Vascular anastomoses in intrauterine growth in monochorionic twins

2020 ◽  
Vol 48 (6) ◽  
pp. 539-543
Author(s):  
Michał Lipa ◽  
Przemysław Kosinski ◽  
Paweł Stanirowski ◽  
Mirosław Wielgos ◽  
Dorota Bomba-Opon
Keyword(s):  
Injection Technique ◽  
Digital Analysis ◽  
Monochorionic Twins ◽  
Intrauterine Growth ◽  
Blood Exchange ◽  
Sharing Patterns ◽  
A Prospective Study ◽  
The Impact ◽  
Umbilical Cords

AbstractObjectivesTo evaluate the impact of placental anastomoses on the intrauterine growth of monochorionic (MC) twins.MethodsA prospective study was conducted in a group of 53 MC twins. Intrapartally umbilical cords were clamped to identify placental sides corresponding to each twin. The postnatal dye injection technique was administered to evaluate vascular anastomoses, their number and type and visualize placental territory sharing patterns. Data from digital analysis were correlated with obstetrical follow-up.ResultsVascular anastomoses were revealed in 88.7% of cases. Arteriovenous (AV) anastomoses occurred in 75.4% and arterioarterial (AA) in 71.1% while venovenous (VV) in 26.4%. In the subgroup of MC twins without placental anastomoses, significantly higher birthweight difference and discordance were revealed when compared to MC twins without anastomoses (382.0 vs. 22 g; P = 0.03 and 49.14% vs. 16.02%; P = 0.03). On the other hand, in subgroups of MC twins with at least one AA anastomosis, twins’ birthweights were similar (p = ns) despite significantly higher placental territory sharing discordance (30.44% vs. 15.81%; P = 0.31).ConclusionsVascular anastomoses have a major impact on the intrauterine growth of MC twins. In certain cases, they may cause specific complications; however, in general, they regulate intertwin blood exchange and may compensate unequal placental territory.

Feasibility of telemedicine in the management strategy of patients with lymphoma amid the COVID-19 pandemic in Spain, a prospective study (Preprint)

2021 ◽  
Author(s):  
Raul Cordoba ◽  
Alberto Lopez-Garcia ◽  
Daniel Morillo ◽  
Maria-Angeles Perez-Saenz ◽  
Elham Askari ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Digital Health ◽  
Hematologic Malignancies ◽  
Patient Portal ◽  
Health Strategy ◽  
Potential Risk Factors ◽  
Hospital Visits ◽  
A Prospective Study ◽  
The Impact

BACKGROUND Recurrent hospital visits were potential risk factors for COVID-19 contagion. OBJECTIVE The aims of this prospective observational study was to analyze the consequences of COVID-19 pandemic in the health care of patients with lymphoma and the impact of telemedicine strategies such as the patient portal in their management. METHODS All data were obtained from the electronic medical record (EMR). Variables such as age, sex, matter of the visit, use of patient’s portal, changes in management, impact in clinical trials and suffering from COVID-19 contagion were recorded. RESULTS 290 patients were attended in the lymphoma clinic accomplishing 437 appointments. The median age was 66 years (range 18-94), and 157 (54.13%) were male. Of them, 109 out of 290 (37.58%) were aged older then 70 years. Regarding number of visits, 214 patients (73.79%) had only 1 visit to the hospital. Only 23 patients (7.93%) didn’t have access to patient’s portal. During the follow-up, only 7 patients (2.41%) suffered from COVID-19, with a median age of 66 years (51-80). CONCLUSIONS Telemedicine such as patient’s portal are feasible strategies in the management of patients with lymphoma during the COVID-19 pandemic, with a reduction of in-person visits to hospital and a very low contagion rate. This experience allowed us to continue with a new digital health strategy in the follow up of patients with hematologic malignancies. CLINICALTRIAL Not registered.

scholarly journals The impact of meningitis on the motor function of adult survivors in Harare, Zimbabwe

1999 ◽  
Vol 55 (1) ◽  
pp. 6-10
Author(s):  
Jennifer Jelsma ◽  
Helen Lilley ◽  
Helen Smith ◽  
Jens Mielke ◽  
James Hakim ◽  
...  
Keyword(s):  
Functional Disability ◽  
Functional Limitation ◽  
Adult Survivors ◽  
Stepwise Logistic Regression ◽  
Motor Impairments ◽  
Forward Stepwise ◽  
The One ◽  
A Prospective Study ◽  
The Impact

Objective: The study aimed to document the spectrum of motor impairments and the degree of functional limitation of those who survived adult meningitis and to identify which factors were associated with a poor functional outcome and mortality.Methods: A prospective study was undertaken in the central hospitals in Harare, Zimbabwe. Twenty six adult patients who had survived meningitis were interviewed between one and five months post-admission. Seventeen of these were examined in the clinic for signs of impairment. Nine did not attend the follow-up session and were interviewed at home. The Barthel Activities of Daily Living Index (BI) was administered to all twenty six subjects.Results: Twenty subjects were HIV sero-positive. Eight subjects died in the time period between the one month interview and the final follow-up five months later. The majority of the seventeen examined in the clinic, demonstrated sensory and motor disturbances. Seven of the twenty six subjects scored eighteen or less on the BI. Forward stepwise logistic regression revealed that a low BI was the only variable which significantly predicted mortality (p.<0.01). The odds of a patient with a low BI dying were 63 times the odds of a patient dying who had a normal BI.Discussion and Conclusions: Survivors of meningitis in this study displayed a diversity of impairments and disabilities. Rehabilitation intervention is recommended to provide functional reeducation and support for those with a low BI and to mitigate against the effects of the impairments. A measure of functional disability should be included in the examination of these clients as functional impairment appears to be a predictor of mortality.

scholarly journals The effect of diabetes mellitus on evolution and outcome of tuberculosis in a prospective study

2021 ◽  
Vol 64 (5) ◽  
pp. 16-20
Author(s):  
Alina Malic ◽  
◽  
Evelina Lesnic ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Prospective Study ◽  
Treatment Effectiveness ◽  
Similar Rate ◽  
Control Group ◽  
Diabetic Patients ◽  
A Prospective Study ◽  
Prospective Longitudinal ◽  
The Impact

Background: In the Republic of Moldova almost 5% of the cases with tuberculosis are diagnosed annually among diabetic patients. The aim of this study was to assess the impact of diabetes mellitus on the evolution and anti-tuberculosis treatment effectiveness in a prospective study. Material and methods: A prospective, longitudinal and case-control study, which included a total number of 252 patients diagnosed with pulmonary tuberculosis and distributed in a study group, consisting of 93 patients diagnosed with diabetes mellitus and a control group, consisting of 159 patients without glycemic disorders, was performed. Results: This study identified that one half of the group with diabetes was detected by active screening and one third received anti-tuberculous treatment before actual episode. A similar rate of diabetic and non-diabetic patients was microbiologically positive, as well confirmed with drug-resistance. The anti-tuberculous treatment effectiveness was lower in diabetic patients, the death rate and the low treatment outcome (lost to follow-up and failed) were higher than in non-diabetic patients. The main causes of unfavorable evolution were: glycemic disorders (hyperglycemia), diabetes complications and the history of the anti-tuberculous treatment in the anamnesis. Conclusions: The individualized approach and a tight follow-up should be performed regularly in all patients with glycemic disorders and tuberculosis for the improvement of the disease outcome.

scholarly journals Sex differences in psychotropic and analgesic drug use before and after initiating treatment with acetylcholinesterase inhibitors

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0243804
Author(s):  
Anne Sverdrup Efjestad ◽  
Hege Ihle-Hansen ◽  
Vidar Hjellvik ◽  
Knut Engedal ◽  
Hege Salvesen Blix
Keyword(s):  
Age Groups ◽  
Acetylcholinesterase Inhibitors ◽  
Prescription Database ◽  
Prescription Pattern ◽  
Before And After ◽  
Norwegian Prescription Database ◽  
Total Prescription ◽  
A Prospective Study ◽  
The Impact

Background/aims The aim was to explore the impact of sex on prevalence, patterns and trends in the prescription of psychotropics and analgesics in users of acetylcholinesterase inhibitors (AChEIs), before and after AChEI initiation, compared to the general population. Methods A prospective study applying data from the Norwegian Prescription Database (NorPD) in the period 2004–2016. Prescription of antidepressants, antipsychotics, analgesics including opioids, benzodiazepines and z-hypnotics in persistent AChEI users was studied in a follow-up period from four years before to two years after AChEI initiation in men and women of four age groups: 37–64, 65–72, 73–80 and 81–88 years. Results Use of antidepressants, antipsychotics and weaker analgesics increased in both sexes during the follow-up period in 11.764 persistent AChEI users. Women with pre-dementia and dementia stages of AD showed a prescription pattern with more use of psychotropics and opioids than men, except for antipsychotics. Conclusion Female sex showed to have a significant influence on the prescriptions of psychotropics and analgesics in AD patients in a pre-dementia and dementia stage. The exception is for antipsychotics, that men used more than women. The prescription pattern showed a higher extent of polypharmacy of psychotropics and/or opioids in women than in men. The total prescription pattern of analgesics could indicate an undertreatment of pain in pre-dementia and dementia stages, most pronounced in men.

SP5.1.1 The harsh reality of a long waiting list for bariatric surgery, a prospective study regarding health-related quality of life (HRQoL) among morbid obese patients following bariatric surgery versus those on a waiting list, a two-year follow-up study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jose Rodicio ◽  
María Moreno ◽  
Tamara Vico ◽  
Emilio Negrete ◽  
Covadonga Valdés ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Bariatric Surgery ◽  
Bodily Pain ◽  
Waiting List ◽  
Emotional Role ◽  
A Prospective Study ◽  
The Impact

Abstract Aims The aims of this study were to assess the changes in HRQoL during the 2 years follow-up between patients who underwent surgery and those on a long waiting list . Methods Between January to December 2017, 70 surgical patients and 69 patients on the waiting list were interviewed at baseline, 12-month and 24-month follow-up. Quality of life was measured by the SF-12v2 and the Impact of Weight on Quality of Life-Lite (IWQoL) questionnaires. Socio-demographics, clinical, and surgical-related variables were collected. Results 139 patients were analyzed, with similar baseline characteristics. Analyzing the entire sample: the higher the BMI, the worse the scores in the IWQoL. Performing more qualified work improves several aspects of the SF-12v2. In contrast, patients with depression tended to score worse on all dimensions of both questionnaires, women scored worse on the Self-Esteem domain and men improved on the Mental Health one. At 12 and 24-month follow-up, statistically significant differences were found among all aspects of the questionnaires between both groups (P&lt;.001). Furthermore, scores were lower in all domains in the evolution of wait-listed patients, with statistically differences among Bodily Pain, Emotional Role, Mental Health, and Mental Component Summary domains (P&lt;.05) at 12 months, but differences were not found at 24 months. Conclusions The quality of life of patients undergoing bariatric surgery is normalized one year after surgery, while patients on the waiting list get worse. Knowing the benefits of bariatric surgery, working on programs with long waiting lists should move us to fight against an unfair and unacceptable situation.

scholarly journals Maternal-Fetal Work-up and Management in Intrauterine Growth Restriction (IUGR)

2010 ◽  
Vol 4 (4) ◽  
pp. 427-432
Author(s):  
Narendra Malhotra ◽  
JP Rao ◽  
Randhir Puri
Keyword(s):  
Intrauterine Growth Restriction ◽  
Perinatal Outcome ◽  
Color Doppler ◽  
Therapeutic Strategies ◽  
Growth Restriction ◽  
Future Generations ◽  
Monochorionic Twins ◽  
Intrauterine Growth ◽  
Work Up

ABSTRACT Intrauterine growth restriction remains befundling problem in obstetrics, dependent on multifactorial, diverse, intrinsic fetal conditions as well as many maternal and environmental factors. Ultrasonography with color doppler assesmenent remains the only tool for follow-up and diagnosis. Multidisciplinary apporach for assesment, mangement, prevention is imperative. Selective IUGR in monochorionic twins needs attention for optimum perinatal outcome. Future intensive research is desired to establish preventive, diagnostic and therapeutic strategies for IUGR, perhaps affecting the health of future generations.

A Prospective Study of the Impact of Home Monitoring on the Family

PEDIATRICS ◽  
1984 ◽  
Vol 74 (3) ◽  
pp. 323-329
Author(s):  
Abby L. Wasserman
Keyword(s):  
Home Monitoring ◽  
Initial Contact ◽  
Semistructured Interviews ◽  
The Family ◽  
Motor Problems ◽  
Two Phases ◽  
A Prospective Study ◽  
The Impact ◽  
Speech Learning

Fourteen families whose infants required home monitoring for apnea were followed for approximately 5 years from the initial contact (1977). Each family received at least three psychiatric interviews and two follow-up contacts. Effects on the monitored infant, siblings, and parents were examined in open and semistructured interviews. At first follow-up (mean of 21 months after monitoring discontinuance), seven of 14 monitored children were characterized as spoiled by parents. By the second follow-up, 2½ years later, nine children showed speech, learning, and motor problems; five of these nine children had required resuscitation during their initial episode. Apnea severity was also related to both duration of monitoring and number of additional psychiatric interviews requested by parents or staff. Of 16 older siblings, 12 had psychological problems reported by their parents at first follow-up; these problems appeared to be largely resolved by the second follow-up, although three children were still having problems that caused parental concern. Monitoring, as well as the apnea itself, caused substantial distress manifested in depression, fatigue, and anxiety in many parents, particularly mothers. However, despite their considerable distress, none of the families discontinued monitoring prematurely. Results of the study indicated that the monitoring experience can be divided into four phases: doubt/acceptance, dependence/frustration, discontinuance, and late effects, with substantial differences in parents' responses occurring only in the last two phases.

Pain following stroke: A prospective study

2012 ◽  
Vol 3 (3) ◽  
pp. 194-195 ◽  
Author(s):  
Anne P. Hansen ◽  
Ninna S. Marcussen ◽  
Henriette Klit ◽  
Helge Kasch ◽  
Troels S. Jensen ◽  
...  
Keyword(s):  
Shoulder Pain ◽  
Joint Pain ◽  
Considerable Effect ◽  
Stroke Onset ◽  
University Hospital ◽  
Prevalence Of Pain ◽  
A Prospective Study ◽  
The Impact

AbstractBackground/aimsPain following stroke is common and affects the quality of life in stroke survivors. The most common types of pain following stroke are headache, shoulder pain, other joint pain and central post-stroke pain (CPSP). The objectives of this study were to determine the prevalence of pain at stroke onset and 6 months after stroke and classify the different pain types.MethodsAll consecutively eligible patients admitted to the Stroke Unit at Aarhus University Hospital from February 1 to October 1, 2007 and from February 1 to August 1, 2008 were included. An interview on pain prior to and at stroke onset was conducted at admission followed by interviews on current pain by phone 3 and 6 months after the stroke.ResultsA total of 300 patients were included in the study, and 275 of them completed the 6-month follow-up. The mean age of the 275 patients was 65.9 years old and 55.2% was male. Pain prior to stroke was reported by 49.1% of patients at stroke onset and newly developed pain defined as pain not experienced prior to stroke was reported by 37.8% at stroke onset, 41.8% at the 3-month follow-up and 45.8% at the six month follow-up. The impact on daily life was moderate to severe in 36.4% and 33.6% of the patients with newly developed pain at the 3- and 6-month follow-up, respectively. More than one type of newly developed pain was experienced by 32.2% and 36.5% at the 3- and 6-month follow-up. Headache was reported by 33.5% at stroke onset and newly developed headache by 15.3% at 3-month follow-up and 13.1% at 6-month follow-up. Shoulder pain was reported by 1.5%, 13.1% and 16.4% at stroke onset, and the 3-and 6-month follow-up, respectively. Other joint pain was reported by 7.4% at 3-month and 11.7% at 6-month follow-up. Evoked pain was experienced by 3.6% at stroke onset and by 5.5% and 9.1% at the follow-up interviews.Other types of pain were also reported; 7.3% at stroke onset, 18.9% at 3-month follow-up and 20.0% at 6-month follow-up. Possible CPSP was identified in 10.5% of patients from the different pain groups.ConclusionPain following stroke is common and may have a considerable effect on the everyday life of the patient.

scholarly journals Impacto da Corionicidade nas Complicações Perinatais da Gestação Gemelar

2017 ◽  
Vol 30 (1) ◽  
pp. 12 ◽  
Author(s):  
Marta Machado ◽  
Elsa Lima Teixeira ◽  
Lígia Maria Ferreira ◽  
Filipa Rodrigues ◽  
Raquel Henriques ◽  
...  
Keyword(s):  
Intrauterine Growth Restriction ◽  
Perinatal Outcomes ◽  
Hyaline Membrane Disease ◽  
Clinical Approach ◽  
Monochorionic Twins ◽  
Intrauterine Growth ◽  
Multiple Gestations ◽  
Tertiary Center ◽  
Significant Difference ◽  
The Impact

Introduction: The incidence of multiple gestations is increasing worldwide and many studies have shown higher perinatal morbidity and mortality rates in monochorionic twins compared to dichorionic. The aim of this study was to assess the twin population born at a tertiary center and to evaluate the impact of chorionicity on perinatal outcomes of twin pregnancies.Material and Methods: Retrospective study of all twins born in a tertiary center from January 2004 to December 2013.Results: In this period, 1051 twins were born, related to 540 gestations (26.7% monochorionic; 73.3% dichorionic). There was no statistical significant difference between the groups concerning obstetric complications. The monochorionic group had a higher incidence of intrauterine growth restriction (20.5 vs 11.3%, p < 0.001), lower mean maternal age (29.9 vs 31.9 years, p < 0.001), lower mean gestational age (33.4 vs 34.3 weeks, p < 0.05) and lower mean birth weight (1943 vs 2147 g, p < 0.001). Monochorionic twins had a higher incidence of hyaline membrane disease (7 vs 4%, p < 0.05), sepsis (10.3 vs 5.8%, p < 0.05) and anemia (9.5 vs 5.4%, p < 0.05). There were no statistical significant differences concerning necrotizing enterocolitis, intraperiventricular hemorrhage or retinopathy of prematurity. Perinatal mortality was higher in the monochorionic group (5.2 vs 2.9%, p < 0.05).Discussion: Monochorionic twins represent considerable challenges to both obstetricians and neonatologists and should be monitored and delivered at tertiary centers.Conclusion: Currently gemelarity has a major impact on total births. It would be interesting to develop protocols to standardize clinical approach to twins.

scholarly journals Impact on core values of family medicine from a 2-year Master’s programme in Gezira, Sudan: observational study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Khalid Gaffer Mohamed ◽  
Steinar Hunskaar ◽  
Samira Hamid Abdelrahman ◽  
Elfatih Mohamed Malik
Keyword(s):  
Family Medicine ◽  
Core Values ◽  
National Guidelines ◽  
Patient Centeredness ◽  
Patient Centered ◽  
Self Assessment ◽  
Orientation Scale ◽  
A Prospective Study ◽  
The Impact

Abstract Background Training of family physicians should include not only clinical and procedural skills, but also core values as comprehensive care, continuity of care, leadership and patient-centeredness. The Gezira Family Medicine Project (GFMP) is a 2 years Master’s programme in family medicine in Sudan. We assessed the impact of GFMP on the candidates’ adherence to some core values of family medicine. Methods This is a prospective study with before-after design based on repeated surveys. We used Patient-Practitioner Orientation Scale (PPOS) to assess physicians’ attitude towards patient-centeredness. Practice based data from individual patients’ consultations and self-assessment methods were used to assess physicians’ adherence to core values. Results At the end of the programme the candidates (N = 110) were significantly more active in community health promotion (p <  0.001), more confident as a team leader (p = 0.008), and showed increased adherence to national guidelines for managing diabetes (p = 0.017) and hypertension (p = 0.003). The responding candidates had more knowledge about patients’ medical history (p <  0.001), family history (p < 0.001) and family situation (p < 0.001). There were more planned follow up consultations (p < 0.001) and more referrals (p = 0.040). In contrast, results from PPOS showed slightly less orientation towards patient-centeredness (p = 0.007). Conclusions The GFMP Master’s programme induced a positive change in adherence to several core values of family medicine. The candidates became less patient-centered.

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