A retrospective analysis of maternal mortality in an urban tertiary care hospital

Background: The aims of the study were to generate information regarding causes and complications leading to maternal deaths in an urban tertiary care centre and to find if any of the causes are preventable.Methods: The medical records of all maternal deaths occurring over a period of 4 years between January 2015 and December 2018 were reviewed.Results: Maternal mortality ratio ranged between 127 and 48 per 1, 00,000 births in the study. The causes of deaths were haemorrhage (29.47%), pregnancy-induced hypertension (PIH) (28.42%), anaemia (12.63%), sepsis (9.47%), thromboembolism (6.31%), hepatic causes (5.26%), blood reactions (3.15%), heart diseases (2.10%), central nervous system (CNS) related (1.05%) and others (2.10%). Maximum deaths occurred in women between 21-30 years of age. Mortality was highest in post-natal mothers (70.52%).Conclusions: Overall maternal mortality due to direct obstetric causes was (73.68%), indirect obstetric causes (22.10%) and unrelated causes (4.2%).

Concurrent cytologic and colposcopic evaluation of symptomatic cervical erosion

Background: Cervical cancer is amongst the leading causes of deaths due to cancer in developing countries. Moreover, preinvasive lesions of the cervix have a long latency period for conversion into malignancy and are also detectable by screening techniques. Hence, colposcopy in addition to cytology should be carried out wherever facility is available to ensure early detection and timely management.Methods: Simultaneous cytology and colposcopy was done for 80 women with symptomatic cervical erosion followed by a colposcopic directed biopsy in women with MRCI >3. Finally, correlation between cytology, colposcopy and histopathological results was done.Results: 65/80 women were biopsied. 12/80 women had MRCI >6 amongst which 10/80 were confirmed to have a high grade lesion on histopathology. 13/80 had lesser abnormalities (ASCUS and LSIL) amongst which 3/80 had CIN1 on histopathology. Only 2/80 had HSIL on cytology as compared to 8/80 on histopathology that had CIN 2/3. Lastly, only 1/80 had SCC on cytology compared to 2/80 on histopathology. The sensitivity, specificity, PPV and NPV of cytology and colposcopy for diagnosing cervical dysplasia was 46.1%, 83.5%, 35.2%, 88.8% and 84.6%, 86.5%, 55%, 96.6% respectively making colposcopy a better screening tool than cytology for evaluating cervical malignancy.Conclusions: Colposcopic examination should ideally be carried out in all women with symptomatic cervical erosion in addition to cytology. Moreover, suspicious areas should be biopsied even if cytology is normal to exclude malignancy.

INTERPRETATION OF INJURIES AND ASSESSMENT OF CAUSES OF DEATH IN WILD MAMMALS RECEIVED AT CETAS / IBAMA IN RIO BRANCO, ACRE, BRAZIL:

The necropsy of wild animals is necessary to raise the awareness of the competent public organizations and the population about the risks of zoonosis. Given the scarcity of information the aim of this article was to survey of the main injuries and causes of deaths of wild mammals kept in captivity was made, through the post mortem diagnosis and who passed through Wild Animal Screening Center (Centro de Triagem de Animais Silvestres - CETAS) of Rio Branco - Acre, Brazil, from September 2012 to September 2015. After death, the animals were kept refrigerated or frozen until the time of necropsy, using the standard technique for small mammals. Fragments of organs and tissues were collected, and the material was processed for histopathology using formalin fixation (10%), paraffin impregnation, hematoxylin and eosin staining, in 4 µm thick sections. 42 animals were submitted to necropsy, 27 males (64.3%) and 15 females (35.7%), of which 21 were adults (50%), 15 were puppies (35.7%) and six were young (14.3%). The main cause of death was hypovolemic shock (11.6%), followed by starvation (9.3%). There were also many deaths from undetermined causes (11.6%). A greater occurrence of deaths was registered in the Guariba monkey (Alouatta senicullus). The identification of necropsy findings and the interpretation of macroscopic lesions showed that cardiovascular lesion was the most common deaths. There does not seem to be an influence between the dry and rainy periods on the number of deaths of these animals.

Determinants of the Underlying Causes of Mortality during the First Wave of COVID-19 Pandemic in Saudi Arabia: A Descriptive National Study

Since the emergence of the COVID-19 pandemic, the mortality statistics are constantly changing globally. Mortality statistics analysis has vital implications to implement evidence-based policy recommendations. This study aims to study the demographic characteristics, patterns, determinants, and the main causes of death during the first half of 2020, in the Kingdom of Saudi Arabia (KSA). Methodology: A retrospective descriptive study targeted all death (29291) registered in 286 private and governmental health settings, from all over KSA. The data was extracted from the ministry of health’s death records after the ethical approval. The International Classification of Diseases (ICD-10) and WHO grouping, were used to classify the underlying causes of deaths. The collected data were analyzed using the appropriate tables and graphs. Results: 7055 (24.9%) died at the middle age (40–59 y), and 19212(65.6%) were males, and 18110 (61.8%) were Saudi. The leading causes of deaths were non-communicable diseases (NCDs) 15340 (62.1%), mainly Cardiovascular diseases (CVDs) 10103(34. 5%). There was a significant relationship between the main causes of deaths and sex (p< 0.05) and nationality (p = 0.01). Conclusion: NCDs mainly CVDs are the leading cause of death. The Covid-19 mortalities were mainly in males, and old age >55y. The lockdown was associated with a reduction in the NCDs and Road traffic accidents mortalities.

Application of Metabolomics to Identify Potential Biomarkers for the Early Diagnosis of Coronary Heart Disease

Coronary heart disease (CHD) is one of the leading causes of deaths globally. Identification of serum metabolic biomarkers for its early diagnosis is thus much desirable. Serum samples were collected from healthy controls (n = 86) and patients with CHD (n = 166) and subjected to untargeted and targeted metabolomics analyses. Subsequently, potential biomarkers were detected and screened, and a clinical model was developed for diagnosing CHD. Four dysregulated metabolites, namely PC(17:0/0:0), oxyneurine, acetylcarnitine, and isoundecylic acid, were identified. Isoundecylic acid was not found in Human Metabolome Database, so we could not validate differences in its relative abundance levels. Further, the clinical model combining serum oxyneurine, triglyceride, and weight was found to be more robust than that based on PC(17:0/0:0), oxyneurine, and acetylcarnitine (AUC = 0.731 vs. 0.579, sensitivity = 83.0 vs. 75.5%, and specificity = 64.0 vs. 46.5%). Our findings indicated that serum metabolomics is an effective method to identify differential metabolites and that serum oxyneurine, triglyceride, and weight appear to be promising biomarkers for the early diagnosis of CHD.

Urolithins: Diet-Derived Bioavailable Metabolites to Tackle Diabetes

Diabetes remains one of the leading causes of deaths and co-morbidities in the world, with tremendous human, social and economic costs. Therefore, despite therapeutics and technological advancements, improved strategies to tackle diabetes management are still needed. One of the suggested strategies is the consumption of (poly)phenols. Positive outcomes of dietary (poly)phenols have been pointed out towards different features in diabetes. This is the case of ellagitannins, which are present in numerous foodstuffs such as pomegranate, berries, and nuts. Ellagitannins have been reported to have a multitude of effects on metabolic diseases. However, these compounds have high molecular weight and do not reach circulation at effective concentrations, being metabolized in smaller compounds. After being metabolized into ellagic acid in the small intestine, the colonic microbiota hydrolyzes and metabolizes ellagic acid into dibenzopyran-6-one derivatives, known as urolithins. These low molecular weight compounds reach circulation in considerable concentrations ranging until micromolar levels, capable of reaching target tissues. Different urolithins are formed throughout the metabolization process, but urolithin A, isourolithin A, and urolithin B, and their phase-II metabolites are the most frequent ones. In recent years, urolithins have been the focus of attention in regard to their effects on a multiplicity of chronic diseases, including cancer and diabetes. In this review, we will discuss the latest advances about the protective effects of urolithins on diabetes.

Radiotherapy (WBRT) or Autologous Stem-Cell Transplantation (ASCT) for Primary CNS Lymphoma in Patients 60 Years of Age and Younger: Long-Term Results of the Intergroup Anocef-Goelams Randomized Phase II Precis Study

Introduction: We previously reported the results of the PRECIS trial with a median follow-up of 33 months. Both whole brain radiotherapy (WBRT) and autologous stem cell transplantation (ACST) were effective according to the predetermined threshold. However, more relapses occurred in the WBRT arm. The 2-year event-free survival (EFS) from consolidation (relapse or death defined as event) were 69% (95% CI, 57% to 83%) and 87% (95% CI, 77% to 98%) after WBRT and ASCT, respectively (p = 0.03). Overall survival (OS) was similar in both arms. Cognitive impairment was observed after WBRT, whereas cognitive functions were preserved or improved after ASCT. A longer follow-up is required to better assess the impact of the treatment on relapse, survival and late complications. We report here the results of the PRECIS trial with a median follow-up of 98.3 months [min= 4,1 - max= 131.1], focusing on the per protocol population from time of consolidation. Methods: Immunocompetent patients (18 to 60 years of age) with untreated primary CNS lymphoma (PCNSL) were randomly assigned upfront to receive WBRT (Arm A) or ASCT (Arm B) as consolidation treatment after an induction chemotherapy consisting of two cycles of R-MBVP (rituximab, methotrexate, VP16, BCNU, prednisone) followed by two cycles of R-AraC (rituximab, cytarabine). Intensive chemotherapy consisted of thiotepa (250 mg/m2/d D9; D8; D7), busulfan (8 mg/kg D6 through D4), and cyclophosphamide (60 mg/kg/d D3; D2). WBRT delivered 40 Gy (2 Gy/ fraction). Cognitive functions were prospectively assessed until disease progression and focused on global cognitive function, episodic verbal memory, attention and mental flexibility, and psychoaffective status. Results: 140 patients were randomized (Arm A: N = 70; Arm B: N = 70). Fifty-three and 44 patients completed WBRT and ASCT respectively (per protocol population), including 3 and 5 patients who were in progressive disease (PD) at time of WBRT and ASCT, respectively. 8-y EFS from time of consolidation in the per protocol population was 75.9% [63.3-91.0] and 39.9% [26.8-59.3] after ASCT and WBRT, respectively (p = 0.007) (fig 1a). The risk of relapse was significantly decreased after ASCT compared to WBRT (8-y relapse-free interval 94.1% [86.4-100] vs 47.6% [34.2-66.3], (p &lt;0.001) (fig 1b). The 8-year overall survival from time of consolidation was similar in both arms, 63.4% [49.8 - 80.6] and 69.3% [56.7-84.8] in the WBRT and ASCT arms, respectively (fig1c). Among the 24 patients who relapsed after WBRT, 13 patients received subsequent salvage chemotherapy and consolidative ASCT, and seven of these patients were disease-free at last follow-up. Causes of deaths after WBRT (n = 17) were PD (n = 12), neurotoxicity (n = 3), second-line ASCT (n = 2). After ASCT, causes of deaths (n = 14) were treatment-related death (n = 5, including 2 occurring &gt; 100 days post-ASCT, and 2 in patients in PD before ASCT), PD (n = 4), neurotoxicity following salvage WBRT (n = 1), second solid cancer (n = 3) and undetermined in one patient. In multivariate analysis, ECOG, disease status at the end of induction, and protein level in the CSF at diagnosis were independent prognostic factors for OS. Disease status at the end of induction and intraocular involvement at diagnosis were independent prognostic factors for EFS. Cognitive decline that could be fatal was only observed in patients who received WBRT. Imaging analysis of post consolidation leukoencephalopathy is ongoing. Conclusions: Consolidation with ASCT after HD-MTX based induction chemotherapy resulted in an excellent disease control but with a higher treatment-related mortality than WBRT. Severe Cognitive decline and late treatment-induced neurotoxic deaths were observed after WBRT. Intensity of the thiotepa-busulfan-cyclophosphamide regimen used before ASCT should be slightly reduced to improve the benefit/risk ratio of ASCT in first-line treatment of young patients with PCNSL. Figure 1 Figure 1. Disclosures Sylvain: Sanofi, Celegene, Roche, Abbvie, Sandoz, Janssen, Takeda: Consultancy. Damaj: takeda: Consultancy, Honoraria; roche: Consultancy, Honoraria. Sanhes: Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding.

The ability of physical activity in reducing mortality risks and cardiovascular loading and in extending life expectancy in patients with COPD

For chronic obstructive pulmonary disease (COPD), the role of physical activity in reducing COPD mortality and heart loading and in extending life expectancy remains unclear. Participants in comprehensive medical screening were recruited with spirometry on everyone. We analyzed physical activity volume calculated from intensity, duration and frequency of self-reported exercise history. Deaths were identified from the National Death File. The impacts of physical activity on mortality, heart rate and life expectancy were analyzed. Among the cohort of 483,603 adults, 32,535 had spirometry-determined COPD, indicating an adjusted national prevalence of 11.4% (male) and 9.8% (female). On the average, COPD increased all-cause mortality with a hazard ratio of 1.44 and loss of 6.0 years in life expectancy. Almost two thirds (65%) of the causes of deaths were extra-pulmonary, such as cardiovascular disease, diabetes, cancer and kidney diseases. In addition, COPD was associated with increases in heart rate proportionate to its severity, which led to higher mortality. Participants with COPD who were fully active physically could reduce mortality and have improved heart rates as compared with those without physical activity. In addition, their life expectancy could be extended close to those of the no COPD but inactive cohort. Fully active physical activity can help patients with COPD overcome most of the mortality risks, decrease heart rate, and achieve a life expectancy close to that of patients without COPD. The effectiveness of physical activity on COPD is facilitated by its systemic nature beyond lung disease.

Assessment of Student’s Knowledge, Attitude and Perceptions about Autopsy

Background: The clinical autopsy is a common term used to help in the identification of person’s clinical conditions and causes of deaths, however, the autopsy plays a vital role in the justice and jurisprudence. Objective: To determine the knowledge, beliefs and understanding of medical students regarding the autopsy Study Design: Descriptive, cross-sectional study Place and Duration of Study: Peoples University of Medical & Health Sciences for Women (PUMHSW) Nawabshah (SBA) Sindh Pakistan from 1st March 2021 to 31st August 2021. Methodology: Four hundred and twenty eight female students of 3rd year and 4th year were enrolled. The students were recruited based on random sampling method. Results: There were 221 students between 23 to 24 years followed by 207 students between 20 to 22 years. One hundred and sixty five were attended 3 autopsies. Autopsy is necessary for all unnatural death and the responses were 327 yes and 101 were no. Education of autopsy is mandatory for the career and the responses were 146 yes and 282 were no understanding, videos are helpful for autopsies and the responses were 178 yes and 250 were no. Conclusion: The autopsies and experiences regarding the autopsies was integral part of medical curriculum. The studies of autopsies are helpful to understand the human anatomy and reasons of deaths. The students’ perceptions supported the medical autopsies as important part of curriculum and teaching particular anatomy of human subjects. Key words: Knowledge, Attitude, Perceptions, Autopsy

Business Intelligence and Data Warehouse Technologies for Traffic Accident Data Analysis in Botswana

Road traffic accidents are a serious problem for the nation of Botswana. A large amount of money is used to compensate those who are affected by road accidents. Traffic accidents are one of the major causes of Deaths in Botswana. It is important for relevant organizations to have a reliable source of data for accurate evaluation of traffic accidents. Similarly, data on vehicle registration must be transformed and be readily available to assist managerial decision makers. In this article, we deploy a Business Intelligence (BI) and Data Warehouse (DW) solution in an attempt to assist the relevant departments in their road traffic accidents and vehicle registration evaluation. In Our evaluation of the traffic accidents our findings suggest that across accident severity, Damage Only accidents had the most interesting recent trend with a 11.93% decrease in the last 3 years on record. Count of Accident Severity for Damage Only accidents dropped from 13,491 to 11,881 between 2018 and 2020 whilst Minor accidents experienced the longest period of growth. Most accidents take place in rural locations and more accidents take place during the weekend. At 28,439, Sunday had the highest number of accidents and was 47.59% higher than Wednesday, which had the lowest count of accidents at 19,269. The results for vehicle registration reveal that the number of vehicle registration decreased for the last 3 years on record. The number of vehicles registered dropped from 65535 to 24457 during its steepest decline between 2019 and 2021.