THE URGENCY AND IMPLICATION OF BREAST MILK DONOR IN INDONESIA IN MASHLAHAH PERSPECTIVE

In Islamic teachings, the issue of breastfeeding is a very important issue to pay attention to, because it can have an impact on the issue of the prohibition of marriage and lineage. The purpose of this study is to dig deeper into the urgency of breastfeeding donors and their implications based on the practice of breastfeeding donors in Indonesia, and a review of the mashlahah of these breast milk donors. This type of research is library research, with analytical descriptive method. This research uses mashlahah theory with ushul fiqh approach. As a result, breast milk donation in Indonesia can be done by fulfilling several conditions: first, the request of the biological mother or the baby’s family. Second, the identity, religion, and address of the breast milk donor are clearly known by the mother or family of the baby receiving the donor. Third, the approval of the breast milk donor by knowing the identity of the donor recipient baby. Fourth, the breast milk donor is in good health and has no medical indication. Fifth, breast milk is not traded. Meanwhile, based on Ijtihâd istishlâhî, breast milk donation which aims to help babies who do not get breast milk from their biological mothers for certain reasons, is a humanitarian aid to save human life. Therefore, it is legally permissible to donate breast milk and can be categorized as mashlahah dharuriyat if the mother of the baby is sick and the baby is premature or sick. Including mashlahah hajiyat if the baby’s mother dies, or her whereabouts are not known.

A study on drug therapy issues in the department of medicine of a tertiary care teaching hospital-prospective observational study

Background: A drug therapy problem (DTP) is any undesirable event experienced by a patient that involves or is suspected to involve, drug therapy, and that interferes with achieving the desired goals of therapy. The improper use of drugs can lead to patient morbidity and even mortality. DTP s are the clinical territory of the pharmaceutical care practitioner and the resolution of identifying the DTPs help patients to achieve their goals of therapy. Identifying DTPs enables risk quantification and determination of the potential impact of prevention strategies. DTPs are associated with prolonged length of stay and increased economic burden and results in increased risk of death.Methods: A hospital based, prospective observational study was conducted at department of medicine in Rajah Muthiah medical college and hospital, 80 patients were enrolled in this study based on the inclusion-exclusion criteria. The DTPs were identified using the Cipolle’s method of classification of DTP.Results: The study has shown that 80 of the patients involved in the study had a total of 136 DTPs. An average of 1.7 DTPs were recorded per patient during the study. The most common DTP identified was unnecessary drug therapy accounting to 47%. The absence of valid medical indication was (30%) and (16%) were due to the duplication of therapy. The second most common DTP was unsafe drug for patients, accounting to 45% were due to patient non-compliance and drug interaction which was minor. Need for additional drug therapy was the third most identified accounting 13% were due to medical indication indicate the need of drug therapy.Conclusions: The foremost commonly observed DTP is unnecessary therapy and patient non-compliance to the drugs. The study suggests that DTPs are significantly occurring in hospital can cause the patient for comorbidity, prolonged hospitalization. The study suggests that clinical pharmacist and general practitioners can work together to spot and resolve the DTPs.

Potentially Preventable Primary Cesarean Sections in Future Placenta Accreta Spectrum

Background Prior cesarean delivery is a well-known risk factor for placenta accreta spectrum disorders. While primary cesarean section is unavoidable in some patients, in others it may not be clearly indicated. Objective The aim of the study is to determine the proportion of patients with placenta accreta spectrum who had a potentially preventable primary cesarean section and to identify factors associated with preventable placenta accreta spectrum. Study Design This was a single-center retrospective cohort study of women with pathology-confirmed placenta accreta spectrum from 2007 to 2019. Primary cesarean sections were categorized as potentially preventable or unpreventable based on practice consistent with the American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine “Safe Prevention of the Primary Cesarean Delivery” recommendations. Fisher's exact test and Mann-Whitney U-test were used for comparison with p <0.05 considered statistically significant. Results Seventy-two patients had pathology-confirmed placenta accreta spectrum over the course of the study period, 15 (20.8%) of whom required a cesarean hysterectomy at the time of primary cesarean section. Fifty-seven patients had placenta accreta spectrum in a pregnancy following their primary cesarean section. Of these, 29 (50.9%) were considered potentially preventable. Most were performed without clear medical indication (37.9%) or for fetal malpresentation without attempted external cephalic version (37.9%). The remainder were due to arrest of labor not meeting criteria (17.2%) and abnormal or indeterminate fetal heart patterns with documented recovery (6.9%). Of the 11 patients without clear medical indication for primary cesarean section, eight (72.7%) were patient-choice cesarean sections and three (27.3%) were for suspected fetal macrosomia with estimated fetal weights not meeting criteria for cesarean delivery. There was no difference in the incidence of potentially preventable primary cesarean sections before and after the ACOG-SMFM “Safe Prevention of the Primary Cesarean Delivery” publication (48.8 vs. 57.1%, p = 0.59). Privately insured patients were more likely to have a potentially preventable primary cesarean section than those with Medicaid (62.5 vs. 23.5%, p = 0.008) and were more likely to have a primary cesarean section without clear medical indication (81.8 vs. 18.2%, p = 0.004). Conclusion Many patients with placenta accreta spectrum had a potentially preventable primary cesarean section. Most were performed without clear medical indication or for malpresentation without attempted external cephalic version, suggesting that at least a subset of placenta accreta spectrum cases may be preventable. This was particularly true for privately insured patients. These findings call for continued investigation of potentially preventable primary cesarean sections with initiatives to address concerns at the patient, provider, and hospital level. Key Points

Associations between cesarean delivery and child mortality: A national record linkage longitudinal study of 17.8 million births in Brazil

Background There is an increasing use of cesarean delivery (CD) based on preference rather than on medical indication. However, the extent to which nonmedically indicated CD benefits or harms child survival remains unclear. Our hypothesis was that in groups with a low indication for CD, this procedure would be associated with higher child mortality and in groups with a clear medical indication CD would be associated with improved child survival chances. Methods and findings We conducted a population-based cohort study in Brazil by linking routine data on live births between January 1, 2012 and December 31, 2018 and assessing mortality up to 5 years of age. Women with a live birth who contributed records during this period were classified into one of 10 Robson groups based on their pregnancy and delivery characteristics. We used propensity scores to match CD with vaginal deliveries (1:1) and prelabor CD with unscheduled CD (1:1) and estimated associations with child mortality using Cox regressions. A total of 17,838,115 live births were analyzed. After propensity score matching (PSM), we found that live births to women in groups with low expected frequencies of CD (Robson groups 1 to 4) had a higher death rate up to age 5 years if they were born via CD compared with vaginal deliveries (HR = 1.25, 95% CI: 1.22 to 1.28; p < 0.001). The relative rate was greatest in the neonatal period (HR = 1.39, 95% CI: 1.34 to 1.45; p < 0.001). There was no difference in mortality rate when comparing offspring born by a prelabor CD to those born by unscheduled CD. For the live births to women with a CD in a prior pregnancy (Robson group 5), the relative rates for child mortality were similar for those born by CD compared with vaginal deliveries (HR = 1.05, 95% CI: 1.00 to 1.10; p = 0.024). In contrast, for live births to women in groups with high expected rates of CD (Robson groups 6 to 10), the child mortality rate was lower for CD than for vaginal deliveries (HR = 0.90, 95% CI: 0.89 to 0.91; p < 0.001), particularly in the neonatal period (HR = 0.84, 95% CI: 0.83 to 0.85; p < 0.001). Our results should be interpreted with caution in clinical practice, since relevant clinical data on CD indication were not available. Conclusions In this study, we observed that in Robson groups with low expected frequencies of CD, this procedure was associated with a 25% increase in child mortality. However, in groups with high expected frequencies of CD, the findings suggest that clinically indicated CD is associated with a reduction in child mortality.

PERLINDUNGAN HUKUM BAGI DOKTER DAN PASIEN DALAM MELAKUKAN INFORMED CONSENT PADA TINDAKAN C-SECTION TANPA INDIKASI MEDIS

<p>Abstract<br />In recent years, Caesarean section without medical indication seems to be a trend of medical action that occurs in society. Many factors cause this to happen. Among them, so that the fetus can be born according to the desired date of the parents, or based on other factors outside of medical conditions. In the implementation of a Caesarean section, medical consent before the Caesarean section is performed is still very necessary to minimize the medical risk that the patient is suspected of experiencing. In addition, with the existence of medical approval before the Caesarean section is carried out, it is hoped that it will also be able to provide legal protection to patients and doctors both preventively and repressively.<br /><br /></p><p>Abstrak<br />Beberapa tahun belakangan ini, tindakan Operasi Caesar tanpa indikasi medis seolah menjadi sebuah trend tindakan medis yang terjadi didalam masyarakat. Banyak faktor yang menyebabkan hal demikian terjadi. Diantaranya, agar janin bisa dilahirkan sesuai tanggal keinginan dari orang tua, ataupun berdasarkan faktor lainnya diluar ketentuan medis. Dalam pelaksanaan upaya Operasi Caesar, tindakan persetujuan medis sebelum upaya Operasi Caesar ini dilakukan masih sangat diperlukan guna meminimalisir resiko medis yang diduga akan dialami oleh pasien. Selain itu, dengan adanya tindakan persetujuan medis sebelum upaya operasi Caesar ini dilaksanakan, diharapkan juga turut mampu memberi perlindungan hukum pada pasien dan dokter baik secara preventif maupun represif.<br /><br /></p>

Early intervention, treatment and rehabilitation of employees with common mental disorders by using psychotherapeutic consultation at work: study protocol of a randomised controlled multicentre trial (friaa project)

Background Common mental disorders are one of the leading causes for sickness absence and early retirement due to reduced health. Furthermore, a treatment gap for common mental disorders has been described worldwide. Within this study, psychotherapeutic consultation at work defined as a tailored, module-based and work-related psychotherapeutic intervention will be applied to improve mental health care. Methods This study comprises a randomised controlled multicentre trial with 1:1 allocation to an intervention and control group. In total, 520 employees with common mental disorders shall be recruited from companies being located around five study centres in Germany. Besides care as usual, the intervention group will receive up to 17 sessions of psychotherapy. The first session will include basics diagnostics and medical indication of treatment and the second session will include work-related diagnostics. Then, participants of the intervention group may receive work-related psychotherapeutic consultation for up to ten sessions. Further psychotherapeutic consultation during return to work for up to five sessions will be offered where appropriate. The control group will receive care as usual and the first intervention session of basic diagnostics and medical indication of treatment. After enrolment to the study, participants will be followed up after nine (first follow-up) and fifteen (second follow-up) months. Self-reported days of sickness absence within the last 6 months at the second follow-up will be used as the primary outcome and self-efficacy at the second follow-up as the secondary outcome. Furthermore, a cost-benefit assessment related to costs of common mental disorders for social insurances and companies will be performed. Discussion Psychotherapeutic consultation at work represents a low threshold care model aiming to overcome treatment gaps for employees with common mental disorders. If successfully implemented and evaluated, it might serve as a role model to the care of employees with common mental disorders and might be adopted in standard care in cooperation with sickness and pension insurances in Germany. Trial registration The friaa project was registered at the German Clinical Trial Register (DRKS) at 01.03.2021 (DRKS00023049): https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023049.

Drug Repurposing Using Biological Networks

Drug repositioning is a strategy to identify new uses for existing, approved, or research drugs that are outside the scope of its original medical indication. Drug repurposing is based on the fact that one drug can act on multiple targets or that two diseases can have molecular similarities, among others. Currently, thanks to the rapid advancement of high-performance technologies, a massive amount of biological and biomedical data is being generated. This allows the use of computational methods and models based on biological networks to develop new possibilities for drug repurposing. Therefore, here, we provide an in-depth review of the main applications of drug repositioning that have been carried out using biological network models. The goal of this review is to show the usefulness of these computational methods to predict associations and to find candidate drugs for repositioning in new indications of certain diseases.

The Question of the Effectiveness of Coptic Pharmacological Prescriptions

Coptic pharmacological texts offer a multitude of medical prescriptions concerning various afflictions, such as eye or skin irritations, affections of the viscera, or even psychological complaints. The content of these texts is medical, and in most cases bereft of any magical or religious ideas. They usually compile prescriptions according to symptoms and/or afflictions, without any further organising principle. Only a handful of texts are grouped according to the illness or to the medicinal plants used. Almost every prescription follows a pattern, with four formal elements: 1) the medical indication (or purpose), 2) the (basic) ingredients, 3) the procedure and application, and 4) the effects and/or the effectiveness of a remedy, or further information. In this article, I give an overview of the entire corpus of Coptic medical prescriptions, explore the four main elements, and especially the discussions of efficacy. I also examine the material in light of placebo research, to see whether something like a placebo effect may have influenced how the pharmacological texts were formulated.

Planned caesarean section versus planned vaginal delivery among women without formal medical indication for planned caesarean section: A retrospective cohort study of short-term complications

Objective: To study complications, within six weeks postpartum, after planned caesarean section (CS) compared with planned vaginal delivery, among women without formal indication for caesarean section. Design: Retrospective cohort study. Setting: Swedish national registries. Population: 714 326 deliveries, 2008-2017. Methods: The risks of complications were compared between planned caesarean section and planned vaginal delivery among women without formal medical indication for planned CS. Adjusted Risk Ratios (ARR) were obtained using modified Poisson-regression models adjusting for; maternal age, parity, body mass index, smoking, country of birth, and county. Main outcome measure: infections, haemorrhage and thromboembolism. Results:. In the planned CS group (n=22 855), 15% had a postpartum infection compared with 10% in the planned vaginal group (n=691 471) (ARR=1.6; 95%CI 1.5-1.6), 8.4% vs 0.6% had haemorrhage >1 litre (ARR=13.4; 95%CI 12.7-14.2), and 0.08% vs 0.05% had a postpartum pulmonary embolism (ARR=1.7; 95%CI 1.0-2.6). The obtained risk estimates correspond to a Number-Needed-to-Harm estimate of 17, 14, and 3448, respectively. When dividing the infections into subgroups, an increased risk of endometritis (ARR 1.2; 95%CI 1.1-1.3), wound infection (ARR 2.7 95%CI 2.4-3.0), urinary tract infections (ARR 1.5 95%CI 1.3-1.7), and mastitis (ARR 2.0; 1.9-2.2) was found after planned CS. Conclusion: The risks of short-term maternal complications were higher in women delivered by planned CS compared with planned vaginal delivery among women without formal medical indication for planned CS. Funding: Gorthon Foundation. Key words: caesarean section, puerperal infection, haemorrhage, thromboembolism.