Cholestasis of pregnancy: effects on maternal and fetal outcome

Background: Intrahepatic cholestasis of pregnancy (ICP) typically occurs in late pregnancy affecting 1.5-2% pregnancies. Limited data is available regarding its fetal and maternal implications. This study aims to assess the impact of ICP on maternal and fetal outcome.Methods: A total 200 patients with pruritus in later half of pregnancy were studied over a period of 18 months out of which 135 were diagnosed as ICP. Clinical and biochemical parameters like serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total protein, and gamma glutamyl transferase was recorded. Maternal and fetal outcome was noted in the form of LSCS rate, preterm births, fetal distress and neonatal ICU admissions.Results: In this study, most common symptom was pruritus. Most of cases had onset of symptoms between 32-36 weeks. High LSCS rates were seen among cases. Intrapartum complications viz. meconium staining of amniotic fluid (57.8%), preterm delivery (11.9%), fetal distress (42.2%) were significantly higher in study population and there was high incidence of NICU admissions (49. 6% neonates) among cases mostly due to meconium aspiration and prematurity.Conclusions: ICP increases maternal morbidity and is associated with adverse perinatal outcome viz. increased risk of fetal distress, preterm births and sudden IUD at term as evidenced in this study. A timely intervention at 37-38 weeks will reduce the adverse outcomes

A comparative prospective study of maternofetal outcome in advanced and younger maternal age group in higher socioeconomic strata

Background: Maternal age in pregnancy is increasing over the world and has been widely documented. Nowadays many women delay their pregnancy even up to the 40th year of life because of different reasons like changing social and economic trend. Simultaneously higher advanced technique and better supported maternal and neonatal care also exist.Methods: To have an idea of balance between advanced age and advanced support this comparative prospective study was done on 40 advanced and 40 younger maternal age groups to compare the pregnancy outcomes. To find out the association Chi-Square and unpaired ‘t’ test was used.Results: It was observed in this study that Assisted reproductive techniques (mode of conception) and cesarean section rates were significantly higher in advanced maternal age. Although there were no significant differences in antenatal and postpartum complications between the two groups.Conclusions: It can be concluded that if a women with advanced maternal age is cared at a hospital with advanced techniques, the adverse pregnancy outcomes will not be different from the non-elderly women

Pregnancy outcome after first trimester vaginal bleeding

Background: First trimester vaginal bleeding is one of the most common complications in pregnancy threatening its proper development and successful outcome.Methods: A case-control study was conducted from October 2016 to April 2018 in the department of obstetrics and gynecology SKIMS.200 cases with vaginal bleeding in first trimester were taken for study. Out of the cases, number of patients who had abortion, ectopic, molar pregnancy or continued their pregnancy beyond 20 weeks was noted. Those who continued their pregnancy were compared with 130 controls for complications developing later in pregnancy.Results: There was significantly higher incidence of PIH (15.4% of cases, 6.9% of controls, p value = 0.005) and abruption (7.7% and 1.5% among cases and controls respectively with p-value of 0.034) among cases than controls. Mean gestational age at delivery in cases was 35.6±3.63 weeks while in controls it was 38.5±1.94 weeks (p value <0.001). Mean birth-weight of the neonates in cases was 2.16±0.78 kgs while in controls was 3.05±0.53 kgs (p value <0.001). IUGR occurred in 9.2% of cases and 3.1% of controls (p value 0.039). There was significantly higher neonatal ICU admission rate in cases than controls (p value 0.019).Conclusions: Patients with first trimester vaginal bleeding are at increased risk for spontaneous loss and adverse pregnancy outcome

Utility of second trimester beta HCG levels in prediction of gestational hypertension: a prospective cohort study

Background: Gestational hypertension is a significant threat both to maternal and fetal health. However, it is still a distant dream to predict accurately its occurrence in early pregnancy. Objective was to find out if β HCG levels determined between 13 to 20 weeks of gestation can be used as a predictor for gestational hypertension.Methods: This prospective observational cohort study was conducted from August 2014 to January 2016. Serum β HCG levels were determined at 13 to 20 weeks of gestation of 190 normotensive pregnant women attending the antenatal clinics. They were followed for the development of gestational hypertension till 40 weeks of gestation or delivery.Results: Out of the total 190 women, 25 (13.1%) developed gestation hypertension. Of those who developed gestational hypertension, 22 (88%) were having β HCG levels >2 MOM (p2 MOM were 83.3, 96.9, 80.0 and 97.5 respectively (95% CI).Conclusions: Pregnant women with high Beta HCG levels in early pregnancy have significantly higher risk for development of gestational hypertension

Conceptos erróneos comunes sobre COVID-19 entre los profesionales de la salud: una encuesta transversal global en línea.

Background: The COVID-19 pandemic has taken the world by storm, with cases continuously increasing by the hour and with a shortage of information regarding the virus available to the general public. Despite the availability of trusted online sources, there are still misconceptions relating to the virus floating around. This study aimed to find out the level of misconceptions among healthcare professionals (HCPs) worldwide about the ensuing COVID-19 pandemic. Materials and Methods: A descriptive cross sectional study was conducted through a global online survey. The self-administered questionnaire was designed and registered at an online website (Kwiksurveys). A total of 652 participants from 35 different countries across the world responded. Statistical analysis was performed using SPSS version 23. Socio-demographic and discipline characteristics were compared with the help of the chi-square test and univariate and multivariate logistic regression to find significant relationships. Results: Among all HCPs, general physicians (61.2%) were the most common respondents. The responses from females (63.3%) almost doubled those of men, and nearly half of the participants were working in private institutes (49.2%). Additionally, the major source of information used by HCPs about COVID-19 was social media (55.4%). Regarding misconception assessment, 71.6% of participants had correct concepts regarding COVID-19. However, 28.4% had incorrect information. Female HCPs were 1.49 times more likely to have correct concepts compared to males (OR=1.49, 95% CI=1.04-2.14). Conclusions: The majority of the HCPs were keeping themselves up-to-date with current information concerning the knowledge, prevention, and hygiene practices of COVID-19 infection. However, some misconceptions are deeply rooted in the mindsets of HCPs worldwide and need to be addressed by the continuous professional development of HCPs. The availability of reliable sources of information on the pandemic should be encouraged, with adequate explanations also available to the general public in simple terms.Antecedentes: la pandemia de COVID-19 ha asolado al mundo, con casos que aumentan continuamente&nbsp; y con una escasez de información sobre el virus disponible para el público en general. A pesar de la disponibilidad de fuentes confiables en línea, todavía hay conceptos erróneos relacionados con el virus. Este estudio tuvo como objetivo dilucidar el nivel de ideas erróneas entre los profesionales de la salud (PS) en todo el mundo sobre la pandemia de COVID-19. Material y Métodos: Se realizó un estudio descriptivo de corte transversal a través de una encuesta global en línea. El cuestionario autoadministrado fue diseñado y registrado en un sitio web en línea (Kwiksurveys). Respondieron un total de 652 participantes de 35 países. El análisis estadístico se realizó con el programa SPSS versión 23. Las características sociodemográficas y disciplinarias se compararon con la ayuda de la la prueba de chi-cuadrado y la regresión logística univariada y multivariada para encontrar relaciones significativas. Resultado: Entre todos los profesionales de la salud, los médicos generales (61,2%) fueron los que más respondieron. Las respuestas de las mujeres (63,3%) casi duplicaron las de los hombres, y casi la mitad de los participantes trabajaban en institutos privados (49,2%). Además, la principal fuente de información utilizada por los profesionales de la salud sobre COVID-19 fueron las redes sociales (55,4%). En cuanto a los conceptos erróneos, el 71,6% de los participantes tenían conceptos correctos con respecto a COVID-19. Sin embargo, el 28.4% poseía información incorrecta. Los profesionales de la salud mujeres tenían 1.49 veces más probabilidades de tener conceptos correctos en comparación con los hombres (OR = 1.49, IC 95% = 1.04-2.14). Conclusion: La mayoría de los profesionales de la salud se mantuvieron actualizados con la información actual sobre el conocimiento, la prevención y las prácticas de higiene de la infección por COVID-19. Sin embargo, algunos conceptos erróneos están profundamente arraigados en la mentalidad de los PS en todo el mundoy deben abordarse mediante el continuo desarrollo profesional de los PS. Se debe alentar la disponibilidad de fuentes confiables de información sobre la pandemia, con explicaciones adecuadas también disponibles para el público en general en términos simples

Use of Ondansetron for Prevention of Spinal Induced Hypotension

Objective: To compare the efficacy of prophylactic administration of Ondansetron before induction of spinal anesthesia with placebo, in preventing spinal induced hypotension. Patients and Methods: This Randomized Control trial was carried out at Holy Family Hospital, Rawalpindi from 29 April 2015 till 28 October 2015. A total of 106 patients were enrolled in the study. Patients in group A, received 6 mg Ondansetron. Patients in group B received normal saline. Mean arterial pressure (MAP) and heart rate (HR) were recorded every 5 minutes after performing spinal anesthesia. The study drug was considered efficacious if absence of hypotension for 20 minutes was recorded after inducing spinal anaesthesia. Data was analyzed using SPSS 17. Results: Hypotension occurred in 7.5% cases in Ondansetron group compared to 28.3% in normal saline group (p=0.005). Conclusion: Ondansetron is effective in preventing spinal induced hypotension.&nbsp

Advances of Proteomic Sciences in Dentistry

Applications of proteomics tools revolutionized various biomedical disciplines such as genetics, molecular biology, medicine, and dentistry. The aim of this review is to highlight the major milestones in proteomics in dentistry during the last fifteen years. Human oral cavity contains hard and soft tissues and various biofluids including saliva and crevicular fluid. Proteomics has brought revolution in dentistry by helping in the early diagnosis of various diseases identified by the detection of numerous biomarkers present in the oral fluids. This paper covers the role of proteomics tools for the analysis of oral tissues. In addition, dental materials proteomics and their future directions are discussed

ASSESSMENT OF RISK FACTORS AND COMPLICATIONS OF DIABETES MELLITUS IN DIFFERENT STAGES OF HYPERTENSION: A RETROSPECTIVE COHORT STUDY FROM A MAJOR METROPOLITAN CITY OF PAKISTAN

Diabetes mellitus is a group of metabolic disorders clinically manifested by hyperglycemia. Diabetic patient having hypertension has more chances of heart diseases, peripheral vascular disease, nephropathy and retinopathy. The aim of the study was to evaluate the prevalence of risk factors and related complications in diabetic patients having hypertension. This retrospective observational study was conducted by enrolling 250 patients for study. Results have indicated that there was higher percentage of female diabetics (60.16%) as compared to males due to more prevalence of obesity in females. Patients in pre-hypertensive stage were having more risk factors; salt intake (66.42%), fat intake (67.8%), aerobic exercise &lt;30 minutes (70.2%) and even 50% were not exercising. They were experiencing more symptoms and complications such as thirst (63.1%), dryness of mouth (60.33%), loss of appetite (59.2%), abdominal pain (67.1%), nausea and vomiting (56.3%), frequent urination (56.7%) and high blood sugar level (56.33%). About 92.30% patients were satisfied with the treatment and were following the instructions by the doctors. The study inferred that the risk factors and complications related to diabetes were more prevalent in pre-hypertensive stage which could progress the disease to advanced stages

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades. Methods: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10–14, 15–19, and 20–24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10–24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010–19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010–19. Interpretation: As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low–middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding: Bill &amp; Melinda Gates Foundation

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens