Normal Physiological Changes Research Articles

Use of a Sepsis Simulation to Teach Undergraduate Nursing Students About Maternal Mortality

The purpose of this project is to illuminate the importance of vigilant postpartum care in reducing maternal morbidity and mortality related to sepsis through the implementation of a simulation-based learning experience. Nursing schools should implement a simulation-based learning experience aimed at reducing maternal morbidity and mortality related to sepsis. The simulation was implemented during the senior medical–surgical critical care course. Groups consisted of 8–10 student participants. A high-fidelity birthing mannequin was used to simulate the patient, and a detailed scenario was presented to the students. Debrief and discussion were provided after the simulation. The Simulation Effectiveness Tool—Modified (SET–M), which is a standardized instrument, was used to assess the simulation effectiveness. The tool asks participants to rate their experience using strongly agree, somewhat agree, or do not agree on questions pertaining to the prebriefing, the scenario, and the debriefing. Of the 95 respondents, 88 (93%) strongly agreed that prebriefing was beneficial to [their] learning; 90 (95%) strongly agreed that [they are] better prepared to respond to changes in [their] patient’s condition; 88 (93%) strongly agreed that [they are] more confident in using evidence-based practice to provide nursing care; and 92 (97%) strongly agreed that debriefing was a constructive evaluation of the simulation and that it contributed to [their] learning. The normal physiologic changes during pregnancy and after birth, along with the complex clinical features associated with maternal sepsis, make maternal sepsis a well-suited clinical scenario for clinical simulation, both within nursing schools and for experienced nurses. Nurses spend more time with laboring and postpartum patients than any other health care provider in the hospital setting, which makes them uniquely poised to identify and treat the early signs and symptoms of sepsis; the ability to do so may lead to decreased maternal morbidity and mortality.

Clinical presentation, risk factors and pathogens involved in bacteriuria of pregnant women attending antenatal clinic of 3 hospitals in a developing country: a cross sectional analytic study

BackgroundPregnancy increases the risk of recurrent bacteriuria and acute pyelonephritis which is associated with significant maternal and fetal risks. The prevalence of bacteriuria varies worldwide. Clinical diagnosis is challenging since it is usually mistaken for normal physiological changes during pregnancy. This study aims to determine the prevalence, clinical presentation, risk factors and microorganism responsible for bacteriuria in pregnant women of Douala city, Cameroun.MethodsA cross-sectional study was conducted in 3 hospitals of Douala from January to April 2015. We consecutively recruited all consented pregnant women aged 18 years and above attending antenatal clinics. Socio-demographic characteristics, medical and obstetrical past history, clinical signs and obstetric characteristics of the index pregnancy were collected. Thereafter, urine were collected aseptically and subjected to routine macroscopy, microscopy examination and culture. The culture was obtained by inoculation of 10 μl of urine on the appropriate medium. Identification of pathogens was done automatically using the VITEK2™ (BioMérieux- France). Data were processed using the Statistical Package for the Social Sciences (SPSS) 18. Statistics were descriptive and analytic; Odds ratios were calculated. Associations between variables and bacteriuria were conducted using the Chi squared test and the fisher exact probability. Associations with p-values < 0.05 were considered statistically significant.ResultsOverall, 354 pregnant women were enrolled with mean of age 28.18 ± 4.4. The prevalence of significant bacteriuria was 9.9% (35 out of 354). The prevalence of bacteriuria in women who were asymptomatic was 5.7%. Cystitis and pyelo-nephritis were observed in 3.6 and 0.6% respectively. The most commonly isolated organism was Escherichia coli (E. coli): 48.6%. History of Urinary Tract Infection (UTI) (p = 0.035, OR = 2.183, CI = 1.055–4.518) was significantly associated with bacteriuria. High level of education was protective.ConclusionsBacteriuria was frequent in pregnant women and significantly increased with the past history of UTI and low level of education. Asymptomatic bacteriuria was more common. E coli was the most frequent uropathogen. Education and proper treatment of UTI should be provided to reduce the burden of this pathology in order to prevent its severe complications.

Metabolic trajectories across early adolescence: differences by sex, weight, pubertal status and race/ethnicity

Background: Biomarkers of cardiovascular and metabolic risk track from adolescence into adulthood, therefore characterising the direction and magnitude of these changes is an important first step to identifying health trajectories that presage future disease risk.Aim: To characterise changes in metabolic biomarkers across early adolescence in a multi-ethnic cohort.Subjects and methods: Among 891 participants in Project Viva we estimated changes in insulin resistance (HOMA-IR), adipokines, lipids, and SBP between ages 6–10 years and 11–16 years. Next, we used multivariable linear regression to examine associations of sex, baseline overweight/obesity, baseline pubertal status and race/ethnicity with change in the biomarkers during follow-up.Results: Boys exhibited a larger decrement in adiponectin (−0.66 [95% CI = −1.14, −0.18)] ng/mL) and a greater increase in SBP (3.20 [2.10, 4.30] mmHg) than girls. Overweight/obese participants experienced larger increases in HOMA-IR, leptin, and triglycerides; and a steeper decrement in HDL. Pubertal youth showed larger decrements in total and LDL cholesterol than their pre-pubertal counterparts. In comparison to White participants, Black youth experienced a larger magnitude of increase in HOMA-IR, and Hispanic youth exhibited larger decrements in adiponectin and HDL.Conclusions: Change in metabolic biomarkers across early adolescence differed by sex, weight status, pubertal status and race/ethnicity. Some of the metabolic changes may reflect normal physiological changes of puberty, while others may presage future disease risk. Future studies are warranted to link metabolic changes during adolescence to long-term health.

ECS Dynamism and Its Influence on Neuronal Excitability and Seizures.

Seizure activity is governed by changes in normal neuronal physiology that lead to a state of neuronal hyperexcitability and synchrony. There is a growing body of research and evidence suggesting that alterations in the volume fraction (α) of the brain's extracellular space (ECS) have the ability to prolong or even initiate seizures. These ictogenic effects likely occur due to the ECS volume being critically important in determining both the concentration of neuroactive substances contained within it, such as ions and neurotransmitters, and the effect of electric field-mediated interactions between neurons. Changes in the size of the ECS likely both precede a seizure, assisting in its initiation, and occur during a seizure, assisting in its maintenance. Different cellular ion and water transporters and channels are essential mediators in determining neuronal excitability and synchrony and can do so through alterations in ECS volume and/or through non-ECS volume related mechanisms. This review will parse out the relationships between how the ECS volume changes during normal physiology and seizures, how those changes might alter neuronal physiology to promote seizures, and what ion and water transporters and channels are important in linking ECS volume changes and seizures.

Histopathological correlation of endometrial samples in pre and postmenopausal women with abnormal uterine bleeding

Abstract Introduction: Abnormal Uterine Bleeding (AUB) is the most common clinical presentations in pre and postmenopausal women and is caused by various etiological factors ranging from inflammatory, benign to malignant lesions. The microscopical examination of the endometrium carries an important role in diagnosing various etiopathological factors in cases of AUB. Objectives: To know the spectrum of lesions of the endometrium with respect to age. To determine histopathological correlation of endometrial samples in pre and postmenopausal women. Materials and Methods: A cross sectional study was conducted from October 2009 to September 2011,involving 250 female patients, 40 years and above presenting with AUB. The patient’s endometrial samples were collected by biopsy, D & C or hysterectomy. Results: The maximum incidence of AUB in premenopausal women were seen in 40-42 years age group (38.42%), while in postmenopausal women, highest incidence of AUB cases were seen in the age group of 50-52(43.3%). years In the present study there was a high association between histopathological spectrum of endometrial lesions and age. Proliferative pattern was the commonest endometrial profile in the age group of 50-54 years (30.31%), where as secretory pattern (30.29%) was common in the age group of 45-49 years, atrophic Endometrium (100%) is seen in the age group of 65-69 years, polyps (24.9%) in the age group of 60-64 years, endometritis (9.0%) in age group of 45-49 years, irregular shedding (21.6%) in the age group of 40-44 years, simple hyperplasia (19.6%) in the age group of 45-49 years, whereas endometrial adenocarcinoma was more frequent in the age group of 55-59 years (11.7%). In premenopausal women, the most common endometrial pattern was secretory (26.8%), while in postmenopausal women majority of the endometrial profiles were atrophic (41.7%). Conclusion: This study showed that other than normal physiological changes in both pre and

Recent Updates and Guidelines in Anesthetic Management of Obstetric Emergencies

The pregnant mother is subjected to major changes in her anatomy and physiology to can feed and accommodate the growing baby. Such changes initiate subsequently after gestation have an influence on body organs. It is essential to discriminate between normal physiological changes and pathological changes. The anesthetist is considered a substantial part in the management of risky pregnancies, and must be a member of the multidisciplinary team who is assigned to concern for seriously ill parturient. Considerations must be taken to physiological modifications during treatment. The aim of this work is to highlight the risk factors and etiology of obstetric emergencies and how to manage them based on recent updates and guidelines

Optimal Management of a Pregnant Patient with Rheumatic Heart Disease

Rheumatic heart disease remains the number one worldwide cause of maternal cardiac complications in pregnancy.1 Since symptoms of rheumatic fever typically do not present until the fourth or fifth decade, the pathophysiologic changes associated with pregnancy may cause as many as 25% of these women to first experience symptoms during pregnancy. For this reason, it is important that obstetric anesthesiologists remain aware of the disease, its complications, and management of valvular lesions throughout the birthing process. The normal physiologic changes of pregnancy cause unique problems to the mother with underlying cardiac disease.2 Intravascular volume and cardiac output (CO) increase while systemic vascular resistance (SVR) decreases to preserve normal mean arterial pressure (MAP). During labor, each uterine contraction results in an auto transfusion of blood, resulting in even higher CO.3 Likewise, pain and apprehension can lead to sympathetically mediated increases in SVR, heart rate (HR), and CO causing further stress.2 Yet, the greatest stress comes immediately after delivery when uterine contraction and involution can increase CO by as much as 80% above third trimester values.3 With all these changes, one must realize how valvular disease is affected during pregnancy. In general, regurgitant lesions are tolerated better due to the increase in intravascular volume and the decrease in SVR, thus improving forward flow of blood through the valves.2,3 In contrast, stenotic lesions are tolerated poorly due to the inability to increase CO through a stenotic valve in the setting of increased intravascular volume and increased preload.2 In patients with rheumatic heart disease, mitral stenosis is the most common heart lesion.1 When these patients become pregnant, the hypervolemia and increased HR can increase the transmitral pressure gradient, leading to increased left atrial volume and pressure. Pressure can be transmitted to the pulmonary vasculature, resulting in pulmonary edema and in severe cases pulmonary hypertension, a significant risk during pregnancy as it can cause right heart failure.4 Further, the chronically dilated left atrium has a propensity to disrupt the cardiac conducting system and cause supraventricular tachycardia, 1 a detrimental event in patients with mitral stenosis who rely on the atrial kick to augment preload. Overall, these factors often cause the previously undiagnosed and asymptomatic patient to develop symptoms during pregnancy, and, in severe cases, experience profound cardiac decompensation.

Hipertiroidismo en el embarazo

La relación hipertiroidismo y embarazo es poco común. Su importancia recae en el pronóstico de la madre y el feto. El reconocimiento de las alteraciones tiroideas durante el embarazo difiere de la población general. En este grupo poblacional es necesario correlacionar las pruebas diagnósticas con los cambios fisiológicos durante este periodo. La principal causa de hipertiroidismo es la enfermedad de Graves, consu componente autoinmune. La tirotoxicosis gestacional transitoria toma relevancia durante el embarazo y es un diagnóstico diferencial importante durante el primer trimestre. El manejo del hipertiroidismo durante el embarazo tiene implicaciones especiales. Las terapias de primera línea convencionales están contraindicadas, y toman relevancia los medicamentos antitiroideos. Ninguna terapia es totalmentesegura durante el embarazo y se deben evaluar los posibles efectos adversos e implicaciones para la madre y el feto. En esta revisión queremos dar a conocer los cambios en la función tiroidea durante la gestación; además, las pautas necesarias para el adecuado reconocimiento, diagnóstico y manejo del hipertiroidismo durante el embarazo, con el fin de disminuir la morbilidad y mortalidad materno-fetal. Se realizó una revisión de la literatura en PubMed y Science Direct utilizando palabras MeSH y conectores. Se incluyeron artículos especiales más relevantes publicados por las sociedades internacionales en los últimos 20 años sobre el diagnóstico y manejo del hipertiroidismo durante el embarazo.

Cardiac Drugs in Pregnancy

AbstractHeart disease complicating pregnancy is an indirect cause of maternal mortality and its incidence in India is 1 to 4%. Cardiac disease in pregnant women is most commonly due to rheumatic heart disease (RHD), congestive heart failure, and less commonly due to ischemic heart disease or cardiomyopathy. Though the frequency of RHD has decreased worldwide, it is still predominant in developing countries such as India. Around 15 to 52% of cardiac abnormalities first diagnosed during routine antenatal checkups or due to the signs and symptoms caused by physiologic changes of pregnancy. The most common clinical features of cardiac lesions such as breathlessness, pedal edema, and murmurs that mimic normal physiologic changes in pregnancy pose a diagnostic difficulty for obstetricians.

Anesthetic Treatment of Cardiac Disease During Pregnancy

This review summarizes the pathophysiology, peripartum treatment, and anesthetic management of parturients with cardiac disease. Valvular disease, coronary disease, and cardiomyopathy are specifically addressed in the context of the normal physiologic changes of pregnancy. We offer recommendations for anesthetic approaches, hemodynamic goals with an emphasis on interdisciplinary planning between anesthesiologists, cardiologists, cardiothoracic surgeons, obstetricians, maternal fetal medicine specialists, and neonatologists. Vaginal delivery with neuraxial analgesia can be well tolerated by many pregnant patients with cardiac disease when coordinated by an interdisciplinary team of experts. Cardiac disease in pregnancy can present a significant challenge for the interdisciplinary care team. A detailed understanding of each patient's cardiac pathology and the physiologic changes of pregnancy are critical to ensure a safe and successful labor and delivery. Optimized medical therapy in the peripartum period and neuraxial anesthesia with the judicious use of vasoactive agents can be of great benefit for these parturients. As is generally the case, cesarean delivery should be primarily reserved for obstetric indications and maternal wellbeing, with careful consideration of the fetus to guide best practices.

Pharmacotherapy management in critically ill older adults

In Brief Caring for critically ill older adults presents many challenges for critical care nurses. One challenge is the management of complex pharmacotherapy in the presence of the normal physiologic changes associated with aging. Complex pharmacotherapy management is a particular challenge in the care of critically ill older adults. Explore the science of pharmacokinetics and pharmacodynamics, as well as nursing implications.

Correlation Between Neck Circumference and Gestational Diabetes Mellitus and Associated Risk Factors During Pregnancy.

IntroductionDue to normal physiological changes in various anthropometric indices during pregnancy, the routine measurements of body weight, height, waist circumference, and waist-to-hip ratio are deemed inappropriate in predicting obesity and risk of gestational diabetes mellitus in pregnancy. Neck circumference is a novel marker to determine the risk of gestational diabetes in pregnancy. We conducted this study to determine the correlation between neck circumference and gestational diabetes mellitus and its associated risk factors.MethodsThis was an observational, cross-sectional study conducted at Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE), Allama Iqbal Medical College/ Jinnah Hospital, Lahore from July 2017 to March 2018. Pregnant females at 16 weeks of gestation underwent measurement of weight, height, body mass index, neck, and waist circumference. At the 24th gestational week, an oral glucose test was conducted and fasting lipid profile, serum albumin, and uric acid were measured. Pearson’s correlation was used to see any correlation between neck circumference and gestational diabetes and its associated risk factors.ResultsThere were 90 subjects in the study with a mean age 30.8 ± 3.2 (range: 26 – 34) years. The waist and neck circumference at 16 weeks of gestation measured 104.2 ± 9.0 cm and 36.1 ± 2.8 cm, respectively. Age, weight, waist circumference, and body mass index were positively and significantly correlated with neck circumference (p-value < 0.05). After adjusting for age, the correlation between neck circumference and weight, waist circumference, and body mass index (BMI) was statistically significant with a p-value < 0.05. Analysis of the receiver operating curve revealed that the cut-off value of neck circumference for predicting gestational diabetes was 35.70 cm with a sensitivity of 51.4% and specificity of 81.2%.ConclusionNeck circumference at the 16th gestational week is a reliable and valid tool to predict gestational diabetes mellitus at 24 weeks of gestation.

Physiology of Pregnancy

The purpose of this review is to familiarize the trauma practitioner with the normal physiologic changes of pregnancy allowing them to recognize when a traumatic injury has caused a derangement to one of these physiologic systems. While nearly every physiologic system is changed during pregnancy, this review focuses on the changes which are clinically relevant to the trauma patient. While there is scant new literature in this area, we review many of the landmark studies and essential text which have allowed practitioners to understand the complex physiology of the pregnant patient. This article summarizes the physiologic changes in anatomy, the cardiovascular system, the respiratory system, the genitourinary system, the gastrointestinal system, the hematologic system, and the musculoskeletal system and highlights the relevant clinical findings which guide evaluation and management of the pregnant trauma patient.

Role of Bioreactor Technology in Tissue Engineering for Clinical Use and Therapeutic Target Design.

Micro and small bioreactors are well described for use in bioprocess development in pre-production manufacture, using ultra-scale down and microfluidic methodology. However, the use of bioreactors to understand normal and pathophysiology by definition must be very different, and the constraints of the physiological environment influence such bioreactor design. This review considers the key elements necessary to enable bioreactors to address three main areas associated with biological systems. All entail recreation of the in vivo cell niche as faithfully as possible, so that they may be used to study molecular and cellular changes in normal physiology, with a view to creating tissue-engineered grafts for clinical use; understanding the pathophysiology of disease at the molecular level; defining possible therapeutic targets; and enabling appropriate pharmaceutical testing on a truly representative organoid, thus enabling better drug design, and simultaneously creating the potential to reduce the numbers of animals in research. The premise explored is that not only cellular signalling cues, but also mechano-transduction from mechanical cues, play an important role.

Small-Group Activity to Reinforce the Impact of Valvular Defects and Heart Failure on Cardiac Pressure-Volume Relationships.

An important topic in cardiac physiology is the relationship between changes in intracardiac pressures and volumes during the cardiac cycle. This topic lends itself well to utilizing active learning principles to facilitate student understanding of pressure and volume changes in normal cardiac physiology and in the pathophysiology of valve disease and heart failure. We describe an active learning exercise regarding this topic that engages and facilitates student learning in a small-group setting. Following an overview lecture on the normal cardiac physiology, small groups of students under the guidance of a facilitator were provided with a worksheet consisting of questions related to background knowledge of cardiac physiology. Additional questions related to five valve disease and heart failure cases were also provided to promote the application of basic physiology principles to clinically relevant problems. The facilitator was provided with a guide to help facilitate the student interactions. Following the group worksheet activity, an animated slide presentation was shown to further engage student learning through active discussion of their worksheet answers. Students were assessed by written examination, and were found to have a higher performance on the subset of questions related to this learning activity compared to the overall exam. Of the 175 students completing the exercise, 23 voluntarily provided feedback via a survey. Student surveys provided overwhelmingly positive feedback on the benefits of this active learning exercise. Small group, active learning exercises benefited student learning by providing a framework for analysis, synthesis, and application of clinically relevant cardiac physiology concepts.

The Many Facets of Metzincins and Their Endogenous Inhibitors: Perspectives on Ovarian Cancer Progression.

Approximately sixty per cent of ovarian cancer patients die within the first five years of diagnosis due to recurrence associated with chemoresistance. The metzincin family of metalloproteinases is enzymes involved in matrix remodeling in response to normal physiological changes and diseased states. Recently, there has been a mounting awareness of these proteinases and their endogenous inhibitors, the tissue inhibitors of metalloproteinases (TIMPs), as superb modulators of cellular communication and signaling regulating key biological processes in cancer progression. This review investigates the role of metzincins and their inhibitors in ovarian cancer. We propose that understanding the metzincins and TIMP biology in ovarian cancer may provide valuable insights in combating ovarian cancer progression and chemoresistance-mediated recurrence in patients.

Maternal engineered nanomaterial inhalation during gestation alters the fetal transcriptome

BackgroundThe integration of engineered nanomaterials (ENM) is well-established and widespread in clinical, commercial, and domestic applications. Cardiovascular dysfunctions have been reported in adult populations after exposure to a variety of ENM. As the diversity of these exposures continues to increase, the fetal ramifications of maternal exposures have yet to be determined. We, and others, have explored the consequences of ENM inhalation during gestation and identified many cardiovascular and metabolic outcomes in the F1 generation. The purpose of these studies was to identify genetic alterations in the F1 generation of Sprague-Dawley rats that result from maternal ENM inhalation during gestation. Pregnant dams were exposed to nano-titanium dioxide (nano-TiO2) aerosols (10 ± 0.5 mg/m3) for 7-8 days (calculated, cumulative lung deposition = 217 ± 1 μg) and on GD (gestational day) 20 fetal hearts were isolated. DNA was extracted and immunoprecipitated with modified chromatin marks histone 3 lysine 4 tri-methylation (H3K4me3) and histone 3 lysine 27 tri-methylation (H3K27me3). Following chromatin immunoprecipitation (ChIP), DNA fragments were sequenced. RNA from fetal hearts was purified and prepared for RNA sequencing and transcriptomic analysis. Ingenuity Pathway Analysis (IPA) was then used to identify pathways most modified by gestational ENM exposure.ResultsThe results of the sequencing experiments provide initial evidence that significant epigenetic and transcriptomic changes occur in the cardiac tissue of maternal nano-TiO2 exposed progeny. The most notable alterations in major biologic systems included immune adaptation and organismal growth. Changes in normal physiology were linked with other tissues, including liver and kidneys.ConclusionsThese results are the first evidence that maternal ENM inhalation impacts the fetal epigenome.

Research and Clinics Partnership Stress and Diabetes Mellitus (DM) at Cell and Molecular Levels

Stress is a state of a living cells and tissues that triggers undesired changes in normal physiology. Cell culture system is a reliable and established way to study the molecular basis of stress and find ways to intervene. India is the potential diabetic capital of the world. Diabetes mellitus may easily trigger the development of heart- and brain-related diseases blindness and liverkidney failure. Mortalin is a member of hsp70 family of stress proteins that regulates mitochondria function and provides quality control mechanism for other proteins. It is one of the key determinant of cancerous properties of cells upregulated and age-linked brain pathologies down regulated.nbsp

Liver Function Tests in Normal Pregnant Women

Changes in liver function tests (LFTs) are normal during pregnancy. However, severe liver disease, although rare, can occur and must be recognized at an early stage to reduce maternal and fetal morbidity and mortality. It is important to differentiate between normal physiological changes and disease pathology. This review highlights the important LFT changes that take place during normal pregnancy.

Skin Changes during Pregnancy: A Study from Northeast India.

Skin Changes during Pregnancy: A Study from Northeast India.