Pathological features in perinatal autopsy and its relation with clinical and antenatal sonography findings

Background: Perinatal mortality is considered as a yardstick of obstetric and maternal care before and around the time of death. Perinatal autopsy is an inevitable procedure which helps to ascertain the cause of death, identify rare diseases, supplements clinical diagnosis and provide risk estimates for future pregnancies. The aim of the study was to describe the pathological features in perinatal autopsy specimens and to compare the pathological features with clinical and antenatal sonography findings.Methods: A descriptive study was conducted among 43 perinatal autopsy cases. A thorough perinatal autopsy was done. Detailed maternal medical and obstetric history including the laboratory and USG findings were collected. Collected data analysed using Statistical package for social sciences (SPSS) software. Results: The results were grouped into fetal, maternal and placental findings. Congenital anomalies were detected in 20% cases. That included gastrochisis, ebstein anomaly, isolated dextrocardia, hypoplastic left heart syndrome, cleft lip and palate, prune belly syndrome, club foot. Placenta findings observed were chorioamnionitis, placental thrombotic vasculopathy and placental findings in COVID-19 positive cases. The most common maternal comorbidity was hypertension (20.9%). Perinatal mortality was high in those cases with past history of abortions and history of infertility treatment. Full agreement between perinatal autopsy and antenatal USG findings was detected in 36.36% cases. Additional anomalies detected on autopsy was 54.54%.Conclusions: A thorough clinical history, prenatal ultrasonography and perinatal autopsy features could be described in detail in all the cases. Comparison of finding at autopsy with antenatal ultrasonography finding indicate that ultrasonography finding have only a reasonable value in assessing fetal status. Advanced radiology techniques could be maximum helpful.

Co-designing Indus Water-Energy-Land Futures

The Indus River Basin covers an area of around 1 million square kilometers and connects four countries: Afghanistan, China, India, and Pakistan. More than 300 million people depend to some extent on the basin’s water, yet a growing population, increasing food and energy demands, climate change, and shifting monsoon patterns are exerting increasing pressure. Under these pressures, a “business as usual” (BAU) approach is no longer sustainable, and decision makers and wider stakeholders are calling for more integrated and inclusive development pathways that are in line with achieving the UN Sustainable Development Goals. Here, we propose an integrated nexus modeling framework co-designed with regional stakeholders from the four riparian countries of the Indus River Basin and discuss challenges and opportunities for developing transformation pathways for the basin’s future

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Significance of fibrotic bands in utero - Amniotic band sequence with limb body wall complex: A rare case of fetal autopsy

Amniotic band sequence (ABS) includes a wide spectrum of abnormalities resulting from entrapment of various fetal parts from a disrupted amnion, ranging from a mere constriction ring affecting a finger to a fatal form called limb body wall complex (LBWC). Reported cases of ABS with LBWC are very few. The spectrum of anomalies depends on which part gets entrapped and at what point of gestation. Hence, the clinical presentation can be extremely variable. Early detection of such cases using sonology is really challenging due to the small size of the fibrotic bands. Here, we present a case of amniotic band syndrome with LBWC in a fetus at 24 weeks of gestation, which was referred for an autopsy. The fetus also showed scoliosis, gastroschisis, lumbosacral meningocele, congenital talipes equinovarus, and cleft palate, thus having features of placenta cranial and placenta abdominal phenotype which is very rare

Placental mesenchymal dysplasia: A report of two cases with review of literature

Placental mesenchymal dysplasia (PMD) is a recently recognized, rare placental vascular anomaly characterized by placentomegaly and grape-like vesicles mimicking partial molar pregnancy. It is associated with significant fetal morbidity and mortality. We describe the histologic features of PMD in two different cases with different disease outcomes, one in a preterm intrauterine death (IUD) and another in a live birth. Placental examination in both the cases revealed large placenta with multiple vesicles and mesenchymal dysplasia

Death of a Himalayan Vulture in South India highlights the potential threat of power infrastructure

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