Risk factors of Gestational Diabetes Mellitus Among Saudi Women

Abstract:Objective: The aim of this study was to identify the main risk factors of Gestational Diabetes Mellitus among Saudi women. Methodology: This is a case control laboratory-based study conducted in Wadi Al Dawasir City in Saudi Arabia.600 pregnant women as follows; 300 screened pregnant women as the study group and 300 non screened pregnant women as the control group.Selection Criteria for the screened group: Should be booked at 28 weeks or before that, not known to be diabetic before pregnancy or diagnosed as cases of GDM before 24 weeks. Selection Criteria for the non-screened group: They were not diagnosed before pregnancy as cases of DM or diagnosed during pregnancy as cases of GDM.Screening for GDM: Screening for GDM was a routine using loading dose glucose (LDG) or glucose challenge test (GCT) between 24-28 weeks gestation according to the hospitals protocol. The pregnant women were classified into high risk or low risk according to the following characteristics  Results: Risk factors in the screened mothers with positive LDG result was: family history was identified in 56.1% (23/41) of mothers and it was absent in 43.8% (18/41). The next main risk factor among the mothers with positive LDG results was a history of baby weight 4 kg or more and was found in 9.76% (4/41) followed by history of intrauterine fetal death that was detected in 7.32% (3/41). Only one mother 2.44% (1/41) had past history of gestational diabetes mellitus similar to mothers with history of babies with congenital malformation that was detected in 2.44% (1/41) also. Family history was the main risk factor among mothers with positive LDG results as it was found in 56.1%. Within the 20 mothers with significant oral glucose tolerance test (OGTT) results, 80% (16/20) had risk factors and 20% (4/20) had no risk factors. Conclusion: Identifying of risk factors is important for screening for GDM but even women with low risk and no risk factors should be screened for GDM

TRAINING COURSE ON DELIVERY CARE AND NEONATAL CARE IN RURAL HOSPITALS, GEZIRA STATE, SUDAN

This paper describes a training course for medical officers working in the rural hospitals in Gezira State to achieve a general objective; safe management of obstetric emergencies, miscarriage and the newborn . the description of the course includes; an introduction, the specific learning objectives, a detailed plan of work, instructional methods, resources , the course timetable, evaluation methods, description of the logbook and the feedback questionnaire. This article also includes descriptions of our experience in three rounds during which 43 medical officesr were traine

SUCCESSFUL TWO PREGNANCIES IN ACHONDROPLASIC MOTHER, A CASE REPORT

The word achondroplasia is derived from Greek and means "without cartilage formation," although individuals with achondroplasia do have cartilage. In genetics, dominance describes the effects of the different versions of a particular gene on the phenotype of an organism. Many animals (including humans) and plants have two copies of each gene in their genome, one inherited from each parent

Helping Mothers Survive Bleeding after Birth Training Join project between University of Gezira, Jhpiego- affiliated with Johns Hopkins University, Sudanese American Medical Association (SAMA), Sudanese Obstetrical and Gynaecological Society

Abstract:The post partum haemorrhage (PPH) Project of Sudan should consider facilitation of implementation of a more comprehensive and innovative program to address prevention, identification and management of PPH with the goal of improving the quality of care and health outcomes related to PPH.The Master Trainer Course was held at the University of Gezira (U of G) followed by Champion courses and Clinical Mentor orientation sessions in 5 hospitals (4 rural and 1 urban). There are additional 5 hospitals in Gezira state where providers have yet to receive the Champions course. The additional courses are planned in March and April of 2016. 23 Master Trainers were mentored in help mother survive (HMS). The PPH Project Director based at UofG and additional 2 more trainers were introduced to the principles of HMS training and the low dose high frequency (LDHF) approach was adopted. 155 providers participated in a bleeding after birth (BAB) Champions Course. 106 of the participants were village midwives who received selected updates around child birth to address gaps identified during the opening role play. Updates included being patient during second stage of labour, no pulling of fetus, delivering babies to mothers, abdomen/skin to skin, drying the baby immediately, changing the wet cloth and covering the baby with dry cloth while on mothers’ abdomen, not to hold babies upside down, not to separate babies from mothers after cutting the cord. No cord milking, evacuation of birth canal in the name of “cleaning” it, no routine episiotomy or pulling the placenta without counter pressure and few others.34 providers from 5 hospitals (4 rural and 1 urban) were oriented as clinical mentors. They will conduct peer mentorship at respective hospitals as well as the downward type of mentorship to midwives at health centers and village midwives from respective community neighborhoo

RAK CERVIKSA U TRUDNOĆI: PRIKAZ BOLESNICE

The case of 29 years old pregnant III-para at 38 weeks of gestational age is presented. The patient was admitted complaining of vague abdominal pain. By speculum examination the large cervix with reddish ulcerative cervical canal was established and punch biopsy performed. The pathohistological diagnosis was well differentiated squamous cell carcinoma. No local metastases or lymph node or other signs of cancer spreading were present (stage 1a). The CS was done, born vital newborn of 2 kg weight, proceeded to total abdominal hysterectomy with bilateral salpingoophorectomy. The pathohistological finding was: Stromal invasion of 3 mm in depth and 6 mm in lateral spread (FIGO stage 1a1). Postoperative period was uneventfull, the patient was reffered to Institute of Nuclear Medicine for further management, where she received only 2 cycles of radiation and chemotherapy and thereafter stopped the treatement. Two years later the patient presented very ill and passed because of uremia.Prikazana je bolesnica dobi 29 godina, III-para, s oko 38 tjedana trudnoće. Primljena je zbog nejasnih boli u donjem trbuhu. Pregledom u spekulima nađen je krupni cerviks s ulceracijom u cervikalnom kanalu. Pod anestezijom je učinjena biopsija cerviksa i dobivena patohistološka dijagnoza: dobro diferencirani karcinom pločastih stanica. Nije bilo lokalnih metastaza, širenja u limfne čvorove ili drugih znakova širenja raka (stupanj 1a). Učinjen je carski rez i nastav¬ljena totalna histerektomija s obostranom salpingooforektomijom. Patohistološki nalaz je bio: stomalna invazija 3 mm u dubinu i postranična zahvaćenost 6 mm (FIGO stupanj 1a1). Postoperativni je tijek bio uredan, bolesnica je upućena u Zavod za nuklearnu medicinu radi zračenja i kemoterapije. Primila je samo dva ciklusa terapije i tada napustila liječenje. Nakon dvije godine pacijentica se pojavila vrlo bolesna, umrla je od uremije

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone