Changing trends in cesarean section: from 1950 to 2020

Caesarean section (C.S) is a part of the standard care in modern obstetrics. The indications for a caesarean section as an alternative to vaginal delivery have evolved over the centuries. Its practicality, disponibility, and apparent safety have placed caesarean section, a first-line procedure in many clinical scenarios. The awareness of perinatal mortality and morbidity associated with safety of caesarean, expert anaesthesia, potent antibiotics, blood transfusion facilities and better neonatal care have increased incidence of caesarean section very fast. Thus, there is fast, steady and definite rise in incidence of caesarean section everywhere. But the question is ‘Is a rising caesarean section rate is inevitable?’. Studies carried out to understand CS deliveries has adopted different framework. The issue treats elements of ethics in the medical profession, gender issues, choices of women, the quality of institutional services, etc. The findings of retrospective studies have suggested that the caesarean section rate could be reduced in certain categories. In this study, we discuss the various ways in which it can be achieved.

Changing trends in maxillofacial trauma: A 15 years retrospective study in the Southern Part of Haryana, India

The aim is to analyze the pattern of maxillofacial injuries and treatment outcomes in the past 15 years (2002–2016). Materials and Methods: One thousand eight hundred and fifty patients from two tertiary referral center hospitals were studied retrospectively in which the age, sex, etiology, site of fracture, and treatment modality was recorded. Results: One thousand two hundred and twenty-eight males and 622 females were operated between 2002 and 2016. Mean age was 29 ± 17.2 years. Maximum incidence was seen in the age group of 16–30 years in males, whereas in females, the predominance of trauma was seen in both 16–30 and 31–45 age groups. Road traffic accidents were responsible for the majority of fractures (42.2%), followed by assaults (26.4), sports injuries (17.6%), and fall (10.7%). Maximum fractures were of the mandible (53.5%) followed by midface (25.6%) and panfacial trauma (20.8%). Nearly 53.6% of patients underwent open reduction, and internal fixation (ORIF), 34.2% managed by the closed method and 12.1% were kept under observation. Conclusion: This study verified a young male predominance, a shift toward more assault related fractures, especially in females. Mandibular fractures were the most common of all. Moreover, the changing trend toward ORIF in the past 15 years.

Changing Trends in Antimicrobial Resistance Among Invasive Pneumococcal Pathogens in Asian Countries:Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study / 감염과화학요법

BACKGROUND: Emergence of pneumococcal resistance became a global issue since 1990s. According to the ANSORP studies with clinical isolates and carriage isolates between 1996 and 1999, some Asian countries showed alarmingly high prevalence of resistance to penicillin and other antimicrobial agents. To investigate the changing trends of pneumococcal resistance, ANSORP study group has performed a multinational surveillance study with invasive pneumococcal isolates from Asian countries. METHODS: All isolates from various invasive pneumococcal diseases were prospectively collected from 14 centers in 12 countries between November 1999 to August 2001. Broth microdilution tests with 16 antimicrobial agents were performed according to the NCCLS procedures. Serotyping was performed by means of Quelling reaction with use of group-specific antisera. RESULTS: A total of 685 isolates were collected. Overall, 52.4% of invasive isolates from Asian countries were not susceptible to penicillin (intermediate (I), 22.9%; Resistant (R), 29.5%). Vietnam showed the highest prevalence of penicillin non-susceptibility (I 20.6%, R 71.4%) followed by Sri Lanka (I 71.4%, R 14.3%), Hong Kong (I 24.1%, R 76%) and Korea (I 9.7%, R 54.8%). China (I 19.8%, R 23.4%) and Malaysia (I 9.1%, R 29.5%) also showed remarkable increase in penicillin resistance compared with previous ANSORP data, which were less than 10%. Vietnam (92.1%), Taiwan (87.7%), Korea (80.6%), and Hong Kong (76.8%) showed high prevalence of erythromycin resistance. MIC90s for ciprofloxacin were 4 microgram/mL (Hong Kong) and 2 microgram/mL (11 Asian countries except Hong Kong), respectively. CONCLUSION: Compared with previous data from ANSORP studies, antimicrobial resistance among invasive pneumococcal isolates has markedly increased in Vietnam, Sri Lanka, Taiwan, China, and Malaysia. Continuous surveillance of pneumococcal resistance in Asia is strongly warranted.

Changing Trends in Antimicrobial Resistance Among Invasive Pneumococcal Pathogens in Asian Countries:Asian Network for Surveillance of Resistant Pathogens (ANSORP) Study / 감염과화학요법

BACKGROUND: Emergence of pneumococcal resistance became a global issue since 1990s. According to the ANSORP studies with clinical isolates and carriage isolates between 1996 and 1999, some Asian countries showed alarmingly high prevalence of resistance to penicillin and other antimicrobial agents. To investigate the changing trends of pneumococcal resistance, ANSORP study group has performed a multinational surveillance study with invasive pneumococcal isolates from Asian countries. METHODS: All isolates from various invasive pneumococcal diseases were prospectively collected from 14 centers in 12 countries between November 1999 to August 2001. Broth microdilution tests with 16 antimicrobial agents were performed according to the NCCLS procedures. Serotyping was performed by means of Quelling reaction with use of group-specific antisera. RESULTS: A total of 685 isolates were collected. Overall, 52.4% of invasive isolates from Asian countries were not susceptible to penicillin (intermediate (I), 22.9%; Resistant (R), 29.5%). Vietnam showed the highest prevalence of penicillin non-susceptibility (I 20.6%, R 71.4%) followed by Sri Lanka (I 71.4%, R 14.3%), Hong Kong (I 24.1%, R 76%) and Korea (I 9.7%, R 54.8%). China (I 19.8%, R 23.4%) and Malaysia (I 9.1%, R 29.5%) also showed remarkable increase in penicillin resistance compared with previous ANSORP data, which were less than 10%. Vietnam (92.1%), Taiwan (87.7%), Korea (80.6%), and Hong Kong (76.8%) showed high prevalence of erythromycin resistance. MIC90s for ciprofloxacin were 4 microgram/mL (Hong Kong) and 2 microgram/mL (11 Asian countries except Hong Kong), respectively. CONCLUSION: Compared with previous data from ANSORP studies, antimicrobial resistance among invasive pneumococcal isolates has markedly increased in Vietnam, Sri Lanka, Taiwan, China, and Malaysia. Continuous surveillance of pneumococcal resistance in Asia is strongly warranted.