scholarly journals Cerebroplacental Ratio on Doppler as a Predictor of Fetuses at Risk of Perinatal Complications

2021 ◽  
pp. 120-131
Author(s):  
Salwa Abdelmaged Elraey ◽  
Mohammed Mohsen Elnamoury ◽  
Ahmed Mohammed Othman ◽  
Ahmed Mahmoud Awara
Keyword(s):  
At Risk ◽  
Neonatal Sepsis ◽  
Neonatal Death ◽  
Perinatal Complications ◽  
Ratio Measurement ◽  
Neonatal Complication ◽  
Cerebroplacental Ratio ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean

Background: Doppler velocimetry is the best method of surveillance for fetal hypoxemia during pregnancy. Cerebroplacental ratio (CPR), has been suggested as a useful clinical simplification. It is believed that the CPR better predicts adverse perinatal outcomes than its individual components and better than conventional anthropometric models. Therefore, the aim of this study is to evaluate the significance of the cerebroplacental 10th centile threshold measured weekly from 36 weeks of gestation till delivery as a screening test for prediction of need for Cesarean section for intrapartum fetal compromise and the adverse neonatal outcome in women with normally grown fetuses and uncomplicated pregnancy. Methods: This study was carried out on 40 pregnant women uncomplicated, singleton pregnancy with appropriately grown fetuses on clinical assessment. The last Doppler indices including cerebroplacental ratio measurement obtained before labor was reported. CPR values below 1.1 were reported as abnormal. Various studies have variably defined the threshold of abnormal CPR ratio as <1.08. Results: There was significant decrease in the Mean of CPR among patients who had anemia compared to those without anemia. In addition, there was no significant association seen between low CPR and having previous history of abortion or IUGR as well as being a smoker. There was no significant difference between cases who had normal and abnormal CPR regarding gestational age at delivery. There was no difference between cases who had normal and abnormal cerebroplacental ratio regarding mode of delivery. there was significant decrease in the prevalence of low birth weight among group who had CPR≥1.08. CPR <1.08 was significantly associated with neonatal complication like NICU admission, and neonatal death. There was no statistically significant relationship between cerebroplacental ratio and neonatal complication like IUFD, and neonatal sepsis. There was no statistically significant association between the mean cerebroplacental ratio and IUFD. There was statistically significant association between the mean cerebroplacental ratio and NICU. There was no statistically significant association between the mean cerebroplacental ratio and neonatal sepsis. The mean cerebroplacental ratio of 0.93± 0.22 has a significant association with neonatal death. Conclusion: A low cerebroplacental ratio reflects redistribution of the cardiac output to the cerebral circulation and has been shown to improve accuracy in predicting adverse outcome compared with Middle cerebral artery (MCA) or Umbilical artery (UA) Doppler alone. Therefore, integrating CPR in clinical management may help to better identify fetuses at risk for adverse perinatal events, since abnormal CPR has been associated with an increased risk of perinatal complications.

scholarly journals A defined grey zone with in fetal growth curves for predicting adverse neonatal morbidity in fetuses being small for their gestational age at term in uncomplicated pregnancies

2019 ◽  
Author(s):  
Mefkure Eraslan Sahin ◽  
Ilknur Col Madendag ◽  
Erdem Sahin ◽  
Yusuf Madendag ◽  
Fatma Ozdemir ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Birth Weight ◽  
Gestational Age ◽  
Apgar Score ◽  
Neonatal Sepsis ◽  
Neonatal Death ◽  
Neonatal Morbidity ◽  
Grey Zone ◽  
Increased Risk ◽  
Significant Difference

Abstract Background: “Small for gestational age” (SGA) is a term used to define an important risk factor for both neonatal morbidity and mortality. Our hypothesis suggests that adverse neonatal morbidity (ANM) in fetuses can occur when the birth weight is closer to 10th percentile. For example, although a fetus with a birth weight within the 11th or 12th percentile is appropriate for gestational age (AGA), it is difficult to clearly distinguish these fetuses from SGA fetuses for ANM; therefore we suggest defining a transition zone, or “grey zone”, for ANM. The aim of the present study was to examine ANM frequency in fetuses using this newly defined grey-zone percentile. Methods: This retrospective analysis comprised 7,817 pregnant women with uncomplicated pregnancies and single deliveries between 37 0/7 and 41 6/7 gestational weeks. The babies were divided into groups according to birth weight percentiles as follows: (1) SGA, (2) 10–20 percentile, and 21–90 percentile. The primary outcome was ANM, defined as any of the following: Apgar score <4 at 5 min; respiratory distress; mechanical ventilation; intraventricular hemorrhage, grade III or IV; necrotizing enterocolitis, stage 2 or 3; neonatal sepsis, stillbirth or neonatal death. Results: Demographic and obstetric characteristics of the mothers were similar among the groups. ANM rates were 10.7% in the SGA group, 6.8% in the 10–20 percentile group, and 2.1% in the 21–90 percentile group, a significant difference. ANM was 5-fold higher in the SGA group and 3.2-fold higher in the 10–20 percentile group than in the 21–90 percentile group. Delivery induction or augmentation, cesarean delivery for non-reassuring fetal heart rate or fetal distress, apgar score <4 at 5 min, mechanical ventilation, neonatal sepsis, stillbirth, or neonatal death significantly increased in the 10–20 percentile group compared with those in the 21–90 percentile group. Conclusion: In uncomplicated pregnancies, ANM for SGA fetuses born at term are significantly worse than that for AGA fetuses. Fetuses with a birth weight within the 10–20 percentile (grey zone) had a significant increased risk of ANM than those within the 21–90 percentile.

scholarly journals Association between Nutritional Status Determined By Mini Nutritional Assessment and Serum Marker Levels in Older Adults at Eldercare Facilities

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Angel G Hilerio Lopez
Keyword(s):  
Older Adults ◽  
At Risk ◽  
Nutritional Status ◽  
Nutritional Assessment ◽  
Mini Nutritional Assessment ◽  
Serum Marker ◽  
Cross Sectional ◽  
Mean Values ◽  
Significant Difference ◽  
The Mean

Malnutrition in the older adult is an ongoing situation in Mexico and is most apparent in individuals that reside in hospitals, nursing homes, and retirement homes. For that reason, it is necessary to evaluate the nutritional status of these adults by means of the Mini Nutritional Assessment (MNA) and levels of three serum indicators that are commonly ordered when making malnutrition diagnosis. An analytical cross-sectional study was carried out on 100 older adults residing in eldercare facilities. Nutritional status was evaluated by means of the MNA and three serum indicators (albumin, ferritin, and hemoglobin). Descriptive statistics were used to analyze sociodemographic characteristics, and a Student’s t test, based on gender and reference values, was used to compare mean values of the three serum indicators.  A Chi-square test was used to compare proportions in individuals, based on gender, who had normal nutritional status or were malnourished, and who were at-risk of malnutrition.  A One-way ANOVA with Scheffé post hoc test was used to identify the association between serum indicators and nutritional status of older adults. Of the 100 older adults studied, 53% were men and 47% were women. The mean age was 85±0.7 years. According to the MNA, 20% had normal nutritional status, 55% were at-risk of malnutrition, and 25% were malnourished. The mean indicator values were: albumin 4.7±0.04 g/dL, ferritin 74.2±8.7 ng/mL, and hemoglobin 13.0±0.1 g/dL. No significant association was found between serum indicators and each MNA classification; however, when the same indicators were compared between the sexes, hemoglobin showed a significant difference (P=0.037). Women had lower values but those values did not extend beyond the established physiological range for this population. There was a 55% prevalence of risk of malnutrition in the nutritional status of older adults living in Mexican eldercare facilities in a Mexican province and it was even more frequent in women. 

scholarly journals Musculoskeletal Screening Tests and Bony Hip Morphology Cannot Identify Male Professional Soccer Players at Risk of Groin Injuries: A 2-Year Prospective Cohort Study

2018 ◽  
Vol 46 (6) ◽  
pp. 1294-1305 ◽  
Author(s):  
Andrea B. Mosler ◽  
Adam Weir ◽  
Andreas Serner ◽  
Rintje Agricola ◽  
Cristiano Eirale ◽  
...  
Keyword(s):  
At Risk ◽  
Groin Pain ◽  
Soccer Players ◽  
Screening Tests ◽  
Radiographic Examination ◽  
Match Play ◽  
Professional Soccer ◽  
Hip Morphology ◽  
Increased Risk ◽  
The Mean

Background: Musculoskeletal hip/groin screening tests are commonly performed to detect at-risk individuals. Bony hip morphology is considered a potential intrinsic risk factor but has not been examined prospectively. Purpose: To evaluate the association between intrinsic risk factors identified from musculoskeletal and radiographic screening tests and hip/groin injuries leading to time loss from training and/or match play in professional male soccer players. Study Design: Prospective cohort study; Level of evidence, 2. Methods: Male professional soccer players, aged ≥18 years, underwent screening specific for hip/groin pain during 2 consecutive seasons of the Qatar Stars League. The screening battery included pain provocation, range of motion, and strength tests as well as a hip radiographic examination. The radiographic examination included an anteroposterior pelvic view and 45° Dunn view, with bony hip morphology determined using quantitative methods. Time-loss (≥1 day) hip/groin injuries and individual player exposure (training and match play) were recorded prospectively, and injuries were categorized as adductor-related, inguinal-related, iliopsoas-related, pubic-related, or hip-related groin pain, or “other,” as recommended in the Doha agreement. We calculated hazard ratios (HRs) from univariate and multivariate Cox regression models to assess the relationship between potential risk factors and hip/groin injuries. Results: There were 438 players, completing 609 player seasons, and 113 hip/groin injuries that met the criteria for inclusion, with 85 injuries categorized as adductor-related. The proportion of players with bony morphological variants was the following: cam, 71%; pincer, 5%; and acetabular dysplasia, 13%. Previous hip/groin injuries (HR, 1.8; 95% CI, 1.2-2.7) and eccentric adduction strength were associated with the risk of hip/groin injuries. Higher (>1 SD above the mean) than normal eccentric adduction strength was associated with an increased risk for all hip/groin injuries (HR, 1.6; 95% CI, 1.0-2.5). Lower (<1 SD below the mean) than normal eccentric adduction strength was associated with an increased risk for adductor-related injuries (HR, 1.7; 95% CI, 1.0-3.0). No other musculoskeletal screening test or bony hip morphology variables were associated with the injury risk. Conclusion: Previous groin injuries and eccentric adduction strength were associated with the risk of groin injuries. However, these associations were not strong enough to identify an “at-risk” individual, and therefore, musculoskeletal screening tests were not useful to dictate individualized prevention strategies. Bony hip morphology was not associated with the risk of groin injuries.

Abstract 17292: Does Morbid Obesity Worsens Outcomes in COVID-19?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sohaib Roomi ◽  
Waqas Ullah ◽  
Nayab Nadeem ◽  
Rehan Saeed ◽  
Donald Haas ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Invasive Mechanical Ventilation ◽  
Multivariate Logistic Regression Analysis ◽  
Odds Ratios ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean ◽  
Mean Differences

Introduction: Given the high prevalence of obesity around the globe, patients with coronavirus disease 2019 (COVID-19) are at an increased risk of devastating complications. Hypothesis: We hypothesize that morbid obesity is independently associated with increased risk of in-hospital mortality, upgrade to intensive care unit, invasive mechanical ventilation(IVM), and acute renal failure necessitating dialysis. Methods: A retrospective cohort study was performed to determine the association of basal metabolic index (BMI) with the above-mentioned outcomes. Independent t-test and multivariate logistic regression analysis were performed to calculate mean differences and adjusted odds ratios (aOR) with its 95% confidence interval (CI), respectively. Results: A total of 176 patients with confirmed COVID-19 diagnosis were included. The mean age was 62.2 years, with 51% of male patients. The mean BMI for non-surviving patients was significantly higher compared to patients surviving on the 7th day of hospitalization (35 vs. 30 kg/m2, p=0.022) and patients with a higher BMI had higher in-hospital mortality (21% vs. 9%, OR 3.2, 95% CI 1.3-8.2, p=0.01) compared to patients with a normal BMI. Similarly, patients requiring IMV had a higher BMI (33 vs. 29, p=0.002) compared to non-intubated patients. aOR of patients needing IMV (56% vs. 28%, OR 3.3, 95% CI 1.6-7.0, p=0.002) and upgrade to ICU (46% vs. 28%, OR 2.2, 1.07-4.6, p=0.04) were significantly higher compared to patients with a lower BMI. There was no significant difference between the two groups in terms of the need for dialysis (5% vs. 13%, OR 3.8, 13% vs. 4%, 1.1-14.1, p=0.07). Adjusted odds ratios controlled for baseline comorbidities and medications mirrored the overall results, except for the need to upgrade to ICU. Conclusions: In patients with confirmed COVID-19, morbid obesity serves as an independent risk factor of high in-hospital mortality and the need for invasive mechanical ventilation.

Tear Rates of the Ipsilateral ACL Graft and the Contralateral Native ACL Are Similar following ACL Reconstruction

2020 ◽  
Author(s):  
Nadia Nastassia Ifran ◽  
Ying Ren Mok ◽  
Lingaraj Krishna
Keyword(s):  
Acl Reconstruction ◽  
Medical Records ◽  
Cruciate Ligament ◽  
Acl Graft ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean ◽  
Anterior Cruciate ◽  
Mean Time

AbstractThe aim of the study is to compare the tear rates of ipsilateral anterior cruciate ligament (ACL) grafts and the contralateral native ACL as well as to investigate the correlation of gender, age at time of surgery, and body mass index (BMI) with the occurrence of these injuries. The medical records of 751 patients who underwent ACL reconstruction surgery with follow-up periods of 2 to 7 years were retrospectively analyzed. Survival analyses of ipsilateral ACL grafts and contralateral native ACL were performed. Univariate and multivariate logistic regression analyses were performed to identify risk factors that were associated with these injuries. The tear rates of the ipsilateral ACL graft and contralateral ACL were 5.86 and 6.66%, respectively with no significant difference between groups (p = 0.998). The mean time of tears of the ipsilateral ACL and contralateral ACL was also similar (p = 0.977) at 2.64 and 2.78 years, respectively after surgery. Both the odds of sustaining an ipsilateral ACL graft and contralateral ACL tear were also significantly decreased by 0.10 (p = 0.003) and 0.14 (p = 0.000), respectively, for every 1-year increase in age at which the reconstruction was performed. However, graft type, gender, and BMI were not associated with an increased risk of these injuries. There was no difference between tear rates of ipsilateral ACL graft and contralateral ACL following ACL reconstruction. Patients who undergo ACL reconstruction at a young age are at an increased risk of both ipsilateral graft and contralateral ACL rupture after an ACL reconstruction. Patients who are young and more likely to return to competitive sports should be counselled of the risks and advised to not neglect the rehabilitation of the contralateral knee during the immediate and back to sports period of recovery. This is a Level III, retrospective cohort study.

Novel Stimuli for Obtaining Nasalance Measures from Young Children

1996 ◽  
Vol 33 (1) ◽  
pp. 67-73 ◽  
Author(s):  
Thomas Watterson ◽  
Julie Hinton ◽  
Stephen Mcfarlane
Keyword(s):  
At Risk ◽  
Statistical Analysis ◽  
Young Children ◽  
Correlation Coefficient ◽  
Communication Disorders ◽  
Velopharyngeal Insufficiency ◽  
Children At Risk ◽  
Significant Difference ◽  
History Of ◽  
The Mean

The use of novel stimuli for obtaining nasalance measures in young children was the focus of this study. The subjects were 20 children without a history of communication disorders and 20 children at risk for velopharyngeal insufficiency (VPI). Each subject recited three passages; the standard Zoo Passage, and two novel stimuli that were named the Turtle Passage and the Mouse Passage. Like the Zoo Passage, the Turtle Passage contained no normally nasal consonants. The Mouse Passage was about 11% nasal consonants, which is similar to the Rainbow Passage. Statistical analysis showed no significant difference between the mean nasalance for the Zoo Passage and the Turtle Passage for either the subjects without risk of VPI (15.4% vs 15.7%) or for those at risk (30.4% vs 28.8%). Nasalance measures for the Mouse Passage were significantly higher than for either the Zoo Passage or the Turtle Passage. Listeners rated the stimuli on a 5-point equal-appearing intervals scale. The correlation coefficient between listener judgments of hypernasality and nasalance was significant for the Zoo Passage (r = 0.70) and for the Turtle Passage (r = 0.51) but not significant for the Mouse Passage (r = 0.32). Using cut-off scores of 22% for nasalance and 2.25 for hypernasality, the sensitivity for the Zoo Passage was 0.72, and for the Turtle Passage, 0.83.

Impact of brachial plexus movement during radical radiotherapy for head and neck cancers: the case for a larger planning organ at risk volume margin

2019 ◽  
Vol 19 (2) ◽  
pp. 103-107
Author(s):  
Asma Sarwar ◽  
Shelly English ◽  
Yanni Papastavrou ◽  
Anna Thompson
Keyword(s):  
At Risk ◽  
Brachial Plexus ◽  
Head And Neck ◽  
Head And Neck Cancers ◽  
Conformity Index ◽  
High Dose ◽  
Radical Radiotherapy ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Mean

AbstractIntroduction:Treatment volumes for radical radiotherapy to head and neck cancers commonly extend into the lower neck, the territory of the brachial plexus (BP). There is a risk of radiation-induced brachial plexopathy, a non-reversible late toxicity experienced by a small number of patients. The BP was anatomically divided into superior and inferior divisions and analysed to establish if segmental inter-fractional BP movement should be considered when planning radiotherapy in this high-dose region.Methods:A retrospective single-centre analysis of 15 patients with head and neck cancers treated with radical bilateral neck irradiation was conducted. The extent of BP movement relative to the planning scan was assessed using weekly cone beam computed tomography (CBCT) scans. The BP was contoured on the planning scan and the subsequent six weekly CBCTs; this was used to calculate the Jaccard Conformity Index (JCI) for the left, right, superior and inferior divisions of the BP.Results:The mean (±SD) JCI for right and left superior BP was 44·4±15·5%, whereas the mean (±SD) JCI for right and left inferior BP was 38·3±15·5%. There was a statistically significant difference between superior and inferior JCI, p=0·0002, 95% CI (−9·26 to −2·88). Bilateral superior BP JCI was higher, with better conformity than the corresponding inferior divisions.Conclusions:Inter-fractional BP movement occurs; the greatest movement is seen at the inferior division. This data suggest the need for re-evaluation of current BP margins and consideration of a larger inferior BP planning at risk volume (PRV) margin.

scholarly journals Use of Renin-Angiotensin System Blockers Increases Serum Potassium in Anuric Hemodialysis Patients

2018 ◽  
Vol 48 (2) ◽  
pp. 79-86 ◽  
Author(s):  
Ezio Movilli ◽  
Corrado Camerini ◽  
Paola Gaggia ◽  
Roberto Zubani ◽  
Giovanni Cancarini
Keyword(s):  
Blood Pressure ◽  
Serum Potassium ◽  
Hemodialysis Patients ◽  
K Value ◽  
Interdialytic Weight Gain ◽  
Increased Risk ◽  
Dialysis Vintage ◽  
Significant Difference ◽  
Severe Hyperkalemia ◽  
The Mean

Background: Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) are increasingly used in uremic patients (pts). However, their effect on serum potassium (sK) concentrations in anuric pts on chronic hemodialysis treatment (HD) is controversial. The aim of the study was to evaluate sK before and after the start of ACEi/ARB therapy. Methods: In the period 1/1/2015 – 31/12/2015, 112 out of 240 prevalent HD pts on thrice weekly HD treatment followed at our institution started the ACEi/ARB therapy. The mean age was 67 ± 14 years, 67/112 were men, dialysis vintage was 6–212 months. In the 3 months before (PRE; N° 36 HD sessions) and after (POST; N° 36 HD sessions) the start of ACEi/ARB therapy, the following variables were evaluated in pre dialysis after the long interdialysis interval: sK (mean of 12 determinations; mmol/L), maximum sK (maximum K value observed during observations; sKmax; mmol/L), serum sodium (sNa; mmol/L), pre dialysis systolic blood pressure (SBP; mm Hg) and diastolic blood pressure (DBP; mm Hg), body weight (BW; Kg), interdialytic weight gain (IWG; Kg), Kt/V, serum bicarbonate concentrations (sBic; mmol/L), protein catabolic rate (PCRn; g/KgBW/day). SBP, DBP, IWG are the mean of the 24 HD sessions. Out of 112 patients, 102 were on antihypertensive therapy. The duration of HD and blood and dialysate flow rates were kept constant. Data are expressed as mean ± SD. Student t test for paired and unpaired data for normally distributed variables, Mann-Whitney test for medians, χ2 test for categorical data were employed to compare groups. A significant difference was defined as p < 0.05. Results: sK increased from 5.0 ± 0.4 mmol/L PRE to 5.7 ± 0.5 mmol/L POST (p < 0.0001). sKmax increased from 5.3 ± 0.5 mmol/L PRE to 6.2 ± 0.6 mmol/L POST (p < 0.0001). The percentage of pts with normal sK concentrations decreased from 82% PRE to 29% POST (p < 0.0001). Mild hyperkalemia increased from 18 to 52% (p < 0.001); in 31% of the patients, it was necessary to reduce the K dialysate concentration. None of the patients had severe hyperkalemia PRE, but 19% developed severe hyperkalemia POST (p < 0.0001) necessitating treatment withdrawal. Mean sK in these pts varied from 5.2 ± 0.3 mmol/L PRE to 6.5 ± 0.2 mmol/L at the moment of withdrawal (p < 0.0001) and sKmax from 5.5 ± mmol/L PRE to 6.9 ± 0.3 mmol/L (p< 0.0001). After withdrawal of ACEi/ARB, sK and sKmax concentrations decreased to basal levels within 1 month. There were no significant changes of BW, IWG, SBP, DBP, Na, Hb, Kt/V, sBic, and PCRn in both periods. Conclusions: ACEi/ARB therapy is associated with an increased risk of hyperkalemia in anuric hemodialysis patients. The proportion of patients with normal sK concentrations decreased from 82 to 29% and with mild hyperkalemia increased from 18 to 52%. Severe hyperkalemia necessitating the interruption of ACEi/ARB therapy developed in 19% of patients. This suggests great caution in the widest utilization of this class of drugs in HD patients.

Comparative effects of suture and non-suture surgical techniques on platysma after Thyroid surgery

2021 ◽  
Vol 15 (7) ◽  
pp. 1661-1664
Author(s):  
Hafiz Ali Wasay ◽  
Muhammad Aamir Jameel ◽  
Muhammad Imran Anwar ◽  
HaroonJavaid Majid ◽  
Sameen Tahir
Keyword(s):  
Randomized Controlled Trial ◽  
Thyroid Surgery ◽  
Controlled Trial ◽  
Surgical Techniques ◽  
Platysma Muscle ◽  
Randomized Controlled ◽  
Post Operative Pain ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean

Background: Thyroidectomy is a routine general surgical procedure and pain after thyroidectomy is responsible for prolongation of hospital stay and increased risk of respiratory complications. Platysma is routinely sutured at the end of thyroidectomy before wound closure. This randomized controlled trial was conducted to compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Aim: To compare the outcome of suturing platysma muscle versus not suturing in thyroid surgery patients. Place and duration of study: Dept. of Surgery at Sh. Zayed Hospital, Lahore from 26-12-2019 to 25-06-2020. Methodology: It is a randomized controlled trial study which consists of 92 patients, between 18 to 70 years of age in both gender and planned for thyroidectomy for nodular thyroid enlargement. Patients were randomly allocated into two treatment groups. After excision of thyroid, platysma was sutured as per conventional practice in one group while in the other group platysma was not sutured. For pain assessment Visual Analogue Scale (VAS) was used to 24 hours after surgery. Results: The mean age was 36.4±13.4 years. The mean VAS score for post-operative pain measured 24 hours after the surgery was significantly lower in patients undergoing thyroidectomy without platysmal suture as compared to those with conventional suturing of platysma during thyroidectomy (2.37±0.97 vs. 3.67±1.28; p <0.001). Similar significant difference was also noted between groups and subgroups which based on patient’s age, gender, BMI and educational status. Conclusion: Avoiding the suturing of platysma significantly reduced the post-operative pain which advocates a change in current practice and encourages non-suturing of platysma to decrease the morbidity of patients in post-operative period. Keywords: Thyroidectomy, Platysma, Suture, No Suture, Pain

scholarly journals Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death

2009 ◽  
Vol 160 (6) ◽  
pp. 985-991 ◽  
Author(s):  
N Benhadi ◽  
W M Wiersinga ◽  
J B Reitsma ◽  
T G M Vrijkotte ◽  
G J Bonsel
Keyword(s):  
Odds Ratio ◽  
Neonatal Death ◽  
Thyroid Dysfunction ◽  
Adjusted Odds Ratio ◽  
Thyroid Peroxidase ◽  
Child Loss ◽  
Increased Risk ◽  
The Mean ◽  
The Relationship ◽  
Tsh Levels

BackgroundTo examine the relationship between maternal TSH and free thyroxine (FT4) concentrations in early pregnancy and the risk of miscarriage, fetal or neonatal death.MethodCohort study of 2497 Dutch women. TSH, FT4, and thyroid peroxidase antibodies concentrations were determined at first booking. Child loss was operationalized as miscarriage, fetal or neonatal death. Women with overt thyroid dysfunction were excluded.ResultsTwenty-seven cases of child loss were observed. The mean TSH and FT4level in the women with child loss was 1.48 mU/l and 9.82 pmol/l compared with 1.11 mU/l and 9.58 pmol/l in women without child loss. The incidence of child loss increased by 60% (OR=1.60 (95% confidence interval (CI): 1.04–2.47)) for every doubling in TSH concentration. This association remained after adjustment for smoking, age, parity, diabetes mellitus, hypertension, previous preterm deliveries, and previous preterm stillbirth/miscarriage (adjusted odds ratio=1.80 (95% CI: 1.07–3.03)). This was not true for FT4concentrations (OR=1.41 (95% CI: 0.21–9.40);P=0.724).ConclusionIn a cohort of pregnant women without overt thyroid dysfunction, the risk of child loss increased with higher levels of maternal TSH. Maternal FT4concentrations and child loss were not associated.

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