Double true umbilical cord knots coexisting with a nuchal cord with successful fetal outcome: A case report.

Umbilical nodes and cords play a crucial role in fetal development and are essential for the transfer of nutrients and oxygen between the mother and the fetus. Sonographic diagnosis of umbilical nodes and cords has become an integral part of prenatal care, allowing for the early detection of abnormalities and potential complications. The umbilical cord is a vital structure connecting the fetus to the placenta, providing essential nutrients and oxygen for fetal growth and development. Sonographic examination of the umbilical cord and its associated nodes has become an indispensable tool in prenatal care, enabling the early detection of abnormalities and potential complications. This review aims to analyze the current literature on sonographic diagnosis of umbilical nodes and cords, highlighting the key points and advancements in this field. A 37-year-old booked G4P2+1A2 Nigerian woman was registered for prenatal tertiary health care at 12 weeks of gestation. The booking investigations were normal and the booking packed cell volume was 37%. She was compliant with scheduled clinic visits and routine drugs. Pregnancy was carried to term uneventfully. Elective cesarean section was successfully performed at 38 weeks of gestation owing to the patient's prior history of third-degree perineal tear. The intraoperative findings included a loose cord around the neck of the baby and double true knots along the length of the 65 cm umbilical cord. The baby was delivered with appearance, pulse, grimace, activity and respiration (APGAR) scores of 7 in the first minute, 9 in the fifth minute, and the birth weight was 3.0 kg. Mother and baby were discharged 48 h postpartum in stable clinical condition. Although the presence of true double umbilical knots is rare, its coexistence with the nuchal cord is even rarer. There are risk factors associated with true umbilical knots. The possible risk factor implicated in this index case is the gender of the fetus and maternal multiparity. True umbilical knots are usually associated with certain fetal negative outcomes of pregnancy. There are currently no evidence-based treatment options available.

Anthropometric Predictors of Health-Related Quality of Life in Obese Patients Attending a Tertiary Hospital in Nnewi, South-East Nigeria: A Cross-Sectional Study.

BACKGROUND: Obesity as a disorder with excess body fat directly decreases quality of life. While Body Mass Index (BMI) has been used largely in health studies as a measure of obesity, it is largely unable to differentiate between body fat and lean body mass, hence other anthropometric measures can be used to assess body fat. OBJECTIVE: To determine the association of anthropometric indicators with health-related quality of life (HRQoL) in obese adults. MATERIALS AND METHODS: A cross-sectional study of obese adults (BMI ≥30kg/m2) attending the general outpatient clinic was conducted over four months. The quality of life was assessed using the short form-36 (SF-36) questionnaire. The anthropometric indicators used were BMI, waist circumference (WC), waist hip ratio (WHR), and waist-height ratio (WHtR). RESULTS: Physical component summary (PCS) was significantly related to BMI, WHtR, and WC. After adjusting for co-variables (gender, age, occupation, and marital status), they remained significantly associated with PCS. Mental component summary (MCS) was significantly related to BMI, WHtR, and WC. After adjusting for the known determinants of HRQoL, only BMI remained significantly associated with MCS (P = -0.004; r = -0.146). When all the indicators were included in the same regression model, no anthropometric indicator was significantly related to MCS while only WHtR was significantly associated with PCS (P = 0.001; r = -0.465). CONCLUSION: HRQoL in obese patients is related to measures of body fat. The physical and mental components of health-related quality of life are correlated differently with the various anthropometric measures of obesity. The WHtR was found to be an independent predictor of the physical component of HRQoL.

Trends in Obesity-Related Mortality and Racial Disparities.

BACKGROUND: Across the globe, obesity stands as a prominent public health concern, linked to a heightened susceptibility to a range of metabolic and cardiovascular disorders. This study reveals a disproportionate impact of obesity on African American (AA) communities, irrespective of socioeconomic status. Structural racism plays a critical role in perpetuating healthcare disparities between AA and other racial/ethnic groups in the United States. These disparities are reflected in limited access to nutritious food, safe exercise spaces, health insurance, and medical care, all of which significantly influence healthcare outcomes and obesity prevalence. Additionally, both conscious and unconscious interpersonal racism adversely affect obesity care, outcomes, and patient-healthcare provider interactions among Blacks. STUDY OBJECTIVE: This study aims to analyze and compare obesity-related mortality rates among AAs, Whites, and other racial groups. METHODOLOGY: We queried the CDC WONDER dataset, incorporating all US death certificates. During data extraction, various ICD 10 codes were used to denote different obesity categories: E66.1 (drug-induced obesity), E66.2 (severe obesity with alveolar hypoventilation), E66.3 (overweight), E66.8 (other forms of obesity), E66.9 (unspecified obesity), E66.0 (obesity due to excess calorie intake), E66.01 (severe obesity due to excess calories), and E66.09 (other forms of obesity caused by excess calorie intake). Our study encompassed decedents aged ≥15 years, with obesity-related diseases as the underlying cause of death from 2018 to 2021. Sex- and race-specific obesity-related mortality rates were examined for AAs, Whites, and other races. Resultant mortality trends were computed and presented as ratios comparing AA and White populations. RESULTS: This study reveals lower obesity-related mortality rates in AAs compared to Whites. Furthermore, women exhibited higher rates than men. In the 15 to 24 age bracket, males comprised 60.11% of the 361 deaths, whereas females made up 39.89%. In this demographic, 35.46% of deaths were among Blacks, with 64.54% among Whites. Within the 25 to 34 age group, females constituted 37.26% of the 1943 deaths, and males 62.74%. Whites made up 62.94% of the fatalities, Blacks 33.40%, with other racial groups accounting for the remainder. These trends extended through the 35-44, 45-54, 55-64, 65-74, and 75+ age categories, with variations in death proportions among genders and races. Whites consistently accounted for the highest death percentages across all age groups, followed by Blacks. Our data indicate that obesity-related mortality tends to occur earlier in life. CONCLUSION: Our results corroborate previous studies linking elevated mortality risk to obesity and overweight conditions. The uniformity of our findings across age groups, as well as genders, supports the proposal for applying a single range of body weight throughout life. Given the ongoing rise in obesity and overweight conditions across the United States, excess mortality rates are projected to accelerate, potentially leading to decreased life expectancy. This highlights the urgency for developing and implementing effective strategies to control and prevent obesity nationwide.

Neutrophil-Lymphocyte, Platelet-Neutrophil, and Platelet-Lymphocyte Ratios as Indicators of Sickle Cell Anaemia Severity.

Background: Sickle cell anaemia (SCA) imposes a substantial healthcare burden, affecting millions of people worldwide. Understanding the determinants influencing SCA severity is crucial for enhanced disease management and optimized patient outcomes. This study aimed to investigate the relationship between Neutrophil-Lymphocyte Ratio (NLR), Platelet-Neutrophil Ratio (PNR), Platelet-Lymphocyte Ratio (PLR), and SCA severity. Methods: A cohort of 45 children diagnosed with SCA and undergoing treatment at Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Awka, was included in this study. Demographic and clinical data, along with laboratory measurements of the aforementioned ratios, were collected. The severity of SCA was assessed using numerical scoring. Results: The analysis revealed that PNR and PLR emerged as significant predictors of SCA severity, irrespective of the level of adiposity. In contrast, NLR demonstrated no predictive value in relation to SCA severity. Conclusion: The findings challenge the conventional notion that neutrophils alone play a central role in the pathogenesis of sickle cell crises. These results contribute to a deeper understanding of the disease and provide insights into possible alternative mechanisms underlying SCA severity. Further research is warranted to explore the intricate interplay between platelets, neutrophils, lymphocytes, and other biological factors within the context of SCA. Ultimately, this knowledge may pave the way for targeted interventions and improved management strategies for individuals living with SCA.

Cesarean section rate and outcomes during and before the first wave of COVID-19 pandemic.

Objectives: The objective of the study was to assess how the current COVID-19 pandemic has affected cesarean section (C-section) rates, indications, and peripartum outcomes. Methods: This was a retrospective cross-sectional study that compared a 3-month rates of and indications for C-sections at three tertiary health care institutions in Nigeria before (October 2019-December 2019) and during the first wave of COVID-19 pandemic (March 2020-May 2020). Primary outcomes were C-section rate and indications between the two periods. Data were analyzed using SPSS 26.0 IBM Corporation. Rates and odds ratios with 95% confidence intervals were used to quantify indications and peripartum outcomes and statistical significance was accepted when p value was <0.05. Results: The baseline characteristics of the two groups were similar. The C-section rate during the COVID-19 period was significantly less than the period prior to the pandemic (237/580, 40.0% vs 390/833, 46.8%; p = 0.027). The rates of postdatism (odds ratio = 1.47, 95% confidence interval = 1.05-2.05, p = 0.022), fetal distress (odds ratio = 3.06, 95% confidence interval = 1.55-6.06, p = 0.017), emergency C-section (odds ratio = 1.43, 95% confidence interval = 1.01-2.05, p = 0.042), and anemia (odds ratio = 1.84, 95% confidence interval = 1.12-3.03, p = 0.016) were significantly higher during the pandemic than prepandemic. Conclusion: The overall C-section rate during the first wave of COVID-19 was significantly lower than the prepandemic period. There were higher rates of postdatism, fetal distress, emergency C-section, and postpartum anemia. Further studies on this changing C-section trend during the pandemic are needed.