revalence and factors associated with cesarean section in HIV-positive patients in a university teaching hospital – A case-control study

INTRODUCTION: Cesarean section (CS), although a relatively safe procedure, is associated with more risks than vaginal delivery, regardless of HIV status. Complications following CS are greater in HIV-positive women than in HIV-negative women. This study’s objective was to determine the prevalence and factors associated with CS in HIV-positive patients in our environment. METHODS: A case-control study of factors associated with and outcomes of CS over 13 years was conducted in HIV-positive and HIV-negative women at UMTH. Multinomial regression analysis was used to determine factors independently associated with CS in HIV-positive women. Stratified analysis was used to determine factors associated with the development of complications following CS in HIV-positive women. A p-value <0.05 was considered statistically significant. RESULTS: The prevalence of CS in HIV-positive women was 3.02%, with PMTCT 51.5% (53/103) as the major indication. Compared to the control, the HIV-positive women were more likely to have pre-operative anemia (P= 0.001) and their CS to be undertaken electively (P<0.001), under general anesthesia (P<0.001), to last more than 60 minutes (P=0.002) and develop a postoperative complication (77.8% vs. 22.2%). Pre-operative anemia and preterm delivery were found to be associated with the development of a complication. CONCLUSION: The prevalence of cesarean section in HIV-positive patients is low in our environment. CS is also more likely to be performed electively for over 60 minutes under general anesthesia on a nulliparous woman with no formal education and pre-operative anemia

Oral Ibrexafungerp for Vulvovaginal Candidiasis Treatment: An Analysis of VANISH 303 and VANISH 306

Background: Ibrexafungerp is a novel antifungal treatment for acute vulvovaginal candidiasis (VVC). Using pooled data from two phase three studies (VANISH 303 and 306) in the treatment of acute VVC, this analysis sought to determine the effectiveness of ibrexafungerp in various patient subgroups that may impact outcomes. Materials and Methods: Data from VANISH 303 (NCT03734991) and VANISH 306 (NCT03987620) evaluating ibrexafungerp 300 mg twice daily (BID) for 1 day versus placebo, were pooled and analyzed to determine clinical cure rate, clinical improvement, and mycological cure at the test-of-cure visit (day 11 ± 3) and symptom resolution at the follow-up visit (day 25 ± 4) in the overall population. Patient subgroups analyzed included race, body mass index (BMI), baseline vulvovaginal signs and symptoms (VSS) score, and Candida species. Results: At the test-of-cure visit, patients receiving ibrexafungerp, compared with those who received placebo, had significantly higher rates of clinical cure (56.9% [214/376 patients] vs. 35.7% [65/182 patients]), clinical improvement (68.4% [257/376 patients] vs. 45.1% [82/182 patients]), and mycological cure (54.0% [203/376 patients] vs. 24.2% [44/182 patients]; all p \u3c 0.0001). At the follow-up visit, patients receiving ibrexafungerp had sustained responses with higher symptom resolution rates (66.8% [251/376 patients]) versus placebo (48.4% [88/182 patients]; p \u3c 0.0001). Race, BMI, baseline VSS score (including VSS severity score 13-18), and Candida species infection did not adversely affect clinical cure rates. Safety analysis results were consistent with the individual studies. Conclusions: Ibrexafungerp provides a safe and well-tolerated first-in-class fungicidal, 1-day oral treatment for patients with acute VVC, the first new therapy in \u3e20 years. Clinical Trial Registration Number: NCT03734991

FORMULATION AND EVALUATION OF IBRUTINIB NANOSPONGES INCOPORATED TABLET

Objective: The present investigation was undertaken to prepare polymeric nanosponges of an anti-cancer drug ibrutinib to achieve controlled and improved drug release. Methods: Nanosponges using a polymer (ethyl cellulose, poloxamer 188 and eudragit RL 30 D) and polyvinyl alcohol as a cross-linker were prepared successfully by the emulsion solvent evaporation method. Prepared nanosponges were evaluated for particle size, zetapotential, entrapment efficiency and in-vitro drug release. Nanosponges with good drug release were formulated into tablets and evaluated for miromeritic properties, post compression parametrs and in-vitro release and final optimised formulation was characterised for globule size, zetapotential, FTIR, SEM and stability studies. Results: The nanosponges' particle sizes were discovered to range between 86.31 nm and 162.4 nm, the Zeta Potential ranges from -22.1 to -29. It was discovered that the drug entrapment efficiency ranged from 92.21 to 99.23% and Formulation F18 exhibited the highest drug release rate of 99.73% in 12h and was discovered to demonstrate good, satisfying results. The tablet formulation's micromeritic and post compression parameters were examined, and it was discovered that F18 had good flow qualities. F18 had a mean globule size of 133.6 nm, a zeta potential of -22.1 mV, and SEM images revealed a sphere-like structure. The complexation of ibrutinib and the amorphous condition of the medication and formulation were confirmed by the FT-IR, and stability investigations to be stable for three months. Conclusion: Hence, Ibrutinib loading into nanosponges made using the emulsion solvent evaporation process thus successfully boosted and controlled the drug release

Prenatal Care Healthcare Communication during the COVID-19 Pandemic: A Digital Divide Extending Beyond Technology Access (Preprint)

BACKGROUND The COVID-19 pandemic brought significant changes in healthcare, specifically the accelerated use of telehealth. Given the unique aspects of prenatal care, it is important to understand the impact of telehealth on healthcare communication, quality, and patient satisfaction. This mixed-methods study examined challenges associated with the rapid and broad implementation of telehealth for prenatal care delivery during the pandemic. OBJECTIVE In this study, we examine patients' perspectives, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. METHODS Pregnant patients who received outpatient prenatal care in Cleveland, Ohio participated in in-depth interviews and completed the Coronavirus Perinatal Experiences- Impact Survey (COPE-IS) between January-December 2021. Transcripts were coded using NVivo12 and qualitative analysis used an approach consistent with grounded theory. Quantitative data were summarized and integrated during analysis. RESULTS Thematic saturation was achieved with 60 interviews. Lead themes focused on: establishing patient-provider relationships that support shared decision-making (SDM), accessing the information needed for SDM, and using technology effectively to foster discussions during the COVID-19 pandemic. In the COPE-IS, 59 (100.0%) felt very well supported by their provider, 31 (52.5%) were moderately to highly concerned about their child’s health, and 17 (28.8%) reported the single greatest stress of COVID-19 was its impact on their child. CONCLUSIONS While telehealth was recognized as an option to ensure timely access to prenatal care during the COVID-19 pandemic, it also came with multiple challenges and opportunities to adapt to diverse patient populations. It is important to address the unique needs of this population during the pandemic and as healthcare increasingly adopts a telehealth model. </sec