Women with chronic constipation have more bothersome urogenital symptoms.

BACKGROUND: The aim of our study was to characterize urogenital symptoms in women with and without constipation, and by severity of constipation. METHODS: This was a retrospective cohort study conducted at a pelvic floor disorder center in a tertiary healthcare facility from May 2007 through August 2019 and completed an intake questionnaire were included. We collected demographic, physical exam data and quality of life outcomes. The Urinary Distress Inventory (UDI-6) was used to assess urogenital symptoms. Women with constipation completed the Constipation Severity Instrument (CSI). We excluded women with a history of a bowel resection, inflammatory bowel disease, or pelvic organ prolapse symptoms. The cohort was then divided into two groups, constipated and non-constipated, and the prevalence and severity of urogenital-associated symptoms were compared. A secondary analysis was made among constipated subjects stratified by constipation severity based on CSI scores. RESULTS: During the study period, 875 women (59.5%) had chronic constipation. Women with chronic constipation were more likely to experience urogenital symptoms, such as dyspareunia, urinary hesitancy, and a sensation of incomplete bladder emptying (all p < 0.05). Moreover, on univariate analysis, women with high CSI scores (75 percentile or higher) were found to have higher UDI-6 scores, increased bladder splinting, pad use, urinary frequency and dyspareunia while on multivariate analysis higher UDI score, increased bladder splinting, urinary frequency and dyspareunia were significantly associated (p < 0.05). CONCLUSION: We found that the presence and severity of chronic constipation worsened the degree of bother from urogenital symptoms. Given that chronic constipation can modulate urogenital symptoms, our study suggests that pelvic floor specialists should assess the presence and severity of urogenital and bowel symptoms to provide comprehensive care.

The design and evaluation of a clinical clerkship for hospital pharmacists.

Forty hospital pharmacists participated in a two week pilot of a postgraduate clinical pharmacy clerkship, utilizing different hospital services as teaching sites at the University of Illinois and Cook County hospitals in Chicago. The clerkship provided eighty hours of instruction in the clinical setting under the guidance of experienced clinical faculty. Though designed as an introductory clerkship for teaching basic clinical skills, general medicine floors were used as instruction sites as well as specialized services including emergency medicine, neonatology, surgical oncology, cardiology and an out-patient rheumatology clinic. Key findings include: the two week clerkship and its emphasis upon basic clinical skills was a meaningful educational experience for both participants and faculty; the limited time frame of the clerkships made crucial the instructional design including systematic development of objectives and faculty preparation; an improvement in participant performance on all but one objective was observed between the 3rd and 10th day; the clerkship enhanced the confidence of participants with respect to the performance of basic clinical skills; and the clerkship experience broadened participants' conceptions of the depth and scope of the clinical pharmacists role. These results indicate that a two week clinical clerkship can be a useful vehicle for pharmacy postgraduate education.

Congenital complete heart block and SSA antibodies: obstetric implications.

Mothers with known or occult rheumatic disorders may be delivered of infants with congenital complete heart block. The more frequent use of ultrasonography during pregnancy now allows early detection of heart block in utero. The transplacental passage of SSA or SSB antibodies, of the IgG class, may mediate or be associated with immune damage to the fetal cardiac conduction system, as reported in our two patients. Maternal and/or newborn screening for SSA and SSB antibodies in selected patients permits an early presumptive diagnosis and will assist perinatal planning, particularly for immediate newborn cardiac pacemaker implantation. Early serologic detection of such antibodies may also assist family counseling of mothers at risk and should promote investigation of techniques to modify the immune status of these mothers. SSA- or SSB-positive maternal/fetal pairs should be prospectively managed by the obstetrician, neonatologist, and rheumatologist.

Placental impermeability to parathormone 125I in the ewe.

Placental permeability and metabolism of parathyroid hormone (PTH) 125I was studied in 5 gravid ewes during the last trimester. The mean plasma half-life was 38 +/- 0.8 and 22.6 +/- 2.7 min in the fetus and ewe, respectively. There was minimal placental transfer of PTH 125I in either the fetal to maternal and maternal to fetal directions. Fetal calcium homeostasis is probably not affected directly by changes in maternal serum PTH levels, and maternal calcium homeostasis probably is not affected directly by changes in fetal serum PTH concentrations.

Effects of magnesium sulfate treatment on perinatal calcium metabolism. II. Neonatal responses.

To evaluate the effects of maternal magnesium sulfate treatment on neonatal magnesium and calcium homeostasis, the authors studied 23 term neonates whose mothers had received intravenous magnesium sulfate for pre-eclampsia and compared them with 14 control neonates. Total and ionized calcium, magnesium, phosphorus, and albumin were measured in maternal and umbilical blood; total calcium, magnesium, phosphorus, and albumin were measured serially in the newborn infants. Magnesium levels were higher in treated than in control infants in umbilical venous and arterial blood samples and in the neonatal blood samples 2, 12, and 24 hours after delivery. However, at 48 hours and beyond there was no difference in serum magnesium levels between treated infants and controls. Calcium levels were not significantly different in treated versus control subjects in umbilical blood or in any neonatal samples. There was no correlation between the maternal magnesium concentration at delivery and the levels of calcium in umbilical or neonatal blood. These data indicate that maternal magnesium sulfate therapy does not cause neonatal hypocalcemia and that the induced neonatal hypermagnesemia is resolved within the first 48 hours of life.

Further observations on the gingival cyst. Three case reports.

Three clinically discernable gingival cysts have been described and documented histologically. Two of these lesions occurred in the same patient in adjacent areas of the mouth. The potential origin of such cysts has been described. We suggest that gingival cysts are not clinical curiosities, as proposed in earlier reports.