Background. This study examines near-miss obstetric events in African hospitals as to the frequency, nature, and ratio of near miss to death and considers whether these could become useful indicators for monitoring the performance of obstetric services in Africa. Methods. Prospective or retrospective reviews of medical records were conducted in nine referral hospitals in three countries (Benin, Co ˆte d'Ivoire, and Morocco). We calculated the incidence of near-miss obstetric events, near-miss cases, and maternal deaths related to hemorrhage, hypertensive diseases of pregnancy, dystocia, infections, and anemia and analyzed these according to hospital and timing relative to admission. Results. The incidence of near-miss cases was varied, and in some hospitals extremely large: from 1% to almost a quarter of all deliveries were near misses. Near-miss cases were 15 times more common than deaths (ranging from a ratio of 9 : 1-108 : 1). Most of the women with near-miss events (NMEs) (83%) were already in a critical condition on arrival at the hospital (range 54-90%), and two in three were referred from another facility. The most frequent types of NMEs were hemorrhage and hypertensive diseases of pregnancy, but anemia was the leading cause in three first referral level hospitals in Benin and Co ˆte d'Ivoire. Near-miss events due to infections were rare. Conclusions. Near-miss events are extremely common in some African hospitals, with a high proportion arriving in critical conditions. Near-miss events must be estimated separately for those already in a critical condition on arrival and those developing after admission; the first as a good indicator of the effectiveness of emergency referrals and the second as a potential tool for monitoring the performance of obstetric services.

Although previous studies suggested the protective effect of zinc for type-2 diabetes (T2D), the unitary causal effect remains inconclusive. We investigated the causal effect of zinc as a single intervention on glycemic control for T2D, using a systematic review of RCTs and two-sample Mendelian randomization (MR). Four primary outcomes were identified: fasting blood glucose/fasting glucose, HbA1c, HOMA-IR, and serum insulin/fasting insulin level. In the systematic review, four databases were searched from the establishment to June 2021. Studies, in which participants had T2D and intervention did not comprise another co-supplement, were included. Results were synthesized through the random-effects meta-analysis. In the two-sample MR, we used random allocation of single nucleotide polymorphisms (SNPs), strongly related to zinc supplements, to infer the relationship causally, but not specified T2D. SNPs were from MR-base. In the systematic review and meta-analysis, 14 trials were included with a total of 897 participants. The zinc supplement led to a significant reduction in the post-trial mean of fasting blood glucose (mean difference (MD): -26.52 mg/dL, 95%CI: -35.13, -17.91), HbA1c (MD: -0.52%, 95%CI: -0.90, -0.13), and HOMA-IR (MD: -1.65, 95%CI: -2.62, -0.68), compared to the control group. In the two-sample MR, zinc supplement with 2 SNPs reduced the fasting glucose (inverse-variance weighted coefficient: -2.04 mmol/L, 95%CI: -3.26, -0.83). From systematic review and two-sample MR analyses, zinc supplementation alone may causally improve glycemic control among T2D patients. The findings are limited by power from the small number of studies and SNPs included in the systematic review and two-sample MR analysis respectively.

Objective China was the first country suffering from the SARS-CoV-2 pandemic and one of the countries with stringent mother-neonate isolation measure implemented. Now increasing evidence suggests that coronavirus disease 2019 (COVID-19) should not be taken as an indication for formula feeding or isolation of the infant from the mother. Methods We conducted a retrospective cohort study in 44 hospitals from 14 provinces in China to investigate the management of neonates whose mothers have confirmed or suspected COVID-19. In addition, 65 members of Chinese Neonatologist Association (CNA) were invited to give their comments and suggestions on the clinical management guidelines for high-risk neonates. Results There were 121 neonates born to 118 mothers suspected with COVID-19 including 42 mothers with SARS-CoV-2 positive results and 76 mothers with SARS-CoV-2 negative results. All neonates were born by caesarean section, isolated from their mothers immediately after birth and were formula-fed. Five neonates were positive for SARS-CoV-2 at initial testing between 36 and 46 h after birth. Regarding the confusion on the clinical management guidelines, 58.78% of the newborns were put into isolation, 32.22% were subject to PCR tests, and 5.16% and 2.75% received breastfeeding and vaccination, respectively. Conclusion The clinical symptoms of neonates born to mothers with confirmed SARS-CoV-2 were mild, though five neonates might have been infected in utero or during delivery. Given the favorable outcomes of neonates born to COVID-confirmed mothers, full isolation may not be warranted. Rather, separation of the mother and her newborn should be assessed on a case-by-case basis, considering local facilities and risk factors for adverse outcomes, such as prematurity and fetal distress.

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