Effects of irregular antenatal care attendance in primiparas on the perinatal outcomes: a cross sectional study

Aim: Antenatal care (ANC) is a key strategy for reducing maternal and neonatal morbidity and mortality rates because adequate utilization of antenatal health care services is associated with improved maternal and neonatal health outcomes. The current study aims to identify the factors causing lack of regular attendance at ANC clinics in primiparas and to determine the effects of lack of antenatal care on perinatal outcomes. Methods: A cross sectional study was carried out at Assiut Women\u27s Health Hospital, Egypt between October 2015 and September 2016. Estimated sample size of 516 primiparous women were divided into two groups according to number of attendance to ANC clinics; women who came four visits or more were considered regular and those who came to less than four visits were considered irregular. Data was collected via a structured interview questionnaire that included personal data, obstetrical, data about current pregnancy and labor. The researcher interviewed the women within 24 hours postpartum. Results: The majority of the study sample (74.8%) had regular ANC visits while only (25.2%) had \u3c4 antenatal visits. Financial problems (44.6%) or lack of awareness about the importance of ANC (20%) were the most common reasons for irregular ANC visits. The incidence of preeclampsia and eclampsia is significantly higher in the irregular attendants (p=0.000). Similarly, preterm birth, stillbirth and low birth weight were significantly more common among irregular attendants (p=0000). Conclusion: Women with irregular antenatal care attendance are much more prone to pregnancy complications such as preeclampsia, eclampsia and anemia besides higher adverse birth outcomes including preterm birth, low birth weight and stillbirth

Churg Strauss Syndrome – Case Report

We report a 49 year old male patient who presented with swelling in both thighs without pain and dyspnea. Platelet count was low (13,000/mm3) with increased eosinophils (48.9%). Patient developed pulmonary embolism. His ADAMTS 13 level was low and was therefore diagnosed as TTP. Treatment given was corticosteroid and plasma exchange. After a year he developed a lump in the skull. Histopathology report revealed vasculitis. Due to presence of vasculitis (TTP) along with eosinophilia, patient was finally diagnosed as a case of Churg Strauss Syndrome (CSS)

Association between non-acute traumatic injury (TI) and heart rate variability (HRV) in adults: A systematic review protocol.

Heart Rate Variability (HRV) is an indirect measure of autonomic function. Attenuated HRV is linked to worsening health outcomes including Major Adverse Cardiovascular Events (MACE). The relationship between traumatic injury (TI) and HRV has been limitedly studied. This research protocol has been designed to conduct a systematic review of the existing evidence on the association between non-acute TI and HRV in adults. Four electronic bibliographic databases (Web of Science, CINAHL, Medline, and Scopus) will be searched. The studies on non-acute (>7 days post injury) TI and HRV in adults will be included, followed by title-abstract screening by two reviewers independently. The quality and risk of bias of the included studies will be assessed using Axis and a six-item Risk of Bias Assessment tool for of Non-randomized Studies (RoBANS) respectively. Grading of Recommendations Assessment, Development and Evaluation (GRADE) will assess the quality of evidence. The extracted data will be synthesized using narrative syntheses and a Forest plot with or without meta-analysis- whichever permitted by the pooled data. This will be the first systematic review to examine the relationship between generalized TI and HRV in adults. Trial registration: (PROPSERO registration number: CRD: CRD42021298530) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021298530

Reliability of carotid-femoral arterial waveforms for the derivation of ultra-short term heart rate variability in injured British servicemen: An inter-rater reliability study

In this study, the comparative precision of carotid versus femoral arterial waveforms to measure ultra-short term heart rate variability (HRVUST) following traumatic injury was investigated for the first time. This was an inter-rater reliability study of 50 British servicemen (aged 23–44 years) with non-acute combat-related traumatic injury (CRTI). Paired continuous arterial waveform data for HRVUST analysis, were simultaneously sampled at the carotid and femoral arterial sites (14–16 seconds) during pulse wave velocity (PWV) measurement. HRVUST was reported as the root mean square of the successive differences (RMSSD). Following the determination of the superior sampling site (carotid versus femoral), the blinded inter-rater agreement in RMSSD for the preferred site was quantified using the Intra-class Correlation Coefficient (ICC) and the Bland-Altman plot. The mean age of participants was 34.06±4.88 years. The femoral site was superior to the carotid site with a significantly higher number of reliable signals obtained (Fisher’s Exact test; p<0.001). The inter-rater agreement in femoral-derived RMSSD was excellent [ICC 0.99 (95%CI: 0.994–0.997)] with a moderate level of agreement (mean difference [bias]: 0.55; 95% CI: -0.13–1.24 ms). In this study, we demonstrated that the femoral artery is a more reliable site than the carotid artery for HRVUST measurement and post-trauma risk stratification following CRTI

Association between non-acute Traumatic Injury (TI) and Heart Rate Variability (HRV) in adults: A systematic review and meta-analysis.

Heart rate variability (HRV) is a non-invasive measure of autonomic function. The relationship between unselected long-term traumatic injury (TI) and HRV has not been investigated. This systematic review examines the impact of non-acute TI (>7 days post-injury) on standard HRV indices in adults. Four electronic databases (CINAHL, Medline, Scopus, and Web of Science) were searched. The quality of studies, risk of bias (RoB), and quality of evidence (QoE) were assessed using Axis, RoBANS and GRADE, respectively. Using the random-effects model, mean difference (MD) for root mean square of successive differences (RMSSD) and standard deviation of NN-intervals (SDNN), and standardized mean difference (SMD) for Low-frequency (LF): High-Frequency (HF) were pooled in RevMan guided by the heterogeneity score (I2). 2152 records were screened followed by full-text retrieval of 72 studies. 31 studies were assessed on the inclusion and exclusion criteria. Only four studies met the inclusion criteria. Three studies demonstrated a high RoB (mean RoBANS score 14.5±3.31) with a low QoE. TI was associated with a significantly higher resting heart rate. Meta-analysis of three cross-sectional studies demonstrated a statistically significant reduction in RMSSD (MD -8.45ms, 95%CI-12.78, -4.12, p<0.0001) and SDNN (MD -9.93ms, 95%CI-14.82, -5.03, p<0.0001) (low QoE) in participants with TI relative to the uninjured control. The pooled analysis of four studies showed a higher LF: HF ratio among injured versus uninjured (SMD 0.20, 95%CI 0.01-0.39, p<0.04) (very low QoE). Albeit low QoE, non-acute TI is associated with attenuated HRV indicating autonomic imbalance. The findings might explain greater cardiovascular risk following TI. Trial registration PROSPERO registration number: CRD: CRD42021298530

Exploratory analysis of spontaneous versus paced breathing on heart rate variability in veterans with combat-related traumatic injury

Background: Respiration is a crucial determinant of autonomic balance and heart rate variability (HRV). The comparative effect of spontaneous versus paced breathing on HRV has been almost exclusively explored in healthy adults and never been investigated in an injured military cohort. Objective: To examine the effect of spontaneous versus paced breathing on HRV in veterans with combat-related traumatic injury (CRTI). Design: Observational cohort study. Setting: ArmeD serVices trAuma rehabilitatioN outComE (ADVANCE) study, Stanford Hall, UK. Participants: The sample consisted of 100 randomly selected participants who sustained CRTI (eg, amputation) during their deployment (Afghanistan 2003–2014) and were recruited into the ongoing ADVANCE prospective cohort study. Intervention: Not applicable. Main Outcome Measure: HRV was recorded using a single-lead ECG. HRV data were acquired during a sequential protocol of 5-minute spontaneous breathing followed immediately by 5 minutes of paced breathing (six cycles/minute) among fully rested and supine participants. HRV was reported using time domain (root mean square of successive differences), frequency domain (low frequency and high frequency) and nonlinear (sample entropy) measures. The agreement between HRV during spontaneous versus paced breathing was examined using the Bland–Altman analysis. Results: The mean age of participants was 36.5 ± 4.6 years. Resting respiratory rate was significantly higher with spontaneous versus paced breathing (13.4 ± 3.4 vs. 7.6 ± 2.0 breaths/minute; p < .001), respectively. Resting mean heart rate and root mean square of successive differences were significantly higher with paced breathing than spontaneous breathing (p < .001). Paced breathing significantly increased median low frequency power than spontaneous breathing (p < .001). No significant difference was found in the absolute power of high frequency between the two breathing protocols. The Bland–Altman analysis revealed poor agreement between HRV values during spontaneous and paced breathing conditions with wide limits of agreement. Conclusion: Slow-paced breathing leads to higher HRV than spontaneous breathing and could overestimate resting “natural-state” HRV

The Influence of Physical and Mental Health Mediators on the Relationship Between Combat-Related Traumatic Injury and Ultra-Short-Term Heart Rate Variability in a U.K. Military Cohort: A Structural Equation Modeling Approach

Introduction: Combat-related traumatic injury (CRTI) adversely affects heart rate variability (HRV). The mediating effect of mental and physical health factors on the relationship between CRTI, its severity and HRV has not been previously studied and investigated. Materials and Methods: A cross-sectional mediation analysis of the ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) prospective cohort study was performed. The sample consisted of injured and uninjured British male servicemen who were frequency-matched based on their age, rank, role-in-theater, and deployment to Afghanistan (2003-2014). CRTI and injury severity (the New Injury Severity Scores [NISS] [NISS < 25 and NISS ≥ 25]) were included as exposure variables. HRV was quantifed using the root mean square of successive differences (RMSSD) obtained using pulse waveform analysis. Depression and anxiety mediators were quantifed using the Patient Health Questionnaire and Generalized Anxiety Disorder, respectively. Body mass index and the 6-minute walk test (6MWT) represented physical health measures. Two mediation pathways between exposure and outcome variables were examined in comparison with the uninjured group using structural equation modeling. Results: Of 862 servicemen, 428 were injured and 434 were uninjured with the mean age at assessment of 33.9 ± 5.4 (range 23-59) years. Structural equation modeling revealed that depression, anxiety, and body mass index did not signifcantly mediate the relationship between injury/injury severity and RMSSD. However, the 6MWT significantly mediated the relationship between CRTI and RMSSD (27% mediation). The indirect effect of 6MWT on the relationship between injury severity (NISS ≥ 25 vs. uninjured) and RMSSD was −0.06 (95% CI: −0.12, −0.00, P < .05). Conclusions: The fndings suggest that greater physical function may improve HRV following CRTI. Longitudinal studies are warranted to further validate these fndings

Biotechnology: a powerful tool for the removal of cadmium from aquatic systems

The prime objective of the present research work was to evaluate the efficiency of bio-machine for the removal of Cadmium (Cd) from aquatic systems. Aspergillus niger fungus was used as bio-machine to remove Cd from aquatic systems. Twenty three different strains (IIB-1 to IIB-23) were isolated from industrial effluents and the Langmuir and Freundlich models were applied to the best Cadmium removal strain IIB-23 in order to obtain the adsorption parameters. Different parameters such as pH, temperatur e, contact time, initial metal concentratio, and biomass dosage on the biosorption of Cd were studied. The percent removal of Cd initially increased with an increase in pH ranging from 5.5-6.5 and then decreased by increasing pH from 7.0-7.5. An optimized pH used for Cd removal from aquatic systems was found to be 6.5. Additionally, an optimum amount of biomass was 1.33 g for the maximum removal of Cd from the aqueous solutions with initial metal concentration of 75 mg/L. The results obtained thus indicated that Langmuir model is the best suited for the removal of Cd from aquatic systems

Estimating Leaching Requirements for Barley Growth under Saline Irrigation

The utilization of marginal water resources for agriculture is receiving considerable attention. The lands irrigated with saline water are required to reduce salt accumulations through leaching and/or drainage practices. A field experiment was carried out to investigate the effect of saline irrigation and leaching fraction on barley (Hordeum vulgare L.) growth. For this purpose highly saline water was diluted to the salinity levels of 3, 6 and 9 dS m-1 and applied by drip irrigation at 0.0, 0.15, 0.20 and 0.25 leaching fractions (LF). The results of the experiment showed that both quantity and quality of water regulated salts distribution within the soil in the following manner: a) the salts were found higher near or immediate below the soil surface; b) an enhanced LF carried more salts down the soil horizon but there was no significant difference in plant yield between different treatments of leaching fractions. Salinity of water significantly impaired barley growth. The good drainage of sandy soil enhanced the leaching process and minimized the differences between leaching fractions. The increment in saline treatments (3, 6 and 9 dS m-1) added more salts and stressed plant growth. However, the conjunctive use of marginal water at proportional LF could be effective in enhancing the yield potential of crops in water-scarce areas