Brief Report: Impact of ART on Maternal Health After Cessation of Breastfeeding
Sean S. BrummelTaha E. TahaKonstantia AngelidouFriday SaidiPatience AtuhaireDingase DulaDhayendre MoodleyAllen MatubuGift CharekaNeetal NevrekarTichaona VhemboLee FairlieGerhard TheronPendo MlayKathleen GeorgeMichael BasarNahida ChakhtouraRenee BrowningMary Glenn FowlerJudith S. Currier
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IMPAACT PROMISE 1077BF/FF was a sequentially randomized study of pregnant and postpartum women living with HIV to investigate the efficacy and safety of antiretroviral therapy (ART). This Maternal Health Component investigated efficacy for the risk of developing AIDS or death; and safety among women randomized to continue ART (CTART: N = 289) or discontinue ART (N = 268) after cessation of breastfeeding or after confirmation of infant infection. No AIDS-defining illnesses were reported during follow-up in either arm. Adverse events of grade 3 or higher were more frequent in the CTART arm [hazard ratio = 1.78, 95% confidence interval: (1.05 to 3.02), P-value = 0.03]. The difference in adverse events in the 2 groups was mostly driven by moderate weight loss for women on the CTART arm.Cite
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Background: Upper abdominal surgeries have been reported to be associated with an increased incidence of postoperative atelectasis.Preventing atelectasis is important for all patients but is more important when caring for obese patients.Objectives: To determine which of the following ventilatory strategies is better in prevention of pulmonary atelectasis in obese patients undergoing non-bariatric surgery: Volume control ventilation "VC", Pressure control Ventilation "PC", Volume control ventilation + Positive End Expiratory Pressure "PEEP", Volume control ventilation + Positive End Expiratory Pressure "PEEP" + lung recruitment maneuver.Patients and methods: A randomized-controlled trial study was carried out in the operating room (OR) in Zagazig University Hospital including 92 patients.Patients were randomly allocated into four groups.G1: Volume control ventilation "VC", G2: Pressure control Ventilation "PC", G3: Volume control ventilation + Positive End Expiratory Pressure "PEEP", G4: as in G3 + lung recruitment maneuver.Results: There was significant difference between the studied groups as regards PaO 2 /FiO 2 ratio as the 4 th group was highly significant.There was also significant difference between the studied groups as regards atelectasis score with the least atelectasis score in group 4.There was a significant difference in group 4 than the other groups as regards length of stay in PACU, and need for 100% Fio2 in PACU.Finally, there was a significant difference between the studied groups as regards postoperative pulmonary complications with the 4 th group has the least postoperative complication. Conclusion:Our results suggest that volume control ventilation + Positive End Expiratory Pressure "PEEP" + lung recruitment maneuver had beneficial effects on oxygenation continued into the early recovery period and decrease pulmonary complications in the early post-operative period in obese patients undergoing non-bariatric upper abdominal surgeries.
Atelectasis
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Background: caesarean sections performed every year are increasing in number dramatically all over the world.So, it became very important to give more attention for their postoperative care.Aim of the Work: to evaluate the effect of immediate oral hydration initiated within 2 hours after uncomplicated caesarean section on the following post-operative outcomes: post-operative vomiting and abdominal distention, post-operative nausea and abdominal pain, the return of intestinal movements, duration of intravenous fluid administration, duration of hospital stay and participant satisfaction.Patients and Methods: this randomized controlled study was conducted at Ain Shams University Maternity Hospital.It was carried during the period from July 2016 to July 2017.140 women, all of them underwent uncomplicated cesarean section under regional anesthesia were randomly assigned into two groups.In the immediate group: oral hydration was received in the first 2 hours postoperatively, and in the early group: oral hydration was received after 8 hours postoperatively.Results: all the results of the postoperative outcomes of both groups had non-significant differences except for the psychological satisfaction which was significantly higher in the immediate group with a (p<0.001).Conclusion: immediate oral hydration group showed non-significant differences comparing with early oral hydration group regarding most of the postoperative outcomes, but the results were relatively better towards the immediate group.Also, immediate hydration is significantly better than early hydration regarding psychological satisfaction of women, allowing them to be more able to breastfeed their kids and to spend a less stressful time in the hospital.
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The prognostic role of survivin in colorectal carcinoma remains controversial. This meta-analysis aimed to explore the association between survivin expression and survival outcomes in patients with colorectal carcinoma. A comprehensive literature search for relevant studies published up to April 2013 was performed using PubMed, MEDLINE and ISI Web of Science. Only articles in which survivin was detected by immunohistochemical staining were included. This meta-analysis was done using STATA and Review Manager. A total of 1784 patients from 14 studies were included in the analysis. Our results showed that survivin overexpression in patients with colorectal carcinoma was significantly associated with poor overall survival (hazard ratio, 1.505; 95% confidence interval, 1.197–1.893; P = 0.000) and disease-free survival (hazard ratio, 2.323; 95% confidence interval, 1.687–3.199; P = 0.000). The results indicated that a significant relationship between survivin expression and overall survival was also exhibited in studies with an Asian country (hazard ratio, 1.684; 95% confidence interval, 1.477–1.921), patient number >100 (hazard ratio, 1.604; 95% confidence interval, 1.371–1.877), the cut-off level <50% (hazard ratio, 1.449; 95% confidence interval, 1.045–2.010), the percentage of survivin overexpression >50% (hazard ratio, 1.528; 95% confidence interval, 1.056–2.211) and the hazard ratio estimated (hazard ratio, 1.643; 95% confidence interval, 1.262–2.139). Moreover, upregulation of survivin was associated with stages (III/IV vs. I/II: odds ratio, 1.08; 95% confidence interval, 0.80–1.46), the depth of invasion (T3/T4 vs. T1/T2: odds ratio, 1.79; 95% confidence interval 0.67–4.74), lymph node metastasis (positive vs. negative: odds ratio, 1.49; 95% confidence interval, 0.99–2.26), distant metastasis (positive vs. negative: odds ratio, 2.37; 95% confidence interval, 0.99–5.72) and grade of differentiation (well/moderate vs. poor: odds ratio, 1.02; 95% confidence interval, 0.43–2.41), but without significance. The present meta-analysis indicated that upregulation of survivin was associated with poor prognosis in patients with colorectal carcinoma.
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OBJECTIVE: The present study described the duration and identified the determinants of exclusive breastfeeding. METHODS: The study used data from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher 2006 (National Demographic and Health Survey on Women and Children 2006). Data were collected using questionnaires administered by trained professionals and refer to a subsample of 1,704 children aged less than 24 months. The estimated durations of exclusive breastfeeding are presented according to socioeconomic, demographic and epidemiological variables. Kaplan Meier estimator curves were used to produce valid estimates of breastfeeding duration and the Cox's proportional hazards model was fitted to identify risks. RESULTS: The median estimated duration of exclusive breastfeeding was 60 days. The final Cox model consisted of mother's age <20 years (hazard ratio=1.53, 95% confidence interval=1.11-1.48), use of pacifier (hazard ratio=1.53, 95% confidence interval=1.37-1.71), not residing in the country's southeast region (hazard ratio=1.22, 95% confidence interval=1.07-1.40) and socioeconomic status (hazard ratio=1.28, 95% confidence interval=1.06-1.55). CONCLUSION: The Kaplan Meier estimator corrected the underestimated duration of breastfeeding in the country when calculated by the current status methodology. Despite the national efforts done in the last decades to promote breastfeeding, the results indicate that the duration of exclusive breastfeeding is still half of that recommended for this dietary practice to promote health. Ways to revert this situation would be ongoing educational activities involving the educational and health systems, associated with advertising campaigns on television and radio mainly targeting young mothers with low education level and low income, identified as those at high risk of weaning their children early.
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