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Article ; Online: Cord clamping - 'hold on a minute' is not enough, and sample your blood gases while waiting.

Andersson, Ola / Zaigham, Mehreen

2023 Volume 47, Issue 4, Page(s) 151739

Abstract: There is confusion regarding the dynamics of the umbilical cord circulation and the concomitant placental transfusion. How long does it continue, and at what rate? These questions remain an enigma for many. In this article we will address some common ... ...

Abstract	There is confusion regarding the dynamics of the umbilical cord circulation and the concomitant placental transfusion. How long does it continue, and at what rate? These questions remain an enigma for many. In this article we will address some common misconceptions about the management of cord circulation, try to explain why there is a lack of clarity, and call in to question the conclusions from an influential meta-analysis and a recently published guideline on cord clamping. We will do that partly by reviewing the rather extensive literature published on the subject over the past 50 to 70 years, which is easily forgotten, but worth considering. In this review, we will also address the important subject of why and how to sample cord blood correctly and to interpret umbilical gases with a sustained cord circulation, which is a crucial part of our ongoing multicenter study 'Sustained cord circulation And Ventilation', the SAVE-study.
MeSH term(s)	Pregnancy ; Female ; Humans ; Constriction ; Placenta ; Umbilical Cord ; Time Factors ; Gases ; Multicenter Studies as Topic
Chemical Substances	Gases
Language	English
Publishing date	2023-03-17
Publishing country	United States
Document type	Meta-Analysis ; Review ; Journal Article
ZDB-ID	752403-1
ISSN	1558-075X ; 0146-0005
ISSN (online)	1558-075X
ISSN	0146-0005
DOI	10.1016/j.semperi.2023.151739
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Article ; Online: Global disparities in caesarean section rates: Why indication-based metrics are needed.

Zaigham, Mehreen / Varallo, John / Thangaratinam, Shakila / Nicholson, Wanda / H A Visser, Gerard

PLOS global public health

2024 Volume 4, Issue 2, Page(s) e0002877

Language	English
Publishing date	2024-02-06
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0002877
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Article ; Online: Adverse perinatal outcomes after Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy: a systematic review.

Kistner, Astrid / Werner, Alva / Zaigham, Mehreen

BMC pregnancy and childbirth

2023 Volume 23, Issue 1, Page(s) 557

Abstract: Background: Pregnancies occurring after bariatric surgery are associated with various perinatal complications. However, there may be differences in the type of perinatal complications occurring after different methods of bariatric surgery. The aim of ... ...

Abstract	Background: Pregnancies occurring after bariatric surgery are associated with various perinatal complications. However, there may be differences in the type of perinatal complications occurring after different methods of bariatric surgery. The aim of the current study was to compare adverse perinatal outcomes in pregnant women following Roux-en-Y Gastric Bypass (RYGB) vs. Sleeve Gastrectomy (SG). Methods: A systematic database search was performed in PubMed, Embase, Scopus and CINAHL. Observational studies comparing perinatal outcomes post-bariatric (RYGB and SG) surgery to pregnancies without prior surgery were selected. Outcomes of interest were: maternal body mass index (BMI) at the time of conception, mode of delivery, time from surgery to conception, birth weight, gestational age and intrauterine fetal death. Article selection, risk of bias assessment and data extraction, were performed by two authors. The study protocol was published in its revised form in PROSPERO, registration number: CRD42021234480. Results: A total of 3201 records were extracted. After duplicates were removed, 3143 records were screened for inclusion. Six studies fitted the selection criteria, of which four studies were RYGB and two SG (1100 post-RYGB vs. 209 post-SG). For the included studies, higher incidence of both SGA (22.9%, 11.9%, 14.2%) and LGA (4.2%, 4.8%, 1.7%) in SG compared to Roux-en-Y (SGA: 8.8%, 7.7%, 11.5%, 8.3% and LGA: 3.4%, 0.7%) were observed. SG had a shorter surgery to conception interval as compared to RYGB. Risk of bias assessment was moderate to serious for the studies included in the review, with bias in selection of participants being the major reason. Conclusion: Our systematic review demonstrated no major differences in BMI, mode of delivery, birthweight, gestational age, or rates of intrauterine death between women having undergone RYGB vs. SG. The rate of SGA and LGA births were higher in the SG group, but this group also had a shorter surgery to conception interval. Future studies are indicated to counsel women of reproductive age on the most appropriate type of bariatric surgery that is associated with the best perinatal outcomes.
MeSH term(s)	Female ; Humans ; Pregnancy ; Bariatric Surgery ; Gastrectomy/adverse effects ; Gastrectomy/methods ; Gastric Bypass/adverse effects ; Gastric Bypass/methods ; Obesity, Morbid/surgery ; Parturition ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2023-08-02
Publishing country	England
Document type	Systematic Review ; Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-023-05515-7
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Article: Saccharomyces cerevisiae for abdominal pain and discomfort in irritable bowel syndrome patients.

Siyal, Mehreen / Abbas, Zaigham / Amir, Muhammad Rafay / Qadeer, Muhammad Ali

Pakistan journal of medical sciences

2024 Volume 40, Issue 3Part-II, Page(s) 492–498

Abstract: Background: Irritable Bowel Syndrome (IBS) leads to significant impairment of health-related quality of life, for the alleviation of which, the efficacy of available therapies is modest. Limited data is available on the role of Saccharomyces cerevisiae ... ...

Abstract	Background: Irritable Bowel Syndrome (IBS) leads to significant impairment of health-related quality of life, for the alleviation of which, the efficacy of available therapies is modest. Limited data is available on the role of Saccharomyces cerevisiae in treating patients with IBS. Methods: Thirty patients with IBS as per Rome-IV criteria, visiting our outpatient department from March 2021 to October 2021, were given capsule Saccharomyces cerevisiae 500 mg twice daily for four weeks. Evaluation for abdominal pain symptoms was done every week and the patient's compliance was assessed. IBS Quality of Life (QOL) questionnaires were filled at baseline and after four weeks of treatment. The QOL and pain scales were adjusted to 0-100 for statistical analysis. Results: Seventeen patients (56.7%) were males. The age range was 21-72 years (mean ± SD: 39. 63 ± 14.32), out of which 18(60%) patients were 20-40 years old. Body Mass Index (BMI) ranged from 18-33 (25.33 ± 4.09), and 17 (56.67%) were overweight or obese. Sixteen patients had constipation predominant (53.3%), nine had diarrhea-predominant (30%), and five had mixed-type (16.7%) IBS. There was an improvement in the pain score from 63.81 at week 0 (W0) to 20.48 at the end of week 4 (W4) (p<0.001). An improvement was noted in all the eight categories of IBS QOL questionnaire, i.e., dysphoria (p<0.001), interference with activity (p<0.001), body image (p<0.001), health worry (p<0.001), food avoidance (p<0.001), social reaction (p<0.001), sexual function (p<0.001) and relationships (p<0.001). There was an overall improvement in QOL score from a mean of 24.68 at baseline to 58.09 at the end of the study duration (p<0.001). The improvement in the pain score showed a positive correlation with the improvement in quality of life (p<0.001). Conclusion: Treatment with Saccharomyces cerevisiae improved the pain and quality of life in patients with IBS and it appears to be a promising option for alleviating symptoms in these patients.
Language	English
Publishing date	2024-01-29
Publishing country	Pakistan
Document type	Journal Article
ZDB-ID	2032827-8
ISSN	1681-715X ; 1682-024X ; 1017-4699
ISSN (online)	1681-715X
ISSN	1682-024X ; 1017-4699
DOI	10.12669/pjms.40.3.8349
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Article ; Online: Apgar score in premature infants associated with neonatal death prediction.

Zaigham, Mehreen / Maršál, Karel

The Journal of pediatrics

2020 Volume 226, Page(s) 309–313

MeSH term(s)	Apgar Score ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Infant, Premature ; Infant, Premature, Diseases/diagnosis ; Perinatal Death
Language	English
Publishing date	2020-10-22
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2020.08.055
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Article ; Online: Adverse neonatal outcome and veno-arterial differences in umbilical cord blood pH (ΔpH) at birth: a population-based study of 108,629 newborns.

Sundberg, Tiia-Marie / Wiberg, Nana / Källén, Karin / Zaigham, Mehreen

BMC pregnancy and childbirth

2023 Volume 23, Issue 1, Page(s) 162

Abstract: Background: Umbilical cord blood gases are routinely used by midwives and obstetricians for quality assurance of birth management and in clinical research. They can form the basis for solving medicolegal issues in the identification of severe ... ...

Abstract	Background: Umbilical cord blood gases are routinely used by midwives and obstetricians for quality assurance of birth management and in clinical research. They can form the basis for solving medicolegal issues in the identification of severe intrapartum hypoxia at birth. However, the scientific value of veno-arterial differences in cord blood pH, also known as ΔpH, is largely unknown. By tradition, the Apgar score is frequently used to predict perinatal morbidity and mortality, however significant inter-observer and regional variations decrease its reliability and there is a need to identify more accurate markers of perinatal asphyxia. The aim of our study was to investigate the association of small and large veno-arterial differences in umbilical cord pH, ΔpH, with adverse neonatal outcome. Methods: This retrospective, population-based study collected obstetric and neonatal data from women giving birth in nine maternity units from Southern Sweden from 1995 to 2015. Data was extracted from the Perinatal South Revision Register, a quality regional health database. Newborns at ≥37 gestational weeks with a complete and validated set of umbilical cord blood samples from both cord artery and vein were included. Outcome measures included: ΔpH percentiles, 'Small ΔpH' (10th percentile), 'Large ΔpH' (90th percentile), Apgar score (0-6), need for continuous positive airway pressure (CPAP) and admission to neonatal intensive care unit (NICU). Relative risks (RR) were calculated with modified Poisson regression model. Results: The study population comprised of 108,629 newborns with complete and validated data. Mean and median ΔpH was 0.08 ± 0.05. Analyses of RR showed that 'Large ΔpH' was associated with a decreased RR of adverse perinatal outcome with increasing UApH (at UApH ≥7.20: RR for low Apgar 0.29, P = 0.01; CPAP 0.55, P = 0.02; NICU admission 0.81, P = 0.01). 'Small ΔpH' was associated with an increased RR for low Apgar score and NICU admission only at higher UApH values (at UApH 7.15-7.199: RR for low Apgar 1.96, P = 0.01; at UApH ≥7.20: RR for low Apgar 1.65, P = 0.00, RR for NICU admission 1.13, P = 0.01). Conclusion: Large differences between cord venous and arterial pH (ΔpH) at birth were associated with a lower risk for perinatal morbidity including low 5-minute Apgar Score, the need for continuous positive airway pressure and NICU admission when UApH was above 7.15. Clinically, ΔpH may be a useful tool in the assessment of the newborn's metabolic condition at birth. Our findings may stem from the ability of the placenta to adequately replenish acid-base balance in fetal blood. 'Large ΔpH' may therefore be a marker of effective gas exchange in the placenta during birth.
MeSH term(s)	Pregnancy ; Humans ; Infant, Newborn ; Female ; Fetal Blood ; Retrospective Studies ; Proton-Motive Force ; Reproducibility of Results ; Arteries ; Infant, Newborn, Diseases ; Hydrogen-Ion Concentration ; Apgar Score
Language	English
Publishing date	2023-03-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-023-05487-8
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Article: Des-gamma-carboxy prothrombin and alpha-fetoprotein levels as biomarkers for hepatocellular carcinoma and their correlation with radiological characteristics.

Qadeer, Muhammad Ali / Abbas, Zaigham / Amjad, Shaima / Shahid, Bushra / Altaf, Abeer / Siyal, Mehreen

World journal of gastrointestinal pathophysiology

2024 Volume 15, Issue 1, Page(s) 90893

Abstract: Background: Alpha-fetoprotein (AFP), a commonly used biomarker for hepatocellular carcinoma (HCC), is normal in up to one-third of patients.: Aim: To evaluate the diagnostic performance of des-gamma-carboxy-prothrombin (DCP) alone and in combination ... ...

Abstract	Background: Alpha-fetoprotein (AFP), a commonly used biomarker for hepatocellular carcinoma (HCC), is normal in up to one-third of patients. Aim: To evaluate the diagnostic performance of des-gamma-carboxy-prothrombin (DCP) alone and in combination with AFP. Methods: In this study, 202 patients with radiologically proven HCC were enrolled, and their DCP and AFP levels were evaluated for their diagnostic performance. Results: The mean age of the enrolled patients was 58.5 years; 72.0% were male. DCP was elevated in 86.6% ( Conclusion: DCP, as an individual marker, had a better diagnostic performance in many cases of HCC. Hence, DCP may replace AFP as the primary HCC biomarker.
Language	English
Publishing date	2024-03-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2583474-5
ISSN	2150-5330
ISSN	2150-5330
DOI	10.4291/wjgp.v15.i1.90893
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Article ; Online: Maternal and perinatal outcomes with COVID-19: A systematic review of 108 pregnancies.

Zaigham, Mehreen / Andersson, Ola

Acta obstetricia et gynecologica Scandinavica

2020 Volume 99, Issue 7, Page(s) 823–829

Abstract: Introduction: The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has exposed vulnerable populations to an unprecedented global health crisis. The knowledge gained from previous human coronavirus outbreaks suggests ... ...

Abstract	Introduction: The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has exposed vulnerable populations to an unprecedented global health crisis. The knowledge gained from previous human coronavirus outbreaks suggests that pregnant women and their fetuses are particularly susceptible to poor outcomes. The objective of this study was to summarize the clinical manifestations and maternal and perinatal outcomes of COVID-19 during pregnancy. Material and methods: We searched databases for all case reports and series from 12 February to 4 April 2020. Multiple terms and combinations were used including COVID-19, pregnancy, maternal mortality, maternal morbidity, complications, clinical manifestations, neonatal morbidity, intrauterine fetal death, neonatal mortality and SARS-CoV-2. Eligibility criteria included peer-reviewed publications written in English or Chinese and quantitative real-time polymerase chain reaction (PCR) or dual fluorescence PCR-confirmed SARS-CoV-2 infection. Unpublished reports, unspecified date and location of the study or suspicion of duplicate reporting, cases with suspected COVID-19 that were not confirmed by a laboratory test, and unreported maternal or perinatal outcomes were excluded. Data on clinical manifestations, maternal and perinatal outcomes including vertical transmission were extracted and analyzed. Results: Eighteen articles reporting data from 108 pregnancies between 8 December 2019 and 1 April 2020 were included in the current study. Most reports described women presenting in the third trimester with fever (68%) and coughing (34%). Lymphocytopenia (59%) with elevated C-reactive protein (70%) was observed and 91% of the women were delivered by cesarean section. Three maternal intensive care unit admissions were noted but no maternal deaths. One neonatal death and one intrauterine death were also reported. Conclusions: Although the majority of mothers were discharged without any major complications, severe maternal morbidity as a result of COVID-19 and perinatal deaths were reported. Vertical transmission of the COVID-19 could not be ruled out. Careful monitoring of pregnancies with COVID-19 and measures to prevent neonatal infection are warranted.
MeSH term(s)	Betacoronavirus/isolation & purification ; COVID-19 ; Cesarean Section/statistics & numerical data ; Coronavirus Infections/complications ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Coronavirus Infections/physiopathology ; Female ; Humans ; Infant ; Infant, Newborn ; Infectious Disease Transmission, Vertical/statistics & numerical data ; Maternal Mortality ; Pandemics/statistics & numerical data ; Perinatal Mortality ; Pneumonia, Viral/complications ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/physiopathology ; Pregnancy ; Pregnancy Complications, Infectious/mortality ; Pregnancy Complications, Infectious/physiopathology ; Pregnancy Complications, Infectious/virology ; Pregnancy Outcome ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-04-20
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	80019-3
ISSN	1600-0412 ; 0001-6349
ISSN (online)	1600-0412
ISSN	0001-6349
DOI	10.1111/aogs.13867
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Article: Point of Care Testing for SARS-COV-2 Antibodies before doing Endoscopy.

Altaf, Abeer / Abbas, Zaigham / Qadeer, Muhammad Ali / Siyal, Mehreen

Pakistan journal of medical sciences

2023 Volume 39, Issue 2, Page(s) 367–370

Abstract: Objectives: COVID-19 has taken the world by storm, creating much disparity among both healthcare and non-healthcare centres regarding the provision of services. The purpose of our study was to see the prevalence of the SARS-COV-2 exposure in the ... ...

Abstract	Objectives: COVID-19 has taken the world by storm, creating much disparity among both healthcare and non-healthcare centres regarding the provision of services. The purpose of our study was to see the prevalence of the SARS-COV-2 exposure in the asymptomatic patients undergoing the endoscopic procedure, already triaged based on history and examination. Methods: Total 207 patients were enrolled during a time period of five months during October 2020 to April 2021 at Dr. Ziauddin Hospital Clifton campus, Karachi. In this prospective observational study patients undergoing endoscopic procedures were included after taking informed consent. The patients who already tested positive for COVID-19 by PCR were excluded. Patients were tested for Covid serology by immunochromatographic rapid serology Result: Total number of patients included was 207; males were 121 (58.5%). The mean age was 48.5 ± 17.55 (range 13 to 92). Forty eight patients (23.2%) were positive for either antibody suggesting exposure to the COVID-19 virus. Out of these combined IgM and IgG positivity was seen in 24 (11.5%), IgM mono antibody positivity was seen in 7 (3.38%) and 17 (8.21%) of the study population tested positive for IgG only. 15 out of 46 (32.6%) patients with chronic liver disease in the cohort were seropositive for COVID antibodies. Conclusion: About one-fourth of the patients undergoing the endoscopic procedure were tested positive for COVID antibodies of which a significant percentage had chronic liver disease. It stresses the need of observing standard precautions to prevent the spread of infection during these procedures, especially in the vulnerable population.
Language	English
Publishing date	2023-01-14
Publishing country	Pakistan
Document type	Journal Article
ZDB-ID	2032827-8
ISSN	1681-715X ; 1682-024X ; 1017-4699
ISSN (online)	1681-715X
ISSN	1682-024X ; 1017-4699
DOI	10.12669/pjms.39.2.5659
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Article ; Online: Unleashing the potential of women in global surgery: Concrete solutions for achieving gender parity.

Dutta, Rohini / Coombes, Carolina / Ehsan, Anam / Bryce-Alberti, Mayte / Campos, Letícia Nunes / Raguveer, Vanitha / Sana, Hamaiyal / Zaigham, Mehreen / Asturias, Sabrina / Saha, Shivangi / Ranganathan, Kavitha

PLOS global public health

2024 Volume 4, Issue 4, Page(s) e0003018

Language	English
Publishing date	2024-04-04
Publishing country	United States
Document type	Journal Article
ISSN	2767-3375
ISSN (online)	2767-3375
DOI	10.1371/journal.pgph.0003018
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