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Nyongesa P, Ekhaguere OA, Marete I, Tenge C, Kemoi M, Bann CM, Bucher SL, Patel AB, Hibberd PL, Naqvi F, Saleem S, Goldenberg RL, Goudar SS, Derman RJ, Krebs NF, Garces A, Chomba E, Carlo WA, Mwenechanya M, Lokangaka A, Tshefu AK, Bauserman M, Koso-Thomas M, Moore JL, McClure EM, Liechty EA, Esamai F. Maternal age extremes and adverse pregnancy outcomes in low-resourced settings. Front Glob Womens Health 2023; 4:1201037. [PMID: 38090046 PMCID: PMC10715413 DOI: 10.3389/fgwh.2023.1201037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/14/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Adolescent (<20 years) and advanced maternal age (>35 years) pregnancies carry adverse risks and warrant a critical review in low- and middle-income countries where the burden of adverse pregnancy outcomes is highest. Objective To describe the prevalence and adverse pregnancy (maternal, perinatal, and neonatal) outcomes associated with extremes of maternal age across six countries. Patients and methods We performed a historical cohort analysis on prospectively collected data from a population-based cohort study conducted in the Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia between 2010 and 2020. We included pregnant women and their neonates. We describe the prevalence and adverse pregnancy outcomes associated with pregnancies in these maternal age groups (<20, 20-24, 25-29, 30-35, and >35 years). Relative risks and 95% confidence intervals of each adverse pregnancy outcome comparing each maternal age group to the reference group of 20-24 years were obtained by fitting a Poisson model adjusting for site, maternal age, parity, multiple gestations, maternal education, antenatal care, and delivery location. Analysis by region was also performed. Results We analyzed 602,884 deliveries; 13% (78,584) were adolescents, and 5% (28,677) were advanced maternal age (AMA). The overall maternal mortality ratio (MMR) was 147 deaths per 100,000 live births and increased with advancing maternal age: 83 in the adolescent and 298 in the AMA group. The AMA groups had the highest MMR in all regions. Adolescent pregnancy was associated with an adjusted relative risk (aRR) of 1.07 (1.02-1.11) for perinatal mortality and 1.13 (1.06-1.19) for neonatal mortality. In contrast, AMA was associated with an aRR of 2.55 (1.81 to 3.59) for maternal mortality, 1.58 (1.49-1.67) for perinatal mortality, and 1.30 (1.20-1.41) for neonatal mortality, compared to pregnancy in women 20-24 years. This pattern was overall similar in all regions, even in the <18 and 18-19 age groups. Conclusion The maternal mortality ratio in the LMICs assessed is high and increased with advancing maternal age groups. While less prevalent, AMA was associated with a higher risk of adverse maternal mortality and, like adolescence, was associated with adverse perinatal mortality with little regional variation.
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Affiliation(s)
- Paul Nyongesa
- Department of Obstetrics and Gynecology, Moi University School of Medicine, Eldoret, Kenya
| | - Osayame A. Ekhaguere
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Irene Marete
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Constance Tenge
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Milsort Kemoi
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - Carla M. Bann
- Social Statistical, and Environmental Sciences Unit, RTI International, Durham, NC, United States
| | - Sherri L. Bucher
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, United States
- Department of Community and Global Health, Richard M. Fairbanks School of Public Health, IU-Indianapolis, Indianapolis, IN, United States
| | - Archana B. Patel
- Department of Pediatrics, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - Farnaz Naqvi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, United States
| | - Shivaprasad S. Goudar
- Women's and Children's Health Research Unit, J N Medical College Belagavi, KLE Academy Higher Education and Research, Karnataka, India
| | - Richard J. Derman
- Global Affairs, Thomas Jefferson University, Philadelphia, PA, United States
| | - Nancy F. Krebs
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, United States
| | - Ana Garces
- Department of Pediatrics, Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia
| | - Waldemar A. Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Adrien Lokangaka
- Department of Pediatrics, Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Antoinette K. Tshefu
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Melissa Bauserman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MA, United States
| | - Janet L. Moore
- Social Statistical, and Environmental Sciences Unit, RTI International, Durham, NC, United States
| | - Elizabeth M. McClure
- Social Statistical, and Environmental Sciences Unit, RTI International, Durham, NC, United States
| | - Edward A. Liechty
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Fabian Esamai
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
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Reddy JP, Liu S, Bathala T, Smith BD, Ramirez D, Shaitelman SF, Chun SG, Brewster AM, Barcenas CH, Ghia AJ, Ludmir EB, Patel AB, Shah SJ, Woodward WA, Gomez DR, Tang C. Addition of Metastasis-Directed Therapy to Standard of Care Systemic Therapy for Oligometastatic Breast Cancer (EXTEND): A Multicenter, Randomized Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:S136-S137. [PMID: 37784348 DOI: 10.1016/j.ijrobp.2023.06.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Prior retrospective and prospective evidence have suggested a potential survival benefit of adding metastasis-directed therapy (MDT) to standard of care systemic therapy for oligometastatic breast cancer. This has led to the increased utilization of MDT in this setting despite the lack of randomized evidence to support this approach. Furthermore, the recent presentation of NRG-BR002 has questioned the value of MDT. Thus, we evaluated whether the addition of MDT to systemic therapy improves PFS in oligometastatic breast cancer. MATERIALS/METHODS EXTEND (NCT03599765) is a phase II randomized basket trial for multiple solid tumors testing whether the addition of MDT improves PFS. The primary endpoint was pre-specified to be independently assessed and reported for the breast basket when a minimum of 6 months of follow-up had been reached. Patients with ≤5 metastases were randomized to standard of care systemic therapy with or without MDT. The choice of systemic therapy was at the discretion of the treating medical oncologist. Number of metastatic lesions and prior lines of systemic therapy for metastatic disease were used as stratification variables pre-randomization. The primary endpoint was progression-free survival (PFS) defined as time to randomization to date of clinical or radiographic progression or death. The study was designed to have 80% power to detect an improvement in median PFS from 18 to 36 months, with a type I error of 0.1. RESULTS Between September 2018 to July 2022, 43 patients were randomized. 22 patients were assigned to the MDT arm, and 21 patients to the no MDT arm. Three patients were not evaluable. The MDT arm patients were older vs the no-MDT arm patients (median 61.5 years vs 48 years, p = 0.01). Otherwise, the arms were well-balanced. Overall, 8 patients had triple negative disease (18.6%), and 12 patients (30%) had de novo metastatic disease. Of those patients with de novo presentation randomized to MDT, all except one had the primary tumor treated with surgery and radiation. At a median follow-up of 19.4 months, 20 events were observed. Among the 40 evaluable patients, there were 5 deaths (3 in the MDT arm and 2 in the no MDT arm). There was no difference in PFS between the MDT and no MDT arms (median 15.6 v 24.9 months, p = 0.66). Similarly, there was no difference in the secondary endpoint of time to new metastatic lesion appearance between the MDT and no MDT arms (median 15.6 months vs not reached, p = 0.09). Two grade 3 toxicities were observed in the MDT arm, and 1 in the no MDT arm. Further analysis of correlative translational biomarkers, including immune markers and ctDNA, are ongoing. CONCLUSION The addition of MDT to standard of care systemic therapy did not improve PFS or time to new metastatic lesion in patients with oligometastatic breast cancer. This data coupled with the recently presented NRG-BR002 results, suggests there is no benefit to MDT in an otherwise unselected oligometastatic breast cancer population.
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Affiliation(s)
- J P Reddy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Liu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - T Bathala
- Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - B D Smith
- Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Ramirez
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - S F Shaitelman
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - S G Chun
- Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A M Brewster
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - A J Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - E B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A B Patel
- Winship Cancer Institute at Emory University, Atlanta, GA
| | - S J Shah
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - W A Woodward
- Department of Breast Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - D R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - C Tang
- Department of Genitourinary Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Ali N, Martin KS, Tobillo R, McCook A, Switchenko J, Shelton JW, Patel AB, Patel PR, Eng TY, Remick JS. Risk Factors and Clinical Features of Fistula after Concurrent Chemoradiation and Brachytherapy for Locally Advanced Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e547-e548. [PMID: 37785686 DOI: 10.1016/j.ijrobp.2023.06.1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The standard treatment for locally advanced cervical cancer (LACC) is concurrent chemoradiation and brachytherapy (CRT-B). Fistula formation is a serious complication of treatment; however, risk factors and clinical outcomes are not well described. We sought to identify the incidence, risk factors and prognosis of radiation-induced fistula in women who underwent CRT-B for LACC. MATERIALS/METHODS A single institution retrospective review of patients treated with CRT-B for LACC from July 2013 to August 2022 across 3 centers was performed. Inclusion criteria were Stage IB-IVB cervical cancer treated with definitive intent. Patients with upfront or adjuvant surgery were excluded. Cox-proportional hazards model was performed to assess factors associated with fistula. Local control and fistula-free survival were estimated using the Kaplan-Meyer method. Clinical significance was defined as p < 0.05. RESULTS A total of 105 patients met the inclusion criteria and were included in this analysis. Patients consisted of FIGO Stage I (n = 20, 19%), Stage II (n = 22, 21%), Stage III (n = 46, 43.8%) or Stage IV disease (n = 17, 16.2%). 12 (11.4%) patients developed fistula following CRT-B; 1/12 patients (8.3%) had fistula present at time of diagnosis. Median time to fistula development was 12 months. Fistula was characterized as vesicovaginal/urethrovaginal in 58.3% (n = 7) and rectovaginal/intestinovaginal in 83.3% (n = 10), including 8 patients (66.7%) who had more than one type of fistula. 4/12 (33.3%) of patients with fistula had concurrent local recurrence. Patients were treated with conservative management (41.7%), hyperbaric oxygen (16.7%) and/or surgery (83.3%). Complications included infection (50.0%), urinary/bowel diversion (83.3%), hospitalization (50.0%) and death (8.3%). Fistula was resolved in 7/12 patients (58.3%) at time of last follow up. Higher BMI (p = 0.04) and use of hybrid applicators (p = 0.02) were associated with decreased likelihood of fistula development. Disease extension into bladder was associated with increased likelihood of fistula development (p = 0.03). Compared to former and never smoking, current smoking was associated with a higher risk of developing fistula (p = 0.04, OR 4.42, CI:1.07-18.34). Compared to intracavitary and hybrid applicators, the use of a Syed applicator was associated with increased likelihood of fistula development (p = 0.02, OR 8.00, CI: 1.37-46.55). Two-year local control was 82.5% (CI: 64.5-91.9) for Stage I-II, 80.7% (CI: 62.8-90.6) for Stage III, and 62.2% (CI: 30.1-82.9) for Stage IV. Two-year fistula free survival was 89.9% (CI: 80.6 - 94.9). CONCLUSION Women who undergo definitive chemoradiation for treatment of LACC have a 11.4% risk of fistula formation overall. The risk is higher amongst patients with current smoking, disease extension into bladder and Syed applicators. Overall two-year local control was 78.7% and fistula free survival was 89.9%.
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Affiliation(s)
- N Ali
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - K Sykes Martin
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - R Tobillo
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - A McCook
- Department of Biostatistics & Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, GA; Winship Cancer Institute at Emory University, Atlanta, GA
| | | | - J W Shelton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - A B Patel
- Winship Cancer Institute at Emory University, Atlanta, GA
| | - P R Patel
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - T Y Eng
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA
| | - J S Remick
- Winship Cancer Institute of Emory University, Department of Radiation Oncology, Atlanta, GA
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Oberlin A, Wallace J, Moore JL, Saleem S, Lokangaka A, Tshefu A, Bauserman M, Figueroa L, Krebs NF, Esamai F, Liechty E, Bucher S, Patel AB, Hibberd PL, Chomba E, Carlo WA, Goudar S, Derman RJ, Koso-Thomas M, McClure EM, Goldenberg RL. Examining maternal morbidity across a spectrum of delivery locations: An analysis of the Global Network's Maternal and Neonatal Health Registry. Int J Gynaecol Obstet 2023; 160:797-805. [PMID: 35949060 PMCID: PMC9911556 DOI: 10.1002/ijgo.14391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To better understand maternal morbidity, using quality data from low- and middle-income countries (LMICs), including out-of-hospital deliveries. Additionally, to compare to the WHO estimate that maternal morbidity occurs in 15% of pregnancies, which is based largely on hospital-level data. METHODS The Global Network for Women's and Children's Health Research Maternal Newborn Health Registry collected data on all pregnancies from seven sites in six LMICs between 2015 and 2020. Rates of maternal mortality and morbidity and the differences in morbidity across delivery location and birth attendant type were evaluated. RESULTS Among the 280 584 deliveries included in the present analysis, the overall maternal mortality ratio was 138 per 100 000, while 11.7% of women experienced at least one morbidity. Rates of morbidity were generally higher for deliveries occurring within hospitals (19.8%) and by physicians (23.6%). The lowest rates of morbidity were noted among women delivering in non-hospital healthcare facilities (5.6%) or with non-physician clinicians (e.g. nurses, midwives [5.4%]). CONCLUSION The present study shows important differences in reported maternal morbidity across delivery sites, with a trend towards lower morbidity in non-hospital healthcare facilities and among non-physician clinicians.
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Affiliation(s)
- Austin Oberlin
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Jacqueline Wallace
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD 20892, USA
| | - Janet L. Moore
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, NC, 27709, USA
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Adrien Lokangaka
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | - Edward Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Sheri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Archana B. Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Elwyn Chomba
- Department of Pediatrics, University Teaching Hospital, Lusaka, Zambia
| | | | - Shivaprasad Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Karnataka, India
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 1 Center Dr, Bethesda, MD 20892, USA
| | - Elizabeth M. McClure
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, NC, 27709, USA
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10032, USA
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Ku JC, Dmytriw AA, Essibayi MA, Banihashemi MA, Vranic JE, Ghozy S, Altschul D, Regenhardt RW, Stapleton CJ, Yang VXD, Patel AB. Embolic Agent Choice in Middle Meningeal Artery Embolization as Primary or Adjunct Treatment for Chronic Subdural Hematoma: A Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2023; 44:297-302. [PMID: 36797028 PMCID: PMC10187811 DOI: 10.3174/ajnr.a7796] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Middle meningeal artery embolization is an emerging treatment option for chronic subdural hematomas. PURPOSE Our aim was to assess outcomes following middle meningeal artery embolization by different techniques, including in comparison with traditional surgical methods. DATA SOURCES We searched the literature databases from inception to March 2022. DATA SELECTION We selected studies reporting outcomes after middle meningeal artery embolization as a primary or adjunctive treatment for chronic subdural hematoma. DATA ANALYSIS We analyzed the risk of recurrence of chronic subdural hematoma, reoperation for recurrence or residual hematoma, complications, and radiologic and clinical outcomes using random effects modeling. Additional analyses were performed on the basis of whether middle meningeal artery embolization was used as the primary or adjunct treatment and by embolic agent type. DATA SYNTHESIS Twenty-two studies were included with 382 patients with middle meningeal artery embolization and 1373 surgical patients. The rate of subdural hematoma recurrence was 4.1%. Fifty (4.2%) patients underwent a reoperation for a recurrent or residual subdural hematoma. Thirty-six (2.6%) experienced postoperative complications. The rates of good radiologic and clinical outcomes were 83.1% and 73.3%, respectively. Middle meningeal artery embolization was significantly associated with decreased odds of subdural hematoma reoperation (OR = 0.48; 95% CI, 23.4-99.1; P = .047) compared with surgery. The lowest rates of subdural hematoma radiologic recurrence, reoperation, and complications were observed among patients receiving embolization with Onyx, whereas good overall clinical outcome occurred most commonly with combined polyvinyl alcohol and coils. LIMITATIONS A limitation was the retrospective design of studies included. CONCLUSIONS Middle meningeal artery embolization is safe and effective, either as a primary or adjunctive treatment. Treatment using Onyx seems to yield lower rates of recurrence, rescue operation, and complications whereas particles and coils produce good overall clinical outcomes.
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Affiliation(s)
- J C Ku
- From the Division of Neurosurgery (J.C.K.)
| | - A A Dmytriw
- Neuroendovascular Program (A.A.D., J.E.V., R.W.R., C.J.S., A.B.P.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Neurointerventional Program (A.A.D., V.X.D.Y.), Department of Clinical Neurological Sciences & Medical Imaging, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - M A Essibayi
- Departments of Radiology (M.A.E., S.G.), Mayo Clinic, Rochester, Minnesota
- Department of Neurosurgery (M.A.E., D.A.), Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
| | - M A Banihashemi
- Department of Surgery and Institute of Medical Science (M.A.B.), University of Toronto, Toronto, Ontario, Canada
| | - J E Vranic
- Neuroendovascular Program (A.A.D., J.E.V., R.W.R., C.J.S., A.B.P.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Ghozy
- Departments of Radiology (M.A.E., S.G.), Mayo Clinic, Rochester, Minnesota
- Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC program) (S.G.), Oxford University, Oxford, UK
| | - D Altschul
- Department of Neurosurgery (M.A.E., D.A.), Montefiore Medical Center, Albert Einstein College of Medicine, New York, New York
| | - R W Regenhardt
- Neuroendovascular Program (A.A.D., J.E.V., R.W.R., C.J.S., A.B.P.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - C J Stapleton
- Neuroendovascular Program (A.A.D., J.E.V., R.W.R., C.J.S., A.B.P.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - V X D Yang
- Neurointerventional Program (A.A.D., V.X.D.Y.), Department of Clinical Neurological Sciences & Medical Imaging, Schulich School of Medicine, Western University, London, Ontario, Canada
| | - A B Patel
- Neuroendovascular Program (A.A.D., J.E.V., R.W.R., C.J.S., A.B.P.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Bai X, Fu Z, Sun Z, Xu R, Guo X, Tian Q, Dmytriw AA, Zhao H, Wang W, Wang X, Patel AB, Yang B, Jiao L. Thrombectomy Using the EmboTrap Clot-Retrieving Device for the Treatment of Acute Ischemic Stroke: A Glimpse of Clinical Evidence. AJNR Am J Neuroradiol 2022; 43:1736-1742. [PMID: 36456081 DOI: 10.3174/ajnr.a7708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/11/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND The EmboTrap Recanalization Device is a novel stent retriever for thrombectomy in the setting of acute ischemic stroke due to large-vessel occlusion. PURPOSE Our aim was to summarize the safety and efficacy of the EmboTrap Recanalization Device in acute ischemic stroke-large-vessel occlusion through a systematic review and meta-analysis. DATA SOURCES Medline, EMBASE, the Cochrane Library, Web of Science, and Google Scholar were searched up to April 2022. STUDY SELECTION Nine observational studies using the EmboTrap Recanalization Device were selected. DATA ANALYSIS We adapted effect size with 95% CIs for dichotomous data. P value <.05 was statistically significant. DATA SYNTHESIS The estimated rate of successful recanalization (modified TICI 2b-3) was 90% (95% CI, 86%-95%; I 2 = 82.4%); 90-day favorable outcome (mRS 0-2), 53% (95% CI, 42%-63%; I 2 = 88.6%); modified first-pass effect, 43% (95% CI, 35%-51%; I 2 = 63.7%); and first-pass effect, 36% (95% CI, 29%-46%; I 2 = 10.7%). The rate of any intracerebral hemorrhage was 19% (95% CI, 16%-22%; I 2 = 0.0%); symptomatic intracerebral hemorrhage, 5% (95% CI, 1%-8%; I 2 = 84.6%); and 90-day mortality, 14% (95% CI, 9%-19%; I 2 = 79.3%). Subgroup analysis showed higher rates of complete recanalization for EmboTrap II than for the EmboTrap System. LIMITATIONS The included studies are single-arm without direct comparison with other stent retrievers. Some of the studies recruited had a small sample size and were limited by the retrospective study design. In addition, the uncertain heterogeneity among studies was high. CONCLUSIONS The EmboTrap Recanalization Device is safe and efficient in treating acute ischemic stroke due to large-vessel occlusion.
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Affiliation(s)
- X Bai
- From the Departments of Neurosurgery (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.).,China International Neuroscience Institute (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.), Beijing, China
| | - Z Fu
- From the Departments of Neurosurgery (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.).,China International Neuroscience Institute (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.), Beijing, China
| | - Z Sun
- From the Departments of Neurosurgery (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.).,China International Neuroscience Institute (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.), Beijing, China
| | - R Xu
- From the Departments of Neurosurgery (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.).,China International Neuroscience Institute (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.), Beijing, China
| | - X Guo
- Department of Neurology (X.G.), Loma Linda University Health, Loma Linda, California
| | - Q Tian
- Beijing Key Laboratory of Clinical Epidemiology (Q.T.), School of Public Health, Capital Medical University, Beijing, China
| | - A A Dmytriw
- Neuroendovascular Program (A.A.D.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - H Zhao
- From the Departments of Neurosurgery (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.).,China International Neuroscience Institute (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.), Beijing, China
| | - W Wang
- Library (W.W., X.W., A.B.P.)
| | - X Wang
- Library (W.W., X.W., A.B.P.)
| | | | - B Yang
- From the Departments of Neurosurgery (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.).,China International Neuroscience Institute (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.), Beijing, China
| | - L Jiao
- From the Departments of Neurosurgery (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.) .,Interventional Neuroradiology (L.J.), Xuanwu Hospital, Capital Medical University, Xicheng District, Beijing, China.,China International Neuroscience Institute (X.B., Z.F., Z.S., R.X., H.Z., B.Y., L.J.), Beijing, China
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7
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Adeeb N, Dibas M, Griessenauer CJ, Cuellar HH, Salem MM, Xiang S, Enriquez-Marulanda A, Hong T, Zhang H, Taussky P, Grandhi R, Waqas M, Aldine AS, Tutino VM, Aslan A, Siddiqui AH, Levy EI, Ogilvy CS, Thomas AJ, Ulfert C, Möhlenbruch MA, Renieri L, Bengzon Diestro JD, Lanzino G, Brinjikji W, Spears J, Vranic JE, Regenhardt RW, Rabinov JD, Harker P, Müller-Thies-Broussalis E, Killer-Oberpfalzer M, Islak C, Kocer N, Sonnberger M, Engelhorn T, Kapadia A, Yang VXD, Salehani A, Harrigan MR, Krings T, Matouk CC, Mirshahi S, Chen KS, Aziz-Sultan MA, Ghorbani M, Schirmer CM, Goren O, Dalal SS, Finkenzeller T, Holtmannspötter M, Buhk JH, Foreman PM, Cress MC, Hirschl RA, Reith W, Simgen A, Janssen H, Marotta TR, Stapleton CJ, Patel AB, Dmytriw AA. Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study. AJNR Am J Neuroradiol 2022; 43:1615-1620. [PMID: 36229166 PMCID: PMC9731249 DOI: 10.3174/ajnr.a7679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Flow diversion has gradually become a standard treatment for intracranial aneurysms of the anterior circulation. Recently, the off-label use of the flow diverters to treat posterior circulation aneurysms has also increased despite initial concerns of rupture and the suboptimal results. This study aimed to explore the change in complication rates and treatment outcomes across time for posterior circulation aneurysms treated using flow diversion and to further evaluate the mechanisms and variables that could potentially explain the change and outcomes. MATERIALS AND METHODS A retrospective review using a standardized data set at multiple international academic institutions was performed to identify patients with ruptured and unruptured posterior circulation aneurysms treated with flow diversion during a decade spanning January 2011 to January 2020. This period was then categorized into 4 intervals. RESULTS A total of 378 procedures were performed during the study period. Across time, there was an increasing tendency to treat more vertebral artery and fewer large vertebrobasilar aneurysms (P = .05). Moreover, interventionalists have been increasingly using fewer overlapping flow diverters per aneurysm (P = .07). There was a trend toward a decrease in the rate of thromboembolic complications from 15.8% in 2011-13 to 8.9% in 2018-19 (P = .34). CONCLUSIONS This multicenter experience revealed a trend toward treating fewer basilar aneurysms, smaller aneurysms, and increased usage of a single flow diverter, leading to a decrease in the rate of thromboembolic and hemorrhagic complications.
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Affiliation(s)
- N Adeeb
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - M Dibas
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - C J Griessenauer
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - H H Cuellar
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - M M Salem
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - S Xiang
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - A Enriquez-Marulanda
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - T Hong
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - H Zhang
- Department of Neurosurgery (S.X., H.Z., T.H.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - P Taussky
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery (P.T., R.G.), University of Utah, Salt Lake City, Utah
| | - R Grandhi
- Department of Neurosurgery (P.T., R.G.), University of Utah, Salt Lake City, Utah
| | - M Waqas
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - A S Aldine
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - V M Tutino
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - A Aslan
- From the Departments of Neurosurgery and Interventional Neuroradiology (N.A., M.D., H.H.C., A.S.A., A.A.), Louisiana State University Hospital, Shreveport, Louisiana
| | - A H Siddiqui
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - E I Levy
- Department of Neurosurgery (M.W., V.M.T., A.H.S., E.I.L.), State University of New York at Buffalo, Buffalo, New York
| | - C S Ogilvy
- Neurosurgical Service (M.M.S., A.E.-M., P.T., C.S.O.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - A J Thomas
- Department of Neurological Surgery (A.J.T.), Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey
| | - C Ulfert
- Department of Neuroradiology (C.U., M.A.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - M A Möhlenbruch
- Department of Neuroradiology (C.U., M.A.M.), Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - L Renieri
- Department of Interventional Neuroradiology (L.R.), University of Florence, Florence, Italy
| | - J D Bengzon Diestro
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - G Lanzino
- Department of Neurological Surgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - W Brinjikji
- Department of Neurological Surgery (G.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - J Spears
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - J E Vranic
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - R W Regenhardt
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - J D Rabinov
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - P Harker
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - E Müller-Thies-Broussalis
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - M Killer-Oberpfalzer
- Department of Neurology/Institut of Neurointervention (C.J.G., E.M.-T.-B., M.K.-O.), University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - C Islak
- Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - N Kocer
- Department of Neuroradiology (C.I., N.K.), Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - M Sonnberger
- Department of Neuroradiology (M.S.), Kepler Universitätsklinikum Linz, Linz, Austria
| | - T Engelhorn
- Department of Neuroradiology (T.E.), University Hospital Erlangen, Erlangen, Germany
| | - A Kapadia
- Departments of Medical Imaging and Neurosurgery (A.K.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - V X D Yang
- Neurointerventional Program (V.X.D.Y., A.A.D.), Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, Ontario, Canada
| | - A Salehani
- Department of Neurosurgery (A. Salehani, M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - M R Harrigan
- Department of Neurosurgery (A. Salehani, M.R.H.), University of Alabama at Birmingham, Birmingham, Alabama
| | - T Krings
- Division of Interventional Neuroradiology (T.K.), Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - C C Matouk
- Department of Neurosurgery (C.C.M.), Yale School of Medicine, New Haven, Connecticut
| | - S Mirshahi
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - K S Chen
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M A Aziz-Sultan
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - M Ghorbani
- Division of Vascular and Endovascular Neurosurgery (M.G.), Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - C M Schirmer
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - O Goren
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - S S Dalal
- Departments of Neurosurgery and Radiology (C.J.G., C.M.S., O.G., S.S.D.), Geisinger, Danville, Pennsylvania
| | - T Finkenzeller
- Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Nuernberg, Germany
| | - M Holtmannspötter
- Institute of Radiology and Neuroradiology (T.F., M.H.), Klinikum Nuernberg Sued, Paracelsus Medical University Nuernberg, Nuernberg, Germany
- Department of Neuroradiology (M.H.), Klinikum Weiden, Weiden, Germany
| | - J-H Buhk
- Department of Neuroradiology (J.-H.B.), University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - P M Foreman
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - M C Cress
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - R A Hirschl
- Neuroscience and Rehabilitation Institute (P.M.F., M.C.C., R.A.H.), Orlando Health, Orlando, Florida
| | - W Reith
- Clinic for Diagnostic and Interventional Neuroradiology (W.R., A. Simgen), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - A Simgen
- Clinic for Diagnostic and Interventional Neuroradiology (W.R., A. Simgen), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - H Janssen
- Institute for Neuroradiology (H.J.), Klinikum Ingolstadt, Ingolstadt, Germany
| | - T R Marotta
- Division of Diagnostic and Therapeutic Neuroradiology (J.D.B.D., J.S., T.R.M.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - C J Stapleton
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A B Patel
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - A A Dmytriw
- Neurointerventional Program (V.X.D.Y., A.A.D.), Departments of Medical Imaging & Clinical Neurological Sciences, London Health Sciences Centre, Western University, Ontario, Canada
- Neuroendovascular Program (J.E.V., R.W.R., J.D.R., P.H., S.M., K.S.C., M.A.A.-S., C.J.S., A.B.P., A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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8
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Patel AB, Bann CM, Kolhe CS, Lokangaka A, Tshefu A, Bauserman M, Figueroa L, Krebs NF, Esamai F, Bucher S, Saleem S, Goldenberg RL, Chomba E, Carlo WA, Goudar S, Derman RJ, Koso-Thomas M, McClure EM, Hibberd PL. The Global Network Socioeconomic Status Index as a predictor of stillbirths, perinatal mortality, and neonatal mortality in rural communities in low and lower middle income country sites of the Global Network for Women's and Children's Health Research. PLoS One 2022; 17:e0272712. [PMID: 35972913 PMCID: PMC9380930 DOI: 10.1371/journal.pone.0272712] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 07/25/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Globally, socioeconomic status (SES) is an important health determinant across a range of health conditions and diseases. However, measuring SES within low- and middle-income countries (LMICs) can be particularly challenging given the variation and diversity of LMIC populations. OBJECTIVE The current study investigates whether maternal SES as assessed by the newly developed Global Network-SES Index is associated with pregnancy outcomes (stillbirths, perinatal mortality, and neonatal mortality) in six LMICs: Democratic Republic of the Congo, Guatemala, India, Kenya, Pakistan, and Zambia. METHODS The analysis included data from 87,923 women enrolled in the Maternal and Newborn Health Registry of the NICHD-funded Global Network for Women's and Children's Health Research. Generalized estimating equations models were computed for each outcome by SES level (high, moderate, or low) and controlling for site, maternal age, parity, years of schooling, body mass index, and facility birth, including sampling cluster as a random effect. RESULTS Women with low SES had significantly higher risks for stillbirth (p < 0.001), perinatal mortality (p = 0.001), and neonatal mortality (p = 0.005) than women with high SES. In addition, those with moderate SES had significantly higher risks of stillbirth (p = 0.003) and perinatal mortality (p = 0.008) in comparison to those with high SES. CONCLUSION The SES categories were associated with pregnancy outcomes, supporting the validity of the index as a non-income-based measure of SES for use in studies of pregnancy outcomes in LMICs.
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Affiliation(s)
- Archana B. Patel
- Lata Medical Research Foundation, Nagpur, India
- Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Carla M. Bann
- RTI International, Research Triangle Park, NC, United States of America
| | | | - Adrien Lokangaka
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Melissa Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F. Krebs
- University of Colorado School of Medicine, Denver, CO, United States of America
| | | | - Sherri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, United States of America
| | | | | | | | - Waldemar A. Carlo
- University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Shivaprasad Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Karnataka, India
| | - Richard J. Derman
- Thomas Jefferson University, Philadelphia, PA, United States of America
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | | | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
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9
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Patel AB, Bang A, Kurhe K, Bhargav S, Hibberd PL. What Helping Babies Breathe knowledge and skills are formidable for healthcare workers? Front Pediatr 2022; 10:891266. [PMID: 36793503 PMCID: PMC9922883 DOI: 10.3389/fped.2022.891266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 12/30/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Most neonatal deaths occur in the first week of life, due to birth asphyxia. Helping Babies Breathe (HBB), is a simulation-based neonatal resuscitation training program to improve knowledge and skills. There is little information on which knowledge items or skill steps are challenging for the learners. METHODS We used training data from NICHD's Global Network study to understand the items most challenging for Birth Attendants (BA) to guide future curriculum modifications. HBB training was provided in 15 primary, secondary and tertiary level care facilities in Nagpur, India. Refresher training was provided 6 months later. Each knowledge item and skill step was ranked from difficulty level 1 to 6 based on whether 91%-100%, 81%-90%, 71%-80%, 61%-70%, 51%-60% or <50% of learners answered/performed the step correctly. RESULTS The initial HBB training was conducted in 272 physicians and 516 midwives of which 78 (28%) physicians and 161 (31%) midwives received refresher training. Questions related to timing of cord clamping, management of a meconium-stained baby, and steps to improve ventilation were most difficult for both physicians and midwives. The initial steps of Objective Structured Clinical Examination (OSCE)-A i.e. equipment checking, removing wet linen and immediate skin-to-skin contact were most difficult for both groups. Midwives missed stimulating newborns while physicians missed cord clamping and communicating with mother. In OSCE-B, starting ventilation in the first minute of life was the most missed step after both initial and 6 months refresher training for physicians and midwives. At the retraining, the retention was worst for cutting the cord (physicians level 3), optimal rate of ventilation, improving ventilation & counting heart rate (midwives level 3), calling for help (both groups level 3) and scenario ending step of monitoring the baby and communicating with mother (physicians level 4, midwives 3). CONCLUSION All BAs found skill testing more difficult than knowledge testing. The difficulty level was more for midwives than for physicians. So, the HBB training duration and frequency of retraining can be tailored accordingly. This study will also inform subsequent refinement in the curriculum so that both trainers and trainees will be able to achieve the required proficiency.
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Affiliation(s)
- Archana B Patel
- Research Unit, Lata Medical Research Foundation, Nagpur, India.,Department of Medical Research, Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Akash Bang
- Department of Pediatrics, All India Institute of Medical Sciences, Nagpur, India
| | - Kunal Kurhe
- Research Unit, Lata Medical Research Foundation, Nagpur, India
| | - Savita Bhargav
- Research Unit, Lata Medical Research Foundation, Nagpur, India
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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10
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Conde R, Laires R, Gonçalves LG, Rizvi A, Barroso C, Villar M, Macedo R, Simões MJ, Gaddam S, Lamosa P, Puchades-Carrasco L, Pineda-Lucena A, Patel AB, Mande SC, Barnejee S, Matzapetakis M, Coelho AV. Discovery of serum biomarkers for diagnosis of tuberculosis by NMR metabolomics including cross-validation with a second cohort. Biomed J 2021; 45:654-664. [PMID: 34314900 PMCID: PMC9486122 DOI: 10.1016/j.bj.2021.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/14/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) is a disease with worldwide presence and a major cause of death in several developing countries. Current diagnostic methodologies often lack specificity and sensitivity, whereas a long time is needed to obtain a conclusive result. Methods In an effort to develop better diagnostic methods, this study aimed at the discovery of a biomarker signature for TB diagnosis using a Nuclear Magnetic Resonance based metabolomics approach. In this study, we acquired 1H NMR spectra of blood serum samples of groups of healthy subjects, individuals with latent TB and of patients with pulmonary and extra-pulmonary TB. The resulting data were treated with uni- and multivariate statistical analysis. Results Six metabolites (inosine, hypoxanthine, mannose, asparagine, aspartate and glutamate) were validated by an independent cohort, all of them related with metabolic processes described as associated with TB infection. Conclusion The findings of the study are according with the WHO Target Product Profile recommendations for a triage test to rule-out active TB.
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Affiliation(s)
- R Conde
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal.
| | - R Laires
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal.
| | - L G Gonçalves
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal.
| | - A Rizvi
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Hyderabad, India.
| | - C Barroso
- CDP Almada-Seixal, ARSLVT, Portugal.
| | - M Villar
- CDP Venda Nova, ARSLVT, Portugal.
| | | | | | - S Gaddam
- Department of Immunology, Bhagwan Mahavir Medical Research Center, Hyderabad, India; Department of Genetics, Osmania University, Hyderabad, India.
| | - P Lamosa
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal.
| | - L Puchades-Carrasco
- Drug Discovery Unit, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
| | - A Pineda-Lucena
- Drug Discovery Unit, Instituto de Investigación Sanitaria La Fe, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Molecular Therapeutics Program, Centro de Investigación Médica Aplicada, University of Navarra, Pamplona, Spain.
| | - A B Patel
- CSIR- Centre for Cellular Molecular Biology, Hyderabad, India.
| | - S C Mande
- National Centre For Cell Science, Pune, India; Present address: Council of Scientific and Industrial Research, New Delhi, India.
| | - S Barnejee
- Department of Biochemistry, School of Life Sciences, University of Hyderabad, Hyderabad, India.
| | - M Matzapetakis
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal.
| | - A V Coelho
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, 2780-157 Oeiras, Portugal.
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11
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Kothari S, Bala N, Patel AB, Donovan A, Narayanaswami V. The LDL receptor binding domain of apolipoprotein E directs the relative orientation of its C-terminal segment in reconstituted nascent HDL. Biochim Biophys Acta Biomembr 2021; 1863:183618. [PMID: 33831404 PMCID: PMC8211829 DOI: 10.1016/j.bbamem.2021.183618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 12/24/2022]
Abstract
Apolipoprotein E (apoE) (299 residues) is a highly helical protein that plays a critical role in cholesterol homeostasis. It comprises a four-helix bundle N-terminal (NT) and a C-terminal (CT) domain that can exist in lipid-free and lipid-associated states. In humans, there are two major apoE isoforms, apoE3 and apoE4, which differ in a single residue in the NT domain, with apoE4 strongly increasing risk of Alzheimer's disease (AD) and cardiovascular diseases (CVD). It has been proposed that the CT domain initiates rapid lipid binding, followed by a slower NT domain helix bundle opening and lipid binding to yield discoidal reconstituted high density lipoprotein (rHDL). However, the contribution of the NT domain on the CT domain organization in HDL remains poorly understood. To understand this, we employed Cys-specific cross-linking and spatially-sensitive fluorophores in the NT and CT domains of apoE3 and apoE4, and in isolated CT domain. We noted that the helices in isolated CT domain are oriented parallel to those in the neighboring molecule in rHDL, whereas full length apoE3 and apoE4 adopt either an anti-parallel or hairpin-like organization. It appears that the bulky NT domain determines the spatial organization of its CT domain in rHDL, a finding that has significance for apoE4, which is more susceptible to proteolytic cleavage in AD brains, showing increased accumulation of neurotoxic NT and CT fragments. We envisage that the structural organization of HDL apoE would have profound functional consequences in its ability to regulate cholesterol homeostasis in AD and CVD.
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Affiliation(s)
- S Kothari
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - N Bala
- Department of Microbiology and Immunology, Cornell University, Ithaca, NY 14853, USA
| | - A B Patel
- Department of Neuroscience, Novartis Institutes for BioMedical Research, Cambridge, MA 02139, USA
| | - A Donovan
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA 90033, USA
| | - V Narayanaswami
- Department of Chemistry and Biochemistry, 1250 Bellflower Blvd., California State University, Long Beach, Long Beach, CA 90840, USA.
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Barrios DM, Phillips GS, Geisler AN, Trelles SR, Markova A, Noor SJ, Quigley EA, Haliasos HC, Moy AP, Schram AM, Bromberg J, Funt SA, Voss MH, Drilon A, Hellmann MD, Comen EA, Narala S, Patel AB, Wetzel M, Jung JY, Leung DYM, Lacouture ME. IgE blockade with omalizumab reduces pruritus related to immune checkpoint inhibitors and anti-HER2 therapies. Ann Oncol 2021; 32:736-745. [PMID: 33667669 PMCID: PMC9282165 DOI: 10.1016/j.annonc.2021.02.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Immunoglobulin E (IgE) blockade with omalizumab has demonstrated clinical benefit in pruritus-associated dermatoses (e.g. atopic dermatitis, bullous pemphigoid, urticaria). In oncology, pruritus-associated cutaneous adverse events (paCAEs) are frequent with immune checkpoint inhibitors (CPIs) and targeted anti-human epidermal growth factor receptor 2 (HER2) therapies. Thus, we sought to evaluate the efficacy and safety of IgE blockade with omalizumab in cancer patients with refractory paCAEs related to CPIs and anti-HER2 agents. Patients and methods: Patients included in this multicenter retrospective analysis received monthly subcutaneous injections of omalizumab for CPI or anti-HER2 therapy-related grade 2/3 pruritus that was refractory to topical corticosteroids plus at least one additional systemic intervention. To assess clinical response to omalizumab, we used the Common Terminology Criteria for Adverse Events version 5.0. The primary endpoint was defined as reduction in the severity of paCAEs to grade 1/0. Results: A total of 34 patients (50% female, median age 67.5 years) received omalizumab for cancer therapy-related paCAEs (71% CPIs; 29% anti-HER2). All had solid tumors (29% breast, 29% genitourinary, 15% lung, 26% other), and most (n = 18, 64%) presented with an urticarial phenotype. In total, 28 of 34 (82%) patients responded to omalizumab. The proportion of patients receiving oral corticosteroids as supportive treatment for management of paCAEs decreased with IgE blockade, from 50% to 9% (P < 0.001). Ten of 32 (31%) patients had interruption of oncologic therapy due to skin toxicity; four of six (67%) were successfully rechallenged following omalizumab. There were no reports of anaphylaxis or hypersensitivity reactions related to omalizumab. Conclusions: IgE blockade with omalizumab demonstrated clinical efficacy and was well tolerated in cancer patients with pruritus related to CPIs and anti-HER2 therapies.
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Affiliation(s)
- D M Barrios
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - G S Phillips
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A N Geisler
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - S R Trelles
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A Markova
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA
| | - S J Noor
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA
| | - E A Quigley
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA
| | - H C Haliasos
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA
| | - A P Moy
- Department of Dermatology, Weill Cornell Medicine, New York, USA; Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - A M Schram
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - J Bromberg
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - S A Funt
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - M H Voss
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - A Drilon
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - M D Hellmann
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - E A Comen
- Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Medicine, Weill Cornell Medicine, New York, USA
| | - S Narala
- Department of Dermatology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
| | - A B Patel
- Department of Dermatology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, USA
| | - M Wetzel
- Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, USA
| | - J Y Jung
- Division of Dermatology, Department of Medicine, University of Louisville School of Medicine, Louisville, USA; Dermatology Service, Department of Medical Oncology, Norton Cancer Institute, Louisville, USA
| | - D Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, USA
| | - M E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA; Department of Dermatology, Weill Cornell Medicine, New York, USA.
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Buda U, Priyadarshini MB, Majumdar RK, Mahanand SS, Patel AB, Mehta NK. Quality characteristics of fortified silver carp surimi with soluble dietary fiber: Effect of apple pectin and konjac glucomannan. Int J Biol Macromol 2021; 175:123-130. [PMID: 33548317 DOI: 10.1016/j.ijbiomac.2021.01.191] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/10/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
The study focused on assessing quality parameters of the surimi incorporated with soluble dietary fibers apple pectin and konjac glucomannan at different levels. The results showed that apple pectin at 0.025% and konjac glucomannan at a 2% level exhibited improved gel-forming ability significantly (p < 0.05). SDS- PAGE revealed high molecular weight protein crosslinks in apple pectin treated surimi gels and disappearance of myosin bands in konjac glucomannan treated surimi gels. The water holding capacity of surimi was the highest when 0.075 g/100 g of apple pectin was added. Konjac glucomannan treated gels exhibited superior whiteness values. The analysis of soluble protein revealed that hydrophobic bonds increased in both the treatments. The hardness values of pectin gels enhanced as the level increased. Other TPA parameters are shown an inconsistent trend. It can be demonstrated that the incorporation of apple pectin and konjac glucomannan at a level of 0.025 and 2.0% may be a novel strategy to improve the gel strength of the surimi.
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Affiliation(s)
- Uma Buda
- Department of Fish Processing Technology and Engineering, College of Fisheries, CAU (Imphal), Lembucherra, West Tripura 799 210, India
| | - M Bhargavi Priyadarshini
- Department of Fish Processing Technology and Engineering, College of Fisheries, CAU (Imphal), Lembucherra, West Tripura 799 210, India.
| | - R K Majumdar
- Department of Fish Processing Technology and Engineering, College of Fisheries, CAU (Imphal), Lembucherra, West Tripura 799 210, India
| | - S S Mahanand
- Department of Fish Processing Technology and Engineering, College of Fisheries, CAU (Imphal), Lembucherra, West Tripura 799 210, India
| | - A B Patel
- Department of Aquaculture, College of Fisheries, CAU (Imphal), Lembucherra, West Tripura 799 210, India
| | - N K Mehta
- Department of Fish Processing Technology and Engineering, College of Fisheries, CAU (Imphal), Lembucherra, West Tripura 799 210, India
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Yu AT, Regenhardt RW, Whitney C, Schwamm LH, Patel AB, Stapleton CJ, Viswanathan A, Hirsch JA, Lev M, Leslie-Mazwi TM. CTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals. AJNR Am J Neuroradiol 2021; 42:435-440. [PMID: 33541900 DOI: 10.3174/ajnr.a6950] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/03/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Telestroke networks support screening for patients with emergent large-vessel occlusions who are eligible for endovascular thrombectomy. Ideal triage processes within telestroke networks remain uncertain. We characterize the impact of implementing a routine spoke hospital CTA protocol in our integrated telestroke network on transfer and thrombectomy patterns. MATERIALS AND METHODS A protocol-driven CTA process was introduced at 22 spoke hospitals in November 2017. We retrospectively identified prospectively collected patients who presented to a spoke hospital with National Institutes of Health Stroke Scale scores ≥6 between March 1, 2016 and March 1, 2017 (pre-CTA), and March 1, 2018 and March 1, 2019 (post-CTA). We describe the demographics, CTA utilization, spoke hospital retention rates, emergent large-vessel occlusion identification, and rates of endovascular thrombectomy. RESULTS There were 167 patients pre-CTA and 207 post-CTA. The rate of CTA at spoke hospitals increased from 15% to 70% (P < .001). Despite increased endovascular thrombectomy screening in the extended window, the overall rates of transfer out of spoke hospitals remained similar (56% versus 54%; P = .83). There was a nonsignificant increase in transfers to our hub hospital for endovascular thrombectomy (26% versus 35%; P = .12), but patients transferred >4.5 hours from last known well increased nearly 5-fold (7% versus 34%; P < .001). The rate of endovascular thrombectomy performed on patients transferred for possible endovascular thrombectomy more than doubled (22% versus 47%; P = .011). CONCLUSIONS Implementation of CTA at spoke hospitals in our telestroke network was feasible and improved the efficiency of stroke triage. Rates of patients retained at spoke hospitals remained stable despite higher numbers of patients screened. Emergent large-vessel occlusion confirmation at the spoke hospital lead to a more than 2-fold increase in thrombectomy rates among transferred patients at the hub.
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Affiliation(s)
- A T Yu
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - R W Regenhardt
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - C Whitney
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - L H Schwamm
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - A B Patel
- Neurosurgery (R.W.R., A.B.P., C.J.S., T.M.L.-M.)
| | | | - A Viswanathan
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.)
| | - J A Hirsch
- Department of Radiology (J.A.H., M.L.), Massachusetts General Hospital, Boston, Massachusetts
| | - M Lev
- Department of Radiology (J.A.H., M.L.), Massachusetts General Hospital, Boston, Massachusetts
| | - T M Leslie-Mazwi
- From the Departments of Neurology (A.T.Y., R.W.R., C.W., L.H.S., A.V., T.M.L.-M.).,Neurosurgery (R.W.R., A.B.P., C.J.S., T.M.L.-M.)
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Patel AB, Iranpour F, Subramanian P. The Mayo cover washout technique. Ann R Coll Surg Engl 2021; 103:141-142. [PMID: 33559546 PMCID: PMC9773913 DOI: 10.1308/rcsann.2020.7054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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16
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Garces A, Perez W, Harrison MS, Hwang KS, Nolen TL, Goldenberg RL, Patel AB, Hibberd PL, Lokangaka A, Tshefu A, Saleem S, Goudar SS, Derman RJ, Patterson J, Koso-Thomas M, McClure EM, Krebs NF, Hambidge KM. Association of parity with birthweight and neonatal death in five sites: The Global Network's Maternal Newborn Health Registry study. Reprod Health 2020; 17:182. [PMID: 33334362 PMCID: PMC7745358 DOI: 10.1186/s12978-020-01025-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Nulliparity has been associated with lower birth weight (BW) and other adverse pregnancy outcomes, with most of the data coming from high-income countries. In this study, we examined birth weight for gestational age z-scores and neonatal (28-day) mortality in a large prospective cohort of women dated by first trimester ultrasound from multiple sites in low and middle-income countries. METHODS Pregnant women were recruited during the first trimester of pregnancy and followed through 6 weeks postpartum from Maternal Newborn Health Registry (MNHR) sites in the Democratic Republic of Congo (DRC), Guatemala, Belagavi and Nagpur, India, and Pakistan from 2017 and 2018. Data related to the pregnancy and its outcomes were collected prospectively. First trimester ultrasound was used for determination of gestational age; (BW) was obtained in grams within 48 h of delivery and later transformed to weight for age z-scores (WAZ) adjusted for gestational age using the INTERGROWTH-21st standards. RESULTS 15,121 women were eligible and included. Infants of nulliparous women had lower mean BWs (males: 2676 gr, females: 2587 gr, total: 2634 gr) and gestational age adjusted weight for age z-scores (males: - 0.73, females: - 0.77, total: - 0.75,) than women with one or more previous pregnancies. The largest differences were between zero and one previous pregnancies among female infants. The associations of parity with BW and z-scores remained even after adjustment for maternal age, maternal height, maternal education, antenatal care visits, hypertensive disorders, and socioeconomic status. Nulliparous women also had a significantly higher < 28-day neonatal mortality rate (27.7 per 1,000 live births) than parous women (17.2 and 20.7 for parity of 1-3 and ≥ 4 respectively). Risk of preterm birth was higher among women with ≥ 4 previous pregnancies (15.5%) compared to 11.3% for the nulliparous group and 11.8% for women with one to three previous pregnancies (p = 0.0072). CONCLUSIONS In this large sample from diverse settings, nulliparity was independently associated with both lower BW and WAZ scores as well as higher neonatal mortality compared to multiparity.
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Affiliation(s)
- Ana Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Wilton Perez
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | | | | | | | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY USA
| | | | | | | | | | | | - Shivaprasad S. Goudar
- KLE Academy Higher Education and Research J N Medical College Belagavi, Karnataka, India
| | | | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD USA
| | | | - Nancy F. Krebs
- University of Colorado School of Medicine, Denver, CO USA
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Harrison MS, Garces AL, Goudar SS, Saleem S, Moore JL, Esamai F, Patel AB, Chomba E, Bose CL, Liechty EA, Krebs NF, Derman RJ, Hibberd PL, Carlo WA, Tshefu A, Koso-Thomas M, McClure EM, Goldenberg RL. Cesarean birth in the Global Network for Women's and Children's Health Research: trends in utilization, risk factors, and subgroups with high cesarean birth rates. Reprod Health 2020; 17:165. [PMID: 33334352 PMCID: PMC7745346 DOI: 10.1186/s12978-020-01021-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The objectives of this analysis were to document trends in and risk factors associated with the cesarean birth rate in low- and middle-income country sites participating in the Global Network for Women's and Children's Health Research (Global Network). METHODS This is a secondary analysis of a prospective, population-based study of home and facility births conducted in the Global Network sites. RESULTS Cesarean birth rates increased uniformly across all sites between 2010 and 2018. Across all sites in multivariable analyses, women younger than age twenty had a reduced risk of cesarean birth (RR 0.9 [0.9, 0.9]) and women over 35 had an increased risk of cesarean birth (RR 1.1 [1.1, 1.1]) compared to women aged 20 to 35. Compared to women with a parity of three or more, less parous women had an increased risk of cesarean (RR 1.2 or greater [1.2, 1.4]). Four or more antenatal visits (RR 1.2 [1.2, 1.3]), multiple pregnancy (RR 1.3 [1.3, 1.4]), abnormal progress in labor (RR 1.1 [1.0, 1.1]), antepartum hemorrhage (RR 2.3 [2.0, 2.7]), and hypertensive disease (RR 1.6 [1.5, 1.7]) were all associated with an increased risk of cesarean birth, p < 0.001. For multiparous women with a history of prior cesarean birth, rates of vaginal birth after cesarean were about 20% in the Latin American and Southeast Asian sites and about 84% at the sub-Saharan African sites. In the African sites, proportions of cesarean birth in the study were highest among women without a prior cesarean and a single, cephalic, term pregnancy. In the non-African sites, groups with the greatest proportion of cesarean births were nulliparous women with a single, cephalic, term pregnancy and all multiparous women with at least one previous uterine scar with a term, cephalic pregnancy. CONCLUSION Cesarean birth rates continue to rise within the Global Network. The proportions of cesarean birth are higher among women with no history of cesarean birth in the African sites and among women with primary elective cesarean, primary cesarean after induction, and repeat cesarean in the non-African sites.
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Affiliation(s)
- Margo S Harrison
- University of Colorado School of Medicine, Denver, CO, USA.
- University of Colorado, Mail Stop B198-2, Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Aurora, CO, 80045, USA.
| | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala, Guatemala
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research J N Medical College, Belagavi, Karnataka, India
| | | | | | | | | | | | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
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Pusdekar YV, Patel AB, Kurhe KG, Bhargav SR, Thorsten V, Garces A, Goldenberg RL, Goudar SS, Saleem S, Esamai F, Chomba E, Bauserman M, Bose CL, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Koso-Thomas M, Nolen TL, McClure EM, Hibberd PL. Rates and risk factors for preterm birth and low birthweight in the global network sites in six low- and low middle-income countries. Reprod Health 2020; 17:187. [PMID: 33334356 PMCID: PMC7745351 DOI: 10.1186/s12978-020-01029-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022] Open
Abstract
Background Preterm birth continues to be a major public health problem contributing to 75% of the neonatal mortality worldwide. Low birth weight (LBW) is an important but imperfect surrogate for prematurity when accurate assessment of gestational age is not possible. While there is overlap between preterm birth and LBW newborns, those that are both premature and LBW are at the highest risk of adverse neonatal outcomes. Understanding the epidemiology of preterm birth and LBW is important for prevention and improved care for at risk newborns, but in many countries, data are sparse and incomplete. Methods We conducted data analyses using the Global Network’s (GN) population-based registry of pregnant women and their babies in rural communities in six low- and middle-income countries (Democratic Republic of Congo, Kenya, Zambia, Guatemala, India and Pakistan). We analyzed data from January 2014 to December 2018. Trained study staff enrolled all pregnant women in the study catchment area as early as possible during pregnancy and conducted follow-up visits shortly after delivery and at 42 days after delivery. We analyzed the rates of preterm birth, LBW and the combination of preterm birth and LBW and studied risk factors associated with these outcomes across the GN sites. Results A total of 272,192 live births were included in the analysis. The overall preterm birth rate was 12.6% (ranging from 8.6% in Belagavi, India to 21.8% in the Pakistani site). The overall LBW rate was 13.6% (ranging from 2.7% in the Kenyan site to 21.4% in the Pakistani site). The overall rate of both preterm birth and LBW was 5.5% (ranging from 1.2% in the Kenyan site to 11.0% in the Pakistani site). Risk factors associated with preterm birth, LBW and the combination were similar across sites and included nulliparity [RR − 1.27 (95% CI 1.21–1.33)], maternal age under 20 [RR 1.41 (95% CI 1.32–1.49)] years, severe antenatal hemorrhage [RR 5.18 95% CI 4.44–6.04)], hypertensive disorders [RR 2.74 (95% CI − 1.21–1.33], and 1–3 antenatal visits versus four or more [RR 1.68 (95% CI 1.55–1.83)]. Conclusions Preterm birth, LBW and their combination continue to be common public health problems at some of the GN sites, particularly among young, nulliparous women who have received limited antenatal care services. Trial registration The identifier of the Maternal and Newborn Health Registry at ClinicalTrials.gov is NCT01073475.Trial registration: The identifier of the Maternal and Newborn Health Registry at ClinicalTrials.gov is NCT01073475.
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Affiliation(s)
| | - Archana B Patel
- Lata Medical Research Foundation, Nagpur, India.,Datta Meghe Institute of Medical Sciences, Wardha, India
| | | | | | | | - Ana Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research J N Medical College , Belagavi, Karnataka, India
| | | | | | | | | | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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Aziz A, Saleem S, Nolen TL, Pradhan NA, McClure EM, Jessani S, Garces AL, Hibberd PL, Moore JL, Goudar SS, Dhaded SM, Esamai F, Tenge C, Patel AB, Chomba E, Mwenechanya M, Bose CL, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Tshefu A, Koso-Thomas M, Siddiqi S, Goldenberg RL. Why are the Pakistani maternal, fetal and newborn outcomes so poor compared to other low and middle-income countries? Reprod Health 2020; 17:190. [PMID: 33334329 PMCID: PMC7745345 DOI: 10.1186/s12978-020-01023-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pakistan has among the poorest pregnancy outcomes worldwide, significantly worse than many other low-resource countries. The reasons for these differences are not clear. In this study, we compared pregnancy outcomes in Pakistan to other low-resource countries and explored factors that might help explain these differences. METHODS The Global Network (GN) Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and their pregnancy outcomes in defined geographic communities in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya, Zambia). Study staff enroll women in early pregnancy and follow-up soon after delivery and at 42 days to ascertain delivery, neonatal, and maternal outcomes. We analyzed the maternal mortality ratios (MMR), neonatal mortality rates (NMR), stillbirth rates, and potential explanatory factors from 2010 to 2018 across the GN sites. RESULTS From 2010 to 2018, there were 91,076 births in Pakistan and 456,276 births in the other GN sites combined. The MMR in Pakistan was 319 per 100,000 live births compared to an average of 124 in the other sites, while the Pakistan NMR was 49.4 per 1,000 live births compared to 20.4 in the other sites. The stillbirth rate in Pakistan was 53.5 per 1000 births compared to 23.2 for the other sites. Preterm birth and low birthweight rates were also substantially higher than the other sites combined. Within weight ranges, the Pakistani site generally had significantly higher rates of stillbirth and neonatal mortality than the other sites combined, with differences increasing as birthweights increased. By nearly every measure, medical care for pregnant women and their newborns in the Pakistan sites was worse than at the other sites combined. CONCLUSION The Pakistani pregnancy outcomes are much worse than those in the other GN sites. Reasons for these poorer outcomes likely include that the Pakistani sites' reproductive-aged women are largely poorly educated, undernourished, anemic, and deliver a high percentage of preterm and low-birthweight babies in settings of often inadequate maternal and newborn care. By addressing the issues highlighted in this paper there appears to be substantial room for improvements in Pakistan's pregnancy outcomes.
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Affiliation(s)
- Aleha Aziz
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA.
| | | | | | | | | | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala, Guatemala
| | | | | | - Shivaprasad S Goudar
- J N Medical College, KLE Academy Higher Education and Research, Belagavi, Karnataka, India
| | - Sangappa M Dhaded
- J N Medical College, KLE Academy Higher Education and Research, Belagavi, Karnataka, India
| | | | | | | | | | | | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
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20
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Patel AB, Bann CM, Garces AL, Krebs NF, Lokangaka A, Tshefu A, Bose CL, Saleem S, Goldenberg RL, Goudar SS, Derman RJ, Chomba E, Carlo WA, Esamai F, Liechty EA, Koso-Thomas M, McClure EM, Hibberd PL. Development of the Global Network for Women's and Children's Health Research's socioeconomic status index for use in the network's sites in low and lower middle-income countries. Reprod Health 2020; 17:193. [PMID: 33334359 PMCID: PMC7745356 DOI: 10.1186/s12978-020-01034-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/30/2020] [Indexed: 12/05/2022] Open
Abstract
Background Socioeconomic status (SES) is an important determinant of health globally and an important explanatory variable to assess causality in epidemiological research. The 10th Sustainable Development Goal is to reduce disparities in SES that impact health outcomes globally. It is easier to study SES in high-income countries because household income is representative of the SES. However, it is well recognized that income is poorly reported in low- and middle- income countries (LMIC) and is an unreliable indicator of SES. Therefore, there is a need for a robust index that will help to discriminate the SES of rural households in a pooled dataset from LMIC. Methods The study was nested in the population-based Maternal and Neonatal Health Registry of the Global Network for Women’s and Children’s Health Research which has 7 rural sites in 6 Asian, sub-Saharan African and Central American countries. Pregnant women enrolling in the Registry were asked questions about items such as housing conditions and household assets. The characteristics of the candidate items were evaluated using confirmatory factor analyses and item response theory analyses. Based on the results of these analyses, a final set of items were selected for the SES index. Results Using data from 49,536 households of pregnant women, we reduced the data collected to a 10-item index. The 10 items were feasible to administer, covered the SES continuum and had good internal reliability and validity. We developed a sum score-based Item Response Theory scoring algorithm which is easy to compute and is highly correlated with scores based on response patterns (r = 0.97), suggesting minimal loss of information with the simplified approach. Scores varied significantly by site (p < 0.001). African sites had lower mean SES scores than the Asian and Central American sites. The SES index demonstrated good internal consistency reliability (Cronbach’s alpha = 0.81). Higher SES scores were significantly associated with formal education, more education, having received antenatal care, and facility delivery (p < 0.001). Conclusions While measuring SES in LMIC is challenging, we have developed a Global Network Socioeconomic Status Index which may be useful for comparisons of SES within and between locations. Next steps include understanding how the index is associated with maternal, perinatal and neonatal mortality. Trial Registration NCT01073475 Plain English summary Socioeconomic status (SES) is an important determinant of health globally, and improving SES is important to reduce disparities in health outcomes. It is easier to study SES in high-income countries because it can be measured by income and what income is spent on, but this concept does not translate easily to low and middle income countries. We developed a questionnaire that includes 10 items to determine SES in low-resource settings that was added to an ongoing Maternal and Neonatal Health Registry that is funded by the National Institutes of Child Health and Human Development’s Global Network. The Registry includes sites that collect outcomes of pregnancies in women and their babies in rural areas in 6 countries in South Asia, sub-Saharan Africa and Central America. The Registry is population based and tracks women from early in pregnancy to day 42 post-partum. The questionnaire is easy to administer and has good reliability and validity. Next steps include understanding how the index is associated with maternal, fetal and neonatal mortality.
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Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation, Nagpur, India.,Datta Meghe Institute of Medical Sciences, Wardha, India
| | - Carla M Bann
- RTI International, Research Triangle Park, NC, USA
| | | | | | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Carl L Bose
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research's J N Medical College, Belagavi, India
| | | | | | | | | | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
| | | | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
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21
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Bauserman M, Thorsten VR, Nolen TL, Patterson J, Lokangaka A, Tshefu A, Patel AB, Hibberd PL, Garces AL, Figueroa L, Krebs NF, Esamai F, Nyongesa P, Liechty EA, Carlo WA, Chomba E, Goudar SS, Kavi A, Derman RJ, Saleem S, Jessani S, Billah SM, Koso-Thomas M, McClure EM, Goldenberg RL, Bose C. Maternal mortality in six low and lower-middle income countries from 2010 to 2018: risk factors and trends. Reprod Health 2020; 17:173. [PMID: 33334343 PMCID: PMC7745363 DOI: 10.1186/s12978-020-00990-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality is a public health problem that disproportionately affects low and lower-middle income countries (LMICs). Appropriate data sources are lacking to effectively track maternal mortality and monitor changes in this health indicator over time. METHODS We analyzed data from women enrolled in the NICHD Global Network for Women's and Children's Health Research Maternal Newborn Health Registry (MNHR) from 2010 through 2018. Women delivering within research sites in the Democratic Republic of Congo, Guatemala, India (Nagpur and Belagavi), Kenya, Pakistan, and Zambia are included. We evaluated maternal and delivery characteristics using log-binomial models and multivariable models to obtain relative risk estimates for mortality. We used running averages to track maternal mortality ratio (MMR, maternal deaths per 100,000 live births) over time. RESULTS We evaluated 571,321 pregnancies and 842 maternal deaths. We observed an MMR of 157 / 100,000 live births (95% CI 147, 167) across all sites, with a range of MMRs from 97 (76, 118) in the Guatemala site to 327 (293, 361) in the Pakistan site. When adjusted for maternal risk factors, risks of maternal mortality were higher with maternal age > 35 (RR 1.43 (1.06, 1.92)), no maternal education (RR 3.40 (2.08, 5.55)), lower education (RR 2.46 (1.54, 3.94)), nulliparity (RR 1.24 (1.01, 1.52)) and parity > 2 (RR 1.48 (1.15, 1.89)). Increased risk of maternal mortality was also associated with occurrence of obstructed labor (RR 1.58 (1.14, 2.19)), severe antepartum hemorrhage (RR 2.59 (1.83, 3.66)) and hypertensive disorders (RR 6.87 (5.05, 9.34)). Before and after adjusting for other characteristics, physician attendance at delivery, delivery in hospital and Caesarean delivery were associated with increased risk. We observed variable changes over time in the MMR within sites. CONCLUSIONS The MNHR is a useful tool for tracking MMRs in these LMICs. We identified maternal and delivery characteristics associated with increased risk of death, some might be confounded by indication. Despite declines in MMR in some sites, all sites had an MMR higher than the Sustainable Development Goals target of below 70 per 100,000 live births by 2030. TRIAL REGISTRATION The MNHR is registered at NCT01073475 .
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Affiliation(s)
- Melissa Bauserman
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA.
| | | | | | - Jackie Patterson
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA
| | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Archana B Patel
- Lata Medical Research Foundation, Nagpur, India
- Adjunct Faculty Medical Research, Datta Meghe Institute of Medical Sciences, Sawangi, India
| | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Lester Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | | | | | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belgaum, Karnataka, India
| | - Avinash Kavi
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Belgaum, Karnataka, India
| | | | | | | | - Sk Masum Billah
- Maternal and Child Health Division (icddr, b), Dhaka, Bangladesh
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Carl Bose
- Department of Pediatrics, University of North Carolina School of Medicine, 101 Manning Drive, CB 7596, Chapel Hill, NC, 27599-7596, USA
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22
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Marete I, Ekhaguere O, Bann CM, Bucher SL, Nyongesa P, Patel AB, Hibberd PL, Saleem S, Goldenberg RL, Goudar SS, Derman RJ, Garces AL, Krebs NF, Chomba E, Carlo WA, Lokangaka A, Bauserman M, Koso-Thomas M, Moore JL, McClure EM, Esamai F. Regional trends in birth weight in low- and middle-income countries 2013-2018. Reprod Health 2020; 17:176. [PMID: 33334365 PMCID: PMC7745347 DOI: 10.1186/s12978-020-01026-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/28/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Birth weight (BW) is a strong predictor of neonatal outcomes. The purpose of this study was to compare BWs between global regions (south Asia, sub-Saharan Africa, Central America) prospectively and to determine if trends exist in BW over time using the population-based maternal and newborn registry (MNHR) of the Global Network for Women'sand Children's Health Research (Global Network). METHODS The MNHR is a prospective observational population-based registryof six research sites participating in the Global Network (2013-2018), within five low- and middle-income countries (Kenya, Zambia, India, Pakistan, and Guatemala) in threeglobal regions (sub-Saharan Af rica, south Asia, Central America). The birth weights were obtained for all infants born during the study period. This was done either by abstracting from the infants' health facility records or from direct measurement by the registry staff for infants born at home. After controlling for demographic characteristics, mixed-effect regression models were utilized to examine regional differences in birth weights over time. RESULTS The overall BW meanswere higher for the African sites (Zambia and Kenya), 3186 g (SD 463 g) in 2013 and 3149 g (SD 449 g) in 2018, ascompared to Asian sites (Belagavi and Nagpur, India and Pakistan), 2717 g (SD450 g) in 2013 and 2713 g (SD 452 g) in 2018. The Central American site (Guatemala) had a mean BW intermediate between the African and south Asian sites, 2928 g (SD 452) in 2013, and 2874 g (SD 448) in 2018. The low birth weight (LBW) incidence was highest in the south Asian sites (India and Pakistan) and lowest in the African sites (Kenya and Zambia). The size of regional differences varied somewhat over time with slight decreases in the gap in birth weights between the African and Asian sites and slight increases in the gap between the African and Central American sites. CONCLUSIONS Overall, BWmeans by global region did not change significantly over the 5-year study period. From 2013 to 2018, infants enrolled at the African sites demonstrated the highest BW means overall across the entire study period, particularly as compared to Asian sites. The incidence of LBW was highest in the Asian sites (India and Pakistan) compared to the African and Central American sites. Trial registration The study is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT01073475.
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Affiliation(s)
- Irene Marete
- Moi University School of Medicine, Eldoret, Kenya.
| | - Osayame Ekhaguere
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Sherri L Bucher
- Division of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College Belagavi, Karnataka, India
| | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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23
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Saleem S, Naqvi F, McClure EM, Nowak KJ, Tikmani SS, Garces AL, Hibberd PL, Moore JL, Nolen TL, Goudar SS, Kumar Y, Esamai F, Marete I, Patel AB, Chomba E, Mwenechanya M, Bose CL, Liechty EA, Krebs NF, Derman RJ, Carlo WA, Tshefu A, Koso-Thomas M, Siddiqi S, Goldenberg RL. Neonatal deaths in infants born weighing ≥ 2500 g in low and middle-income countries. Reprod Health 2020; 17:158. [PMID: 33256782 PMCID: PMC7706246 DOI: 10.1186/s12978-020-01013-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background Babies born weighing ≥ 2500 g account for more than 80% of the births in most resource-limited locations and for nearly 50% of the 28-day neonatal deaths. In contrast, in high-resource settings, 28-day neonatal mortality among this group represents only a small fraction of the neonatal deaths. Yet mortality risks for birth weight of ≥ 2500 g is limited. Knowledge regarding the factors associated with mortality in these babies will help in identifying interventions that can reduce mortality. Methods The Global Network’s Maternal Newborn Health Registry (MNHR) is a prospective, population-based observational study that includes all pregnant women and their pregnancy outcomes in defined geographic communities that has been conducted in research sites in six low-middle income countries (India, Pakistan, Democratic Republic of Congo, Guatemala, Kenya and Zambia). Study staff enroll all pregnant women as early as possible during pregnancy and conduct follow-up visits to ascertain delivery and 28-day neonatal outcomes. We analyzed the neonatal mortality rates (NMR) and risk factors for deaths by 28 days among all live-born babies with a birthweight ≥ 2500 g from 2010 to 2018 across the Global Network sites. Results Babies born in the Global Network sites from 2010 to 2018 with a birthweight ≥ 2500 g accounted for 84.8% of the births and 45.4% of the 28-day neonatal deaths. Among this group, the overall NMR was 13.1/1000 live births. The overall 28-day NMR for ongoing clusters was highest in Pakistan (29.7/1000 live births) and lowest in the Zambian/Kenyan sites (9.3/1000) for ≥ 2500 g infants. ≥ 2500 g NMRs declined for Zambia/Kenya and India. For Pakistan and Guatemala, the NMR remained almost unchanged over the period. The ≥ 2500 g risks related to maternal, delivery and newborn characteristics varied by site. Maternal factors that increased risk and were common for all sites included nulliparity, hypertensive disease, previous stillbirth, maternal death, obstructed labor, severe postpartum hemorrhage, and abnormal fetal presentation. Neonatal characteristics including resuscitation, hospitalization, congenital anomalies and male sex, as well as lower gestational ages and birthweights were also associated with increased mortality. Conclusions Nearly half of neonatal deaths in the Global Network sites occurred in infants born weighing ≥ 2500 g. The NMR for those infants was 13.1 per 1000 live births, much higher than rates usually seen in high-income countries. The changes in NMR over time varied across the sites. Even among babies born ≥ 2500 g, lower gestational age and birthweight were largely associated with increased risk of mortality. Since many of these deaths should be preventable, attention to preventing mortality in these infants should have an important impact on overall NMR. Trial registration: https://ClinicalTrials.gov Identifier: NCT01073475
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Affiliation(s)
| | | | | | | | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | | | | | | | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Yogesh Kumar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | - Irene Marete
- Moi University School of Medicine, Eldoret, Kenya
| | | | | | | | - Carl L Bose
- University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Antoinette Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
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24
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Patel AB, Simmons EM, Rao SR, Moore J, Nolen TL, Goldenberg RL, Goudar SS, Somannavar MS, Esamai F, Nyongesa P, Garces AL, Chomba E, Mwenechanya M, Saleem S, Naqvi F, Bauserman M, Bucher S, Krebs NF, Derman RJ, Carlo WA, Koso-ThomasMcClure MEM, Hibberd PL. Evaluating the effect of care around labor and delivery practices on early neonatal mortality in the Global Network's Maternal and Newborn Health Registry. Reprod Health 2020; 17:156. [PMID: 33256790 PMCID: PMC7708898 DOI: 10.1186/s12978-020-01010-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation's (UN's) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization's Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness. METHODS Data on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD's Global Network's (GN) Maternal Newborn Health Registry (MNHR) between 2010 and 2013, were included. We evaluated if all 8 practices (Care around Delivery - CAD), combined as an index was associated with reduced early neonatal mortality rates (days 0-6 of life). RESULTS A total of 150,848 live births were included in the analysis. The individual indicators varied across sites. All components were present in 19.9% births (range 0.4 to 31% across sites). Present indicators (8 components) were associated with reduced early neonatal mortality [adjusted RR (95% CI):0.81 (0.77, 0.85); p < 0.0001]. Despite an overall association between CAD and early neonatal mortality (RR < 1.0 for all early mortality): delivery by skilled birth attendant; presence of fetal heart and delayed bathing were associated with increased early neonatal mortality. CONCLUSIONS Present indicators (8 practices) of CAD were associated with a 19% reduction in the risk of neonatal death in the diverse health facilities where delivery occurred within the GN MNHR. These indicators could be monitored to identify facilities that need to improve compliance with ENC practices to reduce preventable neonatal deaths. Three of the 8 indicators were associated with increased neonatal mortality, due to baby being sick at birth. Although promising, this composite index needs refinement before use to monitor facility-based quality of care in association with early neonatal mortality. Trial registration The identifier of the Maternal Newborn Health Registry at ClinicalTrials.gov is NCT01073475.
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Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation, Nagpur, India.
- Datta Meghe Institute of Medical Sciences, Wardha, India.
| | | | - Sowmya R Rao
- School of Public Health, Boston University, Boston, MA, USA
| | | | | | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
| | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | - Manjunath S Somannavar
- KLE Academy Higher Education and Research, J N Medical College, Belagavi, Karnataka, India
| | | | | | - Ana L Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | | | | | | | | | | | | | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
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25
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McClure EM, Saleem S, Goudar SS, Garces A, Whitworth R, Esamai F, Patel AB, Tikmani SS, Mwenechanya M, Chomba E, Lokangaka A, Bose CL, Bucher S, Liechty EA, Krebs NF, Yogesh Kumar S, Derman RJ, Hibberd PL, Carlo WA, Moore JL, Nolen TL, Koso-Thomas M, Goldenberg RL. Stillbirth 2010-2018: a prospective, population-based, multi-country study from the Global Network. Reprod Health 2020; 17:146. [PMID: 33256783 PMCID: PMC7706249 DOI: 10.1186/s12978-020-00991-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Stillbirth rates are high and represent a substantial proportion of the under-5 mortality in low and middle-income countries (LMIC). In LMIC, where nearly 98% of stillbirths worldwide occur, few population-based studies have documented cause of stillbirths or the trends in rate of stillbirth over time. METHODS We undertook a prospective, population-based multi-country research study of all pregnant women in defined geographic areas across 7 sites in low-resource settings (Kenya, Zambia, Democratic Republic of Congo, India, Pakistan, and Guatemala). Staff collected demographic and health care characteristics with outcomes obtained at delivery. Cause of stillbirth was assigned by algorithm. RESULTS From 2010 through 2018, 573,148 women were enrolled with delivery data obtained. Of the 552,547 births that reached 500 g or 20 weeks gestation, 15,604 were stillbirths; a rate of 28.2 stillbirths per 1000 births. The stillbirth rates were 19.3 in the Guatemala site, 23.8 in the African sites, and 33.3 in the Asian sites. Specifically, stillbirth rates were highest in the Pakistan site, which also documented a substantial decrease in stillbirth rates over the study period, from 56.0 per 1000 (95% CI 51.0, 61.0) in 2010 to 44.4 per 1000 (95% CI 39.1, 49.7) in 2018. The Nagpur, India site also documented a substantial decrease in stillbirths from 32.5 (95% CI 29.0, 36.1) to 16.9 (95% CI 13.9, 19.9) per 1000 in 2018; however, other sites had only small declines in stillbirth over the same period. Women who were less educated and older as well as those with less access to antenatal care and with vaginal assisted delivery were at increased risk of stillbirth. The major fetal causes of stillbirth were birth asphyxia (44.0% of stillbirths) and infectious causes (22.2%). The maternal conditions that were observed among those with stillbirth were obstructed or prolonged labor, antepartum hemorrhage and maternal infections. CONCLUSIONS Over the study period, stillbirth rates have remained relatively high across all sites. With the exceptions of the Pakistan and Nagpur sites, Global Network sites did not observe substantial changes in their stillbirth rates. Women who were less educated and had less access to antenatal and obstetric care remained at the highest burden of stillbirth. STUDY REGISTRATION Clinicaltrials.gov (ID# NCT01073475).
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Affiliation(s)
- Elizabeth M McClure
- Social, Statistical and Environmental Health Sciences, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA.
| | | | - Shivaprasad S Goudar
- KLE Academy Higher Education and Research J N Medical College Belagavi, Belagavi, Karnataka, India
| | - Ana Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - Ryan Whitworth
- Social, Statistical and Environmental Health Sciences, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA
| | | | | | | | | | | | - Adrien Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Carl L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sherri Bucher
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Edward A Liechty
- Indiana School of Medicine, University of Indiana, Indianapolis, IN, USA
| | - Nancy F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | - S Yogesh Kumar
- KLE Academy Higher Education and Research J N Medical College Belagavi, Belagavi, Karnataka, India
| | | | | | | | - Janet L Moore
- Social, Statistical and Environmental Health Sciences, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA
| | - Tracy L Nolen
- Social, Statistical and Environmental Health Sciences, RTI International, 3040 Cornwallis Rd, Durham, NC, 27709, USA
| | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Robert L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University School of Medicine, New York, NY, USA
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Leslie-Mazwi TM, Fargen KM, Levitt M, Derdeyn CP, Feske SK, Patel AB, Hirsch JA. Preserving Access: A Review of Stroke Thrombectomy during the COVID-19 Pandemic. AJNR Am J Neuroradiol 2020; 41:1136-1141. [PMID: 32439650 DOI: 10.3174/ajnr.a6606] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/29/2020] [Indexed: 01/25/2023]
Abstract
Thrombectomy for large-vessel-occlusion stroke is a highly impactful treatment. The spread of coronavirus 19 (COVID-19) across the United States and the globe impacts access to this crucial intervention through widespread societal and institutional changes. In this document, we review the implications of COVID-19 on the emergency care of large-vessel occlusion stroke, reviewing specific infection-control recommendations, available literature, existing resources, and expert consensus. As a population, patients with large-vessel occlusion stroke face unique challenges during pandemics. These are broad in scope. Responses to these challenges through adaptation of stroke systems of care and with imaging, thrombectomy, and postprocedural care are detailed. Preservation of access to thrombectomy must be prioritized for its public health impact. While the extent of required changes will vary by region, tiered planning for both escalation and de-escalation of measures must be a part of each practice. In addition, preparations described serve as templates in the event of future pandemics.
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Affiliation(s)
- T M Leslie-Mazwi
- From the Departments of Neurology (T.M.L.-M.) .,Neurosurgery (T.M.L.-M., A.B.P.)
| | - K M Fargen
- Department of Neurosurgery (K.M.F.), Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - M Levitt
- Departments of Neurological Surgery, Radiology, Mechanical Engineering and Stroke and Applied Neuroscience Center (M.L.), University of Washington, Seattle, Washington
| | - C P Derdeyn
- Departments of Radiology and Neurology (C.P.D.), University of Iowa, Iowa City, Iowa
| | - S K Feske
- Department of Neurology (S.K.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - J A Hirsch
- Radiology (J.A.H.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Arlington L, Patel AB, Simmons E, Kurhe K, Prakash A, Rao SR, Hibberd PL. Duration of solid fuel cookstove use is associated with increased risk of acute lower respiratory infection among children under six months in rural central India. PLoS One 2019; 14:e0224374. [PMID: 31648283 PMCID: PMC6812868 DOI: 10.1371/journal.pone.0224374] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 10/12/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction India has a higher number of deaths due to acute lower respiratory infections (ALRIs) in children <5 years than any other country. The underlying cause of half of ALRI deaths is household air pollution from burning of solid fuels, according to the World Health Organization. If there is a direct association between duration of exposure and increased ALRI risk, a potential strategy might be to limit the child’s exposure to burning solid fuel. Methods and materials Children born to pregnant women participating in the Global Network for Women and Children's Health Maternal and Newborn Health Registry near Nagpur, India were followed every two weeks from birth to six months to diagnose ALRI. The number of hours per day that the child’s mother spent in front of a burning solid fuel cookstove was recorded. Children of mothers using only clean cookstoves were classified as having zero hours of exposure. Odds Ratios with 95% confidence intervals were obtained from Generalized Estimating Equations logistic models that assessed the relationship of exposure to solid fuels with risk of ≥1 ALRI, adjusted for sex of the child, household smoking, wealth, maternal age, birth weight and parity. Results Between August 2013 and March 2014, 302 of 1,586 children (19%) had ≥1 episode of ALRI. Results from the multivariable analysis indicate that the odds of ALRI significantly increased from 1.2 (95% CI: 0.7–2.2) for <1 hour of exposure to 2.1 (95% CI: 1.4–3.3) for >3 hours of exposure to solid fuel cookstoves compared with no exposure (p<0.01). Additionally, decreasing wealth [middle: 1.2 (0.9, 1.6); poor: 1.4 (1.2–1.7); p<0.001] was associated with ALRIs. Conclusions Our study findings indicate that increasing the time mothers spend cooking near solid fuel cookstoves while children are in the house may be associated with development of ≥1 ALRI in children <6 months.
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Affiliation(s)
- Lauren Arlington
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Archana B. Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
- Department of Pediatrics, Indira Gandhi Government Medical College, Nagpur, Maharashtra, India
| | - Elizabeth Simmons
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Amber Prakash
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Sowmya R. Rao
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Patricia L. Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
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Patel AB, Kuhite PN, Alam A, Pusdekar Y, Puranik A, Khan SS, Kelly P, Muthayya S, Laba TL, Almeida MD, Dibley MJ. M-SAKHI-Mobile health solutions to help community providers promote maternal and infant nutrition and health using a community-based cluster randomized controlled trial in rural India: A study protocol. Matern Child Nutr 2019; 15:e12850. [PMID: 31177631 DOI: 10.1111/mcn.12850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/11/2019] [Accepted: 05/13/2019] [Indexed: 11/28/2022]
Abstract
Reduction of childhood stunting is difficult to achieve by interventions that focus only on improving nutrition during infancy. Comprehensive interventions that extend through the continuum of care from pregnancy to infancy are needed. Mobile phones are now successfully being used for behaviour change communication to improve health. We present the methodology of an mHealth intervention "Mobile Solutions Aiding Knowledge for Health Improvement" (M-SAKHI) to be delivered by rural community health workers or Accredited Social Health Activists (ASHAs) for rural women, below or up to 20 weeks of pregnancy through delivery until their infant is 12 months of age. This protocol paper describes the cluster randomized controlled trial to evaluate the effectiveness of M-SAKHI. The primary objective of the trial is to reduce the prevalence of stunting (height-for-age < -2 z-score) in children at 18 months of age by 8% in the intervention as compared with control. The secondary objectives include evaluating the impact on maternal dietary diversity, birth weight, infant and young child feeding practices, infant development, and child morbidity, along with a range of intermediate outcomes for maternal, neonatal, and infant health. A total of 297 ASHAs, five trained counsellors, and 2,501 participants from 244 villages are participating in this study. The outcome data are being collected by 51 field research officers. This study will provide evidence regarding the efficacy of M-SAKHI to reduce stunting in young children in rural India, and if effective, the cost-effectiveness of M-SAKHI.
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Affiliation(s)
| | | | - Ashraful Alam
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | - Patrick Kelly
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | | | - Tracey-Lea Laba
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Michelle D' Almeida
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michael J Dibley
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Patel AB, Kurhe K, Prakash A, Bhargav S, Parepalli S, Fogleman EV, Moore JL, Wallace DD, Kulkarni H, Hibberd PL. Early Identification of Preterm Neonates at Birth With a Tablet App for the Simplified Gestational Age Score (T-SGAS) When Ultrasound Gestational Age Dating Is Unavailable: Protocol for a Validation Study. JMIR Res Protoc 2019; 8:e11913. [PMID: 30860484 PMCID: PMC6434403 DOI: 10.2196/11913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/19/2018] [Accepted: 11/22/2018] [Indexed: 11/13/2022] Open
Abstract
Background Although rates of preterm birth continue to increase globally, identification of preterm from low birth weight infants remains a challenge. The burden of low birth weight vs preterm is greatest in resource-limited settings, where gestational age (GA) prior to delivery is frequently not known because ultrasound in early pregnancy is not available and estimates of the date of the mother’s last menstrual period (LMP) may not be reliable. An alternative option is to assess GA at birth to optimize referral and care of preterm newborns. We previously developed and pilot-tested a system to measure the simplified gestational age score (SGAS) based on 4 easily observable neonatal characteristics. Objective The objective of this study is to adapt the scoring system as a tablet app (potentially scalable approach) to assess feasibility of use and to validate whether the scoring system accurately predicts prematurity by itself, over and above birth weight in a large sample of newborns. Methods The study is based in Nagpur, India, at the Research Unit of the National Institute of Child Health and Human Development’s Global Network for Women’s and Children’s Health Research. The Android tablet app for the SGAS (T-SGAS) displays de-identified photographs of skin, breasts, and genitalia across a range of GAs and line drawings of infant posture. Each item is associated with a score. The user is trained to choose the photograph or line drawing that most closely matches the newborn being evaluated, and the app determines the neonate’s GA category (preterm or term) from the cumulative score. The validation study will be conducted in 3 second level care facilities (most deliveries in India occur in hospitals, and women known to be at risk of preterm birth are referred to second level care facilities). Within 24 hours of delivery, women and their babies who are stable will be enrolled in the study. Two auxiliary nurse midwives (ANMs) blinded to prior GA assessments will use the T-SGAS to estimate the GA status of the newborn. An independent data collector will abstract the GA from the ultrasound recorded in the hospital chart and record the date of the mother’s LMP. Eligibility for analysis is determined by the ultrasound and LMP data being collected within 1 week of each other to have a rigorous assessment of true GA. Results Publication of the results of the study is anticipated in 2019. Conclusions Until GA dating by ultrasound is universally available and easy to use in resource-limited settings, and where there are restrictions on ultrasound use due to their use for sex determination and abortion of female fetuses, this study will determine whether the T-SGAS app can accurately assess GA in risk categories at birth. Trial Registration ClinicalTrials.gov NCT02408783; https://clinicaltrials.gov/ct2/show/NCT02408783 (Archived by Webcite at http://www.webcitation.org/75S2kmr3T) International Registered Report Identifier (IRRID) DERR1-10.2196/11913
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Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Kunal Kurhe
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Amber Prakash
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Savita Bhargav
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | | | | | - Janet L Moore
- RTI International, Research Triangle Park, NC, United States
| | | | - Hemant Kulkarni
- Lata Medical Research Foundation, Nagpur, Maharashtra, India.,M&H Research, LLC, San Antonio, TX, United States
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
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Thomas PS, Patel AB, Contreras A, Liu DD, Lee JJ, Khan S, Vornik LA, Dimond EP, Perloff M, Heckman-Stoddard BM, Brown PH. Abstract OT2-09-02: A phase I dose escalation study of topical bexarotene in women at high risk for breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-09-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer prevention with anti-estrogens, including tamoxifen, raloxifene, and exemestane, has been shown to reduce the incidence of hormone receptor-positive breast cancer. However, agents that can reduce the incidence of hormone receptor negative breast cancer are currently lacking. Rexinoids such as bexarotene are vitamin A analogues that have been shown to be involved in cell differentiation, growth, and apoptosis. In preclinical mouse models that develop ER-negative breast cancers, bexarotene showed a significant reduction in mammary tumor development. Oral bexarotene has been evaluated in BRCA mutation carriers and significant decreases in cyclin D1 were noted in breast cells suggesting biological activity of bexarotene on breast tissue. Systemic side effects of hyperlipidemia and hypothyroidism were also found. Data from chemoprevention studies with topical 4-hydroxytamoxifen support the concept of topical agents penetrating into the breast tissue and exhibiting biological activity in the tissue. We hypothesize that topical bexarotene can be applied to the breast as a chemoprevention agent with penetration to the breast tissue without subsequent systemic side effects and toxicity as seen with oral bexarotene.
Trial Design: Women at high risk for breast cancer will be recruited and assigned to one of three different dose levels: 10mg (1ml) every other day, 10mg (1ml) daily, 20mg (2ml) daily to one unaffected breast for 4 weeks. The primary endpoint of the study is to determine the recommended phase II dose of topical bexarotene 1% gel for evaluation in healthy at-risk women. Dose Limiting Toxicity (DLT) is defined as a grade 2 skin adverse event that persists for at least 6 days or any grade 3 or greater adverse event related to the study drug. A grade 2 skin adverse event that recurs and persists for at least 3 days is also a DLT. The Maximum Tolerated Dose (MTD) will be defined as the highest dose level at which no more than 2 participants experience a DLT among 10 participants treated. A conservative modification of the standard “3+3” design will be applied. The first three participants will be assigned to the lowest dose level. New cohorts of 3-4 participants will not be treated until toxicity has been fully evaluated for all current participants through 4 weeks. Once the MTD has been determined, an expansion cohort of an additional 10 patients will be recruited at the MTD to further evaluate safety and toxicity at this dose level as well bexarotene concentration in the breast tissue. Secondary endpoints include serum bexarotene level, tissue bexarotene levels, and changes in thyroid function tests, lipid profile, and calcium. The planned accrual for this study if maximally accrued to all dose levels and the dose expansion cohort will be 40 participants.
Citation Format: Thomas PS, Patel AB, Contreras A, Liu DD, Lee JJ, Khan S, Vornik LA, Dimond EP, Perloff M, Heckman-Stoddard BM, Brown PH. A phase I dose escalation study of topical bexarotene in women at high risk for breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-09-02.
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Affiliation(s)
- PS Thomas
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - AB Patel
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - A Contreras
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - DD Liu
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - JJ Lee
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - S Khan
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - LA Vornik
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - EP Dimond
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - M Perloff
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - BM Heckman-Stoddard
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
| | - PH Brown
- University of Texas at MD Anderson Cancer Center, Houston, TX; Northwestern University, Chicago, IL; National Cancer Institute, Bethesda, MD
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Alexander A, Marx AN, Reddy SM, Reuben JM, Le-Petross HC, Lane D, Huang ML, Krishnamurthy S, Gong Y, Gombos DS, Patel N, Tung CI, Allen RC, Kandl TJ, Wu J, Liu S, Patel AB, Futreal A, Wistuba I, Layman RM, Valero V, Tripathy D, Ueno NT, Lim B. Abstract OT3-05-04: Phase II study of atezolizumab, cobimetinib, and eribulin in patients with recurrent or metastatic inflammatory breast cancer (IBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-05-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: IBCs that do not completely respond to chemotherapy often have dysregulated immune pathways, and novel therapies are needed to improve outcomes in recurrent/metastatic disease. One-third of IBCs express the atezolizumab target PD-L1, and cobimetinib increases PD-L1 expression; thus, we hypothesize that atezolizumab and cobimetinib may act synergistically in IBC. The FDA-approved agent eribulin is active in IBC and has anti-stem cell activity and can reverse the IBC phenotype of epithelial-to-mesenchymal transition. Hence the use of eribulin as a chemotherapy backbone in combination with other novel agents is well justified.
Trial Design: This single-arm, open-label trial is enrolling patients with recurrent IBC or de novo metastatic IBC that has progressed on at least 1 line of standard chemotherapy. During a 4-week pharmacodynamic window, patients have an upfront biopsy, receive atezolizumab and cobimetinib treatment for 4 weeks, and have a second biopsy. Triple-combination treatment then commences, with standard eribulin dosing. After 4 cycles of eribulin, patients receive maintenance targeted therapy until disease progression or intolerable toxicity.
Eligibility Criteria: Patients with metastatic IBC of any molecular subtype must have measurable disease (per RECIST 1.1) amenable to biopsy. Patients with HER2+ disease must have received both pertuzumab and T-DM1. Patients with treated stable brain metastases are allowed. Patients must have recovered from the acute effects of any prior therapies and have adequate hematologic, organ, and cardiac function. Patients with autoimmune diseases or a history of pneumonitis are ineligible.
Specific Aims: The primary objective is to determine the overall response rate (ORR) of the combination therapy. Secondary objectives include determining the safety and tolerability, clinical benefit rate, response duration, progression-free survival, 2-year overall survival rate and predictive biomarker analyses.
Statistical Methods: The trial will enroll up to 9 patients in its phase I/safety lead-in portion and up to 33 patients total. A Bayesian optimal interval design is used to efficiently determine the maximum tolerated cobimetinib dose in phase I. Patients start cobimetinib at the FDA-approved dose of 60 mg/day with a target toxicity rate is 0.3. Phase II will enroll 24 patients to determine the efficacy of the triple-combination therapy. The historical ORR in metastatic IBC is 10%; our sample size provides 80% power to detect an ORR improvement to 25%.
Accrual: The trial has enrolled 7 patients since its start in August 2017.
Citation Format: Alexander A, Marx AN, Reddy SM, Reuben JM, Le-Petross HC, Lane D, Huang ML, Krishnamurthy S, Gong Y, Gombos DS, Patel N, Tung CI, Allen RC, Kandl TJ, Wu J, Liu S, Patel AB, Futreal A, Wistuba I, Layman RM, Valero V, Tripathy D, Ueno NT, Lim B. Phase II study of atezolizumab, cobimetinib, and eribulin in patients with recurrent or metastatic inflammatory breast cancer (IBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-05-04.
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Affiliation(s)
- A Alexander
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AN Marx
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - SM Reddy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - JM Reuben
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - HC Le-Petross
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Lane
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - ML Huang
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Y Gong
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - DS Gombos
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - N Patel
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - CI Tung
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - RC Allen
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - TJ Kandl
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Wu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - S Liu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - AB Patel
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - A Futreal
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - I Wistuba
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - RM Layman
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - V Valero
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - D Tripathy
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - NT Ueno
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - B Lim
- University of Texas MD Anderson Cancer Center, Houston, TX
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Widmer M, Piaggio G, Nguyen TMH, Osoti A, Owa OO, Misra S, Coomarasamy A, Abdel-Aleem H, Mallapur AA, Qureshi Z, Lumbiganon P, Patel AB, Carroli G, Fawole B, Goudar SS, Pujar YV, Neilson J, Hofmeyr GJ, Su LL, Ferreira de Carvalho J, Pandey U, Mugerwa K, Shiragur SS, Byamugisha J, Giordano D, Gülmezoglu AM. Heat-Stable Carbetocin versus Oxytocin to Prevent Hemorrhage after Vaginal Birth. N Engl J Med 2018; 379:743-752. [PMID: 29949473 DOI: 10.1056/nejmoa1805489] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Postpartum hemorrhage is the most common cause of maternal death. Oxytocin is the standard therapy for the prevention of postpartum hemorrhage, but it requires cold storage, which is not available in many countries. In a large trial, we compared a novel formulation of heat-stable carbetocin with oxytocin. METHODS We enrolled women across 23 sites in 10 countries in a randomized, double-blind, noninferiority trial comparing intramuscular injections of heat-stable carbetocin (at a dose of 100 μg) with oxytocin (at a dose of 10 IU) administered immediately after vaginal birth. Both drugs were kept in cold storage (2 to 8°C) to maintain double-blinding. There were two primary outcomes: the proportion of women with blood loss of at least 500 ml or the use of additional uterotonic agents, and the proportion of women with blood loss of at least 1000 ml. The noninferiority margins for the relative risks of these outcomes were 1.16 and 1.23, respectively. RESULTS A total of 29,645 women underwent randomization. The frequency of blood loss of at least 500 ml or the use of additional uterotonic agents was 14.5% in the carbetocin group and 14.4% in the oxytocin group (relative risk, 1.01; 95% confidence interval [CI], 0.95 to 1.06), a finding that was consistent with noninferiority. The frequency of blood loss of at least 1000 ml was 1.51% in the carbetocin group and 1.45% in the oxytocin group (relative risk, 1.04; 95% CI, 0.87 to 1.25), with the confidence interval crossing the margin of noninferiority. The use of additional uterotonic agents, interventions to stop bleeding, and adverse effects did not differ significantly between the two groups. CONCLUSIONS Heat-stable carbetocin was noninferior to oxytocin for the prevention of blood loss of at least 500 ml or the use of additional uterotonic agents. Noninferiority was not shown for the outcome of blood loss of at least 1000 ml; low event rates for this outcome reduced the power of the trial. (Funded by Merck Sharpe & Dohme; CHAMPION Australian New Zealand Clinical Trials Registry number, ACTRN12614000870651 ; EudraCT number, 2014-004445-26 ; and Clinical Trials Registry-India number, CTRI/2016/05/006969 .).
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Affiliation(s)
- Mariana Widmer
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Gilda Piaggio
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Thi M H Nguyen
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Alfred Osoti
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Olorunfemi O Owa
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Sujata Misra
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Arri Coomarasamy
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Hany Abdel-Aleem
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Ashalata A Mallapur
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Zahida Qureshi
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Pisake Lumbiganon
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Archana B Patel
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Guillermo Carroli
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Bukola Fawole
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Shivaprasad S Goudar
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Yeshita V Pujar
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - James Neilson
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - G Justus Hofmeyr
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Lin L Su
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Jose Ferreira de Carvalho
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Uma Pandey
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Kidza Mugerwa
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Shobha S Shiragur
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Josaphat Byamugisha
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - Daniel Giordano
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
| | - A Metin Gülmezoglu
- From the Department of Reproductive Health and Research, World Health Organization (WHO), United Nations Development Program-United Nations Population Fund-UNICEF-WHO-World Bank Special Program of Research, Development, and Research Training in Human Reproduction, Geneva (M.W., T.M.H.N., A.M.G.); Statistika Consultoria, Campinas, Brazil (G.P., J.F.C.); the Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya (A.O., Z.Q.); the Department of Obstetrics and Gynecology, Mother and Child Hospital, Akure (O.O.O.), and the Department of Obstetrics and Gynecology, College of Medicine, University of Ibadan, Ibadan (B.F.) - both in Nigeria; Sriram Chandra Bhanja Medical College, Cuttack (S.M.), S. Nijalingappa Medical College and Hangal Shri Kumareshwar Hospital and Medical Research Center (A.A.M.), Karnatak Lingayat Education Academy of Higher Education and Research, Jawaharlal Nehru Medical College (S.S.G., Y.V.P.), and Shri B.M. Patil Medical College, Hospital and Research Center (S.S.S.), Karnataka, Lata Medical Research Foundation and Daga Women's Hospital, Maharashtra (A.B.P.), and the Department of Obstetrics and Gynecology, Institute of Medical Sciences, Banaras Hindu University, Varanasi (U.P.) - all in India; the Institute of Metabolism and Systems Research, University of Birmingham, Birmingham (A.C.), and the Department of Obstetrics and Gynaecology, University of Liverpool, Liverpool (J.N.) - both in the United Kingdom; the Department of Obstetrics and Gynecology, Women's Health Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt (H.A.-A.); the Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand (P.L.); Centro Rosarino de Estudios Perinatales, Rosario, Argentina (G.C., D.G.); the Effective Care Research Unit, Universities of Witwatersrand-Johannesburg, Fort Hare-Alice, and Walter Sisulu-Eastern Cape, and the Eastern Cape Department of Health, Eastern Cape - all in South Africa (G.J.H.); the Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore (L.L.S.); and the Department of Obstetrics and Gynecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda (K.M., J.B.)
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Short VL, Geller SE, Moore JL, McClure EM, Goudar SS, Dhaded SM, Kodkany BS, Saleem S, Naqvi F, Pasha O, Goldenberg RL, Patel AB, Hibberd PL, Garces AL, Koso-Thomas M, Miodovnik M, Wallace DD, Derman RJ. The Relationship between Body Mass Index in Pregnancy and Adverse Maternal, Perinatal, and Neonatal Outcomes in Rural India and Pakistan. Am J Perinatol 2018; 35:844-851. [PMID: 29365329 PMCID: PMC6233294 DOI: 10.1055/s-0037-1621733] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of this study was to describe the relationship between early pregnancy body mass index (BMI) and maternal, perinatal, and neonatal outcomes in rural India and Pakistan. STUDY DESIGN In a prospective, population-based pregnancy registry implemented in communities in Thatta, Pakistan and Nagpur and Belagavi, India, we obtained women's BMI prior to 12 weeks' gestation (categorized as underweight, normal, overweight, and obese following World Health Organization criteria). Outcomes were assessed 42 days postpartum. RESULTS The proportion of women with an adverse maternal outcome increased with increasing maternal BMI. Less than one-third of nonoverweight/nonobese women, 47.2% of overweight women, and 56.0% of obese women experienced an adverse maternal outcome. After controlling for site, maternal age and parity, risks of hypertensive disease/severe preeclampsia/eclampsia, cesarean/assisted delivery, and antibiotic use were higher among women with higher BMIs. Overweight women also had significantly higher risk of perinatal and early neonatal mortality compared with underweight/normal BMI women. Overweight women had a significantly higher perinatal mortality rate. CONCLUSION High BMI in early pregnancy was associated with increased risk of adverse maternal, perinatal, and neonatal outcomes in rural India and Pakistan. These findings present an opportunity to inform efforts for women to optimize weight prior to conception to improve pregnancy outcomes.
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Affiliation(s)
- Vanessa L. Short
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Stacie E. Geller
- Center for Research on Women and Gender, University of Illinois, Chicago, IL, USA
| | - Janet L. Moore
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC USA
| | - Elizabeth M. McClure
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC USA
| | | | - Sangappa M. Dhaded
- KLE University’s Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | | | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farnaz Naqvi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Robert L. Goldenberg
- Department of Obstetrics and Gynecology, Columbia University Medical School, New York, NY, USA
| | | | | | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Menachem Miodovnik
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Dennis D. Wallace
- Social, Statistical and Environmental Health Sciences, RTI International, Durham, NC USA
| | - Richard J. Derman
- Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, PA, USA
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Saleem S, Tikmani SS, McClure EM, Moore JL, Azam SI, Dhaded SM, Goudar SS, Garces A, Figueroa L, Marete I, Tenge C, Esamai F, Patel AB, Ali SA, Naqvi F, Mwenchanya M, Chomba E, Carlo WA, Derman RJ, Hibberd PL, Bucher S, Liechty EA, Krebs N, Michael Hambidge K, Wallace DD, Koso-Thomas M, Miodovnik M, Goldenberg RL. Trends and determinants of stillbirth in developing countries: results from the Global Network's Population-Based Birth Registry. Reprod Health 2018; 15:100. [PMID: 29945647 PMCID: PMC6019981 DOI: 10.1186/s12978-018-0526-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Stillbirth rates remain high, especially in low and middle-income countries, where rates are 25 per 1000, ten-fold higher than in high-income countries. The United Nations’ Every Newborn Action Plan has set a goal of 12 stillbirths per 1000 births by 2030 for all countries. Methods From a population-based pregnancy outcome registry, including data from 2010 to 2016 from two sites each in Africa (Zambia and Kenya) and India (Nagpur and Belagavi), as well as sites in Pakistan and Guatemala, we evaluated the stillbirth rates and rates of annual decline as well as risk factors for 427,111 births of which 12,181 were stillbirths. Results The mean stillbirth rates for the sites were 21.3 per 1000 births for Africa, 25.3 per 1000 births for India, 56.9 per 1000 births for Pakistan and 19.9 per 1000 births for Guatemala. From 2010 to 2016, across all sites, the mean stillbirth rate declined from 31.7 per 1000 births to 26.4 per 1000 births for an average annual decline of 3.0%. Risk factors for stillbirth were similar across the sites and included maternal age < 20 years and age > 35 years. Compared to parity 1–2, zero parity and parity > 3 were both associated with increased stillbirth risk and compared to women with any prenatal care, women with no prenatal care had significantly increased risk of stillbirth in all sites. Conclusions At the current rates of decline, stillbirth rates in these sites will not reach the Every Newborn Action Plan goal of 12 per 1000 births by 2030. More attention to the risk factors and treating the causes of stillbirths will be required to reach the Every Newborn Action Plan goal of stillbirth reduction. Trial registration NCT01073475.
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Affiliation(s)
- Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | | | | | | | - Syed Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sangappa M Dhaded
- KLE Academy of Higher Education and Research, J N Medical College Belgaum, Karnataka, India
| | - Shivaprasad S Goudar
- KLE Academy of Higher Education and Research, J N Medical College Belgaum, Karnataka, India
| | | | | | - Irene Marete
- Moi University School of Medicine, Eldoret, Kenya
| | | | | | | | - Sumera Aziz Ali
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farnaz Naqvi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Patel AB, Mangold AR, Costello CM, Nagel TH, Smith ML, Hayden RE, Sekulic A. Frequent loss of inositol polyphosphate-5-phosphatase in oropharyngeal squamous cell carcinoma. J Eur Acad Dermatol Venereol 2017; 32:e36-e37. [PMID: 28696004 DOI: 10.1111/jdv.14462] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- A B Patel
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - A R Mangold
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
| | - C M Costello
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA.,University of Arizona College of Medicine - Tucson, Tucson, AZ, USA
| | - T H Nagel
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - M L Smith
- Department of Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - R E Hayden
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - A Sekulic
- Department of Dermatology, Mayo Clinic, Scottsdale, AZ, USA
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Garces AL, McClure EM, Pérez W, Hambidge KM, Krebs NF, Figueroa L, Bose CL, Carlo WA, Tenge C, Esamai F, Goudar SS, Saleem S, Patel AB, Chiwila M, Chomba E, Tshefu A, Derman RJ, Hibberd PL, Bucher S, Liechty EA, Bauserman M, Moore JL, Koso-Thomas M, Miodovnik M, Goldenberg RL. The Global Network Neonatal Cause of Death algorithm for low-resource settings. Acta Paediatr 2017; 106:904-911. [PMID: 28240381 DOI: 10.1111/apa.13805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/20/2017] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
AIM This study estimated the causes of neonatal death using an algorithm for low-resource areas, where 98% of the world's neonatal deaths occur. METHODS We enrolled women in India, Pakistan, Guatemala, the Democratic Republic of Congo, Kenya and Zambia from 2014 to 2016 and tracked their delivery and newborn outcomes for up to 28 days. Antenatal care and delivery symptoms were collected using a structured questionnaire, clinical observation and/or a physical examination. The Global Network Cause of Death algorithm was used to assign the cause of neonatal death, analysed by country and day of death. RESULTS One-third (33.1%) of the 3068 neonatal deaths were due to suspected infection, 30.8% to prematurity, 21.2% to asphyxia, 9.5% to congenital anomalies and 5.4% did not have a cause of death assigned. Prematurity and asphyxia-related deaths were more common on the first day of life (46.7% and 52.9%, respectively), while most deaths due to infection occurred after the first day of life (86.9%). The distribution of causes was similar to global data reported by other major studies. CONCLUSION The Global Network algorithm provided a reliable cause of neonatal death in low-resource settings and can be used to inform public health strategies to reduce mortality.
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Affiliation(s)
| | | | | | | | | | | | - Carl L. Bose
- University of North Carolina at Chapel Hill; Chapel Hill NC USA
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Patel AB, Prakash AA, Raynes-Greenow C, Pusdekar YV, Hibberd PL. Description of inter-institutional referrals after admission for labor and delivery: a prospective population based cohort study in rural Maharashtra, India. BMC Health Serv Res 2017; 17:360. [PMID: 28526027 PMCID: PMC5437536 DOI: 10.1186/s12913-017-2302-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 05/11/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In 2008, the Indian government introduced financial assistance to encourage health facility deliveries. Facility births have increased, but maternal and neonatal morbidity and mortality have not decreased raising questions about the quality of care provided in facilities and access to a quality referral system. We evaluated the potential role of inter-institutional transfers of women admitted for labor and delivery on adverse maternal and neonatal outcomes in an ongoing prospective, population-based Maternal and Newborn Health Registry in Central India. METHODS Pregnant women from 20 rural Primary Health Centers near Nagpur, Maharashtra were followed throughout pregnancy and to day 42 post-partum. Inter- institutional referral was defined as transfer of a woman from a first or second level facility where she was admitted for labor and delivery to facility providing higher level of care, after admission to the day of delivery. Maternal mortality, stillbirth, early and late neonatal mortality were compared in mothers who were and were not referred. Factors associated with inter-institutional referral were analyzed using multivariable models with generalized estimating equations, adjusted for clustering at the level of the Primary Health Center. RESULTS Between June 2009 and June 2013, 3236 (9.4%) of 34,319 women had inter-institutional referral. Factors associated with referrals were maternal age (adjusted Relative Risk or aRR 1.1; 1.0-1.2); moderate or severe anemia (aRR 1.2; 1.2-1.4), gestational age <37 weeks (aRR 1.16; 1.05-1.27), multiple gestation (aRR 1.6; 1.2-2.1), absent fetal heart rate (aRR 1.7; 1.3-2.2), primigravida (aRR 1.4; 1.3, 1.6), primigravida with any pregnancy related maternal condition such as obstructed or prolonged labor; major antepartum or post-partum hemorrhage, hypertension or preeclampsia and breech, transverse or oblique lie (aRR 4.7; 3.8, 5.8), multigravida with any pregnancy related conditions (aRR 4.2; 3.4-5.2). Stillbirths, early neonatal,late neonatal and early infant deaths occurred in 7.3% referred mothers vs. 3.7% of not referred. CONCLUSIONS Almost 10% of the women had an inter-institutional referral and still birth or neonatal deaths were doubled in referred women. Conditions associated with referral were often known before onset of labor and delivery. Improvements in maternal and neonatal outcomes will likely require pregnant women with conditions associated with referral to be directly admitted at facilities equipped to care for complicated pregnancies and at risk neonates, as well as prompt detection and transfer those who develop "at risk" conditions during labor and delivery. TRIAL REGISTRATION ClinicalTrials.gov NCT01073475 .
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Affiliation(s)
| | | | - Camille Raynes-Greenow
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Camperdown, New South Wales Australia
| | | | - Patricia L. Hibberd
- Boston University School of Public Health, Boston, USA
- Boston University School of Medicine, Boston, USA
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Kim JA, Rosenthal ES, Biswal S, Zafar S, Shenoy AV, O'Connor KL, Bechek SC, Valdery Moura J, Shafi MM, Patel AB, Cash SS, Westover MB. Epileptiform abnormalities predict delayed cerebral ischemia in subarachnoid hemorrhage. Clin Neurophysiol 2017; 128:1091-1099. [PMID: 28258936 DOI: 10.1016/j.clinph.2017.01.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/14/2017] [Accepted: 01/21/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify whether abnormal neural activity, in the form of epileptiform discharges and rhythmic or periodic activity, which we term here ictal-interictal continuum abnormalities (IICAs), are associated with delayed cerebral ischemia (DCI). METHODS Retrospective analysis of continuous electroencephalography (cEEG) reports and medical records from 124 patients with moderate to severe grade subarachnoid hemorrhage (SAH). We identified daily occurrence of seizures and IICAs. Using survival analysis methods, we estimated the cumulative probability of IICA onset time for patients with and without delayed cerebral ischemia (DCI). RESULTS Our data suggest the presence of IICAs indeed increases the risk of developing DCI, especially when they begin several days after the onset of SAH. We found that all IICA types except generalized rhythmic delta activity occur more commonly in patients who develop DCI. In particular, IICAs that begin later in hospitalization correlate with increased risk of DCI. CONCLUSIONS IICAs represent a new marker for identifying early patients at increased risk for DCI. Moreover, IICAs might contribute mechanistically to DCI and therefore represent a new potential target for intervention to prevent secondary cerebral injury following SAH. SIGNIFICANCE These findings imply that IICAs may be a novel marker for predicting those at higher risk for DCI development.
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Affiliation(s)
- J A Kim
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - E S Rosenthal
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - S Biswal
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - S Zafar
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - A V Shenoy
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - K L O'Connor
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - S C Bechek
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - J Valdery Moura
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - M M Shafi
- Beth Israel Deaconess Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - A B Patel
- Massachusetts General Hospital, Department of Neurosurgery, Harvard Medical School Boston, MA, USA
| | - S S Cash
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA
| | - M B Westover
- Massachusetts General Hospital, Department of Neurology, Harvard Medical School Boston, MA, USA.
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Wang ME, Patel AB, Hansen NI, Arlington L, Prakash A, Hibberd PL. Risk factors for possible serious bacterial infection in a rural cohort of young infants in central India. BMC Public Health 2016; 16:1097. [PMID: 27760543 PMCID: PMC5070173 DOI: 10.1186/s12889-016-3688-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/20/2016] [Indexed: 11/13/2022] Open
Abstract
Background Possible serious bacterial infection (PBSI) is a major cause of neonatal mortality worldwide. We studied risk factors for PSBI in a large rural population in central India where facility deliveries have increased as a result of a government financial assistance program. Methods We studied 37,379 pregnant women and their singleton live born infants with birth weight ≥ 1.5 kg from 20 rural primary health centers around Nagpur, India, using data from the 2010–13 population-based Maternal and Newborn Health Registry supported by NICHD’s Global Network for Women’s and Children’s Health Research. Factors associated with PSBI were identified using multivariable Poisson regression. Results Two thousand one hundred twenty-three infants (6 %) had PSBI. Risk factors for PSBI included nulliparity (RR 1.13, 95 % CI 1.03–1.23), parity > 2 (RR 1.30, 95 % CI 1.07–1.57) compared to parity 1–2, first antenatal care visit in the 2nd/3rd trimester (RR 1.46, 95 % CI 1.08–1.98) compared to 1st trimester, administration of antenatal corticosteroids (RR 2.04, 95 % CI 1.60–2.61), low birth weight (RR 3.10, 95 % CI 2.17–4.42), male sex (RR 1.20, 95 % CI 1.10–1.31) and lack of early initiation of breastfeeding (RR 3.87, 95 % CI 2.69–5.58). Conclusion Infants who are low birth weight, born to mothers who present late to antenatal care or receive antenatal corticosteroids, or born to nulliparous women or those with a parity > 2, could be targeted for interventions before and after delivery to improve early recognition of signs and symptoms of PSBI and prompt referral. There also appears to be a need for a renewed focus on promoting early initiation of breastfeeding following delivery in facilities. Trial registration This trial is registered at ClinicalTrials.gov (NCT01073475). Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3688-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie E Wang
- Division of Infectious Diseases, Department of Medicine, Boston Children's Hospital, Boston, MA, USA. .,Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.
| | - Archana B Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | | | - Lauren Arlington
- Department of Global Health, Boston University School of Public Health, Boston University, Boston, MA, USA
| | - Amber Prakash
- Lata Medical Research Foundation, Nagpur, Maharashtra, India
| | - Patricia L Hibberd
- Department of Global Health, Boston University School of Public Health, Boston University, Boston, MA, USA
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Abstract
Rats were exposed to an acute dose of lead (Pb) to study the effect of Pb intoxication on different sialoglycoconjugates in serum, brain and liver. Serum levels of total sialic acid (TSA), perchloric acid (PCA)-soluble sialic acid (PSA), lipid-bound sialic acid (LBSA), free sialic acid (FSA) and α1-acid glycoprotein (α1-AG) were determined. They were also estimated in brain and liver tissues, except for LBSA and FSA. All these constituents were found to be significantly raised in the serum but not in the brain. In the case of the liver, only α1-AG levels were found to be increased significantly, the rest were not altered. The levels of these sialoglycoconjugates in serum might be useful as biomarkers of heavy metal toxicity.
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Affiliation(s)
- A B Patel
- Department of Neurobehavioural Toxicology, National Institute of Occupational Health, (ICMR), Meghani Nagar, Ahmedabad, (Gujarat), India
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Theoharides TC, Tsilioni I, Patel AB, Doyle R. Atopic diseases and inflammation of the brain in the pathogenesis of autism spectrum disorders. Transl Psychiatry 2016; 6:e844. [PMID: 27351598 PMCID: PMC4931610 DOI: 10.1038/tp.2016.77] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/23/2016] [Accepted: 03/17/2016] [Indexed: 12/12/2022] Open
Abstract
Autism spectrum disorders (ASDs) affect as many as 1 in 45 children and are characterized by deficits in sociability and communication, as well as stereotypic movements. Many children also show severe anxiety. The lack of distinct pathogenesis and reliable biomarkers hampers the development of effective treatments. As a result, most children with ASD are prescribed psychopharmacologic agents that do not address the core symptoms of ASD. Autoantibodies against brain epitopes in mothers of children with ASD and many such children strongly correlate with allergic symptoms and indicate an aberrant immune response, as well as disruption of the blood-brain barrier (BBB). Recent epidemiological studies have shown a strong statistical correlation between risk for ASD and either maternal or infantile atopic diseases, such as asthma, eczema, food allergies and food intolerance, all of which involve activation of mast cells (MCs). These unique tissue immune cells are located perivascularly in all tissues, including the thalamus and hypothalamus, which regulate emotions. MC-derived inflammatory and vasoactive mediators increase BBB permeability. Expression of the inflammatory molecules interleukin (IL-1β), IL-6, 1 L-17 and tumor necrosis factor (TNF) is increased in the brain, cerebrospinal fluid and serum of some patients with ASD, while NF-kB is activated in brain samples and stimulated peripheral blood immune cells of other patients; however, these molecules are not specific. Instead the peptide neurotensin is uniquely elevated in the serum of children with ASD, as is corticotropin-releasing hormone, secreted from the hypothalamus under stress. Both peptides trigger MC to release IL-6 and TNF, which in turn, stimulate microglia proliferation and activation, leading to disruption of neuronal connectivity. MC-derived IL-6 and TGFβ induce maturation of Th17 cells and MCs also secrete IL-17, which is increased in ASD. Serum IL-6 and TNF may define an ASD subgroup that benefits most from treatment with the natural flavonoid luteolin. Atopic diseases may create a phenotype susceptible to ASD and formulations targeting focal inflammation of the brain could have great promise in the treatment of ASD.
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Affiliation(s)
- T C Theoharides
- Molecular Immunopharmacology and Drug Discovery Laboratory, Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, Boston, MA, USA
- Sackler School of Graduate Biomedical Sciences, Program in Cell, Molecular and Developmental Biology, Tufts University, Boston, MA, USA
- Department of Internal Medicine, Tufts University School of Medicine and Tufts Medical Center, Boston, MA, USA
- Department of Psychiatry, Tufts University School of Medicine and Tufts Medical Center, Boston, MA, USA
| | - I Tsilioni
- Molecular Immunopharmacology and Drug Discovery Laboratory, Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, Boston, MA, USA
| | - A B Patel
- Molecular Immunopharmacology and Drug Discovery Laboratory, Department of Integrative Physiology and Pathobiology, Tufts University School of Medicine, Boston, MA, USA
- Sackler School of Graduate Biomedical Sciences, Program in Cell, Molecular and Developmental Biology, Tufts University, Boston, MA, USA
| | - R Doyle
- Department of Child Psychiatry, Harvard Medical School, Massachusetts General Hospital and McLean Hospital, Boston, MA, USA
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Hibberd PL, Hansen NI, Wang ME, Goudar SS, Pasha O, Esamai F, Chomba E, Garces A, Althabe F, Derman RJ, Goldenberg RL, Liechty EA, Carlo WA, Hambidge KM, Krebs NF, Buekens P, McClure EM, Koso-Thomas M, Patel AB. Trends in the incidence of possible severe bacterial infection and case fatality rates in rural communities in Sub-Saharan Africa, South Asia and Latin America, 2010-2013: a multicenter prospective cohort study. Reprod Health 2016; 13:65. [PMID: 27221099 PMCID: PMC4877736 DOI: 10.1186/s12978-016-0177-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/05/2016] [Indexed: 11/24/2022] Open
Abstract
Background Possible severe bacterial infections (pSBI) continue to be a leading cause of global neonatal mortality annually. With the recent publications of simplified antibiotic regimens for treatment of pSBI where referral is not possible, it is important to know how and where to target these regimens, but data on the incidence and outcomes of pSBI are limited. Methods We used data prospectively collected at 7 rural community-based sites in 6 low and middle income countries participating in the NICHD Global Network’s Maternal and Newborn Health Registry, between January 1, 2010 and December 31, 2013. Participants included pregnant women and their live born neonates followed for 6 weeks after delivery and assessed for maternal and infant outcomes. Results In a cohort of 248,539 infants born alive between 2010 and 2013, 32,088 (13 %) neonates met symptomatic criteria for pSBI. The incidence of pSBI during the first 6 weeks of life varied 10 fold from 3 % (Zambia) to 36 % (Pakistan), and overall case fatality rates varied 8 fold from 5 % (Kenya) to 42 % (Zambia). Significant variations in incidence of pSBI during the study period, with proportions decreasing in 3 sites (Argentina, Kenya and Nagpur, India), remaining stable in 3 sites (Zambia, Guatemala, Belgaum, India) and increasing in 1 site (Pakistan), cannot be explained solely by changing rates of facility deliveries. Case fatality rates did not vary over time. Conclusions In a prospective population based registry with trained data collectors, there were wide variations in the incidence and case fatality of pSBI in rural communities and in trends over time. Regardless of these variations, the burden of pSBI is still high and strategies to implement timely diagnosis and treatment are still urgently needed to reduce neonatal mortality. Trial registration The study was registered at ClinicalTrials.gov (NCT01073475).
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Affiliation(s)
| | - Nellie I Hansen
- RTI International, Research Triangle Park, North Carolina, USA
| | - Marie E Wang
- Massachusetts General Hospital for Children, Boston, MA, USA
| | | | | | | | | | - Ana Garces
- Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | | | | | | | | | - Nancy F Krebs
- University of Colorado Health Sciences Center, Denver, CO, USA
| | - Pierre Buekens
- Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - Marion Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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Korade RS, Dhande LA, Bendhari ML, Patel AB. Can Re-training in Baby Friendly Hospital Initiative (BFHI) Improve Breast Feeding Indicators? Indian J Pediatr 2016; 83:475-6. [PMID: 26374736 DOI: 10.1007/s12098-015-1896-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 08/24/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Rajendra Sadanand Korade
- Department of Pediatrics, SMBT Medical College and Research Centre, Nandi Hills, Dhamanagoan, Tal- Igatpuri, Dist-Nashik, Maharashtra, 422403, India.
| | - Leena Ajay Dhande
- Department of Pediatrics, Indira Gandhi Govt Medical College, Nagpur, Maharashtra, India
| | - Manisha Laxman Bendhari
- Department of Community Medicine, R.C.S.M. Govt. Medical College, Kolhapur, Maharashtra, India
| | - Archana B Patel
- Department of Pediatrics, Indira Gandhi Govt Medical College, Nagpur, Maharashtra, India
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Akbik F, Hirsch JA, Chandra RV, Frei D, Patel AB, Rabinov JD, Rost N, Schwamm LH, Leslie-Mazwi TM. Telestroke—the promise and the challenge. Part two—expansion and horizons. J Neurointerv Surg 2016; 9:361-365. [DOI: 10.1136/neurintsurg-2016-012340] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/20/2016] [Indexed: 11/04/2022]
Abstract
Acute ischemic stroke remains a major public health concern, with low national treatment rates for the condition, demonstrating a disconnection between the evidence of treatment benefit and delivery of this treatment. Intravenous thrombolysis and endovascular thrombectomy are both strongly evidence supported and exquisitely time sensitive therapies. The mismatch between the distribution and incidence of stroke presentations and the availability of specialist care significantly affects access to care. Telestroke, the use of telemedicine for stroke, aims to surmount this hurdle by distributing stroke expertise more effectively, through video consultation with and examination of patients in locations removed from specialist care. This is the second of a two part review, and is focused on the challenges telestroke faces for wider adoption. It further details the anticipated evolution of this novel therapeutic platform, and the potential roles it holds in stroke prevention, ambulance based care, rehabilitation, and research.
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Akbik F, Hirsch JA, Chandra RV, Frei D, Patel AB, Rabinov JD, Rost N, Schwamm LH, Leslie-Mazwi TM. Telestroke-the promise and the challenge. Part one: growth and current practice. J Neurointerv Surg 2016; 9:357-360. [PMID: 26984868 DOI: 10.1136/neurintsurg-2016-012291] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/20/2016] [Indexed: 11/04/2022]
Abstract
Acute ischemic stroke remains a major public health concern, with low national treatment rates for the condition, demonstrating a disconnection between the evidence of treatment benefit and delivery of this treatment. Intravenous thrombolysis and endovascular thrombectomy are both strongly evidence supported and exquisitely time sensitive therapies. The mismatch between the distribution and incidence of stroke presentations and the availability of specialist care significantly affects access to care. Telestroke, the use of telemedicine for stroke, aims to surmount this hurdle by distributing stroke expertise more effectively, through video consultation with and examination of patients in locations removed from specialist care. This is the first of a detailed two part review, and explores the growth and current practice of telestroke, including the specific role it plays in the assessment and management of patients after emergent large vessel occlusion.
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Affiliation(s)
- F Akbik
- Department of Stroke Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - J A Hirsch
- Department of Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neuroendovascular, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - R V Chandra
- Department of Neuroendovascular, Monash University Hospital, Melbourne, Australia
| | - D Frei
- Department of NeuroInterventional Surgery, Radiology Imaging Associates/RIA Neurovascular, Swedish Medical Center, Englewood, Colorado, USA
| | - A B Patel
- Department of Neuroendovascular, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - J D Rabinov
- Department of Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neuroendovascular, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - N Rost
- Department of Stroke Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - L H Schwamm
- Department of Stroke Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - T M Leslie-Mazwi
- Department of Stroke Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neuroendovascular, Massachusetts General Hospital, Boston, Massachusetts, USA
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Patel AB, Bang A, Singh M, Dhande L, Chelliah LR, Malik A, Khadse S. A randomized controlled trial of hospital versus home based therapy with oral amoxicillin for severe pneumonia in children aged 3 - 59 months: The IndiaCLEN Severe Pneumonia Oral Therapy (ISPOT) Study. BMC Pediatr 2015; 15:186. [PMID: 26577943 PMCID: PMC4650851 DOI: 10.1186/s12887-015-0510-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 11/14/2015] [Indexed: 11/04/2022] Open
Abstract
Background Pneumonia is the leading cause of child mortality under five years of age worldwide. For pneumonia with chest indrawing in children aged 3–59 months, injectable penicillin and hospitalization was the recommended treatment. This increased the health care cost and exposure to nosocomial infections. We compared the clinical and cost outcomes of a seven day treatment with oral amoxicillin with the first 48 h of treatment given in the hospital (hospital group) or at home (home group). Methods We conducted an open-label, multi-center, two-arm randomized clinical trial at six tertiary hospitals in India. Children aged 3 to 59 months with chest indrawing pneumonia were randomized to home or hospital group. Clinical outcomes, treatment adherence, and patient safety were monitored through home visits on day 3, 5, 8, and 14 with an additional visit for the home group at 24 h. Clinical outcomes included treatment failure rates up to 7 days (primary outcome) and between 8–14 days (secondary outcome) using the intention to treat and per protocol analyses. Cost outcomes included direct medical, direct non-medical and indirect costs for a random 17 % subsample using the micro-costing technique. Results 1118 children were enrolled and randomized to home (n = 554) or hospital group (n = 564). Both groups had similar baseline characteristics. Overall treatment failure rate was 11.5 % (per protocol analysis). The hospital group was significantly more likely to fail treatment than the home group in the intention to treat analysis. Predictors with increased risk of treatment failure at any time were age 3–11 months, receiving antibiotics within 48 h prior to enrolment and use of high polluting fuel. Death rates at 7 or 14 days did not differ significantly. (Difference −0.0 %; 95 % CI −0.5 to 0.5). The median total treatment cost was Rs. 399 for the home group versus Rs. 602 for the hospital group (p < 0.001), for the same effect of 5 % failure rate at the end of 7 days of treatment in the random subsample. Conclusions Home based oral amoxicillin treatment was equivalent to hospital treatment for first 48 h in selected children of chest indrawing pneumonia and was cheaper. Consistent with the recent WHO simplified guidelines, management with home based oral amoxicillin for select children with only fast breathing and chest-indrawing can be a cost effective intervention. Trial Registration ClinicalTrials.gov NCT01386840, registered 25th June 2011 and the Indian Council of Medical Research REFCTRI/2010/000629. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0510-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation and Indira Gandhi Government Medical College, Nagpur, India.
| | - Akash Bang
- Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India.
| | - Meenu Singh
- Post Graduate Institute of Medical Sciences, Chandigarh, India.
| | - Leena Dhande
- Lata Medical Research Foundation and Indira Gandhi Government Medical College, Nagpur, India.
| | | | - Ashraf Malik
- Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India.
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Das SP, Bit A, Patnaik S, Sahoo L, Meher PK, Jayasankar P, Saha TM, Patel AB, Patel N, Koringa P, Joshi CG, Agarwal S, Pandey M, Srivastava S, Kushwaha B, Kumar R, Nagpure NS, Iquebal MA, Jaiswal S, Kumar D, Jena JK, Das P. Low-depth shotgun sequencing resolves complete mitochondrial genome sequence of Labeo rohita. Mitochondrial DNA A DNA Mapp Seq Anal 2015; 27:3517-8. [PMID: 26260184 DOI: 10.3109/19401736.2015.1074197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Labeo rohita, popularly known as rohu, is a widely cultured species in whole Indian subcontinent. In the present study, we used in-silico approach to resolve complete mitochondrial genome of rohu. Low-depth shotgun sequencing using Roche 454 GS FLX (Branford, Connecticut, USA) followed by de novo assembly in CLC Genomics Workbench version 7.0.4 (Aarhus, Denmark) revealed the complete mitogenome of L. rohita to be 16 606 bp long (accession No. KR185963). It comprised of 13 protein-coding genes, 22 tRNAs, 2 rRNAs and 1 putative control region. The gene order and organization are similar to most vertebrates. The mitogenome in the present investigation has 99% similarity with that of previously reported mitogenomes of rohu and this is also evident from the phylogenetic study using maximum-likelihood (ML) tree method. This study was done to determine the feasibility, accuracy and reliability of low-depth sequence data obtained from NGS platform as compared to the Sanger sequencing. Thus, NGS technology has proven to be competent and a rapid in-silico alternative to resolve the complete mitochondrial genome sequence, thereby reducing labors and time.
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Affiliation(s)
- Sofia P Das
- a ICAR - Central Institute of Freshwater Aquaculture , Kausalyaganga , Bhubaneswar , Odisha , India
| | - Amrita Bit
- a ICAR - Central Institute of Freshwater Aquaculture , Kausalyaganga , Bhubaneswar , Odisha , India
| | - Siddhi Patnaik
- a ICAR - Central Institute of Freshwater Aquaculture , Kausalyaganga , Bhubaneswar , Odisha , India
| | - L Sahoo
- a ICAR - Central Institute of Freshwater Aquaculture , Kausalyaganga , Bhubaneswar , Odisha , India
| | - P K Meher
- a ICAR - Central Institute of Freshwater Aquaculture , Kausalyaganga , Bhubaneswar , Odisha , India
| | - P Jayasankar
- a ICAR - Central Institute of Freshwater Aquaculture , Kausalyaganga , Bhubaneswar , Odisha , India
| | - T M Saha
- b Department of Animal Biotechnology , College of Veterinary Science and Animal Husbandry, Anand Agricultural University , Anand , Gujarat , India
| | - A B Patel
- b Department of Animal Biotechnology , College of Veterinary Science and Animal Husbandry, Anand Agricultural University , Anand , Gujarat , India
| | - Namrata Patel
- b Department of Animal Biotechnology , College of Veterinary Science and Animal Husbandry, Anand Agricultural University , Anand , Gujarat , India
| | - P Koringa
- b Department of Animal Biotechnology , College of Veterinary Science and Animal Husbandry, Anand Agricultural University , Anand , Gujarat , India
| | - C G Joshi
- b Department of Animal Biotechnology , College of Veterinary Science and Animal Husbandry, Anand Agricultural University , Anand , Gujarat , India
| | - Suyash Agarwal
- c ICAR-National Bureau of Fish Genetic Resources , Lucknow , Uttar Pradesh , India , and
| | - Manmohan Pandey
- c ICAR-National Bureau of Fish Genetic Resources , Lucknow , Uttar Pradesh , India , and
| | - Shreya Srivastava
- c ICAR-National Bureau of Fish Genetic Resources , Lucknow , Uttar Pradesh , India , and
| | - B Kushwaha
- c ICAR-National Bureau of Fish Genetic Resources , Lucknow , Uttar Pradesh , India , and
| | - Ravindra Kumar
- c ICAR-National Bureau of Fish Genetic Resources , Lucknow , Uttar Pradesh , India , and
| | - N S Nagpure
- c ICAR-National Bureau of Fish Genetic Resources , Lucknow , Uttar Pradesh , India , and
| | - M A Iquebal
- d ICAR-Indian Agricultural Statistics Research Institute , New Delhi , India
| | - Sarika Jaiswal
- d ICAR-Indian Agricultural Statistics Research Institute , New Delhi , India
| | - Dinesh Kumar
- d ICAR-Indian Agricultural Statistics Research Institute , New Delhi , India
| | - J K Jena
- c ICAR-National Bureau of Fish Genetic Resources , Lucknow , Uttar Pradesh , India , and
| | - P Das
- a ICAR - Central Institute of Freshwater Aquaculture , Kausalyaganga , Bhubaneswar , Odisha , India
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Patel AB, Meleth S, Pasha O, Goudar SS, Esamai F, Garces AL, Chomba E, McClure EM, Wright LL, Koso-Thomas M, Moore JL, Saleem S, Liechty EA, Goldenberg RL, Derman RJ, Hambidge KM, Carlo WA, Hibberd PL. Impact of exposure to cooking fuels on stillbirths, perinatal, very early and late neonatal mortality - a multicenter prospective cohort study in rural communities in India, Pakistan, Kenya, Zambia and Guatemala. Matern Health Neonatol Perinatol 2015; 1:18. [PMID: 27057335 PMCID: PMC4823690 DOI: 10.1186/s40748-015-0019-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/25/2015] [Indexed: 01/03/2023] Open
Abstract
Background Consequences of exposure to household air pollution (HAP) from biomass fuels used for cooking on neonatal deaths and stillbirths is poorly understood. In a large multi-country observational study, we examined whether exposure to HAP was associated with perinatal mortality (stillbirths from gestation week 20 and deaths through day 7 of life) as well as when the deaths occurred (macerated, non-macerated stillbirths, very early neonatal mortality (day 0–2) and later neonatal mortality (day 3–28). Questions addressing household fuel use were asked at pregnancy, delivery, and neonatal follow-up visits in a prospective cohort study of pregnant women in rural communities in five low and lower middle income countries participating in the Global Network for Women and Children’s Health’s Maternal and Newborn Health Registry. The study was conducted between May 2011 and October 2012. Polluting fuels included kerosene, charcoal, coal, wood, straw, crop waste and dung. Clean fuels included electricity, liquefied petroleum gas (LPG), natural gas and biogas. Results We studied the outcomes of 65,912 singleton pregnancies, 18 % from households using clean fuels (59 % LPG) and 82 % from households using polluting fuels (86 % wood). Compared to households cooking with clean fuels, there was an increased risk of perinatal mortality among households using polluting fuels (adjusted relative risk (aRR) 1.44, 95 % confidence interval (CI) 1.30-1.61). Exposure to HAP increased the risk of having a macerated stillbirth (adjusted odds ratio (aOR) 1.66, 95%CI 1.23-2.25), non-macerated stillbirth (aOR 1.43, 95 % CI 1.15-1.85) and very early neonatal mortality (aOR 1.82, 95 % CI 1.47-2.22). Conclusions Perinatal mortality was associated with exposure to HAP from week 20 of pregnancy through at least day 2 of life. Since pregnancy losses before labor and delivery are difficult to track, the effect of exposure to polluting fuels on global perinatal mortality may have previously been underestimated. Trial registration ClinicalTrials.gov NCT01073475
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Affiliation(s)
- Archana B Patel
- Lata Medical Research Foundation, Nagpur, Maharashtra 440022 India
| | - Sreelatha Meleth
- RTI International, Research Triangle Park, North Carolina, 27709 USA
| | - Omrana Pasha
- Department of Community Health Sciences & Family Medicine, Aga Khan University, Karachi, Pakistan
| | | | | | - Ana L Garces
- IMSALUD, San Carlos University, Guatemala City, Guatemala
| | | | | | - Linda L Wright
- Center for Research of Mothers and Children, NIH, Rockville, MD 20852 USA
| | - Marion Koso-Thomas
- Center for Research of Mothers and Children, NIH, Rockville, MD 20852 USA
| | - Janet L Moore
- RTI International, Research Triangle Park, North Carolina, 27709 USA
| | - Sarah Saleem
- Department of Community Health Sciences & Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Edward A Liechty
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202 USA
| | - Robert L Goldenberg
- Department of Obstetrics/Gynecology, Columbia University, New York, NY 10032 USA
| | | | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL 35233 USA
| | - Patricia L Hibberd
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital, Boston, MA 02114 USA
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Kleimola LB, Patel AB, Borkar JA, Hibberd PL. Consequences of household air pollution on child survival: evidence from demographic and health surveys in 47 countries. Int J Occup Environ Health 2015; 21:294-302. [PMID: 25843087 DOI: 10.1179/2049396715y.0000000007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Over one-third of the world's population is exposed to household air pollution (HAP) but the separate effects of cooking with solid fuel and kerosene on childhood mortality are unclear. OBJECTIVES To evaluate the effects of both solid fuels and kerosene on neonatal (0-28 days) and child (29 days-59 months) mortality. METHODS We used Demographic and Health Surveys from 47 countries and calculated adjusted relative risks (aRR) using Poisson regression models. RESULTS The aRR of neonatal and child mortality in households exposed to solid fuels were 1.24 (95% CI: 1.14, 1.34) and 1.21 (95% CI: 1.12, 1.30), respectively, and the aRR for neonatal and child mortality in households exposed to kerosene were 1.34 (95% CI: 1.18, 1.52) and 1.12 (95% CI: 0.99, 1.27), controlling for individual, household, and country-level predictors of mortality. CONCLUSIONS Kerosene should not be classified as a clean fuel. Neonates are at risk for mortality from exposure to solid fuels and kerosene.
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Affiliation(s)
- Lauren B Kleimola
- Division of Global Health, Department of Pediatrics, Massachusetts General Hospital , Boston, MA, USA
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Saiyed MA, Joshi RS, Savaliya FP, Patel AB, Mishra RK, Bhagora NJ. Study on inclusion of probiotic, prebiotic and its combination in broiler diet and their effect on carcass characteristics and economics of commercial broilers. Vet World 2015; 8:225-31. [PMID: 27047078 PMCID: PMC4774709 DOI: 10.14202/vetworld.2015.225-231] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/03/2015] [Accepted: 01/09/2015] [Indexed: 11/25/2022] Open
Abstract
Background and Aim: In today era, broiler industry facing a problem of price hiking of feed of broiler, also in competitive era there should be lower feed cost, lower feed conversion ratio, low feed consumption yet good body weight at marketable age. Materials and Methods: Day-old commercial broiler chicks (n=200) were distributed randomly into 5 dietary treatment groups viz. control (T1), probiotic in the feed @ 100 g/tonne of feed (T2), prebiotic in the feed @ 500 g/tonne of feed (T3), probiotic + prebiotic @ 100 g/tonne and 500 g/tonne of feed, respectively (T4) and probiotic + prebiotic @ 50 g/tonne and 250 g/tonne of feed (T5). The growth of broilers and dressing weight along with the weight of giblet (liver without gall bladder, gizzard without serous layer, and heart without pericardium), Kidney, Abdominal fat, Length of Intestine and dressing percentage were measured. Economics in terms of Return Over Feed Cost (ROFC) and European Performance Efficiency Index (EPEI) was calculated. Results: Among all carcass traits, dressing percentage, abdominal fat weight and abdominal fat percentage (as a percentage of dressed weight) were recorded significant (p<0.05) difference among different treatment groups. The income from selling of the birds was significantly (p<0.05) higher in all treatment groups than the control group but there was a non-significant difference between supplemented groups. Feed cost during whole experimental period was significantly (p<0.05) lower in synbiotic supplemented groups (T4 and T5) than other groups. ROFC of all treatment group found significantly (p<0.05) higher than the control group. Conclusion: It can be concluded that the diet supplemented with synbiotic (100% level) was most efficient in terms of EPEI and synbiotic (50% level) in terms of ROFC. Hence, as feed supplement, synbiotic has a beneficial effect over probiotic and prebiotic when used alone.
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Affiliation(s)
- M A Saiyed
- Veterinary Dispensary Tarapur, District Panchayat Anand, Gujarat, India
| | - R S Joshi
- Department of Animal Genetics & Breeding, Veterinary College, Anand Agricultural University, Anand, Gujarat, India
| | - F P Savaliya
- Poultry Complex, Veterinary College, Anand Agricultural University, Anand, Gujarat, India
| | - A B Patel
- Poultry Complex, Veterinary College, Anand Agricultural University, Anand, Gujarat, India
| | - R K Mishra
- Poultry Complex, Veterinary College, Anand Agricultural University, Anand, Gujarat, India
| | - N J Bhagora
- Poultry Complex, Veterinary College, Anand Agricultural University, Anand, Gujarat, India
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