Maternal Obesity and Its Associated Factors and Outcomes in Klang Valley, Malaysia: Finding from National Obstetric Registry

@#Introduction: Maternal obesity presents significant health risks to mothers and their fetuses. This study aimed to determine the proportion, associated factors and outcomes of maternal obesity among pregnant women in Klang Valley, Malaysia. Methods: A retrospective cross-sectional study was conducted between January 2018 and March 2018 using secondary data from the Malaysian National Obstetric Registry (NOR) for the year 2015. All pregnant women with first-trimester booking at 12 weeks and below that were registered with the NOR and met the inclusion and exclusion criteria were included in the study. Descriptive statistics and multiple logistic regression analysis were used. Data were analysed using SPSS version 22.0. A total of 2113 respondents were included in this study to determine the proportion, associated factors and outcomes of maternal obesity. Regarding the univariate and multivariate analyses, respondents were classified into two groups: normal and obese. The obese group comprised overweight and obese mothers. The underweight group was excluded in the subsequent analysis. Results: Out of the 2113 respondents, 7.1% were underweight, 41.7% were of normal weight, 28.6% were overweight, 15.9% were in obese class I, 4.6% were in obese class II, and 2.1% were in obese class III according to the WHO (1995) reference. However, when the MOH (2003) cutoff point was used, there was a marked increase in the proportion of respondents in the overweight categories by 2.7% and obesity class I by 12.8%. The Indian (AdjOR 2.06, 95% CI: 1.11, 3.83, p=0.021) and Malay (AdjOR 1.75, 95% CI: 1.02, 3.00, p=0.040) ethnicities, as well as both multiparity (AdjOR 1.46, 95% CI: 1.23, 1.73, p <0.001) and grand multiparity (AdjOR 2.41, 95% CI: 1.78, 3.26, p <0.001), were significantly associated with maternal obesity. There were significant association between maternal obesity with hypertensive disorder in pregnancy (p=0.025), caesarean section delivery (p=0.002) and macrosomic infant (p <0.001). Conclusion: The identification of risk factors for maternal obesity is important to facilitate intervention programmes focused on improving the pregnancy outcomes for a high-risk group of women.

Assessment of metabolic response after lipoabdominoplasty in normal to overweight women

Lipoabdominoplasty [LEAP] is a cosmetic body contouring procedure used to improve abdominal type of obesity which is implicated in the development of different metabolic; especially insulin resistance; metabolic syndrome, and cardiovascular risks. The aim of the present study was undertaken to investigate the different effects [LEAP] on carbohydrate, lipid metabolism and inflammatory markers as well as the relationship of these changes with insulin resistance in normal to overweight women suffering from abdominal obesity. A total of 16 non-diabetic normal to overweight women [BMI 25.77kg/m[2] +/- 1.3] with a mean age of 34.25 +/- 4.17 years were studied. Before LEAP all demographic data regarding age, smoking and medical history of diabetes or hypertension were obtained. Complete physical examination including measurement of blood pressure [BP] both systolic [SBP] and diastolic [DBP], anthropometric measurements including waist [WC] and hip circumferences, height, weight and calculation of waist to hip ratios [WHR] and body mass index [BMI] were performed. 12-14 hours lasting samples were collected to measure fasting blood glucose [FBS], insulin, total cholesterol [TC], high density lipoprotein [HDL-C], low-density lipoprotein [LDL-C], triglyceride [TG], C-Reactive protein [CRP], apolipoprotein Al [Apo A1], apolipoprotein B [Apo B], lipid risk ratios and Homostaic Model Assessment Index [HOMA-I] were calculated. All measurements and physical examinations were repeated one and six months after the operation. Data were analyzed with SPSS-11 software using student 't' test and Pearson correlation test. LEAP decreased body weight, BMI, WC and WHR significantly one month postoperatively which showed slight nonsignificant increase six months later. SBP, DBP, TC, HDL-C, LDL-C, Apo A1, and CRP did not change significantly throughout the study, TG and Apo B decreased Mgnificantly one month after LBAP but its levels returned nearly to preoperative values six months later. All the changes occurred were independent on insulin resistance throughout she study as evidenced by the nonsignificant correlations of the previous parameters with HOMA-I; as a measure of insulin resistance. LBAP transiently improved but had no lasting effects on some but not all metabolic and lipid risk factors. These changes were independent on insulin resistance. Decreasing adipose tissue mass alone by cosmetic body contouring operations will not achieve the metabolic benefits of weight loss and should be followed by conventional dietary and exercise programs therapy

Fatal prognosis of methanol toxicity: identification of predictive factors

Human methanol poisoning is characterized by serious visual impairment, hepatic toxicity, formic acidosis, central nervous system toxicity, and death. This study was conducted on all patients admitted to Ain Shams Toxicology Centre because of methanol toxicity over one year, form January 1, 2004 to December 31, 2004. The patients were divided into two main groups; Group I included patients who survived after methanol poisoning meanwhile group II included patients who died after methanol poisoning. All patients were clinically examined for cardiovascular system manifestations, neurological, ophthalmic and effects of acidosis. All patients were subjected to routine investigation including renal profiles and liver profiles, as well as specific investigations mainly arterial blood gases and serum electrolytes. Also, data about if the patient was in need for and had haemodialysis was registered. Patients in group I presented with tachycardia, hypertension, pallor, sweating, blurring of vision, and some of them were agitated. On the other hand patients in group II showed hypertension, arrhythmias, convulsion and coma [grade III, IV], elevated renal profiles [serum creatinine mainly], together with hyperkalaemia and sever acidosis. Comparisons between group I and group II were done using student's t-test for continuous variables and Person's Chi-square test for categorical variables. The adjusted predicted factors for fatal prognosis were obtained using the logistic regression analysis. The results of the study revealed that mortality was much more prevalent among those who suffered from significant cardiovascular, CNS, ophthalmic, and renal signs of toxicity together with metabolic acidosis and hyperkalaemia. The multivariable analysis has identified one independent predictive factor significantly associated with fatal prognosis. This factor was convulsion [p < 0.001]. It can be concluded that early diagnosis and management of methanol poisoning may improve survival. Also, cardiovascular, CNS toxic manifestations and metabolic acidosis were strong predictors of methanol poisoning out come. Our results call for further investigation of predictive risk factors for the fatal prognosis of methanol toxicity; future studies preferably should include measuring of serum and tissue formic acid, and performed on large prospective cohorts over several years, to increase their internal validity

Effect of isoflurane plus nitrous oxide versus propofol on intraoperative motor evoked potentials after high frequency repetitive electrical stimulation during neurosurgical procedures

The goal of this study was to test the influence of two widespread techniques of general anaesthesia on motor evoked potentials [MEP] in response to transcranial and cortical high frequency repetitive electrical stimulation. Total intravenous anaesthesia [TIVA] based on propofol and alfentanil was studied in 17 patients [Group A] and balanced anaesthesia [BA] based on nitrous oxide, isoflurane and alfentanil was studied in 13 patients [Group B]. Distinct motor responses were available in 15 of 17 patients [88%]] of [Group A] and in one of 13 patients [8%] of [Group B]. Amplitudes increased significantly with increasing stimulus intensity and number of pulses under conditions of TIVA. At the same time, latencies decreased significantly with increasing stimulus intensity and decreasing inter-stimulus intensity interval, but not with increasing number of pulses. It is hypothesized that propofol suppresses corticospinal I-waves at the cortical level resulting in a conduction block at the level of the alpha-motor neuron; this effect may be overcome by high frequency repetitive stimulation. In contrast, nitrous oxide and isoflurane seem to have an additional suppressive effect on corticospinal D-waves which may be overcome by higher stimulation intensity. It was concluded that transcranial high frequency repetitive stimulation and TIVA provide a feasible setting for intraoperative MEP monitoring, while higher doses of nitrous oxide and isoflurane are not compatible with recording of muscular activity elicited by the stimulation technique as described