scholarly journals Epinephrine Auto-Injector Needle Length (Does Height or BMI add Valuable Information in Adults?)

2019 ◽  
Vol 7 (1) ◽  
pp. 6-19
Author(s):  
Sten Dreborg ◽  
◽  
Gina Tsai ◽  
Harold Kim
Keyword(s):  
High Pressure ◽  
High Risk ◽  
Predictive Value ◽  
Subcutaneous Injection ◽  
Obese Women ◽  
Obese Adults ◽  
Overweight Women ◽  
Increased Risk ◽  
Injection Methods ◽  
Auto Injector

Background: Some overweight and obese adults have an increased risk of subcutaneous injection using epinephrine auto injectors (EAIs). Needle lengths of EAIs vary between brands and lots. Objective: To study if BMI or height adds information to define adults at risk of having intraosseous or subcutaneous injection. Methods: Ninety-nine (99) food allergic adult patients, 32 men and 67 women, 18 – 72 years of age, prescribed EAIs were included. The skin to muscle and skin to bone distances were measured by ultrasonography. The effect of injection on naked skin or through thick clothing was analyzed. High and minimal pressure was applied to the ultrasound probe. Results: Two of three men and 1/5 women with BMI <20 had a risk of intraosseous/periosteal injection using the high pressure auto injector Epipen® , thick clothing, 5/8. Injecting through naked skin using the shortest needle, 14/17 obese women had a high risk of subcutaneous injection (overweight 14/23), through thick clothing all 17 obese women would have a risk of subcutaneous injection (overweight 20/23). Injecting with LPEAIs through naked skin, using the shortest needle 8/17 obese and 4/23 overweight women would have a risk of subcutaneous injection, wearing thick clothing, 10/17 obese and 7/23 overweight women. Height had no predictive value. Conclusion: Using high pressure EAIs, high BMI predicted a very high risk for subcutaneous injection in women and in some men. Even injection with low pressure EAIs had some risk of subcutaneous injection, especially when injected through thick clothing. Height had no predictive value. Keywords: Auto-injector; epinephrine; intramuscular; subcutaneous; intraosseous; skin to bone distance; skin to muscle distance; clothing; overweight; obese; adults; women; men.

Maternal Obesity and Risk for Birth Defects

PEDIATRICS ◽  
2003 ◽  
Vol 111 (Supplement_1) ◽  
pp. 1152-1158 ◽  
Author(s):  
Margaret L. Watkins ◽  
Sonja A. Rasmussen ◽  
Margaret A. Honein ◽  
Lorenzo D. Botto ◽  
Cynthia A. Moore
Keyword(s):  
Spina Bifida ◽  
Birth Defects ◽  
Maternal Obesity ◽  
Heart Defects ◽  
Average Weight ◽  
Maternal Body Mass Index ◽  
Healthy Weight ◽  
Obese Women ◽  
Overweight Women ◽  
Increased Risk

Objective. Several studies have shown an increased risk for neural tube defects associated with prepregnancy maternal obesity. Because few recent studies have examined the relation between maternal prepregnancy obesity and overweight and other birth defects, we explored the relation for several birth defects and compared our findings with those of previous studies. Methods. We conducted a population-based case-control study of several selected major birth defects using data from the Atlanta Birth Defects Risk Factor Surveillance Study. Mothers who delivered an infant with and without selected birth defects in a 5-county metropolitan Atlanta area between January 1993 and August 1997 were interviewed. Maternal body mass index (BMI) was calculated from self-reported maternal prepregnancy weight and height. Women with known preexisting diabetes were excluded. The risks for obese women (BMI ≥30) and overweight women (BMI 25.0–29.9) were compared with those for average-weight women (BMI 18.5–24.9). Results. Obese women were more likely than average-weight women to have an infant with spina bifida (unadjusted odds ratio [OR]: 3.5; 95% confidence interval [CI]: 1.2–10.3), omphalocele (OR: 3.3; 95% CI: 1.0–10.3), heart defects (OR: 2.0; 95% CI: 1.2–3.4), and multiple anomalies (OR: 2.0; 95% CI: 1.0–3.8). Overweight women were more likely than average-weight women to have infants with heart defects (OR: 2.0; 95% CI: 1.2–3.1) and multiple anomalies (OR: 1.9; 95% CI: 1.1–3.4). Conclusions. Our study confirmed the previously established association between spina bifida and prepregnancy maternal obesity and found an association for omphalocele, heart defects, and multiple anomalies among infants of obese women. We also found an association between heart defects and multiple anomalies and being overweight before pregnancy. A higher risk for some birth defects is yet another adverse pregnancy outcome associated with maternal obesity. Obesity prevention efforts are needed to increase the number of women who are of healthy weight before pregnancy.

scholarly journals Epinephrine auto-injector needle length

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Sten Dreborg ◽  
Gina Tsai ◽  
Harold Kim
Keyword(s):  
Drug Delivery ◽  
High Pressure ◽  
Children And Adolescents ◽  
Subcutaneous Injection ◽  
Low Pressure ◽  
Ultrasound Probe ◽  
Needle Length ◽  
Upper Limits ◽  
Auto Injector ◽  
Intramuscular Delivery

Abstract Background Epinephrine auto-injectors are expected to deliver the drug intramuscularly. Objective To study whether injection through clothing influences the frequency of subcutaneous and intraosseous/periosteal deposition of epinephrine. Methods Skin to muscle and skin to bone distances were measured for 303 children and adolescents and 99 adults. Distance was determined by ultrasound, with high or low pressure on the ultrasound probe. The risk/percentage of subcutaneous and intraosseous/periosteal injections was calculated using the lower and upper limits for the authority-approved length of EAI needles as provided by two high pressure EAI manufacturers and one low pressure EAI manufacturer. The addition winter clothing on the delivery of epinephrine was illustrated by comparing drug delivery fissue depth with no clothes. Furthermore, the riof non-intramuscular delivery for the shortest and longest approved needle length was calculated. Results When using EpipenJr® in children < 15 kg the risk of intraosseous/periostal injection was reduced from 1% and 59% for the shortest and longest approved needle length to 0 and 15% with winter clothes. The Auvi-Q® 0.1 mg had no risk of intraosseous/periosteal injection. However, the subcutaneous deposition risk increased from 94% and 28% to 100% and 99% with winter clothes. The risk of subcutaneous injection using EpipenJr® in the youngest children increased from 13% and 0% to 81% and 1% with winter clothes, and with Epipen® in adults from 45% and 17% to 60% and 38%. Emerade®, had a risk of subcutaneous injection in adults increasing from 14% and 10% to 28% and 21% adding winter clothes. Conclusion The risk of intraosseous/periosteal injections decreases and the risk of subcutaneous injection increases when injecting through winter clothes for all EAIs.

The Association Overweight Or Obesity And The Risk Of Uterine Leiomyoma: A Meta-Analysis

2021 ◽  
Vol 17 ◽  
Author(s):  
Ensiyeh Jenabi ◽  
Salman Khazaei ◽  
Soodabeh Aghababaei ◽  
Farzaneh Soltani
Keyword(s):  
Uterine Leiomyoma ◽  
English Language ◽  
Meta Analysis ◽  
Random Effect ◽  
Normal Weight ◽  
Obese Women ◽  
Overweight Women ◽  
Obesity And Overweight ◽  
Increased Risk ◽  
Language Writing

Aim: The present study is a meta-analysis to identify the relationship between BMI and uterine leiomyoma. Methods: The major international databases PubMed, Scopus, and Web of Sciences (WOS) were searched to identify eligible studies in English language writing from their inception to 30 of June 2019. The pooled Odds Ratios (OR), Relative Ratio (RR), and 95% Confidence Intervals (CI) were calculated as random effect estimates of association among studies. The findings of 10 studies showed an increased risk of uterine leiomyoma in the overweight and obese women compared to women with normal weight: RR=1.21 (95% CI: 1.12, 1.30) and OR=1.50 (95% CI: 1.29, 1.71) for overweight women and RR=1.34 (95% CI: 1.11, 1.57) and OR=1.99 (95% CI: 1.11, 2.87) for obese women. Result: Our meta-analysis suggests that obesity and overweight in women are associated with an increase in the risk of uterine leiomyoma. Conclusion: Therefore, clinical attention to uterine leiomyoma should be more performed, because leiomyoma can be a source of mortality in women.

Contraception and thrombophilia

2009 ◽  
Vol 29 (02) ◽  
pp. 193-196 ◽  
Author(s):  
H. Rott ◽  
A. Kruempel ◽  
G. Kappert ◽  
U. Nowak-Göttl ◽  
S. Halimeh
Keyword(s):  
Chronic Illness ◽  
High Risk ◽  
Children And Adolescents ◽  
Hormonal Contraception ◽  
Hormonal Contraceptives ◽  
Thromboembolic Events ◽  
Contraceptive Methods ◽  
Secondary Complications ◽  
Increased Risk ◽  
Coagulation Proteins

SummaryThe risk of thromboembolic events (TE) is increased by acquired or inherited thrombo -philias (IT). We know that some hormonal contraceptives also increase the risk of thrombosis, thus, the use of such contraceptives are discussed as contraindications in women with IT. TEs are infrequent events in children and adolescents and in the majority of cases are associated with secondary complications from underlying chronic illness. Although adolescents are not typically considered to be at high-risk for TE, this cohort is frequently using hormonal contraception, leading to an increased risk in cases with unknown IT. The risk of TE with pregnancy alone is higher than associated with combined hormonal contra -ception. Progestin-only methods have not been found to increase the risk of TE with only moderate changes of coagulation proteins compared to normal reference values. Conclusion: Thrombophilic women are good candidates for progestin-only contraceptive methods.

Markers of Hypercoagulability in Patients with Hemophilia B Given Repeated, Large Doses of Factor IX Concentrates during and after Surgery

1994 ◽  
Vol 71 (06) ◽  
pp. 737-740 ◽  
Author(s):  
E Santagostino ◽  
P M Mannucci ◽  
A Gringeri ◽  
G Tagariello ◽  
F Baudo ◽  
...  
Keyword(s):  
High Risk ◽  
Ex Vivo ◽  
Factor Ix ◽  
Hemophilia B ◽  
Coagulation System ◽  
Prolonged Treatment ◽  
Orthopedic Procedures ◽  
Factor X ◽  
Prothrombin Complex Concentrates ◽  
Increased Risk

SummaryPurer factor IX (FIX) concentrates have been produced for the treatment of hemophilia B in the attempt to reduce the risk of thrombotic complications associated with the use of prothrombin complex concentrates. To evaluate ex vivo whether or not FIX concentrates activate the coagulation system in conditions associated with a high risk for thrombosis, we measured markers of hypercoagulability in 10 patients with hemophilia B who underwent surgery, mainly orthopedic procedures, covered by multiple concentrate infusions (40-80 U/kg/day). Postinfusion plasma levels of prothrombin fragment 1+2 and factor X activation peptide did not differ significantly from the presurgical levels, neither before nor after each concentrate dose. Therefore, it appears that prolonged treatment of patients with hemophilia B undergoing high risk surgical procedures with high doses of FIX concentrate does not cause systemic activation of coagulation. This suggests that purified FIX concentrates are preferable to prothrombin complex concentrates for conditions associated with an increased risk of thrombosis.

Is Colour Doppler Ultrasound a Sensitive Screening Method in Diagnosing Deep Vein Thrombosis after Hip Surgery ?

1996 ◽  
Vol 75 (02) ◽  
pp. 242-245 ◽  
Author(s):  
Marie Magnusson ◽  
Bengt I Eriksson ◽  
Peter Kãlebo ◽  
Ramon Sivertsson
Keyword(s):  
Deep Vein Thrombosis ◽  
High Risk ◽  
Doppler Ultrasound ◽  
Predictive Value ◽  
Screening Method ◽  
Colour Doppler ◽  
Vein Thrombosis ◽  
Colour Doppler Ultrasound ◽  
Asymptomatic Patients ◽  
Deep Vein

SummaryPatients undergoing orthopedic surgery are at high risk of developing deep vein thrombosis. One hundred and thirty-eight consecutive patients undergoing total hip replacement or hip fracture surgery were included in this study. They were surveilled with colour Doppler ultrasound (CDU) and bilateral ascending contrast phlebography. The prevalence of proximal and distal DVT in this study was 5.8% and 20.3% respectively.CDU has a satisfactory sensitivity in patients with symptomatic deep vein thrombosis, especially in the proximal region. These results could not be confirmed in the present study of asymptomatic patients. The sensitivity was 62.5% (95% confidence interval: C.I. 24-91%) and the specificity 99.6% (C.I. 98-100%) for proximal DVT; 53.6% (C.I. 34-73%) and 98% (C.I. 96-99%) respectively for distal thrombi. The overall sensitivity was 58.1% (C.I. 39-75%) and the specificity 98% (C.I. 96-99%). The positive predictive value was 83.3% (C.I. 36-99%) and 75% (C.I. 51-91%) for proximal and distal DVT respectively. The negative predictive value was 98.9% (C.I. 98-100%) and 94.9% (C.I. 92-98%) for proximal and distal DVT respectively. The results of this study showed that even with a highly specialised and experienced investigator the sensitivity of CDU was too low to make it suitable for screening purposes in a high risk surgical population.

The correlation between the sociodemographic characteristics and some hormones with the infertility of women and men

10.32947/357 ◽  
2018 ◽  
Vol 18 (1) ◽  
pp. 1-10
Keyword(s):  
Soft Drink ◽  
Serum Prolactin ◽  
Age Group ◽  
Tea Consumption ◽  
Obese Women ◽  
Overweight Women ◽  
Infertile Women ◽  
Infertile Men ◽  
Overweight Group ◽  
Prolactin Hormone

Thirty three infertile women were divided into two groups according to their BMI (21 obese and 12 overweight) there age ranges between (16-41) years, with their husbands twenty one infertile men and twelve fertile men and their ages range between (23-46) years. In the present study we observed that several indicators affect the fertility such as BMI in infertile obese women which was 34.65 kg/m2. That is higher than that of overweight infertile women that recorded 24.87 kg/m2. obese housewives scored the highest percentage (85.71%) compared with the overweight group (25%), In addition the obese age group between 30-41 years scored (66.67%) compared with the overweight group whose members’ age 16-29.9 years scored 75%. However, drinking cola (soft drink) percentage in obese infertile women was (85.71%) and the tea consumption was higher in overweight group (66.67%). The hormones FSH and LH decrease in obese women but serum prolactin hormone increased twice about 29.27 ng/ml in comparison with overweight group. Testosterone hormone decreased in obese women but Leptin in obese women (19.52 μg/L) was higher than that of overweight women (11.03 μg/L). Infertile unemployed men got the highest percentage of 66.67%. Besides, the smoker infertile men were higher in percentage (80.95%) compared with fertile men 41.67%. The elevated LH, FSH and prolactin values are significantly high (p<0.01) (7.895 mlU/ml, 9.89 mlU/ml and 13.33 ng/ml) respectively, but the testosterone was significantly low (3.91 ng/dl) in comparison with fertile men(21.76ng/dl). Whileleptin significantly increased in infertile men more than the fertile ones. These changes in hormones have a great correlation with semen characteristics as the abnormalities in sperms increased to (64.52) and the percentage of rapid, progressive and non -progressive motility decreased, but the immotile motility was highly significant (65.71) in infertile men. As a result this indicates that the reason of infertility is shared between the wife and husband.

scholarly journals Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome

Molecules ◽  
2021 ◽  
Vol 26 (4) ◽  
pp. 1108
Author(s):  
Admira Bilalic ◽  
Tina Ticinovic Kurir ◽  
Marko Kumric ◽  
Josip A. Borovac ◽  
Andrija Matetic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
High Risk ◽  
Hospital Mortality ◽  
Vascular Calcification ◽  
Matrix Gla Protein ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
St Elevation

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.

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