Comparison of neonatal respiratory morbidity in neonates delivered at term by elective caesarean section with and without antenatal Corticosteroid

Introduction:Performing elective caesarean section prior to 39 completed weeks,it can lead to breathing problems in neonates as compare to those, who are born through caesarean section without antenatal Corticosteroid. WHO recommends the administration of intramuscular corticosteroids either dexamethasone or betamethason (total 24mg in divided doses) in the antenatal period, when there is a risk of preterm birth. The advantages and disadvantages of a similar regimen given after 37 weeksof pregnancy prior to elective caesarean section (LSCS) to prevent respiratory morbidity in a newborn is yet a topic of discussion.In Pakistan still,many clinicians are doing caesarean section at 37 or 38 weeks without antenatal Corticosteroids. The rationale is to emphasize the use of steroidsbefore caesareanat 39 weeks. Objective:To compare neonatal respiratory distress in neonates delivered between 37 --38+6 weeks of gestation by elective caesarean section with and without antenatal Corticosteroid. Study design:Randomized controlled trial. Setting:Department of Gynae & Obstetrics, unit 2, Shalamar Hospital, Lahore. Duration:Six months from 12th September 2018 to 12th March 2019. Materials and Methods:The study included women who were, planned for elective LSCS at 37-38+6 weeks, divided into two groups .The sample size was 140 (70 in each group),recruited by non-probability consécutive sampling. Inclusion criteria were singleton pregnancy, at 37 to 38+6 weeks for elective LSCS due to indications like primi breech, previous caesarian scar/scars, and maternal wish. All eligible participants were allocated to one of the following groups. Group (A) received an injection of dexamethasone 48 to 72 hours before elective LSCS. Group (B), did not receive an injection of dexamethasone. The outcome to be measuredinthis study were the Apgar score at 1& 5 minutes, the incidence of transient tachpnea of the neonate (TTN) and respiratory distress syndrome (RDS) in newborns,and the need for mechanical ventilation among neonates from two different groups. The data was collected and analyzed by SPSS version 20.Descriptive statistic were applied to calculate the mean and SD for age, gestation age & BMI. Student T-test was used to compare the continuous outcome measures. Neonatal respiratory morbidity was compared in two groups by using the chi-square test at the level of significance of 0.05.Results:Mean age in Group-A was 28.12± 5.6 and in Group-B was 28.97± 6.3 years. There was no statistically significant difference in these groups in termsof Body mass index, gestational age at the time of delivery, age of mother, birth weight, Apgar score at 1 and 5 min,and indications for cesarean section. Neonatal respiratory morbidity was higher in Group-B as compared to Group-A (30% vs.12.9%)p-value-0.013. Conclusion:Antenatal dexamethasone administration significantly reduces the respiratory morbidity among neonates delivered at 37 to 38+6by elective cesarean section. But further studies are required to assess the beneficial role of dexamethasone in the reduction of neonatal respiratory morbidity with a large sample size.Keywords:Neonatal respiratory morbidity, transient tachypnea of newborn, elective caesarean section, antenatal corticosteroids

Comparison of neonatal respiratory morbidity in neonates delivered at term by elective caesarean section with and without antenatal Corticosteroid

Introduction:Performing elective caesarean section prior to 39 completed weeks,it can lead to breathing problems in neonates as compare to those, who are born through caesarean section without antenatal Corticosteroid. WHO recommends the administration of intramuscular corticosteroids either dexamethasone or betamethason (total 24mg in divided doses) in the antenatal period, when there is a risk of preterm birth. The advantages and disadvantages of a similar regimen given after 37 weeksof pregnancy prior to elective caesarean section (LSCS) to prevent respiratory morbidity in a newborn is yet a topic of discussion.In Pakistan still,many clinicians are doing caesarean section at 37 or 38 weeks without antenatal Corticosteroids. The rationale is to emphasize the use of steroidsbefore caesareanat 39 weeks. Objective:To compare neonatal respiratory distress in neonates delivered between 37 --38+6 weeks of gestation by elective caesarean section with and without antenatal Corticosteroid. Study design:Randomized controlled trial. Setting:Department of Gynae & Obstetrics, unit 2, Shalamar Hospital, Lahore. Duration:Six months from 12th September 2018 to 12th March 2019. Materials and Methods:The study included women who were, planned for elective LSCS at 37-38+6 weeks, divided into two groups .The sample size was 140 (70 in each group),recruited by non-probability consécutive sampling. Inclusion criteria were singleton pregnancy, at 37 to 38+6 weeks for elective LSCS due to indications like primi breech, previous caesarian scar/scars, and maternal wish. All eligible participants were allocated to one of the following groups. Group (A) received an injection of dexamethasone 48 to 72 hours before elective LSCS. Group (B), did not receive an injection of dexamethasone. The outcome to be measuredinthis study were the Apgar score at 1& 5 minutes, the incidence of transient tachpnea of the neonate (TTN) and respiratory distress syndrome (RDS) in newborns,and the need for mechanical ventilation among neonates from two different groups. The data was collected and analyzed by SPSS version 20.Descriptive statistic were applied to calculate the mean and SD for age, gestation age & BMI. Student T-test was used to compare the continuous outcome measures. Neonatal respiratory morbidity was compared in two groups by using the chi-square test at the level of significance of 0.05.Results:Mean age in Group-A was 28.12± 5.6 and in Group-B was 28.97± 6.3 years. There was no statistically significant difference in these groups in termsof Body mass index, gestational age at the time of delivery, age of mother, birth weight, Apgar score at 1 and 5 min,and indications for cesarean section. Neonatal respiratory morbidity was higher in Group-B as compared to Group-A (30% vs.12.9%)p-value-0.013. Conclusion:Antenatal dexamethasone administration significantly reduces the respiratory morbidity among neonates delivered at 37 to 38+6by elective cesarean section. But further studies are required to assess the beneficial role of dexamethasone in the reduction of neonatal respiratory morbidity with a large sample size.Keywords:Neonatal respiratory morbidity, transient tachypnea of newborn, elective caesarean section, antenatal corticosteroids

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Clinical Analysis of Emergency Peripartum Hysterectomy (EPH)

Background: To find out the incidence, risk factors, indications and outcome of emergency peripartum hysterectomy, including maternal morbidity (ICU admission, blood transfusion, urological injuries, DIC) and maternal mortality.Methods: In this cross sectional study patients requiring emergency peripartum hysterectomy were included. The demographic data, risk factors , indications and outcome including maternal morbidity (ICU admission, blood transfusion, urological injuries, DIC) and maternal mortality, were recorded. Patients who required emergency peripartum hysterectomy at delivery or during 24 hours after delivery and had gestational age more than 28 weeks were included in the study. However patients who had EPH after 24 hours of delivery or before 28 weeks of gestation either due induced septic abortion or uterine perforation were excluded.Result: The total number of patients delivered during the study period was 10,030, out of which 22 patients required EPH ( 2.1 per 1000 .Most common cause of EPH was previous caesarean section and placenta previa type IV with morbidly adherent placenta (n=13 ,59.09% ).Uterine atony not responding to conservative management for EPH was second commonest reason for EPH(n=8 ,36.36%)and uterine rupture was third indication for EPH(n=1,4.55%). Fifty nine percent required admission in intensive care unit,three patients had Urological injuries and two maternal deaths occurred out of 22 patients due to disseminated intravascular coagulation.Conclusion: Emergency peripartum hysterectomy is associated with significant morbidity and maternal mortality. Abnormal adherent placenta is the most common cause of EPH. All of patients who required EPH, had previous cesarean section, so all measures should be adopted to reduce the primary cesarean section rate

Mangifera indica Extracts as Novel PKM2 Inhibitors for Treatment of Triple Negative Breast Cancer

Pyruvate kinase (PK), a key enzyme that determines glycolytic activity, has been known to support the metabolic phenotype of tumor cells, and specific pyruvate kinase isoform M2 (PKM2) has been reported to fulfill divergent biosynthetic and energetic requirements of cancerous cells. PKM2 is overexpressed in several cancer types and is an emerging drug target for cancer during recent years. Therefore, this study was carried out to identify PKM2 inhibitors from natural products for cancer treatment. Based on the objectives of this study, firstly, plant extract library was established. In order to purify protein for the establishment of enzymatic assay system, pET-28a-HmPKM2 plasmid was transformed to E. coli BL21 (DE3) cells for protein expression and purification. After the validation of enzymatic assay system, plant extract library was screened for the identification of inhibitors of PKM2 protein. Out of 51 plant extracts screened, four extracts Mangifera indica (leaf, seed, and bark) and Bombex ceiba bark extracts were found to be inhibitors of PKM2. In the current study, M. indica (leaf, seed, and bark) extracts were further evaluated dose dependently against PKM2. These extracts showed different degrees of concentration-dependent inhibition against PKM2 at 90-360 μg/ml concentrations. We have also investigated the anticancer potential of these extracts against MDA-MB231 cells and generated dose-response curves for the evaluation of IC50 values. M. indica (bark and seed) extracts significantly halted the growth of MDA-MB231 cells with IC50 values of 108 μg/ml and 33 μg/ml, respectively. Literature-based phytochemical analysis of M. indica was carried out, and M. indica-derived 94 compounds were docked against three binding sites of PKM2 for the identification of PKM2 inhibitors. The results of in silico based screening have unveiled various PKM2 modulators; however, further studies are recommended to validate their PKM2 inhibitory potential via in vitro biochemical assay. The results of this study provide novel findings for possible mechanism of action of M. indica (bark and seed) extracts against TNBC via PKM2 inhibition suggesting that M. indica might be of therapeutic interest for the treatment of TNBC

Potential role of probiotic species in ameliorating oxidative stress, effect on liver profile and hormones in male albino rat model

Probiotics are living micro-organism preparations which can vigorously inhibit the probable pathogens colonization in the gut microbial ecology. Current experiment was designed to investigate the efficacy of imported probiotic species compared with the indigenous probiotics species on the oxidative stress, enzymes, and hormones in animal model. Thirty Albino rats were equally divided into three groups with 10 rats ( n  = 10) in each group as Control (C), supplemented with imported probiotic species (IP), and supplemented with indigenous probiotics species (InP) for 21 days under controlled environment. The evaluation of treatments was done by testing the serum oxidative stress markers, liver enzymes (Aspartate transaminase and Alanine aminotransferase), lipid profile, and hormonal dynamics including Lutinizing hormone (LH), follicular stimulating hormone (FSH), and growth hormone (GH) in albino male rats. Results revealed that use of indigenous probiotic species significantly ( p  < 0.05) reduces the oxidative stress and improves the antioxidant capacity; liver enzymes, total cholesterol, and LDL-Cholesterol were also reduced significantly ( p  < 0.05) in InP as compared to IP group. Moreover, results of hormones including LH, FSH, and GH explored that indigenous probiotics have significant ( p  < 0.05) potential to improve these hormones as compared to imported probiotics. Although, it could be concluded that InP have beneficial role in preventing the body from oxidative stress as well as in improving the blood parameters but comprehensive studies are required to investigate the detail gut ecology of the indigenous species which will definitely a strong support in preparing a more suitable local probiotic supplement