scholarly journals The prevalence, implications, and clinical course of pregnancy-related pelvic girdle pain

2021 ◽  
Author(s):  
Stefan Malmqvist
Keyword(s):  
Risk Factors ◽  
Sick Leave ◽  
Pelvic Pain ◽  
Oswestry Disability Index ◽  
Daily Living ◽  
Clinical Course ◽  
University Hospital ◽  
Pelvic Girdle Pain ◽  
Inclusion Criteria ◽  
Prospective Longitudinal

Pelvic girdle pain (PGP) during pregnancy is common and, indeed, has always been considered normal. It is commonly associated with moderate to severe pain that impairs everyday activities such as getting up from a chair, bending, walking, working in the home and caring for children, as well as, of course, paid employment. Also, PGP is a frequent cause of sick leave during pregnancy. The aetiology of PGP is poorly understood and there is no official nomenclature, no effective evidence- based preventive measures or treatment, known risk factors or detailed knowledge of the clinical course of the various subgroups of this condition. Objectives The objectives for this project were to determine the prevalence of PGP during pregnancy in a random population of women, detect factors associated with the development of this condition, explore what influences taking sick leave due to PGP, and examine whether pregnant women with PGP, who have been sub-grouped on the basis of two clinical tests, differ with regards to demographic characteristics and/or the clinical course of PGP during the second half of their pregnancy. Methods The thesis consists of three papers, based on two separate data collections at Stavanger University Hospital. Paper I and II originate from a retrospective cohort study conducted in 2009, in which women giving birth at Stavanger University hospital in a 4-month period were asked to fill in a questionnaire on demographic features, pain, disability, PGP, pain-related activities of daily living, sick leave in general and for PGP, frequency of exercising before and during pregnancy, and Oswestry Disability Index. Inclusion criteria were singleton pregnancy of at least 36 weeks and competence in the Norwegian language. Drawings of the pelvic and low back area were used for the localization of pain. PGP intensity was then rated retrospectively on a numerical rating scale. Non-parametric tests, multinomial logistic regression and sequential linear regression analysis were used in the statistical analysis. Paper III originate from a prospective longitudinal cohort study carried out in 2010. Inclusion criteria were the as for the retrospective data collection and took place at the second-trimester routine ultrasound examination. All eligible women (n=503) filled in questionnaires and answered a weekly SMS question during pregnancy until delivery. Women with pain in the pelvic area underwent a clinical examination following a test procedure recommended in the European guidelines for the diagnosis and treatment of PGP. Results Paper I report that nearly 50% of the women experienced moderate and severe PGP during pregnancy. Approximately half of them had PGP syndrome, whereas the other half experienced lumbopelvic pain. Ten percent of the women experienced moderate and severe LBP alone. These pain syndromes increased sick leave and impaired general level of function during pregnancy. Approximately 50% of women with PGP had pain in the area of the symphysis pubis. The analysis of risk factors did not present a unidirectional and clear picture. In Paper II PGP is reported to be a frequent and major cause of sick leave during pregnancy among Norwegian women, which is also reflected in activities of daily living as measured with scores on all Oswestry disability index items. In the multivariate analysis of factors related to sick leave and PGP were work satisfaction, problems with lifting and sleeping, and pain intensity risk factors for sick leave. Also, women with longer education, higher work satisfaction and fewer problems with sitting, walking, and standing, were less likely to take sick leave in pregnancy, despite the same pain intensity as women being on sick leave. In Paper III, 42% (212/503) reported pain in the lumbopelvic region and 39% (196/503) fulfilled the criteria for a probable PGP diagnosis. 27% (137/503) reported both the posterior pelvic pain provocation (P4) and the active straight leg raise (ASLR) tests positive at baseline in week 18, revealing 7.55 (95% CI 5.54 to 10.29) times higher mean number of days with bothersome pelvic pain compared with women with both tests negative. They presented the highest scores for workload, depressed mood, pain level, body mass index, Oswestry Disability Index and the number of previous pregnancies. Exercising regularly before and during pregnancy was more common in women with negative tests. Conclusions Pelvic pain in pregnancy is a health care challenge in which moderate and severe pain develops rather early and has important implications for society. The observed associations between possible causative factors and moderate and severe LBP and PGP in the analysis of the retrospective data may, together with results from other studies, bring some valuable insights into their multifactorial influences and provide background information for future studies. Some pregnant women with PGP show a higher pain tolerance, most likely dependant on education, associated with work situation and/or work posture, which decreases sick leave. These issues are recommended to be further examined in a prospective longitudinal study since they may have important implications for sick leave frequency during pregnancy. If both P4 and ASLR tests were positive mid-pregnancy, a persistent bothersome pelvic pain of more than 5 days per week throughout the remainder of pregnancy could be predicted. Increased individual control over work situation and an active lifestyle, including regular exercise before and during pregnancy, may serve as a PGP prophylactic.

scholarly journals Can a bothersome course of pelvic pain from mid-pregnancy to birth be predicted? A Norwegian prospective longitudinal SMS-Track study

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e021378 ◽  
Author(s):  
Stefan Malmqvist ◽  
Inger Kjaermann ◽  
Knut Andersen ◽  
Anne Marie Gausel ◽  
Inger Økland ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Outcome Measures ◽  
Pelvic Pain ◽  
Demographic Data ◽  
Test Procedure ◽  
University Hospital ◽  
Pelvic Girdle Pain ◽  
Secondary Outcome ◽  
Pain Provocation ◽  
Prospective Longitudinal

ObjectiveTo explore if pregnant women with pelvic girdle pain (PGP), subgrouped following the results from two clinical tests with high validity and reliability, differ in demographic characteristics and weekly amount of days with bothersome symptoms through the second half of pregnancy.DesignA prospective longitudinal cohort study.ParticipantsPregnant women with pelvic and lumbopelvic pain due for their second-trimester routine ultrasound examination.SettingObstetric outpatient clinic at Stavanger University Hospital, Norway.MethodsWomen reporting pelvic and lumbopelvic pain completed a questionnaire on demographic and clinical features. They were clinically examined following a test procedure recommended in the European guidelines for the diagnosis and treatment of PGP. Women without pain symptoms completed a questionnaire on demographic data. All women were followed weekly through an SMS-Track survey until delivery.Primary and secondary outcome measuresThe outcome measures were the results from clinical diagnostic tests for PGP and the number of days per week with bothersome pelvic pain.Results503 women participated. 42% (212/503) reported pain in the lumbopelvic region and 39% (196/503) fulfilled the criteria for a probable PGP diagnosis. 27% (137/503) reported both the posterior pelvic pain provocation (P4) and the active straight leg raise (ASLR) tests positive at baseline in week 18, revealing 7.55 (95% CI 5.54 to 10.29) times higher mean number of days with bothersome pelvic pain compared with women with both tests negative. They presented the highest scores for workload, depressed mood, pain level, body mass index, Oswestry Disability Index and the number of previous pregnancies. Exercising regularly before and during pregnancy was more common in women with negative tests.ConclusionIf both P4 and ASLR tests were positive mid-pregnancy, a persistent bothersome pelvic pain of more than 5 days per week throughout the remainder of pregnancy could be predicted. Increased individual control over work situation and an active lifestyle, including regular exercise before and during pregnancy, may serve as a PGP prophylactic.

scholarly journals How Prevalent Are Symptoms and Risk Factors of Pelvic Inflammatory Disease in a Sexually Conservative Population.

2020 ◽  
Author(s):  
Oqba Al-Kuran ◽  
Al-Mehaisen Lama ◽  
Alduraidi Hamza ◽  
Naser Alhusban ◽  
Balqees Attarakih ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pelvic Inflammatory Disease ◽  
Symptom Score ◽  
Pelvic Pain ◽  
Inflammatory Disease ◽  
Chronic Pelvic Pain ◽  
University Hospital ◽  
Medical Procedure ◽  
Adult Women ◽  
Jordanian Population

Abstract Background: Pelvic Inflammatory Disease (PID) is the inflammation of the adnexa of the uterus, that mainly manifests in a subclinical/chronic context and goes largely underreported. However, it poses a major threat to women’s health, as it is responsible for infertility and ectopic pregnancies, as well as chronic pelvic pain. Previous studies in Jordan have not reported PID, attributed mainly to the social structure of the country which largely represent a sexually conservative population. Our study aims to report the clinical symptoms that point towards PID and investigate the major risk determinants in a Jordanian population, in a cross-sectional study. Methods: One hundred sixty-eight consecutive adult women that came in the Outpatient Clinics of Gynaecological Department of the Jordan University Hospital were interviewed and their medical history and symptoms were registered and analysed. A Score for PID symptoms, we developed, was given to each woman. Results and correlations were then statistically tested.Results: Our study population consisted of relatively young women (37.7±11) that had their first child at an average age of 24.1 (±4.8) and a mean parity of 3.1 (±2.2). Fifty-eight women (34.5%) reported having undergone at least one CS, while the mean PID Symptom Score was 3.3 (±2.3). The women in our study exhibited 8 symptoms of PID, namely dysmenorrhea and vaginal discharge; being the commonest (45.2% and 44.6% respectively), in addition to chronic pelvic pain, pelvic heaviness, , menorrhagia, dyspareunia, , urinary symptoms, and smelly urine, and reported history of 3 conditions that can be attributed to PID, that is infertility, preterm labour, and miscarriages.Conclusions: Our PID Scoring System seems to identify the risk factors of PID and predict well the PID likelihood. This score predicts that women with higher parity, who used contraceptives and underwent any invasive medical procedure are expected to score higher in the PID Symptom Score. Our data also suggest that PID should not be ruled out in the Jordanian population when symptoms are compatible to this diagnosis.

scholarly journals 175. There Was a Fungus Among Us: A Cohort of Fungal Infectious Endocarditis Cases in East Tennessee

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S110-S111
Author(s):  
Morgan K Morelli ◽  
William Lorson ◽  
Mahmoud Shorman
Keyword(s):  
Risk Factors ◽  
Fungal Pathogen ◽  
Heart Valves ◽  
University Hospital ◽  
Prosthetic Heart Valves ◽  
Inclusion Criteria ◽  
Persons Who Inject Drugs ◽  
East Tennessee ◽  
High Index Of Suspicion ◽  
Healthcare Associated

Abstract Background Fungal infective endocarditis (IE) represents less than 2% of all IE cases, but it carries a mortality rate as high as 50%. While cases of IE are on the rise in recent years due to the increased prevalence of persons who inject drugs (PWID), there are few published studies of fungus as the cause. Candida species is the most likely fungal pathogen in IE. Known risk factors include prosthetic heart valves, healthcare-associated infections, and injection drug use. Since fungi are a rare culprit in endocarditis, there is little information on incidence, treatment recommendations, and outcomes. Methods A retrospective cohort of patients with Candida IE was analyzed between October 2013 and September 2018 at a university hospital in East Tennessee. Demographic, microbiologic, substance use status, mortality, and echocardiographic data were collected. Results Nine patients with Candida IE met inclusion criteria. Mean age was 37, 67% were males. Risk factors included PWID, oral opioid abuse, previous valve surgery and autoimmune disease. 5 (55%) were caused by Candida albicans, 3 (33.3%) Candida paraipsalosis, and 1 (11%) grew both Candida tropicalis and albicans. Valves involved: 4 (66.7%) native tricuspid, 2 (22%) native aortic. 2 (22%) had native mitral, 1 (11%) had both tricuspid and mitral valve involvement. Echinocandins were used in 5 (55%) and 2 (22%) underwent surgery. There was 1 (11%) in-hospital mortality and 2 (22%) within 1 year of discharge (Table 1). Conclusion Fungal IE is a rare disease with high mortality and increasing incidence, especially in PWID. High index of suspicion is required for early diagnosis. Treatment is traditionally a combination of surgery and antifungal therapy. Although, medical treatment alone can be successful in patients who are not surgical candidates, such as in PWID. Disclosures All authors: No reported disclosures.

scholarly journals Dynamics in Anemia Development and Dysregulation of Iron Homeostasis in Hospitalized Patients with COVID-19

Metabolites ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 653
Author(s):  
Lukas Lanser ◽  
Francesco Robert Burkert ◽  
Rosa Bellmann-Weiler ◽  
Andrea Schroll ◽  
Sophie Wildner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Iron Homeostasis ◽  
Clinical Course ◽  
Severe Disease ◽  
University Hospital ◽  
Hospital Death ◽  
Icu Admission ◽  
Increased Risk ◽  
Discharge From Hospital ◽  
New Onset

Anemia and disturbances of iron metabolism are frequently encountered in patients with COVID-19 and associated with an adverse clinical course. We retrospectively analyzed 645 consecutive COVID-19 patients hospitalized at the Innsbruck University Hospital. Pre-existing anemia was associated with increased risk for in-hospital death. We further found that the decline in hemoglobin levels during hospital stay is more pronounced in patients with signs of hyperinflammation upon admission, the latter being associated with a nearly two-fold higher risk for new onset anemia within one week. Anemia prevalence increased from 44.3% upon admission to 87.8% in patients who were still hospitalized after two weeks. A more distinct decrease in hemoglobin levels was observed in subjects with severe disease, and new-onset anemia was associated with a higher risk for ICU admission. Transferrin levels decreased within the first week of hospitalization in all patients, however, a continuous decline was observed in subjects who died. Hemoglobin, ferritin, and transferrin levels normalized in a median of 122 days after discharge from hospital. This study uncovers pre-existing anemia as well as low transferrin concentrations as risk factors for mortality in hospitalized COVID-19 patients, whereas new-onset anemia during hospitalization is a risk factor for ICU admission. Anemia and iron disturbances are mainly driven by COVID-19 associated inflammation, and cure from infection results in resolution of anemia and normalization of dysregulated iron homeostasis.

scholarly journals Epidemiology, Risk Factors and Clinical Course of SARS-CoV-2 Infected Patients in a Swiss University Hospital: An Observational Retrospective Study

2020 ◽  
Author(s):  
Jean Regina ◽  
Matthaios Papadimitriou-Olivgeris ◽  
Raphaël Burger ◽  
Paraskevas Filippidis ◽  
Jonathan Tschopp ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Clinical Course ◽  
University Hospital

scholarly journals FEATURES OF CLINICAL COURSE AND TREATMENT STRATEGY FOR PATIENTS SUFFERING FROM BRONCHIAL ASTHMA IN COMBINATION WITH OBESITY

2017 ◽  
Vol 14 (4-5) ◽  
pp. 46-52
Author(s):  
E F Glushkova ◽  
N V Shartanova
Keyword(s):  
Risk Factors ◽  
Statistical Analysis ◽  
Respiratory Tract ◽  
Bronchial Asthma ◽  
Clinical Course ◽  
Control Group ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Lack Of Control ◽  
Prevalence Of Obesity

Background. Obesity is considered to be one of the risk factors for the development of bronchial asthma (BA) and the reasons for lack of control can probably influence on inflammation of respiratory tract. However, the nature of these relationships needs to be clarified. The aim of the research was to characterise it clinically, functionally, allergologically and endocrinologically, to highlight the features of the course and to define the tactics of treating patients suffering from bronchial asthma in combination with obesity. Methods. The research was made on the basis of the National Research Center - Institute of Immunology of Federal Medical-Biological Agency of Russia: both in outpatient and inpatient conditions. A statistical analysis of 367 patients treated in inpatient conditions due to exacerbation of asthma of various severity and different BMI was performed. 40 patients with BA who satisfied all inclusion criteria and did not have exclusion criteria were treated in outpatient conditions. Patients were divided into two groups. The main group consisted of 20 patients suffering from asthma and having a BMI of more than 30 kg/m2. A control group consisted of 20 patients suffering from asthma and having a normal BMI. Results. When the data of the research was analyzed, it was found that the prevalence of obesity among the 367 patients with asthma and being treated in inpatient conditions in 2013-2015 was 44,9% of patients, which is comparable to the prevalence of obesity among the population in general. Conclusions. The data of the patients suffering from asthma and obesity treated both in inpatient and outpatient conditions, was analyzed and it is set that obesity does not affect the severity of the clinical course of asthma. It is shown that obesity does not affect the control of symptoms of asthma.

scholarly journals Prognostic factors of intraoperative awakening

2021 ◽  
Vol 13 (1) ◽  
pp. 62-67
Author(s):  
Mg. Yacnira L Martínez-Bazán ◽  
Dr. Alberto Rodríguez- Carballo ◽  
Yurisnel Ortiz- Sánchez ◽  
Est. Sandra Blanco- Martínez ◽  
Mg. Bernardo Blanco- Zamora
Keyword(s):  
Risk Factors ◽  
General Anesthesia ◽  
Elective Surgery ◽  
Inclusion Criteria ◽  
Physical Status ◽  
Surgical Risk ◽  
Provincial Hospital ◽  
Relative Risks ◽  
Prospective Longitudinal ◽  
Prospective Longitudinal Cohort

A prospective longitudinal cohort study was carried out in patients announced for major elective surgery, with orotracheal general anesthesia, at the “Carlos Manuel de Céspedes de Bayamo Provincial Hospital, from the Cauto region during the period from January 1, 2016 until December 31, 2018; with the objective of identifying the risk factors hypothetically related to the prognosis of intraoperative awakening. The exposed cohort consisted of two patients who experienced intraoperative awakening in the study period, and met the inclusion criteria. The magnitude of the associations was estimated by calculating the relative risks (RR). Age equal to or greater than 65 years, difficult intubation, patients with ASA III and IV physical status, and chronic alcohol ingestion, were the surgical risk factors depending on the patient, associated with the prognosis of awakening. Intraoperative in patients announced for major elective surgery, under general orotracheal anesthesia, although not significantly; while the female sex did not present an association. The time of surgery equal to or greater than four hours, was constituted in the surgical risk factor depending on the surgery, related to the prognosis of appearance of intraoperative awakening in patients announced for major elective surgery, with orotracheal general anesthesia.

scholarly journals Epidemiology, risk factors and clinical course of SARS-CoV-2 infected patients in a Swiss university hospital: an observational retrospective study

2020 ◽  
Author(s):  
Jean Regina ◽  
Matthaios Papadimitriou-Olivgeris ◽  
Raphael Burger ◽  
Paraskevas Filippidis ◽  
Jonathan Tschopp ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Clinical Course ◽  
Severe Disease ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Global Pandemic ◽  
The Usa ◽  
Multivariable Regression ◽  
Qsofa Score

Background Coronavirus disease 2019 (COVID-19) is now a global pandemic with Europe and the USA at its epicenter. Little is known about risk factors for progression to severe disease in Europe. This study aims to describe the epidemiology of COVID-19 patients in a Swiss university hospital. Methods This retrospective observational study included all adult patients hospitalized with a laboratory confirmed SARS-CoV-2 infection from March 1 to March 25, 2020. We extracted data from electronic health records. The primary outcome was the need to mechanical ventilation at day 14. We used multivariate logistic regression to identify risk factors for mechanical ventilation. Follow-up was of at least 14 days. Results 200 patients were included, of whom 37 (18.5%) needed mechanical ventilation at 14 days. The median time from symptoms onset to mechanical ventilation was 9.5 days (IQR 7.00, 12.75). Multivariable regression showed increased odds of mechanical ventilation in males (3.26, 1.21-9.8; p=0.025), in patients who presented with a qSOFA score ≥2 (6.02, 2.09-18.82; p=0.001), with bilateral infiltrate (5.75, 1.91-21.06; p=0.004) or with a CRP of 40 mg/l or greater (4.73, 1.51-18.58; p=0.013). Conclusions This study gives some insight in the epidemiology and clinical course of patients admitted in a European tertiary hospital with SARS-CoV-2 infection. Male sex, high qSOFA score, CRP of 40 mg/l or greater and a bilateral radiological infiltrate could help clinicians identify patients at high risk for mechanical ventilation.

scholarly journals Epidemiology, risk factors and clinical course of SARS-CoV-2 infected patients in a Swiss university hospital: An observational retrospective study

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0240781 ◽  
Author(s):  
Jean Regina ◽  
Matthaios Papadimitriou-Olivgeris ◽  
Raphaël Burger ◽  
Marie-Annick Le Pogam ◽  
Tapio Niemi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Clinical Course ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Infection Age ◽  
Multivariable Regression ◽  
Male Sex ◽  
Qsofa Score

Background This study aims to describe the epidemiology of COVID-19 patients in a Swiss university hospital. Methods This retrospective observational study included all adult patients hospitalized with a laboratory confirmed SARS-CoV-2 infection from March 1 to March 25, 2020. We extracted data from electronic health records. The primary outcome was the need to mechanical ventilation at day 14. We used multivariate logistic regression to identify risk factors for mechanical ventilation. Follow-up was of at least 14 days. Results 145 patients were included in the multivariate model, of whom 36 (24.8%) needed mechanical ventilation at 14 days. The median time from symptoms onset to mechanical ventilation was 9·5 days (IQR 7.00, 12.75). Multivariable regression showed increased odds of mechanical ventilation with age (OR 1.09 per year, 95% CI 1.03–1.16, p = 0.002), in males (OR 6.99, 95% CI 1.68–29.03, p = 0.007), in patients who presented with a qSOFA score ≥2 (OR 7.24, 95% CI 1.64–32.03, p = 0.009), with bilateral infiltrate (OR 18.92, 3.94–98.23, p<0.001) or with a CRP of 40 mg/l or greater (OR 5.44, 1.18–25.25; p = 0.030) on admission. Patients with more than seven days of symptoms on admission had decreased odds of mechanical ventilation (0.087, 95% CI 0.02–0.38, p = 0.001). Conclusions This study gives some insight in the epidemiology and clinical course of patients admitted in a European tertiary hospital with SARS-CoV-2 infection. Age, male sex, high qSOFA score, CRP of 40 mg/l or greater and a bilateral radiological infiltrate could help clinicians identify patients at high risk for mechanical ventilation.

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