An Audit of Maternal Mortality at a Tertiary Care Hospital

Objective:To find causes of maternal deaths and to calculate maternal mortality ratio at tertiary care hospital Karachi. Study Design and setting:An observational study was conducted from1st January 2019 to 31stDecember 2020 at theDepartment of Obstetrics & Gynecology Unit 1, JPMC Karachi. Methodology:Patients were selected according to inclusion criteria after ethical approval through non probability consecutivesampling technique. Details of patients were obtained from filesand record registers. Their demographic feature like age,parity, gestational age, booking status and presence or absence of medical disorders, their status of delivery and direct andindirect reasons of maternal deaths were noted and their frequency and percentages were calculated. Brought dead patientsand those who died accidently were excluded from the study. Results:During the period of two years the total numbers of deaths certified in the department were 90. Total number ofchild birth and live births were 19084 and 17892 respectively. The maternal mortality ratio was estimated as 503.01 per100,000 live births. Most of the patients 74(82.3%) were un booked. Direct Causes were about 67(74.5%). Haemorrhagewas found to be most common reason of maternal deaths in about21(23.3%). Eclampsia among18(20%) deaths. Anemia, cardiac disease, hepatic failure were the indirect causes of maternal deaths responsible for 23 (25.5%) of maternal deaths. Conclusion:Maternal Death rate is persistently elevated in JPMC, being tertiary care hospital mostly due to serious and referred complicated cases. Haemorrhage and eclampsia are still major killers of mothers as before.

Association of qSOFA with Ludwig's Angina Patient Mortality at Dr. Sutomo Hospital, Surabaya

Objective: This study aims to determine the association between The quick Sequential Organ Failure (qSOFA) score and the mortality of Ludwig's Angina. Material and Methods: Secondary data from the medical records of Ludwig’s Angina patients in the period January 2019 - December 2020. Data included demographic feature, qSOFA data, Outcome patient, comorbidity diseases and complications before treatment. The number of samples was determined using the total sampling method. This study was enrolled into analytical observational study. Results: There were 49 medical records that were included in the inclusion criteria, 6 medical records were excluded because the data were missing. There were more men 36 (73,5%) than women 13 (26,5%). There were 12 (24,5%) high qSOFA and 37 (75,5%) low qSOFA. There were 12 (24,5%) patient outcome dead and 37 (75,5%) outcome alive. The results of Chi-square analysis show qSOFA and confounding Diabetes Mellitus (DM) respectively were statistically significant association with Ludwig's Angina mortality. The results of multivariate logistic regression analysis, shows that there is a significant association between qSOFA and Ludwig's Angina mortality (p: 0.018) with an OR of 20.9 (CI 95% : 1,673 – 263,367). Diabetes mellitus comorbidity factors were also significantly associated with the mortality of Ludwig's angina. Conclusion: There is a significant association between qSOFA and Ludwig's Angina mortality. Keywords: Ludwig’s Angina, Mortality, qSOFA, Sepsis.

COMPARATIVE STUDY OF DIGITAL X-RAY L-S SPINE AND DEXA L-S SPINE IN THE EVALUATION OF OSTEOPOROSIS

AIMS & OBJECTIVES- The aim of the study was to compare the sensitivity of Digital X-ray of L.S.Spine in relation to DEXA Scan in the detection of reduced bone mass (osteopenia/ osteoporosis) and evaluate the association of osteoporosis/ osteopenia with certain factors like age, height, weight, smoking, alcoholism and awareness. MATERIALS AND METHOD- This Prospective, this prospective observational study included 100 patients of both sexes between 40 – 80 years age , who presented to in the Department of Radiodiagnosis, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly (Uttar Pradesh) with presenting symptoms of non- inammatory low back pain and underwent dexa scan of L.S. Spine and X-Ray of L.S.Spine. A detailed history including demographic feature and social factor (history of smoking and alcoholism and education/ knowledge status). The investigation ndings were recorded and tabulated and data were analyzed statistically. RESULTS- The DXR L.S.Spine shows the sensitivity 75.29%, specicity 78.95%, and accuracy was 77.01% in compression to dexa scan in patients with osteopenia/ osteoporosis. There was negative correlation between weight and height and knowledge of the patient with osteopenia/ osteoporosis and no signicant correlation between history of smoking and alcoholism. CONCLUSION- In conclusion, DXR and DEXA measurements shows fair agreement. Our results suggest DXR to be a promising screening tool for detecting low bone quality or osteoporosis.

Ancylostomaduodenale and Ascarislumbricoides Mixed Infection in Pregnant Woman in Maharashtra

Background: More susceptible helminthic infection decreases immunodeficiency in pregnancy and may pose a serious threat to health and sometimes fatal to the new-born baby also. Ancylostomaduodenale and Ascarislumbricoides are categorized as soil-transmitted helminths. These helminths lead to greater impairment of mental and physical development, mainly in developing nations. Due to the shortage of qualified staff and suitable technology, these infections remain hidden and asymptomatic.Furthermore, sporadic shedding of eggs or larvae makes it tough to diagnose. There is, therefore, a desperate necessity of fast and precise tests to diagnose soil-transmitted helminths. Microscopy and molecular approaches are included in the diagnostic methods.In countries where faeces are used as fertiliser and in the absence of sewage systems, these parasites are commonly observed, especially in tropical and subtropical areas.Case Presentation: A woman was enrolled in field survey DMIMS, Sawangi in July, 2017. The community-based field survey was held within four villages of district Wardha. A 22-year-old pregnant woman had a lot of complaints and history also. Symptoms correlated with electrolyte imbalance was seen. For detection purpose, microscopy and qPCR has been used in the case. Conclusion: The purpose of this study is to find out the reasons why pregnant women are more likely to get sick and to investigate the hygiene conditions in houses and evaluate the demographic feature. Throughout childhood to adulthood, a pregnant woman was malnourished. It is assumed from a study that the effect of under-nutrition may persist throughout life. A molecular technique like q PCR gives the most accurate results for infection.

AB0484 PROTEINASE 3–ANTINEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA)–POSITIVE AND ANCA–NEGATIVE OR MYELOPEROXIDASE–ANCA–POSITIVE PATIENTS WITH GRANULOMATOSIS WITH POLYANGIITIS: DISTINCT PATIENT SUBSETS

Background:Most patients with clinical diagnoses of Granulomatosis with polyangiitis (GPA) are proteinase 3 (PR3)-ANCA positive, but a significant minority are myeloperoxidase (MPO)-ANCA positive or are negative for ANCA [1]. Several clinical and genome-wide association studies have suggested that classification based on ANCA type, i.e., PR3-ANCA positivity as opposed to MPO-ANCA positivity, may be more relevant clinically than the traditional classification based on specific diagnosis [2].Objectives:To analyze demographic feature, disease manifestations and laboratory findings of patients with PR3-ANCA positive GPA in comparison with patients ANCA-negative or MPO- ANCA positive GPA.Methods:This is a retrospective analysis of 37 patients with GPA from a single center in Ukraine observed from 2010 till the end of 2019. The clinical and demographic data, initial Birmingham vasculitis activity score (BVAS/WG), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were compared between patients with PR3-ANCA positive GPA and ANCA-negative or MPO-ANCA positive GPA.Results:Of the 37 patients analyzed, 24 (64.9%) had PR3-ANCA–positive GPA, 6 (16.2%) had MPO-ANCA–positive GPA and 7 (18.9%) had ANCA-negative GPA. ANCA–negative GPA patients were younger at diagnosis compared to PR3-ANCA–positive and MPO-ANCA-positive patients (36 versus 47 and 49 years; p = 0.04). The gender ratio was similar in patients with PR3-ANCA–positive GPA and patients with MPO-ANCA–positive GPA or ANCA-negative GPA (33% vs 38% male, p= 0.61). The ocular manifestations - conjunctivitis/episcleritis (15% vs 50%) and ear involvement - otitis, mastoiditis (0% vs 33%) occurred more often in patients with PR3-ANCA–positive GPA (p<0.05), whereas sensory peripheral neuropathy (54 % vs 21%) and Raynaud’s syndrome (31 % vs 0%) were more frequent in compared group (p<0.05). ANCA-negative patients with GPA had lower, but no significant, initial BVAS/WG score than PR3-ANCA–positive or MPO-ANCA-positive patients with GPA (17.9 versus 23.5 and 24.8; p=0.20). There were no significant differences between groups in ESR or CRP levels and in the frequency of involvement of other organs and systems.Conclusion:We demonstrate clinical differences between PR3-ANCA–positive patients with GPA and MPO-ANCA–positive or ANCA-negative patients with GPA. The eye and ear involvement are common for patients with PR3-ANCA–positive GPA. The MPO-ANCA–positive GPA or ANCA-negative GPA is characterized by higher frequency of sensory peripheral neuropathy and Raynaud’s syndrome.References:[1]Lyons PA, Rayner TF, Trivedi S, Holle JU, Watts RA, Jayne DR, et al. Genetically distinct subsets within ANCA-associated vasculitis. N Engl J Med. 2012;367:214–23.[2]Finkielman JD, Lee AS, Hummel AM, Viss MA, Jacob GL, Homburger HA, et al. ANCA are detectable in nearly all patients with active severe Wegener’s granulomatosis. Am J Med. 2007;120:643.e9–14.Disclosure of Interests: :None declared

Online Shopping and its Impact on Customer Satisfaction Considering the Role of Respondents Trust and Gender Influence

As like any market place, the success of online shopping depends mainly on customer satisfaction and many other factors that will also increase customers’ loyalty towards the channel. This study is mainly done to categorize various such factors that affect the consumer behavior for online shopping. The factors of trust, privacy, convenience, social presence, demographic features like gender where deeply studied for their influence on the consumer behavior. The data collected was over 170 respondents made relevance in identifying the key factors contributing for the behavioral change in online shoppers. The effect of factors like vendor reputation, adequate communication, norms, web designing is also studied. The results indicated that it is necessary to target online buyers with a safer and secured mode of transactions for their re purchase behavior towards the channel. Study also focuses on the demographic feature of gender which says that men are more comfortable and happy with online shopping in India. Hence forth the target segment for the emerging strategies of online shopping would be women.

Empirical Research on Relationship between College Students’ Social Identity and Online learning Performance: A case Study of Guangdong Province

From “God’s favored person” to “ordinary worker”, college students become indifferent to life and addicted to web gaming because they face a rapid devaluation of college student identity in China. At the same time, MOOC and other online learning resources are bringing students better personal learning environment and requiring the students to be more self-disciplined and self-educated oriented. Correlation was found among academic performance, life satisfaction and personal identity. The relationship between students’ online learning performance, life satisfaction and social identity has become a key issue for the Chinese educators and academic institutions. This paper investigates college student’s social identity and identify how online learning performance influences their life satisfaction and social identity based on 490 questionnaires using Jonathan M. Cheek relational identity orientation scale for the AIQ. The results suggest that the demographic feature of students has different influence on their social identity, and the effect of online learning performance and life satisfaction on social identity shows a significant difference. Besides, implications for improving college students’ social identity are also discussed.

Feminization of Old Age and Experiences of Subalternity

The demographic feature of twenty-first century has been the rise of the aged population, making them socially visible. However, the concern is that an aging world is also a feminized world. But this transition does not hold a very vivid future as the elderly women are the most vulnerable section of the population. They make up for the majority of the poor due to scarce access to education, property, and employment opportunities. Widowhood often leaves them impoverished and victims of abuse. Until recently, aging women have not been considered a subject requiring serious attention in India. Most of the studies on old age have adopted a gender-neutral approach to the problems of ageing. It is a paradox that the feminist movement has marginally addressed this issue even though gender along with social, economic, and political factors has a profound impact on how people age, thus making aging a gendered experience. The question remains why aging has not been taken up as a feminist issue in India. This chapter gives insight into the reasons for their vulnerability.

Ageing in the Middle East and North Africa: A Contemporary Perspective

One of the central themes in the study of population growth has been ageing. Ageing in the world’s population has grown into a dominant demographic feature in twenty-first century society. An ageing population is the result of many contributing factors including the improvement of the health care system. The Middle East and North Africa (MENA) in recent years has attracted much interest from scholars, policy makers and social gerontology. By applying the geographical case studies of the Middle East and North Africa (MENA) this paper critically explores the issues and debates of ageing in a social policy context.