Vitamin E Supplementation and Cardiovascular Events in High-Risk Patients

OBJECTIVE
We sought to examine etiology and preventability of maternal death and the causal relationship of cesarean delivery to maternal death in a series of approximately 1.5 million deliveries between 2000 and 2006.


STUDY DESIGN
This was a retrospective medical records extraction of data from all maternal deaths in this time period, augmented when necessary by interviews with involved health care providers. Cause of death, preventability, and causal relationship to mode of delivery were examined.


RESULTS
Ninety-five maternal deaths occurred in 1,461,270 pregnancies (6.5 per 100,000 pregnancies.) Leading causes of death were complications of preeclampsia, pulmonary thromboembolism, amniotic fluid embolism, obstetric hemorrhage, and cardiac disease. Only 1 death was seen from placenta accreta. Twenty-seven deaths (28%) were deemed preventable (17 by actions of health care personnel and 10 by actions of non-health care personnel). The rate of maternal death causally related to mode of delivery was 0.2 per 100,000 for vaginal birth and 2.2 per 100,0000 for cesarean delivery, suggesting that the number of annual deaths resulting causally from cesarean delivery in the United States is about 20.


CONCLUSION
Most maternal deaths are not preventable. Preventable deaths are equally likely to result from actions by nonmedical persons as from provider error. Given the diversity of causes of maternal death, no systematic reduction in maternal death rate in the United States can be expected unless all women undergoing cesarean delivery receive thromboembolism prophylaxis. Such a policy would be expected to eliminate any statistical difference in death rates caused by cesarean and vaginal delivery.

Iconographies supplémentaires de l'article : Maternal death in the 21st century: causes, prevention, and relationship to cesarean delivery

Survey paper: A survey on routing algorithms for wireless Ad-Hoc and mesh networks

http://vertinnov.fr/fic_bdd/mag_pdf_fr_fichier/12731575420_SAFETY_EVALUATION_OF_NEEM.pdf

Safety evaluation of neem (Azadirachta indica) derived pesticides

Background
Vitamin C supplementation may help reduce the risk of pregnancy complications such as pre-eclampsia, intrauterine growth restriction and maternal anaemia. There is a need to evaluate the efficacy and safety of vitamin C supplementation in pregnancy.

Objectives
To evaluate the effects of vitamin C supplementation, alone or in combination with other separate supplements on pregnancy outcomes, adverse events, side effects and use of health resources.

Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2015) and reference lists of retrieved studies.

Selection criteria
All randomised or quasi-randomised controlled trials evaluating vitamin C supplementation in pregnant women. Interventions using a multivitamin supplement containing vitamin C or where the primary supplement was iron were excluded.

Data collection and analysis
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.

Main results
Twenty-nine trials involving 24,300 women are included in this review. Overall, 11 trials were judged to be of low risk of bias, eight were high risk of bias and for 10 trials it was unclear. No clear differences were seen between women supplemented with vitamin C alone or in combination with other supplements compared with placebo or no control for the risk of stillbirth (risk ratio (RR) 1.15, 95% confidence intervals (CI) 0.89 to 1.49; 20,038 participants; 11 studies; I² = 0%; moderate quality evidence), neonatal death (RR 0.79, 95% CI 0.58 to 1.08; 19,575 participants; 11 studies; I² = 0%), perinatal death (average RR 1.07, 95% CI 0.77 to 1.49; 17,105 participants; seven studies; I² = 35%), birthweight (mean difference (MD) 26.88 g, 95% CI -18.81 to 72.58; 17,326 participants; 13 studies; I² = 69%), intrauterine growth restriction (RR 0.98, 95% CI 0.91 to 1.06; 20,361 participants; 12 studies; I² = 15%; high quality evidence), preterm birth (average RR 0.99, 95% CI 0.90 to 1.10; 22,250 participants; 16 studies; I² = 49%; high quality evidence), preterm PROM (prelabour rupture of membranes) (average RR 0.98, 95% CI 0.70 to 1.36; 16,825 participants; 10 studies; I² = 70%; low quality evidence), term PROM (average RR 1.26, 95% CI 0.62 to 2.56; 2674 participants; three studies; I² = 87%), and clinical pre-eclampsia (average RR 0.92, 95% CI 0.80 to 1.05; 21,956 participants; 16 studies; I² = 41%; high quality evidence).

Women supplemented with vitamin C alone or in combination with other supplements compared with placebo or no control were at decreased risk of having a placental abruption (RR 0.64, 95% CI 0.44 to 0.92; 15,755 participants; eight studies; I² = 0%; high quality evidence) and had a small increase in gestational age at birth (MD 0.31, 95% CI 0.01 to 0.61; 14,062 participants; nine studies; I² = 65%), however they were also more likely to self-report abdominal pain (RR 1.66, 95% CI 1.16 to 2.37; 1877 participants; one study). In the subgroup analyses based on the type of supplement, vitamin C supplementation alone was associated with a reduced risk of preterm PROM (average RR 0.66, 95% CI 0.48 to 0.91; 1282 participants; five studies; I² = 0%) and term PROM (average RR 0.55, 95% CI 0.32 to 0.94; 170 participants; one study). Conversely, the risk of term PROM was increased when supplementation included vitamin C and vitamin E (average RR 1.73, 95% CI 1.34 to 2.23; 3060 participants; two studies; I² = 0%). There were no differences in the effects of vitamin C on other outcomes in the subgroup analyses examining the type of supplement. There were no differing patterns in other subgroups of women based on underlying risk of pregnancy complications, timing of commencement of supplementation or dietary intake of vitamin C prior to trial entry. The GRADE quality of the evidence was high for intrauterine growth restriction, preterm birth, and placental abruption, moderate for stillbirth and clinical pre-eclampsia, low for preterm PROM.

Authors' conclusions
The data do not support routine vitamin C supplementation alone or in combination with other supplements for the prevention of fetal or neonatal death, poor fetal growth, preterm birth or pre-eclampsia. Further research is required to elucidate the possible role of vitamin C in the prevention of placental abruption and prelabour rupture of membranes. There was no convincing evidence that vitamin C supplementation alone or in combination with other supplements results in other important benefits or harms.

Vitamin C supplementation in pregnancy

Purpose – The purpose of this paper is to examine the nature and perception of corporate frauds in India and their consequences in the business and economic systems, and it highlights the emerging issues so that existing legal and regulatory obligations can be redefined and structured. Design/methodology/approach – An exploratory research was conducted through a combined mode of literature review; case studies; structured questionnaires from 346 sample companies; and 43 interviews with the corporate professionals, management, investors, government offices and authorities having wide experience. Findings – It was found that the regulatory system is weak, and there is dire need to redefine the role of auditors. Coordination among different regulatory authorities is poor, and after every scam, there is a blame game. Reporting of fraud and publication of fraud prevention policy are missing. Banks and financial institutions are ineffective on due diligence, and there is a lack of professionalism on the board a...

Corporate frauds in India – perceptions and emerging issues

Introduction
Abdominal pregnancy is extremely rare and has historically been defined as an implantation in the peritoneal cavity, exclusive of tubal, ovarian or intraligamentary pregnancy.

/pdf/secondary-abdominal-pregnancy-and-its-associated-diagnostic-36rs12ohh6.pdf

Secondary abdominal pregnancy and its associated diagnostic and operative dilemma: three case reports.

Spontaneous perforation of pyometra is a rare pathologic condition that presents as diffuse peritonitis. This report describes an interesting case of spontaneous uterine perforation that mimicked gut perforation clinically and was finally diagnosed at exploratory laparotomy. Although rare, perforation of pyometra should be kept as one of the differential diagnosis in an elderly woman with an acute abdomen. A high index of suspicion is required to make a correct preoperative diagnosis, which allows early intervention, thus reducing morbidity and mortality.

Spontaneous perforation of pyometra presented as an acute abdomen: a case report.

Objectives: To investigate risk factors of Low Birth Weight. Setting: Govt. Medical College and Hospital, Chandigarh. Participants: 193neonates delivered in the health facility. Statistical Analysis: Normal test of proportions. Results: The overall proportion of LBW was 23.8%. Proportion of LBW was comparatively higher among babies born to mothers who were below 20 years of age (50.0%), poorly educated (32.6%), belonging to family with income less than Rs. 2000 per capita, (28.9%), poorly nourished with pre-pregnancy weight less than 45 kg (50.0%), as compared to others. Primi mothers were comparatively at lower risk (18.4%) of delivering LBW babies as compared to multi-gravida mothers (29.5%). Low literacy level, low per capita income, birth order two and above and maternal age above 30 years were found to be significant risk factors of LBW. Conclusions: Population based interventions in terms of improving maternal education and socio-economic status irrespective of parity should be adopted for reducing the prevalence of LBW.

https://print.ispub.com/api/0/ispub-article/7363

Maternal Risk Factors Of Low Birth Weight In Chandigarh India

This was a rare case where a patient presented clinically as a case of post abortal sepsis and ultrasound showing the picture of an intramural degenerating fibroid. Her serum and urine both were negative for beta human chorionic gonadotropin (betaHCG). Patient succumbed to choriocarcinoma 1 month later. Failure to detect urinary and serum betaHCG lead to maternal mortality due to the choriocarcinoma. The failure to detect, certain degradation products of HCG which may predominate in gestational trophoblastic neoplasia, by many common HCG testing kits lead to the error of diagnosis. Only 3 of the 7 common commercial serum HCG tests appropriately detects nicked HCG and its free betaHCG, DPC immulite assay, being the most sensitive method. Though of rare occurrence, this awareness is important for diagnosis and follow-up of gestational trophoblastic neoplasia and could have been life saving in our case.

/pdf/choriocarcinoma-with-negative-urinary-and-serum-beta-human-3swwomsbke.pdf

Pratiksha Gupta

Papers

Corporate frauds in India – perceptions and emerging issues

Secondary abdominal pregnancy and its associated diagnostic and operative dilemma: three case reports.

Spontaneous perforation of pyometra presented as an acute abdomen: a case report.

Maternal Risk Factors Of Low Birth Weight In Chandigarh India

Choriocarcinoma with negative urinary and serum beta human chorionic gonadotropin (betaHCG)--a case report.