Yao Syndrome: An Overview of Genotypic Associations, Clinical Manifestations, Diagnosis, and Treatment.

BACKGROUND: Yao syndrome (YAOS) is a rare systemic autoinflammatory disorder (AID) of the innate immune system. It was recently categorized as genetically transitional disease (GTD) and is associated with NOD2 variants located at multiple NOD2 gene loci. Unlike most other periodic fever syndromes, the estimated disease prevalence is 1-10/100,000 with a predominance for females and white adult population. In this review, we aimed to provide a detailed analysis of different aspects of this syndrome to help better understand the underlying pathogenesis and incorporate the current evidence-based medicine published to diagnose and manage these patients. SUMMARY: We conducted literature search on YAOS from 2011 to 2024 using PubMed, Embase, and Scopus databases. Thirty-two studies were included in our narrative review. A descriptive analysis was performed of both Yao and non-Yao authored records to embrace the syndrome reported from all investigators and assess differences and similarities. The most reported gene variant is the homozygous IVS8+158 followed by compound heterozygous IVS8+158 and R702W. Mean age of disease onset is between 36 and 42 years. The mean age of disease diagnosis is between 40 and 45 years with a variable disease duration. Fever is the most commonly reported symptom followed by musculoskeletal, gastrointestinal symptoms and dermatitis. On laboratory workup, patients have elevated levels of erythrocyte sedimentation rate, C-reactive protein, and serum ferritin with negative autoantibody workup. Arthritic symptoms in YAOS patients have a positive response to sulfasalazine and glucocorticoids, while nonsteroidal anti-inflammatory drugs and colchicine produce minimal response. Anti-IL1 and anti-IL6 agents (canakinumab, anakinra, and tocilizumab) are effective treatment modalities. KEY MESSAGES: The evolving concept and acceptance of GTD will hopefully further our understanding about this SAID and similar disorders. We suggest developing a registry of patients with YAOS to keep track of expanding data on this subject. It is important to understand various aspects of YAOS including genetic and environmental factors, differential diagnosis, clinical manifestations, laboratory findings, and treatment options available to diagnose and manage these patients appropriately and timely.

Postoperative dysgeusia following microsurgical resection for acoustic neuroma: a systematic review and meta-analysis.

OBJECTIVE: To determine the collated rate of postoperative dysgeusia after microsurgical intervention in acoustic neuroma patients. METHODS: The systematic review with meta-analysis was undertaken following PRISMA guidelines. A thorough search of PubMed/Medline, the Cochrane Database of Systematic Reviews, and Epistemonikos was undertaken for studies published up until May 16, 2024 reporting postoperative taste disturbance rates after microsurgical intervention for acoustic neuroma. The methodological quality of the included studies was assessed via the Methodological Index for Non-Randomized research (MINORS) tool. Using MedCalc (v. 20.215) software, the random-effects model was developed for proportional meta-analysis. RESULTS: Eight studies, encompassing 2,402 patients (mean age = 49.06 years; 48.54% female population), were included in the analysis. The overall pooled rate of postoperative dysgeusia following microsurgical management of acoustic neuroma was 23.7% (95% CI: 9.266-42.359, p < 0.0001). When stratified by surgical approach, the rate of postoperative dysgeusia for the retrosigmoid approach was 18.8% (95% CI: 2.821-44.461, p < 0.0001). Postoperative dysgeusia data stratified for other major microsurgical approaches (subtemporal and translabirynthine approaches) was not reported by any of the included studies. CONCLUSION: Our systematic review and meta-analysis calculated a collated rate of almost 25% and recognized postoperative dysgeusia as a common complication following microsurgical management of acoustic neuromas. These results highlight the significance of preoperative counselling and the development of strategies that minimize the likelihood of harm to the chorda tympani nerve during microsurgical intervention for acoustic neuroma.

High prevalence of food insecurity in peri-urban communities in Karachi, Pakistan: The flood aftermath.

BACKGROUND: Food insecurity (FI) is at a steep risk, especially in low middle-income countries. FI is further compounded in areas that experience environmental and economic instability, thus a reassessment in such critical times is required for burden estimation and to propose targeted interventions. AIMS: The objectives of this study were to assess the prevalence of, and sociodemographic factors associated with FI, as well as the coping strategies utilized in response to FI in peri-urban communities in Karachi, Pakistan. METHODS: We conducted a cross-sectional survey from November-December 2022 on 400 households in four peri-urban communities in Karachi, Pakistan. The Household Food Insecurity Access Scale (HFIAS) and reduced Coping Strategies Index (rCSI) questionnaire were used to assess FI. A Poisson regression was used to assess associations between sociodemographic factors and FI. RESULTS: The overall prevalence of FI was found to be 60.2% (n = 241) of which 33.8% (n = 135) were severely food insecure. Age, women's and breadwinners' education, women's occupation, and parity were significantly associated with FI. Participants reported relying on less expensive foods (44%) and borrowing food or help from others (35%) as the most common coping strategies overall in the FI households. CONCLUSION: With more than half the households facing FI and adopting severe measures to cope in these communities, it is pivotal to design and test interventions that can withstand economic and climate catastrophes and help ensure a safety need for food security for the most vulnerable.

Tackling a Post-COVID-19 Cholecystectomy Waiting List: Are We Meeting the Challenge?

Background and Objectives: The COVID-19 pandemic has led to a tremendous backlog in elective surgical activity. Our hospital trust adopted an innovative approach to dealing with elective waiting times for cholecystectomy during the recovery phase from COVID-19. This study aimed to evaluate trends in overall cholecystectomy activity and the effect on waiting times. Materials and Methods: A prospective observational study was undertaken, investigating patients who received a cholecystectomy at a large United Kingdom hospital trust between February 2021 and February 2022. There were multiple phased strategies to tackle a 533-patient waiting list: private sector, multiple sites including emergency operating, mobile theatre, and seven-day working. The correlation of determination (R2) and Kruskal-Wallis analysis were used to evaluate trends in waiting times across the study period. Results: A total of 657 patients underwent a cholecystectomy. The median age was 49 years, 602 (91.6%) patients had an ASA of 1-2, and 494 (75.2%) were female. A total of 30 (4.6%) patients were listed due to gallstone pancreatitis, 380 (57.8%) for symptomatic cholelithiasis, and 228 (34.7%) for calculous cholecystitis. Median waiting times were reduced from 428 days (IQR 373-508) to 49 days (IQR 34-96), R2 = 0.654, p < 0.001. For pancreatitis specifically, waiting times had decreased from a median of 218 days (IQR 139-239) to 28 (IQR 24-40), R2 = 0.613, p < 0.001. Conclusions: This study demonstrates the methodology utilised to safely and effectively tackle the cholecystectomy waiting list locally. The approach utilised here has potential to be adapted to other units or similar operation types in order to reduce elective waiting times.

Defining Success in Transitions from Pediatric to Adult Chronic Pain Care: A Descriptive Qualitative Study of Perspectives of Young Adults Living with Chronic Pain.

OBJECTIVE: To explore how young adults with chronic pain define a successful transition from pediatric to adult chronic pain care and how they would like to be empowered to achieve a successful transition. DESIGN: A descriptive qualitative design. SETTING: Participants were recruited from a hospital-based chronic pain clinic in Toronto, Canada, and through social media. SUBJECTS: Young adults (18-25 years of age, inclusive) who received chronic pain care in a pediatric setting and continued to self-identify as having a need for chronic pain care in an adult chronic pain care setting. METHODS: Semistructured interviews were used to understand the perspectives of young adults with chronic pain. Interviews were audio-recorded, transcribed verbatim, and checked for accuracy. Qualitative inductive content analysis was used to analyze the interview data. RESULTS: Eight young adults with chronic pain were interviewed (all women; median age=19 years). Five themes that addressed the study objectives are described: 1) Young adults value skill-building and knowledge about the transition, 2) establishment of a strong therapeutic alliance with health care providers, 3) coordinated and planned transition, 4) social and environmental support, and 5) respect for young adults' independence and autonomy. CONCLUSION: Findings suggest the need for a collaborative and individualized approach to the successful transition of young adults across the continuum of chronic pain care that addresses their unique needs. To promote successful transition, clinicians should build relationships with young adults that facilitate choice and autonomy while enhancing skill-building and education on available resources.

Concentration and Localization of Fe and Zn in Wheat Grain as Affected by Its Application to Soil and Foliage.

Nutritional status of people can be improved by enhancing zinc (Zn) and iron (Fe) content in cereals used as staple mainly in poor resource countries. Zinc and Fe were applied through soil and foliage in a study to biofortify wheat grains. Foliar application of both micronutrients increased the growth and grain vigor as compared to soil application and control. Also, foliar application significantly enhanced Zn and Fe concentration in grain pre-dominantly localized in aleurone layer. Exogeneous application of Fe and Zn was found beneficial for plant growth and enhanced Fe and Zn concentrations in grain, however aleurone layer and embryonic region of the grain showed higher accumulations than that in endosperm. Therefore, understanding of physiological and molecular pathways for uptake and localization of Fe and Zn in wheat grains need to be critically examined to improve their concentration in grain to achieve the biofortification targets.

Estimation of aerosol optical depth in relation to meteorological parameters over eastern and western routes of China Pakistan economic corridor.

This study finds out seasonal and monthly variations in Aerosol Optical Depth (AOD) over eastern and western routes of China Pakistan Economic Corridor (CPEC) and the relationship between AOD and meteorological parameters (i.e., temperature, rainfall and wind speed). The Moderate Resolution Imaging Spectroradiometer (MODIS) and Multi-angle Imaging Spectroradiometer (MISR) data was used from the terra satellite for the period of 2000-2016. This study aims to overtake the conventional view of the purpose of using the satellite datasets. This study takes on to the concept that validated satellite data sets rather should be used for the analysis instead of just validation specifically for our study region. Hence, after comparing MODIS AOD with MISR AOD, only MISR AOD dataset is used for further analysis. The results show a decreasing trend of AOD in summer season, a positive relationship between temperature and AOD during winter and spring seasons whereas a positive relationship between wind speed and AOD in winter and spring seasons over eastern and western routes. Periodic analysis of MODIS AOD and MISR AOD depicts May-Aug as the peak period of aerosol concentration over central Pakistan. The inter-annual analysis shows the aerosol trend remained higher during summer season however rainfall shows the washout effect. Eastern route has higher standard deviation and larger values for aerosol prevalence as compared to western route. The trajectory analysis using the HYSPLIT model suggests the bias of air mass trajectory caused deviation in the aerosol trend in the year 2014.

Antimicrobial susceptibility patterns among community and health care acquired carbapenem resistant Enterobacteriaceae, in a tertiary care hospital of Lahore.

OBJECTIVE: To compare the disk susceptibility pattern of healthcare acquired carbapenem-resistant enterobacteraceae with that of community-acquired isolates and their associated clinical presentations. METHODS: The cross-sectional study was conducted at the Department of Microbiology, Combined Military Hospital, and the Institute of Dentistry, Lahore, Pakistan, from November 2017 to July 2018. Patients with positive carbapenem-resistant enterobacteraceae cultures from clinical specimens were included. All the isolates were identified through conventional methods and standard biochemical tests. Antibiotic susceptibility testing was performed by Kirby Bauer Disk Diffusion method on Muller Hinton Agar plates. Data was analysed using SPSS 23. RESULTS: Of the 123 isolates identified, 97(79%) were healthcare acquired and 26(21%) were community-acquired. Statistically significant susceptibility patterns (p<0.001) of community acquired isolates were observed against cefoperazone-sulbactum and amikacin, while a low significance was observed with gentamycin (p<0.05). Significant results were obtained in case of colistin against both the groups (p<0.001). CONCLUSIONS: There was low antimicrobial resistance in community acquired carbapenem-resistant enterobacteraceae isolates.

Dietary practices of school children in Sindh, Pakistan.

BACKGROUND: Malnutrition in Pakistan has remained an unresolved issue for decades. Data on nutrient intake and variety in children's diet is lacking. AIM: This paper describes the dietary practices of school children across eight districts of Sindh. METHODS: A school-based survey of dietary practices among 1109 students from classes 2-5 in 36 schools was conducted using a pre-tested interviewer-completed questionnaire. RESULTS: Descriptive and comparative analysis of data showed that more than 75% school children ate breakfast, lunch and dinner regularly. However, 10% children skipped breakfast and nearly one-third of them skipped mid-morning and evening snacks. Skipping breakfast and snacks was related to low socio-economic status and rural residence. Children's intake of protein-rich food items and fruits also illustrated that urban residence and better socio-economic status have a positive effect on the frequency and variety of daily protein and fruit intake. Though affordability and geographic location were key determinants of children's dietary practices, significantly higher percentages of children studying in class 2, 3 and 4 consumed different kinds of protein-rich food items, fruits and vegetables more frequently as opposed to children studying in class 5. Junk food consumption was more common in urban areas and better socio-economic strata. CONCLUSION: Development of school-based nutrition education programmes and behavior change strategies emphasizing the regular intake of meals and nutrient-rich snacks, and encouraging consumption of easily available and affordable food items such as dried seeds, fruits, vegetables, milk and its derivatives is essential for addressing nutrient deficiencies.

Development of a rapid resolution HPLC method for the quantitative determination of sitagliptin in Human plasma.

A new high performance liquid chromatography (HPLC) method for the quantitative determination of sitagliptin in human plasma was developed and validated for pharmacokinetics study. The plasma was spiked with the internal standard (Salbutamol, IS), extracted with trichloro acetic acid. The extracted analyte was injected into a Symmetry® ODS C18 column (250mm×4.5mm, 5m) and the flourometric detector was operated at 267nm for excitation and 575nm for emission. The mobile phase consisting of Potassium dihydrogen phosphate buffer pH (4.9)-Acetonitrile-Methanol (30:50:20 v/v) at flow rate of 1.0mL/min. The method showed high specificity. Calibration curves of the peak area ratio of each analyte/IS versus sitagliptin concentration were linear in the range of 0.122-31.25µg/mL (r>0.989) for plasma and 0.012-25ug/ml for QC solution(r>0.995). The lower limit of quantification (LLOQ) was 0.122µg/mL in plasma and 0.012 in QC solution. The intraday and interday coefficient of variation was lower than 10%. The accuracy (relative recovery) at three levels was 100.95%, 101.03% and 97.79% respectively. The extraction recovery was 97.6%, 92.2% and 91.96% at the concentrations of 6.25, 25 and 100µg/mL, respectively. Short term and long term, freeze thaw stability of standard solutions and plasma samples were satisfactory. The optimized HPLC method was validated and proved to be specific, robust and accurate for determination of Sitagliptin in human plasma.

PTEN: A potential prognostic marker in virus-induced hepatocellular carcinoma.

PTEN is the second most frequently mutated tumor suppresser gene in cancers after p53. Genetic and epigenetic alterations in the PTEN gene and its regulatory regions have been reported in various studies. PTEN is a crucial downregulator of the pro-survival phosphoinositide 3-kinase/Akt/mammalian target of rapamycin pathway and also suppresses insulin signaling. Failure to regulate these pathways leads to increase in cell proliferation and migration which in turn promotes tumorigenesis. PTEN underexpression is mediated by a variety of cytokines and stress kinases which seem to collectively induce the RAS/mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase (ERK) pathway. In the context of hepatocellular carcinoma, reduced expression of PTEN is seen in nearly half of the cases on average. In some cases, PTEN has been observed to be either mutated or methylated which can also lead to reduced expression or in some cases, complete loss of expression. On the cellular level, PTEN is also a target in the pathogenic pathway of hepatitis C virus core protein and hepatitis B virus X protein. These viruses appear to alter PTEN regulation and pro-apoptotic ability to enhance the process of tumor formation. In perspective of the crucial role PTEN plays in balancing proliferation and apoptosis, we propose PTEN as a valuable marker in the diagnosis, assessment of tumor grade, and disease stage in hepatocellular carcinoma patients.

Atrial Myxoma: Presenting as a Large Splenic Infarction.

Cardiac myxomas are the most common benign primary heart tumors, with the majority occurring in the left atrium. Clinical manifestations are a result of constitutional, obstructive, and/or embolic events. Complications include myocardial infarction and stroke, as well as renal and limb ischemia. Our unusual case is a middle-aged female who presented with a one-week history of progressively worsening abdominal pain and was found to have a large splenic infarction on a CT scan. There was no personal or family history of autoimmune diseases or hypercoagulable states. The evaluation revealed a large left atrial myxoma confirmed on biopsy after surgical resection. Our patient's clinical presentation was relatively benign compared to the size of her mass. Although her myxoma was very large, morphologically solid, and attached to the interatrial septum, she did not have any evidence of congestive heart failure. The tumor's irregular surface and mobility likely led to splenic embolization. Hence, the differential diagnosis of splenic infarction should include left atrial myxoma.

Awareness regarding breast cancer amongst women in Pakistan: A systematic review and meta-analysis.

BACKGROUND: Breast cancer (BCa) is the most common cause of cancer death in Pakistan. In 2019, Pakistan saw the highest global BCa-associated death rate. But do Pakistani women know about the various aspects of BCa? And how prevalent are BCa screening methods amongst Pakistani females? These questions formed the basis for our study. METHODS: We conducted this review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. On September 1, 2023, we searched PubMed, Embase, Scopus, and Google Scholar, and performed a citation search to search for eligible studies published in 2010 or after, using the following terms: "breast cancer" and "Pakistan". Observational studies that evaluated BCa awareness and/or practice amongst Pakistani females who were not associated with medicine were eligible. We used the National Institutes of Health quality assessment tool to assess the risk of bias. We conducted a proportion meta-analysis to calculate pooled prevalences for variables. RESULTS: Responses from 9766 Pakistani women across 18 included studies showed alarmingly low levels of BCa knowledge: risk factors, 42.7% (95% CI: 34.1%-51.4%); symptoms, 41.8% (95% CI: 26.2%-57.5%); diagnostic modalities, 36.3% (95% CI: 23.1%-49.4%); treatments, 46.6% (95% CI: 13.5%-79.8%). Prevalence of breast self-examination (BSE) and ever having undergone a clinical breast exam (CBE) was 28.7% (95% CI: 17.9%-39.6%) and 15.3% (95 CI: 11.2%-19.4%), respectively. BCa knowledge was significantly associated with better educational status, age, and socioeconomic status. CONCLUSION: On average, only two in five Pakistani women are aware of one or more risk factors, symptoms, or diagnostic modalities. Approximately one in two women know about possible BCa treatment. Less than one in three women practice regular BSE, and less than one in five women have ever undergone a CBE.

Scalp metastasis from atypical meningioma: A case report and literature review.

Key Clinical Message: Scalp metastasis from atypical meningioma, though rare, underscores the importance of meticulous surgical techniques to prevent tumor cell implantation. Early detection and comprehensive management, including surgery and adjuvant therapy, are crucial for optimal outcomes. Abstract: Meningiomas are tumors of the meninges that originate in the arachnoid layer from arachnoid cap cells. Atypical meningiomas, classified as WHO grade 2 tumors, tend to metastasize and recur if not surgically managed properly. Scalp metastasis is a rare occurrence that presents as a subcutaneous elevation. A 33-year-old patient presented with a complaint of a constant, dull pressure headache persisting for the past 12 months, exacerbated by exertion, along with seizures and neuropsychiatric symptoms. The patient had no significant medical history but had undergone surgery 4 years ago for a WHO grade 2 meningioma. The current brain MRI revealed a dural tail sign, along with masses on both the left and right sides of the frontal lobe, extending to involve the skin on the forehead and scalp. The patient underwent surgical resection and adjuvant radiation therapy. At the 12-month follow-up, no neurological deterioration or tumor recurrence was observed. A literature review on scalp metastasis in patients with atypical meningioma was also conducted, including eight articles published up to September 2023. The mechanism of metastasis development appears to be consistent in all eight reported cases, involving the implantation of tumor cells during resection. Therefore, there is a critical need for meticulous intra- and post-operative surgical techniques to prevent such implantation.

Current otolaryngologic applications of the novel self-assembling RADA-16 peptide matrix.

A novel bioresorbable agent on the market is PuraGel® (3-D Matrix, Tokyo, Japan), a RADA-16 product that acts as a synthetic hemostatic and space-filling gel that promotes wound healing and prevents adhesion formation. Given the reported benefits of accelerated wound healing and scar tissue prevention, there are multiple otolaryngologic applications where RADA-16 might improve outcomes. Our study highlights current utilization and associated post-operative complications with this product.

Does percutaneous cholecystostomy timing in high anaesthetic-risk patients impact on outcome?

The optimal timing for percutaneous cholecystostomy (PCT) in patients with acute biliary sepsis, who are high-risk for cholecystectomy, requires further investigation. We aimed to study local factors influencing the timing to PCT placement, and investigate patient outcomes in early (≤ 48 h) vs. delayed PCT over a six-year period. A retrospective observational study investigating patients who required a PCT at a single hospital in the UK between January 2014 and December 2019. Placement of a PCT was at the discretion of the on-call surgical consultant according to their own personal experience and not based on a standard local protocol. Clinical outcomes, hospital statistics and details of any subsequent bridging surgery were analysed using multivariate logistic regression models adjusting for age, sex, Charlson Comorbidity Index (CCI) and American Society of Anaesthesiologists (ASA) grade. There were 72 patients with 35/72 (48.6%) classed as TG18 AC grade 3; 26/72 (36.1%) had an early PCT placed and 46/72 (63.9%) delayed. Median age was 76 (65-83) years, 52.8% were female, and 51.4% were classed ASA ≥ 3 with 94.0% scoring CCI > 2. Trial on antibiotic therapy was the primary reason for delayed PCT. In adjusted models, early PCT was associated with a shorter length in hospital stay (OR 3.02, p = 0.044), successful definitive treatment (OR 6.26, p = 0.009); and reduced likelihood for catheter dislodgment (OR 0.12, p = 0.004) with fewer patients bridging to later emergency open surgery (OR 0.19, p = 0.024). Clinical outcomes may be superior in urgent or early PCT for high anaesthetic-risk patients following acute biliary sepsis.

Why do women still give birth at home; perceptions of Pakistani women and decision-makers from marginalized communities.

In low- and middle-income countries (LMICs), maternal and newborn mortality is high due to the high prevalence of home births. Understanding the reasons behind this behavior is essential for improving maternal and newborn outcomes. Therefore, a qualitative exploratory study was conducted in a peri-urban community in Karachi, Pakistan to understand the perceptions of pregnant women who delivered at home despite receiving antenatal care and the perceptions of their decision-makers regarding this behavior. In-depth interviews were conducted with 15 randomly sampled women who chose to deliver at home after receiving antenatal care at a health facility, as well as 15 family members who were purposively identified as decision-makers by the women themselves. Thematic analysis was performed to explore the perceptions, myths, and cultural beliefs about homebirths as well as women's decision-making power related to childbirth. The three main themes identified showed that traditional beliefs and practices, poverty and gender inequality, and poor healthcare systems significantly influence the preference for childbirth. Traditional beliefs and practices, including religious and cultural beliefs, played a role in perceiving childbirth as a natural process best managed at home. The presence of traditional birth attendants who provide personalized care and emotional support further reinforced this preference. Gender inequalities, including limited access to mobile phones and women's caregiving roles, were identified as barriers to seeking formal healthcare at the time of delivery. Additionally, poor experiences with the formal healthcare system, such as the poor attitude of formal healthcare workers and fear of medical interventions, also contributed to the decision to deliver at home. The study highlighted the complex interplay between traditional/religious beliefs, gender inequalities, and healthcare experiences in shaping the decision to deliver at home despite receiving ANC services in marginalized settings. Addressing these factors is necessary for promoting facility-based delivery and improving maternal and neonatal outcomes in LMICs.

The Association between Grand Multiparity and Adverse Neonatal Outcomes: A Retrospective Cohort Study from Ha'il, Saudi Arabia.

Inconsistent evidence exists regarding the association of grand multiparity with adverse neonatal outcomes. This study aims to compare specific adverse outcomes in grand multiparas (those with five or more births at twenty or more weeks of gestation, regardless of fetal outcome) compared to those with lower parity (those with less than five births at twenty or more weeks of gestation, regardless of fetal outcome). A retrospective cohort study was undertaken at the Maternity and Children Hospital in Ha'il region, Saudi Arabia. After calculating the required sample size, data were collected from consenting participants with a viable singleton delivery. Socio-demographic variables, select maternal characteristics, and adverse neonatal outcomes (admission to the neonatal intensive care unit, low birth weight, prematurity, and APGAR score less than 7 in the first 5 min) were compared between grand multiparas and women with lower parity. Two hundred ninety-four participants were recruited (ninety-eight grand multiparas and one hundred ninety-six of lower parity). There was a statistically significant difference between the two groups in relation to age, level of education, body mass index, and the occurrence of gestational diabetes. Out of the studied adverse neonatal outcomes after the adjustment for maternal age between the two groups, no statistically significant difference in the adverse neonatal outcomes was found between the two groups. Grand multiparity does not incur an additional risk of adverse neonatal outcomes compared to women of lower parity. Furthermore, increasing maternal age and comorbid conditions might have a more detrimental effect on neonatal outcomes than grand multiparity per se.

The Effect of High Parity on the Occurrence of Anaemia in Pregnant Women.

OBJECTIVE: To compare high-para and low-para women with respect to haematological findings, determinants, and consequences secondary to anaemia. STUDY DESIGN: Descriptive cohort study. Place and Duration of the Study: Maternity and Child Hospital, Hail, Saudi Arabia and Specialist Care Hospital (private), Islamabad, Pakistan, from April 2022 to April 2023. METHODOLOGY: The study population comprised of pregnant women in the last trimester, with the exception of those women who had more than one fetus and history of haematological disease. Purposive non-probability sampling technique was adopted. Hospital data were retrieved retrospectively for the past obstetrical, contraception usage, and supplement history. Blood parameters, type of delivery, and maternofetal complications were noted down. For qualitative-variable and quantitative-variable comparisons, Chi-square test and t-test were applied, respectively. Significance level was kept at p ≤0.05. RESULTS: The frequency of severe anaemia in high-para was 52%. High parity and anaemia had a significant dose-response relationship (p <0.05). There was a significant difference (p <0.05) in blood parameters between high-para and low-para groups. Main determinants identified for anaemia were lack of intake of iron-rich food (36%) followed by inadequate intake of oral iron (25%). Preterm birth (68%) and post-partum haemorrhage (96%) were significantly associated (p <0.05) with high parity. There was a significantly high proportion (83%) of high-para women with more than 3 cesarean deliveries and admissions in ICU. CONCLUSION: High parity and anaemia had a significant dose-response relationship. High parity was the main determinant of maternal and fetal admissions in ICU. KEY WORDS: Parity, Comparison, Maternal anaemia, Haematological findings, Diet, Contraception, Cost-effective.