Objective The aim of this study was to assess long-term effects for women following the use of magnesium sulphate for pre-eclampsia.Design Assessment at 2-3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998(recruitment in -2001, which compared magnesium sulphate with placebo for pre-eclampsia.Setting Follow up after discharge from hospital at 125 centres in 19 countries across five continents.Population A total of 7927 women were randomised at the followup centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow-up, of whom 3375 (71%) were traced.Methods Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed.Main outcome measures Death or serious morbidity potentially related to pre-eclampsia at follow up, other morbidity and use of health service resources.Results Median time from delivery to follow up was 26 months (interquartile range 19-36). Fifty-eight of 1650 (3.5%) women allocated magnesium sulphate died or had serious morbidity potentially related to pre-eclampsia compared with 72 of 1725 (4.2%) women allocated placebo (relative risk 0.84, 95% CI 0.60-1.18). ConclusionsThe reduction in the risk of eclampsia following prophylaxis with magnesium sulphate was not associated with an excess of death or disability for the women after 2 years.

Public health restrictions were not fully relaxed between national lockdown 1 and national lockdown 2. Regional restrictions remained in place during December 2020 and a third national lockdown started on 6 January 2021. (A) Chlamydia diagnoses and tests; (B) gonorrhoea diagnoses and tests; (C) infectious syphilis diagnoses and tests. Infectious syphilis includes primary, secondary and early latent stages. Different scales are used on the y-axes of the graphs above.

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Background Oxygen is vital in the treatment of illnesses in children and adults, yet is lacking in many low and middle-income countries health care settings. Oxygen concentrators (OCs) can increase access to oxygen, compared to conventional oxygen cylinders. We investigated the costs and critical success factors of OCs in three hospitals in Fiji, and extrapolated these to estimate the oxygen delivery cost to all Sub-Divisional hospitals (SDH) nationwide. Methods Data sources included key personnel interviews, and data from SDH records, Ministry of Health and Medical Services, and a non-governmental organisation. We used Investment Logic Mapping (ILM) to define key issues. An economic case was developed to identify the investment option that optimised value while incorporating critical success factors identified through ILM. A fit-for-purpose analysis was conducted using cost analysis of four short-listed options. Sensitivity analyses were performed by altering variables to show the best or worst case scenario. All costs are presented in Fijian dollars. Results Critical success factors identifed included oxygen availability, safety, ease of use, feasibility, and affordability. Compared to the status quo of having only oxygen cylinders, an option of having a minimum number of concentrators with cylinder backup would cost $434,032 (range: $327,940 to $506,920) over 5 years which would be 55% (range: 41 to 64%) of the status quo cost. Conclusion Introducing OCs into all SDHs in Fiji would reduce overall costs, while ensuring identified critical success factors are maintained. This study provides evidence for the benefits of OCs in this and similar settings.

Background Disseminated gonococcal infection (DGI) is caused by the spread of Neisseria gonorrhoeae into the bloodstream and can lead to severe illness. We established a surveillance system for DGI in England to quantify the burden of disease. Methods On June 26, 2020, all sexual health clinicians in England were asked to retrospectively and prospectively report DGI cases to Public Health England. Case finding was conducted for N gonorrhoeae isolates confirmed by the national reference laboratory from sterile sites from June, 2019 onwards. A secure web-based survey was shared with clinicians to collect demographic and clinical data on affected individuals. Individuals with culture-positive or 16S rDNA-positive N gonorrhoeae at a sterile site were classified as confirmed cases. Probable cases were defined as individuals with culture-positive or nucleic acid amplification test-positive N gonorrhoeae from a non-sterile site with clinical manifestations of DGI.

Summary Background A S. capitis strain called NRCS-A ( S. capitis NRCS-A) has emerged as a cause of bloodstream infections and sepsis in neonatal intensive care units (NICUs) worldwide. Aim To identify risk factors for S. capitis NRCS-A colonisation among neonates, Dunedin Hospital NICU, Dunedin, New Zealand, from September 2013 through March 2015. Methods Weekly axillary swabs categorised eligible neonates as a case or a control. A case was defined as a week ending with a neonate's first positive swab for S. capitis NRCS-A and a control as a week in which a neonate remained negative. Weekly exposures were abstracted from hospital medical records. Analyses were performed using conditional logistic regression. Findings The median (range) gestational age at birth of participants was 32.7 (23.1–41.3) weeks. Participants contributed 26 weeks of case data and 177 weeks of control data. On adjusted analysis compared with matched controls, cases had higher odds of requiring invasive mechanical ventilation (OR 3.6, 95% CI: 1.1–11.6, p=0.035) and of a patent ductus arteriosus (PDA) (OR 3.0, 95% CI: 1.0–9.0, p=0.044). Cases had lower odds of being part of a multiple birth (OR 0.24, 95% CI 0.08–0.73, p=0.001), having an area of inflamed skin (OR 0.31, 95% CI: 0.13–0.75, p=0.009), and specifically an area of inflamed axillary skin (OR 0.08, 95% CI: 0.01–0.50, p=0.006). Conclusions We found that premature neonates with invasive mechanical ventilation and PDA had greater odds for S. capitis NRCS-A colonisation. Transmission may be mediated by increased staff contact, but prospective research is needed to confirm this.

Background: Syphilis is a sexually transmitted bacterial infection caused by Treponema pallidum subspecies pallidum, with approximately 6.3 million annual cases globally. Over the last decade, syphilis rates have risen dramatically in many high-income countries, including in England, which has seen a greater than 150% increase. Although this increase is known to be associated with high risk sexual activity in gay, bisexual and other men who have sex with men (GBMSM), cases are rising in heterosexual men and women, and congenital syphilis cases are now seen annually. The transmission dynamics within and between sexual networks of GBMSM and heterosexuals are not well understood. Methods: To determine if whole genome sequencing could be used to identify discrete patterns of transmission, we linked national patient demographic, geospatial and behavioural metadata to whole T. pallidum genome sequences previously generated from 237 patient samples collected from across England between 2012 and 2018. Findings: Phylogenomic analysis and clustering revealed two of the eight T. pallidum sublineages detected in England dominated. These dominant sublineages exhibited different spatiotemporal trends linked to demography or behaviour, suggesting they represent different sexual networks: sublineage 1 was found throughout England and across all patient groups, whereas sublineage 14 occurred predominantly in older GBMSM and was absent from samples sequenced from the North of England. By focussing on different regions of England we were able to distinguish a local heterosexual transmission cluster from a background of transmission amongst GBMSM. Interpretation: These findings demonstrate that despite extremely close genetic relationships between T. pallidum genomes globally, genomics can still be used to identify putative transmission clusters for epidemiological follow-up, and therefore has a role to play in informing public health interventions. Funding: Wellcome funding to the Sanger Institute (#206194 and 108413/A/15/D), UKRI and NIHR (COV0335; MR/V027956/1, NIHR200125), the EDCTP (RIA2018D-249), and UKHSA.