Anaemia during pregnancy, particularly severe anaemia, is not only a major cause of morbidity and mortality in pregnant women in low- and middle-income countries , but also has been associated with increased risks of both maternal and neonatal adverse outcomes.
Data on pregnant women were prospectively recorded from admission to discharge, including maternal age, parity, gestational age, APGAR score, maternal blood haemoglobin level at delivery, birth weight, delivery method, stillbirths, new-borns requiring neonatal intensive care unit , preterm delivery, oxytocin administration for augmentation of labour, foetal gross congenital anomalies, foetal distress, emergency primary caesarean section, prolonged labour, severe preeclampsia or eclampsia,...
Inclusion criteria were age 16–47 years, singleton pregnancy, and documented placental diseases or foetal gross congenital anomalies shortly before or at the time of delivery. Women were excluded in the presence of any of the following: multi gestation, incomplete clinical or hospital data, chronic hypertension, malaria, and diabetes mellitus. Twenty-two women who did not give consent to be enrolled in the study were also excluded.
The study was approved by the Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital Ethics and Research Committee . The study was performed in accordance with the principles and guidelines of the Declaration of Helsinki. All participants were informed about the study and gave consent to publication of the results. Analysis and reporting of the results are in compliance with the Strengthening the Reporting of Observational Studies in Epidemiology checklist.
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Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies - BMC Medical EducationBackground Several studies suggest that medical student empathy declines throughout medical school. However, no studies have synthesised the evidence regarding why empathy declines. Objective To conduct a systematic review and thematic synthesis of qualitative studies investigating why student empathy may change throughout medical school. Methods We included any qualitative study that investigated why empathy might change during medical school. We searched the Medline, Scopus, CINAHL, ERIC, and APA PsycInfo databases for relevant studies. All databases were searched from their inception to 18 July 2022. We also searched the reference lists of the included studies and contacted experts to identify additional studies. We used the Joanna Briggs Institute tool to evaluate the risk of bias in the included studies. Overall confidence in our results was assessed using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. We used thematic methods to synthesise our findings. Results Our searches yielded 2523 records, and 16 studies involving a total of 771 students were eligible for analysis. Most studies (n = 11) were from Europe or North America. The descriptive themes and sub-themes were identified for each study. Increased complexity in patients and their diseases, together with the ‘hidden curriculum’ (including a stressful workload, prioritisation of biomedical knowledge, and (sometimes) poor role models), led to student adaptations, such as cynicism and desensitisation. Students’ prior lives and professional experiences appeared to exacerbate the decline in empathy. However, there were bias concerns for most of the included studies. Discussion Many of the included studies included were small, and some did not include demographic participant data. Given the likely benefits of providing empathic care for patients and practitioners, medical education interventions should focus on developing an ‘empathic hidden curriculum’ that mitigates
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Myocardial injury defined as elevated high-sensitivity cardiac troponin T is associated with higher mortality in patients seeking care at emergency departments with acute dyspnea - BMC Emergency MedicineBackground Elevated levels of cardiac troponin T has been observed in patients seeking care at the emergency department (ED) presenting with chest pain but without myocardial infarction (MI). The clinical importance of this observation remains, however, still unclear. Our main aim was to study the role of cardiac troponin T in patients admitted to the emergency department with acute dyspnea, a group of patients with a high cardiovascular comorbidity, but no primary acute MI. Population and methods Patients from the age of 18 seeking care at the ED for dyspnea, without an acute cardiac syndrome, and with a recorded assessment of high-sensitivity cardiac troponin T (hs-cTnT), were included (n = 1001). Patients were categorized into 3 groups by hs-cTnT level, i.e. 100 µg/l. Cox regression with Hazard Ratios (HRs) and 95% Confidence Intervals (CI) for 3-months mortality was performed, with adjustment for sex, age, respiratory frequency, saturation, CHF, renal disease, and BMI. Results Fully adjusted HRs (95% CI) for 3-month mortality, with hs-cTnT 100 a HR of 10.523 (4.465–24.803). Conclusion Elevated hs-cTnT seems to be a relevant marker of poor prognosis in patients with acute dyspnea without MI and warrants further validation and clinical testing.
Source: BioMedCentral - 🏆 22. / 71 Read more »
Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature - BMC MedicineBackground Diabetes has reached epidemic proportions in recent years with serious health ramifications. The aim of this study was to evaluate the strength and validity of associations between diabetes and anti-diabetic interventions and the risk of any type of gynaecological or obstetric conditions. Methods Design: Umbrella review of systematic reviews and meta-analyses. Data sources: PubMed, Medline, Embase, Cochrane Database of Systematic Reviews, manual screening of references. Eligibility criteria: Systematic reviews and meta-analyses of observational and interventional studies investigating the relationship between diabetes and anti-diabetic interventions with gynaecological or obstetric outcomes. Meta-analyses that did not include complete data from individual studies, such as relative risk, 95% confidence intervals, number of cases/controls, or total population were excluded. Data analysis: The evidence from meta-analyses of observational studies was graded as strong, highly suggestive, suggestive or weak according to criteria comprising the random effects estimate of meta-analyses and their largest study, the number of cases, 95% prediction intervals, I2 heterogeneity index between studies, excess significance bias, small study effect and sensitivity analysis using credibility ceilings. Interventional meta-analyses of randomised controlled trials were assessed separately based on the statistical significance of reported associations, the risk of bias and quality of evidence (GRADE) of included meta-analyses. Results A total of 117 meta-analyses of observational cohort studies and 200 meta-analyses of randomised clinical trials that evaluated 317 outcomes were included. Strong or highly suggestive evidence only supported a positive association between gestational diabetes and caesarean section, large for gestational age babies, major congenital malformations and heart defects and an inverse relationship between metformin use and ovarian cancer incidence. Only
Source: BioMedCentral - 🏆 22. / 71 Read more »