Objective  To develop a practical evidence based list of clinical risk factors that can be assessed by a clinician at ≤16 weeks’ gestation to estimate a woman’s risk of pre-eclampsia. Design  Systematic review and meta-analysis of cohort studies. Data sources  PubMed and Embase databases, 2000-15. Eligibility criteria for selecting studies  Cohort studies with ≥1000 participants that evaluated the risk of pre-eclampsia in relation to a common and generally accepted clinical risk factor assessed at ≤16 weeks’ gestation. Data extraction  Two independent reviewers extracted data from included studies. A pooled event rate and pooled relative risk for pre-eclampsia were calculated for each of 14 risk factors. Results  There were 25 356 688 pregnancies among 92 studies. The pooled relative risk for each risk factor significantly exceeded 1.0, except for prior intrauterine growth restriction. Women with antiphospholipid antibody syndrome had the highest pooled rate of pre-eclampsia (17.3%, 95% confidence interval 6.8% to 31.4%). Those with prior pre-eclampsia had the greatest pooled relative risk (8.4, 7.1 to 9.9). Chronic hypertension ranked second, both in terms of its pooled rate (16.0%, 12.6% to 19.7%) and pooled relative risk (5.1, 4.0 to 6.5) of pre-eclampsia. Pregestational diabetes (pooled rate 11.0%, 8.4% to 13.8%; pooled relative risk 3.7, 3.1 to 4.3), prepregnancy body mass index (BMI) >30 (7.1%, 6.1% to 8.2%; 2.8, 2.6 to 3.1), and use of assisted reproductive technology (6.2%, 4.7% to 7.9%; 1.8, 1.6 to 2.1) were other prominent risk factors. Conclusions  There are several practical clinical risk factors that, either alone or in combination, might identify women in early pregnancy who are at “high risk” of pre-eclampsia. These data can inform the generation of a clinical prediction model for pre-eclampsia and the use of aspirin prophylaxis in pregnancy.

https://www.bmj.com/content/bmj/353/bmj.i1753.full.pdf

Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies

Menstruation is a natural physiological process that requires proper management. Unlike other normal bodily processes, menstruation is linked with religious and cultural meanings that can affect the perceptions of young girls as well as the ways in which the adults in the communities around them respond to their needs. This review aims to answer the following questions: (1) how knowledgeable are adolescent girls in low- and middle-income countries about menstruation and how prepared are they for reaching menarche, (2) who are their sources of information regarding menstruation, (3) how well do the adults around them respond to their information needs, (4) what negative health and social effects do adolescents experience as a result of menstruation, and (5) how do adolescents respond when they experience these negative effects and what practices do they develop as a result? Using a structured search strategy, articles that investigate young girls’ preparedness for menarche, knowledge of menstruation and practices surrounding menstrual hygiene in LMIC were identified. A total of 81 studies published in peer-reviewed journals between the years 2000 and 2015 that describe the experiences of adolescent girls from 25 different countries were included. Adolescent girls in LMIC are often uninformed and unprepared for menarche. Information is primarily obtained from mothers and other female family members who are not necessarily well equipped to fill gaps in girls’ knowledge. Exclusion and shame lead to misconceptions and unhygienic practices during menstruation. Rather than seek medical consultation, girls tend to miss school, self-medicate and refrain from social interaction. Also problematic is that relatives and teachers are often not prepared to respond to the needs of girls. LMIC must recognize that lack of preparation, knowledge and poor practices surrounding menstruation are key impediments not only to girls’ education, but also to self-confidence and personal development. In addition to investment in private latrines with clean water for girls in both schools and communities, countries must consider how to improve the provision of knowledge and understanding and how to better respond to the needs of adolescent girls.

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Mapping the knowledge and understanding of menarche, menstrual hygiene and menstrual health among adolescent girls in low- and middle-income countries

This Cross-sectional descriptive study was conducted amongst 550 secondary school girls in southeastern Nigeria to determine their perceptions, problems, and practices on menstruation. Majority of the students, (75.6%), were aged 15-17 years. Only 39.3% perceived menstruation to be physiological. Abdominal pain/discomfort, (66.2%), was the commonest medical problem encountered by the respondents, although 45.8% had multiple problems. Medical problems were most commonly discussed with the mother, (47.1%), and least commonly discussed with the teachers, 0.4%. Analgesics, (75.6%), were most commonly used to relieve menstrual pain. Only 10% of respondents used non-pharmacologic remedies. Unsanitary menstrual absorbents were used by 55.7% of the respondents. Menstruation perceptions are poor, and practices often incorrect. A multi-dimensional approach focusing on capacity building of mothers, and teachers on sexuality education skills; using religious organizations as avenues for sexuality education; and effectively using the Mass Media as reproductive health education channels are recommended towards improving adolescents’ perceptions and practices on menstruation. (Afr Reprod Health 2008; 12[1]:74-83).

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Perceptions and practices on menstruation amongst Nigerian secondary school girls.

Background: The onset of menstruation is part of the maturation process. However, variability in menstrual cycle characteristics and menstrual disorders are common. The purpose of this study was to determine the age at menarche and patterns of menstruation among school adolescent girls and explore its variation across socio-economic and demographic factors. Methodology: This is a cross-sectional descriptive study carried out on 1100 school adolescent girls in district Wardha, Central India. Data were collected using a self-administered structured questionnaire on menstruation. Data was entered and analyzed by using Epi Info 6.04 software package. Chi- square value was used for testing statistical significance. Results: Mean ages of menarche were 13.51 + 1.04 years and 13.67 + 0.8 years for urban and rural areas respectively. Abnormal cycle length was common and affected 30.48%. The majority 56.15 experienced dysmenorrhoea and 56.16 percent had premenstrual syndrome. Self medication was practiced by 7.13% of the adolescent girls. The most common premenstrual symptom was headache 26.74%. Absenteeism from the school 13.9% was the effect of menstruation related problems on their daily routine. Dysmenorrhea and premenstrual symptoms were perceived as most distressing symptoms leading to school absenteeism. Majority of the girls 75.58% had discussed menstrual problems with someone, most commonly with their mothers 38.15%. There was a general lack of information about menstrual issues especially with regards to cycle length, duration of menses and age at menarche. Girls from families of high socio-economic class have significantly lower mean menarcheal age in both urban and rural area. The mean age of menarche was significantly higher in girls involved in vigorous sporting activity in urban area compared to their non-sporting counterparts. Conclusion: Age at menarche was delayed. The menstrual disorders among female adolescents are common. A school health education on menstrual problems targeting adolescent girls and their parents and routine screening for menstrual problems by healthcare providers can help to prevent the absenteeism in the school.

https://www.ccsenet.org/journal/index.php/gjhs/article/download/13989/9706

Age at menarche and menstrual cycle pattern among school adolescent girls in Central India.

Objects:

This study was designed to examine the magnitude and etiology of gender differences in oral health. South Asia was selected for study because sex differences in caries rates exist in prehistory here, great cultural diversity provides context, and clinical reports document caries by gender.



Methods:

A literature survey yielded extensive data on caries rates in India, Nepal, Bangladesh, and Sri Lanka. The percentage of individuals with caries (prevalence) and the mean number of decayed, missing, and filled teeth (experience) comprise the data. Statistical tests for gender differences come from published sources or were independently computed.



Results:

Higher caries rates were found more often among females than males. The data show that: (a) in male children caries rates are greater than, or equal to, female rates, (b) the gender bias reverses (F > M caries rates) from adolescence through the reproductive years, (c) mature adults typically exhibit significant differences, with higher caries rates in females, (d) a male gender bias in adults is rare, and (e) though some studies find no significant gender difference in caries, a female bias dominates. Tooth loss is also greater in women than men and often results from caries (vs. periodontal disease).



Conclusions:

The gender gap in oral health exists in South Asia and results from genetic, hormonal, and cultural influences. Three cultural factors contribute to this gender gap South Asia: (a) the relative value of sons and daughters, (b) frequent fasting among Hindu women, and (c) the belief that dietary restrictions result in easier childbirth. Am. J. Hum. Biol., 2011. © 2011 Wiley-Liss, Inc.

Gender differences in oral health in South Asia: Metadata imply multifactorial biological and cultural causes

Puberty is the biological transition between the immature and adult reproductive function. This study has been carried out to find out the menstrual pattern, and awareness of the abnormalities in menstrual pattern among school going pubertal age group girls in Dharan. It has been carried out with the aim to follow it with school health education. Cross sectional study was done in 96 girls of two different school of Dharan of the age group ranging from 11 years to 17 years. The median age of menarche was 12 years. There were 6.9% cases of oligomennorhea and 10.0% of hypomenorhea. Menorrhagia was seen in 6.2% of the girls. Spasmodic dysmenorrhea was seen in 67.0% of the girls but the daily activity was hampered only in 20.0%. Out of the 96 students 73.0% were prepared psychologically beforehand. Very less students (8.0%) knew only very little about the abnormalities in menstruation, rest were ignorant about it. Thus, it was seen that these school going girls needed education about the abnormalities of menstruation so that they can differentiate the normal phenomenon from abnormality and report in time in case of aberrance in the menstrual cycle.

Menstrual pattern and abnormalities in the high school girls of Dharan: a cross sectional study in two boarding schools.

This study aimed to find out the maternal mortality rate (MMR) in mothers dying after admission to the gynaecology and obstetrics ward of BP Koirala Institute of Health Sciences, Nepal, and to analyse the most common causative factor. There was a total of 58 mortality cases in 6 years.The MMR in 1997--1998 was 12/100,000 live births, in 1998--1999 144/100,000, in 1999--2000 294/100,000, in 2000--2001 450/100,000, in 2001--2002 546/100,000 and in 2002--2003 400/100,000. The most common cause of death was septic-induced abortion and its complications, followed by eclampsia and puerperal sepsis.

Maternal mortality at B P Koirala Institute of Health Sciences, Nepal: review of 6 years.

Mona Sharma MD Mamta Jha MD Dhruba Uprety MD cavity. The fetal head, the bony spicules and the placenta were removed and subtotal hysterectomy and peritoneal lavage performed. Postoperatively the patient had deep venous thrombosis but ultimately recovered completely. The second case was that ofa woman of25, PH O(three living issue), referred from a district hospital with retention of the aftercoming head of a breech of 6-h duration. She had had a breech delivery at home where the relatives could not deliver the aftercoming head. She was then taken to a district hospital where the head was decapitated and the patient referred to this hospital. On admission her pulse was 11O/min, BP was 90/60mrn of Hg and she was significantly pale. Flank tap showed frank blood. She was taken to theatre for exploratory laparotomy. At operation the placenta and the fetal head were seen lying inside the peritoneal cavity. There was rupture of the right lateral wall of the uterus with extension into the vagina. Total abdominal hysterectomy with repair of the vaginal laceration was performed. The postoperative period was uneventful.

Complications following arrest of the aftercoming head in breech delivery.

ABSTRACT Introduction: Health care professionals are expected to have a basic understanding of all procedures performed on the patient. Their knowledge has direct implications on patients' morbidity. Interns perform intravenous cannulation during their clinical rotation, their awareness about the procedure are unknown. The aim of this study was to find the knowledge of intravenous cannulation among the interns of the teaching hospital. Methods: A descriptive cross-sectional study was conducted in a teaching hospital from November 2020 to October 2021 after clearance from the Institutional Review Committee (Reference number: 2611202002). A total of 151 interns were taken using the convenience sampling method. We prepared a structured questionnaire. This was distributed among interns who had completed 6 months of internship. Data entry and analysis was done using Microsoft Excel. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 151 interns, 84 (55.62%) (47.70-63.54 at 95% Confidence Interval) had knowledge about intravenous cannulation. Most of the interns 117 (77.48%) had knowledge about the appropriate place for cannulation. Awareness about serious complications of cannulation was poor; 106 (70.19%) had never heard of these terms. Handwashing was implied as important by 70 (46.36%). Conclusions: The knowledge about intravenous cannulation among interns of teaching hospitals was poor compared to the similar study done in a similar setting.

Knowledge of Intravenous Cannulation among Interns of a Teaching Hospital: A Descriptive Cross-sectional Study

Introduction: Ichthyosis are a heterogeneous group of hereditary skin disorders characterized by dryness, hyperkeratosis, and desquamation. The purpose of this study was to evaluate quality of life (QoL) of patients with ichthyosis and their families. Materials and Methods: A total of 72 patients were enrolled and 60 patients completed the study. The study instrument included Infants' Dermatitis Life Quality Index and Children's Dermatology Life Quality Index for pediatric patients (5–16 years) and Dermatitis Family Impact Questionnaire (DFI) for family members. Results: Questionnaires were completed in 60 children. The patients had predominantly ichthyosis vulgaris (n = 46), lamellar ichthyosis (n = 10), nonbullous ichthyosiform erythroderma (n = 3), and bullous ichthyosiform erythroderma (n = 1). Male: female ratio was 1:1.5. Large effect on QoL was seen in 77.8% and 66.6% of ichthyosis vulgaris and lamellar, ichthyosis, respectively. Mean score of DFI was 9.94 ± 7.23. Conclusion: The present study reports a poor QoL among pediatric patients suffering from ichthyosis and their families. Psychosocial and mental support is needed for patients and their immediate caregivers/families for this chronic skin disease.

Mona Sharma

Papers

Menstrual pattern and abnormalities in the high school girls of Dharan: a cross sectional study in two boarding schools.

Maternal mortality at B P Koirala Institute of Health Sciences, Nepal: review of 6 years.

Complications following arrest of the aftercoming head in breech delivery.

Knowledge of Intravenous Cannulation among Interns of a Teaching Hospital: A Descriptive Cross-sectional Study

Quality of life among pediatric patients and their families suffering from congenital ichthyosis - A cross-sectional study