Association Between Placenta Previa and Preeclampsia

Background: To determine association between placenta previa and pre-eclampsia in pregnant women presenting to a tertiary care hospital.Methods: In this prospective study 187 pregnant women with placenta previa and 187 pregnant, total 374, women without placenta previa were enrolled. Ultrasonography examination was performed on all patients to ascertain the attachment of placenta on uterine wall. All patients were followed every fourth week till 38th weeks. Pre-eclampsia was labelled if mean of three readings of blood pressure was more than 139/89 in a pregnant woman with history of normal blood pressure before pregnancy and proteinuria on urine laboratory examination.Results: Mean age was 27.23 ± 3.633 and ranged from 21 to 43 years. Primipara were 45.7% and 54.3% were multipara. Eight patients (2.1%) were having pre-eclampsia. All patients belonged to non- placenta previa group. Relative risk came out 1.045 ranging from1.014 to 1.077 at 95% confidence interval. There was no effect of age and parity on the association.Conclusion: There is a protective association between placenta previa and pre-eclampsia in pregnant women

Role of CXR and HRCT in diagnosing COVID-19, a descriptive cross-sectional study, at a tertiary care hospital in Pakistan

ABSTRACT Objectives: Objectives of this study are to do the analysis of chest X-ray and High-resolution CT scan findings in patients who are clinical suspects of COVID-19 infection. The other objective is to classify the radiological findings in mild, moderate or severe diseases according to BSTI criteria for chest X-ray and CTSS for high-resolution CT scan. Methods: This is a cross-sectional descriptive study. A group of 50 patients who were clinically suspected cases of COVID-19 infection, presented to Corona flu filter clinic of Holy Family Hospital (HFH) or admitted to corona isolation wards were included. The time duration of the study was from 15 May 2020 to 15 June 2020. Patients labelled as clinically suspected cases were having positive contact with confirmed positive (based upon positive PCR) patients. Recent travel history from the area having an outbreak. They were having clinical signs/symptoms of fever, cough, and shortness of breath, lethargy and loss of sense of smell or taste. CXR and HRCT was the investigation of choice for all the 50 patients.  I also did PCR to make a correlation with the other two tests. All radiological findings were analyzed based upon Fleischner society glossary of terms for thoracic imaging. Two radiologists then assessed CXRs findings based upon BSTI criteria. They marked those CXR findings as low, moderate and high probability for COVID-19 infection. HRCT findings were analyzed using CT-SS, and researchers labelled outcomes as mild, moderate and severe disease.  Results: Out of 50 patients, 33(66%) were males, and 17(34%) were females. Mean age was 51 with ages ranging from 30-72 years. Presenting complaints were fever in 42(84%) patients, cough in 37(74%), lethargy in 33(66%), shortness of breath in 41(82%) and loss of sense of smell and taste in 21(42%) patients. Out of these 50, 32(72%) were having positive PCR for COVID-19 infection. On CXR 5(10%) patients showed classic findings which were highly probable for COVID-19. 19(38%) patients showed intermediate results for COVID-19, 7(14%) patients had a low probability of COVID-19 infection on CXRS. Out of 50, 19(38%), patients showed normal CXR with no evidence of COVID-19 infection. We did HRCT of the same patients on the same day; it showed 21(42%)patients with mild disease,23(46%)patients with moderate disease and 6(12%)patients with the severe disease according to CTSI.HRCT of 3(6%)patients was ok with no evidence of illness in bilateral lungs.    Conclusion: The role of radiology is crucial in the diagnosis of this viral illness. CXR, with its ability to detect changes of COVID-19 in lungs, should be used as a first-line imaging modality in clinically suspected patients. Moreover, it should also be used for follow up of patients with COVID-19. HRCT is very sensitive in the diagnosis of COVID-19 infection in its milder forms. Due to lack of its widespread availability in countries with inadequate medical facilities, it was not the primary imaging tool/screening tool. Due to risk of infection to radiological staff as well as non-covid-19 patients due to surface contact, due to reduced infection control issues, due to increased burden of ionizing radiations in patients. All these factors limit the role of HRCT as a primary imaging modality for COVID-19 infectio

COMPARATIVE STUDY OF THE FLEXURAL STRENGTH OF MAXILLARY DENTURE BASES MADE IN CONVENTIONAL AND HIGH IMPACT HEAT CURE ACRYLIC RESIN

OBJECTIVE: To compare the flexural strength of maxillary denture bases made in high impact and conventional heat cure acrylic resin. METHODS: This experimental laboratory-based study was conducted in Peshawar Dental College, Materials Research and Centralized Resource Laboratories University of Peshawar, Pakistan. Total 120 edentulous maxillary casts, sixty each of conventional acrylic (30 in subgroup-IA for shallow palate and 30 in subgroup-IB for deep palate and high impact acrylic (30 in subgroup II-A for shallow palate and 30 in subgroup II-B for deep palate) were made. These were then tested for flexural strength using universal testing machine. The load was applied at the rate of 5.0 mm/min. Independent samples t-test was applied for statistical analysis. RESULTS: Mean values of deflection at fracture, fracture load and flexure strength were 0.309±0.059 cm, 87.729±22.497 Kg and 13.645± 4.453 kg/cm² respectively. Mean Flexure Strength (kg/cm2) was 8.30±1.27, 16.54±1.77, 10.88±1.01 and 18.85±1 in subgroups I-A, I-B, II-A and II-B respectively (<0.001). Mean deflection at fracture (cm) was 0.24±0.04, 0.29±0.03, 0.35±0.03 & 0.368±0.03 in subgroups I-A, I-B, II-A and II-B respectively (<0.001).Mean Fracture Load (Kg) was 69.97±3.12, 114.9±6.75, 63.28±7.05 & 102.8±5.5 in in subgroups I-A, I-B, II-A and II-B respectively (<0.001). CONCLUSION: High impact acrylic resin was found to have significantly higher flexure strength as compared to conventional acrylic resi

Homozygous mutation in MCM7 causes autosomal recessive primary microcephaly and intellectual disability

Minichromosomal maintenance (MCM) complex components 2, 4, 5 and 6 have been linked to human disease with phenotypes including microcephaly and intellectual disability. The MCM complex has DNA helicase activity and is thereby important for the initiation and elongation of the replication fork and highly expressed in proliferating neural stem cells. Whole-exome sequencing was applied to identify the genetic cause underlying the neurodevelopmental disease of the index family. The expression pattern of was characterised by performing quantitative real-time PCR, hybridisation and immunostaining. To prove the disease-causative nature of identified , a proof-of-principle experiment was performed. We reported that the homozygous missense variant c.793G>A/p.A265T (g.7:99695841C>T, NM_005916.4) in was associated with autosomal recessive primary microcephaly (MCPH), severe intellectual disability and behavioural abnormalities in a consanguineous pedigree with three affected individuals. We found concordance between the spatiotemporal expression pattern of in mice and a proliferative state: expression was higher in early mouse developmental stages and in proliferative zones of the brain. Accordingly, Mcm7/MCM7 levels were detectable particularly in undifferentiated mouse embryonal stem cells and human induced pluripotent stem cells compared with differentiated neurons. We further demonstrate that the downregulation of in mouse neuroblastoma cells reduces cell viability and proliferation, and, as a proof-of-concept, that this is counterbalanced by the overexpression of wild-type but not mutant . We report mutations of as a novel cause of autosomal recessive MCPH and intellectual disability and highlight the crucial function of MCM7 in nervous system development

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Measuring routine childhood vaccination coverage in 204 countries and territories, 1980-2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1

Background Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dosespecific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in countryreported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings By 2019, global coverage of third-dose DTP (DTP3; 81.6% [95% uncertainty interval 80.4-82 .7]) more than doubled from levels estimated in 1980 (39.9% [37.5-42.1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38.5% [35.4-41.3] in 1980 to 83.6% [82.3-84.8] in 2019). Third- dose polio vaccine (Pol3) coverage also increased, from 42.6% (41.4-44.1) in 1980 to 79.8% (78.4-81.1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56.8 million (52.6-60. 9) to 14.5 million (13.4-15.9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe