The comparison of predictive value of cervical length in singleton spontaneous preterm labor with in vitro fertilization pregnancies: A cohort study

Background: Preterm labor (PTL) is one of the most important factors in neonatal mortality. Some studies have revealed a reverse relationship between cervical length (CL) and PTL, however, further evidence is needed to confirm it. Objective: To investigate the predictive value of CL in spontaneous and in vitro fertilization (IVF) pregnancies. Materials and Methods: This prospective cohort study was performed on 154 pregnant women from 16-26 wk of gestation with a singleton fetus in spontaneous delivery (n = 77) and IVF pregnancies (n = 77) and followed up until delivery. Women with multiple pregnancy, placenta previa, cerclage, and congenital anomalies were excluded from the study. The cut-off determination was done according to the Roc analysis. Results: The mean CL in term delivery and PTL groups were 37 ± 7 mm and 31 ± 6 mm, respectively (p < 0.001). The frequency of PTL in spontaneous and IVF pregnancies were 7.8% and 23.27%, respectively (p = 0.007). According to the Roc analysis, the best cut-off for normal pregnancy was ≤ 36 mm with the negative predictive value of 97.9%, the positive predictive value of 11.4%, sensitivity 83.3%, and specificity of 46.5%. While for the IVF group, the cut off was ≤ 30 mm, with a negative predictive value of 88.4%, a positive predictive value of 57.8%, sensitivity of 63.2%, and a specificity of 86%. Conclusion: In this study, IVF had a significant direct correlation with PTL. CL also had a significant indirect relationship with PTL. Key words: Cervix, IVF, Preterm delivery, PTL

Factors causing timely referral for fetal echocardiography in the final diagnosis of congenital heart malformations: A crosssectional study

Background: Congenital heart disease (CHD) is one of the most frequently inherited illnesses associated with adverse outcomes. Objective: This study aimed to determine the referral cause for fetal echocardiography in the final diagnosis of major CHD. Materials and Methods: In this cross-sectional study, the data of 1772 pregnant women, referred to a diagnostic clinic during 2017-2020, were reviewed. Data were collected from participants on maternal age, gestational age, history of previous child’s heart disease, body mass, the order of birth of children (baby birth rank), type of woman’s disease, history of poor midwifery, and nuchal translucency (NT). Results: Of the 1772 pregnant women, only 33 women (1.8%) had a fetus with CHD major. Abnormality in ultrasound (57.6%), history of abortion (36.4%), increased NT and gestational diabetes (18.2%) and gestational diabetes (18.2%) were identified as the most common referral reasons for fetal echocardiography in these women. Other reasons included a previous child with Down syndrome (12.1%), a previous child with heart disease (12.1%), a history of stillbirth (12.1%), hypothyroidism (12.1%), taking medication during the pregnancy period (9.0%), no underlying disease (9.0%), multiple pregnancies (6.0%), diagnosis with high-risk fetal heart disease (3.0%), highrisk combined aneuploidy screening test in the first trimester (3.0%), in vitro fertilization pregnancy (3.0%), and having a child with an intellectual disability (3.0%). Conclusion: According to the results, it can be concluded that ultrasound abnormality, abortion, increased NT and gestational diabetes are the most important factors for referring pregnant women for fetal echocardiography. Key words: Echocardiography, Fertilization, Heart diseases, Pregnant women

Comparison of uterine preservation versus hysterectomy in women with placenta accreta: A cross-sectional study

Background: Placenta accreta spectrum (PAS) is a major cause of obstetric bleeding in third trimester of pregnancy. Objective: This study aimed to compare the outcomes of uterine preservation surgery vs. hysterectomy in women with PAS. Materials and Methods: In this retrospective cross-sectional study, the records of 68 women with PAS referred to the Imam Khomeini hospital in Ahvaz, Iran, between March 2015 and February 2020 were included. The women were divided into 2 groups according to surgical approach: hysterectomy vs. uterine preservation (including just removing the lower segment, removing the lower segment with uterine artery ligation, or removing the lower segment with hypogastric artery ligation during cesarean section). The need for blood components transfusion (whole blood, packed cells, and fresh frozen plasma), maternal mortality, duration of surgery, and length of hospitalization were compared between groups. Results: In total, we investigated 68 women between the ages of 24-45 yr (mean age of 32.88 ± 5.08 yr). All participants were multiparous and underwent cesarean section. Furthermore, 28 women (41.2%) had a history of curettage. In total, 24 women (35.3%) underwent a hysterectomy, and 44 (64.7%) underwent uterine preservative surgeries. There were no significant differences between groups of hysterectomy and uterinepreservative surgeries in terms of the need for blood components transfusion, maternal mortality, duration of surgery, and length of hospitalization. Conclusion: The results of this study showed no significant difference between groups regarding the studied outcomes. Therefore, conservative surgeries could be used to preserve the uterus instead of hysterectomy in women with PAS. Key words: Placenta accreta, Placenta diseases, Pregnancy complications,Conservative treatment, Hysterectomy

Pediatric Nurses’ Perceptions of Missed Care: A Qualitative Study

Background: Pediatric nurses are responsible for caring for children and their families; thus, investigating missed care in the pediatric ward is important and helps to improve the quality of care. Accordingly, this study aimed to explain the perceptions of pediatric nurses about missed care.Methods: This study was conducted using content analysis on 15 pediatric nurses selected by purposive sampling. The data were collected through in-depth semi-structured interviews. After obtaining informed consent, interviews were audio-recorded and transcribed verbatim. MAXQDA software (version 10) was used to facilitate coding and thematic analysis.Results: Four main categories emerged from the data analysis, including missed family-centered care, unsafe care, predisposing factors, and adverse outcomes.Conclusion: The findings showed that from the perspective of pediatric nurses, missed care occurs in different dimensions, including psychological support, communication, education, assessment, drug treatment, and infection control, and it can ultimately lead to mother’s dissatisfaction and bring about adverse effects on the child’s recovery besides harming the nurse

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

The Planar Index and Outerplanar Index of Some Graphs Associated to Commutative Rings

In this paper, we study the planar and outerplanar indices of some graphs associated to a commutative ring. We give a full characterization of these graphs with respect to their planar and outerplanar indices when R is a finite ring

Detection of neural tube defect in the first and second trimester of pregnancy by ultrasound in Imam Hospital, Ahwaz between December 2008-2010

Background: Central nervous system malformations are the second most common congenital malformations after congenital heart diseases. These malformations are associated with many instances of morbidity and mortality which underline the importance of prevention and their early diagnosis. Objective: The objective of this study is the diagnosis of neural tube defect (NTDs) in the first trimester and its comparison to second trimester diagnoses in order to reduce the complications associated with late pregnancy terminations and its costs. Materials and Methods: This study was a trans-sectional study. A total number of 1074 patients who referred to Imam Khomeini Hospital were enrolled in this study. During the 11th-13th (+6 days) gestational week the patients were screened sonographically; subsequently they were re-scanned for fetal anomalies during 18th-20th gestational week, and we followed the babies after birth. Considering that Intracranial Translucency (IT) was introduced in the newer researches, it was, too, measured in 125 of the cases. Results: In a total number of 1074 patients we had one patient with an anencephalous fetus whom was diagnosed in the first trimester of pregnancy. In the second trimester, we detected one case of myelomenigocele; when we referred to this patient’s first trimester sonography, there was no visible IT. In the 125 cases in whom the IT length was measured, it was normal; the 2nd trimester sonographies in these patients were also normal. Conclusion: It must be noted that the diagnosis of NTD is more accurate in the second trimester of pregnancy. Consequently it is recommended that in high risk patients, the second trimester sonography be performed transvaginally, and in an earlier gestational age (14th-16th gestational weeks)

Synthesis and study the controlled release of etronidazole from the new PEG/NaY and PEG/MCM-41 nanocomposites

Recently, hybrid materials using poly ethylene glycol and porous nanocrystals have been developed for drug release. In this study, a series of poly ethylene glycol (PEG)/NaY zeolite and PEG/MCM-41 nanocomposites get synthesized. These materials are characterized using FT-IR spectroscopy, XRD, TGA and SEM. After loading the metronidazole onto these nanocomposites, the release of Metronidazole was studied in two kinds of release fluids simulating body fluid KH2PO4-Na2HPO4 buffer (pH = 7.4) and gastric fluid (HCl aqueous solution, pH = 1.5) while controlling the time, pH values, and temperature using UV–vis. Results showed that these nanocomposites have further release related to NaY, MCM-41 and the order of release in two pH solutions was PEG/NaY > PEG/MCM-41 > NaY > MCM-41. The behavior of drug release in these nanocomposites is probably due to hydrogen bonding interactions between drug and the hydroxyl group on the composite framework