A case of primary infertility and a patient with ventriculoperitoneal shunt.

Ventriculoperitoneal (VP) shunts are the main treatment modality for patients with hydrocephalus. The complications arising in patients with VP shunts are well documented. We present a case of infertility in a patient with a long-standing VP shunt. Her infertility is thought to be the result of pelvic adhesions due to factors related to the distal end of her VP shunt. A 22-year-old female with a 1-year history of infertility was referred due to bilateral hydrosalpinges. Diagnostic laparoscopy revealed multiple adhesions surrounding the distal end of the fallopian tubes. The distal portion of a VP shunt, which was placed over the course of her childhood, was found to be grossly inflamed and densely adherent to the pelvic viscera. VP shunts may produce abdominal adhesions and can cause mechanical infertility.

Does the presence of symptoms affect pregnancy outcomes in third trimester in women with SARS-CoV-2.

OBJECTIVE: Parturients with symptoms to COVID-19 have an increased risk for neonatal adverse outcomes and for any adverse outcome compared to the asymptomatic COVID-19 positive parturients and to the COVID-19-negative parturients. The purpose of this study was to determine the effect of COVID-19 on obstetric outcomes based on symptom status of parturients at or near term. METHODS: Retrospective cohort study of parturients diagnosed with COVID-19 between 26 March and 30 September 2020. Maternal and neonatal outcomes were assessed by comparing three groups of parturients: COVID-19 negative, asymptomatic COVID-19, and symptomatic COVID-19. RESULTS: A total of 2299 COVID-19-negative parturients and 172 patients with confirmed diagnosis of COVID-19 delivered during the study period. The median gestational age at the time of delivery was 39 (interquartile range 39-40) weeks. The most common symptom was cough (28/56, 50%). Gestational diabetes mellitus was significantly less common in COVID-19-negative than in COVID-19-positive patients. There was no significant increase in cesarean delivery in women who were COVID-19 positive and the incidence of preterm deliveries was not significantly different among the three groups. Of the 172 cases of COVID-19, only one parturient needed mechanical ventilation, and there were no maternal deaths in this group. There were no cases of severe neonatal asphyxia or neonatal death. Composite maternal adverse outcomes were not significantly different between the three groups. The aOR for composite neonatal adverse outcome and overall composite adverse outcome comparing COVID-19 positive to negative parturients was 2.1 (95% confidence interval [CI], 1.1-3.8; p = .02) and 1.6 (95% CI, 1.1-2.3; p = .02), respectively. CONCLUSIONS: An increased risk for neonatal adverse outcomes and for any adverse outcome was found in the symptomatic COVID-19 group compared to the asymptomatic COVID-19-positive parturients and to the COVID-19-negative parturients.

A novel EyePhone© App for improving adherence to glaucoma therapy.

PURPOSE: Despite advances in glaucoma treatment options, patient adherence and compliance remain very low. The EyePhone© App is a free non-commercial reminder application designed specifically for the needs of glaucoma patients. In this study, we evaluated its usefulness in improving adherence to medical treatment among glaucoma patients. METHODS: This is a prospective multicenter interventional study. Glaucoma patients were recruited from a tertiary center and a large community glaucoma service center. After a short explanation, the EyePhone© App was installed on their smartphone device, and the notifications for the current medical treatment were entered. After enrollment and at 1-month follow-up, subjects completed the Morisky Medication Adherence Scale (MMAS-8) and the Quality of Life and Glaucoma 17-item (GlauQOL-17) questionnaires for evaluation of adherence and QOL, respectively. RESULTS: In the study, 133 patients (71 men and 62 women) aged 62±15.5 years and using 2.0±0.9 IOP-lowering drugs participated. The proportion of highly adherent subjects improved from 29.3% (39/133) at baseline to 42.1% (56/133) at follow-up (P < 0.001), and the proportion of poorly adherent subjects decreased from 29.3 (39/133) to 20.3% (27/133) at follow-up (P = 0.012). QOL also improved, as evidenced by a significant increase in the GlauQOL-17 score (P < 0.05). In a subgroup of patients for whom IOP measurements were available, IOP reduced by 0.92 mmHg (P = 0.069). CONCLUSIONS: Significant improvements in glaucoma adherence and QOL were achieved among poorly adherent glaucoma patients after 1 month of using the EyePhone© App.

The Association Between Keratoconus and Body Mass Index: A Population-Based Cross-Sectional Study Among Half a Million Adolescents.

PURPOSE: To analyze the association between keratoconus and body mass index (BMI) among adolescents. DESIGN: Cross sectional study. METHODS: This was a nationwide, population-based study of candidates for military service in Israel attending the draft board in 2006 to 2014 who underwent an ophthalmologic examination. The study population included 579,946 males and females between 16 and 19.9 years of age. Subjects were divided into 4 groups based on adjusted BMI percentiles: underweight (8.3%), normal weight (73.9%), overweight (10.7%), and obese (7.1%). The odds for having keratoconus were compared with the normal weight group. The primary outcome measure was the odds ratio (OR) for the association between BMI groups and keratoconus. RESULTS: The prevalence of keratoconus in the general population was 164 cases per 100,000, increasing over time (P < .05). There was a greater prevalence of keratoconus among obese adolescents (270/100,000) than of overweight (179/100,000), normal weight (154/100,000), and underweight (141/100,000) adolescents. Compared with the normal weight group, the OR for obese adolescents was 1.50 (95% confidence interval [CI] 1.22-1.83; P < .05), the OR for overweight adolescents was 1.42 (95% CI 1.08-1.92; P < .05), and the OR for underweight adolescents was 0.84 (95% CI 0.65-1.09; P = .18) after adjustment for gender, age, height, country of origin, and socioeconomic status. CONCLUSIONS: This study provides strong evidence regarding the independent association between BMI and keratoconus. Overweight and obese adolescents have higher odds of having keratoconus compared with normal weight adolescents. BMI should be considered a risk factor for keratoconus and further research should elucidate how obesity is involved in the progress of keratoconus.

Esophageal atresia in twins compared to singletons: In utero manifestation and characteristics.

OBJECTIVE: Esophageal atresia with/without tracheo-esophageal fistula (EA/TEF) is more common among twins. The detection of polyhydramnios might be altered in twins, leading to EA/TEF underdiagnosis, prenatally. The aim of the study was to compare the prenatal manifestation of EA/TEF between twins and singletons. METHODS: A 12-year study of EA/TEF cases was performed at a tertiary center. Cases exhibiting (a) small/absent stomach or (b) polyhydramnios were considered "suspected"; cases with (c) esophageal pouch were considered "detected." We compared the rate and timing of appearance of these signs between the groups. RESULTS: There were 76 cases of EA/TEF, of which 17 were a co-twin. All twin pairs were EA/TEF discordant. The prevalence of EA/TEF at our center was 1:750 for twins (1:319 monochorionic and 1:1133 dichorionic) and 1:2399 for singletons. The rate of small/absent stomach, polyhydramnios and pouch in twins vs singletons was 23.5%, 47.1%, 29.4% and 39.7%, 72.4%,34.5%, respectively (P = .2, P = .09 and P = .7). Esophageal pouch was detected earlier in twins (P = .03). Twins were scanned more frequently (×1.8 times, P = .01). CONCLUSION: EA/TEF is more prevalent in twins. Despite lower rate of polyhydramnios, twins were similarly detected prenatally as singletons, and this was accomplished earlier in pregnancy; perhaps reflecting more frequent scans.

Preferred way of delivery of the impacted fetal head in cesarean sections during second stage of labor.

AIM: To compare maternal and neonatal outcomes between the 'head first' and 'legs first' delivery methods during a second stage cesarean section. METHODS: We conducted a retrospective study between January 2009 and May 2015 at a large public university tertiary referral center. Included were all women who underwent cesarean delivery with a fully dilated cervix and a fetal head at the level of the ischial spines or below. The study population was divided into two groups according to way of fetal delivery: The 'legs first' (reverse breech) method and the 'head first' method. Demographics and maternal and fetal outcomes were retrieved for both groups. RESULTS: During the study period 447 women underwent a cesarean section while their cervix was fully dilated. Of them, 321 met the inclusion criteria: One hundred and twenty-one (38%) were delivered using the 'legs first' method and 200 (62%) were delivered using the 'head first' method. Indication for surgery and fetal head station was similar for both groups. While no difference in overall intraoperative uterine incision extension rate was observed, a higher rate of uterine incision extension was demonstrated in the 'head first' group in cases in which the second stage was longer than 180 min (33 vs 8 cases, P = 0.02). No differences in maternal postoperative complication rates and neonatal outcomes were observed. CONCLUSION: Fetal extraction via the 'legs first' method during prolonged second stage of labor may lower maternal morbidity. Method of delivery does not seem to have an effect on neonatal outcomes.

E-Bike-Related Trauma in Children and Adults.

BACKGROUND: Electric bike (e-bike) usage is growing worldwide, and so is the e-bike-related injury rate. OBJECTIVE: This study was undertaken to characterize e-bike-related injuries. METHODS: Data of all e-bike-related injuries presenting to our level I trauma center between 2014 and 2016 were collected and analyzed. Adult and pediatric (<18 years of age) e-bike-related injuries were then analyzed separately and compared. RESULTS: Forty-eight patients suffering from e-bike-related injuries presented to our trauma center between January 1, 2014 and December 31, 2016. Seventeen (35%) patients were <18 years of age and 40 (85%) were male. The overall most common mechanism of injury was falling off the e-bike in 24 patients (50%), followed by collision with a static object in 9 patients (18.8%). Head (38%) and facial (33%) injuries were most common in children. In adult patients, orthopedic trauma was predominant, with extremity fractures in 35 (73%) followed by significant lacerations in 14 patients (29%). Severe trauma (Injury Severity Score >15) was found in 17 (35%) patients. The duration of hospital stay was 10.8 ± 6 days, 12 patients (25%) required a stay in the intensive care unit, and 21 patients (43.7%) required surgery. Compared to adults, children (<18 years of age) had significantly more head and face injuries (p = 0.05). CONCLUSION: Our study suggests that e-bike-related trauma may involve serious injuries and have typical injury patterns that resemble those seen in motorcycle-related injuries. Children are more likely to suffer head and face injuries because of their higher head to body ratio. We suggest that these injuries should therefore be triaged appropriately, preferably to a medical facility with proper trauma capabilities.