The perinatal and maternal outcome in pregnancy with advanced maternal age 35 years and >35 years

Background: Purpose of this study is to evaluate maternal and perinatal outcome in advanced maternal age women. As numbers of pregnancies in advanced maternal age continue to grow, obstetric care provider would benefit from up to date outcome data to enhance their preconceptional and antenatal counseling.Methods: It is observational prospective analytic study, conducted in Nowrosjee Wadia maternity hospital, Parel, Mumbai. Total 100 patients were included in study, fulfilling inclusion criteria over period of 1 year.Results: In 100 patients, most common cause of delay conception is infertility (27%). 24% of patients conceived after treatment. out of 100 patients 23% of patients had pre-existing medical and surgical disorders, 50% developed complications in pregnancy. Out of 100 patient 58 patients undergone through biochemical study, 3 patients had high risk for chromosomal disorders. The rate of caeasarean section in our study is 68%. Perinatal mortality and morbidity is high in our study, rate of preterm delivery is 23.7%. Out of 105 babies (including multiple gestation), 42.8% babies are low birth weight out of which 9.5% babies are very low birth weight. Rate of NICU admission is 33%, perinatal mortality rate, neonatal mortality rate and still birth rate is 19.4 per 1000 births. Advanced maternal age is related to high maternal and perinatal morbidity and mortality rate.Conclusions: Pregnancies in women of advanced maternal age are considered high risk for Perinatal and maternal morbidity and mortality. A proper preconception consultation and intensive antenatal care assessment can individualize and potentially reduce the risks for women with advanced maternal age

Multinational Comparative Cross-Sectional Survey of Views of medical students about Acceptable Terminology and Subgroups in Schizophrenia

AIM: The aim of this study was to inform thinking around the terminology for \u27schizophrenia\u27 in different countries. OBJECTIVES: The objective of this study was to investigate: (1) whether medical students view alternative terminology (psychosis subgroups), derived from vulnerability-stress models of schizophrenia, as acceptable and less stigmatising than the term schizophrenia; (2) if there are differences in attitudes to the different terminology across countries with different cultures and (3) whether clinical training has an impact in reducing stigma. DESIGN: This is a cross-sectional survey that examined the attitudes of medical students towards schizophrenia and the alternative subgroups. SETTING: The study was conducted across eight sites: (1) University of Southampton, UK; (2) All India Institute of Medical Science, India; (3) Rowan University, USA; (4) Peshawar Medical College, Pakistan; (5) Capital Medical University, China; (6) College of Medicine and Medical sciences, Bahrain; (7) Queens University, Kingston, Canada and (8) University of Cape Town, South Africa. METHOD: This study extended an initial pilot conducted by the Royal College of Psychiatrists on the term schizophrenia and psychosis subgroups to assess whether the subgroup terminology might have an effect on the attitudes of a convenience sample of medical students from eight different countries and potentially play a role in reducing stigmatisation. RESULTS: 1873 medical students completed a questionnaire recording their attitudes to schizophrenia and the psychosis subgroups. A reduction in negative perceptions were found for the psychosis subgroups, especially for the stress sensitivity psychosis and anxiety psychosis subgroups. Negative perceptions were found for drug-related psychosis. Participants who had undergone clinical training had overall positive attitudes. Differences across different countries were found. CONCLUSION: The attitudes towards psychosis subgroups used in this study have shown mixed results and variation across countries. Further research is warranted to investigate acceptability of terminology. Methods of reducing stigma are discussed in line with the findings. ETHICS: The study received ethical approval from ERGO (Ethics and Research Governance Online; ID: 15972) and subsequently from the ethics committee at each site

The perinatal and maternal outcome in pregnancy with advanced maternal age 35 years and >35 years

Background: Purpose of this study is to evaluate maternal and perinatal outcome in advanced maternal age women. As numbers of pregnancies in advanced maternal age continue to grow, obstetric care provider would benefit from up to date outcome data to enhance their preconceptional and antenatal counseling.Methods: It is observational prospective analytic study, conducted in Nowrosjee Wadia maternity hospital, Parel, Mumbai. Total 100 patients were included in study, fulfilling inclusion criteria over period of 1 year.Results: In 100 patients, most common cause of delay conception is infertility (27%). 24% of patients conceived after treatment. out of 100 patients 23% of patients had pre-existing medical and surgical disorders, 50% developed complications in pregnancy. Out of 100 patient 58 patients undergone through biochemical study, 3 patients had high risk for chromosomal disorders. The rate of caeasarean section in our study is 68%. Perinatal mortality and morbidity is high in our study, rate of preterm delivery is 23.7%. Out of 105 babies (including multiple gestation), 42.8% babies are low birth weight out of which 9.5% babies are very low birth weight. Rate of NICU admission is 33%, perinatal mortality rate, neonatal mortality rate and still birth rate is 19.4 per 1000 births. Advanced maternal age is related to high maternal and perinatal morbidity and mortality rate.Conclusions: Pregnancies in women of advanced maternal age are considered high risk for Perinatal and maternal morbidity and mortality. A proper preconception consultation and intensive antenatal care assessment can individualize and potentially reduce the risks for women with advanced maternal age

Vitamin D and depression: A case series

Introduction: Over two-thirds of Canadians are deficient in vitamin D. Clinical overlap can compound diagnosis of depression in vitamin D deficient individuals. Citing high costs, the Ministry of Health has restricted routine vitamin D screening and hence is not feasible. Objectives: The current case series is an attempt to recognise the clinical overlap between depression and vitamin D deficiency in order to avoid unnecessary antidepressant prescriptions and to demonstrate the role of collaborative care in such patients. Method: After appropriate ethics approval 62 patients from an outpatient clinic were screened for the diagnosis of treatment resistant depression. Those who had predominant somatic complaints were further screened for organic factors and those with inadequate vitamin D levels were referred to family physicians for supplementation with vitamin D. Results: More than 50% were detected deficient in vitamin D after our evaluation. They showed subjective improvement with vitamin D supplements. No modification of antidepressants was needed. Conclusion: Vitamin D deficiency should be suspected in depressed patients with prominent somatic symptoms and their treatment resistance should be reconsidered to avoid unnecessary exposure to mood stabilisers. Collaborating with primary care is advocated. Limitation: Co-prescription of an antidepressant is a confounder in our case series, and we propose more organised studies with objective rating scales

Thérapie de remédiation cognitive, eh ! Une étude exploratoire à une clinique pour adultes canadiens ayant des troubles de l’alimentation

 Cognitive remediation therapy (CRT) is a new pretreatment that is not routinely offered as a part of adult eating disorder programming across Canada. This pilot study examined levels of cognitive flexibility, patient satisfaction, life satisfaction, and psychological symptoms in a group of Canadian adults participating in an open ongoing weekly CRT group. Participants were 38 adults who met DSM-5 criteria for an eating disorder. Pre- and postgroup measures of patient satisfaction, psychological flexibility, satisfaction with life, and low mood and anxiety symptoms were completed. Overall, participants were satisfied with the CRT group and experienced significant changes in their levels of psychological flexibility and satisfaction with life postgroup. Preliminary results provide support for further investigation of CRT as a novel and palatable prepsychological group treatment approach for Canadian adults struggling with an eating disorder that can be easily integrated into preexisting evidence-based programming. La therapie de remediation cognitive (Cognitive remediation therapy, CRT) est un nouveau traitement prealable qui n’est pas offert systematiquement dans le cadre de la programmation pour les adultes ayant des troubles de l’alimentation partout au Canada. Cette etude pilote a examine les niveaux de flexibilite cognitive, satisfaction des patients, et satisfaction a l’egard de la vie et les symptomes psychologiques chez un groupe d’adultes canadiens participant a un groupe CRT ouvert hebdomadaire en cours. Les participants etaient 38 adultes qui repondaient aux criteres DSM-5 pour un trouble de l’alimentation. Des mesures pre- et post-groupe de satisfaction des patients, flexibilite psychologique, satisfaction a l’egard de la vie et de symptomes de depression et d’anxiete ont ete recueillies. Dans l’ensemble, les participants etaient satisfaits du groupe CRT et ont vecu des changements significatifs dans leurs niveaux post-groupe de flexibilite psychologique et de satisfaction a l’egard de la vie. Les resultats preliminaires soutiennent l’examen plus pousse de la CRT comme traitement de groupe pre-psychologique innovateur et acceptable pour les adultes canadiens aux prises avec un trouble de l’alimentation, une approche qui peut etre integree facilement dans la programmation preexistante fondee sur la preuve

Phenotypic expression of HbO Indonesia in two Indian families and its interaction with sickle hemoglobin

Background: Alpha globin chain variants are clinically significant since they directly influence the structure and function of the hemoglobin (Hb) molecules they constitute, either in combination with normal beta globin chains or with variant beta chains, thereby altering the morbidity and mortality associated with the resultant hemoglobinopathies. We describe here two unrelated families from Madhya Pradesh who had a nondeletional alpha-chain variant, HbO Indonesia (CD116 G → A). Members of one of the two families also had coinheritance of sickle hemoglobin (HbS). Aims: The aim was to study the phenotype of HbO Indonesia and its interaction with HbS. Materials and Methods: Hb electrophoresis, high-performance liquid chromatography (HPLC), covalent reverse dot blot hybridization, amplification refractory mutation system, multiplex polymerase chain reaction, and direct gene sequencing were used to identify and characterize the variant Hbs. Results: The abnormal Hb moved in HbS region in Hb electrophoresis at alkaline pH but gave an abnormal peak in HPLC with a retention time (RT) of 4.86–4.89 min. In two members of the family with coinheritance of HbS, it produced small additional abnormal Hb peaks (4.6% in heterozygous and 11.9% in homozygous member) in HPLC with a longer RT (5.15–5.17 min) possibly resulting from a combination of HbO Indonesia alpha chain with HbS beta chain. Conclusions: It appears that depending on the zygosity of HbS, HbO Indonesia would subtract a variable amount of HbS beta chain from the total pool, thereby potentially reducing the clinical severity of HbS disease. HbO Indonesia per se does not cause anemia or alter the red cell indices

Coronary Plaque Microstructure and Composition Modify Optical Polarization

Objectives: This study aimed to evaluate whether polarimetry, performed using a modified optical frequency domain imaging (OFDI) system, can improve the assessment of histological features relevant to characterizing human coronary atherosclerosis. Background: The microscopic structure and organization of the arterial wall influence the polarization of the infrared light used by OFDI. Modification of the OFDI apparatus, along with recently developed image reconstruction methods, permits polarimetric measurements simultaneously with conventional OFDI cross-sectional imaging through standard intravascular imaging catheters. Methods: The main coronary arteries of 5 cadaveric human hearts were imaged with an OFDI system capable of providing polarimetric assessment. Cross-sectional views of tissue birefringence, measured in refractive index units, and depolarization, expressed as the ratio of depolarized signal to total intensity, were reconstructed, together with conventional OFDI images. Following imaging, the vessels underwent histological evaluation to enable interpretation of the observed polarization features of individual tissue components. Results: Birefringence in fibrous tissue was significantly higher than in intimal tissue with minimal abnormality (0.44 × 10-3 vs. 0.33 × 10-3; p < 0.0001). Birefringence was highest in the tunica media (p < 0.0001), consistent with its high smooth muscle cell content, cells known to associate with birefringence. In fibrous areas, birefringence showed fine spatial features and close correspondence with the histological appearance of collagen. In contrast, necrotic cores and regions rich in lipid elicited significant depolarization (p < 0.0001). Depolarization was also evident in locations of cholesterol crystals and macrophages. Conclusions: Intravascular measurements of birefringence and depolarization can be obtained using conventional OFDI catheters in conjunction with a modified console and signal processing algorithms. Polarimetric measurements enhance conventional OFDI by providing additional information related to the tissue composition and offer quantitative metrics enabling characterization of plaque features