Analysis of causes of maternal mortality in tertiary care center, 11 years study

Background: Objectives to study the causes of maternal mortality and the complications leading to maternal death.Methods: A retrospective study of hospital records and death summaries of all maternal death over a period of 11 years from January 2008 to December 2018 was carried out at tertiary care hospital, Mumbai.Results: There were a total of 459 maternal death out of 36930 live birth giving maternal mortality rate mean maternal mortality ratio (MMR) of 1242 per 100000 live births. Unregistered and late referral account for maternal death. The majority of women were in 21-30 years age group in 20 to less than 37 weeks of pregnancy. The commonest cause of death was due to hepatitis infection 129 (28.1%), sepsis 52 (11.32%), PIH including eclampsia 46 (10.02%), cardiovascular diseases 33 (7.18%), haemorrhage 31 (6.75%), Kochs 31 (6.75%) and respiratory diseases 22 (4.79%).Conclusions: Maternal mortality can be reduced by identifying causes which are preventable and giving timely treatment.

Estimating High Mobility Group Box Protein 1 (HMGB1) Single Nucleotide Polymorphisms Among Hepatitis B Virus Infected Patients of Pakistan Origin

HMGB1 is nuclear non-histone protein and unique member of cytokines. In viral hepatitis infection HMGB1 serum level increases and translocates towards cytoplasm and extracellular spaces where it activates single stimulating hepatic stellate cell proliferation which induces fibrogenic protein expression and causes hepatocellular carcinoma. In this study, total 150 subjects were recruited to assess the association between HMGB1 SNPs and HBV. Three types of genotypes were found visible in rs3742305 of HMGB1; wild type homozygous GG with 65%, homozygous minor type CC with 6% and heterozygous minor type GC with 26% frequency distribution. High prevalence of GG genotype in the selected population presenting that GG genotype may have higher risk for susceptibility to HBV infection. Our results showed significant correlation of HMGB1 polymorphism with HBV infection in the selected Pakistani population.

Recommendations of the AGG (Task Force for Obstetrics, Section Maternal Diseases) on the Management of Maternal Hepatitis B, C and D Infection in Pregnancy

These statements and recommendations should provide appropriate information about maternal and fetal routes of infection, screening, detection of risk factors, diagnostic procedures, treatment, birth planning and peripartum and postpartum management of maternal hepatitis infection and offer pointers for prenatal counselling and routine clinical care on delivery wards.

Hepatitis B infection is causally associated with extrahepatic cancers: a Mendelian randomization study

Overwhelming evidence suggests that chronic hepatitis infection is associated with extrahepatic cancers. However, uncertainties exist about this association as much of the current evidence evolve from observational studies which are susceptible to confounding. We performed two-sample Mendelian randomization (MR) to explore the causal associations between chronic hepatitis infection and extrahepatic cancers. Genetic variants associated with chronic hepatitis B virus (HBV) infection and chronic hepatitis C virus (HCV) infection were identified from a large genome-wide association study. Summary level data for cancer of the biliary tract, cervix, colorectum, endometrium, esophagus, gastric, liver, lung, ovary and pancreas were obtained from the Biobank Japan. Using the inverse variance weighted method, we found chronic HBV infection to be causally associated with gastric cancer (odds ratio [OR] = 1.19 and 95% confidence interval [CI] = 1.13-1.25, P-value = 0.001) and lung cancer (OR = 1.21, 95% CI = 1.14-1.28, P-value = 0.001). Moreover, chronic HBV infection (OR = 1.34, 95% CI = 1.17-1.53, P-value = 0.007) and chronic HCV infection (OR = 2.75, 95% CI = 2.21-3.42, P-value = 0.0008) were all causally associated with liver cancer, supporting a well-established association between chronic hepatitis infection and liver cancer. In conclusions, our MR findings revealed that chronic HBV infection is causally associated with extrahepatic cancers including gastric and lung cancers.

Estimating High Mobility Group Box Protein 1 (HMGB1) Single Nucleotide Polymorphisms Among Hepatitis B Virus Infected Patients of Pakistan Origin

HMGB1 is nuclear non-histone protein and unique member of cytokines. In viral hepatitis infection HMGB1 serum level increases and translocates towards cytoplasm and extracellular spaces where it activates single stimulating hepatic stellate cell proliferation which inducesfibrogenic protein expression and causes hepatocellular carcinoma. In this study, total 150 subjects were recruited to assess the association between HMGB1 SNPs and HBV. Three types of genotypes were found visible in rs3742305 of HMGB1; wild type homozygous GG with 65%, homozygous minor type CC with 6% and heterozygous minor type GC with 26% frequency distribution. High prevalence of GG genotype in the selected population presenting that GG genotype may have higher risk for susceptibility to HBV infection. Our resultsshowedsignificant correlationof HMGB1 polymorphism with HBV infection in the selected Pakistani population.

GESTION DES DECHETS SOLIDES DU CENTRE HOSPITALIER REGIONAL DE DALOA (CENTRE-OUEST DE LA COTE D’IVOIRE) ET DES RISQUES ASSOCIES

International audience Health facilities generate multiple wastes on a dailybasis, which constitute a health and environmentalproblem in the event of poor management. Theobjective of our study was to improve wastemanagement at the Daloa Regional Hospital (CHR). Toachieve this, surveys were conducted with DaloaRegional Hospital (CHR) staff and users. Sharp andcutting waste at the level of each department and therisks associated with this waste has been quantified.The results showed that the waste produced withinthe Daloa Regional Hospital is of two types, namelyhealthcare waste (39.1 %) found in specialized serviceand waste treated as household waste (60.9 %) foundin all service. 71.1 % of CHR staff do not sort the wastecollected. The collected waste is transported inwheelbarrows contrary to the recommendations ofthe World Health Organization (WHO). In the absenceof a functional incinerator, sharps waste,pharmaceutical waste, no-sharps waste andhousehold waste are burned in the open air andanatomical waste is buried in landfill pits. The methodand process of waste management produced at DaloaRegional Hospital (CHR) could result in significant risksof HIV-AIDS infection and hepatitis infection,estimated at 40.8 % and 28.7 % respectively. Theacquisition of a banalizer by Daloa Regional Hospital(CHR) staff raises hopes for an improvement in wastemanagement at this important health facility inCentral West-Ivorien. Les établissements de santé génèrent au quotidien demultiples déchets qui constituent un problèmesanitaire et environnemental en cas de mauvaisegestion. L’objectif de cette étude était d’évaluer leslimites des actions afin d’améliorer la gestion desdéchets au sein du Centre Hospitalier Régional deDaloa (CHR). Pour y arriver, des enquêtes ont étémenées auprès du personnel et des usagers du CHRde Daloa. Les déchets piquants et tranchants auniveau de chaque service ont été quantifiés et lesrisques associés ont été évalués. Les résultats ontmontré que les déchets produits au sein du CHR deDaloa sont de deux types à savoir les déchetsd’activités de soins (39,1 %) retrouvés dans lesservices spécialisés et les déchets assimilés auxordures ménagères (60,9 %) retrouvés dans tous lesservices. 71,1 % du personnel du CHR n’effectuent pasde tri des déchets collectés. Les déchets collectés sonttransportés à la brouette contrairement auxrecommandations de l’Organisation Mondiale de laSanté (OMS). En absence d’un incinérateurfonctionnel, les déchets piquants/tranchants, lesdéchets pharmaceutiques, les déchets non piquants/non tranchants et les déchets ménagers sont brulés àl’air libre quant aux déchets anatomiques ils sontenfouis dans les fosses. Le mode de gestion desdéchets produits au sein du CHR de Daloa pourraitêtre à l’origine d’importants risques d’infection à VIHSida,d’infection à hépatite évalués respectivement à40,8 % et 28,7 % par les personnels de l’hôpital.L’acquisition d’un banaliseur par le personnel du CHRde Daloa laisse entrevoir l’espoir d’une améliorationdans la gestion des déchets de cet importantétablissement de santé du Centre-Ouest-ivoirien.