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Jammu: A pregnant woman, who was turned away from the Primary Health Centre (PHC) Teryath due to the absence of a gynecologist, gave birth in a cab after being referred to a higher-level hospital in Rajouri district, Jammu and Kashmir.

According to the PTI report, Deputy Commissioner, Rajouri, Abhishek Sharma visited the PHC Teryath after the incident and instructed the additional deputy commissioner of Kalakote to conduct a detailed inquiry into the matter and submit a report at the earliest, they said.

Both the woman and her baby are in good health and are currently admitted to the PHC.

According to the relatives of the woman, they reached PHC Teryath on Sunday morning but the on-duty doctor, without examining the patient, referred her to a sub-district hospital due to the non-availability of a gynaecologist.

Also Read:Denied admission, woman delivers baby outside Haryana Government Hospital

However, the woman gave birth on the road while they were heading to the hospital in a cab.

During his visit to PHC Teryath on Monday, the deputy commissioner interacted with the woman and her family to understand the circumstances leading to the incident.

He assured the family of strict action and emphasized that such incidents are unacceptable in a system committed to providing accessible healthcare to all, an official spokesperson said.

While addressing the health officials present, the deputy commissioner directed them to work with utmost sincerity and diligence to prevent such incidents in the future.

Medical Dialogues team had earlier reported that altogether 6 doctors and 13 healthcare workers of Dr Ram Manohar Lohia Institute of Medical Sciences (RMLIMS) were suspended in connection to a case of medical negligence. Uttar Pradesh Deputy Chief Minister Brajesh Pathak ordered the suspension of these doctors and health workers after a patient was denied admission and was discharged from the Emergency Department with incomplete treatment.

Also Read:Woman delivers baby in autorickshaw, Maha hospital staff get show cause notice

Evidence on the association between early-life malnutrition exposure at different developmental stages and the subsequent risk of osteoporosis and fractures in adulthood remains sparse and equivocal. This study sought to elucidate the relationship between malnutrition exposure in early life and the occurrence of osteoporosis and fractures later in life. This research is a cross-sectional analysis carried out within the framework of the China Community-based Cohort of Osteoporosis (CCCO), an ongoing community-based cohort study. Participants were stratified by birthdate into several categories: non-exposed, fetal, early childhood, mid-childhood, late childhood, and adolescence exposure groups. The non-exposure and adolescence exposure groups were consolidated into an “age-matched group” to provide a robust comparative framework for analyzing the probability of developing osteoporosis (defined as a T-score ≤ -2.5 in bone mineral density) and the frequency of self-reported fracture. Multiple logistic regression models were utilized to investigate the association between early-life malnutrition exposure and the risks of osteoporosis and fracture. Additionally, we validated our findings using the China Northwest Cohort (CNC). RESULTS: A total of 12,789 participants were included into the final analysis. After adjusting for various covariates, individuals exposed to malnutrition during their fetal and childhood stages (early, middle, and late) increased the likelihood of developing osteoporosis in adulthood, compared to their age-matched counterparts. In these four groups, the ORs (95% CI) for osteoporosis risk were 1.223 (1.035 to 1.445), 1.208 (1.052 to 1.386), 1.249 (1.097 to 1.421), and 1.101 (1.001 to 1.210), respectively (all P values < 0.05). Specifically, the late childhood exposure group showed a heightened risk of fracture, with an OR (95% CI) of 1.155 (1.033 to 1.291) and a P-value of 0.01127. Stratified analyses further found a significant correlation between early-life exposure to malnutrition and an elevated risk of osteoporosis in participants with lower educational attainment, overweight or obese participants. Additionally, corroborating evidence from the CNC confirmed the influence of malnutrition exposure on osteoporosis risk. Early-life exposure to malnutrition had a detrimental impact on bone health. Individuals who had experienced malnutrition during fetal and childhood stages (early, middle, and late) exhibited a high susceptibility to osteoporosis in adulthood, compared to age-matched cohorts. This susceptibility was particularly pronounced in women, and individuals who were overweight or obese, or had lower levels of education.

Reference:

Xu, Hongbin, et al. “Early-life Malnutrition Exposure Associated With Higher Osteoporosis Risk in Adulthood: a Large-scale Cross-sectional Study.” International Journal of Surgery (London, England), 2024

Keywords:

Early-life, exposure, malnutrition, high, susceptibility, osteoporosis, adulthood, study, International Journal of Surgery, Xu, Hongbin

Recent research employing integrative multiomics techniques has illuminated the potential of asporin as a protective factor in PAH. The study, which combined genomic, transcriptomic, proteomic, and metabolomic data, offers new insights into the mechanisms underlying PAH and highlights the promising role of asporin in combating this severe condition.

The researchers identified two gene network modules linked to vascular cells, with asporin emerging as a central hub gene. Asporin was observed to be upregulated in the lungs and plasma of PAH patients and was associated with reduced disease severity.

Pulmonary arterial hypertension is a progressive disease characterized by elevated blood pressure in the pulmonary arteries, leading to heart failure and reduced exercise capacity. Despite advances in treatment, managing PAH remains challenging due to its complex pathophysiology and the need for more targeted therapies.

Integrative multiomics can help us understand pulmonary arterial hypertension better, but getting human lung samples from PAH patients is quite rare. Considering this, Jason Hong, Division of Pulmonary and Critical Care Medicine, University of California, Los Angeles, and colleagues used integrative multiomics to investigate the pathobiology of PAH through transcriptomic profiling and deep phenotyping of the largest multicenter PAH lung biobank.

The researchers utilized transcriptomic profiling and extensive phenotyping from the largest multicenter PAH lung biobank to date, which included 96 PAH samples and 52 control samples. This was integrated with clinicopathologic data, genome-wide association studies, Bayesian regulatory networks, single-cell transcriptomics, and pharmacotranscriptomics.

The study revealed the following findings:

• Two potentially protective gene network modules associated with vascular cells were identified, and ASPN was validated, coding for asporin, as a key hub gene that is upregulated as a compensatory response to counteract PAH.
• Asporin is upregulated in the lungs and plasma of multiple independent PAH cohorts and correlates with reduced PAH severity.
• Asporin inhibits proliferation and transforming growth factor–β/phosphorylated SMAD2/3 signaling in pulmonary artery smooth muscle cells from PAH lungs.
• In Sugen-hypoxia rats, ASPN knockdown exacerbated PAH, while recombinant asporin attenuated the condition.

“The integrative systems biology approach used to analyze the PAH lung transcriptome revealed asporin as a new potential therapeutic target with protective effects in pulmonary arterial hypertension,” the researchers concluded.

Reference:

Hong J, Medzikovic L, Sun W, Wong B, Ruffenach G, Rhodes CJ, Brownstein A, Liang LL, Aryan L, Li M, Vadgama A, Kurt Z, Schwantes-An TH, Mickler EA, Gräf S, Eyries M, Lutz KA, Pauciulo MW, Trembath RC, Perros F, Montani D, Morrell NW, Soubrier F, Wilkins MR, Nichols WC, Aldred MA, Desai AA, Trégouët DA, Umar S, Saggar R, Channick R, Tuder RM, Geraci MW, Stearman RS, Yang X, Eghbali M. Integrative Multiomics in the Lung Reveals a Protective Role of Asporin in Pulmonary Arterial Hypertension. Circulation. 2024 Aug 21. doi: 10.1161/CIRCULATIONAHA.124.069864. Epub ahead of print. PMID: 39167456.

“Among 948 patients, FPSR was achieved in 30.5% of those treated with tirofiban, compared to 23.5% in the placebo group. This enhanced reperfusion was associated with better functional outcomes at 90 days,” the researchers reported.

First-pass successful reperfusion (FPSR), which refers to achieving complete and successful reperfusion after a single thrombectomy pass, is a strong predictor of favorable outcomes in patients with acute ischemic stroke due to large-vessel occlusion. Based on this, Junjie Yuan, Department of Critical Care Medicine General Hospital of Southern Theatre Command, PLA Guangzhou China, and colleagues aimed to assess whether intravenous tirofiban could increase the rate of FPSR in patients with acute anterior large-vessel occlusion stroke.

For this purpose, the researchers analyzed data from patients with acute large-vessel occlusion stroke who presented within 24 hours and underwent endovascular thrombectomy as part of the RESCUE BT (Intravenous Tirofiban for Patients With Large Vessel Occlusion Stroke) clinical trial. While the main analysis of the trial was neutral, it randomized patients to receive either intravenous tirofiban or a placebo before thrombectomy.

The primary endpoint was FPSR, defined as successful reperfusion (using the extended thrombolysis in cerebral infarction scale of 2b50, 2c, or 3) achieved after the first thrombectomy attempt. A modified Poisson regression analysis was conducted to assess the association between intravenous tirofiban treatment and FPSR. Among the 948 enrolled patients, 463 were randomized to receive tirofiban and 485 to the placebo group. The mean age of participants was 67 years, and 41.0% of the patients were women.

The findings from the study can be summarized as follows:

• First-pass successful reperfusion (FPSR):
  • FPSR was achieved more frequently in the tirofiban group compared to the placebo group (30.5% versus 23.5%).
  • The adjusted risk ratio for FPSR in the tirofiban group was 1.24, with statistical significance.
• Functional Outcomes at 90 Days:
  • FPSR was associated with a favorable shift to lower modified Rankin Scale (mRS) disability levels at 90 days.
  • The common odds ratio for a favorable shift in disability was 1.42, with statistical significance.

In the post hoc analysis of the RESCUE BT randomized clinical trial, intravenous tirofiban administration before endovascular thrombectomy was found to facilitate the achievement of FPSR in patients with acute ischemic stroke due to large-vessel occlusion. Achieving FPSR, in turn, was linked to lower levels of global disability at 90 days.

“These findings suggest that tirofiban may serve as an effective periprocedural adjunct to enhance FPSR rates during endovascular thrombectomy. However, further confirmation through future trials is needed to validate these results,” the researchers concluded.

Reference:

https://doi.org/10.1161/JAHA.124.03635

In the cohort of mother-infant pairs, maternal PCOS status was linked to shorter birth length, reduced birth weight, and smaller head circumference in the infants.

“The observed growth restrictions became more pronounced when accounting for maternal BMI, offering deeper insight into the relationship between PCOS and body mass index. This study enhances our understanding of how PCOS impacts fetal growth and development,” the researchers wrote in JAMA Network Open.

PCOS is a common endocrine disorder affecting women of reproductive age, characterized by irregular menstrual cycles, elevated androgen levels, and polycystic ovaries. The condition influences metabolic and reproductive aspects of women’s health. However, its impact on offspring growth has been less studied until now. To fill this knowledge gap, Maren Sophie Aaserud Talmo, Norwegian University of Science and Technology, Trondheim, Norway, and colleagues aimed to investigate the association between maternal PCOS and newborn anthropometrics and the modifying effects of maternal body mass index (BMI), PCOS phenotype, and gestational diabetes.

The cohort study tracked women from the early stages of pregnancy through to birth, integrating data from three clinical trials involving pregnant women with PCOS and a reference population from the Norwegian Mother, Father, and Child Cohort (MoBa) Study, along with the Medical Birth Registry of Norway. The clinical trials were conducted from October 1, 2000, to August 31, 2017, while the MoBa data covered the period from July 1, 1999, to December 31, 2008. The study included women with singleton pregnancies and live-born children, with data analysis between January 1 and June 15, 2023.

The exposure of interest was maternal PCOS status. Key outcomes measured included newborn birth weight, birth length, head circumference (both as continuous variables and z scores), ponderal index (calculated as birth weight in grams multiplied by 100 and divided by birth length in centimeters cubed), placenta weight, and the ratio of birth weight to placenta weight (BWPW).

The study led to the following findings:

• The cohort included 390 pregnant women with PCOS (mean age, 29.6 years) and 68 708 women in the reference group (mean age, 30.4 years).
• The offspring in the PCOS group had lower birth weight, birth length, and head circumference than in the reference group.
• The estimated mean differences in z scores were −0.26 for birth weight, −0.19 for birth length, and −0.13 for head circumference.
• The PCOS group also had a lower ponderal index (−0.04 g × 100/cm3) and placenta weight (−24 g), and a higher BWPW ratio (0.4).
• The association between growth restriction and PCOS was more apparent when additionally adjusting for body mass index.
• Neither PCOS phenotype nor gestational diabetes diagnosis was associated with neonatal anthropometry in women with PCOS.

The key discovery of the cohort study is that neonates born to mothers with PCOS show signs of growth restriction, including lower birth weight, shorter birth length, and smaller head circumference. This growth restriction was more evident when adjusting for BMI, particularly among women with overweight or obesity, though the impact of maternal BMI requires further investigation.

“Additionally, the study observed a smaller placenta and a higher BWPW ratio, indicating a potentially stressed but efficient placenta,” the researchers added.

“This may help explain the increased perinatal mortality associated with PCOS. Further research is necessary to explore these findings in greater depth,” they concluded.

Reference:

Talmo MSA, Fløysand IS, Nilsen GØ, et al. Growth Restriction in the Offspring of Mothers With Polycystic Ovary Syndrome. JAMA Netw Open. 2024;7(8):e2430543. doi:10.1001/jamanetworkopen.2024.30543