ISUOG Practice Guidelines: role of ultrasound in screening for and follow-up of pre-eclampsia.

Hypertensive disease of pregnancy affects up to 10% of pregnant women1 and the pooled global incidence of pre-eclampsia (PE) is approximately 3%2. Significant variations between developed and developing countries can be attributed to true differences or differences arising from data acquisition. PE and its complications are a major contributor to maternal and perinatal morbidity and mortality worldwide1, 3. Given that timely and effective care can improve the outcome of PE3, the development of effective prediction and prevention strategies has been a major objective of prenatal care and of research.Full Tex

The meaning of religious beliefs for a group of cancer patients during rehabilitation

Este estudo exploratório teve o objetivo de identificar como a religião influencia a sobrevivência de um grupo de pacientes oncológicos. Consistiu em estudo de caso etnográfico, com a participação de seis laringectomizados, de ambos os sexos, na faixa etária de 51 a 72 anos, operados de dois a cinco anos. Os dados foram coletados por entrevistas semi-estruturadas e analisados segundo os conceitos de cultura e religião. Sintetizou-se os resultados em três categorias descritivas: a representação moral do câncer, as crenças religiosas na trajetória do câncer e a negociação com a religião para a sobrevivência. O significado que emerge - "a expectativa por uma segunda chance" - enfatiza a importância da religião como parte das redes de apoio que se articulam com o enfrentamento do estigma do câncer, com a expectativa da cura e com as formas de organizar a vida cotidiana, na sobrevivência.La finalidad de este estudio exploratorio fue identificar cómo la religión influencia la supervivencia de un grupo de pacientes oncológicos. Consistió en un estudio de caso etnográfico con la participación de seis laringectomizados, de ambos sexos, con edad de 51 a 72 años, que habían sido operados de dos a cinco años antes. Los datos fueron recogidos por entrevistas semi-estructuradas y analizados según los conceptos de cultura y religión. Sintetizamos los resultados en tres categorias descriptivas: la representación moral del cáncer, las creencias religiosas en el trayecto del cáncer y la negociación con la religión por la supervivencia. El significado que resulta - "la expectativa por una segunda oportunidad" - enfatiza la importancia de la religión como parte de las redes de apoyo que se encadenan con la conciliación con el estigma del cáncer, con la expectativa de cura y con las formas de arreglar la vida cotidiana, en la supervivenvia.The objective of this exploratory study was to identify how religion influences the survival of a group of cancer patients. The study consisted of an ethnographic case with the participation of six laryngectomized male and female patients between 51 and 72 years old, who had been operated on two to five years earlier. Data were collected by semistructured interviews and analyzed on the basis of the concepts of culture and religion. The results were synthesized into three descriptive categories: the moral representation of cancer, religious beliefs about the cancer trajectory, and negotiation with religion for survival. These categories give rise to the meaning "the hope for a second chance", which emphasizes the importance of religion as part of the support networks that articulate with the patient's coping with the stigma of cancer, with the hope for cure, and with the ways of organizing everyday life, during survival

Search for Ultra-high-energy Photons from Gravitational Wave Sources with the Pierre Auger Observatory

A search for time-directional coincidences of ultra-high-energy (UHE) photons above 10 EeV with gravitational wave (GW) events from the LIGO/Virgo runs O1 to O3 is conducted with the Pierre Auger Observatory. Due to the distinctive properties of photon interactions and to the background expected from hadronic showers, a subset of the most interesting GW events is selected based on their localization quality and distance. Time periods of 1000 s around and 1 day after the GW events are analyzed. No coincidences are observed. Upper limits on the UHE photon fluence from a GW event are derived that are typically at & SIM;7 MeV cm(-2) (time period 1000 s) and & SIM;35 MeV cm(-2) (time period 1 day). Due to the proximity of the binary neutron star merger GW170817, the energy of the source transferred into UHE photons above 40 EeV is constrained to be less than 20% of its total GW energy. These are the first limits on UHE photons from GW sources

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030