Venous Thromboembolism Manifesting as Sciatica in Two Pregnant Women.

BACKGROUND: Low back pain is a common presentation among pregnant women. CASE: This case report highlights two women who developed excessive low back radicular nerve symptoms during pregnancy as the initial presentation of proximal venous thromboembolism. CONCLUSION: The use of Doppler ultrasound imaging or magnetic resonance imaging is suggested for women presenting with severe clinical symptoms of radicular low back or leg pain in pregnancy to rule out thromboembolism and guide patient management.

Understanding Patient Perspectives on Specialized, Longitudinal, Postpartum, Cardiovascular Risk-Reduction Clinics.

Background: Females who experience hypertensive disorders of pregnancy (HDP) have an increased lifelong risk of cardiovascular disease. Thus, Canadian clinical practice guidelines recommend cardiovascular risk reduction follow-up after a patient has HDP. This study examined the experiences of patients with HDP who attended a specialized, longitudinal general internal medicine postpartum cardiovascular risk reduction clinic called PreVASC. PreVASC focuses on comprehensive cardiovascular risk reduction through cardiovascular risk factor screening and management tailored specifically for female patients after they have HDP. Methods: This multimethod study examined the experiences of female patients with HDP via the following: (i) a quantitative survey (summarized with descriptive statistics); (ii) semistructured qualitative patient phone interviews (results grouped thematically); and (iii) triangulation of qualitative themes with quantitative survey results. Results: Overall, 37% of eligible clinic patients (42 of 115) participated; 79% of participants (n = 33) reported being "very satisfied" with the PreVASC clinic's specialized longitudinal model of care, and 95% (n = 40) reported making at least one preventive health behaviour change after receiving individualized counselling on cardiovascular risk reduction. Qualitative results found improvements in patient-reported cardiovascular health knowledge, health behaviours, and health-related anxiety. A preference for in-person vs phone clinic visits was reported by participants. Conclusions: An in-person, general internal medicine specialist-led, longitudinal model of cardiovascular disease preventive care focused specifically on cardiovascular risk reduction after HDP had positive impacts on patient experience, health knowledge, and preventive health behaviours. This novel knowledge on patient preferences for a longitudinal, specialized model of care advances cardiovascular risk reduction tailored specifically for high-risk people after HDP.

Contexte: Les femmes qui sont atteintes de troubles hypertensifs de la grossesse (THG) présentent un risque accru de maladie cardiovasculaire durant leur vie. Par conséquent, les lignes directrices canadiennes de pratique clinique recommandent un suivi pour la réduction du risque cardiovasculaire après la survenue d'un THG. Cette étude visait à examiner l'expérience des patientes qui ont été atteintes de THG et qui ont fréquenté l'une des cliniques de médecine interne spécialisées dans la réduction du risque cardiovasculaire post-partum et offrant une prise en charge longitudinale (PreVASC). Les cliniques PreVASC se concentrent sur la réduction des risques cardiovasculaires globaux par la détection des facteurs de risque cardiovasculaire et une prise en charge spécialement adaptée pour les femmes qui ont subi un THG. Méthodologie: Cette étude visait à examiner l'expérience des femmes atteintes d'un THG en faisant appel à diverses méthodes : i) sondage quantitatif (résumé par des statistiques descriptives); ii) entrevues téléphoniques semi-structurées de nature qualitative avec des patientes (résultats regroupés par thèmes); et iii) triangulation des thèmes qualitatifs et des résultats du sondage quantitatif. Résultats: Globalement, 37 % des patientes admissibles (42 sur 115) ont participé à l'étude; 79 % des participantes (n = 33) ont déclaré être « très satisfaites ¼ du modèle de soins longitudinal spécialisé des cliniques PreVASC, et 95 % (n = 40) ont déclaré avoir adopté au moins un comportement préventif pour leur santé après avoir reçu des conseils personnalisés sur la réduction du risque cardiovasculaire. Les résultats qualitatifs obtenus auprès des patientes font état d'une amélioration des connaissances sur la santé cardiovasculaire, les comportements sains et l'anxiété liée à la santé. Les participantes ont dit préférer les visites cliniques en personne aux consultations par téléphone. Conclusions: L'adoption d'un modèle longitudinal de médecine interne comprenant des rencontres avec des spécialistes pour prévenir les maladies cardiovasculaires, en particulier réduire le risque cardiovasculaire après un THG a eu des effets positifs chez les patientes en ce qui concerne l'expérience, les connaissances en matière de santé et les comportements à adopter pour prévenir les problèmes de santé. Ces nouvelles connaissances sur les préférences des patientes à l'égard de soins longitudinaux spécialisés représentent un pas en avant dans la mise en place d'une approche personnalisée de réduction du risque cardiovasculaire pour les personnes présentant un risque élevé après un THG.

Changes in breastfeeding initiation at hospital discharge between first and second births in Nova Scotia: a population-based cohort study.

BACKGROUND: Breastfeeding has well-recognized health benefits for infants and mothers. However, little research has been conducted to investigate changes in breastfeeding from one pregnancy to another. This study was conducted to describe rates of breastfeeding initiation at hospital discharge for women's first and second births and to identify factors associated with changes in initiation at the second birth. METHODS: We conducted a longitudinal, population-based cohort study involving women residing in Nova Scotia who delivered a first and second live-born singleton between 2007 and 2013. Separate analyses were conducted among women who breastfed their first infant and among women who did not breastfeed their first infant. RESULTS: Of the 9643 (82.6%) mothers who initiated breastfeeding in the first birth, 973 (10.3%) did not initiate breastfeeding in the second birth. Of first-birth noninitiators, 526 (26.3%) initiated breastfeeding in the second birth. With the exception of smoking and cesarean births, factors that were associated with breastfeeding initiation in the second birth depended on breastfeeding initiation status in the first birth. These factors were associated with increased odds of not breastfeeding in the second birth among the subset of mothers who breastfed in the first birth, and decreased odds of breastfeeding in the second birth among the subset of mothers who did not breastfeed in the first birth. INTERPRETATION: Most women continue the same method of infant feeding after their first and second births. Identifying factors associated with change in breastfeeding status between the first and second births may help to inform interventions for optimal breastfeeding initiation in the second birth.

Mixed phenotype acute leukemia, B/myeloid, NOS with near-tetraploidy: a case report.

Acute leukemia in adults is usually associated with a myeloid phenotype, and less commonly presents as an acute lymphocytic leukemia. Rarely, the leukemic blast cells express more than one lineage phenotype and satisfy the diagnostic criteria for an acute leukemia of ambiguous lineage (ALAL), further subclassified as mixed phenotype acute leukemia (MPAL). Near-tetraploidy is an unusual presentation of acute leukemia where the blasts contain 80-104 chromosomes. More commonly associated with acute lymphocytic leukemia, near-tetraploidy has been described in only a limited number of cases of acute myeloid leukemias, and near-tetraploid ALAL is rare. We describe the first report of near-tetraploid MPAL, B/myeloid, not otherwise specified.