Frequency of types of parturition and their relationship with maternal characteristics: a cross-sectional analysis

Background: The pathways that are involved for the duration of pregnancy and type of parturition are extremely complex, involving maternal as well as fetal systems. The objective of this study was to determine the frequency of types of parturition and their relationship with maternal characteristics among pregnant female patients.Methods: A cross-sectional survey using a non-probability convenient sampling technique was conducted among 195 healthy pregnant females at Obstetrics and Gynaecological Department of Hamdard Hospital, Karachi, from 1st March 2019 to 31st August 2019. After taking written informed consent from the participants, the relevant data were gathered with the help of a structured questionnaire designed specifically for the study. Statistical package for social sciences was used for data entry while the chi-square test was applied for inferential analysis. The duration of the study was six months. Data were entered and analyzed using Statistical Package for Social Sciences version 20.0. Descriptive analysis was performed by generating means and standard deviations for continuous variables while frequencies and percentages for categorical variables. A Chi-square test was applied to perform the inferential analysis while the significance level was set at 0.05.Results: A total of 195 pregnant females were included in the study, whose mean age was 29.29±5.22 years. The study results showed that BMI before pregnancy (p=0.021), rest is taken during pregnancy (p=0.034) and gravida status (p=0.047) were all significantly associated with the type of parturition among the study participants, but spacing in pregnancies and parity were not.Conclusions: Maternal characteristics were found to be significantly associated with the type of parturition among pregnant females. For gynecologists the maternal characteristics identified in this study may serve as a useful indicator of the type of parturition expected in their patients

Factors associated with perceived stress in students appearing for medical university entrance test: A cross-sectional study

Objective: To evaluate the factors or stressors associated with perceived stress in students appearing for university entrance test-cross sectional study.Materials and Methods: It is a descriptive cross-sectional study, duration was two months from August to September 2021. The Ethical & scientific review committee of KMDC of Karachi, have given written permission. The non-probability convenience sampling technique was used. The Rao soft calculator was used for Sample size and 377 (5% margin of error and 95% confidence level) were calculated. Students were enrolled from four Entrance test/ aptitude training centers of Karachi with written informed consent. The students were having past history of antipsychiatric illness or having history of taking drugs like antidepressants or anxiolytics were excluded. The Cohen’s scale was used for evaluation of perceived stress in students with degree of perceived stress. The statistical Analysis was done by using IBM-SPSS version 23.0, Counts with percentages, Pearson Chi Square test and Binary Logistic Regression Analysis for identification of Risk Factors of Stress. P-value less than 0.05 was considered statistically significant.Results: The association of perceived stress was significantly associated with Mothers job/ working Mother (p<0.05) in our study participants. Anyone from family or friend was suffering from Stress showed significant (p<0.05) association with perceived stress (moderate / high level) in our study.Conclusion: In our study results, factors associated with perceived stress in students, showed working mothers are responsible for development of stress in students

Prevalence of HER-2/ neu receptor amplification and its effects over prognosis of the patients with breast cancer

Background: The diagnosis and prognosis of patients with breast cancer is routinely carried out with biopsy of growth by H&E staining but it is not commonly practice with various immunomarkers including HER2/neu. However HER2/neu association in breast tumour patients with prognosis has not been studied much, so this study is aim to evaluate the frequency of HER2 (human epidermal growth factor receptor) amplification and its effects over prognosis among the patients with breast cancer.Methods: After ethical approval, retrospective observational study was conducted from October 2014 to September 2017. All operated patients with biopsy proven breast cancer, the patients having any stage of disease, with sufficient data present in hospital record and patients who received neo-adjuvant chemo-therapy/radio-therapy were included. Patients unfit for surgery due to co-morbidities like cardio renal diseases and patients having insufficient hospital record or who missed follow-ups were excluded. SPSS version 20.0 was used for data analysis for data analysis with qualitative data presented as frequency and percentages.Results: A Total 120 patients, 48(40%) had HER-2/ neu positive. Among the HER2 +ve patients, 17(35.4%) had local recurrence within 03 years while 21(43.7%) cases had distant recurrence. The disease free survival rate in 03 years was observed in 22(45.83%) out of 48 HER2 +ve cases.Conclusions: Study reveals 40% patients had HER-2/neu positive expression and was associated with poor outcomes and disease free survival time period in comparison to patient with HER-2/ neu negative

Comparing Different Routes of Vitamin D Administration: A Randomized Interventional Trial

Background: Vitamin D maintains overall good health by boosting up of the immune system through proper function of lungs, heart, muscles, brain and bones. The goal of the study was to determine and compare different routes and formulation of vitamin D3 that was per oral, injectable formulation given orally and intramuscular injection in patients of different groups. Methods: This was a randomized clinical trial designed for vitamin D deficient patients. Patients were randomly assigned to three routes of administration i.e. orally, injection formulation given orally andintramuscular injection group. For mild deficiency, 2 doses of 200,000 IU, for moderate deficiency, 3 doses of 200,000 IU and for severe deficiency, 4 doses of 200,000 IU, 25[OH] D was prescribed. Chi-Square (χ2 ) test was used to evaluate the significant association . Results: A total of 150 patients were enrolled in the study. The mean age ±SD of patients was 48.29 ± 4.65 years. At 4 and 12 weeks after completion of vitamin D3 replacement, levels of 25-hydroxycholecalciferol were measured. In the majority of participants of all three groups, the levels of vitamin D were increased to normal range by week 4 after the final dose of vitamin D3. However, the majority of patients failed to maintain their Vitamin D3 levels within the normal range 12 weeks after the final dose. All three routes of administration of Vitamin D were found equally effective with no significant difference between the routes (p>0.05). Conclusion: All three routes of administration of vitamin D supplements had equal efficacy with no significant advantage over one another

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research