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Home > Maternal Inflammatory Markers in the Diagnosis of Chorioamnionitis and Prediction of Neonatal Sepsis in Preterm Pre-Labour Rupture of Membranes: A Systematic Review

Maternal Inflammatory Markers in the Diagnosis of Chorioamnionitis and Prediction of Neonatal Sepsis in Preterm Pre-Labour Rupture of Membranes: A Systematic Review

Thesis Info

Author

Etyang, Angela Koech

Department

Obstetrics and Gynaecology (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2016

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728055360

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Background: There is no consensus on the potential role of inflammatory markers in identifying chorioamnionitis in women with Preterm Pre-labour Rupture of Membranes (PPROM) or in predicting Early Onset Neonatal Sepsis (EONS) in their neonates. Objectives: To perform a quantitative review on the accuracy of maternal C reactive protein (CRP), Procalcitonin (PCT) and Interleukin 6 (IL6) in the diagnosis of Histological Chorioamnionitis and/or Funisitis (HCA/Funisitis) and their role in the prediction of EONS in PPROM. Methods: MEDLINE, EMBASE and The Cochrane Library databases were searched from inception to October 2015, for studies where these markers were assessed against a reference standard of HCA/Funisitis or outcome of EONS in PPROM. Two reviewers independently performed screening, data extraction and quality assessments. The Quality Assessment of Diagnostic Accuracy Studies 2(QUADAS-2) and the Quality in Prognostic Studies (QUIPS) tools were used to assess methodological quality. Hierarchical summary receiver operating characteristic (SROC) models were used in the diagnostic review. In the prognostic review, unadjusted Odds Ratios (ORs) were pooled in a random effects meta-analysis. Results: The diagnostic review included 14 studies reporting 361 episodes (47.4%) of HCA/Funisitis in 761 participants, median prevalence 41% (IQR 36-53). The pooled indices for CRP at the commonest cut-off of 20mg/L (5 studies, 252 participants) were sensitivity 59% (95% CI 48-69), specificity 83% (95% CI 74-89), Likelihood Ratio positive (LR+) 3.45(95% CI 2.24-5.30) and Likelihood Ratio negative (LR-) 0.50(95% CI0.38-0.64 ). The sensitivity, LR+ and LR- for CRP at all cut-offs (11 studies, 570 participants) and at a selected specificity of 80% were 55%, 2.75 and 0.56 respectively. Indices for IL6 at a specificity of 80% were sensitivity 62%, LR+ 3.1 and LR- 0.48. No pooled indices were derived for PCT as included studies were few. The prognostic review included 7 studies with 332 participants and 97 episodes of EONS, median prevalence 26% (IQR 26-34). The pooled unadjusted OR for studies evaluating CRP at the commonest cut-off of 10mg/L (4 studies, 161participants) was 2.79 (95%CI 1.33-v 5.88, p 0.007). No pooled estimates were obtained for PCT and IL6 as included studies were few. Included studies were mainly prospective cohort design but were of poor quality. Conclusions: There is insufficient evidence to support use of CRP, PCT or IL6 in maternal blood for the diagnosis of HCA/Funisitis in PPROM and prediction of EONS in PPROM. Recommendations: We do not recommend the routine use of maternal CRP, PCT or IL6 singly in
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تدوین کی اہمیت

موضوع2:تدوین کی اہمیت
تدوین کی اہمیت:
ماضی کے افکار وخیالات سے آگاہی کا اہم ترین ذریعہ اسلاف کی تحریریں ہیں۔جس طرح ان کے نظریات سے آگاہی ہمیں ماضی، حال اور مستقبل کے رشتوں سے جوڑتی ہے۔اسی طرح ان کے نظریات سے درست آگاہی بھی ہمارے فکری زاویوں کو متوازن اور مربوط رکھنے میں مددگار ثابت ہوتی ہے۔ہم ماضی کے حالات و واقعات سے سبق حاصل کرتے ہیں۔حال میں ان سے کام لیتے ہیں اور مستقبل کے لیے لائحہ عمل وضع کرتے ہیں۔
متن کے حقیقی متن ہونے کا یقین:
جب تک ہمیں یقین نا ہوکہ ہمارے پیش نطر یا زیر مطالعہ کتاب یا تحریر من و عن ہمارے مصنف کے الفاظ اور جملوں پر مشتمل ہے ہم وثوق سے نہیں کہہ سکتے کہ مذکورہ مصنف کے خیالات یا رائے مسئلہ زیربحث کے بارے میں کیا تھی۔
تسکین ذوق:
ہم بسا اوقات ماضی کے طرز املاء کو جانچنا چاہ رہے ہوتے ہیں لیکن جب تک ہمیں پوری طرح یقین نا ہوجائے کہ یہی طرز املا ہے جو اس زمانے میں مروج تھی ہمارے ذوق کو تسکین نہیں ہوتی۔گویا تدوینی کام ذوق تسکین کا بھی باعث ہے۔
اصول تدوین کی پاسداری:
اگر تدوین میں اصول تدوین سے کام نا لیا جائے تو مختلف نسخوں میں سے جو نسخہ ہاتھ لگ جائے وہ اس کے مندرجات کو نقل کرتا رہے گا۔ اس بات کو مدنظر نہیں رکھا گا کہ مندرجات کا تعلق مصنف سے ہے یا کاتب سے ہے۔یوں منشائے مصنف ہم سے اوجھل ہو جائے گا۔
اقتباس کا مستند ہونا:
مستند نسخے کو ماخذ بنائے بغیر کسی اقتباس کواعتماد کے ساتھ پیش نہیں کیا جا سکتا۔اگر اقتباس کا تعلق مستند نسخے سے نا ہو گا تو غیر مستند اقتباس سے مستند نتائج اخذ کرنا محال ہوگا۔
مادی فوائد:
مادیت کے اس دور میں تحقیق وتدوین جیسے خالصتا علمی اور...

مسلم دورِحکمرانی ميں تعليمات نبویﷺ سے اخذ شدہ سراغ رسانی کے رہنما اصول

Intelligence system is considered to be one of the important tools used by military and civil secret agencies to defend and strengthen a nation. Intelligence system is thought to be one of the oldest studies of known history. Intelligence system consists of correct and accurate information, gathered after great struggle and facing difficulties. This department if related to both peace and war. Intelligence is a basis of formulating all military strategies and plans. The importance of intelligence system both in day to day life and as a nation cannot be overemphasized. This article recounts the intelligence systems and management of the resources of secret services of the companions of the Holy Prophet (SAW) and, thereafter, the Muslims rulers. Furthermore, the principles derived from the era of the companions of the Holy Prophet (SAW) regarding intelligence system have also been discussed in this chapter. The guiding principles that are still valid even today includes: (a) Training of Personnel Since espionage helps to strengthen the roots of a state and protect it from its enemies, therefore it requires a team of well trained professionals with latest technology and trends. Islam emphasized on two aspects of early warning, one is professional and the other is ethical.(b) Counter Espionage. An Islamic state must have an effective network of espionage to keep an eye on all the activities of the enemy. This is known as counter espionage. (c) Reconnaissance. This aims at the fore knowledge of the intentions of the enemy so that one can have a better planning in case of an attack. (d) Verification of Information. Information from an agent should be verified from other sources. An operative may feed false information due to lack of experience and competency and that may create an embarrassing situation. (e) Security of Information. Don’t share your secret, try to protect them. If national secrets are compromised they may cause an extensive damage to national interest. (f) Interrogation of POW. Whenever enemy spies or soldiers are arrested in a war they should be interrogated for extraction of information. They may be subjected to mental stress. (g) Fore Warning of the Enemy. This requires the launching of own agents in the enemy ranks for knowledge of their future plan likes attacks. (h)Treatment of Spies. If anyone is found to be guilty of spying for enemy, he may be penalized with death punishment.

A Pedological Study and its Relationship to Halophytic Plants Along Coastal and Inland Areas of Karachi, Pakistan

The present study explores the elemental concentrations (and their ratios) in halophytes and their associated soils. The elemental composition of rocks have also been evaluated in this research to find out the influence of rock on the composition of soils. The study area embraces a coastal strip of the southwestern border of Karachi–a part of Sindh coast, located in the southern part of Pakistan. The results of the coastal site were compared with the findings of the inland site which was located in Karachi University campus. The coastal lithological units of Nari and Gaj formations showed a distinct influence on the chemical composition of soils over which the halophytes grow. The geochemistry, petrography and X–ray diffraction analyses of the rock samples revealed that most likely the sands, clay minerals, Fe, K, Ca and Mg in the soils were attributed from the coastal lithologies of the aforementioned formations. However, Na and Cl ions in the coastal soils were mainly contributed from the sea (revealed through both SEM-EDS and wet chemical analyses). A Significant negative correlation between sand and chloride (Cl−) content in both inland and coastal soils revealed that as expected sands do not possess cation exchange capacity. However, clays showed a strong positive correlation with exchangeable Na compared with other cations (K, Ca and Mg) in coastal soils. The soil’s pH represented negative correlation with electrical conductivity (EC) and chloride (Cl−) in both types of soils. The inorganic cations (Na, K, Ca and Mg) were accumulated in different amounts in plant parts (roots, stems and leaves) of the selected halophytes. Both inland and coastal populations of Atriplex griffithii, Haloxylon recurvum, Salsola imbricata and Suaeda fruticosa while coastal populations of Avicennia marina, Cyperus conglomeratus, Ipomoea pes-caprae, Tamarix indica, Trianthema triquetra showed an increase in Na from roots to stems to leaves. Most of these aforementioned halophytes displayed decrease in K and Ca concentrations from roots to stems to leaves as the Na amount increased. Generally, the roots of both inland and coastal halophytes displayed Ca > Na > K > Mg accumulation, whereas, stems and leaves exhibited Na > Ca > K > Mg sequence for both types of populations. The mutual interaction between Na, K, Ca and Mg in soils and in roots, stems and leaves of xvi halophytes showed interesting results. The coastal soils represented a strong positive relationship between Na vs. K and Na vs. Ca. Plant parts (roots, stems and leaves) revealed positive correlations between Na vs. K and negative correlations between Na vs. Ca in majority of the halophytes. The results of principal component analysis (PCA) for inland soil variables revealed that presumably Cl−, Na, and Mg ions were responsible for soil salinity at inland site. The NO3–N concentration in inland soil samples showed positive correlation with K in the second component which might be due to sewage influx in inland soils. The positively related Ca and SO4 in third component were possibly due to gypsiferous shale from Mulri hills exposed opposite to the inland site (the University of Karachi Campus area). The PCA of coastal soils represented high positive loads of Ca and Mg in the first component which indicated the influence of calcareous rocks of Nari and Gaj formations. The second component followed available P > SO4 > K > Cl > Na trend, whereas, the third component showed a high positive load for NO3–N while negative load for Cl ions. On the basis of bioconcentration factor (BCF) for Na (BCFNa), inland populations of Cressa cretica, Haloxylon recurvum and Suaeda fruticosa while coastal populations of Arthrocnemum macrostachyum and Trianthema triquetra were more salt tolerant halophytes. However, inland populations of Atriplex griffithii while coastal populations of Heliotropium currassavicum and Trianthema portulacastrum were relatively less salt tolerant halophytes; these plants possessed the more bioconcentration factor for K (BCFK). The results of cluster analysis were found to be congruent with the results of bioconcentration factor (BCF) of elements. Two Factor ANOVA (Analysis of Variance) revealed that Na content for plant parts and species differed markedly for both inland and coastal data across all stations. Magnesium amount represented remarkable differences for species and interactions (parts × species) for all inland and coastal stations. Through one-way MANOVA (multivariate analysis of variance) it was found that inland and coastal populations of Atriplex griffithii, Ipomoea pes-caprae exhibited significant difference in the accrual of all elements (Na, K, Ca and Mg). However, both populations of Salsola imbricata and Suaeda fruticosa possessed strong significant effect of parts on the accumulation xvii of Na, K, and Ca. Among micronutrients (Cu, Fe, Mn and Zn), Cu and Zn were deficient while Fe and Mn were ample in almost all soils. However, the concentrations of these micronutrients were found to be greater in inland plants than coastal populations. Coastal populations represented increasing trends for Cu and Fe from roots to stems to leaves.