Thalassemia Effects on Pregnancy

Thalassemia Effects on Pregnancy Thalassemia is the most common hereditary disease in Iran and more than 2 million carriers of the thalassemia mutant gene are living in this country. Material methods: In this retrospective, case-control study, all pregnancies occurred between 2006 and 2008 were included. Patients were divided in two groups regarding the presence of ÃŽÂ ²-thalassemia. Patients in case and control groups were matched according to maternal age, gestational age and number of previous pregnancies. Cesarean delivery, hypertensive disorders, gestational diabetes mellitus, premature rupture of membranes and preterm labor were recorded in each group and were compared using the à Ã¢â‚¬ ¡2 or Fisher exact tests. Results: Overall 510 ÃŽÂ ²-thalassemia subjects and 512 healthy controls were studied. cases with ÃŽÂ ²-thalassemia had significantly higher prevalence of oligohydramnios (P Conclusion: ÃŽÂ ²-thalassemia does not influence the pregnancy outcome in the negative way significantly. Keywords: Minor ÃŽÂ ²-thalassemia, Pregnancy outcome, Gestational diabetes mellitus Oligohydramnios Introduction The prevalence and severity of the thalassemia syndromes are population dependent.(1) Thalassemia minor results in a variable degree of the disease but, depending on the rate of ÃŽÂ ²-chain production, usually presents as asymptomatic anemia of mild degree(2) ÃŽÂ ²-thalassemia is the most common hereditary disease in Iran and more than 2 million carriers of the ÃŽÂ ²-thalassemia mutant gene are living in this country. About 110 mutant genes have been recognized all over the world of which 21 have been identified in the Iranian population. The mutant genes and their frequencies vary greatly in different parts of Iran Prevalence of ÃŽÂ ² thalassemia minor among Iranian is about 7%. (3) ÃŽÂ ²-thalassemia minor represents the heterozygous state. In general, a heterozygote for thalassemia is diagnosed owing to the patient presenting with a mild anemia (hemoglobin A level 1 or 2 g below normal range), low mean cell volume, low mean corpuscular hemoglobin, elevated hemoglobin A2, and normal or elevated hemoglobin F. During pregnancy, women with thalassemia minor will often show more significant anemia, which is often most prominent during the latter half of the second trimester and early third(4,5,6,7). Thalassemia syndromes constitute a group of inherited hemoglobinopathies that require close maternal and fetal surveillance during pregnancy, including appropriate consultation with maternal fetal medicine and hematology specialists. Even for the women who are asymptomatic before pregnancy the added stresses of pregnancy on the hematopoietic system can cause deterioration of maternal status. Health care providers must appreciate that the more severe the thalassemia syndrome the more significant the consequences for both woman and fetus.(4) The impaired globin synthesis impairs oxygen transport and delivery to tissues, placental bed, and fetus because of limited hemoglobin-oxygen binding. Furthermore, in more severe disease states, the accumulation of iron stores in vital maternal organ systems can lead to chronic organ dysfunction, such as cardiomyopathy and diabetes. These women must be monitored closely for worsening anemia and the development of pregnancy-associated complications (8). Because of high prevalence of ÃŽÂ ²-thalassemia in Iran and its possible effects on pregnancy outcome and limited study about this problem. we performed this retrospective case-control study to investigate pregnancy outcome of patients with minor ÃŽÂ ²-thalassemia referring to Hafez Hospital of Shiraz University of Medical Sciences between 2006 and 2009. These results can alert health care providers to take more care about ÃŽÂ ² thalassemia and pregnancy. Methods and material: This study was a case-control one which included all the pregnancies (7290) referring to Hafez Hospital of Shiraz University of Medical Sciences between 2006 and 2008. The patients were divided into two groups regarding the presence of ÃŽÂ ²-thalassemia. Patients in case and control groups were matched according to maternal age, gestational age and number of previous pregnancies. The study was approved by Shiraz University of Medical Sciences ethical committee and all the patients gave their written consents. The data was collected by a means of a questionnaire. Overall 510 ÃŽÂ ²-thalassemia subjects and 512 healthy controls were enrolled in the study. Only women with singleton pregnancy were included. Patient with recurrent abortions (2 or more consecutive pregnancies resulting in spontaneous abortion), history of neural tube defect in previous pregnancies, history of infertility, history of any medical problem, undelivered in this center or mean follow-up visits less than thr ee times were excluded. Follow-up intervals in case and control groups were similar. Gestational age was calculated from the first day of last menstrual period or according to the sonography which was performed in the first months of pregnancy. Anemia was determined on the basis of hemoglobin less than 10 mg/dl. Anemia evaluation was performed in all the cases. Complete blood count (CBC), Iron studies (iron, total iron binding capacity) were performed for excluding iron deficiency anemia and the anemia of chronic disorders. Thalassemia was diagnosed according to CBC and standard hemoglobin electrophoresis criteria in the first trimester: an elevation of Hb A2 (equal or more than 3.5%) demonstrated by electrophoresis and column chromatography confirms the diagnosis of ÃŽÂ ²-thalassemia trait. Blood transfusions were given only when hemoglobin (Hb) dropped significantly (less than 7mg/dl)either due to pregnancy or any other causes. Hemoglobin increased at least to 10 mg/dl with transfusion.(According ACOG criteria(9) Folate supplement in each group (case control) w as given 1mg orally daily. In the study period each patient was evaluated for maternal age, parity, gestational age, maternal anemia during pregnancy (hemoglobin less than 10 g/dL) and birth weight. Poor pregnancy outcomes or complications included hypertensive disorders, gestational diabetes mellitus, premature rupture of membranes (rupture of membrane under 37 weeks gestational age ) and preterm labor.(labor pain under 37 weaks of gestational age) Hydramnios (amniotic fluid index more than 24 cm), oligohydramnios (amniotic fluid index 5 cm or less) and intrauterine growth restriction (IUGR) (when intrauterine growth under 10% by serial sonography especially in third trimester of pregnancy)were also evaluated using sonography in the third trimester. Labor and perinatal outcome included placental abruption, meconium-stained amniotic fluid, cesarean delivery, Apgar score at 1 and 5 minutes less than 7, perinatal mortality, postpartum hemorrhage, and maternal packed-cell transfusions, neonatal ICU admission. Statistical analysis was performed with the SPSS package. Statistical significance was calculated by using the à Ã¢â‚¬ ¡2 or Fisher exact test. A multivariate logistic regression model, with backward elimination, was constructed to find independent risk factors associated with maternal ÃŽÂ ²-thalassemia minor. Odds ratios (ORs) and their 95% confidence intervals (CIs) were computed. A value of P less than 0.05 was considered statistically significant. Results We recorded 510 alive-births and 7 (1.4 %) stillbirths in case and 512 alive births and 5 (1%) stillbirths in control group. The Hb A2 level in our cases usually was approximately 4-6%. Baseline characteristics of subjects in two study groups are shown in Table 1. There was no statistically significant difference between these groups regarding these baseline characteristics. There was no significant difference between these groups regarding pregnancy hypertension and gestational DM (Table 2). Polyhydramnios (AFI>24cm) was observed in 1.4% of cases and 1.9% of control group while oligohydramnios was observed in 10.8% of case and 5.4% of control group (P=0.001, Table 2). Regarding the perinatal complications, 3.1% of case group and 1.5% of control group developed IUGR (P=0.073). Cesarean delivery was significantly more common in case group than control group (38.3% vs 26.5%; P=0.001, Table 3). There was no significant difference between two groups regarding the Apgar score in 1st (P = 0.65) and 5th minute (P = 0.25), ICU admissions (P = 0.17) and placental abruption (P = 0.42). Using a multiple logistic regression model of risk factors for minor ÃŽÂ ²-thalassemia, oligohydramnios, placental abruption and meconium-stained amniotic fluid were significantly associated with cesarean delivery (Table 4). Conclusion Thalassemia syndrome is very common in Iranian population. This case-control study was performed on patients with minor ÃŽÂ ²-thalassemia to determine the maternal and fetal outcomes and describe most risk factors associated with ÃŽÂ ²-thalassemia minor during pregnancy. This study consisting 517 minor ÃŽÂ ²-thalassemia subjects is one of the biggest studies of its kind in Iran. Perinatal mortality (P=0.38) and Apgar score at 1min (P=0.65) and 5 min (P=0.25) after delivery were similar in patients with and without minor ÃŽÂ ²-thalassemia minor. This is consistent with previous studies (9-13). Thalassemia has been associated with an increased incidence of obstetrical complications (14). Adverse pregnancies outcomes detected in these case series, especially low birth weight (Wt Chronic maternal anemia during gestation might lead to fetal hypoxia, predisposing the fetus to IUGR (1,14). Thus, it was suggested that hemoglobin concentration should be maintained above 10 g/dL during these pregnancies (15). No significant association was found between hemoglobin levels and IUGR among thalassemic women in Eyal Sheiner and colleagues study and suggested that a different mechanism is responsible for IUGR in thalassemia minor patients (16). At least one study showed acute splenic infarct in ÃŽÂ ² thalassemia minor .(18).this mechanism may cause placental infarction but this theory needs further study to be approve. In another study all adhesion molecules and CRP (C-reactive protein) increased in patients with thalassemia intermediate (19) .so this molecules and inflammation may cause placental insufficiency in ÃŽÂ ² thalassemia minor but more study is neede Sheiner and associates (2004) reported that oligohydramnios were increased twofold in 261 affected women. In our study oligohydramnios was found in 10.8% of case and 5.4% of control group (P We found no statistically significant difference in the pregnancy outcome, preterm delivery, birth weight, growth restriction, pregnancy induced hypertension and gestational diabetes between thalassemic and non thalassemic patients. All studies investigating pregnancy outcome of patients with ÃŽÂ ²-thalassemia found higher rates of cesarean delivery (11,14,15,17). Likewise, in our study we found significantly higher rates of cesarean delivery. By using a multiple logistic regression model of risk factors for minor thalassemia, the following conditions were significantly associated with cesarean delivery: oligohydramnios, abruption and meconium-stained amniotic fluid. However, IUGR was not statistically independent risk factor for cesarean delivery, unlike previous study that cesarean birth due to fetal distress related to fetal growth restriction (13). In conclusion, Hemoglobinopathies can be associated with a variety of effects on the mother, fetus or newborn. The effects range from absence of clinical disease to severe morbidity and death. Through the obstetrician-gynecologists high index of suspicion based on clinical history and a close working relationship with a consultant hematologist, pregnancy outcome in patients with these disorders can be improved. Since most hemoglobinopathies are inherited as autosomal recessive conditions, screening, counseling, and prenatal diagnosis are important components of prenatal care for these women. Thalassemia syndrome, including minor ÃŽÂ ²-thalassemia during pregnancy can present unique management challenges and requires close maternal and fetal surveillance. The course of pregnancy of patients with ÃŽÂ ²-thalassemia minor, including perinatal outcomes, is favorable. In spite of an attempt to keep hemoglobin levels above 7.0  g/dl, the incidence of fetal growth restriction and preterm birth has been relatively high, though maternal complications are rather not different from general. Care for such pregnancies should be multidisciplinary, incorporating a maternal-fetal medicine specialist, a genetic counselor, and a hematologist. However, since fetal growth restriction complicates more pregnancies with thalassemia syndrome, the need for close antenatal follow-up and frequent sonograp hic assessment of fetal growth can be overemphasized. Further prospective studies among high-risk populations for ÃŽÂ ²-thalassemia with larger sampling should investigate the efficacy of such surveillance programs. The American College of Obstetricians and Gynecologists recommends screening for ÃŽÂ ²-thalassemia in couples of Mediterranean ancestry. We might miss some pregnant ladies with minor thalassemia and normal hemoglobin who were included in control group.

Technology-Enhanced Learning In Education

The Internet is a timely tool for pedagogues who are reforming instruction. If we believe information is the bedrock of cognition, understanding and power, so cosmopolitan entree, to worldwide databases and latest, planetary information and people-to-people networking, is important to supplying pupils with educational challenges. † Children and striplings in modern societies are turning up in a universe where engineering is present everyplace. The extended usage of Information and Communication Technologies ( ICT ) by striplings in their day-to-day life for leisure, amusement and societal interaction is doing a great impact on their acquisition demands, demands and outlooks. They need to larn accomplishments and competencies, for self-development, engagement in society every bit good as for future occupations. Furthermore, they are besides progressively utilizing ICT for any learning intents, frequently outside the schoolroom. This gives rise to new ways of acquisition, including informal 1s which are shaped by new ICT tools, offering exciting larning chances that are basically different than earlier tools. This is the ground why instruction is sing a major invention and the instrument in this development is the computing machine. Computers and cyberspace installations are nowadays available in all our province schools: from primary to secondary and besides at the third degree. It is expected that instruction will see ICT as a major instruction and larning tool across all educational establishments. With its power of interactivity, multimedia and communicating, the computing machine proves an first-class tool for instruction. Psychologists believe that the best feedback is that which comes instantly after the event. What can be more immediate than ‘surfing ‘ the cyberspace and acquiring the consequences wished for within seconds? Of class, the usage of ICT in instruction brings along the demand to larn how to utilize this medium decently because there are legion ways in which the computing machine can be integrated within the learning procedure. Therefore new learning methods need to be explored, equipment has to be purchased, installed, on a regular basis maintained and instructors require preparation. This finally leads to consequences which decidedly need to be evaluated and reviewed for farther betterment.1.1.1 Virtual Learning EnvironmentRecent old ages have seen a considerable scope of tools and programmes that support online acquisition. One such type is a practical acquisition environment which is a web-based information-rich acquisition environment that provides a scope of tools and installations for scholars and instructors to work together. INSPIRAL, a undertaking in the United Kingdom, defined practical acquisition environments as follows: â€Å" VLEs are web-based toolkits that facilitate larning through the proviso and integrating of online instruction and acquisition stuffs and tools. † INSPIRAL ( 2001 ) This brings about a displacement in the important function of the instructor, from that of ‘gatekeeper ‘ of cognition to that of ‘facilitator ‘ and ‘manager ‘ of the acquisition environment, in order to run into the demands of the pupils. Therefore, the pupil, through the counsel of the instructor, sets precedences and accomplishable ends and takes on the duty for making the set ends. Students have the chance to prosecute in autonomous acquisition experiences and activities that promote self-expression, co-operative acquisition and interaction non merely with their immediate environment but with the outside universe every bit good.Aims of the ProbeThere is a sense of urgency for instruction establishments to happen ways to move in favor of the new larning coevals in order to enable new ways of larning guaranting that the accomplishments for future occupations are acquired. It is indispensable to do certain that 21st century acquisition in Europe, p articularly in Malta, becomes more efficient, just and advanced than it of all time was in the yesteryear. The European 2020 scheme high spots of import tendencies, which will take to a extremist transmutation in instruction taking up new accomplishments needed for new occupations. In this regard, e-learning has many assets to offer so as to reenforce and do more accessible educational facets. Teachers hence need to go go-betweens between pupils, cognition and engineering while internet-based societal networking will be a complimentary characteristic to practical acquisition. This scheme aims at sharing best patterns on e-learning undertakings across Europe with a peculiar accent on mobility, quality criterions, instructors ‘ preparation and games. At the European Council held in Lisbon in March 2000, 15 European Heads of Government set a end for Europe to go the most competitory knowledge-based economic system in the universe, capable of sustainable economic growing with more and better occupations and greater societal coherence. Due to the fact that ICT and other related policies play a cardinal function in accomplishing the ends of the Lisbon scheme, the renewed Lisbon ends of 2005 included programs to ease invention through the execution of ICT and higher investing in human capital. Brian Restall, ( 2008 ) in the study ‘The Development of eServices in an Hypertrophied Europium: eLearning in Malta ‘ , presents the consequences of a research on e-learning in Malta. The authorities invested well in ICT in public schools in the last decennary. This has allowed the Maltese instruction sector to be ranked as one of the most technologically connected in the universe. All province schools are networked, connected to broadband cyberspace with a computing machine and an enterprise has been launched to utilize ICT across the course of study. However it is worthy of note that the deficiency of expertness and practical support in seting into pattern e-learning in the course of study, together with appropriate preparation both for instructors and pupils, is still lending significantly to the restrictions of consumption. In fact, most of the attempts that have been noted locally were in most instances consequences of independent attempts at the integrating of ICT in instruction. E-learning is non about taking classroom-based acquisition and forcing it down a wire. Rather, e-learning nowadayss a new position on how engineering can be applied to heighten what instructors do good now, and to present new advanced ways to maximize the handiness, enjoyment and the effectivity of larning for the person. Indeed, online acquisition can besides let educational experiences to be tailored to the demands of persons or groups of persons. Other societal groups, such as scholars with household committednesss and with disablements, can besides profit if the physical and temporal obstructions to instruction are removed with the aid of engineering. â€Å" A major challenge which the present instruction system faces is the effectual and efficient operation of the different educational services in order to supply quality instruction ‘for all kids to win ‘ , a taking aim of the Ministry of Education. The educational substructure and system has grown to such an extent that it requires a more timely and effectual bringing of services and support. † Although the research carried out in this peculiar country has non been conclusive, the ‘laptop for instructors ‘ enterprise, and other similar attempts[ 1 ]hold proven to lend to instructors ‘ betterment of ICT literacy. In secondary schools particularly, holistic attacks to ICT integrating should go the norm instead than the exclusion. The ICT accomplishments that Maltese pupils are geting during their ICT lessons need to be used in other topics in order to implant the accomplishments gained. Some schools are already trying inter-disciplinary and cross-curricular classs and are gaining the potency of ICT ; nevertheless more schools need to do such a measure. On the other manus, a recent â€Å" cognition function † exercising conducted by the World Bank ‘s Information for Development Programme ( InfoDev ) ( Trucano, 2005 ) revealed that, despite decennaries of big investings in ICT to profit instruction in Organisation for Economic Cooperation and Development ( OECD ) states, information to back up the theoretical benefits from ICT are limited. After gaining the job that occurred within the past old ages where merely classroom-based acquisition was taking topographic point without instructors doing usage of ICT tools, as described in this subdivision and as summarised below, the chief aims that this thesis will try to make are: How to outdo integrate the usage of ICT with the acquisition of Mathematics, viz. the subject of Algebra Derive an penetration and hence compare the interactions that happen in the schoolroom and on-lineStructure of the ProbeThe first portion of this thesis gives a reappraisal of different literatures and surveies that have taken topographic point global. Emphasis is put on those coming from the United Kingdom, besides those from Malta. This is because, Maltese instruction has invariably moved, someway, in conformity with British instruction. The method of how the research was carried out will so be explained in item and eventually the informations and consequences obtained will be analysed and compared. The thesis will reason with some recommendations given to instructors who would wish to better, with the aid of ICT, the mathematical acquisition experience offered in Maltese schools.

The Essay Formats Samples Stories

The Essay Formats Samples Stories Using Essay Formats Samples Finding out how to compose an essay introduction may appear the very best start for virtually any student who is fighting with his academic endeavor. At times it just helps to observe how others have tackled essays previously. Due to how the graduate school essay is a complicated work and the most challenging portion of the application procedure, school admissions supply the guidance and instructions for its applicants. There are lots of ways to get ready for the graduate school essay writing. You may discover an MLA format essay example on the site! Essay format doesn't have anything to do with the true content of the essay, it is the way you organize and present it. An essay format is a string of guidelines that determine the way your paper ought to be arranged. Finding the proper format for an essay has never been simpler! The New Angle On Essay Formats Samples Just Released There's, naturally, a limit on th e range of pages even our very best writers can produce with a pressing deadline, but usually, we can satisfy all the clients seeking urgent assistance. When you begin writing an essay, you're aware of all of the work and time you will need to put money into research and writing. Before you even begin writing, make sure you are familiar with the details you are working with. The style of a generic college essay also has to be consistent, in other words, keeping exactly the same register formal from the start to the end. Otherwise, the formatting is left up to you. The MLA formatting style is appropriate for reviews. There are some essential formatting ideas that you should follow for every MBA essay. Writing your very first APA format essay can be a bit intimidating at first, but learning a number of the basic rules of APA style can provide help. Although the subject of your essay functions as the title, the title part of your essay includes several additional elements. T he page should start out with the running head, and in the middle of the following line you want to place the word Abstract. The title page is going to have running head composed of the full heading, name of the author and the university. Furthermore, you'll also get a totally free bibliography page along with an anti-plagiarism check. The Key to Successful Essay Formats Samples When you compose an essay, you should understand what you write about. Then there's the research essay. A persuasive essay should be quite tough and influential. Short essays, just like regular creative essays or, by way of example, psychology coursework essays, might be assigned as homework or last assessment work at the close of the term or academic calendar year. You require essay that starts with the appropriate essay format and dedication to the details required to finish the essay formats accurately. No matter whichever one that you decide to use, you have to be consistent throughout your essay. Last, you would like to understand what an informal essay is. A quick essay demonstrates that you're able to express yourself clearly and concisely. The Number One Question You Must Ask for Essay Formats Samples Do not right justify your complete essay and don't automatically format hyphens if you're utilizing a word processor to type your essay. The internet application essay field will also make block formatting of paragraphs and new paragraphs won't be indented. Three lines down you have to place your name. The format of the works cited page also varies in line with the manner of citation used inside your text. Life, Death and Essay Formats Samples There's rules to follow for each different kind of essay, and it can be tough to keep al l of them in order. Your essay must incorporate an introduction, a body, and a conclusion. Becoming able to compose an essay is an essential part of any educational system, but simply listing ideas in a linear fashion might not always be sufficient. The introduction introduces the subject, giving preliminary, general information regarding the problem that's behind the proposed theme. Since you may see, the format of the graduate school application essay is quite similar to other kinds of essays. Subsequently, essay was defined in a number of ways. Various kinds of essays exist. If you attempt to understand the different kinds of essays and their formats, you've come to the proper place. Your introductory paragraph should also feature some kind of thesis statement, or so the subject of your essay is clear. The last portion of short essays ought to be short but succinct, coherently linked with the former statement of the human body paragraph. Next comes the all-important t hesis statement that comprises a clear outlining of what facets of the author's argument you are going to be discussing. The topic of the sentence always has to be expressed. The author should locate objective and appropriate material and comb through it to find the particular research that supports their ideas. These tips offer you some helpful guidelines which will help you prepare your paper and make sure it is formatted properly. Formatting your essay is just a matter of plugging the suitable information into the correct locations. With keywords unique to the subject matter of each section, it needs to be a whole lot easier to identify its direction and potential informational criteria. One of the absolute most troublesome things in writing essays is finding a very good title. Many young folks are too busy or merely reluctant to compose the essay by themselves. There are 10 basic kinds of essay that are widespread in the sphere of academic writing. There's a normal coll ege essay writing format which you should follow.

Are Animals are Capable of Reasoning Essay - 1592 Words

In his lectures about the way humans treat animals offered at Princeton University, John Coetzee chose to tell his audience a short fictional story about Elizabeth Costello, an aging female novelist. Costello is invited to give a lecture at Appleton College in any topic she wants, which turns out to be about animals. At first, using a story in a lecture seemed to be interesting, but a story about a novelist delivering a lecture should not be more interesting than Coetzee himself giving a lecture. Considering the controversy that usually results from a discussion about animals’ rights, it is also likely that Coetzee chose Costello to be the speaker instead of him because he wanted to detach himself from the discussion of such topic and be†¦show more content†¦Her son, John Bernard, realizes not only that his mother is talking about her death but also that she is going to connect it to the deaths of animals. He also â€Å"has a strong sense that [the] audience— which consists, after all, mainly of young people—wants death-talk even less† (Coetzee 19). Costello also notices the difference between her and the audience’s interest when she says â€Å"†¦I have no reason to believe that you have at the forefront of your minds what is being done to animals at this moment in production facilities†, and avoid talking about the deaths of animals explicitly (Coetzee 19). However, since the purpose of her lectures is to question the way humans treat animals, it is inevitable that she uses â€Å"rhetorical power to evoke these horrors† of animals’ deaths (Coetzee 19). Thus, she cannot ignore a huge gap between her and her audience. The difference between Costello and her audience is parallel to the gap that humans create between them and animals. The other reason that alienates Costello from Appleton community is that she is a female novelist. 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