ABSTRACT Prevalence, clinicobacteriological profile and maternal risk factor analysis of early-on... more ABSTRACT Prevalence, clinicobacteriological profile and maternal risk factor analysis of early-onset sepsis in the neonatal unit of a tertiary care hospital Introduction: Early-onset sepsis (EOS) is defined as an infection that occurs before 7 days of age and is a common cause of neonatal hospitalization with a high fatality rate. The clinical features are non-specific and include refusal to feed, respiratory distress, lethargy, convulsions, jaundice and temperature instability. The causative agent is acquired from the mother by ascending infection during delivery or via the transplacental route. A range of maternal and neonatal risk factors contribute to the development of sepsis and the gold standard for diagnosis is the isolation of bacteria by cultures. Aims and objectives: The aim of the study was to investigate the prevalence of early-onset neonatal sepsis in a tertiary care hospital and to study the clinicobacteriological profile as well as maternal and neonatal risk factors in neonates with EOS. Materials and methods: This retrospective observational study was conducted in the neonatal unit of Saqr Hospital, Ras Al Khaimah, United Arab Emirates, and case records of EOS from January 2011 to December 2013 were studied and analysed. Results: A total of 115 cases of EOS were studied. Blood culture was positive in 34 children (29.6%), and 30 infants (88.2%) were admitted to hospital within 24 hours of birth. The mean hospital stay was 8.1 days (standard deviation 2.05 days). Group B streptococcus (29.4%) and Escherichia coli (20%) were the most commonly isolated organisms, and the most common symptom was respiratory distress (in 60% of cases). Premature rupture of the membranes (in 47% of cases) and prematurity (in 35% of cases) were the most common risk factors. A total of 9 out of 34 babies (26%) developed sepsis despite the absence of any maternal risk factor. Positive correlations were obtained when comparing (1) the risk of sepsis in preterm babies with that of full-term babies with at least one maternal risk factor [relative risk (RR) 6.2], (2) the likelihood of sepsis in low-and normal-birthweight babies with low/normal Apgar scores (≤7 vs. >7) (RR 1.8) and (3) the mode of delivery with hospitalization period,
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, Jul 1, 2022
Background: Life-threatening events associated with pregnancy are called Obstetric emergencies an... more Background: Life-threatening events associated with pregnancy are called Obstetric emergencies and they can occur at any time during pregnancy, labor, delivery, or even after delivery. Timely and proper obstetric care saves lives of the pregnant women and their babies daily, throughout the world. Complications of childbirth cannot be prevented in some cases but they can be treated promptly and effectively. Lack of facilities at primary health care centers can result in signicant maternal and neonatal morbidity and mortality in such cases. This study aims to identify the various obstetric emergencies referred to a tertiary care center and the different reasons for such referral. This retrospectiveMethods: clinical descriptive study was carried out in the Tertiary Health Care Centre (Sheth Vadilal Hospital, Ahmedabad, Gujarat, India) recruiting a total of 100 patients who presented with various obstetric emergencies from September 2013 to September 2015. 86% of patients wereResults: between 21 to 30 years of age. The highest number of indication of referral was due to anaemia(15%), followed by previous caesarean section(12%), preeclampsia(11%), meconium-stained liquor(10%), preterm rupture of membranes(9%), oligohydramnios (7%), postdate(5%), malpresentation (6%) and Obstructed labour(4%). Other indications of referral were cord prolapse (1%), maternal diabetes (1%), polio(1%) and cardiac disease(1%). The main reasons for referral to higher centers included a lack of OT facilities and blood products. The cost factor is responsible especially in those cases who are referred from the private sector. Regular antenatal care can help prevent many obstetricConclusions: emergencies. Improvement of health care in women before pregnancy can go a long way in preventing all pregnancy complications including a majority of obstetric emergencies. Also, better health facilities and trained staff at Primary Health Care Centre are vital for improved delivery of maternal and child health care services.
Background: Life-threatening events associated with pregnancy are called Obstetric emergencies an... more Background: Life-threatening events associated with pregnancy are called Obstetric emergencies and they can occur at any time during pregnancy, labor, delivery, or even after delivery. Timely and proper obstetric care saves lives of the pregnant women and their babies daily, throughout the world. Complications of childbirth cannot be prevented in some cases but they can be treated promptly and effectively. Lack of facilities at primary health care centers can result in signicant maternal and neonatal morbidity and mortality in such cases. This study aims to identify the various obstetric emergencies referred to a tertiary care center and the different reasons for such referral. This retrospectiveMethods: clinical descriptive study was carried out in the Tertiary Health Care Centre (Sheth Vadilal Hospital, Ahmedabad, Gujarat, India) recruiting a total of 100 patients who presented with various obstetric emergencies from September 2013 to September 2015. 86% of patients wereResults: ...
Hemophagocytic lymphohistiocytosis (HLH) secondary to an infection is a great impersonator. It is... more Hemophagocytic lymphohistiocytosis (HLH) secondary to an infection is a great impersonator. It is caused by hyperimmune activation, which leads to a wide array of hematological abnormalities. If the disease is untreated, it is usually fatal. We report the case of a four-year-old girl who presented to our tertiary care hospital with high-grade fever, frequent loose stools, and bleeding from the lips and gums. Investigations showed pancytopenia, hyperferritinemia, hypofibrinogenemia, and hypertriglyceridemia whereas the bone marrow biopsy revealed hemophagocytosis with trilineage suppression. Blood cultures grew Salmonella typhi. After ruling out other possibilities, the diagnosis of HLH was made as per the HLH-2004 diagnostic criteria. The patient responded well to culture-sensitive antibiotics and supportive treatment. We discuss the diagnosis and clinical course of this unique case and strive to create awareness about secondary HLH induced by common diseases, such as typhoid fever.
Saudi Journal of Medicine & Medical Sciences, 2021
Background: Maternal Group B Streptococcus (GBS)/Streptococcus agalactiae colonization rates vary... more Background: Maternal Group B Streptococcus (GBS)/Streptococcus agalactiae colonization rates vary worldwide; however, no such recent data are available from the United Arab Emirates (UAE). Objective: The objective of this study was to determine the prevalence of GBS colonization among pregnant women attending an antenatal clinic of a hospital in Ras Al Khaimah, UAE, along with the antibiotic sensitivity pattern, the clinical profile and pregnancy (maternal and fetal) outcome. Methods: This prospective observational study routinely offered rectovaginal swab for GBS to all women attending the antenatal clinic at 35–37 weeks of pregnancy between January and December 2019. MASTASTREP kit and Vitek-2 identification system was used for culture and identification. Women with positive cultures were followed up for any maternal and neonatal complications and the use of intrapartum antibiotic prophylaxis (IAP). Results: A total of 2295 women were included, of which 158 (6.9%) had positive cul...
Background: Maternal Group B Streptococcus (GBS)/Streptococcus agalactiae colonization rates vary... more Background: Maternal Group B Streptococcus (GBS)/Streptococcus agalactiae colonization rates vary worldwide; however, no such recent data are available from the United Arab Emirates (UAE). Objective: The objective of this study was to determine the prevalence of GBS colonization among pregnant women attending an antenatal clinic of a hospital in Ras Al Khaimah, UAE, along with the antibiotic sensitivity pattern, the clinical profile and pregnancy (maternal and fetal) outcome. Methods: This prospective observational study routinely offered rectovaginal swab for GBS to all women attending the antenatal clinic at 35-37 weeks of pregnancy between January and December 2019. MASTASTREP kit and Vitek-2 identification system was used for culture and identification. Women with positive cultures were followed up for any maternal and neonatal complications and the use of intrapartum antibiotic prophylaxis (IAP). Results: A total of 2295 women were included, of which 158 (6.9%) had positive cultures for GBS colonization. The carriage rate was higher in women without any risk factors for early-onset GBS disease (EOGBS) (P < 0.01). The GBS isolates were about 97% susceptible to linezolid and vancomycin, 90% to benzyl penicillin and 95% to ampicillin. Resistance to trimethoprim/sulfamethoxazole, clindamycin, erythromycin, and levofloxacin were about 77%, 57%, 57%, and 10%, respectively. Urinary tract infection in GBS colonized women were more common in those aged ≤30 years (P = 0.009). Fetal outcome was favorable in women receiving IAP for GBS colonization. No neonate had culture proven EOGBS. Conclusion: The prevalence of GBS colonization in pregnant women as well as the overall maternal and neonatal complications is low in Ras Al Khaimah, UAE. IAP is effective in preventing early-onset sepsis in newborn, and thus should be initiated in those with GBS colonization. The cultured GBS showed sensitivity to most antibiotics.
Background: Urinary tract infection (UTI) is a common complication in pregnancy. The prevalence v... more Background: Urinary tract infection (UTI) is a common complication in pregnancy. The prevalence varies between countries. This research aims at estimating the prevalence, clinico-bacteriological profile, antibiotic resistance, and risk factor analysis of symptomatic UTI in pregnancy. Method: This is a prospective observational study conducted at the Abdullah Bin Omran Hospital, RAK, UAE, from March 2019 to February 2020. All pregnant women attending the antenatal clinic during this period were given a pre-validated questionnaire for the symptoms of UTI. In symptomatic patients, urine was sent for microscopy, culture, and sensitivity. Women were treated for UTI and were followed up for the rest of the pregnancy. Data analysis was performed by SPSS software version 24 using descriptive statistics and comparisons with significance at a p-value of <0.05. Results: The prevalence of symptomatic UTI was 17.9%. E.coli was the commonest isolate followed by Group B streptococcus. The commo...
The balance between different bacterial species is essential for optimal vaginal health. Microbio... more The balance between different bacterial species is essential for optimal vaginal health. Microbiome includes the host genome along with microorganism genomes and incorporates the biotic and abiotic factors, reflecting the habitat as a whole. A significant difference exists in the composition and number of the human microbiota in healthy individuals. About one-tenth of the total body microbiota exists in the urogenital tract and these can be identified by microscopy and culture-based methods, quantitative PCR, next generation and whole genome sequencing. The trend of delaying the planning of pregnancy to a later age nowadays has resulted in magnifying the use of assisted reproductive treatment (ART). Hence, genital microbiota and its impact on fertility has generated immense interest in recent years. In this systematic review, we searched the available evidence on the microbiota of the genital tract in women undergoing ART and studied the outcomes of IVF in different microbial compos...
Coronavirus disease-2019 has been ravaging the world since the past several months with devastati... more Coronavirus disease-2019 has been ravaging the world since the past several months with devastating consequences. Although it is seen that specific categories of patients with comorbidities are especially vulnerable, the risks from the acute disease in pediatric population have been consistently lower. However, the alarming rise in pediatric admissions in intensive care units with varied clinical presentation during this pandemic gave an insight to a new hyperinflammatory response called as multisystem inflammatory syndrome in children. Although overlapping symptoms may mimic toxic shock syndrome, macrophage activation syndrome, secondary hemophagocytic lymphohistiocytosis, myocarditis, or Kawasaki-like illness, clinical findings are relatively consistent across geographically distinct regions. Diagnosis is essentially clinical, and laboratory investigations are suggestive of increased inflammatory markers. Early recognition and appropriate institution of inotropes, intravenous immu...
ObjectiveWe aimed to conduct a systematic review of the available literature to determine the eff... more ObjectiveWe aimed to conduct a systematic review of the available literature to determine the effects of confirmed cases of COVID-19 in pregnant women from the foetal perspective by estimation of mother to child transmission, perinatal outcome and possible teratogenicity.MethodsData sources: eligible studies between 1 November 2019 and 10 August 2020 were retrieved from PubMed, Embase, LitCovid, Google Scholar, EBSCO MEDLINE, CENTRAL, CINAHL, MedRXiv, BioRXiv and Scopus collection databases. English language case reports, case series and cohort studies of SARS-CoV-2 confirmed pregnant women with data on perinatal outcome, congenital anomalies and mother to child transmission were analysed.Results38 case reports, 34 cohort and case series describing 1408 neonates were included for evidence acquisition of mother to child transmission. 29 case reports and 31 case series and cohort studies describing 1318 foetuses were included for the evaluation of perinatal outcome and congenital anom...
ABSTRACT Prevalence, clinicobacteriological profile and maternal risk factor analysis of early-on... more ABSTRACT Prevalence, clinicobacteriological profile and maternal risk factor analysis of early-onset sepsis in the neonatal unit of a tertiary care hospital Introduction: Early-onset sepsis (EOS) is defined as an infection that occurs before 7 days of age and is a common cause of neonatal hospitalization with a high fatality rate. The clinical features are non-specific and include refusal to feed, respiratory distress, lethargy, convulsions, jaundice and temperature instability. The causative agent is acquired from the mother by ascending infection during delivery or via the transplacental route. A range of maternal and neonatal risk factors contribute to the development of sepsis and the gold standard for diagnosis is the isolation of bacteria by cultures. Aims and objectives: The aim of the study was to investigate the prevalence of early-onset neonatal sepsis in a tertiary care hospital and to study the clinicobacteriological profile as well as maternal and neonatal risk factors in neonates with EOS. Materials and methods: This retrospective observational study was conducted in the neonatal unit of Saqr Hospital, Ras Al Khaimah, United Arab Emirates, and case records of EOS from January 2011 to December 2013 were studied and analysed. Results: A total of 115 cases of EOS were studied. Blood culture was positive in 34 children (29.6%), and 30 infants (88.2%) were admitted to hospital within 24 hours of birth. The mean hospital stay was 8.1 days (standard deviation 2.05 days). Group B streptococcus (29.4%) and Escherichia coli (20%) were the most commonly isolated organisms, and the most common symptom was respiratory distress (in 60% of cases). Premature rupture of the membranes (in 47% of cases) and prematurity (in 35% of cases) were the most common risk factors. A total of 9 out of 34 babies (26%) developed sepsis despite the absence of any maternal risk factor. Positive correlations were obtained when comparing (1) the risk of sepsis in preterm babies with that of full-term babies with at least one maternal risk factor [relative risk (RR) 6.2], (2) the likelihood of sepsis in low-and normal-birthweight babies with low/normal Apgar scores (≤7 vs. &gt;7) (RR 1.8) and (3) the mode of delivery with hospitalization period,
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, Jul 1, 2022
Background: Life-threatening events associated with pregnancy are called Obstetric emergencies an... more Background: Life-threatening events associated with pregnancy are called Obstetric emergencies and they can occur at any time during pregnancy, labor, delivery, or even after delivery. Timely and proper obstetric care saves lives of the pregnant women and their babies daily, throughout the world. Complications of childbirth cannot be prevented in some cases but they can be treated promptly and effectively. Lack of facilities at primary health care centers can result in signicant maternal and neonatal morbidity and mortality in such cases. This study aims to identify the various obstetric emergencies referred to a tertiary care center and the different reasons for such referral. This retrospectiveMethods: clinical descriptive study was carried out in the Tertiary Health Care Centre (Sheth Vadilal Hospital, Ahmedabad, Gujarat, India) recruiting a total of 100 patients who presented with various obstetric emergencies from September 2013 to September 2015. 86% of patients wereResults: between 21 to 30 years of age. The highest number of indication of referral was due to anaemia(15%), followed by previous caesarean section(12%), preeclampsia(11%), meconium-stained liquor(10%), preterm rupture of membranes(9%), oligohydramnios (7%), postdate(5%), malpresentation (6%) and Obstructed labour(4%). Other indications of referral were cord prolapse (1%), maternal diabetes (1%), polio(1%) and cardiac disease(1%). The main reasons for referral to higher centers included a lack of OT facilities and blood products. The cost factor is responsible especially in those cases who are referred from the private sector. Regular antenatal care can help prevent many obstetricConclusions: emergencies. Improvement of health care in women before pregnancy can go a long way in preventing all pregnancy complications including a majority of obstetric emergencies. Also, better health facilities and trained staff at Primary Health Care Centre are vital for improved delivery of maternal and child health care services.
Background: Life-threatening events associated with pregnancy are called Obstetric emergencies an... more Background: Life-threatening events associated with pregnancy are called Obstetric emergencies and they can occur at any time during pregnancy, labor, delivery, or even after delivery. Timely and proper obstetric care saves lives of the pregnant women and their babies daily, throughout the world. Complications of childbirth cannot be prevented in some cases but they can be treated promptly and effectively. Lack of facilities at primary health care centers can result in signicant maternal and neonatal morbidity and mortality in such cases. This study aims to identify the various obstetric emergencies referred to a tertiary care center and the different reasons for such referral. This retrospectiveMethods: clinical descriptive study was carried out in the Tertiary Health Care Centre (Sheth Vadilal Hospital, Ahmedabad, Gujarat, India) recruiting a total of 100 patients who presented with various obstetric emergencies from September 2013 to September 2015. 86% of patients wereResults: ...
Hemophagocytic lymphohistiocytosis (HLH) secondary to an infection is a great impersonator. It is... more Hemophagocytic lymphohistiocytosis (HLH) secondary to an infection is a great impersonator. It is caused by hyperimmune activation, which leads to a wide array of hematological abnormalities. If the disease is untreated, it is usually fatal. We report the case of a four-year-old girl who presented to our tertiary care hospital with high-grade fever, frequent loose stools, and bleeding from the lips and gums. Investigations showed pancytopenia, hyperferritinemia, hypofibrinogenemia, and hypertriglyceridemia whereas the bone marrow biopsy revealed hemophagocytosis with trilineage suppression. Blood cultures grew Salmonella typhi. After ruling out other possibilities, the diagnosis of HLH was made as per the HLH-2004 diagnostic criteria. The patient responded well to culture-sensitive antibiotics and supportive treatment. We discuss the diagnosis and clinical course of this unique case and strive to create awareness about secondary HLH induced by common diseases, such as typhoid fever.
Saudi Journal of Medicine & Medical Sciences, 2021
Background: Maternal Group B Streptococcus (GBS)/Streptococcus agalactiae colonization rates vary... more Background: Maternal Group B Streptococcus (GBS)/Streptococcus agalactiae colonization rates vary worldwide; however, no such recent data are available from the United Arab Emirates (UAE). Objective: The objective of this study was to determine the prevalence of GBS colonization among pregnant women attending an antenatal clinic of a hospital in Ras Al Khaimah, UAE, along with the antibiotic sensitivity pattern, the clinical profile and pregnancy (maternal and fetal) outcome. Methods: This prospective observational study routinely offered rectovaginal swab for GBS to all women attending the antenatal clinic at 35–37 weeks of pregnancy between January and December 2019. MASTASTREP kit and Vitek-2 identification system was used for culture and identification. Women with positive cultures were followed up for any maternal and neonatal complications and the use of intrapartum antibiotic prophylaxis (IAP). Results: A total of 2295 women were included, of which 158 (6.9%) had positive cul...
Background: Maternal Group B Streptococcus (GBS)/Streptococcus agalactiae colonization rates vary... more Background: Maternal Group B Streptococcus (GBS)/Streptococcus agalactiae colonization rates vary worldwide; however, no such recent data are available from the United Arab Emirates (UAE). Objective: The objective of this study was to determine the prevalence of GBS colonization among pregnant women attending an antenatal clinic of a hospital in Ras Al Khaimah, UAE, along with the antibiotic sensitivity pattern, the clinical profile and pregnancy (maternal and fetal) outcome. Methods: This prospective observational study routinely offered rectovaginal swab for GBS to all women attending the antenatal clinic at 35-37 weeks of pregnancy between January and December 2019. MASTASTREP kit and Vitek-2 identification system was used for culture and identification. Women with positive cultures were followed up for any maternal and neonatal complications and the use of intrapartum antibiotic prophylaxis (IAP). Results: A total of 2295 women were included, of which 158 (6.9%) had positive cultures for GBS colonization. The carriage rate was higher in women without any risk factors for early-onset GBS disease (EOGBS) (P < 0.01). The GBS isolates were about 97% susceptible to linezolid and vancomycin, 90% to benzyl penicillin and 95% to ampicillin. Resistance to trimethoprim/sulfamethoxazole, clindamycin, erythromycin, and levofloxacin were about 77%, 57%, 57%, and 10%, respectively. Urinary tract infection in GBS colonized women were more common in those aged ≤30 years (P = 0.009). Fetal outcome was favorable in women receiving IAP for GBS colonization. No neonate had culture proven EOGBS. Conclusion: The prevalence of GBS colonization in pregnant women as well as the overall maternal and neonatal complications is low in Ras Al Khaimah, UAE. IAP is effective in preventing early-onset sepsis in newborn, and thus should be initiated in those with GBS colonization. The cultured GBS showed sensitivity to most antibiotics.
Background: Urinary tract infection (UTI) is a common complication in pregnancy. The prevalence v... more Background: Urinary tract infection (UTI) is a common complication in pregnancy. The prevalence varies between countries. This research aims at estimating the prevalence, clinico-bacteriological profile, antibiotic resistance, and risk factor analysis of symptomatic UTI in pregnancy. Method: This is a prospective observational study conducted at the Abdullah Bin Omran Hospital, RAK, UAE, from March 2019 to February 2020. All pregnant women attending the antenatal clinic during this period were given a pre-validated questionnaire for the symptoms of UTI. In symptomatic patients, urine was sent for microscopy, culture, and sensitivity. Women were treated for UTI and were followed up for the rest of the pregnancy. Data analysis was performed by SPSS software version 24 using descriptive statistics and comparisons with significance at a p-value of <0.05. Results: The prevalence of symptomatic UTI was 17.9%. E.coli was the commonest isolate followed by Group B streptococcus. The commo...
The balance between different bacterial species is essential for optimal vaginal health. Microbio... more The balance between different bacterial species is essential for optimal vaginal health. Microbiome includes the host genome along with microorganism genomes and incorporates the biotic and abiotic factors, reflecting the habitat as a whole. A significant difference exists in the composition and number of the human microbiota in healthy individuals. About one-tenth of the total body microbiota exists in the urogenital tract and these can be identified by microscopy and culture-based methods, quantitative PCR, next generation and whole genome sequencing. The trend of delaying the planning of pregnancy to a later age nowadays has resulted in magnifying the use of assisted reproductive treatment (ART). Hence, genital microbiota and its impact on fertility has generated immense interest in recent years. In this systematic review, we searched the available evidence on the microbiota of the genital tract in women undergoing ART and studied the outcomes of IVF in different microbial compos...
Coronavirus disease-2019 has been ravaging the world since the past several months with devastati... more Coronavirus disease-2019 has been ravaging the world since the past several months with devastating consequences. Although it is seen that specific categories of patients with comorbidities are especially vulnerable, the risks from the acute disease in pediatric population have been consistently lower. However, the alarming rise in pediatric admissions in intensive care units with varied clinical presentation during this pandemic gave an insight to a new hyperinflammatory response called as multisystem inflammatory syndrome in children. Although overlapping symptoms may mimic toxic shock syndrome, macrophage activation syndrome, secondary hemophagocytic lymphohistiocytosis, myocarditis, or Kawasaki-like illness, clinical findings are relatively consistent across geographically distinct regions. Diagnosis is essentially clinical, and laboratory investigations are suggestive of increased inflammatory markers. Early recognition and appropriate institution of inotropes, intravenous immu...
ObjectiveWe aimed to conduct a systematic review of the available literature to determine the eff... more ObjectiveWe aimed to conduct a systematic review of the available literature to determine the effects of confirmed cases of COVID-19 in pregnant women from the foetal perspective by estimation of mother to child transmission, perinatal outcome and possible teratogenicity.MethodsData sources: eligible studies between 1 November 2019 and 10 August 2020 were retrieved from PubMed, Embase, LitCovid, Google Scholar, EBSCO MEDLINE, CENTRAL, CINAHL, MedRXiv, BioRXiv and Scopus collection databases. English language case reports, case series and cohort studies of SARS-CoV-2 confirmed pregnant women with data on perinatal outcome, congenital anomalies and mother to child transmission were analysed.Results38 case reports, 34 cohort and case series describing 1408 neonates were included for evidence acquisition of mother to child transmission. 29 case reports and 31 case series and cohort studies describing 1318 foetuses were included for the evaluation of perinatal outcome and congenital anom...
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