Enzymatic Resolution of Racemic Amino Acids

The mold acylase of Aspergillus and Penicillium which hydrolyzes, asymmetrically, only the l-isomer of N-acylated dl-amino acids has been purified previously by the present authors. In this paper the application of asymmetric hydrolysis with the mold acylase to the resolution of N-acylated dl-amino acids, namely, acetylderivatives of dl-tryptophan, dl-leucine and dl-alanine is described. By this enzymatic procedure, the above amino acids were resolved in relatively good yields. It has been noted that the use of the mold acylase is suitable for general resolution of amino acid enantiomorphs of high optical purity.     

Effective Linkages of Continuum of Care for Improving Neonatal,Perinatal, and Maternal Mortality: A Systematic Review and Meta-Analysis

Background

Continuum of care has the potential to improve maternal, newborn, and child health (MNCH) by ensuring care for mothers and children. Continuum of care in MNCH is widely accepted as comprising sequential time (from pre-pregnancy to motherhood and childhood) and space dimensions (from community-family care to clinical care). However, it is unclear which linkages of care could have a greater effect on MNCH outcomes. The objective of the present study is to assess the effectiveness of different continuum of care linkages for reducing neonatal, perinatal, and maternal mortality in low- and middle-income countries.

Methods

We searched for randomized and quasi-randomized controlled trials that addressed two or more linkages of continuum of care and attempted to increase mothers’ uptake of antenatal care, skilled birth attendance, and postnatal care. The outcome variables were neonatal, perinatal, and maternal mortality.

Results

Out of the 7,142 retrieved articles, we selected 19 as eligible for the final analysis. Of these studies, 13 used packages of intervention that linked antenatal care, skilled birth attendance, and postnatal care. One study each used packages that linked antenatal care and skilled birth attendance or skilled birth attendance and postnatal care. Four studies used an intervention package that linked antenatal care and postnatal care. Among the packages that linked antenatal care, skilled birth attendance, and postnatal care, a significant reduction was observed in combined neonatal, perinatal, and maternal mortality risks (RR 0.83; 95% CI 0.77 to 0.89, I² 79%). Furthermore, this linkage reduced combined neonatal, perinatal, and maternal mortality when integrating the continuum of care space dimension (RR 0.85; 95% CI 0.77 to 0.93, I² 81%).

Conclusions

Our review suggests that continuous uptake of antenatal care, skilled birth attendance, and postnatal care is necessary to improve MNCH outcomes in low- and middle-income countries. The review was conclusive for the reduction of neonatal and perinatal deaths. Although maternal deaths were not significantly reduced, composite measures of all mortality were. Thus, the evidence is sufficient to scale up this intervention package for the improvement of MNCH outcomes.     

Factors Influencing Health Facility Delivery in Predominantly Rural Communities across the Three Ecological Zones in Ghana: A Cross-Sectional Study

Background

Maternal and neonatal mortality indicators remain high in Ghana and other sub-Saharan African countries. Both maternal and neonatal health outcomes improve when skilled personnel provide delivery services within health facilities. Determinants of delivery location are crucial to promoting health facility deliveries, but little research has been done on this issue in Ghana. This study explored factors influencing delivery location in predominantly rural communities in Ghana.

Methods

Data were collected from 1,500 women aged 15–49 years with live or stillbirths that occurred between January 2011 and April 2013. This was done within the three sites operating Health and Demographic Surveillance Systems, i.e., the Dodowa (Greater Accra Region), Kintampo (Brong Ahafo Region), and Navrongo (Upper-East Region) Health Research Centers in Ghana. Multivariable logistic regression was used to identify the determinants of delivery location, controlling for covariates that were statistically significant in univariable regression models.

Results

Of 1,497 women included in the analysis, 75.6% of them selected health facilities as their delivery location. After adjusting for confounders, the following factors were associated with health facility delivery across all three sites: healthcare provider’s influence on deciding health facility delivery, (AOR = 13.47; 95% CI 5.96–30.48), place of residence (AOR = 4.49; 95% CI 1.14–17.68), possession of a valid health insurance card (AOR = 1.90; 95% CI 1.29–2.81), and socio-economic status measured by wealth quintiles (AOR = 2.83; 95% CI 1.43–5.60).

Conclusion

In addition to known factors such as place of residence, socio-economic status, and possession of valid health insurance, this study identified one more factor associated with health facility delivery: healthcare provider’s influence. Ensuring care provider’s counseling of clients could improve the uptake of health facility delivery in rural communities in Ghana.     

Gd(+)Cuiabá, a new rare glucose-6-phosphate dehydrogenase variant presenting normal activity

Summary A 33-year-old Brazilian male of Portuguese extraction was found to have a new glucose-6-phosphate dehydrogenase variant, herein named Gd(+)Cuiabá. The enzyme variant is characterized by normal activity, normal electrophoretic mobility, high K_m, for glucose-6-phosphate, high K_i for NADPH, decreased thermal stability, normal utilization of substrate analogues and normal pH curve.     

Meteorin: a secreted protein that regulates glial cell differentiation and promotes axonal extension

Glial cells are major components of the nervous system. The roles of these cells are not fully understood, however. We have now identified a secreted protein, designated Meteorin, that is expressed in undifferentiated neural progenitors and in the astrocyte lineage, including radial glia. Meteorin selectively promoted astrocyte formation from mouse cerebrocortical neurospheres in differentiation culture, whereas it induced cerebellar astrocytes to become radial glia. Meteorin also induced axonal extension in small and intermediate neurons of sensory ganglia by activating nearby satellite glia. These observations suggest that Meteorin plays important roles in both glial cell differentiation and axonal network formation during neurogenesis.     

Transient Increase in the Level of mRNA for a Germin-Like Protein in Leaves of the Short-Day Plant Pharbitis nil during the Photoperiodic Induction of Flowering

A cDNA corresponding to an in vivo labeled protein whose levelincreased during flower-inductive darkness in the cotyledonof the short-day plant Pharbitis nil Choisy cv. Violet was isolatedand characterized. The deduced amino-acid sequence of the protein(designated PnGLP; P. nil germin-like protein) showed homologyto that of a GLP of Sinapis alba, a leaf protein, the mRNA accumulationof which showing circadian oscillations. PnGLP mRNA was detectedspecifically in the cotyledon and leaf, in particular, in theyoung expanded cotyledon and leaf. Accumulation of PnGLP mRNAincreased transiently during flower-inductive darkness and peakedat a time that corresponded approximately to the critical nightlength. This mRNA peak was reduced by a brief exposure to redlight at the 8th hour of darkness. The level of PnGLP mRNA peakedabout 10 h from the beginning of the dark period, whereas itwas reported that the level of mRNA for GLP of a long-day plantS. alba increased about 14 h from the beginning of the lightperiod. Thus, the different time courses of accumulation ofthe mRNAs for leaf-specific GLPs appear to reflect the differencesin photoperiodic responses of each plant. (Received May 16, 1996; Accepted July 5, 1996)     

Evaluation of a package of continuum of care interventions for improved maternal,newborn, and child health outcomes and service coverage in Ghana: A cluster-randomized trial

BackgroundIn low- and middle-income countries (LMICs), the continuum of care (CoC) for maternal, newborn, and child health (MNCH) is not always complete. This study aimed to evaluate the effectiveness of an integrated package of CoC interventions on the CoC completion, morbidity, and mortality outcomes of woman–child pairs in Ghana.Methods and findingsThis cluster-randomized controlled trial (ISRCTN: 90618993) was conducted at 3 Health and Demographic Surveillance System (HDSS) sites in Ghana. The primary outcome was CoC completion by a woman–child pair, defined as receiving antenatal care (ANC) 4 times or more, delivery assistance from a skilled birth attendant (SBA), and postnatal care (PNC) 3 times or more. Other outcomes were the morbidity and mortality of women and children. Women received a package of interventions and routine services at health facilities (October 2014 to December 2015). The package comprised providing a CoC card for women, CoC orientation for health workers, and offering women with 24-hour stay at a health facility or a home visit within 48 hours after delivery. In the control arm, women received routine services only. Eligibility criteria were as follows: women who gave birth or had a stillbirth from September 1, 2012 to September 30, 2014 (before the trial period), from October 1, 2014 to December 31, 2015 (during the trial period), or from January 1, 2016 to December 31, 2016 (after the trial period). Health service and morbidity outcomes were assessed before and during the trial periods through face-to-face interviews. Mortality was assessed using demographic surveillance data for the 3 periods above. Mixed-effects logistic regression models were used to evaluate the effectiveness as difference in differences (DiD). For health service and morbidity outcomes, 2,970 woman–child pairs were assessed: 1,480 from the baseline survey and 1,490 from the follow-up survey. Additionally, 33,819 cases were assessed for perinatal mortality, 33,322 for neonatal mortality, and 39,205 for maternal mortality. The intervention arm had higher proportions of completed CoC (410/870 [47.1%]) than the control arm (246/620 [39.7%]; adjusted odds ratio [AOR] for DiD = 1.77; 95% confidence interval [CI]: 1.08 to 2.92; p = 0.024). Maternal complications that required hospitalization during pregnancy were lower in the intervention (95/870 [10.9%]) than in the control arm (83/620 [13.4%]) (AOR for DiD = 0.49; 95% CI: 0.29 to 0.83; p = 0.008). Maternal mortality was 8/6,163 live births (intervention arm) and 4/4,068 live births during the trial period (AOR for DiD = 1.60; 95% CI: 0.40 to 6.34; p = 0.507) and 1/4,626 (intervention arm) and 9/3,937 (control arm) after the trial period (AOR for DiD = 0.11; 95% CI: 0.11 to 1.00; p = 0.050). Perinatal and neonatal mortality was not significantly reduced. As this study was conducted in a real-world setting, possible limitations included differences in the type and scale of health facilities and the size of subdistricts, contamination for intervention effectiveness due to the geographic proximity of the arms, and insufficient number of cases for the mortality assessment.ConclusionsThis study found that an integrated package of CoC interventions increased CoC completion and decreased maternal complications requiring hospitalization during pregnancy and maternal mortality after the trial period. It did not find evidence of reduced perinatal and neonatal mortality.Trial registrationThe study protocol was registered in the International Standard Randomised Controlled Trial Number Registry (90618993).

Akira Shibanuma and co-workers study a package of maternal and child health interventions in a cluster-randomized trial done in Ghana.