Clinicohaematological study of anaemia in antenatal patients

Background: According to WHO, approximately 75% of pregnant women in developing countries and 18% in developed countries are anaemic. In India prevalence of anaemia is reported to be 33%-89% and is one of the important causes of maternal morbidity and mortality. The present study was done with the objective to study the socio-demographic factors related to anemia and the distribution of different types of anaemia in antenatal patients.Methods: A prospective analytical study was done on 205 pregnant females who presented with anemia (Hb <11 gm/dl) in 1st, 2nd and early 3rd trimester (up to 30 weeks of gestation) in the department of obstetrics and gynecology of Swaroop Rani Nehru Hospital, Prayagraj from September 2017 to September 2018.Results: The rural background with lower socio-economic status comprised majority of the anemic patients (65.9%) with the major cause being iron deficiency anemia (68.8%). The patients mainly presented with anemia at late second or early third trimester (82.4%). Clinical signs like pallor, oedema and symptoms like palpitations and dyspnoea were more associated with severe anemia than mild and moderate anemia.Conclusions: Anemia prevention and prompt detection is the need of the hour with effective management. In India, major cause of anaemia are nutritional deficiencies which can be treated by proper diet and medications. The advises of routine iron supplementation during pregnancy, regardless of whether the mother is anemic or not, is strongly recommended by this study.

Arbuscular mycorrhizal symbiosis and alleviation of salinity stress

Several environmental factors adversely affect plant growth and development and final yield performance of a crop. Drought, salinity, nutrient imbalances (including mineral toxicities and deficiencies) and extremes of temperature are among the major environmental constraints to crop productivity worldwide. Development of crop plants with stress tolerance, however, requires, among others, knowledge of the physiological mechanisms and genetic controls of the contributing traits at different plant developmental stages. In the past two decades,biotechnology research has provided considerable insights into the mechanism of biotic stress tolerance in plants at the molecular level. Furthermore, different abiotic stress factors may provoke osmotic stress, oxidative stress and protein denaturation in plants, which lead to similar cellular adaptive responses such as accumulation of compatible solutes, induction of stress proteins, and acceleration of reactive oxygen species scavenging systems. Recently, various methods are adapted to improve plant tolerance to salinity injury through either chemical treatments (plant hormones, minerals, amino acids, quaternary ammonium compounds, polyamines and vitamins) or biofertilizers treatments (Asymbiotic nitrogen-fixing bacteria, symbiotic nitrogen-fixing bacteria) or enhanced a process used naturally by plants (mycorrhiza) to minimise the movement of Na+ to the shoot. Proper management of Arbuscular Mycorrhizal Fungi (AMF) has the potential to improve the profitability and sustainability of salt tolerance. In this review article, the discussion is restricted to the mycorrhizal symbiosis and alleviation of salinity stress

Clinical outcomes among pregnant patients with cardiac disease only and those with co-existing pregnancy-associated hypertension

Background: Impact of cardiac disease on pregnancy is significant. Impact of hypertension on pregnancy is also significant. “Does occurrence of hypertension along with cardiac disease worsen the outcomes?” forms the crux of this study. The aim of the present study was to determine the impact of pregnancy-associated hypertension on the clinical outcomes of pregnant patients with cardiac disease.Methods: Retrospective, observational, comparative, case control study of one and half year duration conducted in a tertiary care referral hospital. The various medical and obstetric parameters were studied and compared.Results: Among 143 patients studied, 36 were hypertensive and 107 were non-hypertensive. Non-severe hypertension was seen in 17%, severe hypertension in 4% and eclampsia in 4%. Average age was 26 years and majority were first or second gravida. Valvular heart disease was the most common cardiac disease encountered. Gestational age at delivery, perinatal outcome and occurrence of pulmonary hypertension were all similar in both the hypertensive and non-hypertensive groups.  The most common mode of delivery was vaginal delivery. The cesarean section rate was 29% and was similar among both hypertensive and non-hypertensive groups. Requirement for induction of labor, occurrence of small-for- gestational age among the newborns, intensive care unit admission due to heart failure and maternal death was higher (statistically significant (p<0.05) among the hypertensive group.Conclusions: Presence of hypertension worsens outcomes among pregnant patients with cardiac disease. The coexistence of hypertension and cardiac disease should alert the obstetrician and specialist physician towards a more vigilant management. The findings of this study may help risk stratification (development of pregnancy associated hypertension) while counseling patients with heart disease.

Presentation of acute pulmonary edema in severe pre-eclamptic pregnant women: a case report

Pulmonary edema refers to an excessive accumulation of fluid in the pulmonary interstitial and alveolar spaces. It may occur in low risk pregnancies but one very important predisposing factor is association with pre-eclampsia. Acute pulmonary edema during pregnancy is very rare and occurs in 0.08% pregnancies. About 3% of severe pre-eclamptic patients develop acute pulmonary edema. Several risk factors have been identified: preeclampsia or eclampsia, use of tocolytic therapy, severe infection, cardiac disease, iatrogenic fluid overload, and multiple gestations. This case examines one such presentation and reviews some of the diagnostic possibilities

Effect of anaemia on maternal and fetal outcome: an observational study

Background: Anaemia in pregnancy is a globally health-related issue that affects both mothers and their new-born. Hence an observational study to see the effect of anaemia on maternal and foetal outcome was conducted. Methods: 15024 mothers coming in OPD or IPD in past 4 years were recruited and their haemoglobin measured. Descriptive statistics was used for baseline characteristics. This observational study was conducted in department of obs and gynae, GSVM Medical College Kanpur from August 2018 to August 2022. All the data gathered was processed by SPSS version 25. Results: The main outcomes included 4 maternal outcomes (postpartum haemorrhage, shock, ICU admission, and maternal mortality) and 4 neonatal outcomes (foetal growth restriction, birth weight, NICU admission, stillbirth). 60.03% of the mothers were anaemic in our study. Maternal and foetal complications were more in anaemic than non-anaemic mothers with incidence of PPH, shock, ICU admission, and maternal mortality being 14.07%, 11.33% ,4.30 and 1.31% respectively than non-anaemic mothers with incidence of 11.22%, 7.26%, 1.76%, and 7.28% respectively. Foetal outcome was also poorer in anaemic mothers with incidence of FGR, LBW, NICU admission, Still birth being 3.15%, 8.85%, 12.96%, and 1.09% higher than non-anaemic group with incidence being 1.80%, 3.43%, 9.75%, and 0.30 % respectively. Conclusions: This observational study provides valuable insights into the effect of anaemia on both maternal and foetal outcomes. It emphasizes the importance of early detection and management of anaemia to mitigate the risks associated with this condition

Neonatal outcome in early term and late term pregnancy

Background: Full-term neonates born between 37- and 41-weeks’ gestational age have been considered a homogeneous, low-risk group. However, recent evidence from studies has pointed toward increased NICU admissions and morbidity associated with births (37-38 weeks) compared with term neonates (39-41 weeks). The objective of this study was to compare the short-term morbidity of early-term vs term neonates in a county-based birth cohort using the primary objective of admission to a neonatal intensive care unit (NICU) or neonatology service. Methods: Retrospective observational population-based 2 year birth cohort study at Department of Obstetrics and Gynecology GSVM Medical College, Kanpur. All full-term live births comprised the birth cohort; this information was obtained from the hospitals’ perinatal databases, and data pertaining to NICU, or neonatology service admissions were extracted from individual medical records.  Gestational age of early term (37 0/7-38 6/7 weeks) verses term (39 0/7-4 10/7 weeks). Admission to the NICU or neonatology service. Results: There were 17,132 live births during the 2 year period, of which 13679 had a gestational age between 37 and 41 weeks. Of all live births, 6204 (45.3%) were early term. Compared with term infants, early-term neonates had significantly higher risks for the following: hypoglycaemia (29.9% verses 14.7%), NICU or neonatology service admission (20.9% vs12.05 %), need for respiratory support (36.8% verses 29.9%), treatment with intravenous antibiotics [39.4% verses 25. Delivery by caesarean section was common among early-term births (45.9%)]. Conclusions: Early-term births are associated with high neonatal morbidity and with NICU or neonatology service admission. Evaluation of local prevalence data will assist in implementation of specific preventive measures and plans, as well as prioritize limited health care resources

Redox Signaling by the RNA Polymerase III TFIIB-Related Factor Brf2.

TFIIB-related factor 2 (Brf2) is a member of the family of TFIIB-like core transcription factors. Brf2 recruits RNA polymerase (Pol) III to type III gene-external promoters, including the U6 spliceosomal RNA and selenocysteine tRNA genes. Found only in vertebrates, Brf2 has been linked to tumorigenesis but the underlying mechanisms remain elusive. We have solved crystal structures of a human Brf2-TBP complex bound to natural promoters, obtaining a detailed view of the molecular interactions occurring at Brf2-dependent Pol III promoters and highlighting the general structural and functional conservation of human Pol II and Pol III pre-initiation complexes. Surprisingly, our structural and functional studies unravel a Brf2 redox-sensing module capable of specifically regulating Pol III transcriptional output in living cells. Furthermore, we establish Brf2 as a central redox-sensing transcription factor involved in the oxidative stress pathway and provide a mechanistic model for Brf2 genetic activation in lung and breast cancer

Survival in amoeba: a major selection pressure on the presence of bacterial copper and zinc resistance determinants?: identification of a "copper pathogenicity island"

The presence of metal resistance determinants in bacteria usually is attributed to geological or anthropogenic metal contamination in different environments or associated with the use of antimicrobial metals in human healthcare or in agriculture. While this is certainly true, we hypothesize that protozoan predation and macrophage killing are also responsible for selection of copper/zinc resistance genes in bacteria. In this review, we outline evidence supporting this hypothesis, as well as highlight the correlation between metal resistance and pathogenicity in bacteria. In addition, we introduce and characterize the "copper pathogenicity island" identified in Escherichia coli and Salmonella strains isolated from copper- and zinc-fed Danish pigs

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca