Preventable stillbirths in India and Pakistan: a prospective, observational study.

OBJECTIVE: Stillbirths occur 10-20 times more frequently in low-income settings compared with high-income settings. We created a methodology to define the proportion of stillbirths that are potentially preventable in low-income settings and applied it to stillbirths in sites in India and Pakistan. DESIGN: Prospective observational study. SETTING: Three maternity hospitals in Davangere, India and a large public hospital in Karachi, Pakistan. POPULATION: All cases of stillbirth at ≥20 weeks of gestation occurring from July 2018 to February 2020 were screened for participation; 872 stillbirths were included in this analysis. METHODS: We prospectively defined the conditions and gestational ages that defined the stillbirth cases considered potentially preventable. Informed consent was sought from the parent(s) once the stillbirth was identified, either before or soon after delivery. All information available, including obstetric and medical history, clinical course, fetal heart sounds on admission, the presence of maceration as well as examination of the stillbirth after delivery, histology, and polymerase chain reaction for infectious pathogens of the placenta and various fetal tissues, was used to assess whether a stillbirth was potentially preventable. MAIN OUTCOME MEASURES: Whether a stillbirth was determined to be potentially preventable and the criteria for assignment to those categories. RESULTS: Of 984 enrolled, 872 stillbirths at ≥20 weeks of gestation met the inclusion criteria and were included; of these, 55.5% were deemed to be potentially preventable. Of the 649 stillbirths at ≥28 weeks of gestation and ≥1000 g birthweight, 73.5% were considered potentially preventable. The most common conditions associated with a potentially preventable stillbirth at ≥28 weeks of gestation and ≥1000 g birthweight were small for gestational age (SGA) (52.8%), maternal hypertension (50.2%), antepartum haemorrhage (31.4%) and death that occurred after hospital admission (15.7%). CONCLUSIONS: Most stillbirths in these sites were deemed preventable and were often associated with maternal hypertension, antepartum haemorrhage, SGA and intrapartum demise. TWEETABLE ABSTRACT: Most stillbirths are preventable by better care for women with hypertension, growth restriction and antepartum haemorrhage.

Correlation between oxidative stress and antioxidant defence in South Indian urban vegetarians and non-vegetarians.

BACKGROUND AND OBJECTIVES: The diet is a key environmental factor implicated in health and disease. Oxidative stress, antioxidant status and their relation to diet is a subject of interest in recent years. The objective of the study was to compare lipid peroxidation and antioxidant status in healthy vegetarians and non-vegetarians. METHODS: The present study comprises 100 healthy individuals (50 vegetarians and 50 non-vegetarians) residing in Belgaum urban area. All the participants were in the age group of 40-60 years of both sexes. This cross-sectional study was done in one year period from April 2007 to March 2008. Malondialdehyde (MDA) (lipid peroxidation product) was estimated by thiobarbituric acid method, glutathione peroxidase by Beutler's method, Vitamin A and Vitamin E by Bessay et al and Quife et al methods respectively. RESULTS: Our study revealed that the blood MDA level was significantly increased (p value < 0.001) in non-vegetarians compared to lactovegetarians and lacto-ovo-vegetarians. There was significant decrease in the level of enzymatic antioxidant glutathione peroxidase and non-enzymatic antioxidants Vitamin A and Vitamin E in non-vegetarians compared to lactovegetarians and lacto-ovo-vegetarians (p value < 0.001). CONCLUSIONS: Results of this investigation present study indicate that there was an increased lipid peroxidation and a low antioxidant status in non-vegetarians compared to vegetarians. Vegetarian nutrition provides adequate antioxidants which effectively prevent free radicals generation.

Visfatin--a review.

Expedited research on Obesity has confirmed that, adipose tissue is highly active in secreting a variety of proteins, one among them is visfatin. It was originally identified as Pre B cell Colony Enhancing Factor (PBEF), to be secreted by the lymphocytes and can act as a cytokine with immune regulatory action. Besides, it acts as Nicotinamide phosphoribosyl transferase (Nampt), an enzyme involved in the NAD+ salvage pathway. It has been shown to help in the regulation of glucose homeostasis, but whether it binds to insulin receptor and exerts insulin mimetic activity is still a controversy. Visfatin has antiapoptotic activity and has a regulatory role in inflammation. Several studies have identified changes in the circulatory levels of visfatin in diseases. Notable among them are obesity, diabetes mellitus, kidney diseases and bone disorders. It is a molecule of clinical relevance and could be a promising biomarker with diagnostic and prognostic significance.