Every Second Matters - uterine balloon tamponade implementation across ten medical colleges in Maharashtra and Madhya Pradesh in India: A qualitative study.

OBJECTIVE: To understand facilitators, barriers, and perceptions of the Every Second Matters uterine balloon tamponade (ESM-UBT) package implemented across 10 medical colleges in India, 3 years after the program was introduced. METHODS: Semi-structured interviews were conducted until thematic saturation in March 2020. Multiple provider cadres, including nurses, Obstetrics/Gynecology residents, professors, and program leads, were eligible. Interviews were transcribed and thematically coded using an inductive method. RESULTS: Sixty-two obstetric providers were interviewed. Facilitators of implementation included recurrent training, improved teamwork and communication, strong program leadership, and involvement of lower-level facilities. Barriers to implementation included administrative hurdles, high staff turnover, language barriers, and resources required to reach and train lower-level facilities. Overall, the majority of clinicians viewed the ESM-UBT package as a useful intervention in aiding efforts to reduce maternal deaths from postpartum hemorrhage. CONCLUSIONS: Among 10 medical colleges in India the ESM-UBT package is seen as a beneficial intervention for managing refractory atonic postpartum hemorrhage, and for reducing maternal morbidity and mortality. Identified facilitators of and barriers to implementation of the ESM-UBT package in India should be used to guide future implementation efforts.

Evaluation of periostin level for predicting severity and chronicity of childhood atopic dermatitis.

INTRODUCTION: Periostin has some effects on the pathogenesis of atopic dermatitis (AD) via release of pro-inflammatory cytokines and chemokines from activated keratinocytes and it is related to chronicity of skin lesions. AIM: To evaluate the relationship between plasma periostin levels and severity and chronicity of AD in children. MATERIAL AND METHODS: The study population consisted of 29 children with atopic dermatitis without concomitant allergic disease such as asthma or allergic rhinitis and 31 healthy controls. Data of demographic features, serum eosinophil, total IgE and skin prick test results were collected through the patient's medical records. The severity of the disease was assessed by the SCORAD index. Serum periostin levels were measured with a human periostin ELISA kit. RESULTS: The mean ages of the AD patients and the control group participants were 80.7 ±52.8 and 90.3 ±41.6 months, respectively. Mean plasma periostin levels were 63.0 ±19.0 ng/ml in AD patients, and 23.6 ±7.3 in healthy controls, and there was a statistically significant difference between the two groups (p = 0.001). Plasma periostin level did not vary according to total IgE or serum eosinophil count (p > 0.05). Age of onset and duration of symptoms also were not correlated with plasma periostin levels. Although there was a positive relationship between plasma periostin level and the SCORAD index of patients, it was not statistically significant (r = 0.19, p > 0.05). CONCLUSIONS: This study showed that plasma periostin levels were increased in children with atopic dermatitis. Periostin may have a partial role in the pathogenesis of atopic dermatitis, but it is not associated with severity or chronicity in children with atopic dermatitis.

A Case of Anaphylaxis to Measles Vaccination in an Infant with Cow's Milk Allergy.

Background: Cow's milk is one of the most common of the foods that cause food allergies in children. Here, we present a 10-month-old male who was diagnosed with having an allergy to cow's milk and who developed an anaphylactic reaction after being recently vaccinated with a measles vaccine. Case: The patient had been diagnosed with atopic dermatitis and cow's milk allergy at 40 days old after a rash appeared on his face and arms while exclusively breastfeeding. At 9 months, on his routine welfare outpatient appointment, he developed a facial rash and swelling, wheezing, difficulty breathing, and cyanosis within 10 min of having his first measles vaccination (M-VAC®; Serum Institute of India, Hadapsar, Pune, India). After an allergy evaluation and a physical examination that showed that he was otherwise healthy, he was diagnosed with an allergy to cow's milk, which was then eliminated from his diet. Laboratory evaluations were as follows: serum immunoglobulin E (IgE) to cow's milk: 36.2 kU/L, α-lactalbumin: 9.39 kU/L, ß-lactoglobulin: 8.74 kU/L, casein: 34.2 kU/L, latex-specific (sp)IgE: 0.10 kU/L, gelatin spIgE: <0.35 kU/L (normal levels <0.35 kU/L; Pharmacia, Uppsala, Sweden). Results revealed lactalbumin hydrolysate as one of the M-VAC ingredients according to the manufacturer's package insert. Conclusion: In most cases with a cow's milk allergy, vaccines are administered without any problems because the amount of milk proteins contained in the vaccines is not sufficient to represent a risk factor for anaphylaxis; however, the vaccine content should be examined for possible allergens, particularly for children with food allergies, before vaccinating. We should keep in mind when determining the agent responsible for an allergic reaction that the risk from a residual component of milk protein in vaccines can differ according to the nutritional habits of the population.

The minimally invasive approach to the symptomatic isthmocele - what does the literature say? A step-by-step primer on laparoscopic isthmocele - excision and repair.

PURPOSE OF REVIEW: The purpose of this review is to understand the minimally invasive approach to the excision and repair of an isthmocele. RECENT FINDINGS: Previous small trials and case reports have shown that the minimally invasive approach by hysteroscopy and/or laparoscopy can cure symptoms of a uterine isthmocele, including abnormal bleeding, pelvic pain and secondary infertility. A recent larger prospective study has been published that evaluates outcomes of minimally invasive isthmocele repair. Smaller studies and individual case reports echo the positive results of this larger trial. SUMMARY: The cesarean section scar defect, also known as an isthmocele, has become an important diagnosis for women who present with abnormal uterine bleeding, pelvic pain and secondary infertility. It is important for providers to be aware of the effective surgical treatment options for the symptomatic isthmocele. A minimally invasive approach, whether it be laparoscopic or hysteroscopic, has proven to be a safe and effective option in reducing symptoms and improving fertility. VIDEO ABSTRACT: http://links.lww.com/COOG/A37.

Effect of socioeconomic status on allergic diseases and atopy in school children.

Sipahi S, Nacaroglu HT, Can D, Günay I, Ünsal-Karkiner CS, Kamali H, Özdemir A, Günay T. Effect of socioeconomic status on allergic diseases and atopy in school children. Turk J Pediatr 2017; 59: 670-677. Higher family socioeconomic status (SES) has been suggested as a risk factor for allergic diseases. We investigated the effect of SES on the prevalence of allergic diseases and atopy. The study included 13-14-year-old primary school students in Kemalpasa, Turkey. The International Study of Asthma and Allergies in Childhood phase 1 questionnaire was administered to all students to identify allergic diseases. Those identified as having allergic diseases underwent a skin prick test (SPT). Group I included students with allergic diseases and a positive SPT. Group II comprised students with allergic disease who were SPT negative. The control group was randomly selected from the students with no allergic diseases. Three weighted SES scores were calculated for each student (equally weighted, education-weighted, and social class-weighted). SES was classified as lower, middle, or upper according to the weighted SES scores. Allergic diseases were detected in 657 of the 1,373 children who participated in the study. A higher percentage of children with allergic diseases and atopy were in the lower SES group in all weighted SES analyses compared with controls (Group I: 59%, 83.1%, 67.5%; Group II: 62.9%, 80%, 63.5%; control group: 12.4%, 12.9%, 21.2%). Significantly more children with allergic and atopic diseases (Groups I and II) were in the lower SES group compared with the control group (p < 0.001). In contrast to the hygiene hypothesis, we found the incidence of atopic disease was higher in families with lower SES.