Acute Onset of Quadriplegia Secondary to Hypoparathyroidism: Mimicker of AMAN Variant of GBS

Acute onset of quadriplegia is a rare phenomenon seen with hypocalcemia due to hypoparathyroidism. We describe a 33-year gentleman who presented with weakness of all four limbs and areflexia. ECG showed QT abnormality. Nerve conduction study revealed normal sensory and significantly low motor CMAP amplitudes in both the upper and lower extremities. This nerve conduction study can be seen in acute motor neuropathy of various etiologies, among which GBS is the most worrisome. Our patient found to have low calcium and parathyroid hormone level. His symptoms improved after calcium replacement. Occurrence of quadriplegia in hypoparathyroidism, and its improvement after correction of calcium, suggests crucial role of calcium in neuromuscular transmission. One should suspect electrolyte imbalance, like hypocalcemia in patients presenting with nerve conduction features of AMAN variant of GBS

Generalized linear mixed models can detect unimodal species-environment relationships

Niche theory predicts that species occurrence and abundance show non-linear, unimodal relationships with respect to environmental gradients. Unimodal models, such as the Gaussian (logistic) model, are however more difficult to fit to data than linear ones, particularly in a multi-species context in ordination, with trait modulated response and when species phylogeny and species traits must be taken into account. Adding squared terms to a linear model is a possibility but gives uninterpretable parameters. This paper explains why and when generalized linear mixed models, even without squared terms, can effectively analyse unimodal data and also presents a graphical tool and statistical test to test for unimodal response while fitting just the generalized linear mixed model. The R-code for this is supplied in Supplemental Information

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

Generalized linear mixed models can detect unimodal species-environment relationships

Niche theory predicts that species occurrence and abundance show non-linear, unimodal relationships with respect to environmental gradients. Unimodal models, such as the Gaussian (logistic) model, are however more difficult to fit to data than linear ones, particularly in a multi-species context in ordination, with trait modulated response and when species phylogeny and species traits must be taken into account. Adding squared terms to a linear model is a possibility but gives uninterpretable parameters. This paper explains why and when generalized linear mixed models, even without squared terms, can effectively analyse unimodal data and also presents a graphical tool and statistical test to test for unimodal response while fitting just the generalized linear mixed model. The R-code for this is supplied in Supplemental Information

Temperature-independence of COVID-19 Epidemic

The pandemic of the COVID-19 disease extended from China across the north-temperate zone, and more recently to the tropics and southern hemisphere. We find no evidence that spread rates decline with temperatures above 20 oC, suggesting that the COVID-19 disease is unlikely to behave as a seasonal respiratory virus.This research was supported by funding provided by the King Abdullah University of Science and Technology to the CBRC.N

Maternal Obesity: A Global Health Problem and It's Implications on Maternal and Fetal Health

Objective: To compare maternal complications and labor outcome in obese and non-obese women. Materials and methods: It is a retrospective comparative study conducted at the Department of obstetrics and gynecology, Unit 1, Civil Hospital, Karachi from December 2008 to December 2009. A sample size of 220 gravid women is selected by Non Probability Convenience sampling technique. In these 110 obese women as cases was compared with 110 non-obese women as controls, booked at <20 weeks of gestation. Data were collected regarding maternal complication, mode of delivery and neonatal outcome by trained medical officers. Data were entered and analyzed by SPSS version 11.0 through descriptive analysis, chi-square test and independent sample t test. The p-value of <0.05 was considered significant. Results: Pregnancy induced hypertension was present in 9 (8.2%) women in control group and 21 (19.1%) in cases (p=0.01). Gestational diabetes was seen in one (0.9%) in control compared to 8 (7.3%) in obese women (p=0.01). Obese women were found to be at increased risk of caesarean section [17 (15.5%)  Vs. 39 (35.4%), p=0.002]. Apgar score at 1 and 10 minute were lower in cases compared to controls (p=0.0001). Conclusion: Obese women are at increased risk of pregnancy induced obesity and associated with an increased risk of hypertension, gestational diabetes mellitus, thromboembolic disease and urinary tract infection

Trait-Environment Relationships and Tiered Forward Model Selection in Linear Mixed Models

To understand patterns of variation in species biomass in terms of species traits and environmental variables a one-to-one approach might not be sufficient, and a multitrait multienvironment approach will be necessary. A multitrait multienvironment approach is proposed, based on a mixed model for species biomass. In the model, environmental variables are species-dependent random terms, whereas traits are fixed terms, and trait-environment relationships are fixed interaction terms. In this approach, identifying the important trait-environment relationship becomes a model selection problem. Because of the mix of fixed and random terms, we propose a novel tiered forward selection approach for this. In the first tier, the random factors are selected; in the second, the fixed effects; in the final tier, nonsignificant terms are removed using a modified Akaike information criterion. We complement this tiered selection with an alternative selection method, namely, type II maximum likelihood. A mesocosm experiment on early community assembly in wetlands with three two-level environmental factors is analyzed by the new approach. The results are compared with the fourth corner problem and the linear trait-environment method. Traits related to germination and seedling establishment are selected as being most important in the community assembly in these wetland mesocosms

Bivariate scatter plot of environmental variables temperature (in °C), and chlorophyll-a (in log(<i>µg L</i>⁻¹)).

<p>Different climate zones are indicated with different colors.</p