Maternal and perinatal outcomes in pregnancy with high BMI in the Jabal Akhdar region of Libya

Background: Overweight maternal pre-pregnancy, obesity and excessive gestational weight gain are significant risk factors for unfavorable maternal and perinatal outcomes during pregnancy. The association of obesity with maternal and perinatal outcomes is poorly understood in Jabal Akhdar region of Libya. This study was to examine maternal and perinatal outcomes in obese mothers compared to non-obese mothers in Jabal Akhdar region of Libya.Methods: This is a Cross sectional survey design study with internal comparison groups. The study was conducted between May 2015 and May 2016 in Jabal Akhdar region od Libya. A total of 415 women at reproductive age were deemed eligible for this study. BMI categories were defined as; underweight (BMI30 kg/m2. Pregnancy-induced hypertension was more prevalent in obese mothers compared to non-obese women. The rate of operative delivery and caesarean section were also demonstrated between obese and non-obese mothers and these differences were significant.Conclusions: This study demonstrates extent of obstetric risks associated with obesity in pregnancy, though more research is required to fully elucidate the effect that maternal obesity is having on maternal and perinatal outcomes in pregnancy in Libyan populations. Since high weight gain is a modifiable risk factor, pre pregnancy health education awareness of health care providers, good behavioral counseling and weight control program during pregnancy should help to modify this risk

Impact of Covid-19 on Online Teaching of Obstetrics and Gynaecology

The Covid-19 pandemic has tremendous effect in the educational system worldwide, resulting in closure of schools, colleges and universities. Royal College of surgeons, Ireland was among the first institutions to shut down their campus facilities. This meant that students and staff had to turn to online teaching in order to continue their education. This change dramatically altered the teaching environment and required both students and educators to adapt and be creative. Here, the author reports a reflection on their online teaching of two different groups of undergraduate medical students and the challenges students and educators faced during this perio

Diagnostic and prognostic biomarkers in ovarian cancer

THESIS 10784Ovarian cancer is the fifth most common cancer in women and the most frequent cause of gynaecological malignancy-related mortality in women. The vast majority present in advanced stages and this is due to lack of a reliable screening test and the vagueness of symptoms. Acquired resistance to further chemotherapy is generally responsible for treatment failure. Currently, no standardized reliable screening test exists. Pelvic examination is practiced widely, but it is not sensitive enough to be used as a reliable screening tool. There is a need for reliable diagnostic and prognostic markers for this disease. MicroRNA profiling has allowed the identification of signatures associated with diagnosis, prognosis and response to treatment of human tumours. Furthermore a novel biomarker Human epididymis protein 4 (HE4) has been recently demonstrated to be a sensitive and specific serum biomarker for ovarian cancer that is elevated less frequently by benign conditions that occur in premenopausal women

Covid-19 and teaching challenges

The coronavirus 2019 (COVID-19) pandemic has impacted all aspects of the healthcare system, particularly education. Educators were required to re-evaluate and fundamentally alter the way medical students are being taught, balancing concerns of safety and sufficient clinical learning. Of particular interest is the impact of COVID-19 on clinical obstetrics and gynaecology (OBGYN) rotations for medical students.</p

Role of Color Doppler Ultrasound in Prediction of Adherent Placenta Previa

IntroductionAdherent placenta is a decidualisation disorder that includes placenta accreta, increta, and percreta. They are uncommon but potentially life-threatening conditions due to the risk of massive hemorrhage that may warrant hysterectomy. Risk factors include age, multiparity, previous uterine scar and placenta previa. Prediction of adherent placenta is possible using color Doppler ultrasonography.The aims of this study are to describe the pattern of adherent placenta among cases of placenta previa and to investigate diagnostic performance of abdominal ultrasound scanning and Doppler ultrasound in diagnosis of adherent placenta among placenta previa. Materials and methodsA prospective study over a 4-month period from August 2016 – November 2016 with institutional ethical approval was conducted in Benghazi Medical Centre, Libya. Ninety-one women with placenta previa complicated pregnancies, who had Doppler ultrasound at 36 weeks gestation, were included in the study.ResultsOf 91 cases of placenta previa, 16.5% among them were adherent. Risk factors for adherent placenta in placenta previa only included the history of previous scars as more cesarean sections was significantly related to the occurrence of adherent placenta (P = 0.029). Presence of previous scar confers a high sensitivity (86.7%) and a high negative predictive value (94.3%). Doppler ultrasound predicted adherent placenta with different signs, the most sensitive being retroplacental hypervascularity and placenta covering the os (86.7%) while serosal disruption was the most specific sign (100.0%). The highest overall test performance signs were serosal disruption (89.0%), followed by presence of lacunae and absence of retroplacental clear zone (both 85.7%).ConclusionPlacenta previa confers high risk for adherent placenta, with 16.5% of cases of placenta previa having adherent placenta. Doppler ultrasound predicted adherent placenta with different signs, the most sensitive being retroplacental hypervascularity and placenta covering the os while serosal disruption was the most specific sign. Further well-designed research investigating abnormal decidualisation disorders and factors related to adherent placenta is required

Pre-Treatment of Platinum Resistant Ovarian Cancer Cells with an MMP-9/MMP-2 Inhibitor Prior to Cisplatin Enhances Cytotoxicity as Determined by High Content Screening

Platinum resistance is a major cause of treatment failure in ovarian cancer. We previously identified matrix metalloproteinase 9 (MMP-9) as a potential therapeutic target of chemoresistant disease. A2780cis (cisplatin-resistant) and A2780 (cisplatin-sensitive) ovarian carcinoma cell lines were used. The cytotoxic effect of MMP-9/MMP-2 inhibitor, (2R)-2-[(4-Biphenylsulfonyl) amino]-3 phenylpropionic acid (C21H19NO4S) alone or in combination with cisplatin was determined using high content screening. Protein expression was examined using immunohistochemistry and ELISA. Co-incubation of cisplatin and an MMP-9/MMP-2 inhibitor, (2R)-2-[(4-Biphenylsulfonyl) amino]-3 phenylpropionic acid (C21H19NO4S) resulted in significantly greater cytotoxicity as compared to either treatment alone in a cisplatin resistant MMP-9 overexpressing cell line; A2780cis. In addition, pre-incubating with MMP-9i prior to cisplatin further enhances the cytotoxic effect. No significant difference was observed in MMP-9 protein in tissue but a trend towards increased MMP-9 was observed in recurrent serum. We propose that MMP-9/MMP-2i may be utilized in the treatment of recurrent/chemoresistant ovarian cancers that overexpress MMP-9 mRNA but its role in vivo remains to be evaluated