The Mid-Upper Arm Circumference as a Substitute for Body Mass Index in the Assessment of Nutritional Status among Pregnant Women: A Cross-Sectional Study.

To compare mid-upper arm circumference (MUAC) with body mass index (BMI) and propose MUAC cut-off points corresponding to BMIs of <18.5 kg/m2 (underweight) and ≥30.0 kg/m2 (obesity) for pregnant Sudanese women, a cross-sectional community-based study was conducted in the city of New Halfa, Sudan. Healthy pregnant women were recruited. Body parameters such as height, weight, and MUAC were measured. The MUAC (cm) cut-off values for underweight and obesity were determined using receiver operating characteristic (ROC) curve analysis. Of 688 pregnant women, 437 were in early pregnancy (<20 weeks of gestation) and 251 were in late pregnancy (≥20 weeks of gestation). There was a significant positive correlation between BMI and MUAC among women in both early pregnancy (r = 0.734) and late pregnancy (r = 0.703). The cut-off points of MUAC for detecting underweight and obesity were found to be 24.0 cm and 29.0 cm, respectively, for women in early pregnancy, with good predictive values. For women in late pregnancy, the cut-off points for detecting underweight and obesity were 23.0 cm and 28.0 cm, respectively. We concluded that for Sudanese pregnant women, the MUAC cut-off points identified in the study for diagnosing underweight and obesity are both sensitive and specific.

Efficacy and Safety of the Telestroke Drip-And-Stay Model: A Systematic Review and Meta-Analysis.

OBJECTIVES: To compare outcomes between two models of acute ischemic stroke care. Namely 1) "drip-and-stay", i.e. IV tissue plasminogen activator (tPA) administered at a spoke hospital in a telestroke network, with the patient remaining at the spoke, versus 2) "drip-and-ship", i.e. tPA administered at a spoke hospital with subsequent patient transfer to a hub hospital, and 3) "hub", i.e. tPA and subsequent treatment at a hub hospital. MATERIALS AND METHODS: We performed a systematic review and meta-analysis according to PRISMA guidelines. Literature searches of MEDLINE, Embase, and Cochrane from inception-October 2019 included randomized control trials and observational cohort studies comparing the drip-and-stay model to hub and drip-and-ship models. Outcomes of interest were functional independence (modified Rankin Scale ≤ 1), symptomatic intracranial hemorrhage (sICH), mortality, and length of stay. Pooled effect estimates were calculated using a fixed-effects meta-analysis and random-effects Bayesian meta-analysis. Non-inferiority was calculated using a fixed-margin method. RESULTS: Of 2806 unique records identified, 10 studies, totaling 4,164 patients, fulfilled the eligibility criteria. Meta-analysis found no significant difference in functional outcomes (mRS0-1) (6 studies, RR=1.09, 95%CI 0.98-1.22, p=0.123), sICH (8 studies, RR=0.98, 95%CI 0.64-1.51, p=0.942), or 90-day mortality (5 studies, RR=0.98, 95%CI 0.73-1.32, p=0.911, respectively) between patients treated in a drip-and-stay model compared to patients treated in drip-and-ship or hub models. There was no significant heterogeneity in these outcomes. Drip-and-stay outcomes (mRS 0-1, sICH) were non-inferior when compared to the combined group. CONCLUSIONS: Our findings indicate that drip-and-stay is non-inferior to current models of drip-and-ship or hub stroke care, and may be as safe and as effective as either.

Association of Maternal Anemia and Cesarean Delivery: A Systematic Review and Meta-Analysis.

Anaemia during pregnancy is associated with an increased incidence of caesarean delivery (CD). This study was conducted to explore the association between CD and maternal anaemia. The PubMed/MEDLINE, Cochrane, Google, Google Scholar and ScienceDirect databases were searched for relevant studies on this topic. The assessment and review were conducted with the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. The studies were assessed using the modified Newcastle−Ottawa quality assessment scale. Data were collected in an Excel sheet, and the 'meta' package of the R 4.0.3 software was used for statistical analysis. Fourteen studies that enrolled 336,128 pregnant women were included in the meta-analysis. Women with anaemia were found to be at a higher risk for CD (OR = 1.63, 95% CI = 1.23−2.17). As heterogeneity was detected in the studies, the random-effects model was used for the pooled meta-analysis (Q = 96.7, p < 0.001). In the subgroup analysis, anaemic women were found to be at higher risk for CD in studies from both low-middle-income (7) and high-income countries (7). In meta-regression analysis, none of the investigated covariates were associated with the pooled OR of CD. This evidence demonstrates with a moderate level of certainty that anaemic pregnant women are more likely to have CD than non-anaemic pregnant women.

Prevalence of and risk factors for periodontal disease among pregnant women in an antenatal care clinic in Khartoum, Sudan.

OBJECTIVES: The aim was to investigate the prevalence of and factors associated with periodontal disease among pregnant Sudanese women. A cross-sectional study was conducted at the Antenatal Care Clinic of Saad Abualila Hospital (Khartoum, Sudan) from August to October 2018. Socioeconomic-demographic information and reproductive history were gathered using a questionnaire. Body mass index was computed from the weight and height. The diagnosis of periodontal disease was performed using criterion that also evaluated bleeding upon probing. RESULTS: Four hundred and four women were enrolled in the study, with a mean (SD) gestational age of 30.0 (8.7) weeks. Their mean (SD) age and parity were 27.0 (5.7) years and 1.6 (1.7), respectively. Ninety-seven (24.0%) of these 404 women had periodontal disease, which was mild, moderate and severe in 49 (12.1%), 36 (8.9%) and 12 (3.0%) women respectively, while 307 (76.0%) women had no periodontal disease. In logistic regression, age, parity, education, and brushing were not associated with periodontitis, but lower gestational age was associated with periodontal disease (OR = 0.96, 95% CI 0.94-0.99, P = 0.011).

Low neonatal blood glucose levels in cesarean-delivered term newborns at Khartoum Hospital, Sudan.

BACKGROUND: Glucose is the main source of energy for organ function in neonates. There are few published recent data on neonatal glucose levels during cesarean delivery. METHODS: A case (cesarean delivery) -control (vaginal delivery) study was conducted at Khartoum Hospital Sudan to compare blood glucose levels of term newborns born after elective cesarean delivery with those born vaginally. RESULTS: Cord blood glucose levels at delivery were significantly lower in women who had a cesarean delivery compared with those who delivered vaginally (99.8 ± 20.6 vs. 106.8 ± 11.1 mg/dl, P=0.026), but there was no significant difference (97.8 ± 16.7 vs. 102.1 ± 9.6, P=0.110) in newborn glucose levels at 2 hours after delivery between the groups. In linear regression, cesarean delivery (-6.475 mg/dl, P=0.013) and maternal blood glucose levels at the time of delivery (+0.619 mg, P<0.001) were significantly associated with mean cord glucose levels. CONCLUSION: This study shows that cord blood glucose levels are significantly lower in cesarean-delivered neonates than vaginally-delivered neonates. In addition, cord blood glucose levels are significantly associated with cesarean delivery and maternal blood glucose levels at delivery. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2011479878124993.

Epidemiology of underweight and overweight-obesity among term pregnant Sudanese women.

BACKGROUND: The increasing prevalence of obesity in young women is a major public health concern. Few data are available concerning the epidemiology of malnutrition especially obesity among pregnant women in the developing countries. A cross sectional study was conducted at Khartoum hospital during February-April 2008, to investigate prevalence of underweight, obesity, and to identify contemporary socio-demographic predictors for obesity among term pregnant women in Khartoum Hospital, Sudan. After taking an informed consent, a structured questionnaire was administered to each woman to gather information on educational level, age and parity. Maternal weight and height were measured and expressed as body mass index (BMI - weight (kg)/height (m) 2). FINDINGS: Out of 1690 term pregnant women, 628 (37.1%) were primigravidae, 926 (54.8%) had ≥ secondary educational level (minimum of 8 years) and 1445 (85.5%) were housewives. The mean (SD) of the age and parity were 27.2 (6.3) years and 2.0 (2.1) respectively. Out of these 1690 women, 94(5.5%) were underweight (BMI of ≤ 19.9 Kg/m2), 603 (35.6%) were overweight (BMI of 25 - 29.9 Kg/m2) and 328 (19.4%) were obese (BMI of ≥ 30 Kg/m2).In multivariate analyses, obesity was positively associated with age (OR = 1.2, 95% CI = 1.0-1.1; P< 0.001), and with women's education (OR = 1.8, 95% CI = 1.2-2.7; P = 0.001). Obesity was positively associated with parity in univariate analyses only (OR = 1.1, 95% CI = 1.0-1.2; P = 0.02) CONCLUSION: The high prevalence of obesity in these pregnant women represents a competing public health problem in Sudan. More research is needed.