Is Appendectomy During Late Stages of Pregnancy Associated with an Increased Cesarean Delivery Rate? - a Retrospective Analysis of One Center During 10 Years.

Introduction: About one in 500 pregnant women requires a surgical intervention that is not pregnancy-related. One of the most common surgical interventions during pregnancy is appendectomy. The primary aim of this study was to assess surgical access of appendectomy during pregnancy and pregnancy outcome. Secondary outcomes were clinical symptoms and diagnostics as well as histopathological analysis. Methods and Material: This is a single-center retrospective data analysis conducted at a tertiary perinatal center. A digital search of the hospital record archive was conducted focusing on pregnant women beyond 24 0/7 weeks of pregnancy encoding appendectomy. Descriptive statistical analysis was performed. Results: Between January 2013 and January 2023, a total of 20 appendectomies were performed during pregnancy with gestational age beyond 24 0/7 weeks of pregnancy. All of them were performed as lower midline laparotomy. The rate of appendix perforation was 3/20 (15.0%). 19/20 patients (95.0%) delivered via cesarean. In 7/20 patients (35.0%) appendectomy was performed during cesarean delivery due to incidental finding of irritated or abnormal vermiform appendix. In the pathological work-up, only 2/7 (28.6%) of these subjects had inflammation. Conclusion: In this small monocentric cohort, only open appendectomies were performed. Our data indicate that it is safe to perform open appendectomy during pregnancy if necessary. In this small patient group, there was an increase in simultaneous cesarean deliveries.

Covid-19 during Pregnancy - Histopathological Lesions of the Placenta.

INTRODUCTION: Pregnant women and their offspring represented a vulnerable patient collective during the Covid-19 pandemic. Beyond the direct effect of SARS-CoV-2 via vertical transmission, an indirect impact on the fetus can occur through placental lesions deteriorating placental villous function. We performed a histopathological analysis of placentas of parturients with SARS-CoV-2 compared to healthy controls. METHODS AND MATERIALS: Between February 2022 and July 2022 we conducted a prospective case-control study analyzing placental specimens of parturients with SARS-CoV-2 infection compared to specimens of placentas of healthy controls. Patient history, Covid-19-specific symptoms, and obstetric outcomes were recorded. Statistical analysis was performed. RESULTS: During the observation period 71 patients were included with a gestational age 37 1/7-41 5/7 weeks. Thirty-six patients presented with SARS-CoV-2 infection. The control group consisted of 35 patients and showed no placental abnormalities. Among SARS-CoV-2-positive parturients, 66.7% of placentas of the case group showed histopathological abnormalities classified as vascular or inflammatory abnormalities. 22.2% of placentas showed acute ischemic infarction areas. 8.3% of placentas showed subchorionic layered thrombi. There was one case of severe acute subchorionitis. SARS-CoV-2 increased the risk of placental lesions significantly (OR 3.000, CI 1.890-4.762, p=0.0001). Placental lesions had no significant impact on perinatal acidosis (OR 0.455, CI 0.044-4.667, p=0.498) or number of cesarean sections (OR 2.314, CI 0.717-7.473, p=0.156). CONCLUSION: SARS-CoV-2 infection during labor and delivery increased the risk of adverse outcomes. Histopathological analysis indicated that the placenta as a maternal-fetal interface was affected by SARS-CoV-2, leading to systemic vasculopathy and inflammation.

Synthetic Osmotic Dilators for Pre-Induction Cervical Ripening - an Evidence-Based Review.

Mechanical methods have gained growing interest for pre-induction cervical ripening in women with an unripe cervix, since they have a better safety profile compared to prostaglandins. Balloon catheters have been the gold standard method for decades, while there was a lack of data on synthetic osmotic cervical dilators. Not until 2015, when Dilapan-S was approved by the Food and Drug Administration (FDA) for induction of labor, numerous studies have been published on the use of Dilapan-S in this field. The rate of vaginal deliveries associated with the use of Dilapan-S ranges from 61.6 to 81.7%, and no serious complications needing further interventions have been reported to this date. Dilapan-S was shown to be as effective as the Foley balloon catheter as well as the 10 mg PGE 2 vaginal insert and orally applied misoprostol (25 µg every 2 hours) in achieving vaginal delivery, but patient's satisfaction during the cervical ripening process was significantly higher compared to the other methods and the rate of uterine hyperstimulation was significantly lower compared to prostaglandins (PGs). Minor complications (e.g. vaginal bleeding) associated with the use of Dilapan-S were < 2%, and maternal infectious morbidity was not higher compared to Foley balloon and vaginal PGE 2 or misoprostol. Due to these beneficial properties Dilapan-S might be an ideal option for outpatient cervical ripening, as shown in a recent randomized clinical trial comparing inpatient to outpatient cervical ripening. Furthermore, according to the manufacturers' product information, Dilapan-S is the only cervical ripening method that is not contraindicated for induction of labor in women with a previous cesarean section. Upcoming guidelines should consider synthetic osmotic cervical dilators as an effective and safe method for cervical ripening/induction of labor acknowledging that more evidence-based data are mandatory, particularly in patients with a previous cesarean section.

Cervical ripening as an outpatient procedure in the pandemic - minimizing the inpatient days and lowering the socioeconomic costs.

OBJECTIVES: With an increasing incidence of labor induction the socioeconomic costs are increasing and the burden on hospital capacities is rising. In addition, the worldwide SARS-CoV-2 pandemic asks for improvements in patient care during pregnancy and delivery while decreasing the patient-staff contact. Here, we are retrospectively analyzing and comparing a mechanical ripening device that is utilized as an outpatient procedure to misoprostol and dinoprostone as inpatient induction methods in a low risk cohort. METHODS: This is a retrospective comparative analysis of obstetric data on patients who presented for cervical ripening and labor induction. Ninety-six patients received a mechanical ripening agent as an outpatient procedure. As a control group, we used 99 patients with oral misoprostol (PGE1) and 42 patients with vaginal dinoprostone (PGE2) for cervical ripening in an inpatient setting. Data from 2016 until 2020 were analysed. RESULTS: Baseline characteristics showed no significant differences. Delivery modes were similar in all groups. The time period from patient admission to onset of labor was significantly shorter in the outpatient group (p<0.001): 10.9 h/0.5 days (±13.6/0.6) for osmotic dilator vs. 17.9 h/0.7 days (±13.1/0.5) for oral misoprostol vs. 21.8 h/0.8 days (±15.9/0.7) for vaginal dinoprostone. With 20.4 h/0.8 days (±14.3/0.6) the osmotic dilator group displayed significantly the shortest inpatient stay from admission to delivery (p=0.027). The patient subgroup of misoprostol had 25.7 h/1.1 days (±14.9/0.6) of inpatient stay from admission to delivery and the patient group of dinoprostone 27.5 h/1.1 days (±16.0/0.7). There were fewer hospital days in the outpatient group: 84.9 h/3.5 days vs. 88.9 h/3.7 days vs. 93.6 h/3.9 days (outpatient osmotic dilator vs. inpatient misoprostol and dinoprostone, respectively). CONCLUSIONS: New approaches are required to decrease individual contacts between patients and staff while maintaining a high quality patient care in obstetrics. This analysis reveals that outpatient mechanical cervical ripening can be as safe and effective as inpatient cervical ripening with PGE1/PGE2, while lowering patient-staff contact and total hospital stays and therefore decreasing the socioeconomic costs.

Do we need a 200 µg misoprostol vaginal insert? A retrospective cohort study comparing the misoprostol vaginal insert to oral misoprostol.

AIM: The misoprostol vaginal insert (MVI) was reported to be more effective than dinoprostone but discussed critically because of high rates of fetal heart rate changes due to uterine tachysystole. The aim of this study was to investigate the outcome of induced labor using the MVI compared to off-label orally-administered misoprostol (OM). METHODS: Retrospective study including a total of 401 patients with singleton pregnancies in whom labor was induced at ≥36 0/7 gestational weeks with MVI (203) or OM (198). Primary outcomes were the time from induction to delivery, vaginal delivery in 24 h and the mode of delivery and the neonatal outcome. RESULTS: Median time until any delivery was 833 min (645-1278) for MVI and 1076.5 min (698-1686.3) for OM group; 83.7% of the patients in the MVI group gave birth within 24 h versus 63.6% in the OM group. The MVI group needed significantly less pre-delivery oxytocin (29%). Tachysystole (6.4%) and pathological CTG (30.5%) occurred at a significantly higher frequency in the MVI group. The cesarean section rate was significantly higher in the MVI group amounting to 21.7% versus 14.6% in the OM group (P < 0.05). Neonatal outcome did not differ between the groups. CONCLUSION: The MVI might be an option if you are in need for an approved and faster method to induce labor. Although we observed a significantly higher rate of fetal heart rate changes and cesarean sections in the MVI group this did not affect the neonatal outcome.

Expression of VEGFR-2 during Liver Regeneration after Partial Hepatectomy in a Bioluminescence Mouse Model.

BACKGROUND: Liver regeneration requires the formation of new blood vessels. Endothelial cell proliferation is stimulated by vascular endothelial growth factor (VEGF) and its receptor tyrosine kinase VEGFR-2. The aim of this study was to investigate VEGFR-2 expression in vivo during liver regeneration after partial hepatectomy (PHx). METHODS: Transgenic VEGFR-2-luc mice were used in which the luciferase reporter gene was under control of the VEGFR-2 promoter. Following 2/3 PHx, the mice underwent in vivo bioluminescence imaging until the 14th postoperative day. Additionally, liver tissue was analyzed by immunohistochemistry, in vitro luminescence assays, and quantitative RT-PCR. RESULTS: In vivo bioluminescence imaging showed a significant increase in VEGFR-2 promoter activity after PHx. Maximum signal was recorded on the 3rd day; 8 days postoperatively the signal intensity decreased significantly. On the 14th day, bioluminescence signal reached almost baseline levels. Immunohistochemistry, quantitative RT-PCR, and in vitro luminescence confirmed a significant increase on the 3rd day following resection. The mRNA expression of VEGFR-2 was significantly higher on day 3 than preoperatively as well as on day 8. CONCLUSION: In vivo bioluminescence imaging with transgenic VEGFR-2-luc mice is feasible and provides a convenient model for noninvasively studying VEGFR-2 expression during liver regeneration. This may facilitate further experiments with modulation of angiogenesis by different substances.

Influência da dor crônica na capacidade funcional do idoso / Influence of chronic pain on functional capacity of the elderly

Justificativa e objetivos: No âmbito das afecções do aparelho locomotor, a dor é o sintoma mais frequente e, além da alta prevalência, sua importância decorre por estar presente nas doenças que causam maior impacto negativo na qualidade de vida e na produtividade dos indivíduos acometidos. O objetivo deste estudo foi investigar tópicos relevantes sobre a influência da dor osteoarticular crônica na capacidade funcional no idoso. Conteúdo: Foi realizado um estudo bibliográfico mediante consulta às principais publicações sobre o tema. O material foi identificado com auxílio das bases eletrônicas de dados da Medline, LILACS, Scielo e Pubmed. Foram empregados os descritores "dor crônica", "doenças osteoarticulares" e "capacidade funcional". Conclusão: Deve haver maior atenção às políticas públicas de implementação de programas que visem principalmente a prevenção e o controle das doenças crônicas osteoarticulares, promovendo funcionalidade e maior qualidade de vida para essa população.

Background and objectives: Among locomotor system diseases, pain is the most frequent symptom and, in addition to its high prevalence, it is important because it is present in diseases causing the highest negative impact on quality of life and productivity of affected individuals. This study aimed at investigating relevant topics on the influence of chronic osteoarticular pain on the functional capacity of the elderly. Contents: A bibliographic study was carried out by querying major publications on the subject. Material was identified with the aid of electronic databases Medline, LILACS, Scielo and Pubmed. Keywords used were "chronic pain", "osteoarticular diseases" and "functional capacity". Conclusion: Further attention should be given to public policies implementing programs aiming especially at preventing and controlling chronic osteoarticular diseases, promoting functionality and better quality of life for this population.

Autopercepção de saúde em idosos residentes em um município do interior do Rio Grande do Sul / Self-perceived health in elderly living in a city in Rio Grande do Sul state

Objetivo: Avaliar a percepção de saúde de idosos residentes em um município do interior do Rio Grande do Sul. Método: Estudo quantitativo, descritivo de corte transversal, onde foi aplicado um questionário sociodemográfico e clínico, em uma população de 274 idosos no período de agosto de 2011 a setembro de 2012. Resultados: Houve predominância do sexo feminino, na faixa etária dos 60-69 anos de idade, baixa renda e escolaridade. Em relação a patologias, 77,38% relataram possuir alguma doença associada, sendo a hipertensão a mais prevalente, acometendo 56,20% dos idosos, seguida da osteoartrite com 28,10%. Relataram ser etilistas 13,14% e tabagistas, 6,57%. Quanto à prática de atividade física, 67,52% relataram realizar atividade física de forma regular. Do total de idosos entrevistados, 47,81% consideraram sua saúde boa. Conclusão: Apesar de a maioria dos idosos ter referido boa saúde, grande número deles relatou ser portador de doenças crônicas, o que reforça a ideia de que a percepção de ser doente está mais relacionada às incapacidades do que a ser portador de danos crônicos. .

Objectives: To assess the health perception of elderly living in a town in Rio Grande do Sul state, Brazil. Methods: Quantitative, descriptive cross-sectional study in which a sociodemographic and clinical questionnaire was administered in a population of 274 elderly from August 2011 to September 2012. Results: There was a predominance of females, aged 60-69 years, low income and education. In relation to pathologies, 77.38% reported having chronic disease, hypertension being the most prevalent, affecting 56.20% of the elderly, followed by 28.10% with osteoarthritis. Only 13.14% reported being drinkers and 6.57% reported being smokers. As for the practice of physical activity, 67.52% reported physical activity on a regular basis. Of the total elderly respondents, 47.81% considered their health good. Conclusion: Although most elderly have mentioned good health, a large proportion being reported chronic diseases, which reinforces the idea that the perception of being sick is more related disability than being a carrier of chronic damage. .

Tratamento fisioterapêutico das artralgias / Physiotherapeutic treatment of arthralgias

BACKGROUND AND OBJECTIVES: Aging is a dynamic, progressive and unavoidable process bringing several physical and emotional changes. Arthralgia is one of the most limiting factors with regard to elderly people's functionality. This study aimed at reviewing the literature in search of possible non-pharmacological treatments which may contribute to improve the quality of life (QL) of arthralgia patients. CONTENTS: LILACS, Medline, Pubmed, Bireme and Scielo databases were queried from 1998 to 2012. Among intervention methods to rehabilitate arthralgias in the elderly there are kinesiotherapy, thermotherapy, electrotherapy and hydrotherapy. CONCLUSION: Hydrotherapy associated to kinesiotherapy may bring significantly positive results to the treatment of rheumatoid arthritis, osteoarthritis and osteoporosis.

JUSTIFICATIVA E OBJETIVOS: O envelhecimento é um processo dinâmico, progressivo e inevitável que traz consigo uma série de alterações, tanto físicas quanto emocionais. A artralgia é um dos fatores mais limitantes no que diz respeito à funcionalidade do idoso. O objetivo deste estudo foi realizar uma revisão na literatura em busca de possíveis tratamentos não farmacológicos que possam contribuir para melhorar a qualidade de vida (QV) dos pacientes portadores de artralgias. CONTEÚDO: Para a realização do levantamento bibliográfico foram consultadas as bases de dados: LILACS, Medline, Pubmed, Bireme e Scielo, no período de 1998 a 2012. Dentre os métodos de intervenção utilizados na reabilitação das artralgias no idoso, estão a cinesioterapia, a termoterapia, a eletroterapia e a hidroterapia. CONCLUSÃO: A hidroterapia associada à cinesioterapia pode trazer resultados significativamente positivos no tratamento da sintomatologia da artrite reumatoide, da osteoartrite e da osteoporose.

Poor sleep quality is associated with depressive symptoms in patients with heart disease.

BACKGROUND: Depression in cardiac patients has gained importance due to increased mortality. Although sleep disturbances are a core symptom of depression, the prevalence and patterns of sleep disturbances in heart disease have hardly been examined regarding depression. PURPOSE: This cross-sectional study aims to examine sleep disturbances and depressive symptoms in consecutively admitted cardiac patients and depressed patients. METHODS: Two hundred four inpatients (113 male, 91 female) were examined: 94 cardiac inpatients (mean age 49.3 ± 14.3 years) with different heart diseases and 110 psychiatric inpatients (mean age 41.6 ± 13.0 years) with depressive disorders (DP). A depressive episode according to International Classification of Diseases (ICD)-10 was also diagnosed in 14 of the cardiac patients (DCP). The Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI) were used to assess subjective sleep quality and severity of depressive symptoms. RESULTS: Poor sleep quality (PSQI > 5) was reported in all comorbid DCP (PSQI 12.00 ± 3.53, BDI 17.86 ± 4.28), in 60% of the 80 non-DCP (PSQI 5.59 ± 3.73, BDI 4.47 ± 3.07), and in 86.4% of the DP (PSQI 11.76 ± 4.77, BDI 27.11 ± 10.54). The cardiac inpatients showed a significant correlation between increased depressive symptoms and the PSQI components subjective sleep quality (r = 0.40) and daytime dysfunction (r = 0.34). Both sleep components were significant predictors of self-rated depression (R² = 0.404). CONCLUSIONS: Most cardiac patients experience poor sleep quality. Self-reported sleep disturbances in heart disease could serve as predictors of clinical or subclinical comorbid depression outside of a psychiatric setting in cardiology and other fields, and such patients should be referred to consultation-liaison psychiatry or polysomnography where sleep disorders like sleep apnea are suspected.