Increased susceptibility to malaria in pregnancy is well recognized, and has generally been assumed to be due to hormonal changes resulting in altered immunity. Based on previous work demonstrating enhanced parasite growth in young normal and thalassemic red blood cells, we hypothesized that in pregnancy increased malaria susceptibility may be due, in part, to the increase in the population of young red cells.FC27 strain of Plasmodium falciparum was cultured in the red cells and sera from healthy primigravida pregnant (n=9) and non-pregnant (n=9) women. Red cells from both pregnant and non-pregnant women were each placed in three cultures containing the sera from pregnant, non-pregnant and pooled control samples. Cultures were set up in triplicate and incubated for 144 hours. Parasite development and growth were assessed by slide microscopy.At 96 hours the median parasite growth in cells from pregnant samples (5.7%) was significantly better than that in the non-pregnant cells (4.8%) (p=0.01). There was no significant difference in parasite growth in cultures with pregnant and non-pregnant sera. As expected, there were significant differences in parameters measuring red cell age between the cells from pregnant and nonpregnant samples: median red cell creatine (11.09 mg/dl) versus (6.90 mg/dl) (p=0.004) and median reticulocyte count (2.3%) versus (1.4%) (p=0.0006).These preliminary results are consistent with the hypothesis that an increased population of young red cells may contribute to increased malaria susceptibility during pregnancy.
Myotonic Dsytrophy (DM) is a multi-system disease that affects muscle function. DM is the most common muscular dystrophy occurring in adulthood and the prevalence is around 10 cases per 100,000. There are two distinct forms Type 1 and Type 2. DM predominantly causes weakness of the voluntary muscles but involuntary muscles can also be affected. As the disease progresses respiratory, cardiac and gastrointestinal symptoms can arise. Despite treatment options for management of complications, DM remains a progressive life limiting condition. Severn Hospice is now affiliated with Robert Jones Agnes Hunt Hospital in Oswestry to provide a symptom control clinic for DM patients; something that is not routinely done nationally. Palliative Care should be involved early in the diagnosis to allow more effective symptom control and discussions around Advance Care Planning.
Methods & Results
We collated the data for the 5 patients with a DM diagnosis that were referred to Severn Hospice and/or joint symptom control clinics. All 5 patients were assessed for symptoms that included but were not limited to: breathlessness, pain, dysphagia and low mood. 3/5 patients are still alive and have ongoing support. We coordinated referrals to other specialities including PEG/Respiratory teams for ongoing assessment. 1 patient was admitted to the inpatient unit which allowed for symptoms to be optimised and Advance Care Planning to occur.
Conclusions
The role of Palliative Care in the management of DM patients is paramount and early involvement in the disease trajectory is optimal for improving symptom control and providing opportunities for advance care planning relating to specific complications, e.g. cardiac arrhythmias/feeding tube insertion/respiratory support. Clinical guidelines for the role of Palliative Care in DM are limited, despite the fact it is a life limiting illness. This has prompted a focus group who are looking to put together some National Guidance moving forwards.
Hong Kong's seasonal influenza schedule follows the World Health Organization's northern hemisphere vaccine composition recommendations but with year-round influenza activity there is the potential to implement routine age- and gestation-based schedules utilising both northern and southern hemisphere vaccines for children aged 6 months to 2 years and for pregnant women. This study assessed the potential feasibility of such schedules.A literature review was conducted and in-depth interviews with vaccine experts, policy makers and nurses were undertaken.The following schedules were proposed and assessed for perceived feasibility: 1) a four-dose schedule in the first two years of life requiring an additional unscheduled clinic visit at 7 months; 2) a three-dose schedule excluding the 4-week booster after the first dose; 3) a two-dose schedule for pregnant women involving a dose at the booking visit and a dose with pertussis vaccine at 7 months gestation; and 4) a one-dose schedule at 7 months gestation.Age- and gestation-based routine influenza vaccination schedules are theoretically feasible for both young children and pregnant women. The three-dose paediatric and one-dose obstetric schedules were assessed in interviews with vaccine experts, policy makers and nurses to be most acceptable. Further clinical studies are required to determine whether such schedules are non-inferior to current seasonal-based schedules in terms of vaccine effectiveness and vaccine uptake.
To document child care practices in Hong Kong which has a very low SIDS rate of 0.3/1000 live births.Data were collected by interview and postal questionnaires using a protocol developed in southern New Zealand. 195 mothers were recruited at the Prince of Wales Hospital and 100 completed the study.81% babies slept in the parents room. 32% shared a bed with parents but only a third were described as being "in direct contact". Only 9% of infants were still breast feeding by 4 weeks of age. 78% of babies slept on their backs, 18% on their sides and 3% on the fronts. Sheepskins were not used and 56/58 described underbedding as firm or moderately firm. At the time of birth only 3% of mothers smoked.Certain SIDS risk factors (bedsharing, lack of breast feeding) are common in Hong Kong, whereas others (prone sleep position, soft underbedding, maternal smoking) appear uncommon.
This pediatric hospital-based study of 388 diarrhea cases and 306 controls analyzed predominant E. coli colonies from primary culture (253 cases and 177 controls) with eight DNA probes for enteropathogenic, enterotoxigenic, enteroaggregative, and diffusely adherent E. coli. Only enteropathogenic E. coli adherence factor was identified significantly more frequently in cases (10) than in controls (0).
Hong Kong has a high burden of influenza hospitalisation. This study estimated influenza vaccine effectiveness in hospitalised Hong Kong children aged 6 months to below 6 years using data potentially obtainable from routine surveillance sources.This 'test-negative' case-control study was conducted over two summer and one winter influenza seasons in five public Hong Kong hospitals during 2015 and 2016. Patients admitted for febrile and/or respiratory-associated illnesses who met inclusion criteria were invited to participate. Case-patients were respiratory-associated admissions with nasopharyngeal aspirate or nasopharyngeal swab specimens obtained during the first 48 h of hospitalisation that tested positive for influenza A or B, whereas control-patients were those with specimens that tested negative for both influenza A and B. Reliability of a routinely collected influenza immunisation status form was evaluated. Vaccine effectiveness for administration of full or partial series of influenza vaccination was calculated as 1 minus the odds ratio for influenza vaccination history for case-patients versus control-patients.2900 eligible subjects had influenza vaccination status available. A simple record form, designed to collect upon admission information on influenza vaccination status, was found to be reliable when compared to confirmed vaccination status from immunisation records and guardians' self-reports. Influenza vaccine effectiveness for preventing influenza A or B hospitalisation in children aged from 6 months to below 6 years during the period June 2015 to November 2016 was 68% (95% confidence interval [CI]: 55%, 77%) from unconditional analyses and 64% (95% CI: 46%, 75%) from conditional analyses.Seasonal influenza vaccine was effective in preventing hospitalisation from influenza A or B in young Hong Kong children during 2015 and 2016. As influenza vaccination status is not currently routinely recorded, implementation of an influenza immunisation status form in all paediatric wards, and centralising the data in Hong Kong's central computerised database, could provide real-time monitoring of influenza vaccine effectiveness.
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