Association of intrapartum drugs to spontaneous intestinal perforation: A single center retrospective review

2021 ◽  
Author(s):  
Ashley Mantle ◽  
Michelle J Yang ◽  
Allison Judkins ◽  
Iwa Chanthavong ◽  
Bradley A Yoder ◽  
...  
Keyword(s):  
Intestinal Perforation ◽  
Limited Data ◽  
Chi Square ◽  
Exact Test ◽  
Factors Analysis ◽  
Increased Risk ◽  
Maternal Medication ◽  
Combined Exposures ◽  
Student’S T ◽  
Spontaneous Intestinal Perforation

ABSTRACT Background: Spontaneous intestinal perforation (SIP) occurs commonly in extremely low gestational age newborns (ELGANs; < 30 weeks GA). Early, concurrent neonatal use of indomethacin (Neo_IN) and hydrocortisone (Neo_HC), is a known risk for SIP. Mothers in premature labor often receive indomethacin (Mat_IN) for tocolysis and steroids (Mat_S) for fetal maturation. Coincidentally, ELGANs may receive Neo_IN or Neo_HC within the first week of life. There is limited data on the effect of combined exposures to maternal and neonatal medications. We hypothesized that proximity exposure to these medications may increase the risk of SIP. Design: We reviewed the medical records of ELGANS from June 2014 to December 2019 at a single Level III NICU. We compared antenatal and postnatal indomethacin and steroid use between neonates with and without SIP. Chi-Square, Student’s t-test, Fisher’s Exact test, and Mann-Whitney U tests were used for analysis. Results: Among 417 ELGANs, SIP was diagnosed in 23; predominantly neonates <26 weeks GA (n = 21/126, 16.7%). Risk factors analysis focused on this GA cohort in which SIP was most prevalent. Mat_IN administration within two days of delivery increased SIP risk (OR 3.00, 95%Cl 1.25-7.94, p=0.036). Neo_HC was not independently associated with SIP (p=0.38). A higher proportion of SIP group had close temporal exposure of Mat_IN and Neo_HC compared to the non-SIP group, though not statistically significant (14% v. 7%, p=0.24). Conclusions: Peripartum Mat_IN was associated with increased risk for SIP in this small study sample. Larger studies are needed to further delineate SIP risk from the interaction of peripartum maternal medication with early postnatal therapies and disease pathophysiology.

Adverse Maternal Outcomes Associated with Uterine Extensions at the Time of Cesarean Delivery

2019 ◽  
Vol 36 (08) ◽  
pp. 785-789
Author(s):  
Soha S. Patel ◽  
Nathanael C. Koelper ◽  
Sindhu K. Srinivas ◽  
Mary D. Sammel ◽  
Lisa D. Levine
Keyword(s):  
Maternal Morbidity ◽  
Length Of Hospital Stay ◽  
Maternal Outcomes ◽  
Chi Square ◽  
Exact Test ◽  
Prolonged Length ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Student’S T ◽  
Student’S T Test

Objective We sought to compare adverse maternal outcomes between women with and without a uterine extension at the time of cesarean. Study Design We conducted a retrospective cohort study of women with and without a uterine extension during a primary low transverse cesarean of a full-term singleton gestation. The primary outcomes were (1) estimated blood loss (EBL) and (2) composite maternal morbidity (defined as ≥ 1 of the following: blood transfusion, endometritis, or readmission). Pearson's chi-square or Fisher's exact test was used to compare categorical data; Student's t-test or Mann–Whitney's U-tests was used for continuous data. Linear and logistic regressions were used to adjust for confounding factors. Results There were 252 women included (126 with extension and 126 without an extension). Women with extensions had a higher EBL (1,038 vs. 832 mL, p < 0.001) and higher rate of the composite maternal morbidity (19.1 vs. 5.6%, p = 0.001). Additionally, women with extensions had an increased risk of postpartum hemorrhage ≥ 1 L (53.2 vs. 23.8%, p < 0.001) and 1.5 L (12.7 vs. 0%, p < 0.001) and were associated with prolonged length of hospital stay (29 vs. 17%, p = 0.04). Conclusion Uterine extensions are associated with adverse maternal outcomes including higher EBL and increase in maternal morbidity.

PREEMPTIVE ANALGESIA WITH AMITRIPTYLINE IN WOMEN UNDERGOING ABDOMINAL HYSTERECTOMY: A RANDOMIZED CLINICAL TRIAL

2020 ◽  
pp. 2-5
Author(s):  
Antônio Henriques De França Neto ◽  
Alexandre Magno Nóbrega Marinho ◽  
Eveline Pereira De Arruda Agra ◽  
Priscilla Guimarães Alves ◽  
Josikwylkson Costa Brito ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Postoperative Pain ◽  
Pressure Pain Threshold ◽  
Abdominal Hysterectomy ◽  
Tricyclic Antidepressant ◽  
Preemptive Analgesia ◽  
Chi Square ◽  
Double Blind ◽  
Exact Test ◽  
Student’S T

The concept of preemptive analgesia, albeit long-standing, has reemerged. Consequently, recent research has focused on testing a variety of drugs preoperatively to prevent the occurrence of postoperative pain, a major factor of morbidity. Amitriptyline is a tricyclic antidepressant used to treat chronic pain. Because amitriptyline acts on pain transmission pathways, it could theoretically be used as an agent for the prevention of postoperative pain. This study evaluated the effectiveness of amitriptyline in preventing pain in patients submitted to hysterectomy, the most commonly performed gynecological surgery. A randomized, double-blind clinical trial was conducted with 145 patients, 72 of these receiving amitriptyline and 73 placebo. All patients were evaluated at 6, 12, 24 and 48 hours after surgery using a visual analog scale (VAS) for pain and algometry to determine the pressure-pain threshold. Statistical analysis was conducted using the chi-square test of association, Student's t-test, and the Mann-Whitney test, with Fisher's exact test being used whenever appropriate. No statistically signicant difference was found between the two groups with respect to pain at any of the time points evaluated, leading to the conclusion that at a dose of 25 mg, amitriptyline is ineffective in preventing postoperative pain in patients submitted to abdominal hysterectomy

scholarly journals Acute Kidney Injury in Patients With Acute Chemical Poisoning: the Experience of the Toxicological Center in Ryazan

2021 ◽  
Vol 9 (4) ◽  
pp. 639-645
Author(s):  
N. V. Shatrova ◽  
M. N. Rudakova ◽  
L. G. Zaytseva ◽  
Zh. A. Varenova
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Acute Poisoning ◽  
Annual Reports ◽  
Infusion Therapy ◽  
Chi Square ◽  
Exact Test ◽  
Risk Of Death ◽  
Increased Risk ◽  
Microsoft Office

Relevance. Acute kidney injury (AKI) is one of the leading causes of death worldwide. However, the epidemiology of AKI is not well understood. In Russia, toxic kidney damage plays a significant role in the nosological structure of AKI — 12.2%.Aim of study. To study the features of AKI in patients with acute chemical poisoning.Material and methods. We analyzed 26 case histories of patients with acute chemical poisoning with AKI (according to KDIGO). The comparison group included 25 patients with acute chemical poisoning without AKI. All patients were hospitalized in a toxicological center on the basis of the emergency department of the Ryazan Region State Budgetary Institution “City Clinical Emergency Hospital” (SBI RR “CCH EMC”) in 2016–2018. The analysis of the annual reports of the chief toxicologist of the Ministry of Health of the Ryazan Region for 2016–2018 was carried out. Data processing was performed using Microsoft Office Excel 2013 and on the website medstatistic.ru (Pearson’s chi-square test and Fisher’s exact test).Results. In most patients AKI developed during poisoning with cauterizing action substances - 38.4% (23% - vinegar essence, 15.4% - unidentified cauterizing action substance). The poisoning with alcohol substitutes (12%) took the 2nd place, with narcotic substances (8%) – the 3 rd place. Also, isolated cases of AKI (4% each) were reported in case of poisoning with pregabalin, tramadol, ketorol and ethanol. Poisoning with an unknown toxicant was noted in 29.6% of cases. Most patients (69.2%.) had stage 3 AKI. The second stage was registered in 7.7% of patients, the first — in 23.1%. Proteinuria was detected in all patients who underwent common urine test (CUT). Infusion therapy using crystalloids was performed in 100% of cases.Conclusion. Acute renal injury most often develops in acute poisoning with cauterizing poisons. The development of acute kidney injury in acute chemical poisoning leads to an increased risk of death. Acute kidney injury is the second most common immediate cause of death in acute chemical poisoning. Infusion therapy is an integral part of the management of toxicological patients with acute kidney injury.

Risk factors for biopsy complications in initial versus subsequent biopsies in native and transplant kidneys

2020 ◽  
pp. 028418512096668
Author(s):  
Björn Peters ◽  
Henri Afghahi ◽  
Salar Maitlo ◽  
Henrik Hadimeri
Keyword(s):  
Risk Factors ◽  
Binary Logistic Regression ◽  
Chi Square ◽  
Exact Test ◽  
Major Complications ◽  
Native Kidney ◽  
Transplant Kidney ◽  
Student’S T ◽  
Biopsy Complications ◽  
Student’S T Test

Background Few studies exist about risk factors for complications in subsequent biopsies. Purpose To explore risk factors for complications in initial versus subsequent biopsies in native and transplant kidneys, which may predict biopsy complications. Material and Methods In a multicenter study, 2830 native kidney biopsies (4.3% subsequent) were analyzed for major complications (1251 of these were also analyzed for minor) and 667 transplant kidney biopsies (29% subsequent) were analyzed for major and minor complications. No death or nephrectomy were described. Fisher’s exact test, Student’s t-test, chi-square analyses, and univariate and multiple binary logistic regression analyses were employed; P < 0.05 was considered significant. Results In initial native kidney biopsies, the frequency of major complications was higher in women compared to men (odds ratio 1.6, 95% confidence interval 1.1–2.2), in younger patients (50 vs. 54 years, P = 0.007), and in patients with lower weight (78 vs. 82 kg, P = 0.005). In subsequent native kidney biopsies, patients with major complications had a higher systolic blood pressure (145 vs. 132 mmHg, P = 0.03). In initial transplant kidney biopsies, biopsies with major complications had less glomeruli in the biopsy (17 vs. 24, P = 0.046). In subsequent transplant kidney biopsies, patients with major complications had a higher mean arterial pressure (112 vs. 98 mmHg, P = 0.002). In subsequent native kidney biopsies, there was a higher number of SLE-nephritis (12% vs. 4.6%, P = 0.001) compared to initial biopsies. Conclusion The different types of risk factors for complications in initial versus subsequent renal biopsies could be important for the clinicians to improve patients’ safety.

scholarly journals Prevalence of microalbuminuria and associated factors among HIV − infected ART naïve patients at Mulago hospital: a cross-sectional study in Uganda

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Thomas Kiggundu ◽  
Robert Kalyesubula ◽  
Irene Andia-Biraro ◽  
Gyaviira Makanga ◽  
Pauline Byakika-Kibwika
Keyword(s):  
Antiretroviral Therapy ◽  
Cross Sectional Study ◽  
Cd4 Count ◽  
P Value ◽  
Mulago Hospital ◽  
Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Increased Risk

Abstract Background HIV infection affects multiple organs and the kidney is a common target making renal disease, one of the recognized complications. Microalbuminuria represents an early, important marker of kidney damage in several populations including HIV-infected antiretroviral therapy (ART) naïve patients. Early detection of microalbuminuria is critical to slowing down progression to chronic kidney disease (CKD) in HIV-infected patients, however, the burden of microalbuminuria in HIV-infected antiretroviral therapy (ART) naïve patients in Uganda is unclear. Methods A cross-sectional study was conducted in the Mulago Immune suppression syndrome (ISS) clinic among adult HIV − infected ART naïve outpatients. Data on patient demographics, medical history was collected. Physical examination was performed to assess body mass index (BMI) and hypertension. A single spot morning urine sample from each participant was analysed for microalbuminuria using spectrophotometry and colorimetry. Microalbuminuria was defined by a urine albumin creatinine ratio (UACR) 30-299 mg/g and macroalbuminuria by a UACR > 300 mg/g. To assess the factors associated with microalbuminuria, chi-square, Fisher’s exact test, quantile regression and logistic regression were used. Results A total of 185 adult participants were consecutively enrolled with median age and CD4+ counts of 33(IQR = 28–40) years and 428 (IQR = 145–689) cells/μL respectively. The prevalence of microalbuminuria was 18.9% (95% CI, 14–25%). None of the participants had macroalbuminuria. CD4+ count <350cells/μL was associated with increased risk of microalbuminuria (OR: 0.27, 95% CI: 0.12–0.59), P value = 0.001). Diabetes mellitus, hypertension, smoking, alcohol intake were not found to be significantly associated with microalbuminuria. Conclusion Microalbuminuria was highly prevalent in adult HIV − infected ART naive patients especially those with low CD4+ count. There is need to study the effect of ART on microalbuminuria in adult HIV − infected patients.

Incidence of adverse drug reactions induced by N-acetylcysteine in patients with acetaminophen overdose

2010 ◽  
Vol 29 (3) ◽  
pp. 153-160 ◽  
Author(s):  
Sa'ed H Zyoud ◽  
Rahmat Awang ◽  
Syed Azhar Syed Sulaiman ◽  
Waleed M Sweileh ◽  
Samah W Al-jabi
Keyword(s):  
Adverse Drug Reactions ◽  
Univariate Analysis ◽  
Drug Reactions ◽  
Chi Square ◽  
Exact Test ◽  
Acetaminophen Overdose ◽  
Significant Difference ◽  
Chi Square Test ◽  
Comparative Results ◽  
Student’S T

Background: Intravenous N-acetylcysteine (IV-NAC) is widely recognized as the antidote of choice for acetaminophen overdose. However, its use is not without adverse drug reactions (ADR) that might affect therapeutic outcome or lead to treatment delay. Objective: the aim of this study was to investigate the type and incidence of ADR induced by IV-NAC in patients treated for acetaminophen overdose. Methods: This is a retrospective study of patients admitted to the hospital for acute acetaminophen overdose over a period of 4 years (1 January 2005 to 31 December 2008). The primary outcome of interest in this study was the occurrence of ADR during NAC administration. Pearson chi-square test or Fisher’s exact test, student’s t test, and Mann-Whitney U test were used in univariate analysis. SPSS 15 was used for data analysis. Results: Two hundred and fifty five patients were studied. Different types of ADR were observed in 119 (46.7%) cases. Of those patients, 83 (69.7%) had been treated with IV-NAC versus 36 (30.3%) who had not (p < .001). The following ADR were significantly associated with IV-NAC administration: vomiting (p = .001), flushing (p < .001), rash (p < .001), pruritus (p < .001), chest pain (p = .001), bronchospasm (p = .03), coughing (p = .01), headache (p = .001), dizziness (p < .001), convulsion (p = .03), and hypotension (p = .001). ADR were mild in 54 (43.2%), moderate in 17 (13.6%), and severe in 12 (9.6%) patients. There were no ADR in 42 (33.6%) patients. Comparative results of the characteristics of patients who reacted to IV-NAC and nonreactors showed that patients with ADR had no significant difference in age, gender, ethnicity, amount ingested, latency time, and acetaminophen level than nonreactors. Conclusion: ADR to IV-NAC were common among patients with acetaminophen overdose, but mostly minor and all reported adverse reactions were easily managed.

scholarly journals RELATIONSHIP BETWEEN OBESITY, TWIN-PREGNANCY AND PREVIOUS HISTORY OF PREECLAMPSIA WITH PREECLAMPSIA

2021 ◽  
Vol 5 (3) ◽  
pp. 307
Author(s):  
Riani Widia Parantika ◽  
Gatut Hardianto ◽  
Muhammad Miftahussurur ◽  
Wahyul Anis
Keyword(s):  
Risk Factors ◽  
Previous History ◽  
Significant Risk ◽  
Multiple Pregnancies ◽  
Chi Square ◽  
Exact Test ◽  
Pregnancy And Childbirth ◽  
Increased Risk ◽  
History Of ◽  
Risk Of Preeclampsia

Background: Preeclampsia can threaten the health of the mother and fetus during pregnancy and childbirth, besides that it also increases the risk of long-term complications and has the potential to cause death. The incidence of preeclampsia at the RSUD Engku Haji Daud Tanjung Uban showed an increase in the last three years, namely the occurrence from 2017 as many as 23 cases to 56 cases in 2019. The condition of preeclampsia can worsen quickly and without warning, for that, it must be detected and managed appropriately. This study aimed to identify the association of obesity, multiple pregnancies, and previous history of preeclampsia with the incidence of preeclampsia in maternity women. Methods: This study uses a case-control study design. Performed on women giving birth in the period January – December 2019, consisting of 56 cases and 112 controls. Maternal women with preeclampsia were cases and women who were not diagnosed with preeclampsia were controls. The data was obtained from the respondents' medical records, then analyzed using the Chi-Square test or Fisher's Exact test with a value of = 0,05. Results: Obesity was associated with an increased risk of preeclampsia (OR= 4,746, 95% CI 2,381-9,460; P=0,000). Multiple pregnancies were associated with a significantly increased risk of preeclampsia (OR=15,857, 95% CI 1,899-132,384; P=0,002). Likewise, a previous history of preeclampsia was associated with a markedly increased risk of preeclampsia (OR=99,000, 95% CI 22,057-444,343; P=0,000). Conclusion: Based on these data, it was found that obesity, multiple pregnancies, and previous history of preeclampsia were significant risk factors for the occurrence of preeclampsia. It is important to identify risk factors for preeclampsia early, so that appropriate management can be carried out, to prevent complications.

scholarly journals Nursing team knowledge on care for patients with fungating wounds

2020 ◽  
Vol 73 (1) ◽  
Author(s):  
Fernanda Mateus Queiroz Schmidt ◽  
Flávia Firmino ◽  
Nariman de Felício Bortucan Lenza ◽  
Vera Lúcia Conceição de Gouveia Santos
Keyword(s):  
Staff Training ◽  
Cross Sectional Study ◽  
Chi Square ◽  
Cross Sectional ◽  
Orientation Data ◽  
Exact Test ◽  
Nursing Team ◽  
Student’S T ◽  
Educational Variables ◽  
Student’S T Test

ABSTRACT Objective: to evaluate the nursing team knowledge of a cancer hospital on care for patients with Malignant Fungating Wounds (MFW) and to analyze associated sociodemographic and educational factors. Method: an observational and cross-sectional study, conducted between September and October 2015, after approval by the Research Ethics Committee. A questionnaire was applied containing sociodemographic, educational and related components to the accomplishment of dressings, dressings choice and orientation. Data were analyzed by using Chi-square, Fisher’s exact test, Student’s t-Test and Pearson’s correlation. Results: 37 professionals participated in the study, most of whom were technicians (56.8%), women (91.9%) and with a mean age of 32 years. The professionals presented 56.5% of correct answers. There were no statistically significant associations between sociodemographic/educational variables and number of correct answers. Conclusion: there was a lack of important knowledge about care for patients with MFW, which should guide strategies for the oncology staff training.

scholarly journals Polymorphisms in Phase I (CYP450) Genes CYP1A1 (rs4646421), CYP1B1 (rs1056836), CYP19A1 (rs749292) and CYP2C8 (rs1058930) and Their Relation to Risk of Breast Cancer: A Case-Control Study in Mazandaran Province in North of Iran

2019 ◽  
Vol 7 (15) ◽  
pp. 2488-2496 ◽  
Author(s):  
Golpar Golmohammadzadeh ◽  
Abbas Mohammadpour ◽  
Nematollah Ahangar ◽  
Mohammad Shokrzadeh
Keyword(s):  
Breast Cancer ◽  
Case Control Study ◽  
Control Group ◽  
Fisher Exact Test ◽  
Mazandaran Province ◽  
Chi Square ◽  
Exact Test ◽  
Cyp1b1 Gene ◽  
Increased Risk ◽  
Control Study

BACKGROUND: The second leading cause of cancer-related death in women is breast cancer. Xenobiotic Metabolizing Enzymes (XMEs) contribute to the detoxification of numerous cancer therapy-induced products. In the metabolism of xenobiotic, cytochrome P450s or monooxygenases perform an important function by catalysing the hydroxylation reaction. In this study, the susceptibility and genetic polymorphisms of CYP450 isoenzymes was investigated that may have an etiological role in breast cancer. AIM: The main purpose of this study was to evaluate the association of CYP1A1 (rs4646421), CYP1B1 (rs1056836), CYP2C8 (rs1058930), and CYP19A1 (rs749292) polymorphisms with the risk of breast cancer in Mazandaran province. MATERIAL AND METHODS: This cross-sectional case-control study were recruited 72 patients and 51 healthy individuals and was performed between March 2018 to May 2018 in the Oncology Department at Imam Hospital in Sari city, Iran. Peripheral blood samples were collected in EDTA tube, and DNA extraction was performed using the salting-out method and WizPrep extraction kits. Breast cancer patients with known clinicopathological characters and healthy women as control group were genotyped for genes polymorphisms by PCR-RFLP technique, using restriction enzymes. Chi-square, Fisher exact test and Logistic regression model, were applied for statistical analysis. RESULTS: The results of the experiments showed that there was a significant relationship between two groups and the age of the patients is significantly higher than the control group (p = 0.044). According to the chi-square and Fisher exact test, education, pregnancy, menopause status and oppose were significant between the two groups. Based on using a logistic regression model in two normalized and age-adjusted models to finding relationship between the genotypes of each gene and breast cancer risk, it was determined that in the CYP2C8 genotype, those who have the CG allele have a 7.74 degree increased risk of breast cancer (CI = 95% 0.95-62.5) and in the CYP19A1 gene, individuals with GA genotype, increased risk of breast cancer (CI = %95 1.52-27.21), about the CYP1B1 gene, people with two genotypes of CG + GG had higher risk of breast cancer (CI = %95 1.19-5.71) and allele G has decreased risk of breast cancer in this gene (P = 0.0271), also allele G in CYP2C8 gene had the protective effect (P = 0.02). In the age-adjusted model, for the CYP2C8 gene, GG genotype increased risk of breast cancer (CI = %95 1.11-75.84) as well as, the CG + GG genotype in CYP1B1 gene (CI = %95 1.31-6.57). CONCLUSION: Our results confirm the association between CYP2C8 (rs1058930), CYP19A1 (rs749292) and CYP1B1 (rs1056836) gene polymorphisms and increased risk of breast cancer in women in Mazandaran province.

scholarly journals Evaluating the Presence of Paresthesia in Patients with Juxta-apical Radiolucency after Third Molar Surgery: A Case-control Study

2021 ◽  
Author(s):  
Mahvash Hasani ◽  
Nasim Razavi ◽  
Abdolaziz Haghnegahdar ◽  
Motahhareh Zarifi
Keyword(s):  
Significant Relationship ◽  
Third Molar ◽  
Mandibular Canal ◽  
Cortical Plate ◽  
Third Molar Surgery ◽  
Surgical Removal ◽  
Third Molars ◽  
Chi Square ◽  
Exact Test ◽  
Increased Risk

Abstract Background: Juxta-apical radiolucency (JAR) has been presented as a radiographic sign, suggestive of the IAN injury through third molar surgery. This study aimed to evaluate the relation of JAR with paresthesia in cone-beam computed tomography (CBCT) images and to determine whether the presence of JAR is related to tooth angulation, proximity to the mandibular canal, position to the IAN and thinning of the cortical plates.Methods: Of an initial sample of 545 mandibular third molars, a total of 75 JAR and 75 control teeth were evaluated by CBCT. The association of JAR with the IAN, position to IAN, lingual cortical plate thinning, and tooth angulation was investigated in this study. Temporary and permanent paresthesia were also examined in the subjects. Descriptive statistics, Chi-square test, and Fisher’s exact test were performed for statistical analysis.Results: A significant relationship was found between JAR and temporary paresthesia (P=0.034). However, there was no case of permanent paresthesia. JAR showed no significant relationship with the tooth angulation, cortical plate thinning, position to IAN and proximity to the mandibular canal. The lingual position of JAR relative to the mandibular canal was related to the presence of paresthesia in the JAR group. Also, most cases of paresthesia showed some degree of lingual cortical plate thinning (P=0.012). Conclusion: JAR is generally in contact with the mandibular canal, and some degree of cortical thinning can be found in most cases. In this study, JAR was significantly related to temporary paresthesia. The present findings may indicate the increased risk of nerve injury during the surgical removal of third molars.

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