Predictors of sling revision after mid-urethral sling procedures: a case-control study.

OBJECTIVE: To identify patient characteristics and surgical factors predictive of complications requiring mid-urethral sling (MUS) revision/removal. DESIGN: Case-control study. SETTING: Tertiary academic centre in Canada. POPULATION: One hundred and seven women undergoing MUS revision/removal between 2005 and 2016 were matched with 214 controls by date of index MUS procedure (2:1 ratio). METHODS: Data on patient and surgical factors were obtained via manual electronic and paper chart review. Three sets of pre-specified simple and multivariable logistic regression models were fitted to: (1) examine previously reported risk factors for MUS revision after primary surgical treatment; (2) identify preoperative predictors of MUS complications requiring revision/removal; and (3) identify surgical factors associated with this outcome after adjusting for potential confounding factors. MAIN OUTCOME MEASURES: Crude and adjusted odds ratios (ORs) with 95% confidence intervals (95% CIs) for patient and surgical factors. RESULTS: The median time to MUS revision was 153 days (interquartile range, IQR 49-432 days). Active smoking status (OR 2.29, 95% CI 1.13-4.63, P = 0.03), having had a previous hysterectomy (OR 3.88, 95% CI 2.02-7.46, P < 0.01), and undergoing concomitant pelvic organ prolapse surgery at the time of the index MUS procedure (OR 2.63, 95% CI 1.32-5.52, P < 0.01) were independently associated with the need for MUS revision/removal. Sling type (obturator versus retropubic), method of tensioning (to cough versus over instrument), anaesthetic type, and estimated blood loss were not associated with this outcome in the analysis presented here. CONCLUSIONS: Active smoking status, having had a previous hysterectomy, and undergoing concomitant surgery for pelvic organ prolapse are risk factors for requiring subsequent MUS revision/removal. TWEETABLE ABSTRACT: Risk factors for sling revision include smoking, previous hysterectomy, and concomitant prolapse surgery.

Evaluating the concurrent validity of body mass index (BMI) in the identification of malnutrition in older hospital inpatients.

BACKGROUND: Nutrition screening and assessment tools often include body mass index (BMI) as a component in identifying malnutrition risk. However, rising obesity levels will impact on the relevancy and applicability of BMI cut-off points which may require re-evaluation. This study aimed to explore the relationship between commonly applied BMI cut-offs and diagnosed malnutrition. METHODS: Data (age, gender, BMI and Subjective Global Assessment (SGA) ratings) were analysed for 1152 inpatients aged ≥65 years across annual malnutrition audits (2011-2015). The receiver operation characteristic (ROC) curve analysed the optimal BMI cut-off for malnutrition and concurrent validity of commonly applied BMI cut-offs in nutritional screening and assessment tools. RESULTS: Malnutrition prevalence was 36.0% (n = 372) using SGA criteria (not malnourished, moderate or severe malnutrition). Median age was 78.7 (IQR 72-85) years, median BMI 25.4 (IQR 21.8-29.7) kg/m2; 52.1% male and 51.2% overweight/obese. ROC analysis identified an optimal BMI cut-off of <26 kg/m2, 80.8% sensitivity and 61.5% specificity (AUC 0.802, 95% CI 0.773, 0.830; p < 0.0001). Commonly applied BMI cut-offs (between 18.5 and 23 kg/m2) failed to meet the alpha-priori requirement of 80% sensitivity and 60% specificity. However, BMI <23 kg/m2 had the highest agreement (κ = 0.458) with malnutrition diagnosed using the SGA. CONCLUSIONS: Both malnutrition and overweight/obesity are common in older inpatients. Continuing increases in the prevalence of overweight and obesity will impact on the sensitivity of BMI as a screening component for malnutrition risk. The current study suggests tools developed over a decade ago may need to be revisited in future.

A randomized trial investigating an iron-rich bread as a prophylaxis against iron deficiency in pregnancy.

The iron-rich bread (2.2 mg iron per 50 g slice) used in the study was developed using Eragrostis tef flour, naturally rich in iron. Iron deficiency is prevalent in pregnancy and compliance with supplements can be low. In this double-blind, randomized trial 34 Caucasian, primiparous antenatal patients were randomized to receive intervention bread or a placebo for 6 weeks. Women consumed on an average of 2.3 slices per day, providing a total of 5.0 mg iron. Using World Health Organisation (2001) haemoglobin cut-offs, 12% of participants eating the iron-rich bread were iron deficient by the end of the study compared with 27% in the control group. For other markers of iron status, these were improved in the placebo versus the treatment group. For example, a significant decline in serum iron and transferrin saturation was not observed in this group. Findings demonstrate that other modes of delivery, i.e. food fortification, may be needed to generate 'physiological effects', or further measures are taken to improve intervention compliance.

Ovarian activity and vaginal bleeding patterns with a desogestrel-only preparation at three different doses.

A randomized, double-blind, group-comparative study was performed over a 6 month period to compare ovarian suppression and vaginal bleeding during the use of three oral contraceptives containing doses of 30, 50 or 75 micrograms desogestrel. A total of 44 female volunteers with regular cycles and established ovulation by ultrasonography were recruited from an out-patient clinic in a university hospital and asked to participate in the study. Ultrasonography and serum oestradiol and progesterone measurements were performed during two assessment periods. The 75 microgram dose showed complete suppression of ovulation and a more acceptable bleeding pattern than the lower doses. The 75 microgram dose of desogestrel is the most promising dose for the development of a new progestogen-only oral contraceptive agent.

[Current status of contraceptive vaginal rings]. / Etat actuel des anneaux vaginaux contraceptifs.

PIP: Vaginal administration of contraceptive steroids has several advantages over oral administration, including avoidance of the digestive tract and the 1st passage effect, continuous release of the active principle allowing lower doses and fewer side effects, independence of the method from sexual relations, and possibility of application directly by the user. An early vaginal ring containing medroxyprogesterone acetate in silastic inhibited ovulation but released the progesterone in large initial bursts followed by rapid decline, offering no advantage over parenteral administration. The problem was resolved through development of a vaginal ring with an inert core covered with a fine layer of a mixture of silastic and progesterone, in turn covered by a fine layer of silastic. The speed of release of the new ring was proportional to t he surface of the ring and inversely proportional to the thickness of the outer layer. This method was used to release variable quantities of levonorgestrel over 3-6 cycles, which inhibited ovulation in 85% of users but provided only mediocre cycle control. The World Health Organization at about the same time was sponsoring research focussed on development of a vaginal ring releasing small doses of progestins with a minimal blocking of ovulation but a major contraceptive effect at the level of the cervical mucus and endometrium. Several progestins were evaluated and dose-response tests were conducted on a number of them. A ring releasing 20 mcg/day of levonorgestrel was found to cause fewer cycle problems and to have a moderate affect on ovarian function. The Population Council in New York developed a method adding estrogen to the progestin to resolve the problem of irregular bleeding and obtain better cycle control. Development was halted despite promising results because of difficulties of mass production and the results of metabolic studies that indicated the method had undesirable effects on lipoprotein levels. But large scale multicountry trails with the levonorgestrel-releasing ring continued to give positive results. Bleeding problems, when they arose, were less serious than those with low-dose oral progestins. The efficacy was at least equal. A detailed study of social acceptability found the level of acceptability of the vaginal ring to be high, with women appreciating their ability to remove the ring themselves. Despite the favorable results, marketing of the levonorgestrel vaginal ring was delayed by problems in mass production and in procuring adequate supplies of silastic. Recent developments have included new lightweight plastics and a model that allows the ring to be divided into sections. A multicenter study is underway of a ring releasing 120 mcg of desogestrel and 30 mcg of ethinyl estradiol. Results have been very favorable. A vaginal ring is likely to be commercially available by 1995.^ieng

Comparison of weights for left and right breast muscle of broilers.

Two studies were conducted to investigate the differences in the yield of broiler breast meat (pectoralis muscles) between the left and right sides of the bird. In the first study, 42-day-old male broilers had 3.3% more meat on the left side of the breast than on the right side. This difference was observed for both the Pectoralis superficialis and Pectoralis profundis muscles. In the second study, male broilers were sampled at 50, 57, and 64 days of age. There was 2.7% more meat on the left side of the breast than on the right side, and the percentage difference was not affected by age. The results indicated that both sides of the breast should be sampled in studies concerning the yield of breast meat.

A comparative study of trout and chicks regarding dietary effects on glycogen concentration in liver and muscle during feeding and subsequent to feed withdrawal.

1. Glycogen concentrations in liver and skeletal muscle were compared in rainbow trout and in chicks of two genetic sources. 2. Tissue glycogen concentrations were determined during feeding and after feed withdrawal in response to diets high in carbohydrate and oil, respectively. 3. Livers of trout and chicks were heavier and glycogen concentrations were higher in both liver and muscle of trout and chicks fed high-carbohydrate diets. 4. Feed withdrawal resulted in gradual but steady declines in trout glycogen over a 16-day period but caused sharp declines in liver glycogen in chicks followed by a rebound and a more gradual decline within a 5-day period. 5. Feed withdrawal from trout caused declines in muscle glycogen followed by rebounds which occurred more rapidly when the high-carbohydrate diet had been fed. 6. Feed withdrawal had little effect on muscle glycogen in broiler-type chicks. In White Leghorn chicks there was a general decline in muscle glycogen which showed marked fluctuations when the high-fat diet had been fed.