Objective This study aimed to determine whether specific factors of the built environment related to physical activity and diet are associated with inadequate and excessive gestational weight gain (GWG). Study Design This analysis is based on data from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be, a prospective cohort of nulliparous women who were followed from the beginning of their pregnancies through delivery. At each study visit, home addresses were recorded and geocoded. Locations were linked to several built-environment characteristics such as the census tract National Walkability Score (the 2010 Walkability Index) and the number of gyms, parks, and grocery stores within a 3-km radius of residential address. The primary outcome of GWG (calculated as the difference between prepregnancy weight and weight at delivery) was categorized as inadequate, appropriate, or excessive based on weight gained per week of gestation. Multinomial regression (generalized logit) models evaluated the relationship between each factor in the built environment and excessive or inadequate GWG. Results Of the 8,182 women in the analytic sample, 5,819 (71.1%) had excessive GWG, 1,426 (17.4%) had appropriate GWG, and 937 (11.5%) had inadequate GWG. For the majority of variables examined, built environments more conducive to physical activity and healthful food availability were associated with a lower odds of excessive or inadequate GWG category. For example, a higher number of gyms or parks within 3 km of a participant's residential address was associated with lower odds of having excessive (gyms: adjusted odds ratio [aOR] = 0.93 [0.89–0.96], parks: 0.94 [0.90–0.98]) or inadequate GWG (gyms: 0.91 [0.86–0.96]; parks: 0.91 [0.86–0.97]). Similarly, a higher number of grocery stores was associated with lower odds of having excessive GWG (0.94 [0.91–0.97]). Conclusion Among a diverse population of nulliparous women, multiple aspects of the built environment are associated with excessive and inadequate GWG. Key Points
Objective: To assess the maternal and neonatal outcomes after expectant management of pre-viable preterm premature rupture of membranes (PPROM). Data Sources:We searched PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science databases for publications from 2008 to 2018 and ClinicalTrials.gov. Methods of Study Selection:All studies that reported pregnancy outcomes of pre-viable PPROM were included. Excluded were the review articles, case reports, and studies that exclusively included patients with a particular characteristic (oligohydramnios/prolonged latency), those evaluating the effect of a specific intervention, or the ones providing aggregate data from which information for patients with PPROM <24 weeks could not be delineated.Tabulation, Integration, and Results: Eighteen studies were reviewed that examined the outcomes of 1,372 pre-viable PPROM women following expectant management. Data was extracted in the form of predesigned tables. We used Microsoft Excel to integrate the results of included studies. The overall neonatal survival to discharge was 41.5%. Of these, 48.8% neonates survived without a major morbidity. Respiratory morbidity was the most common morbidity among surviving neonates: 49.5% neonates suffered from respiratory distress syndrome, 30% from bronchopulmonary dysplasia, and 10.7% from pulmonary hypoplasia. Chorioamnionitis was the most frequently observed maternal morbidity, complicating 49.3% pre-viable PPROM. The predictors for favorable outcomes included a later gestational age at PPROM and delivery, absence of oligohydramnios, and iatrogenic PPROM. Of note, 21.6% of pre-viable PPROM women opted for the termination of pregnancy. Conclusion:The neonatal survival rate of pre-viable PPROM after expectant management is 4 of 10 affected neonates, and nearly half of them survive without any major morbidity. Maternal morbidity remains substantial, however, serious maternal complications are rare.
Objective: The purpose of this study was to compare the effectiveness of AST to platelet index (APRI) and FIB-4 with transient elastography, also known as fibro scan, in patients who suffered from chronic Hepatitis C. Study Design: Retro-prospective/ Cross-sectional Place & Duration: Khalifa Gulnawaz Teaching Hospital Bannu Pakistan, From August, 2021 to May, 2022. Material and Methods: This research included 360 men and women. After obtaining written consent, detailed demographics of all cases were recorded. In 360 HCV infected individuals, the diagnosis comprised CBC, LFTs, ELISA, PCR, and fibro. We compared AST, apric, FIB-4, and fibro scans for detecting HCV fibrosis progression. SPSS 22.0 was used to analyze all data. Results: There were majority males 220 (61.1%) and 140 (38.9%) females. 85 (23.6%) had age 20-30 years 180 (50%) cases had age 31-40 years and 95 (26.4%) patients had age >40 years. We found that 210 (58.3%) patients had fibrosis stage F0-F1, F2 stage was in 28 (7.8%) cases, F3 stage was in 52 (14.4%) patients and F4 stage in 70 (19.4%) cases. Among 360cases, genotype 3a was found in 260 (72.2%) patients, genotype 1b in 70 (20.8%) cases and genotyped 1a in 30 (8.3%) cases. Conclusion: In this study, we found that the AST to Platelet Index (APRI) and FIB 4 were able to successfully identify among cirrhotic and non-cirrhotic phases among HCV-infected patients. Keywords: Liver, Hepatitis C, Fibrosis
Objective: The current study aims to determine whether an increase in visfatin level resulted in Gestational Diabetes Mellitus (GDM) in pregnant females. Study Design: Retrospective Study Place and Duration: Department of Medicine, Dr. Ziauddin Hospital, North Nazimabad, Karachi, From November 2021 to April 2022. Methods: In this study, 83 pregnant females aged 18-46 years were inducated. After obtaining informed written consent, detailed demographic data were recorded. Gestational age and gravidity among all females were recorded. Previous history and frequency of GDM were assessed. Blood samples were taken to determine the concentration of visfatin and glucose levels. SPSS 24.0 was used to analyze all data. Results: In this study, the mean age was 29.11±8.42 years, and the mean BMI was 26.2±3.32 kg/m2. The mean gestational age was 34.11±4.33 weeks. Most of the cases were from rural areas and had poor socio-economic status. We found that 44 (53.01%) subjects had gestational diabetes mellitus while 39 (46.9%) had no diabetes. The visfatin level in patients with gestational diabetes was higher, 4.2±7.124, compared to non-diabetes cases, 1.4±1.432, with a p-value<0.003. Conclusion: Ultimately, we determined that visfatin levels were considerably elevated in gestational diabetes mellitus beginning in the first trimester of pregnancy. An innovative biomarker for GDM detection is increased visfatin levels during pregnancy. Keywords: Visfatin, Gestational Diabetes, Pregnant Females
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