Impact of interventions to prevent and manage preeclampsia and eclampsia on stillbirths

<p>Abstract</p> <p>Background</p> <p>Pre-eclampsia and Eclampsia are relatively common complications of pregnancy, leading to considerable maternal and fetal mortality and morbidity. We sought to review the effect of aspirin, calcium supplementation, antihypertensive agents and magnesium sulphate on risk stillbirths.</p> <p>Methods</p> <p>A systematic literature search was conducted to identify studies evaluating the above interventions. We used a standardized abstraction and grading format and performed meta-analyses where data were available from more than one studies. The estimated effect on stillbirths was determined by applying the standard Child Health Epidemiology Reference Group (CHERG) rules for multiple outcomes. For interventions with insufficient evidence for overall effect, a Delphi process was undertaken to estimate effectiveness.</p> <p>Results</p> <p>We identified 82 relevant studies. For aspirin, maganesium sulphate and use of antihypertensive we found an insignificant decrease in stillbirth and perinatal mortality. For calcium supplementation, there was a borderline significant reduction in stillbirths (RR 0.81, 95 % CI 0.63-1.03). We undertook a Delphi consultation among experts to assess the potential impact of a package of interventions for the management of pre-eclampsia and eclampsia (antihypertensive, magnesium sulphate and C-section if needed). The Delphi process suggested 20% reduction each in both antepartum and intrapartum stillbirths with the use of this package.</p> <p>Conclusions</p> <p>Despite promising benefits of calcium supplementation and aspirin use cases on maternal morbidity and eclampsia in high risk cases, further work is needed to ascertain their benefits in relation to stillbirths. The Delphi process undertaken for assessing potential impact of a package of interventions indicated that this could be associated with 20% reduction in stillbirths, for input into LiST.</p

Mumps myocarditis: a forgotten disease?

Mumps is an acute viral illness that follows a self-limiting course but up to 10% of cases have a complicated course with the involvement of other organ systems. Myocarditis is reported as a complication but the incidence has greatly fallen ever since the development of the mumps vaccine. A child presented to our department with parotid swelling and fever. Persistent tachycardia with irregular pulse led to further cardiac work up which showed decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With ionotropic agents and supportive care, there was complete normalization of ejection fraction and serum cardiac enzyme levels. He was discharged within a week of admission. This case highlights the importance of suspecting myocarditis in the setting of mumps, a diagnosis that precludes early suspicion in mumps patients suffering from cardiac symptoms not explained by other potential aetiologies. Early suspicion and timely supportive care are essential to ensure favourable outcomes

Clinical profile and outcome of infective endocarditis at the Aga Khan University Hospital

Background: The spectrum of infective endocarditis (IE) is significantly different in developed and developing countries. The present study was conducted to study the clinical profile and outcome of infective endocarditis in Pakistan.Methods: A descriptive cross-sectional study with review of medical records for 188 patients admitted to our teaching hospital with a diagnosis of IE from January 1988 to December 2001. One hundred fifty-nine subjects fulfilled the modified Duke diagnostic criteria.Results: Definite IE was found in 59.7% (95/159) patients, while the rest had possible IE. One-third of subjects had acute IE 55/159 (34.5%). Subacute IE was found in 62% (99/159) and Nosocomial IE in 3% of the cases. Eighty six (54%) were classified as having culturenegative endocarditis and 73 (46%) as culture positive. Ninty four patients (59%) had an underlying predisposing factor including congenital heart disease (31%) and rheumatic heart disease (21%). The most frequently isolated organisms were streptococci (52%) and followed by staphylococci (29%). Fourteen (8.1%) patients had right-sided cardiac involvement. Using univariate analysis, patients with heart failure, neurologic or renal complications, septicemia, nosocomial endocarditis, and prosthetic valve endocarditis were at increased risk of death (p ≤ 0.05), however no individual microorganism, or specific site, size, or morphology of vegetation seen on echocardiogram were significantly associated with death. Thirty-seven (23%) patients died of endocarditis or its complications.Conclusion: Endocarditis continues to be an important contributor to morbidity and mortality in Pakistan, especially in young adults. Our patients differ from the west in terms of epidemiology, predisposing factors, microbiology, complications, and outcom

Why Current Statistical Approaches to Ransomware Detection Fail

The frequent use of basic statistical techniques to detect ransomware is a popular and intuitive strategy; statistical tests can be used to identify randomness, which in turn can indicate the presence of encryption and, by extension, a ransomware attack. However, common file formats such as images and compressed data can look random from the perspective of some of these tests. In this work, we investigate the current frequent use of statistical tests in the context of ransomware detection, primarily focusing on false positive rates. The main aim of our work is to show that the current over-dependence on simple statistical tests within anti-ransomware tools can cause serious issues with the reliability and consistency of ransomware detection in the form of frequent false classifications. We determined thresholds for five key statistics frequently used in detecting randomness, namely Shannon entropy, chi-square, arithmetic mean, Monte Carlo estimation for Pi and serial correlation coefficient. We obtained a large data set of 84,327 files comprising of images, compressed data and encrypted data. We then tested these thresholds (taken from a variety of previous publications in the literature where possible) against our dataset, showing that the rate of false positives is far beyond what could be considered acceptable. False positive rates were often above 50% and even above 90% on several occasions. False negative rates were also generally between 5% and 20%, numbers which are also far too high. As a direct result of these experiments, we determine that relying on these simple statistical approaches is not good enough to detect ransomware attacks consistently. We instead recommend the exploration of higher-order statistics such as skewness and kurtosis for future ransomware detection techniques

Infective endocarditis in patients with congenitally malformed hearts: characterization of the syndrome in a developing country

Cardiac surgery for correction or palliation of congenital cardiac disease in infancy and childhood remains a privilege that is rarely accessible to two-thirds of the world’s population. This imbalance has created a unique spectrum of illness in patients with underlying congenital cardiac disease and complicating infective endocarditis in developing countries, including Pakistan. In this study, we characterize endocarditis as seen in such patients presenting in Karachi. We reviewed retrospectively patients admitted to Aga Khan University with underlying congenitally malformed hearts and endocarditis between 1991 and 2004. We identified 48 patients with endocarditis according to the modified Duke Criterions, with just over half the cases (54%) classified as definite endocarditis. Of the patients, 23 (49%) patients were more than 16 years old. Uncorrected left-to-right-shunts, tetralogy of Fallot, and congenital mitral valvar disease were the most common underlying defects. Patients with cyanotic defects, particularly of the complex type, were underrepresented (4%). Only 11 (22.9%) of the patients had a previous palliative or corrective surgery. In one-third of the patients (16), streptococcal species were identified as the microbiologic cause of endocarditis, and 22 (45.8%) had culture-negative endocarditis. In contrast, Staphylococcus aureus and enterococci caused endocarditis in only one patient each. There were no differences in mortality or complications between cyanotic and acyanotic congenital defects. Surgery was performed in nine (18.7%) patients with endocarditis, and of these, 13 (27.1%) died. In contrast to the developed world, endocarditis in the developing countries, such as Pakistan, complicates uncorrected left-to-right shunts and tetralogy of Fallot, probably because patients with complex cyanotic defects fail to survive long after birth due to the lack of available surgery. Almost half of patients had culture-negative endocarditis, likely related to several factors

True prevalence of twin HDV-HBV infection in Pakistan: a molecular approach

Hepatitis Delta Virus (HDV) infects only patients that are already infected by hepatitis B virus (HBV) because this is sub satellite virus which depends on and propagate only in the presence of HBV. HDV causes co-infection or super infection with sever complication as compared to only HBV infection. No study on molecular level on HDV is available from this region; therefore, the aim of this study was to found out the molecular epidemiology of HDV (as a co-infection with HBV) in different geographical regions of Pakistan

NoCry: No More Secure Encryption Keys for Cryptographic Ransomware

Since the appearance of ransomware in the cyber crime scene, researchers and anti-malware companies have been offering solutions to mitigate the threat. Anti-malware solutions differ on the specific strategy they implement, and all have pros and cons. However, three requirements concern them all: their implementation must be secure, be effective, and be efficient. Recently, Genç et al. proposed to stop a specific class of ransomware, the cryptographically strong one, by blocking unauthorized calls to cryptographically secure pseudo-random number generators, which are required to build strong encryption keys. Here, in adherence to the requirements, we discuss an implementation of that solution that is more secure (with components that are not vulnerable to known attacks), more effective (with less false negatives in the class of ransomware addressed) and more efficient (with minimal false positive rate and negligible overhead) than the original, bringing its security and technological readiness to a higher level

On Deception-Based Protection Against Cryptographic Ransomware

In order to detect malicious file system activity, some commercial and academic anti-ransomware solutions implement deception-based techniques, specifically by placing decoy files among user files. While this approach raises the bar against current ransomware, as any access to a decoy file is a sign of malicious activity, the robustness of decoy strategies has not been formally analyzed and fully tested. In this paper, we analyze existing decoy strategies and discuss how they are effective in countering current ransomware by defining a set of metrics to measure their robustness. To demonstrate how ransomware can identify existing deception-based detection strategies, we have implemented a proof-of-concept anti-decoy ransomware that successfully bypasses decoys by using a decision engine with few rules. Finally, we discuss existing issues in decoy-based strategies and propose practical solutions to mitigate them

Whole-of-school physical activity implementation in the context of the Dubai Fitness Challenge

Introduction: Physical activity (PA) promotion among school-aged youth is a global health priority. Recommendations for such promotion include implementing whole-of-school approaches that maximize resources across the school environment. This study examined schools’ participation in an annual, government-led, and emirate-wide initiative in Dubai, called the Dubai Fitness Challenge, in which the goal is to accrue 30 minutes of PA every day for 30 days (as such, the initiative is colloquially referred to as “Dubai 30x30”). Methods: A mixed-methods design was employed for this study. Three schools were recruited using convenience sampling. Participants were 18 physical education teachers, 20 classroom teachers, 2 principals and 45 students. Data sources included surveys, focus groups, and interviews. Data were analyzed using descriptive statistics, multinomial logistic regression, and open and axial coding to develop themes. Results: School staff reported that most Dubai 30x30 activities were provided in physical education, at break times during school, and before and after school. Students reported that they mainly participated in Dubai 30x30 activities during physical education and occasionally participated in activities after school and on weekends. During school, students were more likely to reach higher PA intensity levels when they were in contexts other than the regular classroom setting. Among school staff, physical education teachers were most involved and classroom teachers were least involved in promoting Dubai 30x30. Parent engagement was high. Staff perceived that Dubai 30x30 brought the community together, but physical education teachers also indicated there was a lack of implementation guidance and they felt burdened. Participants believed Dubai 30x30 increased PA participation and helped to promote their schools. Discussion: This study provides an initial glimpse into schools’ participation in Dubai 30x30 and suggests that a whole-of-school PA lens is useful in gleaning information that could help to increase and optimize PA opportunities for students