scholarly journals The distribution of pelvic organ support defects in women undergoing pelvic organ prolapse surgery and compartment specific risk factors

2021 ◽  
Author(s):  
Emmanuel Payebto Zoua ◽  
Michel Boulvain ◽  
Patrick Dällenbach
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Pelvic Organ Prolapse ◽  
Reconstructive Surgery ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Pelvic Organ ◽  
Posterior Compartment ◽  
Anterior Compartment ◽  
Specific Risk

Abstract Introduction and hypothesis The objective of our study was to describe the distribution of pelvic organ prolapse (POP) in a population of women undergoing POP reconstructive surgery and to identify compartment-specific risk factors. Methods We conducted a retrospective observational study in a cohort of 326 women who underwent POP repair and had a standardized preoperative POP assessment using the Baden-Walker classification. The distribution of POP grade was described for each vaginal compartment. The association between the involvement of each specific compartment and predictors was evaluated with a logistic regression model. Results The frequency of significant POP (grade ≥ 2) was 79% in the anterior compartment, 49% in the middle/apical compartment and 31% in the posterior compartment. Combined significant anterior and apical defects were present in 25% of women. Increasing age was a significant risk factor for apical defect (between 60 and 70 years OR = 2.4, 95% CI 1.2–4.6; > 70 years OR = 3.4, 95% CI 1.7–6.6). Previous hysterectomy (OR = 2.2, 95% CI 1.0–4.6) was a significant risk factor for posterior defect. Conclusions In a population undergoing POP surgery, anterior compartment involvement is the most common and serious defect and can often be associated with an apical defect, especially in older women. In case of previous hysterectomy, the posterior compartment may be weakened. These findings may help surgeons to select the appropriate POP reconstructive surgery, which often should address both anterior and apical defects.

scholarly journals Hydroureteronephrosis in women with pelvic organ prolapse: a prospective cohort study

2018 ◽  
Vol 7 (9) ◽  
pp. 3664
Author(s):  
Pushplata Kumari ◽  
Emily Divya Ebenezer ◽  
Caroline Salomi ◽  
Vaibhav Londhe ◽  
Aruna Nitin Kekre
Keyword(s):  
Chronic Kidney Disease ◽  
Risk Factor ◽  
Pelvic Organ Prolapse ◽  
Kidney Disease ◽  
Prospective Observational Study ◽  
Surgical Repair ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Pelvic Organ ◽  
The Mean

Background: Pelvic organ prolapses (POP) is a common problem in women. The prevalence of POP increase with age. The true prevalence and risk factor for developing hydroureteronephrosis (HUN) in women with pelvic organ prolapse is still unclear due to lack of prospective studies on sufficiently large cohorts. This prospective study was done to study the prevalence of HUN in women with POP and to identify the risk factors for developing HUN.Methods: In this prospective observational study 219 patients were recruited for surgical repair for pelvic organ prolapse for 2 years.  Preoperatively, all patients had transabdominal scan to assess the uterus, adnexa and to look for Hydroureteronephrosis (HUN). Women with presence of HUN were followed postoperatively look for the resolution of HUN.Results: The prevalence of bilateral HUN was 6.85%. The mean age of women with HUN ranged from 51-69 years. Diabetes and hypertension were significant risk factor for development of HUN (OR 4.70, 95% CI -1.59-13.88 and OR 3.72, 95% CI- 1.23-11.1 respectively). There was a statistically significant correlation between chronic kidney disease and HUN. (OR 1 with 95%: CI 9.49-30.42). The correlation between stage of pelvic organ prolapse and HUN was not statistically significant (p = 0.062). There was a statistically significant correlation between the duration (2years -15 years) of POP to HUN. (OR 0.233, 95%0.13-0.419). Patients were followed up post operatively for resolution of HUN. HUN resolved in 9 women (60%) and persisted in 6 (40%).Conclusions: The prevalence of bilateral HUN in women with pelvic organ prolapse was 6.8%. Presence of hypertension, diabetes and chronic kidney disease was a risk factor for HUN. HUN resolved in 60% of women after pelvic reconstructive surgery.

scholarly journals Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eren Akbaba ◽  
Burak Sezgin
Keyword(s):  
Pelvic Organ Prolapse ◽  
De Novo ◽  
Pelvic Organ ◽  
Laparoscopic Technique ◽  
Life Questionnaire ◽  
Advanced Stage ◽  
Posterior Compartment ◽  
Anterior Compartment ◽  
Mesh Graft ◽  
Laparoscopic Lateral Suspension

Abstract Background Laparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments. Methods Data from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used. Results The median post-operative follow-up was 20 (13–34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76–112) minutes. The median length of hospitalization was 2 (1–3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery. Conclusions In advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.

Comorbidity and severity-of-illness risk adjustment for hospital-onset Clostridioides difficile infection using data from the electronic medical record

2020 ◽  
pp. 1-7
Author(s):  
Stephanie M. Cabral ◽  
Katherine E. Goodman ◽  
Natalia Blanco ◽  
Surbhi Leekha ◽  
Larry S. Magder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Risk Adjustment ◽  
Community Hospital ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Bivariate Analysis ◽  
Patient Admissions ◽  
Clostridioides Difficile ◽  
Risk Adjustment Model

Abstract Objective: To determine whether electronically available comorbidities and laboratory values on admission are risk factors for hospital-onset Clostridioides difficile infection (HO-CDI) across multiple institutions and whether they could be used to improve risk adjustment. Patients: All patients at least 18 years of age admitted to 3 hospitals in Maryland between January 1, 2016, and January 1, 2018. Methods: Comorbid conditions were assigned using the Elixhauser comorbidity index. Multivariable log-binomial regression was conducted for each hospital using significant covariates (P < .10) in a bivariate analysis. Standardized infection ratios (SIRs) were computed using current Centers for Disease Control and Prevention (CDC) risk adjustment methodology and with the addition of Elixhauser score and individual comorbidities. Results: At hospital 1, 314 of 48,057 patient admissions (0.65%) had a HO-CDI; 41 of 8,791 patient admissions (0.47%) at community hospital 2 had a HO-CDI; and 75 of 29,211 patient admissions (0.26%) at community hospital 3 had a HO-CDI. In multivariable regression, Elixhauser score was a significant risk factor for HO-CDI at all hospitals when controlling for age, antibiotic use, and antacid use. Abnormal leukocyte level at hospital admission was a significant risk factor at hospital 1 and hospital 2. When Elixhauser score was included in the risk adjustment model, it was statistically significant (P < .01). Compared with the current CDC SIR methodology, the SIR of hospital 1 decreased by 2%, whereas the SIRs of hospitals 2 and 3 increased by 2% and 6%, respectively, but the rankings did not change. Conclusions: Electronically available patient comorbidities are important risk factors for HO-CDI and may improve risk-adjustment methodology.

scholarly journals Pelvic Organ Prolapse in Countries of Different Economy: A Systematic Review

2019 ◽  
Vol 14 (2) ◽  
pp. 7-21
Author(s):  
Shishir Paudel ◽  
Anisha Chalise ◽  
Ganesh Dangal ◽  
Tulsi Ram Bhandari ◽  
Gehanath Baral
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Pelvic Organ Prolapse ◽  
Uterine Prolapse ◽  
National Income ◽  
Significant Risk ◽  
Pelvic Organ ◽  
Reference List ◽  
Medical Subject Headings ◽  
Pubmed Database

Aims: This review was done to identify the reported prevalence rate of pelvic organ prolapse among the different world populations. Methods: Systematic review of Pelvic Organ Prolapse (POP) using the PRISMA checklist; PubMed database was searched on reportingthe prevalence of POP and its management measures in January 2020. Medical Subject Headings (MeSH) like "Pelvic Organ Prolapse"OR "Uterine Prolapse" OR “Vaginal Wall Prolapse” OR "Cystocele"AND "Prevalence [key word/s]" were used. Additional articles were identified through the reference list of the retrieved articles. Results: Out of 91 screened articles, 46 full articles were eligible and only 15 satisfied by selection criteria for the systematic review.The methodological score rated for the quality of studies is 4.5±1.7 (range=2-7) out of 8 points. The mean prevalence of POP diagnosis was 40%; with 42.44% in low and lower-middle-income countries,and 35.56%in upper-middle and high-income countries. Increasing age and parity, body mass indexand fetal macrosomia were found to be the significant risk factors irrespective of the country’s economy. Conclusions:The low and lower-income countries have almost twice the burden of prolapse than the countries of the higher economy. The major risk factors associated with prolapse remain common in all countries irrespective of national income or development.  

scholarly journals Risk factors for hypertensive crisis in children with acute glomerulonephritis

2016 ◽  
Vol 56 (2) ◽  
pp. 101
Author(s):  
Sherly Yuniarchan ◽  
Risky Vitria Prasetyo ◽  
Ninik Asmaningsih Soemyarso ◽  
Mohammad Sjaifullah Noer
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Pediatric Population ◽  
Hypertensive Crisis ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
P Value ◽  
Acute Glomerulonephritis ◽  
Female Ratio

Background Hypertensive crisis occurs in 1-4% of the hypertensive pediatric population, mostly due to acute glomerulonephritis (AGN). Some factors have been suggested to affect blood pressure (BP) in children, such as age, sex, race/ethnicity, obesity, and socioeconomic status, but little is known for risk factors for hypertensive crisis in AGN.Objective To analyze the risk factors for hypertensive crisis in children with AGN.Methods Retrospectively, we studied possible risk factors for hypertensive crisis in children with AGN at Dr. Soetomo Hospital from 2007 to 2011. Hypertensive crisis was defined as systolic BP ≥180 mmHg or diastolic BP ≥120 mmHg (for children ≥ 6 years of age); and systolic and/or diastolic BP >50% above the 95th percentile (for children aged <6 years). We evaluated the demographic and clinical characteristics as potential risk factors. Statistical analysis was done with Chi-square, Fisher’s exact, and logistic regression tests. Variables with P <0.25 in the univariable analysis were further analyzed by the multivariable logistic regression model. A P value of < 0.05 was considered statistically significant.Results There were 101 children included (mean age 9.7 (SD 2.17) years), with a male-to-female ratio of 2.7:1. Hypertensive crisis occurred in 42 (41.6%) children, of whom 8 had hypertensive urgency and 34 had hypertensive emergency. Proteinuria was seen in 53 children with AGN (52.5%) and was the significant risk factor for hypertensive crisis in our subjects (OR=2.75; 95%CI 1.16 to 6.52; P=0.021). Gender, clinical profiles, ethnicity, nutritional status, blood urea nitrogen (BUN), and glomerular filtration rate (GFR) were not significant risk factors for hypertensive crisis.Conclusion Proteinuria is the significant risk factor for hypertensive crisis in children with AGN.

scholarly journals Risk factors for mortality in children with Wilms tumor

2016 ◽  
Vol 56 (4) ◽  
pp. 226
Author(s):  
Yuni Purwanti ◽  
Sutaryo Sutaryo ◽  
Sri Mulatsih ◽  
Pungky Ardani Kusuma
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Wilms Tumor ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Stage Iii ◽  
Control Group ◽  
Case Group ◽  
Chi Square ◽  
Potential Risk Factors

Background Wilms tumor is the most common renal malignancy in children (95%) and one of the leading causes of death in children, with high mortality rates in developing countries. Identifying risk factors for mortality is important in order to provide early intervention to improve cure rates.Objective To identify risk factors for mortality in children with Wilms tumor.Methods We performed a case-control study of children (0-18 years of age) with Wilms tumor admitted to Dr. Sardjito Hospital between 2005 and 2012. The case group consisted of children who died of Wilms tumor, whereas the control group were children who survived. Data were collected from medical records. Statistical analyses using Chi-square and logistic regression tests were done to determine odds ratios and 95% CI of the potential risk factors for mortality from Wilms tumor.Results Thirty-five children with Wilms tumor were admitted to Dr. Sardjito Hospital during the study period. Nine (26%) children died and 26 survived. Stage ≥III was a significant risk factor for mortality in chidren with Wilms tumor (OR 62.8; 95%CI 5.6 to 70.5). Age ≥2 years (OR 1.4; 95%CI 0.1 to 14.3) and male sex (OR 1.2; 95%CI 0.1 to 10.8) were not significant risk factors for mortality.Conclusion Stage ≥III is a risk factor for mortality in children with Wilms tumor. 

scholarly journals Risk factors of childhood leukemia

2014 ◽  
Vol 54 (6) ◽  
pp. 358
Author(s):  
Paulina K. Bangun ◽  
Bidasari Lubis ◽  
Sri Sofyani ◽  
Nelly Rosdiana ◽  
Olga R. Siregar
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Birth Weight ◽  
Maternal Age ◽  
Childhood Leukemia ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
High Birth Weight ◽  
Parental Age ◽  
Prenatal Risk Factors

Background The incidence of childhood leukemia has increasedannually. Recent studies have shown that childhood leukemia isinitiated in utero, and have focused on prenatal risk factors suchas birth weight and parental age. Exposure to pesticides andradiation, as well as parental smoking, breastfeeding, and thenumber of older siblings have also been sugges ted as risk factorsfor childhood leukemia.Objective To evaluate possible risk factors for childhood leukemia,including birth weight, parental age, and other risk factors.Methods This case-con trol study was conducted from October2011 to February 2012 in Haji Adam Malik Hospital, Medan .Case subjects were children aged below 18 years and diagnosedwith leukemia. Control subjects were children aged below 18years who were diagnosed with any non-cancerous acute illnessesin this hospital, and individually matched for age and gen der tothe case subject group. Patients and parents were asked to fill astructured questionnaire. Data was analyzed using conditionallogistic regression .Results A total of 140 subjects were eligible, with 70 subjects ineach group. Birth weight 2: 4000 g and maternal age 2:35 yearswere significant risk factors with OR 10.13 (95%CI 1.124 to 91.2 7)and OR 4.98 (95%CI 1.276 to 19.445), respectively. Paternal ageof 2:35 years was not a significant risk factor. Exposure to pesticideswas also noted as another significant risk factor (OR= 6.66; 95%CI2.021 to 21.966) .Conclusion High birth weight, advan ced maternal age, andexposure to pesticides are risk factors of childhood leukemia.

scholarly journals MON-585 Racial/Ethnic Contribution and Metabolic Factors of NAFLD/NASH in the US Population: Data from NNANES III

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Theodore C Friedman ◽  
Magda Shaheen ◽  
Dulcie Kermah ◽  
Deyu Pan ◽  
Katrina Schrode ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Liver Enzyme ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Healthy Eating Index ◽  
C Peptide ◽  
The Us ◽  
Race Ethnicity ◽  
Racial Ethnic

Abstract Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver condition. It is manifested by hepatic steatosis (HS) that can progress to non-alcoholic steatohepatitis (NASH), and even liver failure. Interestingly, it is marked by racial/ethnic disparities, with a high prevalence in Hispanics. We aimed to identify the risk factors for these chronic conditions in the US. To this end, we analyzed data from NHANES III (1988-1994) using multiple or multinomial logistic regression considering the design and sample weight. HS was identified by ultrasound. NAFLD was defined as HS in the absence of viral hepatitis or excessive use of alcohol or hepatotoxic drugs. The NAFLD population was further divided into those with NASH (defined by the HAIR score), or with simple NAFLD. The prevalence of HS was 19.8%, 16.6%, and 27.9%; of NAFLD was 17.8%, 14.7%, and 25.5%; and of NASH was 3.2%, 2.5%, and 5.1% in non-Hispanic Whites, non-Hispanic Blacks and Hispanics, respectively. Race/ethnicity was a significant predictor of HS, NAFLD and NASH, with Hispanics having the highest odds for all conditions, and non-Hispanic Blacks having the lowest odds relative to Whites (p&lt;0.05). Other significant risk factors for all three conditions were older age, higher BMI, abnormal levels of C-peptide, and elevated serum glucose and triglycerides (p&lt;0.05). HOMA insulin resistance was associated with HS and NAFLD (p&lt;0.05). While smoking status was not associated with HS (p&gt;0.05), current smokers had lower odds of NAFLD & NASH than non-smokers (p&lt;0.05). Elevation of the liver enzyme aspartate aminotransferase was a significant risk factor of HS, while elevation of the liver enzyme alanine transaminase was a significant risk factor of NAFLD. Elevation in the levels of both liver enzymes was predictive of NASH (p&lt;0.05). Although we included physical activity relative to national recommendation variable and the Healthy Eating Index (a measure of diet quality) in our analyses, neither of these factors was a predictor of any of the liver conditions (p&gt;0.05). Our results showed an independent association between race/ethnicity and HS, NAFLD, and NASH, whereby Hispanics had the highest odds for every condition relative to non-Hispanic Whites. Providers should consider the race/ethnicity of their patients when evaluating the risk for NAFLD and NASH, and also be aware of the other risk factors, such as BMI and levels of C-peptide, glucose, and triglycerides.

scholarly journals Risk Factors and Outcomes of Revision Arthroscopic Posterior Shoulder Capsulolabral Repair in Contact Athletes

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0031
Author(s):  
Justin W. Arner ◽  
Sachidhanand Jayakumar ◽  
Dharmesh Vyas ◽  
James P. Bradley
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Revision Surgery ◽  
Significant Risk ◽  
Return To Sport ◽  
Significant Risk Factor ◽  
Return To Play ◽  
Bone Width ◽  
Posterior Shoulder

Objectives: Risk factors and outcomes of revision arthroscopic posterior capsulolabral repairare currently not well defined in contact athletes.Evaluation of risk factors for contact athletes who require revision arthroscopic posterior unidirectional capsulolabral repair is needed. Methods: A total of 186 contact athletes’ shoulders that underwent arthroscopic posterior capsulolabral repair at minimum 2 year follow-up were reviewed. Those who required revision surgery were compared with those who did not. Parameters assessed included age, gender, labral and/or capsular injury, level of sport, and return to sport. Glenoid bone width, bone version, labral width, and labral version were also compared. Results: Eleven shoulders required revision surgery (5.9%) at mean 12.0 year follow-up. The only significant risk factor was glenoid bone width (revision=26.4 mm vs. non-revision=29.1 mm, p=0.005). Cartilage version (p=0.676), labral version (p=0.539), and bone version (p=0.791) were not significantly different between groups, nor was labral width (p=0.751). Gender (p=0.326), labral injury (p=0.349), capsule injury (p=0.683), and level of sport (p=0.381) were not significant factors for requiring revision surgery. Both return to sport at the same level (revision=16.7% vs. non-revision=72.1%, p<0.001) and overall return to sport (revision=50% vs. non-revision=93.7%, p<0.001) was significantly worse in the revision group. Of those who had revision surgery, 33.3% stated their original surgery was not worthwhile, which was significantly higher than the 4.5% in the non-revision group (p=0.041). Conclusion: Contact athletes underwent revision arthroscopic posterior capsulolabral repair at an incidence of 5.9% at 12 year follow-up. The only significant risk factor for requiring revision surgery was smaller glenoid bone width. Return to play was significantly worse in those who required revision surgery. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder capsulolabral repair in contact athletes that require revision has not previously been evaluated.

scholarly journals Incidence and risk factors of neonatal thrombocytopenia: a pr

2016 ◽  
Vol 50 (1) ◽  
pp. 31
Author(s):  
Nila Kusumasari ◽  
Rinawati Rohsiswatmo ◽  
Djajadiman Gatot ◽  
Darlan Darwis
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Necrotizing Enterocolitis ◽  
Late Onset ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Neonatal Thrombocytopenia ◽  
Complete Blood Counts

Background Thrombocytopenia is the most common hematological abnormality in the neonatal period. Hemorrhagic manifestations are found in 10% cases of thrombocytopenia. Neonatal thrombocytopenia commonly assumed due to sepsis, despite many risk factors that may caused thrombocytopenia.Objective To obtain incidence and risk factors of neonatal thrombocytopenia.Methods A cross sectional study was conducted in April 2009. Complete blood counts investigation was performed before age of 24 hours, medical conditions and risk factors of mothers and subjects were noted, as well as hemorrhagic manifestations. Subjects with thrombocytopenia were followed for 2 weeks. The risk factors consisted of hypertension in pregnancy, pre-eclampsia, eclampsia, intrauterine growth retardation, gestational diabetes mellitus, perinatal infection, asphyxia, sepsis, and necrotizing enterocolitis.Results Neonatal thrombocytopenia was found 17 (12.1%) of 140 subjects, consisted of 88.2% early onset and 11.8% late onset. Significant risk factor of mother was pre-eclampsia (PR 3.97, 95%CI 1.70 to 9.25), while significant risk factors of neonates were asphyxia (PR 5.66, 95%CI 2.49 to 12.86), sepsis (PR 5.33, 95%CI 2.33-12.19) and necrotizing enterocolitis (p=0.014; PR 9.2 95% CI 5.17 to14.84). We found 29.4% hemorrhagic cases of neonatal thrombocytopenia (i.e.,. skin, gastrointestinal, intracranial hemorrhage).Conclusions The incidence of neonatal thrombocytopenia was 12.2%. Significant risk factor of mother that caused thrombocytopenia was pre-eclampsia, while risk factors of neonates were asphyxia, sepsis and necrotizing enterocolitis.[Paediatr Indones. 2010;50:31-7].

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