A retrospective analysis of emergency hysterectomy intervention strategy in obstetrics

Objectives: To investigate the indications of obstetric emergency hysterectomy and analyze the clinical effects of subtotal hysterectomy and total hysterectomy. Methods: We included 247 hospitalized women who had undergone abdominal hysterectomy due to obstetric reasons in Fujian Province Maternity and Child Health Hospital (a provincial class-A hospital) and Ningde People’s Hospital (a primary Class-B hospital) between January 2002 and December 2018. We identified surgical indications and clinical characteristics of the patients. Furthermore, the patients from Fujian Provincial Maternity and Child Health Hospital were subdivided into subtotal hysterectomy group and total hysterectomy group to examine general operation conditions, and postoperative complications. Results: The main surgical indications for emergency obstetric hysterectomy in Fujian Maternity and Child Health Hospital were placental implantation (49.6%) and uterine weakness (31.9%), while uterine weakness (37.5%) was the most important indication in Ningde People’s Hospital. No differences were found in operation time, hospitalization time, intraoperative blood loss, postpartum blood loss, and intraoperative fresh frozen plasma transfusion between the subtotal hysterectomy group and the total hysterectomy group. Postoperative test parameters, including postoperative prothrombin time (PT), thrombin time (TT), activated partial thromboplastin time (APTT), hemoglobin (HGB), and hematocrit (HCT), were not significantly different between the two groups. No significant difference was noted in postoperative vesicoureteral injury, pelvic hematoma, infection, and disseminated intravascular coagulation (DIC) incidence, but renal failure incidence was different (P=0.040). Conclusion: The treatment effect of subtotal hysterectomies for the cases without placenta accreta and placenta previa was similar in the two hospitals. There is no statistically significant difference in therapeutic effect between total hysterectomy and subtotal hysterectomy. doi: https://doi.org/10.12669/pjms.38.3.5335 How to cite this:Fang Z, Zhang H, Zheng S, Weng L, Yan J. A retrospective analysis of emergency hysterectomy intervention strategy in obstetrics. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5335 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Management of Choroid Plexus Papillomas

Introduction: Choroid plexus papillomas are rare neuroepithelial tumors found primarily in children. It represents less than 1% of all central nervous system tumors. Materials and methods: A retrospective study including 14 patients with choroid plexus papilloma tumors were performed at the Neurosurgery Department in Ait IDDIR Health Hospital Establishment between January 2010 and December 2017. In each case, diagnosis was made clinically and confirmed radiologically and histo-pathologically. All patients were operated. Results and discussion: The mean age was 26 years (ranged 3 months –48 years) .In our department, we grouped together 14 cases of choroid plexus papilloma tumors. For mortality we had one case who died during surgery, survival rate for 04 years is 100% .We had not recurrence during the study period.All patients had intracranial hypertension (HIC) without neurological deficit and benefited from brain CT, MRI and an Angiography. The location of the tumor was: Lateral ventricle, Fourth ventricle, Third ventricle. All patients underwent surgical excision with or without ventriculo-peritoneal shunt. Conclusion: Choroid plexus papillomas are rare neuroepithelial tumors, typically considered benign lesions, derived from the choroid plexus and appear like cauliflower.

Health Literacy And Health-Related Quality of Life Among Patients With Cardiovascular Disease in Tagus Valley Regional Health Hospital, Portugal: A Cross-Sectional Study

Purpose The aims of this study were to examine the association between health literacy (HL) and health-related quality of life (HRQoL) and to investigate the possible determinants of both variables among patients with cardiovascular diseases in Tagus Valley Regional Health Hospital, Portugal.Methods A descriptive cross-sectional study was conducted among 28 patients with CVD. A convenient sampling technique was used to enrol the study participants. Data were collected using a validated Portuguese version of Short Assessment of Health Literacy (SAHPLA-23) and a validated Portuguese version of Short Form Health Survey (SF-36v2). The multiple linear regression was used to investigate the possible associated variables and the association between HL and HRQoL by using SPSS version 25.Results The results showed the majority of patients with CVD had inadequate HL (89.3%). The majority of the participants had poor HRQoL with Physical Component Score (PCS) scored lower (38.77±9.9) than the Mental Component Score (MCS) (44.13±9.9). Educational level was found to be associated with HL. Level of education, employment status, family history of CVD and history of readmission because of CVD were the variables found to be associated with the PCS. However, no variable was found to be associated with the MCS of QoL. HL was shown to be the best predictor of the PCS (β=0.518, p=0.002) while the history of readmission because of CVD was identified as the second-best predictor of the PCS (β=-0.373, p=0.022). Conclusions Health literacy was significantly associated with the PCS of HRQoL.

Living With Parents-In-Law Increased the Risk of Postpartum Depression in Chinese Women

Background: A variety of psychological and socioeconomic factors contribute to the development of postpartum depression (PPD). However, the relationship between maternal living arrangements and PPD is unclear.Objective: To assess the relationship between maternal living arrangements and PPD in Chinese population.Methods: A cross-sectional survey was conducted among puerperal women delivered in Baoan Maternal and Child Health Hospital in Shenzhen, China. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD. A score of ≥10 was used as the threshold for postpartum depression.Results: A total of 4,813 women were recruited, of whom 2,535 (52.7%) lived only with their husbands, 664 (13.8%) lived with their parents, and 1,614 (33.5%) lived with their parents-in-law. Compared with women who lived with husbands, puerperal women who lived with their parents-in-law were more likely to be positive for PPD screening (14.1 vs. 10.5%, P < 0.001). After adjusting for other influencing factors, living with parents-in-law was significantly associated with the risk of PPD (OR = 1.38, 95% CI, 1.12–1.70). Additionally, stratification analyses showed that the association between living with parents-in-law and the presence of PPD was more significant in women with anxiety during pregnancy (P for interaction <0.05).Conclusions and Relevance: Our data confirms that the maternal living arrangements affect the risk of PPD, especially among women with anxiety during pregnancy. Therefore, more targeted preventive measures should be taken for postpartum depression in women who live with their parents-in-law.

Psychiatrists should investigate their patients less

Summary Psychiatrists often order investigations such as blood tests, neuroimaging and electroencephalograms for their patients. Rationales include ruling out ‘organic’ causes of psychiatric presentations, providing baseline parameters before starting psychotropic medications, and screening for general cardiometabolic health. Hospital protocols often recommend an extensive panel of blood tests on admission to a psychiatric ward. In this Against the Stream article, we argue that many of these investigations are at best useless and at worst harmful: the yield of positive findings that change clinical management is extremely low; special investigations are a poor substitute for a targeted history and examination; and incidental findings may cause anxiety and further unwarranted investigation. Cognitive and cultural reasons why over-investigation continues are discussed. We conclude by encouraging a more targeted approach guided by a thorough bedside clinical assessment.

A Retrospective Study of 657 Women With Vaginal Intraepithelial Neoplasia (VaIN)

Objective: The aim of this study was to explore the clinical characteristics of patients with VaIN and identify more sensitive diagnostic methods.Methods: This study retrospectively analyzed 657 patients with VaIN from the International Peace Maternal and Child Health Hospital in Shanghai during a ten-year period. Results: Among the 657 patients, 26.5% were diagnosed with VaIN 2/3. The proportions of patients with VaIN 2/3 among those who did and did not undergo hysterectomy were 39.5% and 24.7%, respectively. The sensitivity of cytology for VaIN in those with only VaIN, VaIN concomitant with cervical or vulvar lesions, and posthysterectomy VaIN was 56.7%, 66.5%, and 72.3%, respectively. The sensitivity of hrHPV for VaIN in the same categories was 87.7%, 86.5%, and 74.3%, respectively. The sensitivity of cytology and hrHPV cotesting for VaIN in the same categories was 95.2%, 95.6%, and 95.0%, respectively. In patients who did not undergo hysterectomy, HPV16 was detected in 9.5% of VaIN 1 lesions among the HPV DNA-positive patients, while the other 12 types of HPV were detected in 62.6% of VaIN 1 lesions. In patients who underwent hysterectomy, HPV16 was detected in 2.1% of VaIN 1 lesions, and the other 12 types of HPV were detected in 54.2% of VaIN 1 lesions.Conclusions: A combination of cytology and colposcopy could increase the sensitivity of the diagnosis of VaIN. The other 12 high-risk types of HPV positive may be more closely related to VAIN 1, more attention should be paid.