Overlapping public health crises during the coronavirus disease pandemic

To date, the worldwide death toll from the coronavirus disease (COVID-19) pandemic has rapidly increased.We are in the midst of a global pandemic that poses enormous challenges to our healthcare systems globally.Emergency department (ED) physicians have played a significant role in saving lives of patients infected with severe acute respiratory syndrome coronavirus 2 (SARSCo V-2).Efficient,timely,andaccuratediagnosisand application of the most appropriate treatment modality to save lives are important tasks for ED physicians.

Epidemiology of children and adolescent eye injuries in British Columbia

AIM To quantify and characterize children and adolescent eye injuries treated in trauma department.METHODS A retrospective analysis was conducted of children and adolescent patients(0-19 years of age) with eye injuries using the British Columbia Trauma Registry(BCTR) data. BCTR data was obtained from January 1,2000 to December 31,2008. The BCTR provides the most detailed information on severe injuries throughout the province of BC. There are 12 trauma-receiving facilities in BC from which BCTR collects data.RESULTS A total of 162 patients with eye injuries were registered in BCTR during the data collection period. The highest number of injuries occurred in the 15-19 age group,followed by 10-14 and 5-9 age groups. Seventy-one point six percent of all patients were male. The mean age for all patients was 12.9(SD = 5.8) years. Vehicular crash was by far the most common mechanism of injury among all patients(42.0%) followed by blunt injury(14.2%) and cuts(12.3%). The child and adolescent eyeinjury data set we used for our study indicated that there were in total,50 patients that were tested for alcohol and drug use. The majority of them were 15-19 years of age(n = 38). Among the tested eye injury patients in the 15-19 age group,47%(18/38) tested positive for alcohol. There were approximately 30 cases of physical fighting(assault) and fighting-related injury among adolescents. Some injuries were caused by use of fire arms and knife during the assaults. Out of all patients,62(38%) were seen by an Ophthalmologist on admission,whereas 100(62%) patients were not seen by an eye specialist on admission. The most common injury diagnosis among the patients not consulted by ophthalmologist was conjunctiva injury(53%),whereas almost 9 out of 10 patients with ophthalmological consultation had laceration of cornea injury diagnoses. Using Glasgow Coma Scale(GCS)-based classification of brain injury severity,3.7% of all patients were classified with severe brain injury(GCS ≤ 8),while more than 64% had diagnosed with a mild brain injury(GCS ≥ 13).CONCLUSION This study suggests that most child and adolescent eye injuries in BC occur at street/highway locations followed by incidents at home. Vehicular crash was by far the most common mechanism of injury among all patients(42%). Sixty-four point two percent of child and adolescent eye injury patients also had mild brain injuries. Further,the child and adolescent eye injury data set we used for our study indicated that there were in total,50 patients tested for alcohol and drug use. There is an urgent need for a child and adolescent eye injury prevention plan in our province.

Pregnancy,childbirth and neonatal outcomes associated with adolescent pregnancy

Objective:To assess the obstetric and neonatal outcomes associated with adolescent pregnancy in Iran.Methods:We retrospectively assessed women who gave birth between January 1st,2020,and January 1st,2022.These pregnant women were separated into two groups:(1)women aged 19 and younger;(2)women aged 20-34 years.Main outcome measures include preterm birth,maternal comorbidities,preeclampsia,eclampsia,low birth weight(LBW),intrauterine growth restriction(IUGR),placenta abnormalities,placenta abruption,cho-rioamnionitis,meconium fluid,fetal distress,methods of delivery,rate of cesarean section(CS),perineal lacer-ations,postpartum hemorrhage,childbirth trauma,shoulder dystocia,congenital malformation,and unfavorable maternal and neonatal outcome.Logistic regression models were used to determine the influence of teenage pregnancy on adverse pregnancy and childbirth outcomes.Results:Of 7033 deliveries,92.4%of women were adults,and 7.6%were adolescents.Adolescents residing in rural districts were more common than adults(42.3%vs.33.7%).However,access to prenatal facility care was the same as the majority of women had 6-10 prenatal care visits during their pregnancy.There was no difference in the risk of preeclampsia,placenta abruption,placenta previa,fetal distress,preterm labor,shoulder dystocia,perineal lacerations,childbirth trauma,congenital malformation,postpartum hemorrhage,intensive care unit admission,maternal death,and unfavorable neonatal outcome including stillbirth,neonatal intensive care unit admission,neonatal death in adolescent pregnancies compared to adults.Adolescents had a significantly higher risk of LBW(OR:1.47,95%CI:1.01-2.73),IUGR(OR:1.96,95%CI:1.31-2.45),and meconium fluid(OR:1.74,95%CI:1.41-2.32),however,there was no statistically significant difference after adjusting the confounding factors.Compared with adults,adolescents had a significantly lower risk of CS(aRR:0.67,95%CI:0.51-0.77)and a lower risk of gestational diabetes(aRR:0.78,95%CI:0.51-0.95).Conclusions:Although we found no serious consequences of adolescent pregnancy,more research is needed to reach a more accurate conclusion about teenage pregnancy.

Does cesarean section prevent adverse neonatal outcomes associated with meconium amniotic fluid?

Background Making decisions regarding the mode of delivery in the cases of meconium amniotic fluid(MAF)presents a challenge for healthcare providers.We aimed to compare the neonatal outcome of MAF cases delivered via cesarean section(CS)versus those delivered vaginally to determine if CS is a protective factor against the adverse neonatal outcomes.Methods In this retrospective study,we assessed singleton pregnant mothers diagnosed with MAF who gave birth at a tertiary hospital in Bandar Abbas,Iran,between January 2020-2022.Mothers with certain adverse pregnancy conditions were excluded from the study.These conditions included:abnormal fetal heart rate and pattern,bloody amniotic fluid,malpresentation,abnormal placentation,chorioamnionitis,intrauterine growth restriction,intrauterine fetal death,obstructed labor,and maternal comorbidities.The MAF mothers were divided into two groups based on the method of delivery:those who had CS and those who had a normal vaginal delivery(NVD).Demographic factors,obstetrical factors,and neonatal outcomes were compared between the two groups.Results Out of 746 MAF mothers,213(28.5%)underwent CS,while 533(71.4%)had NVD.There were no significant differences between the groups in terms of demographic characteristics.Among MAF mothers who had CS,66.2%were primiparous,and 33.8%were multiparous.For those who had NVD,35.1%were primiparous,and 64.9%were multiparous.The first and 5-min Apgar values,rates of asphyxia,neonatal intensive care unit(NICU)admission,and neonatal death were not statistically different between the two delivery modes.The rate of newborns who breastfed within the first hour did not differ depending on the mode of delivery.Although initial resuscitation steps were required more frequently in MAF mothers with NVD than in those with CS(11.1%vs.2.3%),no correlation was found between the mode of delivery and the need for resuscitation using logistic regression.Conclusions Our research findings suggest that there were no superior neonatal outcomes in terms of CS compared to NVD in MAF mothers.Further studies are needed to provide more substantial evidence to support this conclusion.

Urban-rural differences in the pregnancy-related adverse outcome

Background:Little is known about potential urban-rural differences in adverse pregnancy outcomes.The purpose of this study is to look into the urban-rural differences in the trend of adverse maternal and neonatal outcomes.Methods:We retrospectively assessed the pregnancy outcome of singleton pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas,Iran,between January 1st,2020,and January 1st,2022.Mothers were divided into two groups based on living residency:1)urban groupand 2)rural group.Demographic factors,obstetrical factors,maternal comorbidities,and adverse maternal and neonatal outcomeswere extracted from the electronic data of each mother.The Chi-square testwas used to compare differences between the groups for categorical variables.Logistic regression models were used to assess the association of adverse pregnancy,childbirth,and neonatal outcome with living residency.Results:Of 8888 mothers that gave birth during the study period,2989(33.6%)lived in rural areas.Adolescent pregnancy was more common in the rural area.Urban mothers had a higher education than rural mothers.Rural mothers were at higher risk for preterm birth aOR 1.81(CI:1.24-2.99),post-term pregnancy aOR 1.5(CI:1.07-2.78),anemia aOR 2.02(CI:1.07-2.34),low birth weight(LBW)aOR 1.89(CI:1.56-2.11),need for neonatal resuscitation aOR 2.66(CI:1.78-3.14),and neonatal intensive care unit(NICU)admission aOR 1.98(CI:1.34-2.79).On the other hand,the risk of cesarean section was significantly lower compared to urban mothers aOR 0.58(CI:0.34-0.99).Conclusions:Our study discovered that mothers living in rural areas had a higher risk of developing anemia,preterm birth,post-term pregnancies,LBW,need for neonatal resuscitation,and NICU admission,but a lower risk of cesarean section.

Predicting risk of postpartum hemorrhage using machine learning approach:A systematic review

Background Postpartum hemorrhage(PPH)could be avoided by identifying high-risk women.The objective of this systematic review is to determine PPH predictors using machine learning(ML)approaches.Method This strategy included searching for studies from inception through November 2022 through the database included:Cochrane Central Register,PubMed,MEDLINE,EMBASE,ProQuest,Scopus,WOS,IEEE Xplore,and the Google Scholar database.The search methodology employed the PICO framework(population,intervention,control,and outcomes).In this study,“P”represents PPH populations,“I”represents the ML approach as intervention,“C”represents the traditional statistical analysis approach as control,and“O”represents prediction and diagnosis outcomes.The quality assessment of each included study was performed using the PROBAST methodology.Results The initial search strategy resulted in 2048 citations,which were subsequently refined by removing duplicates and irrelevant studies.Ultimately,four studies were deemed eligible for inclusion in the review.Among these studies,three were classified as having a low risk of bias,while one was considered to have a low to moderate risk of bias.A total of 549 unique variables were identified as candidate predictors from the included studies.Nine distinct models were chosen as ML algorithms from the four studies.Each of the four studies employed different metrics,such as the area under the curve,false positive rate,false negative rate,and sensitivity,to report the accuracy of their models.The ML models exhibited varying accuracies,with the area under the curve(AUC)ranging from 0.706 to 0.979.Several weighted predictors were identified as significant factors in PPH risk prediction.These included pre-pregnancy maternal weight,maternal weight at the time of admission,fetal macrosomia,gestational age,level of hematocrit at the time of admission,shock index,frequency of contractions during labor,white blood cell count,pregnancy-induced hypertension,the weight of the newborn,duration of the second stage of labor,amniotic fluid index,body mass index,and cesarean delivery before labor.These factors were determined to have a notable influence on the prediction of PPH risk.Conclusion The findings from ML models used to predict PPH are highly encouraging.

Addressing e-cigarette health claims made on social media amidst the COVID-19 pandemic

We are in a global pandemic that is responsible for more than 73.6 million confirmed cases and over 1.64 million deaths.Recent evidence highlights that electronic cigarette(e-cig)use by young people has a strong association with COVID-19 diagnosis[1].The e-cig industry has successfully utilized social media platforms to market e-cigs to adolescents[2].The industry typically posts on various social media sites,such as Ins-tagram and Reddit,frequented by adolescents.

Advanced maternal age and adverse obstetrical and neonatal outcomes of singleton pregnancies

Objective:To assess the impact of advanced maternal age on pregnancy and childbirth outcomes of singleton pregnancies.Study design:We retrospectively assessed singleton pregnant mothers who gave birth at Khaleej-e-Fars Hospital in Bandar Abbas,Iran,from January 2020 to January 2022.Demographic and obstetrical factors include educational level,medical insurance,residency place,access to prenatal care facilities,number of prenatal care visits,smoking status,gestational age,parity,infertility,maternal comorbidities,preeclampsia,eclampsia,preterm birth,low birth weight(LBW),intrauterine growth restriction(IUGR),macrosomia,placenta abnormalities(previa/acreta),placenta abruption,chorioamnionitis,meconium fluid,fetal distress,methods of delivery,rate of cesarean section(CS),perineal lacerations,postpartum hemorrhage,childbirth injury,shoulder dystocia,congenital malformation,neonatal asphyxia,and unfavorable maternal and neonatal outcome were compared between two groups.The Chi-square test assessed the relationship between categorical factors and maternal age groups.The influence of advanced maternal age on the risk of unfavorable pregnancy outcomes was evaluated using bivariate and multivariate logistic regression.Results:Of 8354 singleton deliveries,22.2%belonged to advanced-age mothers.Advanced-age mothers had less education than those aged 20–34 years old.Chronic hypertension,cardiovascular disease,overt diabetes,and thyroid dysfunction were more prevalent among advanced-age mothers.Compared with mothers aged 20–34 years,mothers aged 35 years and higher had a significantly higher risk of gestational diabetes(aOR:3.18,95%CI:1.56–6.95),preeclampsia(aOR:2.91,95%CI:1.35–4.72),placenta abnormalities(aOR:1.09,95%CI:0.77–1.94),CS(aOR:3.16,95%CI:1.51–3.87),postpartum hemorrhage(aOR:1.94,95%CI:1.24–2.61),intensive care unit admission(aOR:1.36,95%CI:1.15–1.99),LBW(aOR:1.35,95%CI:0.97–2.96),preterm birth(aOR:2.36,95%CI:1.65–4.83),stillbirth(aOR:1.18,95%CI:1.01–3.16),and neonatal intensive care admission(aOR:2.09,95%CI:0.73–3.92).According to bivariate regression,the risk of meconium fluid was lower in advanced-age mothers;however,the result of multivariate logistic regression found no correlation between advanced age and the Incidence of meconium fluid.Conclusion:Advanced-age mothers are at increased risk of adverse pregnancy and childbirth outcomes,which persist even after adjusting for several potential confounders.

Royal jelly for genitourinary syndrome of menopause:A randomized controlled trial

Objective:Genitourinary syndrome of menopause is a progressive condition characterized by a decrease in estrogen,which causes bothersome genital symptoms.The purpose of the study was to determine the effect of royal jelly on the genitourinary syndrome of menopause.Materials and methods:A randomized controlled trial was carried out from November 2018 to June 2019 in Bandar Abbas,Iran.The trial was registered in the Iranian Registry of Clinical Trials(1RCT20181107041585N1)with the main objective of determining if royal jelly could reduce the genitourinary syndrome of menopausal women.Eligible women were randomly assigned to receive either daily 1g of oral royal jelly or placebo for 8 weeks.The urogenital subscale of the Menopausal Rating Scale was used to determine genitourinary syndrome.Independent samples t-test was used for inter-group comparisons and paired samples t-test for pre-and post-treatment comparisons.Results:There were no differences in the severity of sexual problems,bladder complications,or vaginal dryness between groups before intervention.Although the intervention group's bladder complications improved slightly after eight weeks of royal jelly treatment compared to the control group(p?0.04),there were no significant changes in vaginal dryness,sexual problems,or total urogenital score.The within-group changes(before and after treatment)also showed no differences in urogenital symptoms.Conclusions:A daily dose of 1g royal jelly taken orally for 8 weeks did not alleviate menopausal genitourinary syndrome.No serious side effects were observed.To make more reliable decisions about the use and safety of royal jelly in the future,different doses of royal jelly and longer trials are required.