Martin H. Prins

ABO blood group system and placental malaria in an area of unstable malaria transmission in eastern Sudan

BackgroundUnderstanding the pathogenesis of malaria in pregnancy and its consequences for both the mother and the baby is fundamental for improving malaria control in pregnant women.AimThe study aimed to investigate the role of ABO blood groups on pregnancy outcomes in an area of unstable malaria transmission in eastern Sudan.MethodsA total of 293 women delivering in New Half teaching hospital, eastern Sudan during the period October 2006–March 2007 have been analyzed. ABO blood groups were determined and placental histopathology examinations for malaria were performed. Birth and placental weight were recorded and maternal haemoglobin was measured.Results114 (39.7%), 61 (22.1%) and 118 (38.2%) women were primiparae, secundiparae and multiparae, respectively. The ABO blood group distribution was 82(A), 59 (B), 24 (AB) and 128 (O). Placental histopathology showed acute placental malaria infections in 6 (2%), chronic infections in 6 (2%), 82 (28.0%) of the placentae showed past infection and 199 (68.0%) showed no infection. There was no association between the age (OR = 1.02, 95% CI = 0.45–2.2; P = 0.9), parity (OR = 0.6, 95% CI = 0.3–1.2; P = 0.1) and placental malaria infections. In all parity blood group O was associated with a higher risk of past (OR = 1.9, 95% CI = 1.1–3.2; P = 0.01) placental malaria infection. This was also true when primiparae were considered separately (OR = 2.6, 95% CI = 1.05–6.5, P = 0.03).Among women with all placental infections/past placental infection, the mean haemoglobin was higher in women with the blood group O, but the mean birth weight, foeto-placental weight ratio was not different between these groups and the non-O group.ConclusionThese results indicate that women of eastern Sudan are at risk for placental malaria infection irrespective to their age or parity. Those women with blood group O were at higher risk of past placental malaria infection.

Low birth weight, preterm birth and short interpregnancy interval in Sudan

Objective.u2003To investigate whether short interpregnancy interval (IPI) is associated with increased risk of low birth weight and preterm labour. Methods.u2003The study was conducted in the labour ward of Khartoum hospital in Sudan during November 2007 through February 2008. Odds ratios (ORs) were adjusted for the confounding factors using multiple logistic regression models. Results.u2003Compared with IPI of 18–30 months, those women with intervals shorter than 18 months had an increased risk of low birth weight (OR = 1.9, 95% CI = 1.0–3.5, P = 0.04) and preterm labour (OR = 2.3, 95% CI = 1.1–4.7, P = 0.01). Conclusion.u2003In this study, IPI shorter than 18 months are independently associated with increased risk of adverse perinatal outcomes.

No effect of rosuvastatin on left ventricular hypertrophy in patients with hypertension: a prospective randomised open-label study with blinded endpoint assessment.

BACKGROUNDnThis study tested the hypothesis that statins may reduce left ventricular hypertrophy (LVH) in patients with hypertension and LVH.nnnMETHODnA prospective randomised open-label study with blinded endpoints assessment was performed in 142 patients. Inclusion criteria were hypertension, left ventricular ejection fraction ≥50% and echocardiographic determined LVH, defined as a left ventricular mass index (LVMI) of ≥ 100 g/m(2) in women and ≥ 116 g/m(2) in males. Patients were randomised between rosuvastatin 20mg once daily vs control. For each patient an echocardiogram and blood samples were obtained. These tests were repeated after 6 months.nnnRESULTSnBaseline characteristics: mean age was 62 ± 11year and 62 (44%) were male. In both groups, there was a non-significant reduction in LVMI: 118 ± 22 to 111 ± 19 g/m(2) in the control group and 118 ± 21 to 114 ± 22 in the rosuvastatin group (p=0.376 for the comparison between rosuvastatin and control after 6 months). After six months, LDL-cholesterol was reduced from 3.5 ± 1.0 to 2.1 ± 1.2 mmol/L (40% reduction) in the rosuvastatin group and remained unchanged in the control group (3.5 ± 0.9 vs 3.6 ± 0.9 mmol/L. Hs-CRP decreased more with rosuvastatin compared to control (-38% vs -15%, p=0.006) There was no significant reduction in NT-pro-BNP levels after 6 months.nnnCONCLUSIONnRosuvastatin does not reduce LVH despite a large LDL reduction in patients with hypertension and LVH.

Optimisation of the diagnostic strategy for suspected deep-vein thrombosis in primary care

Recently, a diagnostic score was developed to safely exclude deep-vein thrombosis (DVT) in primary care. A large prospective study, in which general practitioners used this diagnostic score to decide which patients needed referral, revealed that the number of referrals for ultrasound measurements was reduced by almost 50%, at the cost of an acceptably low risk (1.4%, 95% confidence interval [CI] 0.6% to 2.9%) of venous thromboembolic events in non-referred patients. However, simple adjustments to the diagnostic score (so-called updating) might further improve the accuracy; i.e. reduce the proportion of missed diagnoses (safety) or increase the proportion of patients who do not need to be referred (efficiency). We applied two updating methods to determine whether adjusting the weights of the predictors or adding new predictors could further improve the accuracy of the diagnostic score. The weights of the predictors did not need to be adjusted, but inclusion of history of DVT and prolonged travelling significantly added predictive value (p-values 0.014 and 0.023, respectively). However, adding these predictors to the diagnostic score did not improve the safety and efficiency: at equal safety (1.4% missed diagnoses among the non-referred patients), the efficiency was lower (43.5%, 95% CI 40.4% to 46.6% compared to 49.4%, 95% CI 46.3% to 52.5%). The diagnostic score for excluding DVT in primary care has good accuracy in its original form and could not be improved by including additional predictors. This suggests that the original diagnostic score can be used to safely exclude clinically suspected DVT in primary care.

PP241-MON QUALITATIVE ANALYSIS OF BARRIERS AND FACILITATORS FOR NUTRITIONAL INTERVENTION IN HIP FRACTURE PATIENTS

PP241-MON QUALITATIVE ANALYSIS OF BARRIERS AND FACILITATORS FOR NUTRITIONAL INTERVENTION IN HIP FRACTURE PATIENTS J. Breedveld-Peters1, P.L. Reijven2, C.E. Wyers1, A.A. Hendrikx1, A.D. Verburg3, J.M. Schols4,5, M.H. Prins1,6, T. van der Weijden7, P.C. Dagnelie1. 1Department of Epidemiology, CAPHRI School for Public Health, Maastricht University, 2Department Clinical Dietetics, Maastricht University Medical Centre, Maastricht, 3Department of Orthopaedic Surgery, Orbis Medical Centre, Sittard, 4Department of General Practice and Department of Health Service Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, 5Manager of the Medical and Paramedical Treatment Department, Vivre, 6Department of Medical Technology Assessment, Maastricht University Medical Centre, 7Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands