Modified World Health Organization Research Articles

Successful Thrombolytic Therapy Using Ultraslow Low-Dose Infusion During Pregnancy for Mitral Mechanical Valve Thrombosis: A Case Series and Review of the Literature.

Pregnancy in women with mechanical heart valves significantly increases the risk of maternal mortality or severe morbidity.Non-compliance with anticoagulant therapy and/or less frequent monitoring of therapeutic levels during pregnancy can result in serious complications such as valve thrombosis and thromboembolism.Thrombolytic therapy with low-dose tissue-type plasminogen activator can be an attractive alternative to surgical valve replacement and medical treatment in appropriately selected pregnant women with thrombosis of a mechanical valve.

Assessment of Prosthetic Status and Oral Frailty among The Geriatric Population Residing in Old Age Homes of Bhubaneswar City-a Cross Sectional Study

Objective: The aim of this study was to assess the prosthetic status and oral frailty of the elderly population residing in old age homes of Bhubaneswar city. Material and Methods: A cross-sectional questionnaire study was conducted among 310 geriatric patients aged 60 years and above residing in old age homes of Bhubaneswar city. Data collection was done using a modified World Health Organization (WHO) 1997 and oral frailty index 8. Descriptive statistics, chi-square test, Pearsons correlation and multinomial logistic regression were used. Results: The mean age of the study population was 66.72±6.86 years. Forty-seven percent of the study population required multiple units in the upper arch and approximately 30% in the lower arch. There was a significant positive correlation between the prosthetic status of the upper teeth and oral frailty (Pearson correlation coefficient: 0.315, p-value <0.0001). A ~1.751-fold risk of oral frailty was detected in participants with increasing age (p-value=0.049). Conclusions: The results of this study suggest that most of the need for prostheses in the aged population was inadequate.

A PREGNANT WOMAN WITH AN EXTRA CARDIAC CAVITY: AN ACQUIRED IATROGENIC COMPLICATION - A CASE REPORT AND LITERATURE REVIEW.

Left atrial appendage aneurysm is a rare entity and, in most cases, is congenital due to poor myocardial contractility of dysplastic pectinate muscles.Clinical manifestations range from an asymptomatic course with an incidental finding on echocardiography up to serious sequelae such as cardioembolic manifestations.The treatment approach includes a conservative strategy using anticoagulation and a surgical strategy with aneurysmectomy.

Efficacy and Safety of Inhaled Ethanol in Early-Stage SARS-CoV-2 Infection in Older Adults: A Phase II Randomized Clinical Trial

Inhaled ethanol in the early stages of SARS-CoV-2 infection may reduce the viral load, decreasing progression and improving prognosis. The ALCOVID-19 trial was designed to study the efficacy and safety of inhaled ethanol in older adults at initial phases of infection. Randomized, triple-blind, placebo-controlled phase II clinical trial. Experimental group (n = 38) inhaled 65° ethanol through an oxygen flow, while in the control group (n = 37), water for injection was used. General endpoint was to evaluate disease progression according to the modified World Health Organization (WHO) Clinical Progression Scale. Specific effectiveness endpoints were body temperature, oxygen saturation, viral load assessed by cycle threshold (Ct) on real-time polymerase chain reaction (RT-PCR), analytical biomarkers and use of antibiotics or corticosteroids. Specific safety outcomes were the absence of ethanol in plasma, electrographic, analytical, or respiratory alterations. In the intention-to-treat population, no differences were found regarding disease progression. Mean Ct values increased over time in both groups, being numerically higher in the ethanol group, reaching a value above 33 only in the ethanol group on day 14, a value above which patients are considered non-infective. No differences were found in the other specific effectiveness endpoints. Inhaled ethanol was proven to be safe as no plasma ethanol was detected, and there were no electrocardiographic, analytical, or respiratory alterations. The efficacy of inhaled ethanol in terms of the progression of SARS-CoV-2 infection was not demonstrated in the present trial. However, it is positioned as a safe treatment for elderly patients with early-stage COVID-19.

Assessment of non-communicable disease risk factors among Andhra Pradesh state road transport corporation bus drivers of Vijayawada

Background: Non-communicable diseases (NCDs) are lifestyle disorders, which contribute to 41 million total deaths globally. In India, it contributes to around 6 million (60%) of all deaths in 2021. The main objective of the study was to assess the socio-demographic factors, prevalence, and association between demographic profile and major NCD risk factors among Andhra Pradesh state road transport corporation bus drivers of Vijayawada. Methods: It is a cross-sectional study conducted from July to October 22 among APSRTC bus drivers aged above 20 years in Vijayawada. Data was collected by using a pre-designed modified world health organization questionnaire. Results: The results(n=120) from the current study showed that the majority of the driver’s mean age was 46.4±10.9, 37.5% had hypertension, 24.2% had diabetes, 54.2% had insufficient sleep, and 79.2% had work-related stress. Conclusions: Occupational groups like bus drivers have more prevalence of NCD risk factors and which creates a burden on the healthcare system. A vigorous effort is needed to develop strategies for preventing and managing NCDs.

Pregnancy outcomes in women with heart disease: how to improve?

*No data available on delivery, foetal and neonatal outcomes in the CARPREG II study. CARPREG, Cardiac disease in Pregnancy registry; LMIC, low-and-middle-income country; M-PAC, Madras medical college Pregnancy And Cardiac registry; mWHO, modified World Health Organization; ROPAC, Registry of Pregnancy And Cardiac disease.

Determinants of Hypertension in Outpatients in East Java, Indonesia

Objective: To assess the prevalence of hypertension and to identify the causative factors. Method: The cross- cross-sectional study was conducted at Dr Soegiri Hospital, Lamongan, Indonesia, from March to July 2019, and comprised outpatients of either gender. Data was collected using a modified World Health Organisation STEPwise approach to surveillance questionnaire to identify the risk factors for hypertension. Data were analysed using the SPSS 16.0 statistical tool and logistic regression test. Results: Of the 184 subjects, 118(64.1%) were females and 66(35.9%) were males, and 96(52%) were aged <60 years. Overall, 120(65.2%) subjects were hypertensive; 80(66.7%) females and 40(33.3%) males. The two main factors that significantly influenced the incidence of hypertension were body mass index (p=0.001) and consumption of vegetables (p=0.013). After adjusting for confounding factors, only body mass index was found to affect the incidence of hypertension (odds ratio: 5.61; 95% confidence interval: 1.686-18.659). Conclusion: Body mass index and and dietary patterns affected the incidence of hypertension. After adjusting for confounding factors, only the former was found to have significant association with hypertension. Keywords: Blood pressure, Body mass, Hypertension, Feeding, Dietary.

Predictors of low dental service utilization among school children in Mekelle, Northern Ethiopia: a cross-sectional study

BackgroundDental service utilization is important for maintaining and enhancing children’s oral health status. However, there is paucity of information regarding dental service utilization and factors affecting it among school aged children in Ethiopia.ObjectivesThe purpose of this study was to determine the dental service utilization and associated factors among school aged children (6–15) years in Mekelle city, Northern Ethiopia.MethodsA school-based cross-sectional study was conducted in Mekelle city of Northern Ethiopia from January 2016 to June 2016. A multi-stage sampling method was used to select 405 school children. A modified World Health Organization oral health assessment form for children was used to collect data. Univariate and multivariable logistic regressions with 95% CI were used to test the association between past-year dental service utilization, as an outcome variable, and parental socio-demographic, and child characteristics as independent variables.ResultsA total of 398 school children participated in the study. The overall dental service utilization among these children was (10.6%), 95% Confidence Interval (CI) (7.5%, 13.6%). In multivariable logistic regression analysis, maternal educational status (illiterate versus college and above (adjusted odds ratio (AOR) 0.13, 95% CI 0.01, 0.93)), higher monthly income (AOR 11.69, 95% CI 1.19, 114.61)), and having dental pain (AOR 50.8, 95% CI 17.8, 145.17)) were significantly associated with past year dental service utilization.ConclusionOur findings showed that a small proportion of the study population visited a dentist in the past year. Maternal educational status, monthly income, and dental pain were associated with past year dental service utilization. Oral health education programs focusing on dental service utilization targeting school children are crucial.

Vascular malperfusion and abruption are prevalent in placentas from pregnancies with congenital heart disease and not associated with cardiovascular risk

Congenital heart disease (CHD) in pregnancy is associated with an increased risk of adverse maternal, obstetric, and neonatal outcomes, plausibly through mechanisms involving abnormal placental development and function. This retrospective study aims to elucidate how maternal CHD influences placental health. Demographic and clinical information were collected via electronic medical record review, and placentas underwent histopathological evaluation. Fifty-three singleton pregnancies were included: 35 participants (66%) were classified as lower cardiovascular risk (modified World Health Organization Classification (mWHO) I, II, II-III), and 18 (34%) were classified as higher cardiovascular risk (mWHO III, IV). 12 participants (23%) had a fetus with small for gestational age (SGA). Maternal vascular malperfusion (53%) and placental abruption (11.6%) were common in this cohort, with prevalence above baseline risk. Participants at higher cardiovascular risk had higher rates of SGA (p = 0.04), subchorionic hematomas (p = 0.01) and birth weight:placental weight < 10th percentile (p = 0.04), but did not differ in rates of maternal vascular malperfusion (p = 0.15) compared to those at lower cardiovascular risk. In pregnancies with maternal CHD, SGA and histologic evidence of maternal vascular malperfusion and placental abruption were common, though patients at higher cardiovascular risk did not show evidence of worsened placental health compared to those at lower risk.

Vaccination Rates, Perceptions, and Information Sources Used by People With Inflammatory Arthritis.

To determine vaccination rates, perceptions, and information sources in people with inflammatory arthritis. Participants enrolled in the Australian Rheumatology Association Database were invited to participate in an online questionnaire, conducted in January 2020, prior to the COVID-19 pandemic. Included questions were about vaccination history, modified World Health Organization Vaccination Hesitancy Scale, views of the information sources consulted, the Beliefs About Medicines Questionnaire, education, and the Single-Item Health Literacy Screener. Response rate was 994 of 1498 (66%). The median age of participants was 62 years, with 67% female. Self-reported adherence was 83% for the influenza vaccine. Participants generally expressed positive vaccination views, particularly regarding safety, efficacy, and access. However, only 43% knew which vaccines were recommended for them. Vaccine hesitancy was primarily attributable to uncertainty and a perceived lack of information about which vaccines were recommended. Participants consulted multiple vaccination information sources (median 3, interquartile range 2-7). General practitioners (89%) and rheumatologists (76%) were the most frequently used information sources and were most likely to yield positive views. Negative views of vaccination were most often from internet chatrooms, social media, and mainstream media. Factors of younger age, male gender, and having more concerns about the harms and overuse of medicines in general were associated with lower adherence and greater uncertainty about vaccinations, whereas education and self-reported literacy were not. Participants with inflammatory arthritis generally held positive views about vaccination, although there was considerable uncertainty as to which vaccinations were recommended for them. This study highlights the need for improved consumer information about vaccination recommendations for people with inflammatory arthritis.

Outcomes of pregnant women hospitalized with unrepaired congenital heart disease: Insights from a multidisciplinary center in Vietnam

Background In developing countries, fewer women have access to multidisciplinary congenital heart disease and reproductive programs staffed by experts. We report pregnancy outcomes of a multidisciplinary healthcare strategy utilizing an in-hospital teamwork approach in Vietnam. Methods This retrospective cohort study included pregnant women with unrepaired congenital heart disease managed at a referral cardiovascular center. Results Undiagnosed congenital heart disease before pregnancy, a lack of pre-pregnancy cardiology counseling, and modified World Health Organization class III/IV were common. Under the multispecialty healthcare strategy, although the rate of maternal death was 8.2% in the modified World Health Organization class IV group, no deaths occurred in any other group. Fetal/neonatal complications occurred in 54% of pregnancies, and 49.4% of neonates survived. Poor pregnancy outcomes were associated with admission during the first/seconde trimester for fetus/neonates, third trimester for mother, modified World Health Organization class III/IV, cyanosis, and heart failure. Conclusion The outcomes of pregnant women with unrepaired congenital heart disease were poor but seemed to improve with a multidisciplinary in-hospital healthcare teamwork strategy.

Enablers and Barriers to the Scaling Up of Pneumococcal Conjugate Vaccine in India During the COVID-19 Pandemic: A Qualitative Study.

Pneumonia is one of the leading causes of death in under-5 children in India. This led the Ministry of Health & Family Welfare (MoHFW) in India to decide for the nationwide roll-out of the Pneumococcal Conjugate Vaccine (PCV). However, the introduction of PCV became more complex in the face of unprecedented challenges set forth by the COVID-19 pandemic. The study aims to assess enablers and barriers to the introduction of PCV in India during the pandemic. Qualitative research approach involving key-informant interviews from John Snow India (JSI), the lead technical agency that supported MoHFW in the PCV expansion was employed to delineate the enablers and barriers. Principle of saturation was employed to derive the sample size. Thematic analysis using inductive approach was based on the modified World Health Organization (WHO) framework for new vaccine introduction impact on the Immunization and Health Systems, using NVIVO 12 qualitative data analysis software. A total of 11 key informants (4 national-level program managers and 7 state technical officers) were telephonically interviewed. The study found social acceptance, lower cost of the vaccine, and intensive communication activities as potential enablers. Other enablers for PCV introduction included a robust vaccine supply-chain system, ample cold-chain space availability, and strong political commitment, despite the ongoing second wave. Further, the identified barriers included poor physical access, insufficient social mobilization, and limited advocacy along with a stretched workforce. The study delineated several enablers and barriers to introducing PCV in the country during the pandemic. The existing barriers in the PCV roll-out prompted the need to address these gaps, making key program-based recommendations to improve future new vaccine introductions during the pandemic.

Cardiac disease and risk of hypertensive disorders of pregnancy

Cardiovascular disease affects 1-4% of US pregnancies and is the leading cause of pregnancy related deaths. There are limited data on rates of hypertensive disorders of pregnancy (HDP) in this population. ACOG and USPSTF guidelines for aspirin (ASA) use for reduction of preeclampsia (PEC) do not include cardiac disease in the high or moderate risk categories. Our objective was to determine if cardiovascular disease is a risk factor for developing HDP. This was a retrospective cohort study of pregnancies complicated by maternal cardiac disease at a single academic center between 2018 and 2022. Patients with cardiac disease (congenital or acquired) who delivered after 20 weeks were included. For patients with multiple pregnancies during the timeframe, only the first pregnancy was included. Patient demographics and pregnancy outcomes were recorded. The primary outcome was development of HDP. Secondary outcomes were correlation of HDP with presence of one high or two moderate risk factors based on ACOG guidelines for ASA use and severity of cardiac disease based on modified World Health Organization (mWHO) risk class. 115 patients were included. Demographic and outcomes are shown in Table 1. 18 (15.7%) patients developed HDP and 71 patients (61.7%) were on ASA. Among the 18 patients with HDP, 55% developed PEC with severe features and 44% developed PEC post-partum. HDP was associated with multiple gestations (p< 0.01), age (p=0.04) and the combination of one high risk or two moderate risk factors for PEC (p=0.03). mWHO class was not associated with development of HDP (p=0.86). It has not been established if cardiac disease in pregnancy is an independent risk factor for developing PEC. Our study reveals high rates of HDP in this cohort (15.7% in our population compared to CDC rate of 4% of US pregnancies), even in the setting of ASA use and regardless of mWHO risk class. While more research is needed, based on our data it would be reasonable to offer patients with cardiac disease ASA for prevention of PEC.

Mucocutaneous Changes in End-Stage Renal Disease Under Regular Hemodialysis - A Cross-Sectional Study.

Patients with end-stage renal disease (ESRD) suffer from mucocutaneous changes that could significantly impair the quality of life. We aimed this study to assess the mucocutaneous changes in hemodialysis patients and to correlate the serum creatinine to these changes. Data were collected from the Hemodialysis Center at Benha University. A cross-sectional study design on 130 chronic kidney disease (CKD) patients (30-60 years old, 84 males, 46 females) undergoing hemodialysis. Oral examinations were done for these patients as per the modified World Health Organization oral health survey 2013 criteria. All the mucocutaneous changes were recorded then types, distribution, and frequencies were calculated and correlated to serum creatinine. Mucocutaneous abnormalities were present in 100% of the studied CKD sample. We observed that pallor (76.2%), xerostomia (70%), petechiae/purpura (49.2%), altered taste (49.2%), and lip pigmentation (40.8%) were the most prevalent mucocutaneous changes among the CKD patients undergoing hemodialysis. A strong association was detected between serum creatinine and the following: abnormal lip pigmentation and lichen planus. There is an association between lip pigmentation and lichen planus in CKD patients and the level of serum creatinine as the higher level of serum creatinine was found in the patients with abnormal lip pigmentation and the atrophic lichen planus patients.

Oral Health Status and Dental Treatment Needs among Children with and without Hearing Impairment in Hyderabad, India: A Cross-sectional Study

Aim: The study aimed to assess the oral health status and dental treatment needs of children with hearing impairment (CHI) and children without hearing impairment (HI). Materials and Methods: A cross-sectional study was conducted among 110 CHI and 105 children without HI (13–18 years) in Hyderabad, India from February–March 2019. Two special schools (for CHI) and one government (regular) school were selected by purposive sampling. American Dental Association Type-4 dental examination was conducted at respective school premises and modified World Health Organization Oral Health Assessment form, 2013 was used to record the oral health findings. Chi-square test/Fisher’s exact test and Z-test were calculated at P &lt; 0.05. Results: Prevalence of dental caries was 69% and 26% among CHI and children without HI, respectively (P &lt; 0.001). Good oral hygiene, as determined by oral hygiene index scores, was merely 31.8% among CHI compared to 82.9% in children without HI. CHI in need of any dental treatment was higher at 89.1% compared to 43.8% of children without HI. Conclusion: The present study demonstrates that CHI has a higher prevalence of dental caries than children without HI in Hyderabad, India. This high prevalence of caries among CHI represents the unmet dental needs and neglect of their oral health care. Oral health promotion is the need of the hour to help nurture good oral health practices among children in general and CHI in particular.

Oral health status and barriers to oral healthcare among children with cerebral palsy attending a health care center in Kampala, Uganda

BackgroundCerebral palsy (CP) is a non-progressive neuromuscular condition diagnosed in childhood. CP as a form of disability, does not cause any specific oral disease. However, some oral conditions are more commonly associated with people with CP compared to the general population. The overarching aim of the current study was to determine the oral hygiene status, gingival status, and the prevalence of dental caries in children with CP attending a leading hospital institution for children with disabilities in Kampala, Uganda. Additionally, we determined the barriers faced by children with CP in accessing oral healthcare.MethodsThis cross-sectional study was carried out at the Comprehensive Rehabilitation Services Uganda hospital in Kampala, Uganda. Our study population consisted of a convenient sample of 90 children diagnosed with CP aged 3–17 years and their caregivers. A validated and interviewer administered structured questionnaire was used to collect socio-demographic data of the participants. A modified World Health Organization oral health assessment form for those aged 3–17 years was used to gather data on oral health status (plaque score, gingival bleeding and dental caries.) The data was subjected to statistical tests with critical value set up at 5%.ResultsOnly 32.2% of the children evaluated had adequate oral hygiene, while 44.4% of the children experienced gingival bleeding. The prevalence of dental caries for both deciduous and permanent dentition was 63.3%, with DMFT values of 3.8 ± 4.5. The most common barrier reported by the caregivers was the challenge in modality of transportation availability from the children’s homes to the health facilities (34.4%).ConclusionsChildren with CP in the study population have a significant prevalence of oral diseases and face several barriers to oral healthcare. Results from this study aim to provide relevant support to advocate for a nationwide change in policy to improve access to dental care to decrease the burden of oral diseases in children with special healthcare needs.

Epidemiology of influenza in Ghana, 2011 to 2019.

Influenza virus is an important contributor to acute respiratory illnesses and is estimated to cause up to 650,000 respiratory deaths each year. Ghana recorded influenza viruses as far back as 1918 when the Spanish influenza pandemic led to the death of >100,000 people in a population of 4 million at the time. An outbreak of highly pathogenic avian influenza A(H5N1) among poultry in Ghana in 2007, led to the establishment of virological surveillance for influenza-like illness (ILI) by the Noguchi Memorial Institute for Medical Research (NMIMR). This surveillance system, supported by the U.S. Naval Medical Research Unit-No. 3 (NAMRU-3) and the Ghana Health Service (GHS), monitors circulating influenza strains and activity to better understand the epidemiology of influenza in Ghana. We present here the results of this surveillance system from 2011 to 2019. As part of the Integrated Disease Surveillance and Response (IDSR) system of the GHS under the Ministry of Health (MOH), oropharyngeal and nasopharyngeal swabs were collected from patients who met a modified World Health Organization (WHO) case definition for ILI or severe acute respiratory illness (SARI) through a sentinel surveillance system in the country. Samples were transported to the National Influenza Centre (NIC) at the NMIMR and tested for influenza virus using protocols defined by the United States Centers for Disease Control and Prevention (CDC). Selected isolates were sent to the WHO collaborating centre in the United Kingdom for further antigenic characterization. From 2011 to 2019, the NIC tested a total of 21,747 ILI samples and 3,429 SARI samples. Influenza positivity rates were highest in the 5-14 year old group for both ILI (20.8%) and SARI (23.8%). Compared to females, more males were seen at the health facilities for ILI and SARI symptoms with a statistically significant difference in influenza positive ILI (15% vs 13.2%, p <0.001). In terms of absolute numbers, more cases were seen at the health centres during the wet seasons (April to October) compared to the dry seasons (November to March) in Ghana. This study presents 9 years of surveillance data from outpatient and inpatient setting on influenza activity as well as the influenza A subtypes and B lineages that drive the activity. This presents useful information for influenza vaccine selection and administration. Ghana's unique influenza activity patterns also present a challenge in predicting when an outbreak could occur.

Changes in the characteristics and outcomes of COVID-19 patients from the early pandemic to the delta variant epidemic: a nationwide population-based study

ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed because of virus mutations, vaccine dissemination, treatment development and policies, among other factors. These factors have a dynamic and complex effect on the characteristics and outcomes of patients. Therefore, there is an urgent need to understand those changes and update the evidence. We used a large-scale real-world data set of 937,758 patients with COVID-19 from a nationwide claims database that included outpatients and inpatients in Japan to investigate the changes in their characteristics, outcomes and risk factors for severity/mortality from the early pandemic to the delta variant-predominant waves. The severity of COVID-19 was defined according to the modified World Health Organization clinical-progression ordinal scale. With changing waves, mean patient age decreased, and proportion of patients with comorbidities decreased. The incidences of “severe COVID-19 or death (i.e. ≥severe COVID-19)” and “death” markedly declined (5.0% and 2.9%, wild-type-predominant; 4.6% and 2.2%, alpha variant-predominant and 1.4% and 0.4%, delta variant-predominant waves, respectively). Across the wave shift, risk factors for ≥ severe COVID-19 and death, including older age, male, malignancy, congestive heart failure and chronic obstructive pulmonary disease, were largely consistent. The significance of some factors, such as liver disease, varied as per the wave. This study, one of the largest population-based studies on COVID-19, showed that patient characteristics and outcomes changed during the waves. Risk factors for severity/mortality were similar across all waves, but some factors were inconsistent. These data suggest that the clinical status of COVID-19 will change further with the coming epidemic wave.

Impact of Pre-Existing Ischemic Heart Disease on Severe Maternal Morbidity and Mortality During Delivery Hospitalizations

BackgroundThe impact of pre-existing ischemic heart disease (IHD) on pregnancy is incompletely described. ObjectivesThe purpose of this study was to compare adverse pregnancy outcomes between those with IHD and those with a cardiac diagnosis categorized by the modified World Health Organization classification and those without a cardiac diagnosis. MethodsThis retrospective study used the 2015 to 2018 Nationwide Readmissions Database. Delivery hospitalizations, comorbidities, and outcomes were identified using diagnosis and procedure codes. The exposure was isolated IHD. The primary outcome was severe maternal morbidity (SMM) or death during the delivery hospitalization, analyzed using adjusted relative risk (aRR) regression and weighted to account for the Nationwide Readmissions Database's complex survey methods. ResultsOf 11,556,136 delivery hospitalizations, 65,331 had another cardiac diagnosis, and 3,009 had IHD alone. Patients with IHD were older and had higher rates of diabetes and hypertension. In unadjusted analyses, adverse outcomes were more common among patients with IHD alone than among patients with no cardiac disease and modified World Health Organization class I-II disease. After adjustment, patients with IHD alone were associated with a higher risk of SMM or death (aRR: 1.51; 95% CI: 1.19-1.92) than those without a cardiac disease. In comparison, the aRR was 1.90 (95% CI: 1.76-2.06) for WHO class I-II diseases and 5.87 (95% CI: 5.49-6.27) for WHO II/III-IV diseases. Nontransfusion SMM or death (aRR: 1.60; 95% CI: 1.11-2.30) and cardiac SMM or death (aRR: 2.98; 95% CI: 1.75-5.08) were also higher for those with IHD. ConclusionsIsolated IHD in pregnancy is associated with worse outcomes than no cardiac disease during delivery hospitalization and approximates the risk associated with WHO I-II diagnoses.

Burden of noncommunicable diseases in Pakistan.

Cases of noncommunicable (NCD) diseases are increasing in Pakistan. They are responsible for 58% of all deaths and information on the risk factors is lacking. To determine the prevalence of diabetes, hypertension and abnormal heart rate and their risk factors in a multiethnic, low-income area of Lahore. This was a cross-sectional study conducted in an urban settlement of Lahore in 2018-2019. Eligible participants were aged ≥ 30 years and resident in selected settlements. We used a modified World Health Organization stepwise approach to NCD risk factor surveillance (STEPS) questionnaire to collect data from a random sample of 906 residents. The modified questionnaire had a Cronbach alpha of 80.0%. Participants were interviewed in their homes and their height, weight, heart rate, and hip circumference were measured. Most of the respondents were women (64.5%). The greatest proportion of the participants were aged 30-39 years (42.4%). Of all the respondents, 40.1% had hypertension, 15.8% had diabetes and 17.0% had ischaemic heart disease. Of the risk factors examined, 68.8% of the respondents were overweight or obese, 37.0% had pre-hypertension, 13.6% used tobacco, and 1.8% used alcohol. Age was the most significant risk factor for noncommunicable diseases. Body mass index was significantly associated with diabetes in women, while family history of diabetes was significantly associated with diabetes in men. The prevalence of hypertension and diabetes was higher among our study participants in Lahore than reported in the national statistics. Significant proportions of the respondents had pre-hypertension and pre-diabetes, making them vulnerable to serious complications of hypertension and diabetes.