A Sequent of Gram-Negative Co-Infectome-Induced Acute Respiratory Distress Syndrome Are Potentially Subtle Aggravators Associated to the SARS-CoV-2 Evolution of Virulence.

Acute respiratory distress syndrome (ARDS) is one of the major problems in COVID-19 that is not well understood. ARDS is usually complicated by co-infections in hospitals. Although ARDS is inherited by Europeans and Africans, this is not clear for those from the Middle East. There are severe limitations in correlations made between COVID-19, ARDS, co-infectome, and patient demographics. We investigated 298 patients for associations of ARDS, coinfections, and patient demographics on COVID-19 patients' outcomes. Of the 149 patients examined for ARDS during COVID-19, 16 had an incidence with a higher case fatality rate (CFR) of 75.0% compared to those without ARDS (27.0%) (p value = 0.0001). The co-infectome association showed a CFR of 31.3% in co-infected patients; meanwhile, only 4.8% of those without co-infections (p value = 0.01) died. The major bacteria were Acinetobacter baumannii and Escherichia coli, either alone or in a mixed infection with Klebsiella pneumoniae. Kaplan-Meier survival analysis of COVID-19 patients with and without ARDS revealed a significant difference in the survival time of patients with ARDS (58.8 +/- 2.7 days) and without ARDS (41.9 +/- 1.8 days) (p value = 0.0002). These findings prove that increased hospital time was risky for co-infectome-induced SDRS later on. This also explained that while empiric therapy and lethal ventilations delayed the mortality in 75% of patients, they potentially did not help those without co-infection or ARDS who stayed for shorter times. In addition, the age of patients (n = 298) was significantly associated with ARDS (72.9 +/- 8.9) compared to those without it (56.2 +/- 15.1) and was irrespective of gender. However, there were no significant differences neither in the age of admitted patients before COVID-19 (58.5 +/- 15.3) and during COVID-19 (57.2 +/- 15.5) nor in the gender and COVID-19 fatality (p value 0.546). Thus, Gram-negative co-infectome potentially induced fatal ARDS, aggravating the COVID-19 outcome. These findings are important for the specific differential diagnosis of patients with and without ARDS and co-infections. Future vertical investigations on mechanisms of Gram-negative-induced ARDS are imperative since hypervirulent strains are rapidly circulating. This study was limited as it was a single-center study confined to Ha'il hospitals; a large-scale investigation in major national hospitals would gain more insights.

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.

Role of Parity and Age in Cesarean Section Rate among Women: A Retrospective Cohort Study in Hail, Saudi Arabia.

In the context of the global increase in the rate of cesarean deliveries, with an associated higher morbidity and mortality, this study aimed to investigate the role of maternal age and parity in the cesarean section rate among women in the Hail Region of Saudi Arabia. This retrospective cohort study used data collected from the labor ward of the Maternity and Child Health Hospital, Hail, over a period of 8 months, forming a cohort of 500 women. Women were categorized into four different parity classes. The results revealed that there was no significant relationship between cesarean deliveries and maternal age (p-value, 0.07). There was no significant difference in the mode of delivery between the study's parity cohort group. A significant increase in cesarean deliveries was noticed among obese women with a BMI between 35-39.9 (52.14%). This increase was even greater among those with a BMI above 40 (63.83%). Fetal distress, malpresentation and abruptio placenta were the most significant indications for CS among all age groups (p-value 0.000, 0.021, and 0.048, respectively). Conclusions: The number of cesarean deliveries has no association with parity or age. However, there was a statistically significant association with BMI, a perineal tear after previous vaginal delivery, and a history of diabetes mellitus and gestational diabetes. The most reported reasons for CS were fetal distress, malpresentation, and abruptio placenta among all age groups.

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.

Comparison of Fetomaternal Complications in Women of High Parity with Women of Low Parity among Saudi Women.

High parity is associated with the risk of fetomaternal complications such as gestational diabetes mellitus, hypertensive disorders, maternal anemia, preterm labor, miscarriage, postpartum hemorrhage, and perinatal and preterm mortality. The objective of the study was to compare fetomaternal complications in women of high parity with women of low parity. This involved a cohort study on a sample size of 500 women who had singleton births. Data were collected from the Maternity and Child Hospital, Ha'il, Kingdom of Saudi Arabia. Participants were classified into two groups according to parity, i.e., women of low parity and women of high parity. Socio-demographic data and pregnancy complications, such as gestational diabetes, hypertension, preeclampsia, intrauterine growth restriction, etc., were retrieved from participants' files. Participants were followed in the postnatal ward until their discharge. The results revealed that women of high parity mostly (49%) were married before 20 years of age, less educated, obese, and were of un-booked cases. Premature babies and fetal mortality are significantly high (0.000) in this group. There is a significant difference between the two groups with respect to maternal anemia, gestational diabetes mellitus, joint pain, perineal tear, miscarriage, postpartum hemorrhage, preeclampsia, vaginal tear, and cesarean section. Determinants responsible for high parity should be identified via evidence-based medicine. Public health education programs targeting couples, weight control, nutrition, and contraception would be a cost-effective strategy for reducing the risk of possible fetomaternal complications.