Antibiotics before miscarriage surgery not tied to fewer infections

first_imgThe findings from a multi-country clinical trial published today in the New England Journal of Medicine show that the use of preventive antibiotics before miscarriage surgery did not result in a significantly lower risk of pelvic infection than the use of a placebo.Roughly 10% to 20% of the 208 million pregnancies that occur each year globally end in miscarriage, and surgery is often required to remove the contents of the uterus. But whether prophylactic antibiotics help prevent post-surgical infection remains unclear.And in low- and middle-income countries (LMICs), where rates of miscarriage and post-surgical infection are higher but antibiotics are frequently overused, more definitive evidence of the value of antibiotic prophylaxis is needed.While the results suggest the value is limited, the international team of researchers who conducted the study and an outside expert say, however, that the broadening of the definition of pelvic infection in the middle of the trial muddies the picture.The results of the Antibiotics in Miscarriage Surgery (AIMS) trial showed that, under pragmatic, broad criteria for pelvic infection that included clinical judgment, women who were given prophylactic antibiotics had a lower rate of infection 14 days after miscarriage surgery than those who received a placebo, but the risk of infection was not significantly lower (a 23% drop). Under a stricter definition of infection based on international diagnostic criteria, however, the risk of infection in women who had received antibiotics before surgery was 40% lower, suggesting “a possible benefit when pelvic infection was defined by strict criteria,” the authors of the study write.Expanded definition of infectionThe randomized, double-blinded, placebo-controlled study involved women and adolescents recruited from hospitals in Malawi, Tanzania, Uganda, and Pakistan from June 2014 through April 2017. All the patients in the study had experienced miscarriages at less than 22 weeks before gestation and were scheduled to undergo surgery. Patients were assigned 1:1 to receive either 400 milligrams (mg) of doxycycline or 400 mg of metronidazole orally or five matched placebos 2 hours before surgery.At the start of the trial, the initial primary outcome—pelvic infection 14 days after surgery—was defined according to criteria designated by the US Centers for Disease Control and Prevention and the World Health Organization. Under this definition, diagnosis of a pelvic infection requires two or more of four clinical features.But during the trial, there was concern that this strict definition could lead to some missed infections. So the criteria were broadened to require only one of four clinical features of infection, along with the clinician’s judgment that the patient had a pelvic infection and needed antibiotics for treatment. The initial primary outcome then became the secondary outcome. The changes were made before the data were un-blinded.A total of 3,412 patients were enrolled in the study, with 1,705 assigned to receive antibiotics and 1,707 to receive placebo. Primary outcome data were obtained for 3,360 patients. The rate of pelvic infection was 4.1% in the antibiotic arm (68 of 1,676 pregnancies) and 5.3% (90 of 1,684 pregnancies) in the placebo arm (risk ratio [RR], 0.77; 95% confidence interval [CI], 0.56 to 1.04, P = 0.09).For the secondary outcome, the rate of pelvic infection—diagnosed according to the stricter definition—was 1.5% (26 of 1,700 pregnancies) for the antibiotics group and 2.6% (44 of 1,704 pregnancies) for the placebo group (RR, 0.60; 95% CI, 0.37 to 0.96). The authors of the study note that they did not adjust these rates for multiple comparisons.There were no significant differences in the rates of adverse events—including diarrhea, vomiting, and blood transfusion—between the two groups. More sensitivity, less specificityThe investigators, led by David Lissaur, MBChB, PhD, of the University of Birmingham in England, acknowledge that while broadening the criteria for diagnosis increased the sensitivity for identifying pelvic infection, it may have also decreased the specificity. Under the broader criteria, there were an additional 42 infections diagnosed in the antibiotic-prophylaxis arm and an additional 46 in the placebo arm. “The addition of clinician judgment to the pragmatic definition is likely to have diluted the observed treatment effect,” they write.But were those additional diagnosed infections truly pelvic infections?Writing in an accompanying commentary, Ugandan physician and infectious disease expert David Serwadda, MBChB, MPH, says that including clinician judgment is problematic because there was no clear definition of what constituted the perceived need for antibiotics among the clinicians. And in low- and middle-income countries with poor diagnostic facilities, he notes, healthcare providers may err on the side of caution and prescribe antibiotics for a miscarriage patient who’s feverish and had surgery performed in less-than-optimal settings.Serwadda believes that this less specific definition of infection may have inadvertently reduced the odds of observing a true difference in pelvic infection rates between the two groups.As a result, he writes, “I would interpret the results as indicating that antibiotic prophylaxis prevented pelvic infections as defined by international diagnostic criteria. Given the risks associated with pelvic infections in LMICs, these data provide reasonable support for prescribing prophylactic antibiotics in these settings. Antibiotic resistance, however, will need to be monitored.”See also:Mar 13 N Engl J Med studyMar 13 N Engl J Med commentarylast_img read more

Mammoet lights up Seattle

first_imgMammoet hoisted the three 125-ton (113.4-tonne) transformers using a Liebherr LTM 1400.The long reach of the crane enabled Mammoet to complete the lifting operations and the setting of foundations from a single location. This eliminated crane movements, which Mammoet says saved time in the execution.The installation of four metal clad capacitor banks was also completed by Mammoet. As overhead obstructions prevented the banks from being directly lifted into place, they were hoisted onto a jack and slide rail system, from which they were set onto the foundations.According to Mammoet, the Denny Substation, when completed, will be one of the largest developed by Seattle City Light. It is scheduled to be energised in early 2018. www.mammoet.comlast_img read more

$10K reward offered for killer of rare Yellowstone wolf

first_img Author: AP Published: May 14, 2017 2:58 PM EDT $10K reward offered for killer of rare Yellowstone wolf CHEYENNE, Wyo. (AP) The reward for information leading to whoever shot a rare white wolf found inside Yellowstone National Park rose to $10,000 on Friday after a wolf advocacy group matched a $5,000 reward offered earlier by the park.Yellowstone officials euthanized the severely injured wolf after hikers found the animal suffering in the northern edge of the park, near Gardiner, Montana, on April 11. The 12-year-old wolf that was killed was the alpha female of a group of wolves dubbed the Canyon Pack and a popular target of photographers.The park offered a $5,000 reward Thursday for information leading to a conviction after announcing a preliminary necropsy finding that the wolf had been shot.The Montana group Wolves of the Rockies followed up with its own $5,000 reward.Park officials have not said whether they have leads in their investigation into who killed the wolf, but Wolves of the Rockies President Marc Cook speculated the wolf’s killer was someone angry about the reintroduction of wolves to the park more than two decades ago.“People take matters into their own hands and feel they are above the law and they kind of flaunt that fact that they can do what they want to do and there’s no repercussions,” Cook said.Park officials also have not commented on a motive for the wolf’s killing, but many hunting outfitters and ranchers oppose the presence of the wolves, which now number about 100 in the park. Wolves prey on big-game animals popular with hunters, such as elk, and sometimes kill cattle on pastures outside Yellowstone.The shooting happened at a time of transition for wolves in nearby Wyoming, where a federal appeals court ruled in March that they could be removed from Endangered Species Act protection.Environmentalists had persuaded a judge to put wolves back on the endangered list in Wyoming in 2014. Their concerns included a shoot-on-sight provision for wolves in most of the state, one that does not exist in Idaho or Montana.The U.S. Court of Appeals for the District of Columbia found Wyoming adequately addressed those concerns. Wolves went back off the endangered list in Wyoming on April 25.Reclassified by the state as predators of livestock, they once again may be shot on sight by anyone in most of Wyoming outside Yellowstone, Grand Teton National Park and nearby wild country. Relatively few wolves wander far from the Yellowstone region in Wyoming.The wolf found shot in Yellowstone was more than 70 miles (110 kilometers) from where it could legally have been shot on sight in Wyoming two weeks later when wolves found there had been taken off the endangered list.The dead wolf was double the average age of a Yellowstone wolf and had at least 20 pups, of which 14 became yearlings. She was together with the same alpha male wolf for more than nine years, park officials said.center_img Do you see a typo or an error? Let us know. SHARElast_img read more

News in 60 seconds

first_imgUK tech ambitionsA new panel aims to make the UK the ‘perfect’ destination for LawTech companies. The LawTech Delivery Panel, launched at last week’s LegalGeek conference and co-sponsored by the Ministry of Justice and the Law Society, will tackle challenges in areas including regulation, ethics and training. Dog control update A patchwork of dog control laws, some dating back 150 years, is causing unnecessary confusion about liability, MPs have warned. The Commons select committee on environment, food and rural affairs has told the government to consolidate the ‘disparate’ legislation into a ‘single, coherent’ Dog Control Act.Harassment guidanceThe SRA is to update guidance for people making allegations of harassment, following a rise in reports. A letter from chief executive Paul Philip to the House of Commons women and equalities committee revealed that the regulator now has 50 ongoing cases – up from 23 in March.Civil standard of proofThe Legal Services Board has granted permission for the bar regulator to change the standard of proof applied in disciplinary proceedings from criminal to civil. The change will come into force next March. A consultation on shifting to the civil standard at the Solicitors Disciplinary Tribunal closed this month.Employment claims riseThe number of people seeking to bring claims against their employer continues to rise sharply, as the judiciary moves forward with a recruitment spree for tribunal judges. According to the latest figures, in the financial year ended March 2018 there were 109,698 claims accepted, up 23% from 88,476 the year before.last_img read more

Rouen bypass completed

first_imgFRANCE: RFF has completed a €50m project to upgrade and electrify the 36 km route between Motteville and Montérolier-Buchy, enabling freight trains from the port of Le Havre to reach Amiens, northeastern France, the Benelux countries and Germany without negotiating the rail bottlenecks of Rouen and the Paris region. The single-track route now has sufficient capacity to offer paths for up to 30 freight trains a day. It is expected to offer significant savings on end-to-end journey times, as much as 50% according to RFF.Work has taken three years to complete and has included track renewals to raise the maximum speed to 100 km/h, resignalling with automatic block and KVB intermittent ATP, and level crossing automation. The French government provided 47% of the total cost, with the Haute-Normandie region contributing 27·2%, European sources 12·2%, the département of Seine-Maritime 6·8% and RFF 6·8%.last_img read more

Bahamian Health Minister Says Bodies Remain Unclaimed Following Hurricane Dorian

first_imgNASSAU, Bahamas (CMC) – Health Minister Dr Duane Sands says that weeks after the passage of Hurricane Dorian, there are bodies that remain unclaimed in a refrigerated trailer on the island of Abaco.“In the trailer in Abaco, a significant number of bodies I believe probably about 50 (have not been claimed). DNA samples have been taken and the expected time from DNA sampling until comparison and conclusion can be as long as six to nine months,” he said.According to Sands, while the remains of a few storm victims have been to their families, the government might use an independent third party to act as an intermediary to enable undocumented migrants – who may be fearful – to identify the remains.“Bear in mind that some people may be afraid to come forward if their immigration status is not ideal. This problem is not unique to The Bahamas and so (a consideration is) to have an independent third party perhaps act as an intermediary so that the process of identification can take place,” said Sands, who was speaking outside Cabinet on Tuesday.He added that health officials would like to curtail the length of time the bodies are kept in the Abaco trailer.“In Abaco…we’d like to limit the length of time. We have remains in New Providence that would have been here in refrigerated trailers for years. There is no absolute limit as to how long you can keep refrigerated remains. In this instance however at that facility to have a trailer sitting there for an indefinite time is not ideal and so what we would like to be able to do is to be very aggressive in terms of making it safe and easy for individuals to identify.”Concerning a burial site for the remains for the unidentified remains of those killed by the hurricane, he said that not much progress has been made for the burial site.last_img read more

Coronavirus stirs rancour in South Africa on democracy anniversary

first_imgA homeless person stands outside a temporary tent in Pretoria, South Africa, April 15, 2020. South Africa has provided temporary tents and food for the homeless to better control the COVID-19 outbreak. (Photo by Shiraaz Mohamed/Xinhua) A homeless person stands outside a temporary tent in Pretoria, South Africa, April 15, 2020. South Africa has provided temporary tents and food for the homeless to better control the COVID-19 outbreak. (Photo by Shiraaz Mohamed/Xinhua)South Africa’s divisions over race and wealth inequality, which the COVID-19 crisis had briefly sidelined, returned to the fore on Monday’s 26th anniversary of the end of apartheid.President Cyril Ramaphosa has been praised for decisive action to curb the epidemic in Africa’s most industrialised nation, which has one of the continent’s strictest lockdowns and has recorded just 4,546 cases and 87 deaths.“South Africans have come together like never before to wage the struggle against this virus,” Ramaphosa told the nation.However, recriminations are rising over inequalities in conditions to cope with the restrictions and distribution of aid around an economy already in recession.“Our government loves … to keep white people happy and safe, even at the expense of Africans,” complained Julius Malema, firebrand leader of the far-left Economic Freedom Fighters party, in a statement.At the other end of the political spectrum, white minority party Afriforum and allied union Solidarity threatened legal action against the tourism department which they accused of overlooking white-owned businesses for assistance.Of a 500 billion rand ($26.64 billion) coronavirus rescue package, nearly a fifth has been set aside for the poor and unemployed. Much of the rest will help businesses keep afloat, not least the ravaged tourism sector.But Afriforum and Solidarity, who plan to go to court on Tuesday, complained that “the Department of Tourism will … discriminate against you based on the colour of your skin” when it came to deciding who gets aid.In a rebuff earlier this month, Tourism Minister Mmamoloko Kubayi-Ngubane said that the state was offering one-off small grants to small businesses guided by black empowerment criteria, but added: “Any person or business in the tourism sector can apply for the fund, regardless of the colour of their skin.”ENDURING INJUSTICESTwenty-six years ago, South Africans rejoiced at their first ever fully inclusive democratic election, which saw Nelson Mandela elected as their first president under black majority rule, ending decades of toxic apartheid.But critics say Mandela’s legacy party, the African National Congress, has not done enough to redress inequalities in land, wealth and access to services that are apartheid’s most enduring legacy, and which on some measures have worsened.A government study last year found that whites on average earned more than four times as much as blacks. A year ealier, the state Human Rights Commission said in a report that the richest 10% of South Africans owned more than 90% of wealth.Daniel Silke, of Political Futures Consultancy, said the coronavirus crisis had briefly put political divisions on the backburner before then pumping them up with “steroids”.“The corona outbreak has brought into sharpest focus, the … inequalities that exist between black and white people in South Africa,” added Malema in a withering statement few would deny, although it omitted to mention a growing, wealthy black elite that includes him.“Even when they want to be in self-isolation, our people do not have spacious houses to isolate into because they stay in shacks. Even when they want to keep maximum hygiene … they do not have access to clean water.”In his televised speech, Ramaphosa acknowledged that while “some people have been able to endure the coronavirus lockdown in a comfortable home with a fully stocked fridge, for millions of others, this has been a month of misery, of children going to bed and waking up hungry.”Related South Africa coronavirus cases reach 1,505 South Africa celebrates ruling party 104 anniversarycenter_img South Africa coronavirus cases rise to 2,173last_img read more

Shawford resident hails Water Supply Project

first_img Share 34 Views   no discussions Resident of Shawford and member of the Project Monitoring Committee (PMC) Vernanda RaymondThe newly commissioned Shawford Water Supply Project has responded directly to the needs of the community, a resident and member of the Project Monitoring Committee (PMC) Vernanda Raymond has revealed.“This water supply system being commissioned today will and I believe sincerely contribute to all members of the community to improve our hygienic environment, enhance and significantly improve our lives,” she said at the commissioning of the water supply Wednesday afternoon.The project which cost $1, 180 320.80 includes a 30, 000 gallon tank as well as ten fire hydrants erected throughout the villages.The journey to the celebration began about fifteen months ago she said when a July 2012 news article, “One million dollar water project for Shawford” caught residents’ attention.The article she said predicted an end to their water woes announcing that the government and Basic Needs Trust Fund had officially signed the contracts for the commencement of the water project for Shawford and that the Dominica Water and Sewerage Company (DOWASCO) Limited had partnered with stakeholders to tackle this water issue.“Work was set to begin in seven days; we were ecstatic, delightful, joyful”.Parliamentary Representative for the Roseau Valley Constituency Dr Colin McIntyreIt was then she began her role as part of the PMC a role which she said she took seriously in “in guarding the interest of my community” by attending all meetings, doing site visits and ensuring every part of the community was covered.Fire hydrants as proposed were added at the request of the communities she said.“I sought to report the processes and progress of the project to those within the communities that inquired and explained the hiccups, setbacks and delays”.“Shawford residents we will share that together,” she said and added that they would no longer have to look to the mountains for rain or carry laundry to other places.“That was then, this is now. To all residents I do hope we all appreciate the fact that we now have easy access to clean and safe pipe borne water- an essential and needed resource”.She added that it is her hope that collective responsibility will be taken in ensuring the resourceful use of the water.“People of Shawford take care of your water system; you know where you came from,” Parliamentary Representative for the Roseau Valley Constituency, Dr Colin McIntyre warned.He described the water supply project as a blessing in disguise for people of the Shawford and Fond Canie.Dominica Vibes News Sharing is caring! Tweetcenter_img Share Share LocalNews Shawford resident hails Water Supply Project by: – September 19, 2013last_img read more

3 foreigners remanded on drug charges

first_img Share 462 Views   no discussions Share Sharing is caring! LocalNews 3 foreigners remanded on drug charges by: Dominica Vibes News – August 2, 2016center_img Three foreign nationals have been remanded at the Dominica State Prison in relation to drug charges.The three male adults were intercepted on an open keel boat of Antigua by the Marine Unit of the Commonwealth of Dominica Police Force on Thursday 28 July 2016 at Scotts Head during an anti-drug operation at sea about 1PM.According to Police Public Relations Officer, Pelham Jno Baptiste, the vessel contained four hundred and nineteen pounds of cannabis weed.“As a result, Ralph James of Jamaica, and Jeffrey Stapleton and Alwin Lawrence, male adults of St Vincent have been jointly charged for possession of cannabis and possession with intent to supply cannabis weed”. The three men appeared before the Roseau Magistrate’s Court on Friday 29 July 2016 and were remanded in custody at the Dominica State Prison. Share Tweetlast_img read more

National Emblems Week added to Independence Calendar

first_imgDominica will commence a seven-week long observance of its thirty-eighth anniversary of Independence this weekend with two days of prayer and thanksgiving.This year, independence celebrations will be observed under the theme‘Strengthening our commitment to nation building’, which takes into account the country’s rebuilding process post Tropical Storm Erika.Chairman of the Independence Committee, Raymond Lawrence told the media launch of the Independence celebrations on Wednesday 14 September 2016, now is the time to keep on persevering.“In life we sometimes have to face storms and some of them are severe but with God’s grace and strength, we have to try to stand up, dust ourselves off, weather the storm and many times we have to persevere in spite of the storm, knowing that God is in control and that he will make a way for us”.“So we have to dig deep, learn lessons from the experience and somehow find that source of joy and strength deep within us to keep persevering and building; this is what our theme is calling us to do this year, strengthen our commitment to nation building,” Lawrence said.A significant change in this year’s celebrations is that the opening ceremony will be merged with the annual Titiwi Festival at Layou. The venue for the opening ceremony was the Old Mill Cultural Centre at Canefield.“The Independence celebrations will open with an exciting ceremony at the scenic and beautiful Layou beach on Saturday September 24th from 5:00 P.M in collaboration with the Titiwi Festival which takes place on that Saturday and continues on the Sunday,” Lawrence informed.At the opening ceremony, there will be performances by Ophelia, Michele Henderson, Janae Jackson, the Paix Bouche, Capuchin and Flamboyant cultural groups, the Karina Cultural Group, the Waitukubuli Dance Theatre Company, Ian Anthony, the Paix Bouche Drummers and Tradibelle among others.The Titiwi festival will continue after the opening ceremony and it will continue the next day, Sunday 25th at the Layou Beach.National Emblems Week from 17 – 21 October, to promote the island’s symbols, is a new feature on this year Independence Calendar.A national emblem is an official emblem or seal reserved for use as a symbol of a nation. These include the flag, coat of arms, bird, flower and national dish.National Emblem Week will commence with Flag Day on Monday October 17th and “during the week media houses, schools and community organizations are encouraged to feature the various National Emblems in their programs and activities”.Meanwhile, two existing events have been added to the Independence calendar; the Dominica Council on Ageing’s ‘Senior Awards and Appreciation Day’ on 25 September and Shop Dominica on 27 – 29 October organized by the Dominica Association of Industry and Commerce (DAIC).The cultural finals, athletic competitions, E. O LeBlanc memorial lecture, market day with a difference in Marigot, Portsmouth and Roseau will be held this year.The pageants; Ti Matador, Miss Wob Dwiyet and Madam Wob Dwiyet, as well as Pan In the City, Creole Dress Parade, Creole Day, National Youth Rally, National Day Parade, Cultural Gala and Community Day of Service are among the other activities scheduled to commemorate Independence 2016.Independence celebrations will be held from 17 September to 4 November. Tweet LocalNews National Emblems Week added to Independence Calendar by: Dominica Vibes News – September 14, 2016 Share Sharing is caring! Share – / 10 Share 401 Views   2 commentslast_img read more