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Universal Versus Selective Risk Factor-Based Screening Strategy for Gestational Diabetes Mellitus

Thesis Info

Author

Muriithi, Francis G.

Department

Obstetrics and Gynaecology (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2012

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728073954

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Background: Gestational hyperglycaemia is associated with a higher incidence of adverse maternal and fetal outcomes than is seen in normal pregnancy. Untreated gestational diabetes mellitus (GDM) has an increased perinatal morbidity and mortality. Morbidity related to macrosomia includes shoulder dystocia with birth injury and perinatal asphyxia in the fetus. In the mother, macrosomia is a risk factor for genital tract injury, obstructed labour, uterine atony and increased risk of Caesarean section. Long term sequelae in the baby include obesity, development of type 2 diabetes mellitus, intellectual and neurological developmental problems. For the mother, GDM is a very strong risk factor for the development of type 2 diabetes later in life. Published studies show that after GDM, 35-60% of women develop type 2 diabetes within 10 years. Therefore it is prudent that gestational diabetes is diagnosed and appropriate treatment and monitoring instituted. Screening is an important component of the diagnostic process. Objectives: To compare detection rates of the universal to the selective risk factor-based screening strategy for gestational diabetes mellitus. Methodology: A prospective cross-sectional study involving 185 participants consecutively recruited at or less than 28 weeks gestation . All participants had their risk factors for gestational diabetes identified and recorded at the beginning of the study then underwent the 50g oral glucose challenge screening test. Detection rates and prevalence of universal and selective strategies were calculated and compared. An exploratory analysis of risk factors was also done. Results: The Prevalence of an abnormal screening test in the sample with risk factors was 12.0% (95% CI: 6.0%, 17.9%) and in the sample without risk factors it was 19.1% (95% CI: 9.5%, 28.7%). Conclusion: Overlap of confidence intervals indicates no evidence of a difference between the screening strategies. However despite the non-significant, higher detection rates by the universal strategy, clinical practice safety demands that as many cases of gestational diabetes as possible are detected because of adverse clinical correlates hence justifying universal screening.
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۱-مَنْ

۱-مَنْ

"وَمَنْ أَظْلَمُ مِمَّنِ ٱفْتَرَىٰ عَلَى ٱللَّهِ كَذِباً" [[1]]

"اوراس شخص سے بڑھ کر ظالم کون ہوگا جو اللہ پر جھوٹ باندھے"۔

 



[[1]]     القرآن ،۶: ۹۳۔

غریبوں کی معاشی کفالت میں صحابیات رضی اﷲ عنھن کا کردار

Islamic cardinal precepts include seeking benefaction and patronage of other Muslims. Generally, Islamic history is replete with such munificent and generous personages as were ever geared up to serving humanity, yet the golden era of Islamic history excelled in profusion of such noble persons. When we review the aspect of serving mankind in the life history of the reverend Sahaba (the holy prophet’s disciples), we come to know that they had highly remarkable passions for helping, beneficing, supporting and sustaining their relatives, friends as well as the common run. The level of their charity was so great that they felt felicity and prostrated to Allah in gratitude even after giving away their all possessions and belongings for Allah’s sake only. In fact, the motivation behind this generosity was the attainment of pleasing Allah and the obedience and submission to the holy prophet. They had no iota of worldly voracity or avarice. Therefore, they were ever elated over giving away their assets.

Fortification of Compost Through Microbes and Inorganic Fertilizer in Cereal-Legume Intercropping Systems

Organic wastes are becoming severe threat to the environment. Organic wastes can be effectively utilized as a potential resource of nutrients through composting. Composts can be claimed as fortified compost after nutrient enrichment and blending with Plant growth promoting rhizobacteria (PGPR). This new technology can prove feasible in terms of lower application rates of compost (300-500 Kg ha-1 as compared to normal application of 1-2 tonnes ha-1) and can reduce upto 50 % of the recommended dose of inorganic fertilizers. Low organic matter is major limiting factor for agricultural productivity especially in semi arid and arid regions. Composted organic material can be applied on agricultural soils as an amendment to provide nutrients, to enhance their organic matter content and to improve the physio-chemical properties of soils. The presence of PGPR in rhizosphere significantly increase plant growth and yield under nitrogen limiting conditions. Cereal-legume intercropping have also been shown to increase productivity, improve soil fertility and control spread of pests, diseases and weeds. Intercropping reduces nitrate leaching from fields without loss of crop yields. Production of pulses is affected by many biotic and abiotic stresses, little use of bacterial inoculums which hamper the realization of actual yield potential. There is major decline in cultivated area of pulses in Pakistan due to displacement of traditional growing areas and low soil fertility. to address all these issues this study was carried out with the following objectives: (i) to assess the impact of fortified compost on soil fertility under cereal- legume intercropping (ii) to increase production of maize and pulses, especially mashbean through utilization of spring xxi season along with summer and (iii) to enhance farm profitability through enriched compost and appropriate cropping system. Two years field experiment for the proposed study was carried out at Farmers filed, Union Council Girja, Rawalpindi, Punjab, Pakistan during 2010-2012 in both spring and summer seasons. Maize (Zea mays L.), mashbean (Vigna mungo L.) and mungbean (Vigna radiata L.) sole as well cereal-legume intercrop which were tested against the given fertility treatments. Sandy clay loam soil with 30 % clay, 50% sand, and 20 % silt was exist at experimental site. The field experiment was laid out in a Randomized Complete Block Design with strip plot arrangements keeping cropping system in main plot and fertility treatments in subplots replicated thrice. Maize variety “Agati 2002”, mashbean cultivar “Chakwal mash” and mungbean cultivar “Mung-06” was used in both years for both seasons. Spring crop was sown in mid of February and summer crop in mid July during both the years, using single row hand drill. Five cropping systems viz. sole maize, sole mungbean, sole mashbean, maize + mungbean intercropping and maize + mashbean intercropping and four fertility treatments; chemical fertilizer recommended (Maize NP@ 120:80 kg ha-1 & Legumes/Intercropping NP@ 40:60 kg ha-1), compost @ 1000 kg ha-1, compost@ 1000 kg ha-1 + ½ chemical fertilizer and compost @ 1000 kg ha-1 + PGPR + ½ chemical fertilizer were compared against control. In fortification process commercial compost was fortified (nutrient enrichment) with half recommended NP fertilizer @ 60:40 kg ha-1 and potential PGPR strains were tested under maize-mungbean/mashbean cropping systems. xxii On the basis of agronomic, competitive indices as well as economic performance of different cereal-legumes intercropping, it was well evident that Integrated Nutrient Management System, i.e., combination of organic, biological and chemical fertilizers {Compost @ 1000 kg ha-1 + PGPR + ½ Chemical fertilizer (60 & 40 kg ha-1 NP)} among fertility treatments performed best (better than full dose chemical fertilizer, PGPR and compost) in terms of net returns and soil fertility status improvement. As by above mentioned combination Rs. 274528 net returns ha-1 year-1 were recorded in maize + mashbean intercropping which was 40.43 % higher than the control and enhanced soil N and P. Among tested Cropping systems, cultivation of mashbean in the spring season proved to be successful like maize and mungbean, so cereal-legume intercrop proved to be beneficial in both summer and spring seasons. Maize + mashbean and maize + mungbean intercropping proved better than any of the sole crop in terms of total production and net returns for the area. Net returns (Rs. ha-1 Year-1) data also revealed that maximum net returns per year obtained from maize + mashbean intercropping. Combined application of compost @ 1000 kg ha-1 + PGPR + ½ chemical fertilizer attained highest net returns of Rs. 274528 ha-1 Year-1 (US $ 2745) (summer + spring). It was 40.43 % higher than the control under same cropping system. However maize + mashbean intercropping system yielded 37.97 % higher than sole maize and 68.67 % higher than sole mashbean. Under above mentioned fertility combination maize + mashbean intercropping attained 12.10 % higher net returns than maize + mungbean due to higher market price of mashbean as compared to mungbean.