Growth patterns and associated risk factors of congenital malformations in twins

Abstract Background: The rate of twinning continues to increase due to the combined effect of a rise in parental age and increased use of assisted reproductive technology. The risk of congenital anomalies in twins is higher than in singletons, but it is less well reported in relation to growth patterns. We focused to the auxological outcome of twin pregnancies when one or both of twins are affected by one or more malformations. Methods: We conducted a retrospective observational study reviewing the clinical charts of twins admitted in the period between January 2003 and December 2018 at the University Hospital of Palermo. The associations between malformations and anthropometric variables at birth were analyzed by comparison within each twin pair and regarding each variable as ordered difference between the two twins. Results: We studied data of 488 neonates (52% females) from 244 pregnancies. The rate of major congenital anomalies was 11%, affecting significantly the smaller twin (p = .00018; Odds ratio 3.21; 95% CI 1.65 6.59). Malformation class distribution was as following: genitourinary (24%), gastrointestinal (20%), cardiovascular (18.5%), musculoskeletal (11%), central nervous system (9%), syndromic (9%), ocular (5.5%) and diaphragmatic hernia (2%). The most predictive value, the Birthweight (BW) difference mean ratio in malformed versus not malformed neonates (-0.31 vs 0.02; p= .0016) was distributed equally lower than zero in all malformed twins, except for those with congenital heart defects ( p= .0000083). Microcephaly (head circumference <2 standard deviation, SD) was present in 3% of symmetrically smaller twin, and severe microcephaly (<3 SD) was present in 0.6%. We found that an intertwin BW discordance of 18% or greater identified 50% of neonates with microcephaly, but only 11% of malformed twins. Conclusions: In case of one twin with a BW <10 th centile, a concomitant intertwin BW discordance ≥18% could reveal an increased risk for microcephaly but not for malformation. Lower values of BW, Ponderal index, Body mass index but above all negative value of BW difference mean ratio are associated with malformations in twin pairs.

Download Full-text

Prevalence, Persistence, and Factors Associated with SARS-CoV-2 IgG Seropositivity in a Large Cohort of Healthcare Workers in a Tertiary Care University Hospital in Northern Italy

Viruses ◽

10.3390/v13061064 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1064

Author(s):

Gitana Scozzari ◽

Cristina Costa ◽

Enrica Migliore ◽

Maurizio Coggiola ◽

Giovannino Ciccone ◽

...

Keyword(s):

Tertiary Care ◽

Multivariable Analysis ◽

Northern Italy ◽

University Hospital ◽

Care Workers ◽

Increased Risk ◽

Never Smokers ◽

The University ◽

Job Profile ◽

Pandemic Wave

This observational study evaluated SARS-CoV-2 IgG seroprevalence and related clinical, demographic, and occupational factors among workers at the largest tertiary care University-Hospital of Northwestern Italy and the University of Turin after the first pandemic wave of March–April 2020. Overall, about 10,000 individuals were tested; seropositive subjects were retested after 5 months to evaluate antibodies waning. Among 8769 hospital workers, seroprevalence was 7.6%, without significant differences related to job profile; among 1185 University workers, 3.3%. Self-reporting of COVID-19 suspected symptoms was significantly associated with positivity (Odds Ratio (OR) 2.07, 95%CI: 1.76–2.44), although 27% of seropositive subjects reported no previous symptom. At multivariable analysis, contacts at work resulted in an increased risk of 69%, or 24% for working in a COVID ward; contacts in the household evidenced the highest risk, up to more than five-fold (OR 5.31, 95%CI: 4.12–6.85). Compared to never smokers, being active smokers was inversely associated with seroprevalence (OR 0.60, 95%CI: 0.48–0.76). After 5 months, 85% of previously positive subjects still tested positive. The frequency of SARS-COV-2 infection among Health Care Workers was comparable with that observed in surveys performed in Northern Italy and Europe after the first pandemic wave. This study confirms that infection frequently occurred as asymptomatic and underlines the importance of household exposure, seroprevalence (OR 0.60, 95%CI: 0.48–0.76).

Download Full-text

Acute Polyhydramnios Complicating Twin Pregnancies

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000004700 ◽

1985 ◽

Vol 34 (3-4) ◽

pp. 179-184 ◽

Cited By ~ 27

Author(s):

K.T.M. Schneider ◽

K. Vetter ◽

R. Huch ◽

A. Huch

Keyword(s):

Mortality Rate ◽

Amniotic Fluid ◽

Bed Rest ◽

Positive Influence ◽

University Hospital ◽

Monozygous Twin ◽

The Mean ◽

The University ◽

Twin Pregnancies ◽

Placental Vessel

AbstractAcute polyhydramnios in the second trimestr is a typical complication in monozygous twin pregnancies. It is caused by a feto-fetal transfusion with anemia on the donor and polycytemia on the recipient twin. Contrary to the chronic hydramnios, there is no increase in malformations. In view of the high mortality rate (100%, according to most authors), the clinical management has to be reconsidered. During the years 1979 to 1983, 10 cases of acute polyhydramnios have been observed at the University Hospital in Zurich. This corresponds to an incidence of 9% in our twin population. All cases investigated were MZ twin pregnancies. With the exception of one patient, who underwent an abortion, all women were hospitalized, had bed rest and received recurrent removals of amniotic fluid and prophylactic tocolysis. The mean gestational age at the time of diagnosis was 23 4/7 weeks and at delivery 30 3/7 weeks. In two cases – one of which is presented in detail – with an unintentional puncture of a placental vessel, the recurrence of the hydramnios did not appear. Eight of 18 newborns survived. No malformations were found. Bed rest, tocolysis and recurrent amniocenteses seem to have a positive influence on the prolongation and outcome of the gestation in acute polyhydramnios.

Download Full-text

Psychosocial emergency care in times of COVID-19: the Essen University Hospital concept for corona-infected patients, their relatives, and medical staff

International Archives of Occupational and Environmental Health ◽

10.1007/s00420-020-01580-z ◽

2020 ◽

Author(s):

Vanessa Rentrop ◽

Johanna Sophie Schneider ◽

Alexander Bäuerle ◽

Florian Junne ◽

Nora Dörrie ◽

...

Keyword(s):

Medical Staff ◽

Online Training ◽

University Hospital ◽

High Psychological Distress ◽

Increased Risk ◽

Psychosocial Emergency ◽

Low Threshold ◽

Long Term Consequences ◽

The University

Abstract Due to the SARS CoV-2-virus (COVID-19), anxiety, distress, and insecurity occur more frequently. In particular, infected individuals, their relatives, and medical staff face an increased risk of high psychological distress as a result of the ongoing pandemic. Thus, structured psychosocial emergency concepts are needed. The University hospital of Essen has taken up this challenge by creating the PEC concept to reduce psychosocial long-term consequences for infected patients, relatives, and medical staff at the university hospital. The concept includes professional medical as well as psychological support to convey constructive coping strategies and the provision of adequate tools such as the low-threshold online training program (CoPE It), which is accessible via the webpage www.cope-corona.de.

Download Full-text

The Possibility of Contralateral Non-Sentinel Groin Node’s Metastasis in Early Primary Vulvar Cancer Women After Unilateral Sentinel Node’s Metastasis: A Single Center Evaluation in University Hospital of Düsseldorf

10.21203/rs.3.rs-50733/v1 ◽

2020 ◽

Author(s):

Andreas Suhartoyo Winarno ◽

Anne Mondal ◽

Franca Christina Martignoni ◽

Tanja Natascha Fehm ◽

Monika Hampl

Keyword(s):

Vulvar Cancer ◽

University Hospital ◽

Morbidity Rate ◽

Current Guideline ◽

Single Center ◽

Standard Management ◽

Increased Risk ◽

Early Primary ◽

The University ◽

Current Guidelines

Abstract Background: Sentinel node biopsy (SLNB) technique in unifocal vulvar cancer (diameter of < 4cm) and unsuspicious groin lymph nodes, the morbidity rate of patients has significantly decreased all over the world. In contrast to SLNB, bilateral inguinofemoral lymphadenectomy (IFL) has been associated with increased risk of common morbidities. Current guidelines (NCCN, ESGO, RCOG, and German) suggest that in cases of metastasis of unilateral SLNB, groin node dissection with IFL, should be performed bilaterally. However, a publication by Woelber et al. 0% (p=0/28) and Nica et al. 5.3% (p=1/19) contradicted the current guideline. Methods: A single-center analysis conducted in the University Hospital of Dusseldorf, evaluating vulvar cancer patients treated with SLNB retrospectively from 2002 to 2018. Result, discussion and conclusion: Current guideline for bilateral IFL should remain as the standard management because 22.2% women (n=4/18) had contralateral IFL groin metastasis after unilateral SLNB metastasis initially. The depth of tumor infiltrating cells was correlated significantly and positively with the incidence rate of groin metastasis (p=0.0038). Therefore, it is an indication for bilateral IFL.

Download Full-text

Prevalence of sleep disorders in obese before bariatric surgery.

Manual Therapy Posturology & Rehabilitation Journal ◽

10.17784/mtprehabjournal.2017.15.444 ◽

2020 ◽

pp. 1-5

Author(s):

Renata Carlos ◽

Nicole Oliver ◽

Ana Luísa F. Cruz ◽

Suzanny Lays da Silva ◽

Jesimiel Missias de Souza ◽

...

Keyword(s):

Bariatric Surgery ◽

Sleep Disorders ◽

Cross Sectional Study ◽

University Hospital ◽

Anthropometric Measures ◽

Cross Sectional ◽

Obesity Epidemic ◽

Increased Risk ◽

Stanford Sleepiness Scale ◽

The University

Introduction: The prevalence of sleep disorders (SD) has increased significantly in recent decades in parallel to the worldwide obesity epidemic. The presence of SD provides an increased risk of postoperative complications, requiring greater care in these patients. The gold standard for evaluation and diagnosis of SD is polysomnography, but it is an expensive and highly complex exam, making the questionnaires and scales more accessible for diagnosis and screening. Objectives: To evaluate the presence of SD and to analyze the influence of anthropometric measures on the scores of the Epworth Sleepiness Scale (ESS), snoring (ERS) and Stanford Sleepiness Scale (SSS) in obese patients. Method: An observational, cross-sectional study performed from August 2015 to August 2016. The patients in the preoperative group of bariatric surgery of the University Hospital were submitted to anthropometric evaluation and application of the ESS, ERS and SSS during the preoperative physiotherapy evaluation. Results: Were evaluated 100 obese (78 women), mean age of 41.4±10.7 years and BMI of 46.1±7.8kg/m2 . SD were identified in 25% by ESS and 21% by SSS of obese. There were no differences between genders for the scales scores. The score of the ERS correlated itself with waist (r=0.20, p=0.04) and neck (r=0.33, p=0.001) circumferences. Conclusion: The use of scales for diagnosis of SD is useful in the follow-up of the preoperative of bariatric surgery and our study found that 25% of patients present daytime somnolence. We also observed the influence of waist and neck circumferences on increasing snoring scale.

Download Full-text

Hormonal, metabolic and nutritional alterations in smokers: emergency for smoking abstinence

Jornal Brasileiro de Psiquiatria ◽

10.1590/s0047-20852013000400003 ◽

2013 ◽

Vol 62 (4) ◽

pp. 261-267 ◽

Cited By ~ 1

Author(s):

Gláucia Renata Souza Rodrigues ◽

Marcela Melquíades ◽

Maria Alvim Leite ◽

Maíra Barros Louro ◽

Carmen Perches ◽

...

Keyword(s):

Smoking Cessation ◽

Cross Sectional Study ◽

The Body ◽

University Hospital ◽

Anthropometric Parameters ◽

Cross Sectional ◽

Convenience Sample ◽

Fasting Glycemia ◽

Increased Risk ◽

The University

OBJECTIVE: To evaluate the biochemical and nutritional status of smokers in treatment for smoking cessation and its association with anthropometric parameters. METHODS: This is a cross-sectional study with convenience sample. Adult smokers were assessed at the start of treatment in the Interdisciplinary Center for Tobacco Research and Intervention of the University Hospital of the Federal University of Juiz de Fora (CIPIT/HU-UFJF). We evaluated the body mass index (BMI), conicity index (CI); waist circumference (WC), percentage of body fat (%BF), fasting glycemia, cortisol, insulin, total cholesterol (TC), LDL-c, HDL-c, triglycerides (TG) and metabolic syndrome (MS). RESULTS: Most participants (52.2%) had MS and high cardiovascular risk. The fasting glycemia was abnormal in 30.4%. There was a significant positive correlation between BMI and WC (r = 0.90; p = 0.0001), %BF (r = 0.79; p = 0.0001), CI (r = 0.65; p = 0.0001), glycemia (r = 0.42; p = 0.04) and TG (r = 0.47; p = 0.002). The CI presented positive correction with insulin (r = 0.60; p = 0.001), glycemia (r = 0.55; p = 0.007), TG (r = 0.54; p = 0.008) and %BF (r = 0.43; p = 0.004). Patients with longer duration of smoking had a higher risk of developing MS (OR = 9.6, p = 0.016). CONCLUSION: The smokers evaluated had increased risk for developing MS, especially those with longer duration of smoking, requiring urgent smoking cessation.

Download Full-text

Rate of Infection in Rheumatoid Arthritis Patients

Saudi Journal of Internal Medicine ◽

10.32790/sjim.4.1.4 ◽

2014 ◽

Vol 4 (1) ◽

pp. 15-21

Author(s):

Aisha A. Al Ghamdi ◽

Suzan M. Attar

Keyword(s):

Rheumatoid Arthritis ◽

University Hospital ◽

Inflammatory Disorder ◽

Risk Of Infection ◽

Kingdom Of Saudi Arabia ◽

Steroid Use ◽

Increased Risk ◽

King Abdulaziz University ◽

Associated Risk Factors ◽

Common Infections

Objectives: Rheumatoid arthritis is an autoimmune inflammatory disorder associated with increased risk of infection. The aim of this study was to evaluate infections frequency in rheumatoid arthritis patients and to report the independent associated risk factors. Methods: Rheumatoid arthritis patients (n = 200) were retrospectively reviewed at King Abdulaziz University Hospital Jeddah, Kingdom of Saudi Arabia from January 2008 to December 2010. The rate and predictors of infection were evaluated. Results: The frequency of infection in rheumatoid arthritis patients was (36%). The most common infections were pneumonia, bacteremia and urinary tract infection occurring in 18%, 12%, and 10%, respectively. The strongest and significant predictors for infection were cardiovascular disease (OR = 8.87), renal impairment (OR = 7.12), and steroid use (OR = 1.67). Conclusions: Infection rate in rheumatoid arthritis patients was high but lower than other studies. Comorbid illnesses (renal and cardiovascular diseases) and steroids in rheumatoid arthritis patients predisposed them to develop infections that may necessitate hospitalization. Comorbid illnesses should be managed early and steroids to be used cautiously in order to reduce infection risk among rheumatoid arthritis patients.

Download Full-text

Risk for Falls in Patients with Limb Amputations in the Clinical Institute for Rehabilitation and Orthopedic Aids of the University Hospital Centre Zagreb

Croatian Nursing Journal ◽

10.24141/2/5/1/6 ◽

2021 ◽

Vol 5 (1) ◽

pp. 67-73

Author(s):

Danijela Golub ◽

Slađana Režić

Keyword(s):

Hospital Setting ◽

Clinical Problem ◽

Primary Diagnosis ◽

University Hospital ◽

Patient Falls ◽

Number Of Patients ◽

Increased Risk ◽

Risk Of Falls ◽

The Cost ◽

The University

Introduction. Patient falls are a significant clinical problem, as the fall can result in disability and, in some cases, death. The fall affects the patients’ quality of life, prolongs hospitalization, and increases the cost of treatment. Falls are the result of interaction between various factors. In the hospital setting, falls are considered adverse events. Aim. To determine the number of patients’ falls at the Clinical Institute for Rehabilitation and Orthopedic Aids of the University Hospital Centre Zagreb (UHC Zagreb) between September 1, 2019, and February 29, 2020. Methods. The data was extracted after the event from the Hospital Information System (Nursing records) and then processed. The study included 212 patients with limb amputations (both sexes) who were hospitalized in the Clinical Institute for Rehabilitation and Orthopedic Aids. Results. The results showed that patients with limb amputations have a risk for falls when doing rehabilitation for their primary diagnosis. Of the 212 patients admitted, 209 were at risk of falling according to the Morse Falls Scale, but of the total number of patients, only 2 fell. Conclusion. Patients with limb amputations have a higher risk of falls. The retrospective study shows that despite the increased risk of falls, the actual number of falls is very small. This shows that the medical staff are doing excellent work.

Download Full-text

Southampton Arm Fracture Frailty and Sarcopenia Study (SAFFSS): a study protocol for the feasibility of assessing frailty and sarcopenia among older patients with an upper limb fracture

BMJ Open ◽

10.1136/bmjopen-2019-031275 ◽

2019 ◽

Vol 9 (8) ◽

pp. e031275

Author(s):

Kinda Ibrahim ◽

Mark Mullee ◽

Guiqing Lily Yao ◽

Shihua Zhu ◽

Mark Baxter ◽

...

Keyword(s):

Upper Limb ◽

Ethics Committee ◽

University Hospital ◽

Major Health Problem ◽

Limb Fracture ◽

Increased Risk ◽

Registration Number ◽

Upper Limb Fracture ◽

Limb Fractures ◽

The University

IntroductionFalls are a major health problem for older people; 35% of people aged 65+ years fall every year, leading to fractures in 10%–15%. Upper limb fractures are often the first sign of osteoporosis and routine screening for osteoporosis is recommended by the National Institute for Health and Care Excellence to prevent subsequent hip fractures. However, both frailty and sarcopenia (muscle weakness) are associated with increased risk of falling and fracture but are not routinely identified in this group. The aim of this study is to evaluate the feasibility of assessing and managing frailty and sarcopenia among people aged 65+ years with an upper limb fracture.Methods and analysisThis study will be conducted in three fracture clinics in one acute trust in England. 100 people aged 65+ years with an upper arm fracture will be recruited and assessed using six validated frailty measures and two sarcopenia tools. The prevalence of the two conditions and the best tools to use will be determined. Those with either condition will be referred to geriatric clinical teams for comprehensive geriatric assessment (CGA). We will document the proportion who are referred for CGA and those who receive CGA. Other outcome measures including falls, fractures and healthcare resource use over 6 months will be collected. In-depth interviews with a purposive sample of patients who undergo the frailty and sarcopenia assessments and healthcare professionals in fracture clinics and geriatric services will be carried out to their acceptability of assessing frailty and sarcopenia in a busy environment.Ethics and disseminationThe study was given the relevant ethical approvals from NHS Research Ethics Committee (REC No: 18/NE/0377), the University Hospital Southampton NHS Foundation Trust, and the University of Southampton, Faculty of Medicine Ethics Committee and Research Governance Office. Findings will be published in scientific journals and presented to local, national and international conferences.Trial registration numberISRCTN13848445

Download Full-text

ESBL-colonization at ICU admission: impact on subsequent infection, carbapenem-consumption, and outcome

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.5 ◽

2019 ◽

Vol 40 (4) ◽

pp. 408-413 ◽

Cited By ~ 7

Author(s):

Aurélien Emmanuel Martinez ◽

Andreas Widmer ◽

Reno Frei ◽

Hans Pargger ◽

Daniel Tuchscherer ◽

...

Keyword(s):

Rectal Swab ◽

Length Of Hospital Stay ◽

University Hospital ◽

Subsequent Infection ◽

Icu Admission ◽

Icu Stay ◽

Hazard Ratios ◽

Increased Risk ◽

Screening Strategies ◽

The University

AbstractObjective:To determine whether colonization with extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE) predicts the risk for subsequent infection and impacts carbapenem-consumption and outcome in intensive care unit (ICU) patients.Design:Prospective cohort study.Setting:The 2 ICUs in the University Hospital Basel in Switzerland.Patients:All patients admitted to the 2 ICUs providing mechanical ventilation and an expected ICU stay >48 hours.Methods:Patients were routinely screened for ESBL-PE carriage by rectal swab on admission. Competing risk regression analyses were applied to calculate hazard ratios (HRs) for infection with ESBL-PE and mortality. Length of hospital stay, length of ICU stay, and duration of carbapenem exposure were compared using the Mann-Whitney U test.Results:Among 302 patients, 24 (8.0%) were colonized with ESBL-PE on ICU admission. Infections with ESBL-PE occurred in 4 patients, of whom 3 (75%) were identified as ESBL-PE colonized on admission. ESBL-PE colonization on admission was associated with subsequent ESBL-PE infection (hazard ratio [HR], 25.52; 95% confidence interval [CI], 2.40–271.41; P = .007) and exposure to carbapenems (HR, 2.42; 95% CI, 1.01–5.79; P = .047), whereas duration of carbapenem exposure did not differ in relation to ESBL-PE colonization (median, 7 days [IQR, 3–8 days] vs median, 6 days [IQR 3–9 days]; P = 0.983). Patients colonized with ESBL-PE were not at increased risk for death overall (HR, 1.00; 95% CI, 0.44–2.30; P = .993) or death attributable to infection (HR, 1.20; 95% CI, 0.28–5.11; P = .808).Conclusions:Screening strategies for detection of ESBL-PE colonization on ICU admission may allow the identification of patients at highest risk for ESBL-PE infection and the correct allocation of empiric carbapenem treatment.

Download Full-text