Complicated History Research Articles

Risk of severe influenza infection in women with a history of pregnancy complications: A longitudinal cohort study.

Risk factors for influenza complications in women are poorly understood. We examined the association between pregnancy outcomes and risk of influenza hospitalization up to three decades later. We analyzed a cohort of 1,421,531 pregnant women who delivered in Quebec, Canada between 1989 and 2021. Patients were followed over time beginning at the first delivery. The main exposure measures included obstetric complications such as preeclampsia, gestational diabetes, and preterm birth. The main outcome was influenza hospitalization up to 32 years later. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between obstetric complications and risk of influenza hospitalization following pregnancy. A total of 4,016 women were hospitalized for influenza during 32 years of follow-up. Influenza hospitalization was more frequent among women with pregnancy complications than women without complications (18.0 vs 14.1 per 100,000 person-years). Compared with no pregnancy complication, women with gestational diabetes (HR 1.48, 95% CI 1.30-1.69), preeclampsia (HR 1.45, 95% CI 1.28-1.65), placental abruption (HR 1.36, 95% CI 1.12-1.66), preterm birth (HR 1.40, 95% CI 1.27-1.55), cesarean section (HR 1.22, 95% CI 1.13-1.31), and severe maternal morbidity (HR 1.43, 95% CI 1.22-1.68) had a greater risk of influenza hospitalization later in life. These pregnancy outcomes were associated with severe influenza infections requiring critical care. Women with pregnancy complications have an elevated risk of severe influenza complications later in life and have potential to benefit from seasonal vaccination to prevent influenza hospitalization.

Voices from La Frontera

Established in 1972, the University of Texas at El Paso (UTEP) Institute of Oral History (IOH) holds the largest collection of border-related oral histories in the United States. Containing interviews dating back to the 1960s, the collection is particularly strong with themes related to labor, immigration, the Bracero Program, and the Mexican Revolution. This article explores the history of the U.S. Border Patrol as gleaned from UTEP oral histories. El Paso and the Border Patrol have a very long and complicated history. The first officers were stationed in El Paso and the first training academy was there. Today, the presence of the Border Patrol is ubiquitous. Using the collection, we investigate what oral histories can tell us that official government documents cannot. How did Border Patrol officers feel about their work and about the people they encountered trying to enter the United States? How did the day-to-day work of Border Patrol officers change over time while the mission of the agency “to detect and prevent the illegal entry of individuals into the United States” remained the same? The article also sheds light on the response of migrants and immigration advocates to the work of the Border Patrol.

Patient-reported and Clinical Outcomes following Gender-affirming Chest Surgery: A Comparison of Binary and Nonbinary Transmasculine Individuals.

Nonbinary individuals assigned female at birth are increasingly presenting for gender-affirming chest surgery (GCS). However, little is known about psychosocial outcomes in this group. We compare patient-reported and clinical outcomes after GCS between nonbinary and binary transmasculine individuals who underwent GCS. We performed an institutional retrospective chart review. Demographic information, medical comorbidities, history of gender-affirming medical care, operative details, and complications were collected and compared between nonbinary and binary patients. Two validated patient-reported outcomes measures, the Gender Congruence and Life Satisfaction (GCLS) scale and the chest dysphoria measure were administered postoperatively. A total of 281 patients were included, of which 40.6% (114) identified as nonbinary and 59.4% (167) identified as binary transgender men. Fewer nonbinary patients used testosterone (P < 0.001). Nonbinary patients underwent a wider variety of masculinizing chest operations than binary patients, with fewer nonbinary patients electing for free nipple-areolar complex grafts (P < 0.001) and more nonbinary patients undergoing breast reduction (P = 0.001). A total of 137 (48.7%) patients responded to postoperative surveys. Nonbinary and binary respondents had comparable scores on the overall GCLS (P = 0.86), GCLS chest subscale (P = 0.38), and chest dysphoria measure (P = 0.40). The absence of nipple-areolar complex grafts was associated with higher GCLS chest scores (P = 0.004). Nonbinary individuals have similarly positive outcomes following GCS compared with binary individuals. Surgeons should be aware of greater medical and surgical heterogeneity in this population and seek to understand individual patients' goals and priorities.

Mesh-associated pain syndrome: predictors for continence and prolapse mesh removal surgery in a single centre

ObjectiveOver the last two decades one of the main surgical treatment for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) surgery was the insertion of non-absorbable mesh to restore continence and prolapse respectively. Over time complications arose including mesh-associated pain syndrome (MAPS), mesh exposure, mesh, erosion, chronic bladder/vaginal infections, and dyspareunia. Consequently, women chose surgical mesh removal to counter these problems. However, little is known about the demographics, medical co-morbidities, mesh types involved and the timing from mesh insertion to mesh removal. This retrospective study will look at which of these factors may be closely associated with mesh removal surgery.DesignRetrospective evaluation.SettingFemale Pelvic Medicine and Reconstructive Surgery (FPMRS) Clinic at University College London Hospitals NHS Foundation Trust.PopulationAll patients presenting to the FPMRS Clinic between June 2011 to December 2019, requesting mesh removal surgery with a history of MAPS and other mesh complications were included in this study.MethodsPatient demographics including age, ethnicity, obstetric history, and medical co-morbidities; type of mesh/anatomical route used; onset of symptoms; and time from insertion to removal were recorded.Main Outcome MeasuresDetermination of correlation coefficients between patient demographics, patient reported symptoms and mesh removal surgery.ResultsThree hundred and forty-five women with a history of MAPS were included in the study. Women in the 40–60 year old cohort accounted for 54.4% of mesh removal surgery; 54.8% had a BMI under 30 and almost 90% were Caucasian. 96.5% had had children, with over 77% having had a vaginal delivery. 91.9% of patients reported other health conditions including 18.8% with a concomitant history of mental health problems and 15.4% with a history of heart disease. Over 80% of women undergoing mesh removal surgery had a continence mesh (49% retropubic and 32% obturator continence mesh) removed, whereas 20% had an abdominal prolapse and/or vaginal prolapse mesh removed. The average time from mesh insertion to mesh removal was seven years, with the prevalence of mesh removal surgery averaging 85% (range 50–100%) depending on the comorbidity determined.ConclusionsAll women presented to the clinic with a history of MAPS and other comorbidities which may have influenced their decision to pursue mesh removal surgery. There were no specific predictors, other than chronic pain associated with mesh, determining which women underwent surgery, though those with continence mesh were more likely to do so.

Influence of post-weld rolling and artificial aging on microstructure and mechanical properties of friction stir welded 2195-T4 Al-Li alloy joints

Fiction stir welding (FSW) of a naturally aged (T4) 2195 Al-Li alloy was conducted to study the effect of post-weld artificial aging (AA) and rolling+artificial aging (R+AA) on microstructure and mechanical properties of the FSW joints. Grain features were analyzed by electron back scattered diffraction (EBSD) technology, and precipitates were characterized using transmission electron microscopy (TEM) along [011]Al and [001]Al zone axes. Mechanical properties of the joints were evaluated through micro-hardness and tensile testing. The results indicate that grain development, including grain orientation, grain boundary components and dislocation density, varies within different regions of the As-welded joints due to complicated thermal-mechanical history. The alloying elements mostly exist as Guinier-Preston zones in the base material (BM) with a few formations of δ'/β', and slightly precipitate into T1 in the heat affected zone (HAZ), form σ in the thermal-mechanical affected zone (TMAZ), as well as develop T1 and S' in the nugget zone (NZ) after FSW. The lowest hardness zone (LHZ) exhibits elevated precipitation levels, generating coarse T1 and grain boundary precipitates with evident σ and precipitate free zone. The overall precipitation level of the As-welded joints remains minor, resulting in a slight decrease in hardness at the LHZ. Post-weld AA promotes many T1 formations, enhancing the joint strength and hardness. As a result, the ultimate tensile strength (UTS) of the joints increases from 440 MPa to 506.5 MPa, while the elongation decreases from 13.5% to 3.4%. Furthermore, hardness profiles transform from a low-amplitude wave curve to a high-amplitude W-shaped curve, generating a significant LHZ due to the minimal precipitation of T1. Pre-rolling deformation can enhance dislocation density and low angle grain boundaries (LAGBs), promoting the nucleation of high-density, fine T1 during artificial aging, and especially improves precipitation ability of the LHZ, leading to an elevated hardness increment in the region after AA. Compared to the Joint-AA, both strength and elongation of the Joint-R+AA increase, obtaining 530.5 MPa and 3.9%, respectively.

Multicyclic Phanerozoic orogeny recorded in the Qaidam continent, northern Tibet: Implications for the tectonic evolution of the Tethyan orogenic system

The growth and evolution of the Eurasian continent involved the progressive closure of major ocean basins during the Phanerozoic, including the Tethyan and Paleo-Asian oceanic realms. Unraveling this complicated history requires interpreting multiple overprinted episodes of subduction-related magmatism and collisional orogeny, the products of which were later affected by the Cenozoic construction of the Himalayan-Tibetan orogen due to the India-Asia collision. In particular, the tectonic evolution of northern Tibet surrounding the Cenozoic Qaidam Basin is poorly resolved due to several phases of Phanerozoic orogeny that have been reactivated during the Cenozoic deformation. In this study, we investigated the geology of the northern Qaidam continent, which experienced Paleozoic−Mesozoic tectonic activity associated with the development of the Eastern Kunlun orogen to the south and the Qilian orogen to the north. We combined new and published field observations, geochronologic and thermochronologic ages, and geochemical data to construct regional tectonostratigraphic sections and bracket phases of Paleozoic−Mesozoic magmatism associated with oceanic subduction and continental collision. Results suggest that the Qaidam continent experienced two major phases of subduction magmatism and collision. First, a Cambrian−Ordovician magmatic arc developed in the northern Qaidam continent due to south-dipping subduction. This phase was followed by the closure of the Qilian Ocean and the collision of the North China craton and Qaidam continent, resulting in Silurian−Devonian orogeny and the development of a regional unconformity across northern Tibet. A subsequent Permian−Triassic magmatic arc developed across the northern Qaidam continent due to north-dipping subduction. This phase was followed by the closure of the Neo-Kunlun Ocean and the collision of the Songpan Ganzi terrane in the south and Qaidam continent. These interpretations are incorporated into a new and comprehensive model for the Phanerozoic formation of northern Tibet and the Eurasia continent.

The Green Party of the United States: Establishment and Entry into Big Politics

The article considers the long and complicated history of the Green Party in the United States (from 1984 to 2001), as well as its further political role as a «third party» – up to the establishment of the Green New Deal as its main ideological and election platform for the 2012 presidential elections. This topic is of interest due to the fact that, amid the global relevance of «green» political and economic agenda in the 21st century, the environmental parties are meant to play a special role – let alone in the country that claims leadership in the field of environmental (primarily, climate) policy. In this context, the situation that the Green Party in the United States is in a secondary position and does not have a decisive influence on real politics, looks all the more illogical. The specifics of the American Greens’ political strategy and tactics are analyzed, which allowed to reach a new level of political struggle as an alternative and oppositional political force towards both establishment parties – the Democratic Party and the Republican Party. Nevertheless, the Democrats led by President J. Biden have intercepted the Green Party’s preelection program and won the 2020 elections with it. This testifies to strategic mistakes made by the American Greens and casts doubt on their future political fate.

Analysis of Biological Factors Associated with Preeclampsia in Pregnant Women

Preeclampsia is a serious complication during pregnancy that poses significant health risks to both mother and fetus, potentially leading to death. Early identification of biological factors associated with preeclampsia is crucial for effective prevention. This study aims to analyze the biological factors influencing preeclampsia incidence among pregnant women. A quantitative design with a case-control approach was used, focusing on pregnant women with a history of preeclampsia in the Curug Community Health Center, Karawang Regency. The sample included 10 respondents. The results revealed a significant relationship between parity and preeclampsia incidence (p-value 0.031), BMI (p-value 0.018), diet (p-value 0.041), and history of complications (p-value 0.001). However, no significant association was found between lifestyle activities and preeclampsia (p-value 0.114). These findings suggest that factors like parity, BMI, diet, and complications history are significantly linked to preeclampsia incidence. These results provide a basis for targeted interventions in pregnant women's care. Future studies should expand the sample size and consider additional variables such as employment status, family support, and stress levels for more comprehensive insights into preeclampsia risk factors.

Pregnancy-Associated Maternal Mortality Within One Year After Childbirth: Population-Based Cohort Study.

The objective of this study is to assess associations between pregnancy complications and pregnancy-associated maternal mortality (PAM) within 1 year after childbirth. Population-based cohort study. Norway, 1967-2020. 1 237 254 mothers with one or more singleton pregnancies registered in the Medical Birth Registry, 1967-2019 and followed in the Cause of Death Registry to 2020. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for maternal education, age, year of first childbirth and chronic medical conditions. PAM by lifetime history of pregnancy complications: placental abruption, preeclampsia, preterm birth, perinatal death, small for gestational age (< 2.5 percentile), gestational diabetes and gestational hypertension. Crude OR for PAM was 4.24 (95% CI 3.53-5.10), if complications occurred in the last pregnancy, whereas 2.52 (2.08-3.06) if complications occurred in the first pregnancy, compared to mothers without complications in any pregnancy. Adjusted ORs for PAM when complications occurred in the last pregnancy were, for placental abruption 3.75 (1.20-11.72), preeclampsia: 4.42 (3.17-6.15), preterm birth: 4.32 (3.25-5.75), perinatal death: 24.18 (16.66-35.08), small for gestational age: 2.90 (1.85-4.54), gestational diabetes: 1.43 (0.63-3.25) and pregnancy hypertension: 2.05 (1.12-3.74) compared to mothers without complications. The OR for PAM increased slightly by increasing the number of complicated pregnancies but the trend was stronger for increasing number of complications in the last pregnancy (e.g., during 1999-2019: one complication; 4.14 [2.79-6.13], two complications; 11.50 [6.81-19.43]). Complications in the last pregnancy were more strongly associated with PAM than those in the first pregnancy.

Complicated history with huge potential: Israeli-Japanese relations’ development

From an analysis of Russian, Israeli, Japanese, and various English-language sources, the authors conclude that this paper is one of the few studies on the topic of Japanese-Israeli relations in the field of Oriental studies. In particular, in Russian Oriental studies, this is the first article focusing on Japanese-Israeli relations. The authors aim not only to trace the dynamics of bilateral relations in socio-political and economic aspects but also to identify the reasons for their complex history. The study also explores potential future developments.This goal has shaped the article’s structure. It includes a literature review, an examination of cooperation prerequisites, an analysis of political and economic components, and a conclusion.The study’s analysis of historical factors, primarily the Japanese Empire’s attitude towards Jewry, reveals that no significant obstacles existed before diplomatic relations were established to hinder current bilateral and multilateral interaction. Moreover, Japan’s Prime Minister Abe Shinzō relied on positive past experiences to foster increased contacts between Tokyo and Jerusalem.Economic considerations and dependence on external energy resources have played a crucial role in the political and diplomatic sphere for both states. This has led Japanese authorities to maintain a balanced course in the Middle East. Over time, the significance of this task has grown as Tokyo seeks to enhance its international status, particularly within the UN and its specialized agencies.In the realm of economic cooperation, internal crises and differing economic models have hindered progress for a considerable period. However, the distinctive national economies and entrepreneurial cultures of Japan and Israel now present significant opportunities for collaboration.

No Evolution Without Revolution: Historical Revelations for LIS Education

As the field evolves and adapts to emerging technologies and societal changes, the rich historical context and radical changes that have shaped libraries and information systems risks being overshadowed. This SIG panel presentation will feature presentations ranging from understanding the role of caucuses in the LIS field, using creative storytelling to illuminate LIS history, and how AI will impact our ability to tell, know, and make history. Following the presentations, we expect to have a conversation about how we preserve and share LIS history in the face of technological change. National Associations of Librarians of Color Provides Historical Context to Teach Social Justice Work - Long Before DEI and social justice were integrated into statements, core principles, standards, or competencies for LIS education, there were efforts conducted by BIPOC library leaders who moved the needle in the profession by establishing professional associations that represented their communities. This presentation makes the connection between diversity efforts in LIS history and LIS pedagogy, by proposing the use of the specific historical context of social movements to substantiate and inform the social justice work that current LIS graduates will encounter. Demystifying the Past to Examine the Present and Shape the Future: Historical Research and Creative Storytelling in LIS Education - Ely-Ledesma Unpacking the complicated history of libraries in the United States, and recognizing historical threads that connect past to present, is vital as the profession continually adapts to emerging technologies and societal changes. When considering implementing historical perspectives into LIS education, we must ask a basic question: How can we infuse historical perspectives into LIS courses in an effective way? Historical research and creative storytelling are one way to address this question. To this end, I propose a three-step process for a project suitable for foundational courses or courses on library history. Teaching the History and the Evolution of the Information and Knowledge Profession - Hawamdeh According to Marcus Garvey “A person without the knowledge of their past history, origin, and culture is like a tree without roots." Understanding the LIS history, evolution and the radical changes is a key to the continued transformation of the information and knowledge profession. The continued expansion, evolution, and the emergence of concepts such as knowledge management, data science and generative AI are raising questions like how these concepts are related to LIS, how can they be woven into LIS curriculum, and how historical perspectives can be used to shape the future of the information and knowledge profession.

Beyond Technique: Maggie’s Story of Determination, Resilience and Growth Through SFBT and a Focus on the Therapeutic relationship.

This paper provides insights and reflections on the use of Solution Focused Brief Therapy (SFBT) over 16 months to assist a client with both a complicated history and complex needs. However, this is not a typical case study. The purpose of this paper is not to provide details about SFBT or a detailed analysis of the conversation within the sessions, but rather to provide perspectives from each of the people involved: the client (Maggie), the clinician (David), and the mother (Kate). Each of these people have expertise in their own right, but Kate has a fourth and very unique perspective as one of the early team members of the Brief Family Therapy Centre of Milwaukee in the 1980’s. In this paper, we will refer directly to sessions as well as emails and activities that occurred between sessions. Our aim is to show that SFBT is an approach that can be used in long-term therapy and in complex situations, emphasising that a flexible and tailored approach is required, and that the therapeutic relationship is an integral part of the therapy.

Spectrum of liver affection in children with sickle cell disease: case series

BackgroundSickle cell hepatopathy (SCH) is a relatively uncommon complication of sickle cell disease (SCD), yet it does not accommodate variations in presentation, outcome, or severity according to age.AimTo present SCH characteristics and assess the effect of implementation of a high-suspicion systematic diagnostic approach and early intervention plan of management.MethodsThis case series presented the characteristics of five children with SCD with variable hepatic manifestation and implemented a diagnostic approach that included testing the transaminases and bilirubin in any patient with any suspicion of liver affection.ResultsThe five patients had a complicated SCD history. They all presented with fever, abdominal pain, and deepening of jaundice. The final diagnosis was reached with a more individualized approach; two had significant coagulopathy and were diagnosed with sickle cell intrahepatic cholestasis, while one had normal synthetic functions of the liver with rising transaminases and bilirubin levels, as well as high titer of Epstein–Barr virus diagnosed as acute viral hepatitis complicated with sickle cell hepatic crisis. One other patient had markedly elevated bilirubin with mild elevation of transaminases, and magnetic resonance cholangiopancreatography showed acute extrahepatic biliary dilatation treated by endoscopic removal of the stone. The fifth patient proved to have portal vein thrombosis by portal duplex causing portal hypertension and decompensated liver. The management plan included early exchange transfusion to keep their hemoglobin S (HbS) below 15% which was performed in three of the patients, in addition to aggressive supportive measures for correction of coagulopathy with full recovery and normalization of their liver functions.ConclusionDespite the diagnostic challenges, the lack of standard diagnostic criteria, and the overlapping clinical presentation of SCH, the management and outcomes improved by following a systematic diagnostic approach.

Long-term results of artificial urinary sphincter in women: A retrospective monocentric study

BackgroundStress urinary incontinence (SUI) is a public health issue, with major impact on quality of life. An efficient treatment for intrinsic sphincter deficiency (ISD) is the artificial urinary sphincter (AUS). ObjectivesAnalyzing patient survival in terms of revision-free survival, removal-free survival and global survival without reintervention long-term results concerning continence status and complications. DesignWomen with severe ISD and negative Bonney test who were treated with AUS first implantation between 1987 and 2022 were included. ResultsIn our study, 478 patients were treated by AUS first implantation with a mean age of 59.7. The median follow-up time was 13.2years. The median revision-free survival was 19.5years with survival rates at 10, 20 and 30years were 86%, 47% and 32% respectively. Removal-free survival rates at 10, 20 and 30years were 84%, 80% and 60% respectively. Median reintervention-free survival was 17.5years. Survival was negatively affected by neurological etiology of the ISD, history of previous incontinence treatment and intraoperative complications with more early removals in the latter group. The absence of previous incontinence surgery was a protecting factor. Continence status was assessed at 10, 20 and 30years follow-up with a fully continence rate of respectively 83%, 68% and 61%. Intraoperative complication rate was 17.7%, explantation rate was 14% and the revision rate was 23%. ConclusionWomen treated with AUS have an excellent revision-free, removal-free and global survival rate. AUS is a very efficient treatment for women with ISD in terms of continence results with an acceptable intraoperative and long-term complication rate of which patients should be well informed before choosing this treatment for their SUI. Level of evidence4.

Assessment of Risk Factors Associated with Placenta Previa in a Tertiary Health Institution in Southeast Nigeria

Background: Placenta previa is a significant obstetric complication that can lead to adverse maternal and fetal outcomes. Understanding its risk factors is crucial for early diagnosis and management, particularly in healthcare settings in Nigeria. Objective: To assess the risk factors associated with placenta previa among pregnant women in a tertiary health institution in Southeast Nigeria. Materials and Methods: This prospective descriptive study was conducted over two years (January 2021 to December 2022) and included all pregnant women who delivered in the institution during this period. Data were collected using a structured, interviewer-administered questionnaire after obtaining informed consent from participants. Placenta previa was identified through abdominal ultrasonography, and all confirmed cases were managed according to the MacAfee regimen. Descriptive statistics and chi-square tests were used to analyze the data using SPSS version 26. Results: Out of the 8,766 deliveries recorded in the hospital during the period of this study, 94 (1.07%) were diagnosed with placenta previa. Significant associations were found between placenta previa and factors such as advanced maternal age (≥40 years, p=0.041), history of complications during previous pregnancies (p=0.039), previous cesarean section (p=0.009), history of placenta previa (p&lt;0.001), multiple pregnancies (p=0.001), bleeding during pregnancy (p&lt;0.001), and uterine surgeries apart from cesarean sections (p=0.001). Smoking history was also a significant risk factor (p&lt;0.001). Conclusion: The study identified several risk factors for placenta previa, including advanced maternal age, previous cesarean section, history of placenta previa, multiple pregnancies, uterine surgeries, and smoking. These findings highlight the importance of targeted interventions and close monitoring of at-risk pregnant women to reduce complications.

Obstetric and gynecological management in a patient with abnormal invasion of the placenta (placenta percreta)

Pathological placental invasion is a dangerous anomaly during pregnancy, which causes increased maternal morbidity and mortality. Patients with abnormal placental invasion may experience life-threatening uterine bleeding during delivery, particularly in cases of placenta percreta. This often requires surgical intervention, specifically a hysterectomy, which some researchers refer to as the “gold standard” treatment for pathological placental invasion, with rates ranging from 47% to 77.8%. Conversely, other researchers recommend a conservative approach, involving the complete removal of the placenta percreta, excision of damaged areas on the uterine walls and bladder, and metroplasty and restoration of the integrity of the. This article presents a clinical case of a 40-year-old patient with a complicated obstetric history, including abnormal placental invasion (placenta percreta) involving the anterior wall of the uterus and the bladder. Delayed diagnosis of such pathology leads to inappropriate treatment and, consequently, acute massive bleeding, posing a risk to the patient’s health and life. The applied comprehensive diagnostic and therapeutic measures facilitated the preservation of the pelvic organs and restoration of the patient’s reproductive function.

Childbirth at advanced reproductive age: the impact of biopsychosocial factors on the mode of delivery

Introduction Contemporary society reflects a clear trend towards delayed motherhood, raising significant concerns in the management of pregnancy and childbirth in women of advanced reproductive age. In this context, the mode of delivery and associated risks for this age category require increased attention. Birth methods have been thoroughly examined to identify risks and influencing factors within this specific cohort. Material and methods A descriptive cross-sectional study was conducted on a sample of 528 women. Data were collected using a pre-tested semi-structured questionnaire, and respondents were divided into three groups based on the mode of delivery: vaginal delivery, planned cesarean section, and emergency cesarean section. Sociodemographic, anthropometric, medical, and obstetric characteristics were analyzed using linear regression. Statistical analyses included descriptive and inferential statistics (Chi-square), with a 95.0% confidence interval. Results The analysis revealed statistically significant variations in the mode of delivery based on maternal age (p=0.013) and paternal age (p=0.001), with an increased rate of cesarean sections at more advanced ages. Significant variations were also found in relation to area of residence (p=0.003), education level (p=0.001), nature of work (p=0.028), GP appointments (p=0.020), number of GP appointments(p&lt;0.001), number of obstetrician appointments (p=0.032), time of informing on risk factors (p=0.005), parity (p&lt;0.001), multiple pregnancies (p=0.016), mode of first delivery (p&lt;0.001), pregnancy complications (p=0.003), delivery complications (p&lt;0.001), gestational age at birth (p=0.017), Apgar scores at 1 and 5 minutes (p&lt;0.001). Conclusions Advanced reproductive age has been associated with a higher risk of cesarean section compared to vaginal delivery. The influence of age is modulated by various sociodemographic, medical, and obstetric characteristics, including area of residence, education level, history of cesarean section, parity, pregnancy and delivery complications, pre-existing chronic conditions, antenatal care and provision of information on risk factors.

Características clínicas y epidemiológicas en pacientes con leucemia linfoblástica aguda de un instituto especializado en pediatría de Perú, periodo 2017-2022

Objective: To describe the clinical-epidemiological characteristics at the time of the diagnosis in patients with acute lymphoblastic leukemia (ALL) at a specialized pediatric institute in Peru, from 2017 to 2022. Materials and Methods: An observational, descriptive, cross-sectional, and retrospective study was conducted. Medical records of patients under 18 years old with a recent confirmed diagnosis of ALL were included. Variables analyzed included sex, age, origin, discharge outcome, hospital stay, signs, symptoms, history of chronic diseases, laboratory findings, and hematological complications. Data were collected through medical record review and processed using STATA v. 16. Results: Out of 247 medical records, 25 patients who did not meet inclusion criteria were excluded. The study sample consisted of 222 patients. 54.1% of the patients were male, with a median age of 5 years. 64.0% had fever, and 78.8% had pallor. 91.8% of patients had hemoglobin below 11 g/dL, 65.3% had platelets below 50,000/µL, and 13.1% had leukocytosis above 100,000/µL. The most common hematological abnormality was the simultaneous presentation of anemia, thrombocytopenia, and leukocytosis (43.0%). Conclusion: ALL predominantly occurred in male children and those under 5 years old. A high frequency of hematological alterations such as anemia, thrombocytopenia, and leukocytosis was observed. Clinically, two-thirds of the patients had fever, and nearly three-quarters had pallor. Further studies on the progression of ALL in the Peruvian population are suggested.

Insights into obstetric anesthesia practices: a quantitative survey among physicians across Arab countries

BackgroundObstetric anesthesia guidelines are essential for standardizing obstetric anesthesia practices globally and ensuring high-quality patient care. However, practices may vary across different settings, and there are limited data from Arab countries. This study aims to gain insights into obstetric anesthesia practices in several major hospitals across Arab countries.MethodsA questionnaire was emailed to 85 obstetric anesthesiologists/anesthesia chairpersons in major hospitals, including academic medical institutions and central hospitals, across 11/22 Arab countries. This survey gathered data on key structural and process-related obstetric anesthesia indicators.ResultsOut of 85 contacted, we had 56 responses (65.8%), with 41 being fully completed, providing insights into obstetric anesthesia indicators. Regarding structure: 31 (76%) hospitals had an operating room adjacent to the delivery room, all had intensive care units, and 22 (54%) had a lead obstetric anesthesiologist. For equipment, 19 (46%) had a video laryngoscope in the delivery suite, and 20 (49%) occasionally used ultrasound for epidurals. Regarding process: 33 (81%) held regular meetings, and 21 (51%) conducted research. Before epidural and spinal procedures, 26 (63%) and 28 (68%) required coagulation studies for patients without a history of hemorrhagic complications, while 38 (93%) and 36 (88%) mandated a platelet count, respectively. For labor analgesia, 34 (83%) primarily used epidurals, and 15 (37%) placed preemptive catheters in high-risk pregnancies. For cesarean delivery, 40 (98%) used spinals, with 16 (39%) using intrathecal morphine and 22 (54%) administering aspiration prophylaxis before general anesthesia. Regarding spinal-induced hypotension, 6 (15%) used prophylactic phenylephrine infusion.ConclusionThis survey highlights variations in obstetric anesthesia practices among various major hospitals in several Arab countries, compared to international recommendations. It emphasizes the need for obstetric anesthesia registries in the Arab world for future research. Further studies are required to outline country-specific practices, improve resource allocation, and enhance obstetric population safety and satisfaction.

(Un)deserving victims: the race-gender-geopolitics nexus of migration discourses in Poland

ABSTRACT What makes some displaced populations deserving protection more than others? I discuss this complex problem in a critical analysis of discursive narratives, presented by Polish authorities about the situation on its two Eastern borders between 2021 and 2023. I propose the race-gender-geopolitics nexus of intersectional analysis to reveal how and why migrants on the Polish-Belarusian border were presented as threatening and ingenuine as asylum-seekers, and Ukrainians became real ‘war refugees’. While the identified narratives corresponded with the existing studies on the influence of race and gender on perceived deservingness and victimisation, considering geopolitics offers a novel, context-specific analytical layer of discourse production. I thus move beyond the ‘deserving/undeserving’ binary, complicating the picture with other groups of displaced people, often silenced in the analysed representations. I demonstrate how the widespread post-colonial, racializing and patriarchal attitudes have been intertwined with regional geopolitical goals and relations with neighbouring countries. For Poland, these are the aspirations to anchor its position within the West, as well as its complicated history with Russia and Belarus but also Ukraine. I argue that all of that, coupled with the long-standing antimigrant attitudes, resulted in particular discourses about the incoming people.