RESUMO
Background: Complications during pregnancy and childbirth are a leading cause of death and disability among women in developing countries. The target for mortality reduction is important, yet accurate data of maternal mortality remains challenging as reporting errors including misclassification of cause of death continue to pose a major challenge. Objectives: This study aimed to identify if there is any discrepancy between clinical and autopsy causes of maternal death. Methods: A review of all maternal deaths records that had two sources for registered cause of death; one made by the obstetrician depending on clinical setting and the other by forensic medicine after autopsy and search for any discrepancies between the two sources. Results: A total of 468 maternal death reports were reviewed; the discrepancies were more with the second commonest cause of maternal death in Iraq which is pulmonary embolism. The review revealed that 10.1% of those clinically died because of pulmonary embolism turned to be dead from other causes; 8.7% of them from postpartum hemorrhage, and the rest from sepsis and other indirect causes. Conclusion: There is a substantial discrepancy between clinical and autopsy causes of maternal death which necessitates asking for autopsy in cases of maternal mortality of uncertain cause. The use of maternal death review within 3-6 weeks of death as a tool to identify causes of maternal deaths is recommended.
RESUMO
BACKGROUND: Anti- N-methyl-D-aspartate receptor (NMDAR) antibodies were found most probably to be accompanied by seizures, particularly in children and sometimes it may be the sole presenting feature. Therefore, testing these antibodies in children with seizure of unexplained cause might be helpful to identify the spectrum of these antibody-mediated disorders. The objective of this study was to determine the frequency of anti-NMDAR antibodies in patients who presented with seizures of unknown cause. METHODS: A case-control study was conducted in two hospitals in Medical City Complex-Baghdad in 2019. Children aged 2-18 years who manifested seizures solely without identified causes were recruited over a period of ten months, with an additional sex- and age-matched control group (forty children in each group). Serum was tested in both groups for anti-NMDAR antibodies. RESULTS: In the study group, males predominated in ages younger than 5 years. The mean age was 6.6 years and the mean duration since their seizures` onset was 2 months. In contrast to male patients, female patients manifested more focal seizures. Only 5 patients (12.5%) were positive for Anti- NMDAR antibodies, in contrast to no one in the control group. Significantly, most of the seropositive patients were females (4, 80%) and showed focal types of seizures (4, 80%). CONCLUSIONS: This is a preliminary epidemiological study about the prevalence of anti-NMDAR antibodies in a sample of pediatric patients with isolated seizures of unknown cause. Anti-NMDAR antibodies were found to be prevalent in a relatively small proportion of children who presented with seizures of unknown causes. Demographic characteristics of the patients with variable testing status were found to be nearly comparable to the results from other related studies.