Evolution of second trimester low implanted placenta to previa at term: a prospective cohort study

Background: The objective of this study is to identify the percentage of low implanted placenta (LIP) at second trimester of pregnancy and identify the risk factors of its persistence to placenta previa (PP) at term.Methods: Through a registered prospective cohort study conducted at tertiary hospital in Upper Egypt, authors screened all pregnant ladies comes to present facility for antenatal second trimester USG between 18-24 weeks gestation. All participants interviewed for detailed risk factors of placenta previa. Those diagnosed to have a LIP (≤1.5 cm from the internal os) had had TVS to confirm the exact distance between the lower edge of the placenta and the internal os. Serial USG had been done every 4 weeks up to delivery to measure the same distance. The primary outcome was the percentage of LIP at 18-24 weeks. Logistic regression analysis was performed to predict the risk factors for PP at term.Results: Through screening of 1000 pregnant lady, LIP had been identified in (52 cases) 5.2% of pregnant women between 18-24 weeks. This percentage dropped gradually to reach 1.3% at 36 weeks of gestation and at time of delivery. The logistic regression analysis demonstrated that the distance between the internal os and the lower edge of the placenta between 18-24 weeks was the single significant variable associated with PP at term (p<0.001, odds ratio 0.319, 95% CI 0.20-0.50). However, excluding the distance from the regression model demonstrated other risk factors as previous miscarriage, previous cesarean section (CS), and history of multiple pregnancies and history of previous PP.Conclusions: About 5.0% of pregnant women have LIP at the second trimester of pregnancy (18-24 weeks) and only 25.0 % of them remain placenta previa at term. A cut-off value of 10 mm between the internal os and the lower edge of the placenta is the most important predictor of development of PP

Perspective Chapter: Reflection from the Field of Medical Education in the COVID-19 Pandemic—New Strategies and Practices in Achieving Needed Competencies for Students

The COVID-19 issue forced necessary changes in medical education that have been demanding and adjusting for different medical colleges, but they also provide a great opportunity for the betterment and possible challenging and useful transformation of medical education. This chapter examined the responses of medical organizations to this pandemic, its merits, and its challenges. It analyzed the potential effects of new strategies’ recognition and application on medical education in the post-COVID-19 period. The status of medical education before COVID-19 and the challenges of adopting competencies have been reviewed. The teaching and assessment strategies innovated in the COVID-19 era and reflections from faculty and students were discussed. Over the previous years, the pandemic has questioned concepts about how medical education should be delivered. The COVID-19 pandemic offers the medical education community a unique chance to reorient itself away from outdated standards and practices and toward more societally responsible and accountable standards and practices. All involved in medical education should all work together to prevent situations from “snapping back” to how they have always been because they were accepted practices and would be lost if the pandemic had the potential to disrupt growth and reform

Vaginal misoprostol before elective cesarean section for preventing neonatal respiratory distress: a randomized controlled trial

Objective: The current study aims to evaluate the efficacy of vaginal misoprostol before elective cesarean section (ECS) for preventing the occurrence of neonatal respiratory distress (RD). Materials and Methods: A randomized controlled trial (NCT03239327) was carried out in a tertiary-care university-affiliated hospital between June 2016 and August 2017. All eligible pregnant women scheduled for ECS were randomly allocated in a 1:1 ratio to two groups. One group, the Misoprostol group, received a misoprostol 50 mcg vaginal tablet 60 minutes before ECS while the other, the Control group, received no drugs before ECS. The primary outcome was the rate of neonatal RD among the study groups. Results: The study included 146 women in each arm, with no significant difference between the baseline characteristics of members in each group. Primary outcomes resulted in 22 (15.1%) newborns in the misoprostol group having RD at birth versus 44 (30.1%) newborns with RD in the control (P =0.02). No differences were found between the groups regarding the need for neonatal intensive care unit (NICU) admission (P =0.61), duration of NICU stay (P =0.08) and neonatal mortality rate (P =0.73). Conclusion: Prophylactic vaginal misoprostol at a dose of 50 mcg administered 60 minutes before ECS could reduce the rate of neonatal RD and improve the neonatal respiratory outcomes

Community pharmacists' management of minor ailments in developing countries: A systematic review of types, recommendations, information gathering and counselling practices

Aims: To conduct a systematic review of the management of minor ailments by community pharmacists in developing countries, and to identify the specific minor ailments encountered, the medications recommended or requested and the information gathering and counselling practices. Method: Observational studies from developing countries published in English language from inception to 2019 and report the management of minor ailments by community pharmacists were systematically searched in PubMed, ScienceDirect and Cochrane Library. Results: Thirty full-text studies, out of 7876 retrieved and screened, were included in the systematic review. Minor ailment-induced encounters by patients with community pharmacists are generally pervasive and involve mainly verbal request for specific medicines by name (60%). The most frequent minor ailments reported were respiratory, gastrointestinal and musculoskeletal conditions, and the most common medicines recommended or requested for were cough/cold preparations, antimotility and oral rehydration preparation, and analgesic/antipyretic. Inappropriate recommendation of antibiotics were reported for acute diarrhoea and cough/colds (40%) (10/25). Community pharmacists encountered 11-30 customers with minor ailments per day, with an average of about 4.8 (1.3-20.5) minutes per encounter. None of the studies reported the availability and/or use of a specific protocol to guide the management of minor ailments. There was wide variation in the type and depth of information gathered and used for the management of minor ailments; and the counselling information provided by community pharmacists, and there was no evidence of the documentation activities related to the management of minor ailments. Conclusions: Community pharmacists' encounter with and management of minor ailments appear extensive in developing countries and probably present an opportunity to contribute significantly to reduce disease burden and enhance public health. However, the management process is currently unstructured, unguided by a specific protocol and vary in the quality of recommendations, information gathering and counselling practices.Qatar National Research Fund, UREP24-147-3043; Open Access funding provided by the Qatar National Library

Fecal Lactoferrin As A Diagnostic and Prognostic Marker in Egyptian IBD Patients

Background: Inflammatory bowel diseases (IBD) are organic chronic inflammation of the gastrointestinal tract characterized by variable disease activity with repeated periods of remission and exacerbation. Irritable bowel syndrome (IBS) is prevalent in up to fifth of population; diarrhea type has the broadest differential diagnosis. To distinguish inflammatory versus functional disorder fecal biomarkers as fecal lactoferrin (FL), being non-invasive acute phase proteins produced by inflamed mucosa, can help to avoid invasive procedures. Objective: The aim of this study was to assess sensitivity and specificity of fecal lactoferrin as a non-invasive biomarker in Egyptian patients with IBD and to detect its role in assessment of disease severity. Patients and methods: This comparative case control study was held through one year duration. Patients were recruited from Internal Medicine and Hepatology Department at a University Hospital. 50 subjects were classified into 3 groups: Group I included 30 patients with inflammatory bowel disease, Group II included 10 patients with irritable bowel syndrome, Group III included 10 healthy subjects as control group. Results: fecal lactoferrin assay (FLA) levels were highest in patients with IBD in comparison with IBS patients and healthy group. Moreover FLA levels also correlated significantly with disease severity in patients with IBD as higher levels of FLA were found in patients with severe ulcerative colitis (UC) or Crohn`s disease. Conclusion: Fecal lactoferrin can be used to differentiate IBD from IBS with 96.7% sensitivity and 100% specificity at cutoff value of 37 ug/ml while at cutoff value 7.2 ug/ml FLA has 100% sensitivity and specificity in differentiating IBD patients from healthy subjects in Egyptian population. Yet it can’t differentiate ulcerative colitis versus Crohn’s disease

AI‐based intra‐tumor heterogeneity score of Ki67 expression as a prognostic marker for early‐stage ER+/HER2− breast cancer

arly-stage estrogen receptor positive and human epidermal growth factor receptor negative (ER+/HER2−) luminal breast cancer (BC) is quite heterogeneous and accounts for about 70% of all BCs. Ki67 is a proliferation marker that has a significant prognostic value in luminal BC despite the challenges in its assessment. There is increasing evidence that spatial colocalization, which measures the evenness of different types of cells, is clinically important in several types of cancer. However, reproducible quantification of intra-tumor spatial heterogeneity remains largely unexplored. We propose an automated pipeline for prognostication of luminal BC based on the analysis of spatial distribution of Ki67 expression in tumor cells using a large well-characterized cohort (n = 2,081). The proposed Ki67 colocalization (Ki67CL) score can stratify ER+/HER2− BC patients with high significance in terms of BC-specific survival (p < 0.00001) and distant metastasis-free survival (p = 0.0048). Ki67CL score is shown to be highly significant compared with the standard Ki67 index. In addition, we show that the proposed Ki67CL score can help identify luminal BC patients who can potentially benefit from adjuvant chemotherapy

AI-enabled routine H&E image based prognostic marker for early-stage luminal breast cancer

Breast cancer (BC) grade is a well-established subjective prognostic indicator of tumour aggressiveness. Tumour heterogeneity and subjective assessment result in high degree of variability among observers in BC grading. Here we propose an objective Haematoxylin & Eosin (H&E) image-based prognostic marker for early-stage luminal/Her2-negative BReAst CancEr that we term as the BRACE marker. The proposed BRACE marker is derived from AI based assessment of heterogeneity in BC at a detailed level using the power of deep learning. The prognostic ability of the marker is validated in two well-annotated cohorts (Cohort-A/Nottingham: n = 2122 and Cohort-B/Coventry: n = 311) on early-stage luminal/HER2-negative BC patients treated with endocrine therapy and with long-term follow-up. The BRACE marker is able to stratify patients for both distant metastasis free survival (p = 0.001, C-index: 0.73) and BC specific survival (p < 0.0001, C-index: 0.84) showing comparable prediction accuracy to Nottingham Prognostic Index and Magee scores, which are both derived from manual histopathological assessment, to identify luminal BC patients that may be likely to benefit from adjuvant chemotherapy

Maternal mortality and morbidity burden in the Eastern Mediterranean region : findings from the Global Burden of Disease 2015 study

Assessing the burden of maternal mortality is important for tracking progress and identifying public health gaps. This paper provides an overview of the burden of maternal mortality in the Eastern Mediterranean Region (EMR) by underlying cause and age from 1990 to 2015. We used the results of the Global Burden of Disease 2015 study to explore maternal mortality in the EMR countries. The maternal mortality ratio in the EMR decreased 16.3% from 283 (241-328) maternal deaths per 100,000 live births in 1990 to 237 (188-293) in 2015. Maternal mortality ratio was strongly correlated with socio-demographic status, where the lowest-income countries contributed the most to the burden of maternal mortality in the region. Progress in reducing maternal mortality in the EMR has accelerated in the past 15 years, but the burden remains high. Coordinated and rigorous efforts are needed to make sure that adequate and timely services and interventions are available for women at each stage of reproductive life