Maternal Risk Factors and Short Term Outcome of Prematurity: A Descriptive Study at a Secondary Care Hospital

Background: Approximately 15 million babies are born premature (before 37 weeks of gestation) and 1 million babies die due to prematurity complications every year. Less is known about risk factors of prematurity in middle and low-income countries. The prevalence of prematurity ranges from 5% - 18%. Objective: To determine the prevalence of premature births and to assess the rate of survival, along with the morbidity, among preterm newborns. Furthermore, to document our experience with different gestational age groups of preterm births;and to analyze the association among these strata and their clinical outcomes. Study Design: A descriptive study. Place and Duration of Study: The Aga Khan Maternal and Childcare Centre Hyderabad, Pakistan, from 1st January 2017 to 31st December 2018. Methodology: All pregnant women registered at the obstetric clinic before 24 weeks of gestation having at least three subsequent visits at the same clinic were included in the study. The women who were lost to follow up before completing three visits were excluded from the study. All un-booked women were also excluded from the study. Demographic profile was recorded including maternal age, parity, no of visits at the clinic, gestational age, mode of delivery, birth weight and pregnancy outcome. Newborns were subsequently followed at nursery or well-baby till discharge. Further subgroups were made for gestational age to assess the frequency of various morbidities in each group. Results: One thousand and ninety-one (1091) women were included in the study period that fulfilled the inclusion criteria. Two pregnancies were terminated before 24 weeks due to major congenital malformations. The prevalence of prematurity was recorded as 13.4% (146/1089). Perinatal mortality rate (no of stillbirths plus the number of early neonatal death/1000 live birth) was 17 (15.6/1000 live births) out of them, 12 were still births and 5 were early neonatal death. Out of the total preterm babies born, 59.5% (87/146) were admitted to the nursery. In the study group (2%/3146) were extreme preterm, while 7.5% were severe preterm (11/146). Moderate preterm was 11.6% (17/146) and the majority were late preterm accounting for 78.7% (115/146). Though the incidence of birth asphyxia were noted more in late preterm babies i.e. 10 as the number of these babies are also high in our study but the overall percentage was low (8.7%) as compared with the babies of extreme prematurity (100%) and moderate late prematurity (23.5%) respectively. In pregnancy outcome, 12 were still births in which six (50%) were in the late preterm group. Total of 17 newborns suffered from birth asphyxia in which ten newborns (58.8%) were in late preterm group. Overall, it was noted that the decreasing gestational age was directly correlated to morbidity and mortality. Conclusion: Among the different strata, the late preterm group has been observed to be associated with greater morbidity and mortality. Prior awareness of the morbidities associated with late preterm babies is helpful for the health care providers to anticipate and manage potential complications in preterm infants.

Spinal cord injury regeneration using autologous bone marrowderived neurocytes and rat embryonic stem cells:A comparative study in rats

BACKGROUND Spinal cord injury(SCI)is an important cause of traumatic paralysis and is mainly due to motor vehicle accidents.However,there is no definite treatment for spinal cord damage.AIM To assess the outcome of rat embryonic stem cells(rESC)and autologous bone marrow-derived neurocytes(ABMDN)treatment in iatrogenic SCI created in rats,and to compare the efficacy of the two different cell types.METHODS The study comprised 45 male Wistar rats weighing between 250 and 300 g,which were divided into three groups,the control,rESC and ABMDN groups.The anesthetized animals underwent exposure of the thoracic 8th to lumbar 1st vertebrae.A T10-thoracic 12th vertebrae laminectomy was performed to expose the spinal cord.A drop-weight injury using a 10 g weight from a height of 25 cm onto the exposed spinal cord was conducted.The wound was closed in layers.The urinary bladder was manually evacuated twice daily and after each evacuation Ringer lactate 5 mL/100 g was administered,twice daily after each bladder evacuation for the first 7 postoperative days.On the 10th day,the rats underwent nerve conduction studies and behavioral assessment[Basso,Beattie,Brenham(BBB)]to confirm paraplegia.Rat embryonic stem cells,ABMDN and saline were injected on the 10th day.The animals were euthanized after 8 wk and the spinal cord was isolated,removed and placed in 2%formalin for histopathological analysis to assess the healing of neural tissues at the axonal level.RESULTS All the animals tolerated the procedure well.The BBB scale scoring showed that at the end of the first week no recovery was observed in the groups.Post-injection,there was a strong and significant improvement in rats receiving rESC and ABMDN as compared to the control group based on the BBB scale,and the Trainof-four-Watch SX acceleromyography device exhibited statistically significant(P<0.0001)regeneration of neural tissue after SCI.Histological evaluation of the spinal cord showed maximum vacuolization and least gliosis in the control group compared to the rESC and ABMDN treated animals.In the ABMDN group,limited vacuolization and more prominent gliosis were observed in all specimens as compared to the control and rESC groups.CONCLUSION This study provided strong evidence to support that transplantation of rESC and ABMDN can improve functional recovery after iatrogenic SCI.The transplanted cells showed a beneficial therapeutic effect when compared to the control group.

Overexpression of Her1 (EGFR) in Gastric Cancer: A Saudi Regional Population Based Study

Background: Gastric cancer is one of the commonest malignant tumor worldwide. Its treatment remains a challenge for physicians. Epidermal growth factor receptor (EGFR) inhibitors have played a significant role in the management of solid malignancies including colorectal cancer. In this study we aimed to determine EGFR expression in gastric adenocarcinoma by standardized immunohistochemistry in a Saudi regional population based cohort and also to evaluate Ki-67 proliferating index and p-53 mutation status. Materials and Methods: Gastric carcinoma (GC) cases comprising surgical resection specimens and endoscopic biopsies, were selected, from the pathology archives of King Fahd Hospital of the University of Dammam (KFHU), spanning a time period of 6 years. The histological GC type was delineated according to Laurens classification and immunohistochemical (IHC) protein analysis for EGFR, Ki-67 and p-53 was carried out. Results: 42 cases of gastric GC were analyzed and EGFR overexpression was demonstrated in 4.76% of cases. Out of these 2.38% had membranous and the remaining demonstrated predominantly cytoplasmic along with focal membranous positivity. Ki-67 proliferation index ranged from moderate to high and p-53 mutation status was negative in these cases. Conclusion: Low EGFR expressivity could be reflective of regional variation in cancer characteristics. The study also highlights the inadequacy of the currently employed gastric EGFR interpretation criterions and stresses on development of standardized and uniform EGFR evaluation protocols tailored for gastric needs.