scholarly journals 1303 Obesity: A Growing Concern in Gynaecological Surgery

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
P Raja
Keyword(s):  
Precancerous Lesions ◽  
Health Effect ◽  
Obesogenic Environment ◽  
Gynaecological Surgery ◽  
Mortality And Morbidity ◽  
Genetic Components ◽  
Increased Risk ◽  
The Face ◽  
Unbalanced Diet ◽  
Searching Method

Abstract Introduction Obesity is becoming a major concern in healthcare. The rise in obesity has now reached alarming levels. Obesity is driven by the economic growth, unbalanced diet, and a sedentary lifestyle. Obesity has played a disastrous role in the health of many but significantly has had a detrimental health effect among girls and women. This review focuses on the effect of obesity on various aspects of women’s health including prognosis after gynaecological surgery. Method The search engine used for this literature review was Ovid MEDLINE. Only studies reported in English have been included in this review. The snowball and citation searching method was used to find further relevant articles. Results Various genetic components have been identified to increase the risk of obesity which is further exacerbated with the current obesogenic environment. Women with a BMI≥35 had longer surgeries and an increased rate of severe postoperative adverse events. Additionally, women with a higher BMI had an increased risk of cervical cancer due to under-diagnosis of cervical precancerous lesions, though obesity did not directly alter the association between preoperative biopsy and final tumour grade. Conclusions Despite increased awareness, obesity is still a major contributor of mortality and morbidity. Women in particular are facing severe consequences of the obesogenic environment. In women obesity not only increases their risk of developing gynaecological conditions but also adversely affects prognosis after surgical treatment. In the face of an obesogenic environment, it is important to sought out potential ways to reduce the risk of surgical complications in obese patients.

scholarly journals Particulate Matter as a Driven Factor Covid19 Transmission at Outdoor: Review

2020 ◽  
Vol 12 (3) ◽  
pp. 225
Author(s):  
Hanien Firmansyah ◽  
Azmi Nur Fadlillah ◽  
Aditya Sukma Pawitra
Keyword(s):  
Particulate Matter ◽  
Physiological Condition ◽  
The Body ◽  
Mortality And Morbidity ◽  
Virus Rna ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Mucous Membranes ◽  
The Face ◽  
Droplet Transmission

Introduction: Coronavirus Disease 2019 (Covid19) is an infectious disease caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome-related Coronavirus) which attacks the respiratory tract, with mild to severe symptoms. The virus can infect the body through mucous membranes on the face with droplet transmission. Air pollution is thought to contribute to Covid19 events which can worsen the situation of people with Covid19. The aims of this literature review is to analyze Particulate Matter (PM) as environmental factors that contributes Covid19, so it is expected to be a study in terms of prevention and prevention in the field of environmental health. Discussion: PM is thought to have contributed to an increased risk of mortality and morbidity in Covid19 events. PM which has toxic properties can enter the lungs and affect the physiological condition of the lung organs. The findings regarding the presence of SARS-CoV-2 virus RNA strengthen the suspicion that PM plays a role in Covid19 transmission. Several studies have found that there is a relationship between PM and Covid19. PM2.5 which is smaller than PM10 has a higher ability to be a risk factor for ballast in Covid19. Conclusion: The results of this synthesis state that PM can be one of the driving factors of Covid19 transmission in air.

External sources promoting resilience in adults with intellectual disabilities: A systematic literature review

2020 ◽  
pp. 174462952096194 ◽  
Author(s):  
Femke Scheffers ◽  
Xavier Moonen ◽  
Eveline van Vugt
Keyword(s):  
Social Network ◽  
Literature Review ◽  
Intellectual Disabilities ◽  
Positive Emotions ◽  
Network Support ◽  
Increased Risk ◽  
The Social ◽  
The Face ◽  
External Sources ◽  
Adults With Intellectual Disabilities

Background: Persons with an intellectual disability are at increased risk of experiencing adversities. The current study aims at providing an overview of the research on how resilience in adults with intellectual disabilities, in the face of adversity, is supported by sources in their social network. Method: A literature review was conducted in the databases Psycinfo and Web of Science. To evaluate the quality of the included studies, the Mixed Method Appraisal Tool (MMAT) was used. Results: The themes: “ positive emotions,” “ network acceptance,” “ sense of coherence” and “ network support,” were identified as sources of resilience in the social network of the adults with intellectual disabilities. Conclusion: The current review showed that research addressing sources of resilience among persons with intellectual disabilities is scarce. In this first overview, four sources of resilience in the social network of people with intellectual disabilities were identified that interact and possibly strengthen each other.

scholarly journals Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

2011 ◽  
Vol 114 (2) ◽  
pp. 283-292 ◽  
Author(s):  
Laurent G. Glance ◽  
Andrew W. Dick ◽  
Dana B. Mukamel ◽  
Fergal J. Fleming ◽  
Raymond A. Zollo ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Noncardiac Surgery ◽  
Pulmonary Complications ◽  
Wound Complications ◽  
Severe Anemia ◽  
Thromboembolic Complications ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

scholarly journals Newborns at risk of Covid-19 ― lessons from the last year

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Malika D. Shah ◽  
Ola Didrik Saugstad
Keyword(s):  
Horizontal Transmission ◽  
Mode Of Delivery ◽  
Newborn Infants ◽  
World Health ◽  
Premature Delivery ◽  
Mortality And Morbidity ◽  
Skin Contact ◽  
Cord Clamping ◽  
Increased Risk ◽  
Health Organization

Abstract After more than 1 year of the SARS-CoV-2 pandemic, a great deal of knowledge on how this virus affects pregnant women, the fetus and the newborn has accumulated. The gap between different guidelines how to handle newborn infants during this pandemic has been minimized, and the American Academy of Pediatrics (AAP)’s recommendations are now more in accordance with those of the World Health Organization (WHO). In this article we summarize present knowledge regarding transmission from mother to the fetus/newborn. Although both vertical and horizontal transmission are rare, SARS-CoV-2 positivity is associated with an increased risk of premature delivery and higher neonatal mortality and morbidity. Mode of delivery and cord clamping routines should not be affected by the mother’s SARS-CoV-2 status. Skin to skin contact, rooming in and breastfeeding are recommended with necessary hygiene precautions. Antibodies of infected or vaccinated women seem to cross both the placenta and into breast milk and likely provide protection for the newborn.

Surgical Anatomy for Extended Facelift Techniques

2020 ◽  
Vol 36 (03) ◽  
pp. 309-316
Author(s):  
Ozcan Cakmak ◽  
Ismet Emrah Emre
Keyword(s):  
Facial Nerve ◽  
Soft Tissues ◽  
Extended Techniques ◽  
Surgical Anatomy ◽  
Superficial Musculoaponeurotic System ◽  
Increased Risk ◽  
The Face ◽  
Facial Soft Tissues ◽  
Relationship Of ◽  
The Relationship

AbstractPreservation of the facial nerve is crucial in any type of facial procedure. This is even more important when performing plastic surgery on the face. An intricate knowledge of the course of the facial nerve is a requisite prior to performing facelifts, regardless of the technique used. The complex relationship of the ligaments and the facial nerve may put the nerve at an increased risk of damage, especially if its anatomy is not fully understood. There are several danger zones during dissection where the nerve is more likely to be injured. These include the areas where the nerve branches become more superficial in the dissection plane, and where they traverse between the retaining ligaments of the face. Addressing these ligaments is crucial, as they prevent the transmission of traction during facelifts. Without sufficient release, a satisfying pull on the soft tissues may be limited. Traditional superficial musculoaponeurotic system techniques such as plication or imbrication do not include surgical release of these attachments. Extended facelift techniques include additional dissection to release the retaining ligaments to obtain a more balanced and healthier look. However, these techniques are often the subject of much debate due to the extended dissection that carries a higher risk of nerve complications. In this article we aim to present the relationship of both the nerve and ligaments with an emphasis on the exact location of these structures, both in regard to one another and to their locations within the facial soft tissues, to perform extended techniques safely.

Risks and Benefits of Hormone Replacement Therapy

Cephalalgia ◽  
2000 ◽  
Vol 20 (3) ◽  
pp. 164-169 ◽  
Author(s):  
B de Lignières ◽  
E A MacGregor
Keyword(s):  
Hormone Replacement Therapy ◽  
Replacement Therapy ◽  
Hormone Replacement ◽  
Mortality And Morbidity ◽  
Oestrogen Deficiency ◽  
Disease Mortality ◽  
Increased Risk ◽  
Deficiency Diseases ◽  
Symptomatic Side ◽  
Natural Progesterone

Menopause, the permanent cessation of menstruation, is due to ovarian failure, which may lead to oestrogen deficiency diseases, particularly osteoporosis, cardiovascular disease and cerebrovascular disease. Mortality and morbidity caused by these conditions can be modified by using hormone replacement therapy, but the benefits of this therapy must be weighed against the increased risk of breast cancer and the symptomatic side-effects the treatment may cause. The combination of transdermal oestrogen and natural progesterone offers the most favourable risk-to-benefit profile.

MO817ALDOSTERONE ANTAGONISTS FOR PATIENTS WITH CHRONIC KIDNEY DISEASE REQUIRING DIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Takeshi Hasegawa ◽  
Hiroki Nihiwaki ◽  
Erika Ota ◽  
William Levack ◽  
Hisashi Noma
Keyword(s):  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Standard Care ◽  
Meta Analysis ◽  
Cardiovascular Death ◽  
Aldosterone Antagonists ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background and Aims Patients with chronic kidney disease (CKD) undergoing dialysis are at a particularly high risk of cardiovascular mortality and morbidity. This systematic review and meta-analysis aimed to evaluate the benefits and harms of aldosterone antagonists, both non-selective (spironolactone) and selective (eplerenone), in comparison to control (placebo or standard care) in patients with CKD requiring haemodialysis or peritoneal dialysis. Method We searched the Cochrane Kidney and Transplant Register of Studies up to 29 July 2019 using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register Search Portal and ClinicalTrials.gov. We included individual and cluster randomised controlled trials (RCTs), cross-over trials, and quasi-RCTs that compared aldosterone antagonists with placebo or standard care in patients with CKD requiring dialysis. We used a random-effects model meta-analysis to perform a quantitative synthesis of the data. We used the I2 statistic to measure heterogeneity among the trials in each analysis. We indicated summary estimates as a risk ratio (RR) for dichotomous outcomes with their 95% confidence interval (CI). We assessed the certainty of the evidence for each of the main outcomes using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. Results We included 16 trials (14 parallel RCTs and two cross-over trials) involving a total of 1,446 patients. Among included studies, 13 trials compared spironolactone to placebo or standard care and one trial compared eplerenone to a placebo. Most studies had an unclear or high risk of bias. Compared to control, aldosterone antagonists reduced the risk of all-cause death for patients with CKD requiring dialysis (9 trials, 1,119 patients: RR 0.45, 95% CI 0.30 to 0.67; moderate certainty of evidence). Aldosterone antagonist also decreased the risk of death due to cardiovascular disease (6 trials, 908 patients: RR 0.37, 95% CI 0.22 to 0.64; moderate certainty of evidence) and cardiovascular and cerebrovascular morbidity (3 trials, 328 patients: RR 0.38, 95% CI 0.18 to 0.76; moderate certainty of evidence). While aldosterone antagonists had an apparent increased risk of gynaecomastia compared with control (4 trials, 768 patients: RR 5.95, 95% CI 1.93 to 18.3; moderate certainty of evidence), the elevated risk of hyperkalaemia due to aldosterone antagonists was uncertain (9 trials, 981 patients: RR 1.41, 95% CI 0.72 to 2.78; low certainty of evidence). Conclusion Based on moderate certainty of the evidence, aldosterone antagonists could reduce the risk of all-cause and cardiovascular death and morbidity due to cardiovascular and cerebrovascular disease but increase the risk of gynaecomastia in patients with CKD requiring dialysis.

Nutritional Support in Acute Kidney Injury

2018 ◽  
Author(s):  
Alice Sabatino ◽  
Giuseppe Regolisti ◽  
Filippo Fani ◽  
Enrico Fiaccadori
Keyword(s):  
Acute Kidney Injury ◽  
Oxidation Rate ◽  
Nutritional Support ◽  
Rapid Change ◽  
Kidney Injury ◽  
Resting Energy Expenditure ◽  
Protein Energy Wasting ◽  
Mortality And Morbidity ◽  
Protein Energy ◽  
Increased Risk

Protein-energy wasting (PEW) is particularly common in patients with acute kidney injury (AKI). It is correlated, at least in part, with specific factors of the reduction of renal function and is associated with significant increase in mortality and morbidity. In this clinical condition, the optimal nutritional support remains an open question due to its qualitative composition in terms of macro- and micronutrients. In fact, data on critically ill patients have confirmed that nutritional support targeting the real protein and energy needs is associated with improvement of clinical outcome. However, data available in AKI patients are still scarce. AKI is characterized by increased risk of both under- and overfeeding because of the coexistence of many factors that can influence the evaluation of nutrient needs, such as a rapid change in body weight due to alterations in fluid balance, loss of nutrients during renal replacement therapy (RRT), and the presence of hidden calories in the RRT (ie, calories derived from anticoagulants and/or from solutions used in the different dialysis methods). As AKI comprises a highly heterogeneous group of patients, with oscillatory nutrient needs during patients’ clinical course, nutritional requirements should be frequently reassessed, individualized, and carefully integrated with RRT. Nutrient needs in patients with AKI can be difficult to estimate and should be directly measured, especially in the intensive care unit setting. This review contains 4 figures, 3 tables and 104 references Keywords: Malnutrition In ICU Patients,  Acute Kidney Injury, Nutritional Support, Indirect Calorimetry, Resting Energy Expenditure, Lipid Oxidation Rate, Glucose Oxidation Rate, Micronutrients

scholarly journals Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction

2006 ◽  
Vol 124 (4) ◽  
pp. 186-191 ◽  
Author(s):  
Afonso Celso Pereira ◽  
Roberto Alexandre Franken ◽  
Sandra Regina Schwarzwälder Sprovieri ◽  
Valdir Golin
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Hospital Death ◽  
Inferior Wall ◽  
Mortality And Morbidity ◽  
Killip Class ◽  
Increased Risk ◽  
The Impact

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.

scholarly journals Modern statin therapy in clinical practice: The lower the better

2013 ◽  
Vol 141 (1-2) ◽  
pp. 104-106 ◽  
Author(s):  
Edita Stokic
Keyword(s):  
Heart Disease ◽  
Cardiovascular Risk ◽  
Ischemic Heart Disease ◽  
Statin Therapy ◽  
Meta Analysis ◽  
Ischemic Heart ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
Coronary Events ◽  
Risk Treatment

Lipid and lipoprotein disorders are well known risk factors for atherosclerosis and its complications. The level of atherogenic LDL-cholesterol (LDL-C) is directly related to an increased risk of occurrence and progression of ischemic heart disease. Epidemiological and clinical studies have shown that the use of statin therapy to decrease LDL-C can significantly reduce the incidence of mortality, major coronary events and the need for revascularization procedures in the different groups of patients. The findings of a large meta-analysis conducted by the Cholesterol Treatment Trialists? (CTT) collaborators showed that every 1.0 mmol/l reduction of atherogenic LDL-C is associated with a 22% reduction in cardiovascular diseases mortality and morbidity. However, despite the impressive results of the benefits of statin therapy, the EUROASPIRE study showed that about 50% of patients with ischemic heart disease did not achieve target LDL-C levels. According to the new ESC/EAS Guidelines for the Management of Dyslipidaemias in patients with a very high cardiovascular risk, treatment goal should be to decrease LDL-C below 1.8 mmol/l or ?50% of initial values. In the majority of patients that can be achieved by statin therapy. For this reason an adequate choice of statins is of crucial importance, whereby the needed reduction in atherogenic LDL-C, after the identification of its target level based on the assessment of total cardiovascular risk, can be achieved.

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