Comparison between oxytocin, ergometrine and misoprostol in active management of the third stage of labour: a randomized controlled trial

Background: The aim of the present study was to compare the effectiveness of sublingual misoprostol, intravenous infusion of oxytocin, and intravenous infusion of Ergometrine in reducing blood loss during the third stage of labor.Methods: This is a no-random trial study conducted in in Ribat University Hospital, Khartoum among 150 laboring ladies with a healthy singleton pregnancy. After obtaining their written informed consent to participate in the study, they were randomly assigned to one of three possible treatment groups: 400 μg of sublingual misoprostol; 10 IU of intravenous infusion oxytocin; and 0.5 mg of intravenous infusion of Ergometrine. Blood loss was estimated by weighing the collected blood and converting the weight to milliliters.Results: The shortest mean duration of the third stage of labor was seen in patients who received misoprostol (3.89±0.37 min), followed by oxytocin (4.6±0.9 min), and Ergometrine (5.45±0.9 min). The lowest mean blood loss was seen in the patients who received 400 µg misoprostol (168.36±24.83 ml), followed by those who received 10 IU oxytocin (205.56±34.82 ml), and 0.5 mg Ergometrine (214.49±35.97 ml).Conclusions: Present study showed that 400 µg sublingual misoprostol was more effective than the conventional parenteral uterotonics in reducing the amount of the blood loss during the third stage of labor and has comparable effect to that of 10 IU intravenous oxytocin in shortening the duration of third stage of labor. It also showed that the use of misoprostol reduces the need for extra-uterotonics and blood transfusion

Correlation of ultrasonographic estimated fetal weight with actual birth weight at a rural setting

Background: Ultrasound estimation of fetal weight in term pregnancies is used to determine fetal growth. The objective of this study was to assess the precision of sonographic estimation of fetal weight in normal vaginal deliveries at a rural setting.Methods: The study was cross-sectional. A group of 74 pregnant women delivered normally in Muglad hospital in West Kordofan, Sudan, were considered in the study. Fetal weight was estimated by Hadlock and shephards formulae within one week prior to delivery and then newborn weight was taken within 24 hours after delivery. Data were collected by a questionnaire and medical examination as well as sonographic examination. Data analysis was done by SPSS version 23 and Kruskal Wallis Test (post-hoc analysis) Pearson’s correlation coefficient within 95% confidence interval. p value <0.05 was considered as statistically significant.Results: The correlation, by Paired sample, to assess fetal weight was as follows: between Hadlock and shephards was 0.901 (p < 0.001), between Hadlock and AFW was 0.908 (p < 0.001) and between Shephards and AFW was 0.781 (p < 0.001).Conclusions: Estimation of fetal weight by Hadlock has been more correlated with actual fetal weight (AFW) than that done with shephards. The study recommends using Hadlock formula which is more accurate in estimation of fetal weight by sonography

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Medical students' opinion toward the application of complementary and alternative medicine in healthcare

Context: An accelerated approach to popularize complementary and alternative medicine (CAM) in healthcare services has led to the need to assess medical students' knowledge of CAM. Furthermore, their attitude toward its efficacy and usage will determine its growing popularity in healthcare. Another key idea is to integrate CAM with conventional medical teaching to make it a part of the mainstream medical curriculum. The objectives were to assess the medical students' perceptions about integrating CAM with conventional medicine and to assess the attitude of prescribing different CAM modalities to patients presenting with a particular disease or health disorder. Settings and Design: This is a descriptive, institutional based study conducted on undergraduate 3rd year medical students. Materials and Methods: Data were collected by a structured and pretested questionnaire to be filled in by the participants in the presence of the investigator. Statistical data were entered in SPSS software, and descriptive analysis was conducted. Results: Most of the students (74%) agreed that conventional and CAM therapy can be integrated to achieve a better health care outcome. Forty-eight percent of the participants were positive that knowledge of CAM is important since many patients still prefer this option, particularly for chronic illnesses. Conclusions: The students were receptive to the introduction of a new treatment method in their curriculum, which although unconventional, presents an alternative and traditional form of treatment even if it does not have major backing from the scientific community. The participants felt that more knowledge is required to make an informed opinion about its usefulness to the community as a whole

Satisfaction, self-use and perception of medical students in Majmaah University, Kingdom of Saudi Arabia, towards Complementary and Alternative Medicine

AbstractObjectivesComplementary and Alternative Medicine (CAM) is a growing industry in the health care system, and the use of CAM is rapidly evolving. In the Kingdom of Saudi Arabia (KSA), little research has addressed the satisfaction, use and perception of medical students towards CAM. The objectives of the current study were to assess the level of medical students' satisfaction and perception towards studying CAM and to determine their self-use of different modalities of CAM.MethodsThis descriptive study was conducted by administering a questionnaire to the first and second batches of the medical students studying the CAM module at the College of Medicine, Majmaah University KSA. The instrument used in this study was a validated self-administered questionnaire, and the retrieved data were analysed using SPSS.ResultsThirty students (43%) were satisfied with studying CAM as a part of the medical curriculum. The rest of the students were either dissatisfied (32%) or neutral (25%). The most important CAM modalities self-used by the medical students were prayers (46 students or 66.7%), herbal products (42 students or 60.9%) and massage (32 students or 46.4%). Forty-three students (62%) showed a positive perception towards practicing CAM in the future.ConclusionThis study has shown that there is an overall low satisfaction among the medical students regarding CAM as a part of the medical curriculum. The most common self-use CAM modalities by the medical students were prayers, herbal products, massage, nutritional supplements and acupuncture

Comparison between oxytocin, ergometrine and misoprostol in active management of the third stage of labour: a randomized controlled trial

Background: The aim of the present study was to compare the effectiveness of sublingual misoprostol, intravenous infusion of oxytocin, and intravenous infusion of Ergometrine in reducing blood loss during the third stage of labor.Methods: This is a no-random trial study conducted in in Ribat University Hospital, Khartoum among 150 laboring ladies with a healthy singleton pregnancy. After obtaining their written informed consent to participate in the study, they were randomly assigned to one of three possible treatment groups: 400 μg of sublingual misoprostol; 10 IU of intravenous infusion oxytocin; and 0.5 mg of intravenous infusion of Ergometrine. Blood loss was estimated by weighing the collected blood and converting the weight to milliliters.Results: The shortest mean duration of the third stage of labor was seen in patients who received misoprostol (3.89±0.37 min), followed by oxytocin (4.6±0.9 min), and Ergometrine (5.45±0.9 min). The lowest mean blood loss was seen in the patients who received 400 µg misoprostol (168.36±24.83 ml), followed by those who received 10 IU oxytocin (205.56±34.82 ml), and 0.5 mg Ergometrine (214.49±35.97 ml).Conclusions: Present study showed that 400 µg sublingual misoprostol was more effective than the conventional parenteral uterotonics in reducing the amount of the blood loss during the third stage of labor and has comparable effect to that of 10 IU intravenous oxytocin in shortening the duration of third stage of labor. It also showed that the use of misoprostol reduces the need for extra-uterotonics and blood transfusion

Empower Generations: Longitudinal Study for National Capacities in Life Sciences and Healthcare

Background: The decrease in the number of adolescents showing genuine interest in the fields of healthcare has been one of the recent concerns worldwide. A plethora of studies have discussed the factors that influence career choices of high school students, including science educational pedagogies, gender, environment, the student’s cognitive capabilities, and social perceptions of occupations being gender-based. As reported in 2012, a majority of the Qatari high-school students have shown a greater interest in business, technological, and administrative careers and a lower interest in healthcare. Comprehensive national and institutional strategies have since been utilized to direct the interest of Qatari generation toward healthcare careers. Objective: The primary objective of this case-control study is to assess the effect of schooling type on the enrollment in the Empower Generations (EG) career training in healthcare at the Qatar University. The secondary objectives are: (1) to describe the effect of initial career interest on the EG and healthcare majors composite’s enrollments and (2) assess the association between the history of enrollment in EG and university GPAs. Method: This is a case-control study that utilized the Qatar University’s enrollment databases for the health professions majors, that is, Health Sciences, Medicine, Pharmacy, and Dentistry. The datasets were collected from the registration records between 2013 and 2020. The statistical analysis was performed on the Statistical Package for the Social Sciences (SPSS) software version 26; the study used Chi-Square Test and Independence and logistic regression to assess the effect of schooling type and initial career interest on the enrollment in the EG training at the Qatar University. All statistics were tested for p = 0.05 and 95% CI. Results: Total QU-Health records of admissions from 2013 to 2020 involve 562 eligible students. A total of 180 students (32%) attended EG training before they were admitted to QU-Health, whereas a total of 382 (68%) were enrolled to QU-Health without attending EG training. The study revealed significant findings regarding the association between EG training and international schools (p < 0.001). Among the group who attended EG training, there were 63 students (75%) who reported that they did not have an initial career interest before they joined the EG training compared to 21 students (25%) reported that they did not have an initial career interest but enrolled immediately to healthcare majors. The findings indicate insignificant association between the history of EG training and the high school percentage p = 0.397. However, the association between a history of EG training and the university’s GPA is significant, with a p < 0.001, OR 5.016 (2.954–8.518). Conclusion: The study has shown significant association between the EG training enrollment and the type of school and the initial career interest of high school students. The EG training is perceived to direct the interest of high school students toward the careers of healthcare and is thought to enhance the performance of college students through their university’s GPAs