Early miscarriage (EMC) is a devastating obstetrical complication. ATP-binding cassette (ABC) transporters mediate cholesterol transfer across the placenta and enhance cell survival by effluxing substrates from target cells in the presence of stressors. Recent evidence reports an intricate interplay between autophagy and ABC transporters. We hypothesized that dysregulated autophagy and oxidative stress (OS) in the placenta leads to abnormal expression of membrane transporters contributing to poor pregnancy survival in EMC. We determined mRNA and protein expression of autophagy genes (Beclin-1/Bcl-2/LC3I/LC3II/p62) and ABC transporters (ABCA1/ABCG1/ABCG2) in placentae from EMC patients (n = 20), term controls (n = 19), first trimester (n = 6), and term controls (n = 5) controls. Oxidative/antioxidant status and biomarkers of oxidative damage were evaluated in maternal serum and placentae from EMC and healthy controls. In EMC, placental expression of LC3II/LC3I as well as of the key autophagy regulatory proteins Beclin-1 and Bcl-2 were reduced, whereas p62 was increased. Both in the serum and placentae of EMC patients, total OS was elevated reflected by increased oxidative damage markers (8-OHdG/malondialdehyde/carbonyl formation) accompanied by diminished levels of total antioxidant status, catalase, and total glutathione. Furthermore, we found reduced ABCG1 and increased ABCG2 expression. These findings suggest that a decreased autophagy status triggers Bcl-2-dependent OS leading to macromolecule damage in EMC placentae. The decreased expression of ABCG1 contributes to reduced cholesterol export to the growing fetus. Increasing ABCG2 expression could represent a protective feedback mechanism under inhibited autophagy conditions. In conclusion, dysregulated autophagy combined with increased oxidative toxicity and aberrant expression of placental ABC transporters affects materno-fetal health in EMC.

BACKGROUND: Diabetic kidney disease is a common and severe microvascular complication of diabetes mellitus (DM). There are limited data regarding alteration of urine parameters other than proteinuria among DM patients.METHODS: Institution based cross-sectional study was conducted from February to May 2017 to assess alteration of urine parameters among DM patients at the University of Gondar Hospital, Northwest Ethiopia. A Systematic random sampling technique was used to recruit adult (≥18 years) diabetic participants. Data were collected after ethical requirements had been fulfilled. The degree of association between variables was evaluated through bivariable and multivariable logistic regression models.RESULTS: The majority (69.4%) of the study participants were type 2 DM patients. The prevalence of altered urine chemical parameters was 11.3% proteinuria, 4.5% ketonuria, 13.6% hematuria, 53.8% glucosuria, 24.9% leukocyturia and 1.7% positive for nitrite. Diastolic blood pressure and poor glycemic control were significantly associated with proteinuria. Male participants were 2.4 times more likely to have leukocyturia than female participants. The prevalence of abnormally increased microscopic findings was red blood cells 3.1%, white blood cells 12.5%, epithelial cells 27.5%, yeast cells 1.7%, bacteria 17.8%, casts 3.7% and crystals 29.2%.CONCLUSIONS: The prevalence of altered urine parameters among DM patients is found to be considerable. These increased prevalences of altered urine parameters are potential indicators for diabetic kidney disease.

Objective: To comparison of the efficacy of dapagliflozin+metformin versus sitagliptin+metformin: in newly diagnosed type 2 diabetes Methodology: In this Randomized Control Trial, we enrolled a total of 180 cases; 90 cases newly diagnosed type 2 diabetes mellitus (HbA1c>6.5) in two equal groups A&B on the basis of computer-generated randomization table. Group A was allotted to the cases 100mg q.d sitagliptin plus 850 mg in addition to 500mg metformin 2 times a day. Patients of Group B were advised for 10mg qd dapagliflozin+500mg metformin 2 times a day for six months. Patients were followed up on monthly basis for any inconvenience. The final follow-up was done on 6th month of treatment. All the patients with poor/non-compliance were excluded from the study. All cases with HbA1c <6.0 were considered as effectively treated patients. Results: Comparison of Efficacy in both groups shows 44(48.9%) in Group A and 31(34.4%) in Group B, the overall efficacy was 41.7%, p-value=0.0.35 showing a significant difference. Conclusion: Dapagliflozin+metformin is significantly higher than sitagliptin+metformin for newly diagnosed type 2 diabetes Keywords: Newly type 2 diabetes, treatment, Dapagliflozin & Metformin Vs Sitagliptin & Metformin

Postpartum haemorrhage is a leading cause of severe maternal morbidity and mortality in both developed and developing countries. We aimed to determine the frequency of maternal morbidity and mortality in women with primary postpartum hemorrhage. This descriptive case study was conducted at Department of Obstetrics & Gynecology, Allied Hospital, Faisalabad, from 15th September 2018 to 14th March 2019. A total of 241 women with PPH, having the age of 18-40 years, and gestational age of 37- 41 weeks were recruited. Patients were evaluated for the presence of sepsis, disseminated intravascular coagulation, acute renal failure, anaemia, and acute respiratory distress syndrome. In this study mean age was detected as 28.96 ± 4.11 years. Majority of the patients 146 (60.58%) were between 18 to 30 years of age. Mean gestational age was 38.87 ± 1.32 weeks. Mean parity was 3.10 ± 0.85 and mean BMI was 28.54 ± 2.54 kg/m2. Sepsis was found in 25 patients (10.37%), disseminated intravascular coagulation in 16 (6.64%), acute renal failure in 21 (8.71%), anaemia in 201 patients (83.40%), acute respiratory distress syndrome in 13 (5.39%) and mortality in 44 (18.26%) patients. This study indicates that frequency of maternal morbidity and mortality in women with primary postpartum hemorrhage is quite high. This necessitates early identification of high-risk pregnancies and provision of urgent, skilled and multidisciplinary intensive care.