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1.
J Clin Anesth ; 84: 110989, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36370589

RESUMO

OBJECTIVE: To evaluate the association between early postoperative hypoventilation in the last hour of the post-anesthesia care unit (PACU) stay and hypoventilation during the rest of the first 48 postoperative hours in the surgical ward. DESIGN: Sub-analysis of a clinical trial. SETTING: PACU and surgical wards of a single medical center. PATIENTS: Adults having abdominal surgery under general anesthesia. INTERVENTIONS: Monitoring with a respiratory volume monitor from admission to PACU until the earlier of 48 h after surgery or discharge. MEASUREMENTS: The exposure was having at least one low minute-ventilation (MV) event during the last hour of PACU stay, defined as MV lower than 40% the predicted value lasting at least 1 min. The primary outcome was low MV events lasting at least 2 min during the rest of the first 48 postoperative hours, while in the surgical ward. The secondary outcome was the rate of low MV events per monitored hour. MAIN RESULTS: Data of 292 patients were analyzed, of which 20 (6.8%) patients had a low MV event in PACU. Low MV events in the surgical ward were found in 81 (28%) patients. All patients who had low MV events in PACU had events again in the ward, while 61/272 (22%) had an event in the ward but not in PACU. The incidence rate of low MV events per hour was 24 (95% CI: 13, 46) among patients having an event in the PACU, and 2 (1, 4) among those who did not. CONCLUSIONS: In adults recovering from abdominal surgery, events of hypoventilation during the first postoperative hour are associated with similar events during the rest of the first 48 postoperative hours, with positive predictive value approaching 100%. Sixty-one patients had ward hypoventilation that was not preceded by hypoventilation in PACU.


Assuntos
Anestesia Geral , Hipoventilação , Adulto , Humanos , Hipoventilação/epidemiologia , Hipoventilação/etiologia , Estudos Prospectivos , Período Pós-Operatório , Anestesia Geral/efeitos adversos , Monitorização Fisiológica
2.
J Clin Anesth ; 84: 110995, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36371943

RESUMO

STUDY OBJECTIVE: Determine if psoas muscle area measured in routine preoperative computed tomography scans (CT) can be used to identify patients at increased risk of adverse postoperative outcomes after major elective abdominal surgery. DESIGN: Retrospective analysis of data from a single-centre cohort study conducted in York Hospital between the 1st August of 2015 and the 31st of august of 2020. SETTING: Preoperative clinic. PATIENTS: 639 patients who attended the preoperative assessment clinic prior to major elective colorectal surgery and had an abdominal CT scan done up to 120 days before surgery. INTERVENTIONS: None. MEASUREMENTS: Psoas muscle area at the L3 level was measured in preoperative CT scans and normalised to patient height (psoas muscle index). The lowest sex-stratified tertile of psoas muscle index (PMI) was classed as sarcopenic. The primary outcome was 2-year mortality. Secondary outcomes included postoperative complications assessed using Clavien-Dindo graded major and minor complications, comprehensive complication index (CCI), and length of stay. MAIN RESULTS: Multivariable regression analysis showed that sarcopenia was associated with 2-year mortality (aOR 1.79, 95% CI 1.03-3.10; p = 0.037) and survival at 2-years was significantly reduced in sarcopenic patients (log-rank test, p = 0.012). Sarcopenia was the only statistically significant predictor of major complications in multivariable logistic regression analysis (aOR 1.69, 95% CI 1.04-2.74, p = 0.034) and associated with an estimated increase of 16.6% in the comprehensive complication index (CCI) score of patients that had complications in multivariable linear regression analysis. Sarcopenia was not associated with length of stay. CONCLUSIONS: Sarcopenia defined by psoas muscle mass is an independent predictor of 2-year mortality, major complications and severity of complications after major colorectal surgery and may be used for preoperative risk assessment.


Assuntos
Cirurgia Colorretal , Sarcopenia , Humanos , Músculos Psoas/diagnóstico por imagem , Estudos Retrospectivos , Sarcopenia/complicações , Sarcopenia/diagnóstico por imagem , Sarcopenia/epidemiologia , Estudos de Coortes , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco
3.
Microvasc Res ; 145: 104449, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36374796

RESUMO

OBJECTIVE: Tissue hypoxia due to microvasculopathy is the main cause of digital ulcers (DUs) in systemic sclerosis (SSc). Reduced oxygen delivery (DO2) to the tissues may also contribute to the development of DU. This study was conducted to investigate the association between DO2 and DUs in patients with SSc. METHODS: In all, 111 patients and 30 healthy controls were enrolled. DO2 was calculated by using the formula; DO2 = Cardiac output × arterial oxygen saturation (SpO2) × serum haemoglobin level × 1.39 × 10. Both right index finger SpO2 measurements (index-SpO2) and highest value of SpO2 (maximum SpO2) obtained among the fingers of the subjects were used for the calculations and DO2 results were adjusted both for weight and body surface area (BSA). RESULTS: Mean DO2 was lower in SSc patients as compared to controls in all 4 different calculations but the difference was only statistically significant when using index-SpO2 and adjusting for BSA (498 mL/min/m2 vs 549 mL/min/m2, p = 0.03). There was a strong positive correlation between cardiac output and DO2 calculated by using the index-SpO2 (r = 0.903; p < 0.001). Of the SSc patients, 46 (41.4 %) had DUs within the last 12 months. Patients with DUs had higher mean mRSS, lover mean FVC and more frequently diffuse disease, interstitial lung disease, anti-SCL70 antibody positivity (p < 0.05 for all). No difference was observed in DO2 among DU positive or DU negative groups by any calculation (p > 0.05 for all). CONCLUSIONS: DO2 in SSc patients seems to be lower than healthy controls. However, DO2 is similar between the patients with and without DUs. Our results suggest that the contribution of DO2 is negligible to the development of DU and support the major role of microvasculopathy in SSc patients with DUs.


Assuntos
Escleroderma Sistêmico , Úlcera Cutânea , Humanos , Úlcera/diagnóstico , Úlcera/complicações , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/etiologia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico , Dedos , Oxigênio
4.
J Ethnopharmacol ; 302(Pt B): 115947, 2023 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-36403740

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Zibu Piyin Recipe (ZBPYR) is a traditional Chinese medicine compound composed of 12 kinds of Chinese herbal medicines including red ginseng and yam. Long-term basic and clinical applications have proved that ZBPYR can prevent and treat cognitive dysfunction. Previous studies showed that chronic psychological stress can increase the risk of type 2 diabetes mellitus (T2DM), and lead to cognitive decline. Mitochondrial dysfunction plays a key role in chronic psychological stress-induced diabetes mellitus. While the mechanism of mitochondrial dysfunction and insulin resistance in diabetes-associated cognitive decline (DACD) is unclear. AIM OF THE STUDY: Our previous research found that a ZiBuPiYin recipe (ZBPYR) has significant pharmacological effects against DACD. The present study investigated changes in mitochondrial dysfunction in the brain and the mechanism of insulin resistance and mitochondrial damage to explore the relationship between neuronal mitochondrial dysfunction and insulin resistance in chronic psychologically stressed DACD rats. MATERIALS AND METHODS: Zucker diabetic fatty (ZDF) rats with spontaneous T2DM and rats with diabetic cognitive impairment that was induced by chronic psychological stress were used in in vivo experiments. PC12 cells that were damaged by rotenone were used for the in vitro experiment. RESULTS: The findings indicated that the number of mitochondria decreased, morphology and membrane potential were damaged, and reactive oxygen species increased in the cortex and hippocampus in psychologically stressed DACD rats. Protein kinase Cß2 (PKCß2) activation and insulin resistance were markedly induced by chronic psychological stress, together with decreases in peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α) and mitochondrial fusion protein 2 (Mfn2). Furthermore, ZBPYR exerted protective effects both in in vivo and in vitro. CONCLUSION: Mitochondrial damage and insulin resistance were observed in the brain in chronic psychologically stressed DACD rats. The ZBPYR significantly improved brain mitochondrial damage and insulin resistance in chronic psychologically stressed DACD rats. These results provide novel insights for the development of ZBPYR as a traditional Chinese medicine for the treatment of chronic psychological stress and DACD.


Assuntos
Disfunção Cognitiva , Diabetes Mellitus Tipo 2 , Resistência à Insulina , Animais , Ratos , Ratos Zucker , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/etiologia , Mitocôndrias , Proteínas Mitocondriais
5.
Neurol Clin ; 41(1): 161-176, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36400553

RESUMO

Diagnosis and treatment of postconcussional syndrome (PCS) is challenging because symptoms are vague, difficult to confirm, and attributable to other conditions. There are no uniformly accepted diagnostic PCS criteria. Clinical care largely focuses on symptom reduction and management. Moreover, the coronavirus disease 2019 (COVID-19) pandemic has increased the challenge because post-acute COVID-19 syndrome symptoms overlap with PCS. Future research should center on base rates of PCS-type symptoms in nonneurological samples and the identification and improved understanding of moderating variables contributing to the frequency, intensity, and duration of PCS symptoms.


Assuntos
COVID-19 , Síndrome Pós-Concussão , Humanos , Testes Neuropsicológicos , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/etiologia
6.
Neurol Clin ; 41(1): 193-213, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36400555

RESUMO

Dysautonomias are a heterogenous group of disorders that can cause variable symptoms ranging from isolated impairment of one autonomic function to multisystem failure. The causes are also diverse and can be central or peripheral and primary (owing to an intrinsic neurologic cause) or secondary (owing to a disorder that secondarily causes damage to the autonomic nervous system). This review covers common phenotypes of dysautonomias, primary and secondary causes, initial clinical workups, interpretation of common autonomic tests, and first-line treatments. A brief review of autonomic impairment associated with acute and long-COVID is also presented.


Assuntos
COVID-19 , Disautonomias Primárias , Humanos , Disautonomias Primárias/diagnóstico , Disautonomias Primárias/etiologia , Disautonomias Primárias/terapia
7.
Neurol Clin ; 41(1): 77-85, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36400560

RESUMO

Axial neck pain is a common and important problem in the outpatient setting. In isolation, neck pain tends to have a musculoskeletal etiology and responds best to medication and targeted physical therapy. Careful history and physical examination are required to ascertain if there is a neurologic component in addition to the patient's neck pain. For patients needing surgical intervention, there are a variety of approaches and operations that can decompress the appropriate nerve root or the spinal cord itself. These operations are generally well-tolerated and provide significant benefit for appropriately selected patients.


Assuntos
Cervicalgia , Exame Físico , Humanos , Cervicalgia/diagnóstico , Cervicalgia/etiologia , Cervicalgia/terapia , Diagnóstico Diferencial , Exame Físico/efeitos adversos
8.
Neurol Clin ; 41(1): 61-76, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36400559

RESUMO

Back pain is a common condition affecting millions of individuals each year. A biopsychosocial approach to back pain provides the best clinical framework. A detailed history and physical examination with a thorough workup are required to exclude emergent or nonoperative etiologies of back pain. The treatment of back pain first uses conventional therapies including lifestyle modifications, nonsteroidal anti-inflammatory drugs, physical therapy, and cognitive behavioral therapy. If these options have been exhausted and pain persists for greater than 6 weeks, imaging and a specialist referral may be indicated.


Assuntos
Terapia Cognitivo-Comportamental , Dor Lombar , Humanos , Dor Lombar/diagnóstico , Dor Lombar/etiologia , Dor Lombar/terapia , Diagnóstico Diferencial , Dor nas Costas/diagnóstico , Dor nas Costas/etiologia , Dor nas Costas/terapia , Anti-Inflamatórios não Esteroides
9.
Artigo em Inglês | MEDLINE | ID: mdl-36411077

RESUMO

BACKGROUND AND OBJECTIVES: Acute inflammatory CNS diseases include neuromyelitis optica spectrum disorders (NMOSDs) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Both MOGAD and acute disseminated encephalomyelitis (ADEM) have been reported after vaccination. Consequently, the mass SARS-CoV-2 vaccination program could result in increased rates of these conditions. We described the features of patients presenting with new acute CNS demyelination resembling NMOSDs or MOGAD within 8 weeks of SARS-CoV-2 vaccination. METHODS: The study included a prospective case series of patients referred to highly specialized NMOSD services in the UK from the introduction of SARS-CoV-2 vaccination program up to May 2022. Twenty-five patients presented with new optic neuritis (ON) and/or transverse myelitis (TM) ± other CNS inflammation within 8 weeks of vaccination with either AstraZeneca (ChAdOx1S) or Pfizer (BNT162b2) vaccines. Their clinical records and paraclinical investigations including MRI scans were reviewed. Serologic testing for antibodies to myelin oligodendrocyte glycoprotein (MOG) and aquaporin 4 (AQP4) was performed using live cell-based assays. Patients' outcomes were graded good, moderate, or poor based on the last clinical assessment. RESULTS: Of 25 patients identified (median age 38 years, 14 female), 12 (48%) had MOG antibodies (MOGIgG+), 2 (8%) had aquaporin 4 antibodies (AQP4IgG+), and 11 (44%) had neither. Twelve of 14 (86%) antibody-positive patients received the ChAdOx1S vaccine. MOGIgG+ patients presented most commonly with TM (10/12, 83%), frequently in combination with ADEM-like brain/brainstem lesions (6/12, 50%). Transverse myelitis was longitudinally extensive in 7 of the 10 patients. A peak in new MOGAD cases in Spring 2021 was attributable to postvaccine cases. Both AQP4IgG+ patients presented with brain lesions and TM. Four of 6 (67%) seronegative ChAdOx1S recipients experienced longitudinally extensive TM (LETM) compared with 1 of 5 (20%) of the BNT162b2 group, and facial nerve inflammation was reported only in ChAdOx1S recipients (2/5, 40%). Guillain-Barre syndrome was confirmed in 1 seronegative ChAdOx1S recipient and suspected in another. DISCUSSION: ChAdOx1S was associated with 12/14 antibody-positive cases, the majority MOGAD. MOGAD patients presented atypically, only 2 with isolated ON (1 after BNT162b2 vaccine) but with frequent ADEM-like brain lesions and LETM. Within the seronegative group, phenotypic differences were observed between ChAdOx1S and BNT162b2 recipients. These observations might support a causative role of the ChAdOx1S vaccine in inflammatory CNS disease and particularly MOGAD. Further study of this cohort could provide insights into vaccine-associated immunopathology.


Assuntos
COVID-19 , Encefalomielite Aguda Disseminada , Mielite Transversa , Neuromielite Óptica , Neurite Óptica , Feminino , Humanos , Glicoproteína Mielina-Oligodendrócito , Aquaporina 4 , Mielite Transversa/etiologia , Vacinas contra COVID-19/efeitos adversos , SARS-CoV-2 , Vacina BNT162 , COVID-19/prevenção & controle , Sistema Nervoso Central , Encefalomielite Aguda Disseminada/etiologia , Vacinação/efeitos adversos , Inflamação
10.
Ultrasound Med Biol ; 49(1): 309-317, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36441032

RESUMO

Accurate assessment of radiation-induced breast toxicity is crucial for the management of breast radiation therapy (RT). Standard assessment of breast toxicity based on clinicians' visual inspection and palpation has considerable inter- and intra-observer variability. To overcome this challenge, we present an ultrasound histogram method that objectively evaluates radiation-induced breast toxicity longitudinally. In a prospective study, patients enrolled (n = 67) received ultrasound scans at four time points: prior to RT, last day of RT, 3-4 wk post-RT and 9-12-wk post-RT. Ultrasound scans were acquired at five locations (tumor bed and 3, 6, 9 and 12 o'clock) on both breasts. Two hundred sixty-four ultrasound scans and 2640 B-mode images were analyzed. The histogram differences between irradiated and contralateral breasts were calculated to evaluate radiation-induced breast changes. On the basis of the B-mode images, the severity of breast toxicity was graded as absent, mild, moderate or severe. The performance of the histogram method was assessed with the receiver operating characteristic (ROC) curve. The areas under the ROC curve ranged from 0.78 to 0.9 (sensitivity: 0.88-0.96, specificity: 0.53-0.83) at the lower quadrant for differentiating absent/mild from moderate/severe toxicity at various time points. This study provides preliminary evidence that ultrasound histogram differences can serve as an imaging biomarker to longitudinally assess radiation-induced acute toxicity.


Assuntos
Neoplasias da Mama , Lesões por Radiação , Humanos , Feminino , Estudos Prospectivos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/radioterapia , Estudos Longitudinais , Mama/diagnóstico por imagem , Ultrassonografia , Lesões por Radiação/diagnóstico por imagem , Lesões por Radiação/etiologia
12.
Nicotine Tob Res ; 25(1): 12-18, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-35895382

RESUMO

INTRODUCTION: We aimed to calculate the Population Attributable Fraction (PAF) of cancers due to tobacco use in the Eastern Mediterranean Region (EMRO), where water-pipe smoking is prevalent but its effect was not considered in previous studies. AIMS AND METHODS: We applied Levin's formula to estimate PAFs of cancers due to tobacco use (defined as all type tobacco including both cigarette and water-pipe). We also calculated PAF of water-pipe smoking separately. Exposure prevalence data were retrieved from representative national and subnational surveys. Data on cancer incidence and death were also and cancer cases were obtained GLOBOCAN 2020. We also obtained associated relative risks from published meta-analyses. RESULTS: Of the total 715 658 incident adult cancer cases that were reported in 2020 in EMRO, 14.6% (n = 104 800) was attributable to tobacco smoking (26.9% [n = 92 753]) in men versus 3.3% (n = 12 048) in women. Further, 1.0% of incident adult cancers were attributable to current water-pipe use (n = 6825) (1.7% [n = 5568]) in men versus 0.4% (n = 1257 in women). CONCLUSIONS: PAFs of cancers due to tobacco smoking in EMRO were higher in our study than previous reports. This could be due to the neglected role of water-pipe in previous studies that is a common tobacco smoking method in EMRO. The proportion of cancers attributable to water-pipe smoking in EMRO might be underestimated due to lack of research on the risk of cancers associated with water-pipe smoking and also less developed cancer registries in EMRO. IMPLICATIONS: In this study, we found higher PAFs for cancers due to tobacco smoking in the Eastern Mediterranean (EMR) region than previous reports. This difference could be due to ignoring the role of water-pipe smoking in previous studies. In 2020, 1% of incident cancers and 1.3% of cancer-related deaths in EMRO were attributable to water-pipe smoking. We also found a big difference in PAFs of cancers due to tobacco and water-pipe smoking across EMRO countries, with Tunisia, Lebanon, and Jordan having the highest, and Djibouti, Sudan, and Somalia having the lowest proportions of cancers attributable to tobacco and water-pipe smoking.


Assuntos
Neoplasias , Produtos do Tabaco , Fumar Cachimbo de Água , Adulto , Masculino , Humanos , Feminino , Incidência , Tabaco , Neoplasias/epidemiologia , Neoplasias/etiologia , Prevalência , Fumar Tabaco
14.
BJOG ; 130(1): 99-106, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36043332

RESUMO

OBJECTIVE: To investigate women's preference for modified Manchester (MM) or sacrospinous hysteropexy (SH) as surgery for uterine prolapse. DESIGN: Labelled discrete choice experiment (DCE). SETTING: Eight Dutch hospitals. POPULATION: Women with uterine prolapse, eligible for primary surgery and preference for uterus preservation. METHODS: DCEs are attribute-based surveys. The two treatment options were labelled as MM and SH. Attributes in this survey were treatment success ( levels SH: 84%, 89%, 94%; levels MM: 89%, 93%, 96%), dyspareunia (levels: 0%, 5%, 10%), cervical stenosis (levels: 1%, 6%, 11%) and severe buttock pain (levels: 0%, 1%). A different combination of attribute levels was used in each choice set. Women completed nine choice sets, making a choice based on attribute levels. Data were analysed in multinomial logit models. MAIN OUTCOME MEASURES: Women's preference for MM or SH. RESULTS: 137 DCEs were completed (1233 choice sets). SH was chosen in 49% of the choice sets, MM in 51%. Of all women, 39 (28%) always chose the same surgery. After exclusion of this group, 882 choice sets were analysed, in which women preferred MM, likely associated with a labelling effect, i.e. description of the procedure, rather than the tested attributes. In that group, MM was chosen in 53% of the choice sets and SH in 47%. When choosing MM, next to the label, dyspareunia was relevant for decision-making. For SH, all attributes were relevant for decision-making. CONCLUSIONS: The preference of women for MM or SH seems almost equally divided. The variety in preference supports the importance of individualised healthcare.


Assuntos
Dispareunia , Prolapso Uterino , Feminino , Humanos , Prolapso Uterino/cirurgia , Preferência do Paciente , Dispareunia/etiologia , Útero/cirurgia , Inquéritos e Questionários , Resultado do Tratamento , Comportamento de Escolha
15.
BJOG ; 130(1): 70-77, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36052568

RESUMO

OBJECTIVE: To study the impact of shoulder dystocia (SD) simulation training on the management of SD and the incidence of permanent brachial plexus birth injury (BPBI). DESIGN: Retrospective observational study. SETTING: Helsinki University Women's Hospital, Finland. SAMPLE: Deliveries with SD. METHODS: Multi-professional, regular and systematic simulation training for obstetric emergencies began in 2015, and SD was one of the main themes. A study was conducted to assess changes in SD management and the incidence of permanent BPBI. The study period was from 2010 to 2019; years 2010-2014 were considered the pre-training period and years 2015-2019 were considered the post-training period. MAIN OUTCOME MEASURES: The primary outcome measure was the incidence of permanent BPBI after the implementation of systematic simulation training. Changes in the management of SD were also analysed. RESULTS: During the study period, 113 085 vertex deliveries were recorded. The incidence of major SD risk factors (gestational diabetes, induction of labour, vacuum extraction) increased and was significantly higher for each of these factors during the post-training period (p < 0.001). The incidence of SD also increased significantly (0.01% vs 0.3%, p < 0.001) during the study period, but the number of children with permanent BPBI decreased by 55% after the implementation of systematic simulation training (0.05% vs 0.02%, p < 0.001). The most significant change in the management of SD was the increased incidence of successful delivery of the posterior arm. CONCLUSIONS: Systematic simulation-based training of midwives and doctors can translate into improved individual and team performance and can significantly reduce the incidence of permanent BPBI.


Assuntos
Traumatismos do Nascimento , Plexo Braquial , Distocia , Distocia do Ombro , Treinamento por Simulação , Gravidez , Criança , Feminino , Humanos , Distocia do Ombro/epidemiologia , Distocia do Ombro/terapia , Distocia/epidemiologia , Distocia/terapia , Distocia/etiologia , Traumatismos do Nascimento/epidemiologia , Traumatismos do Nascimento/prevenção & controle , Incidência , Plexo Braquial/lesões , Parto Obstétrico/efeitos adversos , Parto Obstétrico/educação , Fatores de Risco , Ombro
16.
BJOG ; 130(1): 33-41, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36073305

RESUMO

OBJECTIVE: To describe the rates of and risk factors associated with iatrogenic and spontaneous preterm birth and the variation in rates between hospitals. DESIGN: Cohort study using electronic health records. SETTING: English National Health Service. POPULATION: Singleton births between 1 April 2015 and 31 March 2017. METHODS: Multivariable Poisson regression models were used to estimate adjusted risk ratios (adjRR) to measure association with maternal demographic and clinical risk factors. MAIN OUTCOME MEASURES: Preterm births (<37 weeks of gestation) were defined as iatrogenic or spontaneous according to mode of onset of labour. RESULTS: Of the births, 6.1% were preterm and of these, 52.8% were iatrogenic. The proportion of preterm births that were iatrogenic increased after 32 weeks. Both sub-groups were associated with previous preterm birth, extremes of maternal age, socio-economic deprivation and smoking. Iatrogenic preterm birth was associated with higher body mass index (BMI) (BMI >40 kg/m2 adjRR 1.59, 95% CI 1.50-1.69) and previous caesarean (adjRR 1.88, 95% CI 1.83-1.95). Spontaneous preterm birth was less common in women with a higher BMI (BMI >40 kg/m2 adjRR 0.77, 95% CI 0.70-0.84) and in women with a previous caesarean (adjRR 0.87, 95% CI 0.83-0.90). More variation between NHS hospital trusts was observed in rates of iatrogenic, compared with spontaneous, preterm births. CONCLUSIONS: Just over half of all preterm births resulted from iatrogenic intervention. Iatrogenic births have overlapping but different patterns of maternal demographic and clinical risk factors to spontaneous preterm births. Iatrogenic and spontaneous sub-groups should therefore be measured and monitored separately, as well as in aggregate, to facilitate different prevention strategies. This is feasible using routinely acquired hospital data.


Assuntos
Nascimento Prematuro , Gravidez , Recém-Nascido , Feminino , Humanos , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Idade Gestacional , Estudos de Coortes , Medicina Estatal , Fatores de Risco , Doença Iatrogênica/epidemiologia
18.
Am J Cardiol ; 186: 181-185, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36270826

RESUMO

Adverse cardiac events after laparoscopic bariatric surgery are rare, yet preoperative cardiology evaluation and testing remain common, resulting in the overuse of cardiac testing in low-risk patients. Our objective was to assess the frequency of, and factors associated with, overuse of preoperative cardiac testing in patients at low cardiac risk before laparoscopic bariatric surgery. We retrospectively reviewed data from 1,094 adult patients who underwent laparoscopic bariatric surgery at our institution from January 1, 2015, through December 31, 2019. The cardiac risk was determined using the Revised Cardiac Risk Index (RCRI) and the National Surgical Quality Improvement Program Myocardial Infarction and Cardiac Arrest (NSQIP MICA) risk model. Multivariate logistic regression was used to evaluate risk factors associated with the overuse of cardiac testing in low-risk patients. Overall, 1,059 patients (96.8%) were estimated to be at low cardiac risk by the RCRI, and 1,094 (100%) were at low cardiac risk by NSQIP MICA. A total of 587 patients (51.8%) were referred to cardiology for preoperative evaluation, and 643 patients (56.7%) underwent one or more preoperative cardiac tests. Factors associated with overuse of preoperative cardiac testing in low-risk patients included preoperative cardiology referral (adjusted odds ratio 37.2, 95% confidence interval 25.3 to 54.7) and patient age (adjusted odds ratio 1.05, 95% confidence interval 1.03 to 1.07). Overuse of preoperative cardiac testing was common in patients at low cardiac risk before laparoscopic bariatric surgery. Preoperative referral to cardiology was the most significant risk factor associated with the overuse of preoperative cardiac testing. Application of risk models such as the RCRI or NSQIP MICA at the time of bariatric program enrollment may reduce unnecessary preoperative cardiac testing in low-risk patients.


Assuntos
Cirurgia Bariátrica , Laparoscopia , Adulto , Humanos , Estudos Retrospectivos , Cirurgia Bariátrica/efeitos adversos , Fatores de Risco , Complicações Pós-Operatórias/etiologia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Medição de Risco/métodos
19.
Am J Otolaryngol ; 44(1): 103676, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36279829

RESUMO

PURPOSE: Patients with thyroid goiters and compressive symptoms are treated with surgery. The adequate extent of this surgery for these cases remains unclear. In the current study, we analyze the effect of surgery, total thyroidectomy versus hemithyroidectomy, on the resolution of various compressive symptoms. MATERIALS AND METHODS: This retrospective analysis utilized the TriNetX Research Network to recognize adults with thyroid goiters treated surgically. International Classification of Diseases 10 (ICD10) was used to identify patients. Two groups were created based on surgical treatment, for either a hemithyroidectomy or total thyroidectomy. The primary outcomes were compression symptoms, including dysphagia, choking/globus sensation, dyspnea, cough, and hoarseness/dysphonia. RESULTS: This retrospective review included 45,539 subjects. Of these, 9293 had a partial thyroidectomy, and 36,246 had a total thyroidectomy. After propensity score matching was done for compression symptoms before surgery, there were 8280 patients in each group. There were no differences in symptoms between the matched groups, except for increased hoarseness and dysphonia after total thyroidectomy (RR, 95 % CI) (0.781, 0.67-0.91). Compression symptoms significantly decreased after surgical treatment in both the hemithyroidectomy and total thyroidectomy groups. CONCLUSIONS: Hemithyroidectomy is associated with efficacy similar to total thyroidectomy in reducing compression symptoms postoperatively. Hemithyroidectomy may be able to alleviate compressive symptoms with less surgical risk.


Assuntos
Disfonia , Bócio , Neoplasias da Glândula Tireoide , Adulto , Humanos , Tireoidectomia/efeitos adversos , Estudos Retrospectivos , Rouquidão/etiologia , Rouquidão/cirurgia , Bócio/complicações , Bócio/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/complicações
20.
Behav Brain Res ; 438: 114171, 2023 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-36280008

RESUMO

Cognitive dysfunction is the main clinical manifestation of Alzheimer's disease (AD). Previous research found that elevated orexin level in the cerebrospinal fluid was closely related to the course of AD, and orexin-A treatment could increase amyloid ß protein (Aß) deposition and aggravate spatial memory impairment in APP/PS1 mice. Furthermore, recent research found that dual orexin receptor (OXR) antagonist might affect Aß level and cognitive dysfunction in AD, but the effects of OX1R or OX2R alone is unreported until now. Considering that OX1R is highly expressed in the hippocampus and plays important roles in learning and memory, the effects of OX1R in AD cognitive dysfunction and its possible mechanism should be investigated. In the present study, selective OX1R antagonist SB-334867 was used to block OX1R. Then, different behavioral tests were performed to observe the effects of OX1R blockade on cognitive function of 3xTg-AD mice exhibited both Aß and tau pathology, in vivo electrophysiological recording and western blot were used to investigate the potential mechanism. The results showed that chronic OX1R blockade aggravated the impairments of short-term working memory, long-term spatial memory and synaptic plasticity in 9-month-old female 3xTg-AD mice, increased levels of soluble Aß oligomers and p-tau, and decreased PSD-95 expression in the hippocampus of 3xTg-AD mice. These results indicate that the detrimental effects of SB-334867 on cognitive behaviors in 3xTg-AD mice are closely related to the decrease of PSD-95 and depression of in vivo long-term potentiation (LTP) caused by increased Aß oligomers and p-tau.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Camundongos , Animais , Feminino , Doença de Alzheimer/complicações , Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/metabolismo , Peptídeos beta-Amiloides/metabolismo , Orexinas/metabolismo , Camundongos Transgênicos , Modelos Animais de Doenças , Disfunção Cognitiva/tratamento farmacológico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/patologia , Hipocampo/metabolismo , Antagonistas dos Receptores de Orexina/farmacologia , Proteínas tau/metabolismo , Precursor de Proteína beta-Amiloide/metabolismo
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