Antepartum transabdominal amnioinfusion in oligohydramnios - a comparative study

Background: The purpose of this study was to evaluate the role of antepartum transabdominal amnioinfusion in oligohydramnios with the view to improving pregnancy outcome in oligohydramnios, a serious complication of pregnancy that is associated with a poor perinatal outcome and complicates 1-5% of pregnancies.Methods: The study comprised of a prospective analysis of 130 pregnant women with oligohydramnios, divided into two groups, the study and control group of 65 patients each and were similar with regard to age, gravidity, parity, gestational age. TAA was performed on all patients in the study group and the results were compared and analyzed.Results: Mean gestational age at first treatment was 29.98 weeks in study group. Mean pre-procedure amniotic fluid index was 4.01 and post-procedure was 12.49. A total of 106 infusions were done on 65 patients (mean1.63). Mean latency period in study group was 49.53 and in controls 26.49. There was significant decrease in fetal distress in patients in study group. 30 % of patients needed caesarean section in study group compared to 60% in controls. Number of preterm deliveries was 18 and 45 respectively in study and control groups. 61% of newborns in the study group weighed more than 2.5 kg compared to only 24% in control group. Neonatal ICU admissions and newborn deaths were lesser in study group.Conclusions: Transabdominal amnioinfusion is an extremely useful procedure to reduce complications arising from oligohyramnios. It significantly increases the latency period, decreases the occurrence of fetal distress preterm deliveries, need for caesarean or instrumental deliveries, improves birth weight of the newborns and significantly reduces the neonatal morbidity and mortality

Spectrum of abdominal organ injury in a primary blast type

Research articl

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Diagnostic role of magnetic resonance hysterosalpingography in the evaluation of female infertility

Abstract Background In the evaluation of female infertility, hysterosalpingography (HSG) with fluoroscopy provides limited evaluation of congenital uterine malformation and extrauterine disease. Transvaginal ultrasonography (TVS) is though commonly used, has its limitations in assessment of tubes. Addition of sonosalpingography can help assess tubal patency but may be inconclusive in cases of unilateral or bilateral obstruction and is grossly operator dependent. Recent past has seen evolution of magnetic resonance imaging (MRI) to evaluate problems associated with female infertility, with unparalleled advantages of having no radiation and being less operator-dependent. The need to assess tubal patency has been addressed by increasing literature on utilization of gadolinium (Gd) in MRI and comparing it with HSG alone or a mixture of HSG and laparoscopy. We aimed to evaluate the sensitivity and specificity of using magnetic resonance imaging (MRI) and magnetic resonance hysterosalpingography (MRHSG) as a screening test for female infertility and to compare accuracy, positive predictive value and efficacy of MRI and MRHSG with laparoscopy. Results Fifty-four out of 63 patients had bilateral tubal patency (85.7%). Nine patients had tubal pathology (14.3%) out of which one had unilateral and eight had bilateral tubal obstruction. Endometrial cavity abnormality was found in four patients and ovarian abnormalities were detected in 28.5% patients. MRHSG has shown high sensitivity and specificity for tubal patency evaluation when compared to the true gold standard for tubal patency assessment, laparoscopic chromotubation. With laparoscopy as standard, there was 100% sensitivity and specificity for structural abnormality, myometrial abnormalities and endometrial cavity assessment in MRHSG. Conclusions In comparison with diagnostic laparoscopy, MRHSG was found to have good sensitivity and specificity for assessment of tubal patency, excellent sensitivity and specificity for the assessment of structural malformation and endometrial cavity lesions. Furthermore MRHSG was good in picking up extra-uterine diseases