Evolution of second trimester low implanted placenta to previa at term: a prospective cohort study

Background: The objective of this study is to identify the percentage of low implanted placenta (LIP) at second trimester of pregnancy and identify the risk factors of its persistence to placenta previa (PP) at term.Methods: Through a registered prospective cohort study conducted at tertiary hospital in Upper Egypt, authors screened all pregnant ladies comes to present facility for antenatal second trimester USG between 18-24 weeks gestation. All participants interviewed for detailed risk factors of placenta previa. Those diagnosed to have a LIP (≤1.5 cm from the internal os) had had TVS to confirm the exact distance between the lower edge of the placenta and the internal os. Serial USG had been done every 4 weeks up to delivery to measure the same distance. The primary outcome was the percentage of LIP at 18-24 weeks. Logistic regression analysis was performed to predict the risk factors for PP at term.Results: Through screening of 1000 pregnant lady, LIP had been identified in (52 cases) 5.2% of pregnant women between 18-24 weeks. This percentage dropped gradually to reach 1.3% at 36 weeks of gestation and at time of delivery. The logistic regression analysis demonstrated that the distance between the internal os and the lower edge of the placenta between 18-24 weeks was the single significant variable associated with PP at term (p<0.001, odds ratio 0.319, 95% CI 0.20-0.50). However, excluding the distance from the regression model demonstrated other risk factors as previous miscarriage, previous cesarean section (CS), and history of multiple pregnancies and history of previous PP.Conclusions: About 5.0% of pregnant women have LIP at the second trimester of pregnancy (18-24 weeks) and only 25.0 % of them remain placenta previa at term. A cut-off value of 10 mm between the internal os and the lower edge of the placenta is the most important predictor of development of PP

Insulin sensitizing agent improves clinical pregnancy rate and insulin resistant parameters in polycystic ovarian syndrome patients with acanthosis nigricans: a randomized controlled study

Objective: To investigate the effect of adding metformin to clomiphene citrate (CC) in polycystic ovarian syndrome (PCOS) patients with acanthosis nigricans (AN) who were previously not responding to CC. Material and Methods: A double blinded randomized controlled trial (NCT02562664) included 66 PCOS women with acanthosis nigricans who were CC resistant (at least 3 months). Day 3 follicle stimulating hormone (FSH) level, fasting insulin, fasting glucose and homeostatic model assessment were used to quantify insulin resistance. Participants were randomly assigned to either group I (CC with placebo tablets) or group II (CC with metformin) for three cycles. Insulin resistance parameters as well as clinical pregnancy rate had been evaluated in both groups. The statistical analysis was done using Chi- square and Fischer exact tests. Results: The demographic data was comparable in both groups, however; there was higher cumulative pregnancy rate after three cycles of stimulation in group II (18/33) (54.5%) in comparison with group I (7/33) (21.1%) (P=0.03). There was a significant improvement in the insulin resistance parameters after three months of combining clomiphene citrate with metformin as compared with CC alone. Conclusion: Adding metformin to CC in clomiphene citrate resistant PCOS patients who have acanthosis nigricans improves the pregnancy rate and insulin resistant parameters

The correlation between Aflatoxin B1 and Placental Apoptosis in Pregnant women with Intrauterine Growth Restriction

Objective:To explore the effect of Aflatoxin B1 toxicity as a risk factor of intrauterine growth restriction (IUGR) and to determine the role of placental apoptotic indices in the pathogenesis of IUGR and their association with maternal risk factors including residency, working and exposure to smoking. Materials and Methods:A case-control study was done at Women Health Hospital; Assiut University, Egypt. Sixty pregnant women with asymmetrical IUGR and a control group of 40 normal pregnancies were selected. Maternal urine samples were obtained for Aflatoxin B1 level measurement by layer chromatography. Quantitative determination of human placental Bcl-2 and caspase-3 using a monoclonal antibody-based enzyme-linked immunosorbent assay kits were performed. Results:The results showed that aflatoxin B1 positive cases in the IUGR group had significantly higher placental caspase-3 and lower placental Bcl-2 concentrations than those which were aflatoxin B1 negative (p<0.01). The levels of placental apoptotic indices were higher in working women who lived in urban areas and those exposed to cigarette smoke than non-working women who lived in rural areas and non-smokers. Conclusions: Aflatoxin B1 may affect the fetal growth by increasing the placental apoptosis. These results may highlight the importance of aflatoxin B1 which may contribute to the complex etiology of IUGR. Placental apoptotic indices levels were significantly affected by maternal residence, working and exposure to smoking in pregnancies complicated with IUGR

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Effects of antenatal dexamethasone administration on fetal and uteroplacental Doppler waveforms in women at risk for spontaneous preterm birth

Objective: Maternal administration of synthetic corticosteroids is essential to improve fetal lung surfactant production and hasten the fetal lung maturity in women at risk for preterm birth. The current study aimed to investigate the effects of dexamethasone exerted on fetal and uteroplacental circulation as measured by Doppler in pregnancies at risk for preterm birth after 24 h of its administration. Materials and methods: A prospectively registered study at www.ClinicalTrials.gov (NCT02662790) was conducted in Women Health Hospital, Assiut, Egypt, included 50 pregnant women with singleton pregnancies. Doppler studies were performed on the umbilical artery, fetal middle cerebral artery (MCA), fetal descending aorta and maternal uterine arteries just before dexamethasone administration and repeated 24 h after completion of the dexamethasone course. Results: The mean age of the study group was 27.7 ± 4.5 years. There was a statistically significant difference between all Doppler indices in umbilical artery, fetal MCA and aorta in comparison before and 24 h after maternal dexamethasone administration. Also uterine artery Pulsatility index was significantly different (p = 0.001). Conclusion: Maternal dexamethasone administration to pregnant women at risk of preterm labor improves the blood flow of the maternal uterine artery, fetal MCA, descending aorta and umbilical artery 24 h after its administration

The rate of SARS-CoV-2 among asymptomatic non-immunised low-risk parturient women between the two waves

This study was conducted to evaluate the rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and immunity among asymptomatic non-immunised low-risk parturient women and their newborns. A cross-sectional study conducted in a tertiary hospital during the nadir period of new cases in Egypt. All asymptomatic pregnant, low risk and non-immunised women were included. All eligible participants had been subjected to SARS-CoV-2 nasopharyngeal swabs according to CDC and sampling of maternal and umbilical blood to evaluate the presence of coronavirus disease 2019 (COVID-19) IgM and IgG antibodies by immunochromatographic assay. Two cases out of 171 (1.2%) parturient women were tested positive for PCR swab to COVID-19 infection. Furthermore, COVID-19 IgG and IgM antibodies testing showed that 67.8% of women were negative for both IgG and IGM, 24.6% were positive for IgG only, 4.1% were positive for IgM only, while 3.5% were positive for both IgG and IgM. Regarding neonatal testing for immunity, 28.1% of the neonates were positive to IgG only and none for IgM. The rate of positive PCR patients among asymptomatic low-risk parturient women was 1.2%. About quarter of women had got herd immunity as evident by positive IgG antibodies. IgG antibodies transferred to the neonates in almost all cases.Impact Statement What is already known on this subject? Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global public health emergency. Asymptomatic pregnant women with coronavirus disease can transmit their infection to their newborn, family members and the health care providers. What do the results of this study add? The study showed very low (1.2%) prevalence of COVID positive cases among asymptomatic pregnant women admitted to our facility. Only two cases out of 171 parturient women tested PCR positive for COVID-19 infection (1.2%). SARS-Cov-2 IgG and IgM antibodies testing showed, about a quarter (24.6%) were positive for IgG antibodies, 4.1% were positive for IgM antibodies, while 3.5% were positive for both IgG and IgM. On the other hand, 28.1% of the neonates were positive to IgG only and none of the newborns had had IgM antibodies in their cord blood. What are the implications of these findings for clinical practice and/or further research? The first wave of COVID-19 pandemic in Egypt left behind at least a quarter of pregnant women with a positive antibody denoting some immunity. This immunity is usually transmitted to the neonates in almost all cases

Determinants of Obtaining COVID-19 Vaccination among Health Care Workers with Access to Free COVID-19 Vaccination: A Cross-Sectional Study

Introduction: Despite global efforts to contain the illness, COVID-19 continues to have severe health, life, and economic repercussions; thus, maintaining vaccine development is mandatory. Different directions concerning COVID-19 vaccines have emerged as a result of the vaccine&rsquo;s unpredictability. Aims: To study the determinants of the attitudes of healthcare workers (HCWs) to receiving or refusing to receive the vaccine. Methods: The current study adopted an interviewed questionnaire between June and August 2021. A total of 341 HCWs currently working at Assiut University hospitals offered to receive the vaccine were included. Results: Only half of the HCWs (42%) accepted the COVID-19 vaccine. The most common reason that motivated the HCWs was being more susceptible than others to infection (71.8%). On other hand, the common reasons for refusing included: previously contracted the virus (64.8%); did not have time (58.8%); warned by a doctor not to take it (53.8%). Nearly one-third of nonaccepting HCWs depended on television, the Internet, and friends who refused the vaccine for information (p &lt; 0.05). In the final multivariate regression model, there were six significant predictors: sex, job category, chronic disease, being vaccinated for influenza, and using Assiut University hospital staff and the Ministry of Health as sources of information (p &lt; 0.05). Conclusion: Misinformation and negative conceptions are still barriers against achieving the desired rate of vaccination, especially for vulnerable groups such as HCWs