Period Of Maximum Risk Research Articles

STUDY ON STILL BIRTH: A CATASTROPH FOR PATIENT AND NIGHTMARE FOR THE OBSTETRICIAN

Introduction: Still Birth is a catastrophic event for both treating doctor and the patient.World wide in 2015, for every 1000 total births, 18.4 babies were stillborn, mostly in low and middle income countries. India has the highest number of stillbirths, with an estimated 592 100 deaths per year Aim : To evaluate the still birth rate of our institution and to assess the sociodemographic factors contributing to it, and to predict the maximum risk period for still birth. Material and Methods: All patients who gave consent and delivered a baby either vaginally or by caeserian section after 28 weeks of gestation during the study period(july 2019-June 2020) were included in the study.Still Birth was defined as a baby born after 28 completed weeks of gestation or weighing more than 1 kg,with no signs of life .Total no of patients during the study period were 2629, with 5 sets of twins. So total no of birth during the study period was 2634. Epidemiological data were compared between still birth and total births.Causes of still births were analysed and period of maximum risk for still birth was predicted. Statistical Analysis :Descriptiveanalytes were expressed in proportion. Chi square test was used to assess the significance level and p value of <.05 was taken as significant. Result: Total no. of births by either vaginal route or caesarean section during june 2019 to july 2020 were 2634 foetuses. among which,137 fetus were still born. So still birth rate was 52/1000 live births.Maximum no of still births were in the age group of 20-25 years 69(50.3%), were primigravida 46(33.5%), belonged to low socioeconomic status 95(69.3%), came from rural areas79(57.6%) and were unbooked 94(68.6%).There was statistically significant difference(p=.0012) in unbooked cases when still births and total births were compared. No cause could be attributable to still birth in 15(10.9%) of cases, whereas 81(59.1%) had maternal causes,17(12.4%) had fetal causes, 19(13.8%) had placental causes while 5(3.6%) had other reasons like acute infections or thermal burns. Major reason of StillBirth amongst the maternal causes, was labour complications 38(37.7%), whereas intra uterine growth restriction was the leading cause 8(5.8%) amongst the fetal factors.36-40 week was the gestational age during which maximum still births occured.95(69.31%) of still birth cases were delivered by vaginal route Conclusion:Majority of still births were in unbooked cases and labourcomplications were the leading cause of still births overall. Hence antenatal care and delivery by skilled attendant is of paramount importance. Routine antenatal care would also lead to early recognition of maternal and fetal high risk factors and their management.

The Effect of Health Risk on Housing Values: Evidence from a Cancer Cluster.

This paper measures the impact of an outbreak of pediatric leukemia on local housing values. A model of location choice is used to describe conditions under which the gradient of the hedonic price function with respect to pediatric leukemia risk is equal to household marginal willingness to pay to avoid risk. This equalizing differential is estimated using property-level sales records from a county in Nevada where residents recently experienced a severe increase in pediatric leukemia. Housing prices are compared before and after the increase with a nearby county acting as a control group. The variation in health risk over time makes it possible to control for unobserved differences across locations. In addition, because many houses were sold repeatedly during the sample period it is possible to control for property-specific heterogeneity. The results indicate that housing values decreased 15.6 percent during the period of maximum risk. Results are similar for different measures of risk and across houses of different sizes. Using lifetime estimates of risk derived from a Bayesian learning process the results imply that the statistical value of pediatric leukemia is $5.6 million. These estimates provide some of the first market-based estimates of the value of health for children.

Proyecto EHSA: estudio de hemorragias subaracnoideas espontáneas en Andalucía. Incidencia y resultados

To evaluate the incidence and results of spontaneous subarachnoid haemorrhages (SAH) in Andalusia. We conducted a longitudinal prospective study of the cases of SAH attended in 28 hospitals in Andalusia over a three month period in 2000. SAH was defined as cases of acute haemorrhagic strokes diagnosed by tomography. The gross incidence rate (GR) was determined from census information from the Instituto Andaluz de Estad stica. Standard rates (SR) were estimated with relation to the European population. Results were evaluated on hospital discharge according to the Glasgow Outcome Score (GOS) and at 12 months, according the Barthel index (BI). The GR per 100,000 inhabitants/year was found to be 5.7 cases and the SR was 5.8. A comparison of incidences by province or sex showed no statistically significant differences. The period of maximum risk was the age bracket between 55 74 years (GR: 14.1). The acute fatality GR and SR rose to 1.9 per 100,000 inhabitants and year. Mortality was concentrated in a statistically significant way (p< 0.01) among those over the age of 65; sex did not exert any influence, but clinical gravity (p< 0.001) and the amount of bleeding did (p< 0.005). The incidence of spontaneous SAH in Andalusia was found to be within the average rates. Unfavourable results were high, although similar to those in other series. Fatality is significantly associated with factors that cannot be modified medically (age, clinical gravity and volume of bleeding)

A study of cryptosporidiosis in a cohort of neonatal calves

During calving time on an experimental farm, 32 newborn calves were selected at random and monitored for infection with Cryptosporidium parvum for the first 30 days of their lives. The animals were fed pooled colostrum for 2–3 days after birth and housed in individual pens, which were washed daily using a pressure hose. Fecal smears were examined by microscopy after staining with carbol fuschin for visualization of oocysts. Oocyst shedding was scored semiquantitatively according to the average number of oocysts in 20 randomly selected fields at 1000× magnification. All the animals acquired the infection before 18 days of age. The period of maximum risk was between 9 and 12 days; 50% of the animals were infected by 9.4 days of age. It was found that the earlier the animals acquired the infection, the longer the patent period. Oocyst shedding, which did not always begin with the onset of diarrhea, lasted between 8 and 23 days (mean 12.4±3.3 days). Furthermore, fecal samples from 32 periparturient cows (within ±7 days of giving birth) were filtered, concentrated and examined for oocysts using a fluorescent monoclonal antibody test, which revealed that six of the cows, although asymptomatic, were excreting C. parvum oocysts.

Intracranial haemorrhage in idiopathic thrombocytopenic purpura. Paediatric Haematology Forum of the British Society for Haematology.

A UK survey was carried out to discover the frequency, circumstances, and outcome of intracranial haemorrhage (ICH) complicating idiopathic thrombocytopenic purpura (ITP) of childhood. A questionnaire was circulated through the membership of the UK Paediatric Haematology Forum, and thence to local paediatricians and haematologists. It sought information on any child with ITP who had had an ICH during the 20 year period to January 1994. Fourteen instances were discovered, seven before 1984 and seven after. Six children survived the event with minimal or no sequelae, four without craniotomy. An immediately precipitating cause was noted in four; two had arteriovenous malformations and two suffered head injuries. The event occurred over two weeks from diagnosis in seven cases and over two months in five. All children were profoundly thrombocytopenic at the time of their intracranial bleed. By calculation the 14 children would have represented some 0.1% of the total with ITP during the period under review. ICH in childhood ITP may have a precipitating cause and is not necessarily fatal. There is no period of maximum risk, and it can occur at any time during the course of the illness when the platelet count is less than 10-15 x 10(9)/l. It is an extremely rare event and previous estimates of its incidence may have been too high.

Changes in a proposed new neuroendocrine marker of oestrogen receptor function in postpartum women

We describe a novel neuroendocrine test which reflects a central response to activation of oestrogen receptors. This is achieved by measurement of plasma levels of oestrogen-stimulated neurophysin (ESN) following an oestrogen challenge. In normal women the ESN response to ethinyl oestradiol is dose-dependent. This response is attenuated in normal women during the first postpartum month, although it is unchanged in patients with anorexia nervosa, in spite of their similar concurrent hypo-oestrogenic state. The altered puerperal response may result from the acute oestrogen withdrawal which occurs at delivery. The time course of the altered ESN response coincides with the period of maximum risk for puerperal psychosis. The ESN response to oestrogen provides a novel neuroendocrine measure to test the relevance of changes in central oestrogen receptor responsiveness in the pathogenesis of puerperal psychosis.