Critical signs and symptoms for self-assessment in the immediate postnatal period: an international Systematic Scoping Review and Delphi consensus study

Background Every two minutes a woman dies from complications of pregnancy and childbirth. Most maternal deaths occur within the first 24 hours following birth, highlighting the importance of immediate postnatal care (iPNC). Self-care strategies are increasingly being employed to promote women-centred, continuous care provision. Despite international calls for development of strategies promoting self-care, none have been developed for self-monitoring in the immediate postnatal period. Fundamental to the development of a self-monitoring strategy, is an understanding of which signs and symptoms are predictive of maternal morbidity and mortality and can be easily assessed by mothers and birth companions, in health facilities, without the need for equipment. The objective of this study was to develop and achieve international consensus on the key signs and symptoms. Methods A multi-step approach involving a systematic scoping review, two- round Delphi Survey, and expert consensus was employed to identify key signs and symptoms that can be self- assessed and predict morbidity and mortality in the immediate postnatal period. Results A comprehensive list of 351 key signs and symptoms was identified from 44 clinical practice guidelines. Subsequently, 134 signs and symptoms were reviewed by Delphi respondents and international expert consensus was achieved for 19 key signs and symptoms across seven condition categories. The signs that were considered both important and able to be self-assessed by mothers and birth companions in the first 24 hours following birth included change in consciousness, seizure, severe headache, persistent visual impairment, urinary incontinence, chest pain, shortness of breath, severe pallor, fast heartbeat, rejection of baby, suicidal/infanticidal, fever, heavy blood loss, soft flabby uterus, unable to urinate easily, foul smelling discharge, rigors, syncope/dizziness, abnormal coloured urine. Conclusion This study identified key signs and symptoms which can be easily assessed by mothers and birth companions in the immediate postnatal period to identify those most at risk of morbidity and mortality. Further work is needed to validate this screening tool, and adapt it regionally and nationally

Chromosome Xq23 is associated with lower atherogenic lipid concentrations and favorable cardiometabolic indices

AbstractAutosomal genetic analyses of blood lipids have yielded key insights for coronary heart disease (CHD). However, X chromosome genetic variation is understudied for blood lipids in large sample sizes. We now analyze genetic and blood lipid data in a high-coverage whole X chromosome sequencing study of 65,322 multi-ancestry participants and perform replication among 456,893 European participants. Common alleles on chromosome Xq23 are strongly associated with reduced total cholesterol, LDL cholesterol, and triglycerides (min P = 8.5 × 10−72), with similar effects for males and females. Chromosome Xq23 lipid-lowering alleles are associated with reduced odds for CHD among 42,545 cases and 591,247 controls (P = 1.7 × 10−4), and reduced odds for diabetes mellitus type 2 among 54,095 cases and 573,885 controls (P = 1.4 × 10−5). Although we observe an association with increased BMI, waist-to-hip ratio adjusted for BMI is reduced, bioimpedance analyses indicate increased gluteofemoral fat, and abdominal MRI analyses indicate reduced visceral adiposity. Co-localization analyses strongly correlate increased CHRDL1 gene expression, particularly in adipose tissue, with reduced concentrations of blood lipids.Abstract Autosomal genetic analyses of blood lipids have yielded key insights for coronary heart disease (CHD). However, X chromosome genetic variation is understudied for blood lipids in large sample sizes. We now analyze genetic and blood lipid data in a high-coverage whole X chromosome sequencing study of 65,322 multi-ancestry participants and perform replication among 456,893 European participants. Common alleles on chromosome Xq23 are strongly associated with reduced total cholesterol, LDL cholesterol, and triglycerides (min P = 8.5 × 10−72), with similar effects for males and females. Chromosome Xq23 lipid-lowering alleles are associated with reduced odds for CHD among 42,545 cases and 591,247 controls (P = 1.7 × 10−4), and reduced odds for diabetes mellitus type 2 among 54,095 cases and 573,885 controls (P = 1.4 × 10−5). Although we observe an association with increased BMI, waist-to-hip ratio adjusted for BMI is reduced, bioimpedance analyses indicate increased gluteofemoral fat, and abdominal MRI analyses indicate reduced visceral adiposity. Co-localization analyses strongly correlate increased CHRDL1 gene expression, particularly in adipose tissue, with reduced concentrations of blood lipids

Neuroprotection with Glycine-2-methylproline-Glutamate (G-2MePE) after hypoxic-ischemic brain injury in adult rats

Background and Purpose: Hypoxic -ischemic brain injury, due to reduced supply of oxygen, is a major cause of death and disability. There is no exclusive treatment available so far. Glycine-2-Methylproline-Glutamate(G-2MePE, NNZ 2566) , an analogue of Glycine-Proline-Glutamate reduces neuronal injury after focal ischemia in adult rats. The current study investigated into the neuroprotective effects of G-2MePE (1.2mg/kg) 3h post hypoxic-ischemic brain injury or the same volume of normal saline. Brains were extracted 5 days after the treatment. Tissue damage in the cortex, hippocampus and striatum was assessed. Neuronal survival, glial reactions, caspase-3 activity and TNF-a cytokine activity were also assessed. Results: The treatment with G-2Me-PE was associated with a significant reduction of tissue damage, improvement in neuronal survival, reduction in reactive microglia, TNF-a positive cells and caspase-3 positive cells in hippocampus and cortex but an elevation of astrocytosis. Conclusion: Neuroprotection with G-2MePE after hypoxic -ischemic brain injury in adult rats is associated with reduced neuronal necrosis, apoptosis, modulated inflammatory response and augmented astrocytosis

Structural, Optical, and Compactness Characteristics of Nanocrystalline CaNb2O6 Synthesized through an Autoigniting Combustion Method

Nanoparticles of calcium metaniobate compound are prepared by an autoigniting combustion technique and its structural, optical, and dielectric properties are investigated. The X-ray diffraction, Fourier-transform Raman, and infrared studies reveal that calcium metaniobate possesses phase pure orthorhombic columbite structure with space group of Pbcn. The average particle size of the as-prepared nanoparticles obtained from both the Scherrer formula and transmission electron microscopy is ~37 nm. The optical band gap calculated from Tauc's Plot is 3.25 eV. Photoluminescence studies reveal that Calcium metaniobate can be used as an idealphotoluminarmaterial. The powders are pelletised and sintered at an optimized temperature of 1350∘C in a short duration of two hours, yielding a high density. The morphology of the sintered pellet is further examined using scanning electron microscopy. The dielectric constant and loss factor values measured at 5 MHz for a well-sintered Calcium metaniobate pellet are found to be 27.6 and 5.3×10−4 respectively, at room temperature

A novel diketopiperazine improves functional recovery given after the onset of 6-OHDA induced motor deficit in rats

Cyclo-L-glycyl-L-2-Allylproline (NNZ 2591) , a modified diketppiperazine, is neuroprotective and improves long-term function after hypoxic-ischemic brain injury in rats. The present studies reveal that early treatment with NNZ 2591 protects against the motor deficit induced by 6-OHDA and the tretment initiated after the establishment of motor impairment siginificantly improves long-term motor function. These effects of NNZ 2591 on functional recovery were independent of dopamine depletion and also appeared not to be symptomatic as the improved motor function was long -lasting. NNZ 2591 has potential as a therapeutic agent for neurodegeneratiive disorder