Drivers for COVID 19 vaccine hesitancy among breastfeeding women in Eastern tribal state, India.

Background: In the COVID-19 pandemic age, vaccination hesitancy also known as vaccine refusal is a cause for worry since it hinges on the five Cs of confidence, complacency, convenience, calculation, and shared responsibility. The current study was to pinpoint the elements that contribute to breastfeeding women's hesitation to receive the coronavirus disease-19 (COVID-19) vaccine. Materials and Methods: A cross-sectional observational study was carried out at the Department of Obstetrics and Gynaecology, Tertiary Care Hospital, Ranchi, Jharkhand. Result: Out of 365 nursing mothers, 242 (66.3%) were hesitant to get the COVID-19 vaccination. Those who chose not to receive the COVID-19 vaccination mostly belong to those aged 18 to 25 (38.1%), living in rural regions (44.9%), and belonging to non-tribal ethnic groups (41.1%). On application of logistic regression, it was found that rural areas had 3 times higher rate of vaccine hesitancy than urban residents, and that husbands' education levels up to the 12th grade had a 3.55 times higher rate and 5 times agriculture by husband's occupation, which was statistically significant (P value less than 0.05) The most prevalent grounds for rejection were fear of side effects (85.8%) and worry of adverse effects on newborns (83.48%). Conclusion: Both husband and wife, who had completed high school and were aware of the vaccination, were fearful of the COVID-19 vaccine. Concerns about the side effects and undesirable effects of vaccination on their newborns were the main reasons for refusal.

Case series of unscarred uterine rupture in primigravida.

Objective: To present a highly rare case series of uterine rupture in primigravida individuals with an unscarred uterus. Case: The unscarred uterus in primigravida patients is supposed to be impervious to rupture, yet we have four cases of ruptured uterus in primigravida patients in our institute over a three-year period (2018-2021). In this case series, the ruptured uterus was discovered in primigravida women with premature labour, obstructed labour, instrumental delivery, and abruptio placentae. In the absence of previous surgery or multiparity, uterine rupture may go unnoticed, resulting in late diagnosis and considerable mortality and morbidity. All four cases required immediate resuscitation and laparotomy; uterine repair was performed in three cases, although a peripartum hysterectomy was needed in one. Conclusion: Rupture uterus can occur even in the unscarred uterus of primigravida patients and early diagnosis and timely management can prevent high maternal mortality and morbidity.

Effects of COVID-19 during pregnancy on maternal and neonatal outcome: A retrospective observational study in tertiary teaching hospital, India.

Aim: This study aims to describe the clinical characteristics, maternal and neonatal outcome of pregnancies complicated with COVID-19 infection. Methods: This is a retrospective, single center, observational study conducted on all COVID-19 positive pregnant women who were admitted in our institution from 1st April 2020 to 30th November 2020. During the study period, a total of 201 pregnant and postpartum women with COVID-19 infection confirmed by RT-PCR test, regardless of their symptoms, were admitted and included in the study. Data were collected from hospital records about the demographic profile, clinical characteristics, maternal and neonatal outcomes. Results: The mean age was 26 years (SD = 5.21). Majority patients (71.6%) were asymptomatic and 22.3% had mild symptoms. Only 4 (1.99%) women had severe COVID pneumonia. Majority (75.62%) were admitted in 3rd trimester. Cesarean section rate in COVID-19 infected pregnant women was 53.8%, which was almost similar to 52.8% rate in COVID-19 negative pregnant population. Incidence of preterm birth was 11%. Most neonate were asymptomatic and only 2 of them tested positive on testing within 48 h of birth. Conclusion: There is no major effect of COVID-19 infection during pregnancy on maternal and neonatal outcome. The incidence of preterm birth and cesarean section is similar to COVID-19 negative pregnant population.

Updated meta-analysis on the diagnostic accuracy of serum anti-Mullerian hormone in poly cystic ovary syndrome involving 13 509 subjects.

AIM: To determine the diagnostic accuracy of anti-Mullerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS). METHODS: Two independent reviewers searched the electronic databases and search engines using PubMed, Cochrane library, and Google Scholar systematically to retrieve relevant articles published from inception to September 2021. The diagnostic efficacy of AMH was computed using the random-effects model in terms of pooled sensitivity, specificity, and diagnostic odds ratio (DOR) with 95% confidence interval (CI). A meta-regression and subgroup analysis were performed to check for any source which could explain possible heterogeneity. Risk of bias assessment was conducted using the QUADAS-2 tool recommended by Cochrane Library. RESULTS: This meta-analysis included a total of 41 studies involving 13 509 subjects. We observed promising pooled sensitivity 0.78 (95% CI 0.74 to 0.81), specificity 0.87 (95% CI 0.84 to 0.90), and diagnostic odds ratio (DOR) 24 (95% CI 15 to 37), for AMH in detecting PCOS and discriminatory power (summary receiver operating characteristic [SROC] curves, 0.89 [95% CI 0.86-0.92]). The most prominent bias was noted in the patient selection and index test assessment. CONCLUSIONS: With the findings of this current meta-analysis, we conclude serum AMH to be a promising biomarker for the diagnosis of PCOS, however, substantial heterogeneity among studies needs individual patient data analysis in order to identify an optimal cut-off value and homogenous findings. REGISTRATION NUMBER AND GUIDELINES: This meta-analysis was performed according to constructed protocol registered in the PROSPERO database with registration number CRD42021246910.

Study of Association of Fetal Cerebroplacental Ratio with Adverse Perinatal Outcome in Uncomplicated Term AGA Pregnancies.

BACKGROUND: The cerebroplacental ratio (CPR) is emerging as a predictor for adverse perinatal outcome in term pregnancies. Earlier, it has shown a role in small for gestational age (SGA) pregnancies, but a proportion of appropriate for gestational age foetuses (AGA) despite of good size have impaired growth velocity and are thereby at risk of adverse outcome. CPR has implication for assessment of well being of SGA and AGA foetuses close to term. OBJECTIVE: To investigate the association between foetal CPR and adverse perinatal outcome in uncomplicated term AGA pregnancies. METHODS: This was a prospective observational study done in Department of Obstetric and Gynaecology, King George Medical University, Lucknow, over a period of one year. Women > 37 week singleton pregnancy with no known risk factor who had Doppler USG done within a week of delivery were included. CPR was calculated by dividing the Doppler indices of middle cerebral artery (MCA) by umbilical artery (MCA PI/UA PI). CPR < 1 was taken as abnormal. These patients were followed up till delivery to look for various perinatal outcomes. Results Out of 127 low-risk AGA pregnancies who went for USG colour Doppler scan, 117 patients who met our inclusion criteria were analysed; out of 117 patients 23(i.e. 19.65 %) were having CPR < 1 and 94 patients (i.e. 80.34%) were having CPR>1. Among 23 patients with CPR < 1, 22 (91.30%) had adverse outcome as compared to only 20.21% patients with CPR > 1, and this is found to be statistically significant (p < 0.001). CONCLUSION: Our study found CPR measure to be a very promising tool for optimising the identification of at risk foetus in low-risk AGA pregnancies.

Clinical effectiveness of the massachusetts childhood obesity research demonstration initiative among low-income children.

OBJECTIVE: To examine the extent to which a clinical intervention resulted in reduced BMI z scores among 2- to 12-year-old children compared to routine practice (treatment as usual [TAU]). METHODS: The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a multifaceted initiative to prevent childhood obesity among low-income children. At the federally qualified community health centers (FQHCs) of two communities (Intervention Site #1 and #2), the following were implemented: (1) pediatric weight management training, (2) electronic decision supports for clinicians, (3) on-site Healthy Weight Clinics, (4) community health worker integration, and (5) healthful clinical environment changes. One FQHC in a demographically matched community served as the TAU site. Using electronic health records, we assessed BMI z scores and used linear mixed models to examine BMI z score change over 2 years in each intervention site compared to a TAU site. RESULTS: Compared to children in the TAU site (n = 2,286), children in Intervention Site #2 (n = 1,368) had a significant decline in BMI z scores following the start of the intervention (-0.16 units/y; 95% confidence interval: -0.21 to -0.12). No evidence of an effect was found in Intervention Site #1 (n = 111). CONCLUSIONS: The MA-CORD clinical interventions were associated with modest improvement in BMI z scores in one of two intervention communities compared to a TAU community.

Effect of Trimeric Myricetin Rhamnoside (TMR) in Carrageenan-induced Inflammation and Caecal Ligation and Puncture-induced Lung Oxidative Stress in Mice.

The Eugenia jambolana is used in folklore medicine. Leaves of E. jambolana contain flavonoids as their active constituents which possess in vitro antiinflammatory, antioxidant and the antimicrobial activity. The aim of the present study was to investigate the antiinflammatory and antioxidant effects of a flavonoid glucoside, trimeric myricetin rhamnoside (TMR) isolated from leaves of E. jambolana. TMR was studied for antiinflammatory activity in carrageenan-induced hind paw oedema and antioxidant activity in lung by caecal ligation and puncture (CLP)-induced sepsis in mice. Results of the present study indicated that TMR significantly attenuated the oedema, myeloperoxidase (MPO), cytokines and prostaglandin levels in the paw after 5 h of carrageenan injection as compared to vehicle control. It also reduced the lung MPO, lipid peroxides, and serum nitrite plus nitrate levels and increased lung reduced glutathione levels 20 h of CLP as compared to vehicle control. Thus the results of this study concluded that the TMR appears to have potential benefits in diseases that are mediated by both inflammation and oxidative stress and support the pharmacological basis of use of E. jambolana plant as traditional herbal medicine for the treatment of inflammatory diseases.

Design of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study.

BACKGROUND: Childhood obesity is highly prevalent, is associated with both short- and long-term adverse outcomes, disproportionately affects racial/ethnic minority and economically deprived children, and represents a major threat to public health. Among the most promising approaches for its prevention and management are multilevel, multisector strategies. METHODS/DESIGN: The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study was a comprehensive, systematic intervention to prevent and reduce childhood obesity among low-income children ages 2-12 years in two selected cities in Massachusetts. Building on the Obesity Chronic Care Model, MA-CORD expanded a state public health department community-level obesity prevention initiative that incorporated evidence-based interventions in primary healthcare, the Women, Infants, and Children program, early care and education, schools/afterschool programs, as well as community-wide programs to improve food, beverage, physical activity (PA), and messaging environments. The study used a combination of pre- and post-time series and quasi-experimental designs to examine the extent to which the intervention resulted in changes in BMI, individual-level lifestyle behaviors, satisfaction with healthcare services, and quality of life among children, as well as changes in health policies, programs, and environments in the two intervention cities, compared to a comparison city. The intervention period was 2 years. CONCLUSIONS: MA-CORD will determine the extent to which a multisetting, multilevel intervention that integrates activities in primary care with broader public health interventions in schools, early care and education, and the community at large can improve children's dietary and PA behaviors and ultimately reduce obesity in low-income children.

Analgesic activity of Eugenia jambolana leave constituent: a dikaempferol rhamnopyranoside from ethyl acetate soluble fraction.

CONTEXT: Eugenia jambolana Lam. (Myrtaceae) is a medicinal plant used in folk medicine for the treatment of diabetes, inflammation, and pain. OBJECTIVE: We investigated the antinociceptive effect of kaempferol-7-O-α-l-rhamnopyranoside]- 4'-O-4'-[kaempferol-7-O-α-l-rhamnopyranoside (EJ-01), isolated from the E. jambolana leaves. MATERIALS AND METHODS: EJ-01 (3, 10, and 30 mg kg(-1), orally) was assessed for peripheral (formalin-nociception and acetic acid-writhing) and central (hot plate and tail flick test) analgesic activity in mice and the in vitro anti-inflammatory activity (25, 50, and 100 µg mL(-1)) in lipopolysaccharide (LPS)-stimulated RAW 264.7 cells. RESULTS AND DISCUSSION: EJ-01 (10 and 30 mg kg(-1)) significantly inhibited mean writhing counts (37.74 and 36.83) in acetic acid writhing and paw licking time (55.16 and 45.66 s) in the late phase of the formalin test as compared with the respective control (60.66 and 104.33 s). EJ-01 did not show analgesic activity in central pain models. Significant reduction in the tumor necrosis factor (TNF)-α (295.48, 51.20, and 49.47 pg mL(-1)) and interleukin (IL)-1ß (59.38, 20.08, and 15.46 pg mL(-1)) levels were observed in EJ-01-treated medium (25, 50, and 100 µg mL(-1)) as compared with vehicle-treated control values (788.67 and 161.77 pg mL(-1)), respectively. Significant reduction in total nitrite plus nitrate (NOx) levels (70.80 nmol) was observed in the EJ-01-treated medium (100 µg mL(-1)) as compared with the vehicle-treated value (110.41 nmol). CONCLUSION: EJ-01 is a valuable analgesic constituent of E. jambolana leaves and this study supports the pharmacological basis for the use of this plant in traditional medicine for curing inflammatory pain.

The Healthy Weight Collaborative: quality improvement methods promoting healthy weight.

Promoting healthy weight requires innovative approaches and a concerted response across all sectors of society. This commentary features the framework guiding the Healthy Weight Collaborative, a two-phased quality improvement (QI) learning collaborative and key activity of the Collaborate for Healthy Weight initiative. Multi-sector teams from primary care, public health, and community-based organizations use QI to identify, test, and implement program and policy changes in their communities related to promoting healthy weight. We describe the Collaborative's overall design based on the Action Model to Achieve Healthy People 2020 Goals and our approach of applying QI methods to advance implementation of sustainable ways to promote healthy weight and healthy equity. We provide specifics on measurement and change strategies as well as examples of Plan-Do-Study-Act cycles from teams participating in Phase 1 of the Collaborative. These teams will serve as leaders for sustainable, positive change in their communities.

Specialized care of overweight children in community health centers.

We have developed a new approach to child obesity that supports the delivery of so-called secondary care-referral-based specialized visits-by primary care teams within community health centers. The Healthy Weight Clinic reorganizes care to provide access to a trained team consisting of a pediatric provider, nutritionist, and case manager during dedicated weight management visits. Our model improves obesity care by promoting local specialization and increasing capacity for specialized care; building multidisciplinary teams within primary care; focusing on health behavior change as a critical determinant of chronic disease outcomes; and using health information technology to promote high-quality care.

Diabetes mellitus screening in pediatric primary care.

OBJECTIVE: The goal was to determine the rates of diabetes screening and the prevalence of screening abnormalities in overweight and nonoverweight individuals in an urban primary care clinic. METHODS: This study was a retrospective chart review conducted in a hospital-based urban primary care setting. Deidentified data for patients who were 10 to 19 years of age and had > or = 1 BMI measurement between September 1, 2002, and September 1, 2004, were extracted from the hospital electronic health record. RESULTS: A total of 7710 patients met the study criteria. Patients were 73.0% black or Hispanic and 47.0% female; 42.0% of children exceeded normal weight, with 18.2% at risk for overweight and 23.8% overweight. On the basis of BMI, family history, and race, 8.7% of patients met American Diabetes Association criteria for type 2 diabetes mellitus screening, and 2452 screening tests were performed for 1642 patients. Female gender, older age group, and family history of diabetes were associated with screening. Increasing BMI percentile was associated with screening, exhibiting a dose-response relationship. Screening rates were significantly higher (45.4% vs 19.0%) for patients who met the American Diabetes Association criteria; however, less than one half of adolescents who should have been screened were screened. Abnormal glucose metabolism was seen for 9.2% of patients screened. CONCLUSIONS: This study shows that, although pediatricians are screening for diabetes mellitus, screening is not being conducted according to the American Diabetes Association consensus statement. Point-of-care delivery of consensus recommendations could increase provider awareness of current recommendations, possibly improving rates of systematic screening and subsequent identification of children with laboratory evidence of abnormal glucose metabolism.

A content analysis of e-mail communication between primary care providers and parents.

BACKGROUND: E-mail exchange between parents of patients and providers has been cited by the Institute of Medicine as an important aspect of contemporary medicine; however, we are unaware of any data describing actual exchanges. OBJECTIVE: The purpose of this study was to evaluate the content of e-mails between providers and parents of patients in pediatric primary care, as well as parent attitudes about e-mail. DESIGN/METHODS: Over a 6-week period, all e-mail exchanges between 2 primary care pediatricians and their patients' parents were evaluated and coded. An exchange was defined as the e-mails between parent and primary care provider about a single inquiry. Parents also completed a questionnaire regarding this service. RESULTS: Of 55 parents, 54 (98%) agreed to have their e-mails with their pediatrician reviewed. The 54 parents generated 81 e-mail exchanges; 86% required only 1 e-mail response from the pediatrician, and the other 14% required an average of 1.9 responses. E-mail inquiries were all for nonacute issues (as judged by S.G.A.) and included inquiries about a medical question (n = 43), medical update (n = 20), subspecialty evaluation (n = 9), and administrative issue (n = 9). The 81 exchanges resulted in 9 appointments, 21 phone calls, 4 subspecialty referrals, 34 prescriptions or recommendations for over-the-counter medications, 11 administrative tasks, and 1 radiograph. Of 91 pediatrician-generated e-mails, 39% were sent during the workday (9 am to 5 pm, Monday to Friday), 44% were sent on weeknights, and 17% were sent on weekends. During the study period, the 2 physicians estimated an average of 30 minutes/day spent responding to e-mail. Of the 54 parents, 45 (83%) returned the survey; 93% were mothers and 86% had completed college. Ninety-eight percent were very satisfied with their e-mail experience with their pediatrician. Although 80% felt that all pediatricians should use e-mail to communicate with parents and 65% stated they would be more likely to choose a pediatrician based on access by e-mail, 63% were unwilling to pay for access. CONCLUSIONS: This is the first study to describe actual e-mail exchange between parents and their providers. Exchanges seem to be different from those generated by the telephone, with more e-mails related to medical versus administrative issues and more resulting in office visits. Approximately 1 in 4 exchanges result in multiple e-mails back and forth between parent and provider. Parents who have actually exchanged e-mails with their providers overwhelmingly endorse it, although they are reluctant to pay for it.