Evaluation of the association between dyslipidemia and hypertensive disorder of pregnancy: a nested case control study

Background: Hypertensive disorders of pregnancy are an elusive group of diseases with multifactorial etiopathologies and varied manifestation. Abnormal pre pregnancy lipid profile is shown to have a positive correlation with endothelial dysfunction which in turn leads to development of hypertensive disorder of pregnancy.Methods: A total of 222 pregnant women who were aged between 18-35 years, with no obstetric and medical risk factors and less than 16 weeks of gestation who gave informed written consent were recruited for the study. Their baseline demographics and fasting blood samples were collected, blood samples were centrifuged, and serum was stored at -80-degree celsius. Patients were followed up till delivery and those with hypertensive disorders in pregnancy (n=22) was identified, defined as case. Control was selected after matching for body mass index and frozen serum samples were analyzed.Results: Overall incidence of hypertensive disorders in pregnancy in the study group was 12.4%. The mean early trimester fasting lipid values were higher in patients who developed hypertensive disorders, difference in mean between cases and controls was TC  - 16.25 mg/dl (p-0.061), TGL- 21.45 mg/dl (p-0.143),  LDL- 2.4 mg/dl (p-0.82) and for HDL 4.55 mg/dl (p-0.25). However, on stratification of early trimester fasting lipid level based on National Cholesterol Education Program (NCEP) criteria, Total cholesterol level greater than 160 mg/dl showed an odds ratio of 12.66 (p-0). Patients with early trimester fasting total cholesterol levels greater than 160mg/dl has a higher risk of developing hypertensive disorder in pregnancy.

Process evaluation protocol for the I-WOTCH study : an opioid tapering support programme for people with chronic non-malignant pain

Introduction The Improving the Wellbeing of people with Opioid Treated CHronic Pain (I-WOTCH) randomised controlled trial uses a multicomponent self-management intervention to help people taper their opioid use. This approach is not widely used and its efficacy is unknown. A process evaluation alongside the trial will help to assess how the intervention was delivered, looking at the dose of intervention received and the fidelity of the delivery. We will explore how the intervention may have brought about change through the experiences of the participants receiving and the staff delivering the intervention and whether there were contextual factors involved. Methods and analysis A mixed methods process evaluation will assess how the processes of the I-WOTCH intervention fared and whether these affected the outcomes. We will collect quantitative data, for example, group attendance analysed with statistical methods. Qualitative data, for example, from interviews and feedback forms will be analysed using framework analysis. We will use a ‘following a thread’ and a mixed methods matrix for the final integrated analysis. Ethics and dissemination The I-WOTCH trial and process evaluation were granted full ethics approval by Yorkshire and The Humber—South Yorkshire Research Ethics Committee on 13 September 2016 (16/YH/0325). All data were collected in accordance with data protection guidelines. Participants provided written informed consent for the main trial, and all interviewees provided additional written informed consent. The results of the process evaluation will be published and presented at conferences

Mental Health Problems among Medical Students during COVID-19 Lockdown: A Cross- Sectional Study

Background: COVID-19, which originated in China, became a pandemic affecting more than 180 countries. By April 2020, India had announced lockdown in an attempt to control the spread of the virus. Lack of social interaction and apprehension about the studies had created emotional disturbances among medical students. Methods: The study was done in a medical college situated in Central Travancore, Kerala, between 2020 April 20 to May 31. Depression Anxiety Stress Scale (DASS) and Impact Event Scale-Revised (IES-R) were administered in Google forms to the MBBS batch WhatsApp groups. Results: Out of 320 responses from medical students, 239 were females, and 82 were male students. 56% of male students and 54% of female students have mild to severe depressive symptoms, 58% of male students and 54% of female students have symptoms of anxiety, and 63% of male students and 50% of female students experienced mild to severe stress.68% of males and 62% of females have higher Impact events scale. Conclusion: There is a high prevalence of anxiety and depression among medical students during the COVID lockdown period. There is a significant difference between genders in scores of anxiety, stress and impact of events. This shows the need for resilience training among medical students

Dynamical Properties of Postural Control in Obese Community-Dwelling Older Adults

Postural control is a key aspect in preventing falls. The aim of this study was to determine if obesity affected balance in community-dwelling older adults and serve as an indicator of fall risk. The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a longitudinal assessment of their fall history. The standing postural balance was measured for 98 participants with a Body Mass Index (BMI) ranging from 18 to 63 kg/m2, using a force plate and an inertial measurement unit affixed at the sternum. Participants’ fall history was recorded over 2 years and participants with at least one fall in the prior year were classified as fallers. The results suggest that body weight/BMI is an additional risk factor for falling in elderly persons and may be an important marker for fall risk. The linear variables of postural analysis suggest that the obese fallers have significantly higher sway area and sway ranges, along with higher root mean square and standard deviation of time series. Additionally, it was found that obese fallers have lower complexity of anterior-posterior center of pressure time series. Future studies should examine more closely the combined effect of aging and obesity on dynamic balance