Intrauterine Foetal Death: A Hospital Based Study

Introduction: Foetal death at any stage of pregnancy is not just a tragic event but also a more traumatic for the mental well-being of a mother. It is one of the most wrenching events in the field of obstetrics. Aims: The study was done to determine the probable risk factors of intrauterine foetal death and role of antenatal care in its prevention. Methods: The study was conducted in Obstetrics and Gynecology department at Nepalgunj Medical college from July 2018 to July 2020 .Inclusion criteria were intrauterine fetal death of >28 weeks of gestation and baby weighing 1000 grams or more . An exclusion criterion was molar pregnancy. Results: There were 115(3.52%) intrauterine fetal death during the study period, making it 35 per 1000 cases. In 17(14.78%) the cause of intrauterine fetal death was not known. The other common associated risk factors were prematurity in 14(12.17%) and hypertension in 13(11.30%). Similarly anemia and antepartum hemorrhage were seen in 13(11.30%) each. 11(9.56%) patients had oligohydramnios. Mal presentation was found in 8(6.95%) patients while polyhydromnios in 6(5.21%).The commonest age range in whom intrauterine fetal death was seen was 20-30 (73.90%). 28 (24.34%) patients were at preterm pregnancy ranging between 28-30 weeks whereas 17(14.78) intrauterine fetal death occured at 32-34 weeks. 77 foetuses were preterm and their birth weight was between 1 - 1.5 kg with the mean wt of 1175.73 gms. Conclusion: Intrauterine fetal death is still common inspite of the improving awareness in importance of regular antenatal care. In majority, the cause of intrauterine fetal death is still unknown. However, where the cause was known prematurity was the commonest.

Impact of covid-19 on quality of life in COVID recovered patients: A cross-sectional survey

COVID-19 pandemic has affected India to a great extent. Till date total of 3.30 crore peoples has been cured and discharged and 44.6 lakh are died due to covid -19 in India. COVID-19 has a long-term systemic effect on lungs, liver, spleen, anxiety and depression and persistence of inflammatory response even after getting cured or COVID negative. Which may affect quality of life. So, there is a need to evaluate quality of life in post COVID patients.A cross-sectional study was conducted on the 100 COVID-19 recovered Participants. Participants were selected on the basis of inclusion and exclusion criterion. Basic assessment of symptom history, medical history and hospitalisation was done by investigator. A quality of life was evaluated using short form-36 questionnaire (SF-36). Statistical analysis was done using Microsoft excel-2019.A total of 100 participants 61% were male and 39% were female participants. We found that general health component was greatly affected with 68.50%. Following general health emotional well-being (69.68%), social functioning (68.14), pain (64.38%), limitation due to emotional problems (64.19%), energy/fatigue (63.3%), limitation due to physical health (59.61) and physical functioning (48.27%) were affected.We found that there was mild – moderate affection in quality of life in covid recovered subjects. There was more affection in quality of life in participants with other comorbidities. We also found that there were persistence of breathlessness and fatigue after recovery.

Sellar germinoma mimicking IgG4-related hypophysitis: a case report

Background The differential diagnosis of IgG4-related hypophysitis and other inflammatory diseases or tumors involving sellar region is challenging even after sellar biopsy. Sellar germinoma is usually infiltrated by lymphocytes or plasma cells, and may be confused with hypophysitis. Case presentation A 36-year-old man with diabetes insipidus, elevated serum IgG4 level (336 mg/dl), and sellar mass was suspected to have IgG4-related hypophysitis, and no other lesion of IgG4-related disease was detected. After treated by prednisone and mycophenolate mofetil, the serum IgG4 decreased to 214 mg/dl. However, after withdrawal of the drugs, the IgG4 level increased to 308 mg/dl. Endocrine assessments revealed panhypopituitarism, and the sellar mass enlarged. Transsphenoidal sellar exploration and biopsy was conducted. Pathological examination showed that the lesion was germinoma with lymphocytes and plasma cells infiltration, and IgG4-staining was positive (70/HPF, IgG4/IgG ratio = 10%). The patient was then treated by cisplatin and etoposide. After four cycles of chemotherapy, the serum IgG4 was 201 mg/dl, and the sellar mass was invisible. Conclusion Sellar germinoma can mimic the clinical characteristics of IgG4-related hypophysitis. Poor response to glucocorticoids can be used as an exclusion criterion in the clinical diagnosis of IgG4-related hypophysitis.

Fetal-maternal surgery for spina bifida in a HIV-infected mother

INTRODUCTION: In select cases, in utero surgery for MMC leads to better outcomes than postnatal repair. However, maternal HIV infection constitutes a formal exclusion criterion due to the potential of vertical HIV transmission. Encouraged by a previous case of a successful fetal spina bifida repair in a Hepatitis Bs antigen positive woman, a plan was devised allowing for fetal surgery. CASE REPORT: In utero MMC repair was performed although the mother was HIV-infected. To minimize the risk of in utero HIV transmission, the mother was treated by HAART throughout gestation as well as intravenous zidovudine administration during maternal-fetal surgery. The mother tolerated all procedures very well without any sequelae. The currently 20 month-old toddler, is HIV negative and has significantly benefitted from fetal surgery. DISCUSSION/CONCLUSION: This case shows that maternal HIV is not a priori a diagnosis that excludes fetal surgery. Rather, it might be a surrogate for moving towards personalized medicine and away from applying too rigorous exclusion criteria in the selection of candidates for maternal-fetal surgery.

Latin Americans and US Hispanics show differences in IBD phenotype: a systematic review with meta-analysis

Latin America has experienced a rise in the prevalence and incidence of inflammatory bowel disease (IBD). Differences in IBD phenotype between Hispanics in Latin America and those in the USA have not been described. We conducted a systematic review with meta-analysis of population-based and cohort studies comparing the phenotype of ulcerative colitis (UC) and Crohn’s disease (CD) in Latin Americans and US Hispanics. A systematic search was conducted up to March 2019 using MEDLINE, EMBASE and Google Scholar. Inclusion criterion includes studies describing IBD phenotype in Latin Americans or in US Hispanics. Exclusion criterion includes prevalence or incidence studies not describing phenotype. A random effects model was chosen “a priori” for analysis of pooled proportions. A total of 46 studies were included from Latin America and 7 studies from the USA. The predominant IBD subtype in Latin America was UC with a more balanced UC:CD ratio noted in Puerto Rico (0.53) and Brazil (0.56). UC-related extensive colitis was more common in US Hispanics (0.64) than in Latin Americans (0.38), p<0.001. CD phenotype was similar between US Hispanics and Latin Americans. UC is the predominant IBD subtype in Latin America, with the exception of Puerto Rico and Brazil which demonstrate a more balanced UC:CD ratio. In UC, extensive colitis was more frequently seen in US Hispanics than in Latin Americans. CD phenotype was similar in both US Hispanics and Latin Americans.

Prediction of Self-care Behaviors in COVID-19 Prevention Based on Persuasion Techniques

Background: Persuasion is a method used to correct and modify the attitude and behaviors of community members to protect collective benefits, especially during crises. Objectives: The present study aimed to predict COVID-19 preventive behaviors based on persuasion techniques in five countries. Methods: This descriptive, correlational study was conducted on the population aged more than 18 years in Iran, Australia, the United Kingdom, Sweden, and Canada. The sample size determined by Morgan’s table was 498 individuals who were selected via convenience sampling in the spring of 2020. Data were collected online using a Demographic Questionnaire, a Persuasion Scale (2020), and the Questionnaire of Healthy Preventive Behaviors for COVID-19 (2020). The inclusion criteria were the age of more than 18 years and basic literacy, and the exclusion criterion was incomplete questionnaires. Data analysis was performed in SPSS version 21 using Pearson’s correlation-coefficient and multiple regression analysis. Results: A positive significant correlation was observed between persuasion techniques and healthy preventive behaviors for COVID-19 (P < 0.001). Among the components of persuasion, fear, interest in the messenger, frequency of the message, and reliability of the messenger could most significantly predict healthy behaviors (P < 0.001). Conclusions: According to the results, the mass media and authorities could enhance the effectiveness of their agenda by identifying the influential factors in the success of persuasion techniques. These findings could be beneficial to social psychiatrists, authorities, and the mass media.

Active surveillance inclusion criteria under scrutiny in magnetic resonance imaging-guided prostate biopsy: a multicenter cohort study

Background Although multiparametric magnetic resonance imaging (mpMRI) is recommended for primary risk stratification and follow-up in Active Surveillance (AS), it is not part of common AS inclusion criteria. The objective was to compare AS eligibility by systematic biopsy (SB) and combined MRI-targeted (MRI-TB) and SB within real-world data using current AS guidelines. Methods A retrospective multicenter study was conducted by a German prostate cancer (PCa) working group representing six tertiary referral centers and one outpatient practice. Men with PCa and at least one MRI-visible lesion according to Prostate Imaging Reporting and Data System (PI-RADS) v2 were included. Twenty different AS inclusion criteria of international guidelines were applied to calculate AS eligibility using either a SB or a combined MRI-TB and SB. Reasons for AS exclusion were assessed. Results Of 1941 patients with PCa, per guideline, 583–1112 patients with PCa in both MRI-TB and SB were available for analysis. Using SB, a median of 22.1% (range 6.4–72.4%) were eligible for AS. Using the combined approach, a median of 15% (range 1.7–68.3%) were eligible for AS. Addition of MRI-TB led to a 32.1% reduction of suitable patients. Besides Gleason Score upgrading, the maximum number of positive cores were the most frequent exclusion criterion. Variability in MRI and biopsy protocols potentially limit the results. Conclusions Only a moderate number of patients with PCa can be monitored by AS to defer active treatment using current guidelines for inclusion in a real-world setting. By an additional MRI-TB, this number is markedly reduced. These results underline the need for a contemporary adjustment of AS inclusion criteria.

Using semantics to scale up evidence-based chemical risk-assessments

Background The manual processes used for risk assessments are not scaling to the amount of data available. Although automated approaches appear promising, they must be transparent in a public policy setting. Objective Our goal is to create an automated approach that moves beyond retrieval to the extraction step of the information synthesis process, where evidence is characterized as supporting, refuting, or neutral with respect to a given outcome. Methods We combine knowledge resources and natural language processing to resolve coordinated ellipses and thus avoid surface level differences between concepts in an ontology and outcomes in an abstract. As with a systematic review, the search criterion, and inclusion and exclusion criterion are explicit. Results The system scales to 482K abstracts on 27 chemicals. Results for three endpoints that are critical for cancer risk assessments show that refuting evidence (where the outcome decreased) was higher for cell proliferation (45.9%), and general cell changes (37.7%) than for cell death (25.0%). Moreover, cell death was the only end point where supporting claims were the majority (61.3%). If the number of abstracts that measure an outcome was used as a proxy for association there would be a stronger association with cell proliferation than cell death (20/27 chemicals). However, if the amount of supporting evidence was used (where the outcome increased) the conclusion would change for 21/27 chemicals (20 from proliferation to death and 1 from death to proliferation). Conclusions We provide decision makers with a visual representation of supporting, neutral, and refuting evidence whilst maintaining the reproducibility and transparency needed for public policy. Our findings show that results from the retrieval step where the number of abstracts that measure an outcome are reported can be misleading if not accompanied with results from the extraction step where the directionality of the outcome is established.

Medical Students Viewpoints towards Development of Telemedicine Methods at Army University of Medical Sciences

Aim: The study aimed to investigate the viewpoints of medical students towards the development of telemedicine methods at the Army of the Islamic Republic of Iran (AJA) University of Medical Sciences. Method: This cross-sectional, descriptive-analytical study, which lasted 4 months, was performed on 117 medical students of AJA University of Medical Sciences in 2021. In doing so, a Stratified sampling method and researcher-made questionnaire were used to collect data. Thus, the inclusion criterion was being a medicine student and the exclusion criterion was the incomplete completion of the questionnaire. Results: Students showed the most positive view (90.6%) regarding organizational factors to having a codified program in telemedicine development, and the most positive view towards high-speed Internet access (92.3%) concerning technology factors. In addition, as far as the stakeholders were concerned, they had the most positive view (70.1%) on community support for telemedicine development. As for information literacy, 88.9% emphasized computer and Internet skills. Also, 83.8% had the most positive view on raising awareness for telemedicine development regarding environmental factors. Conclusion: To sum up, the students had the most positive attitudes towards comprehensive telemedicine development plan, high-speed Internet access, and community support for telemedicine development, computer skills, Internet, and awareness. Hence, it is recommended to enhance these factors to help the development and implementation of telemedicine in medical education.

Equity in Vaccine Trials for Higher Weight People? A Rapid Review of Weight-Related Inclusion and Exclusion Criteria for COVID-19 Clinical Trials

Higher weight status, defined as body mass index (BMI) ≥ 30 kg/m2, is frequently described as a risk factor for severity and susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (known as COVID-19). Therefore, study groups in COVID-19 vaccine trials should be representative of the weight spectrum across the global population. Appropriate subgroup analysis should be conducted to ensure equitable vaccine outcomes for higher weight people. In this study, inclusion and exclusion criteria of registered clinical trial protocols were reviewed to determine the proportion of trials including higher weight people, and the proportion of trials conducting subgroup analyses of efficacy by BMI. Eligibility criteria of 249 trial protocols (phase I, II, III and IV) were analysed; 51 protocols (20.5%) specified inclusion of BMI > 30, 73 (29.3%) specified exclusion of BMI > 30, and 125 (50.2%) did not specify whether BMI was an inclusion or exclusion criterion, or if BMI was included in any ‘health’ screenings or physical examinations during recruitment. Of the 58 protocols for trials in phase III and IV, only 2 (3.4%) indicated an intention to report subgroup analysis of vaccine efficacy by weight status. Higher weight people appear to be significantly under-represented in the majority of vaccine trials. This may result in reduced efficacy and acceptance of COVID-19 vaccines for higher weight people and exacerbation of health inequities within this population group. Explicit inclusion of higher weight people in COVID-19 vaccine trials is required to reduce health inequities.