisfaction with the prenatal care provider and the prenatal care system. There is evidence that a midwife's clinic for provision of antenatal care for low-risk pregnancies is feasible and therapy reduction in costs achievable.

Appointments and Schedules↗
PubMed1998

The WHO antenatal care randomised controlled trial: rationale and study design.

The World Health Organisation and collaborating institutions in developing countries are conducting a multicentre randomised controlled trial to evaluate a new antenatal care (ANC) programme, consisting of tests, clinical procedures and follow-up actions scientifically demonstrated to be effective in improving maternal and newborn outcomes. These activities are distributed, for practical reasons, over four visits during the course of pregnancy and are aimed at achieving predetermined goals. The study is taking place in four countries, Argentina, Cuba, Saudi Arabia and Thailand. Recruitment of study subjects started on 1 May 1996. All 53 ANC clinical units had been enrolled by December 1996. Clinics in each country were randomly allocated (cluster randomisation) to provide either the new programme or the traditional programme currently in use. Approximately 24,000 women presenting for ANC at these clinics over an average period of 18 months will have been recruited. As women attending the control clinics receive the 'best standard treatment' as currently offered in these clinics, individual informed consent is requested only from women attending the intervention clinics. Authorities of the corresponding health districts and all participating clinics have provided written institutional informed consent before randomisation. The primary outcome of the trial in relation to maternal conditions is the rate of a morbidity indicator index, defined as the presence of at least one of the following conditions for which ANC is relevant: (a) pre-eclampsia or eclampsia during pregnancy or within 24 h of delivery; (b) postpartum anaemia (haemoglobin < 90 g/L); or (c) severe urinary tract infection/pyelonephritis, defined as an episode requiring antibiotic treatment and/or hospitalisation. The primary fetal outcome is the rate of low birthweight (< 2500 g). Adverse maternal and fetal outcomes are expected for approximately 10% of the control group. Several maternal and perinatal secondary outcomes are also considered. A comprehensive cost-effectiveness analysis and women's and providers' satisfaction evaluation are performed concurrently with the trial. Health-care programmes should be rigorously evaluated by randomised controlled trials, which are feasible in developing countries and should be conducted before introducing new treatments or health interventions.

Argentina↗
PubMed1998

Methodological considerations in the design of the WHO Antenatal Care Randomised Controlled Trial.

We discuss methodological issues arising in a recent evaluation trial of a new antenatal care programme, as sponsored by the Special Programme of Research, Development and Research Training in Human Reproduction, and WHO's Division of Reproductive Health (Technical Support). The randomisation unit for the trial is the antenatal care clinic, with 53 clinics located in four countries randomly allocated to provide either the new programme or the traditional programme currently in use. Approximately 24,000 women presenting for antenatal care over an average period of 18 months will have been recruited.

Argentina↗
PubMed1998

Neonatal morbidity associated with disproportionate intrauterine growth retardation at term.

We set out to compare neonatal morbidity between disproportionate intrauterine growth retarded newborn infants and proportionate retarded ones at term, based on ponderal index. This is a prospective study of 185 single pregnancies with evidence of intrauterine growth retardation at term. Sixty three cases (34%) were disproportionate and 122 (66%) proportionate in terms of ponderal index. All were born in the University Hospital 'Principe de Asturias' of Alcala de Henares, Madrid, Spain. Proportionate or disproportionate intrauterine growth retardation diagnosis was established using the ponderal index (weight/length3). The following outcomes of neonatal morbidity were investigated: (1) perinatal asphyxia (meconium-stained amniotic fluid, abnormal fetal heart rates, newborn acidosis or low Apgar score 7 at 5 minutes) and/or (2) early neonatal medical complications. Disproportionate intrauterine growth retardated newborn infants presented higher rates of perinatal asphyxia (54% vs. 32%, P 0.01), with higher abnormal fetal heart rates (37% vs. 15%, P 0.01), higher frequency of arterial pH 7.20 (31% vs. 16%, P 0.05); and also higher rates of early neonatal medical complications (40% vs. 11%, P 0.001), mainly hypoglycaemia (25% vs. 4%, P 0.01). Morbidity among disproportionate intrauterine growth retardated Aconates is significantly higher compared with proportionate ones, demonstrating the heterogeneity of the intrauterine growth retardation population. Proportionate and disproportionate intrauterine growth retardation should be diagnosed as early as possible, since the majority of the morbidity is intimately related to this difference.

Journal Article↗
PubMed1998

Nutritional and antimicrobial interventions to prevent preterm birth: an overview of randomized controlled trials.

The study was conducted to assess the effectiveness of interventions for the prevention or treatment of nutritional and infectious disorders during pregnancy on preterm birth rates. Cochrane systematic reviews or any other more up-to-date systematic review of antimicrobial and nutritional interventions were sought. Electronic searches of the Cochrane Controlled Trials Register were carried out to identify any trials published since the most recent update of the systematic review. Also, authors of Cochrane systematic reviews, which have not been updated recently, were contacted regarding new information. Systematic reviews of nutritional and antimicrobial interventions during pregnancy, reporting preterm delivery rates (delivery before 37 weeks) and "prematurity" (including low birth weight) either as primary or secondary outcomes, were included. General interventions without a specific nutritional supplementation or antimicrobial component were not considered for inclusion. Interventions to stop labor or prolong pregnancy after a diagnosis of preterm labor were excluded. For each systematic review, data on preterm delivery rate by intervention group was obtained. The total number of trials in the review, number of trials reporting preterm birth as an outcome, number of participants and events have been systematically extracted. Eighteen systematic reviews (10 nutritional and 8 antimicrobial) were considered. Our results indicated that, overall, the treatment of asymptomatic bacteriuria reduces the incidence of preterm birth or low birth weight (< 2500 gm) (typical relative risk (RR): 0.67; 95 percent confidence interval (CI): 0.52-0.85). The protective effect of treating asymptomatic bacteriuria for preterm delivery persisted when only the three trials reporting preterm delivery (< 37 weeks) were included in the meta-analysis (typical RR: 0.53, 95 percent CI: 0.33-0.86). Routine iron supplementation prevents maternal anemia and one trial comparing routine versus selective iron supplementation showed a statistically nonsignificant reduction in preterm birth. Zinc, magnesium, and fish oil supplementations show promising results in reducing preterm birth, but the evidence is not strong. Calcium supplementation remains controversial, although there was a statistically significant reduction in preterm delivery in the subgroup of women at high risk of developing hypertension during pregnancy. Two trials with use of metronidazole (alone or with erythromycin) showed a reduction in preterm delivery in women who were at a high risk of preterm delivery and had bacterial vaginosis at screening. We have concluded that asymptomatic bacteriuria should be screened and treated in all settings that offer antenatal care. Single dose treatment seems to be as effective as longer (4-7 days) treatment, although this needs to be confirmed by a large, methodologically rigorous trial. There are a number of promising interventions such as calcium supplementation in women with low calcium intake, iron, zinc, magnesium, and fish oil supplementation, and treatment of bacterial vaginosis in women at high risk of preterm delivery that need additional research to determine a possible role for prevention of preterm delivery.

Anti-Infective Agents↗
PubMed1998

Levels and patterns of intrauterine growth retardation in developing countries.

The aim of this paper is to quantify the magnitude and describe the geographical distribution of intrauterine growth retardation (IUGR) in developing countries. We estimate that at least 13.7 million infants are born every year at term with low birth weight (LBW), representing 11% of all newborns in developing countries. This rate is approximately 6 times higher than in developed countries. LBW, defined as < 2500 g, affects 16.4% of all newborns, or about 20.5 million infants each year. IUGR defined as birth weight below the 10th percentile of the birth-weight-for-gestational-age reference curve, represents 23.8%, or approximately 30 million newborns per year. Overall, nearly 75% of all affected newborns are born in Asia--mainly in South-central Asia--20% in Africa, and about 5% in Latin America. Although some of these are healthy, small infants who merely represent the lower tail of a fetal growth distribution, in most developing countries a large proportion of newborns suffer from some degree of intrauterine growth retardation. These data demonstrate that many developing countries currently exceed the internationally recommended IUGR (> 20%) and LBW (> 15%) cut-off levels for triggering public health action, and that population-wide interventions aimed at preventing fetal growth retardation are urgently required.

Birth Weight↗