Progressing haemolysis, elevated liver enzymes, low platelet count syndrome: near miss case

A 25 years old women presented in labour room with 30 weeks’ pregnancy in labour with breech with previous two caesarean section and scar tenderness with foetal bradycardia (FHR 90) and jaundice. After caesarean section in emergency hour she started bleeding in abdominal drain while uterus was well contracted. On investigation and examination diagnosed as HELLP syndrome, managed promptly by medical teams of three departments (obstetrician, anaesthesia and medicine)

The use of whatsapp social media group for nutrition counselling among parents with children of congenital heart defects

Introduction; Ignorance about appropriate Infant and Young Child Feeding (IYCF) practices among parents with children of Congenital Heart Defects (CHD) can exacerbate malnutrition in these children leading to significant morbidity and mortality. The use of novel methods for Intensive Nutrition Counselling such as in a WhatsApp social media group can result in significant improvements in the child’s nutritional status. Objective of this study is to assess the efficacy of WhatsApp group for Intensive Nutritional Counselling to parents with children of CHD. Methods; This was a two-years prospective interventional study, one-group before-after study design, conducted at a tertiary care referral institute in Central India. Here, intervention is in the form of specialised focused nutrition counselling for parents of children with CHD through a WhatsApp social media group. Results; The majority of the patients 16 (30.0%) were between the ages of 7 and 12 months, and the most common diagnosis in 25 patients (48.9%) was a Ventricular Septal Defect (VSD). 68.0% of patient-families belonged to the lower socio-economic classes. Before the intervention, 71.1% of children (37 of 52) were found to be underweight, 35.5% of children were stunted and 65.6% of children were wasted. Post intervention, there was 50.0% improvement in weight and 14.0% improvement in height. This intervention particularly helped improve IYCF habits for the age group of 7-12 months. Post-intervention, all parents included the 8 food groups in their children’s diet, thus providing them with wholesome nutrition, whereas pre-intervention, parents only provided 2-3 food groups to children on a daily basis. Conclusions; This was the first study to explore the use of WhatsApp groups to educate parents of children with CHD about specific nutrition counselling, resulting in an improvement in all 3 child anthropometric indices

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

Background The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic; characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic; and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and Development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95$7·3 trillion (95% UI 7·2–7·4) in 2019; 293·7 times the $24·8 billion (95$43·1 billion in development assistance was provided to maintain or improve health. The pandemic led to an unprecedented increase in development assistance targeted towards health; in 2020 and 2021, $1·8 billion in DAH contributions was provided towards pandemic preparedness in LMICs, and$37·8 billion was provided for the health-related COVID-19 response. Although the support for pandemic preparedness is 12·2% of the recommended target by the High-Level Independent Panel (HLIP), the support provided for the health-related COVID-19 response is 252·2% of the recommended target. Additionally, projected spending estimates suggest that between 2022 and 2026, governments in 17 (95% UI 11–21) of the 137 LMICs will observe an increase in national government health spending equivalent to an addition of 1% of GDP, as recommended by the HLIP. Interpretation There was an unprecedented scale-up in DAH in 2020 and 2021. We have a unique opportunity at this time to sustain funding for crucial global health functions, including pandemic preparedness. However, historical patterns of underfunding of pandemic preparedness suggest that deliberate effort must be made to ensure funding is maintained

A cross sectional study on the analysis of periodontal parameters in adult patients with clear aligners orthodontics treatment versus three other types of brackets

Objective: To analyse the gingival parameters in the orthodontic treatment using clear aligners versus the three other types of brackets, i.e., conventional metal, conventional ceramic, and metal self‑ligating. Materials and methods: The current study comprised 80 individuals who came in for regular appointments and were receiving orthodontic treatment. They were then separated into four groups, each with 20 patients: Group 1 received traditional brackets (CB); Group 2 received traditional ceramic brackets (CCB); Group 3 received self-ligating (SL) brackets; and Group 4 received clear aligner (CA) treatment. The inclusion criteria were any patient under the age of 18 with a Class II or Class III skeletal link who was receiving orthodontic treatment for at least 6 months with fixed orthodontic appliances (FOA) on their teeth. Smokers, pregnant women, diabetics, and those using medications that impact gingival health or who have cardiovascular illnesses were all excluded from the study. Patients who had used antiseptic solutions or mouthwash in the previous six months, had any periodontal procedures in the previous six months, or had fixed bridges and crowns or extensive restorations adjacent to the gingival borders were also excluded

Vulnerability and Risk Assessment to Climate Change in Sagar Island, India

Inhabitants of low-lying islands face increased threats due to climate change as a result of their higher exposure and lesser adaptive capacity. Sagar Island, the largest inhabited estuarine island of Sundarbans, is experiencing severe coastal erosion, frequent cyclones, flooding, storm surges, and breaching of embankments, resulting in land, livelihood, and property loss, and the displacement of people at a huge scale. The present study assessed climate change-induced vulnerability and risk for Sagar Island, India, using an integrated geostatistical and geoinformatics-based approach. Based on the IPCC AR5 framework, the proportion of variance of 26 exposure, hazard, sensitivity, and adaptive capacity parameters was measured and analyzed. The results showed that 19.5% of mouzas (administrative units of the island), with 15.33% of the population at the southern part of the island, i.e., Sibpur–Dhablat, Bankimnagar–Sumatinagar, and Beguakhali–Mahismari, are at high risk (0.70–0.80). It has been concluded that the island has undergone tremendous land system transformations and changes in climatic patterns. Therefore, there is a need to formulate comprehensive adaptation strategies at the policy- and decision-making levels to help the communities of this island deal with the adverse impacts of climate change. The findings of this study will help adaptation strategies based on site-specific information and sustainable management for the marginalized populations living in similar islands worldwide