Population-based rates, timing and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa: a multi-country prospective cohort study

BackgroundModelled mortality estimates have been useful for health programmes in low-income and middle-income countries. However, these estimates are often based on sparse and low-quality data. We aimed to generate high quality data about the burden, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in south Asia and sub-Saharan Africa.MethodsIn this prospective cohort study done in 11 community-based research sites in south Asia and sub-Saharan Africa, between July, 2012, and February, 2016, we conducted population-based surveillance of women of reproductive age (15–49 years) to identify pregnancies, which were followed up to birth and 42 days post partum. We used standard operating procedures, data collection instruments, training, and standardisation to harmonise study implementation across sites. Verbal autopsies were done for deaths of all women of reproductive age, neonatal deaths, and stillbirths. Physicians used standardised methods for cause of death assignment. Site-specific rates and proportions were pooled at the regional level using a meta-analysis approach.FindingsWe identified 278 186 pregnancies and 263 563 births across the study sites, with outcomes ascertained for 269 630 (96·9%) pregnancies, including 8761 (3·2%) that ended in miscarriage or abortion. Maternal mortality ratios in sub-Saharan Africa (351 per 100 000 livebirths, 95% CI 168–732) were similar to those in south Asia (336 per 100 000 livebirths, 247–458), with far greater variability within sites in sub-Saharan Africa. Stillbirth and neonatal mortality rates were approximately two times higher in sites in south Asia than in sub-Saharan Africa (stillbirths: 35·1 per 1000 births, 95% CI 28·5–43·1 vs 17·1 per 1000 births, 12·5–25·8; neonatal mortality: 43·0 per 1000 livebirths, 39·0–47·3 vs 20·1 per 1000 livebirths, 14·6–27·6). 40–45% of pregnancy-related deaths, stillbirths, and neonatal deaths occurred during labour, delivery, and the 24 h postpartum period in both regions. Obstetric haemorrhage, non-obstetric complications, hypertensive disorders of pregnancy, and pregnancy-related infections accounted for more than three-quarters of maternal deaths and stillbirths. The most common causes of neonatal deaths were perinatal asphyxia (40%, 95% CI 39–42, in south Asia; 34%, 32–36, in sub-Saharan Africa) and severe neonatal infections (35%, 34–36, in south Asia; 37%, 34–39 in sub-Saharan Africa), followed by complications of preterm birth (19%, 18–20, in south Asia; 24%, 22–26 in sub-Saharan Africa).InterpretationThese results will contribute to improved global estimates of rates, timing, and causes of maternal and newborn deaths and stillbirths. Our findings imply that programmes in sub-Saharan Africa and south Asia need to further intensify their efforts to reduce mortality rates, which continue to be high. The focus on improving the quality of maternal intrapartum care and immediate newborn care must be further enhanced. Efforts to address perinatal asphyxia and newborn infections, as well as preterm birth, are critical to achieving survival goals in the Sustainable Development Goals era

Emerging applications of immunohistochemistry in head and neck pathology

Immunohistochemistry is important in diagnosis, investigation, and determining the behavior and pathogenesis of oral tumors. Immunohistochemistry protocols were developed using antibodies tagged with chromogens to identify specific markers. In these protocols, antigen-antibody reactions using nonfluorescent chromogens are analyzed in an optical microscope. Specific diagnostic markers appear extensively in cells of a particular neoplasm and not in other tumors. These markers can be used to assess the cellular lineage and histogenic origin of various neoplasms. This paper reviews the literature on Emerging Applications of Immunohistochemistry in Head and Neck Pathology

Botox: In orthodontics

Botulinum toxin type A (BTX-A) (Botox, Allergan, Irvine, CA, USA) has been studied since the late 1970s for the treatment of several conditions associated with excessive muscle contraction. Smile esthetics has become a major concern among patients and orthodontists. This article describes the efficient, nonsurgical, and less invasive use of BTX-A injection for the correction of a gummy smile in orthodontics

Comparison of the efficacy of ibuprofen and belladonna in the control of orthodontic separator pain

Background: The purpose of this study was to compare the efficacy of ibuprofen and Belladonna in the control of orthodontic pain and to ascertain the pain relief by Belladonna in comparison with ibuprofen during orthodontic separation. Materials and Methods: Patients, between 20 and 35 years of age, 51 females and 21 males, were included in this study. Patients were randomly divided into two groups; one group was assigned to ibuprofen 400 mg and second group was allocated to Belladonna 6C group. Patients were given two doses of medication of their respective groups, 1 h before placement of elastomeric separators (Ormco Separators, Ormco Corporation, CA, USA) which was administered in the department and one dose 6 h after the placement. Pain scores recorded on visual analogue scale (VAS). VAS was a 10 cm scale with millimetre calibration to record their pain at the following intervals, 2 h after placement, 6 h after placement, bedtime, day 1 morning, day 2 morning, day 3 morning and day 5 morning. Results: Post hoc comparisons indicated that there was no difference between the two groups at 2 h (P = 0.77), 6 h (0.073), 1 day (P = 0.120), 2 days (P = 0.283), 3 days (P = 0.363), 5 days (P = 0.622) and 7 days. Conclusion: Ibuprofen and Belladonna 6C are effective and provide adequate analgesia with no statistically significant difference. Lack of adverse effects with Belladonna 6C makes it an effective and viable alternative

Severe skeletal Class II Division 1 malocclusion in postpubertal girl treated using Forsus with miniplate anchorage

This case report outlines the treatment of a 17-year-old female with Class II Division 1 malocclusion with mandibular retrusion, deep bite, and convex facial profile. The Forsus fatigue resistance device with miniplate was used for this patient and it was very affecting tool in correcting both skeletal and dental parameters. The total active treatment time was 19 months. This method can serve as an alternate choice of treatment, especially those who refuse orthognathic surgery. Hence, Forsus with miniplate might be useful in both growing and postpubertal patients

Assessment of stress changes in dentoalveolar and skeletal structures of the mandible with the miniplate anchored Forsus: A three-dimensional finite element stress analysis study

Objective: The study conducted to assess the effects of a fixed functional appliance (Forsus Fatigue Resistant Device; 3M Unitek, Monrovia, CA, USA) on the mandible with three-dimensional (3D) finite element stress analysis. Materials and Methods: A 3D finite element model of mandible with miniplate at mandibular symphysis was prepared using SolidEdge software along with the plate geometry. The changes were deliberated with the finite element method, in the form of highest von Mises stress and maximum principal stress regions. Results: More areas of stress were seen in the model of the mandible at cortical bone in canine region at bone and miniplate interface. Conclusions: This fixed functional appliance studied by finite element model analysis caused more von Mises stress and principal stress in both the cortical bone and the condylar region