Related Medical Complications Research Articles

Maternal Predictors of Intrauterine Growth Retardation.

To identify maternal factors associated with intrauterine growth restriction (IUGR). A case-control study. Neonatal Unit of The Aga Khan Hospital for Women (AKHW), Karimabad, from January 2014 to December 2015. Cases were IUGR live born babies (n=90), while control were appropriate-for-gestational age (AGA) babies (n=180). Information recorded in pre-designed proforma included gestational age and birth weight of baby, demographics of mothers, pregnancy related medical and obstetric complications. Data were analysed through SPSS-19. Multivariable logistic regression was used to determine the maternal factors associated with the intrauterine growth restriction. Maternal factors associated with IUGR after adjusting for confounders in the multivariable model included younger age (OR=0.9, CI=0.8-0.9), poor gestational weight gain (OR=3.0, CI=1.6-6.1) and history of previous abortion (OR=3.06, CI=1.1-8.0). Significant interaction was found between pregnancy-induced hypertension (PIH) and parity of mother, primary-para mother with PIH having an increased risk for IUGR babies (OR=10.1, CI=1.0-23.2). Young age, primigravida status, low gestational weight gain, previous history of abortion, PIH and GDM have strong association with IUGR; hence, special consideration is essential to overcome these issues in order to improve maternal and neonatal health.

FGF-21 as a Potential Mediator for the Antidepressant Effects of Physical Exercise

Major depressive disorder (MDD), a common psychiatric disease co-morbid with obesity and diabetes, has been one of the most important causes of disability worldwide. Physical exercise by far, is the most effective strategy for the prevention and treatment of MDD. Fibroblast growth factor 21 (FGF-21) is critically involved in energy metabolism and a potential therapeutic agent for treating obesity and its related medical complications. Although the brain is known to be a target of FGF-21 actions, its role in neuropsychological disorders remain unclear. Here, we showed that serum FGF-21 increased progressively with physical exercise and peaked at 3 hours after running, which was 1-2 hours later than that of free fatty acids, suggesting that increased free fatty acids might be the natural agonist of PPARα that induces FGF-21 production during exercise. Real-time PCR analysis further demonstrated that exercise-induced elevation of circulating FGF-21 was predominately from the liver. Furthermore, a series of behavior studies, including tail suspension test, forced swimming test and saccharin preference test uniformly showed that exercise training significantly alleviated depressive symptoms in wild type (WT) mice, which were largely diminished in FGF-21 knockout (KO) mice. Likewise, levels of inflammation markers in the hippocampus were significantly decreased, while synaptic plasticity were notably increased in exercised WT, but not in FGF-21 KO mice, suggesting that inhibition of neuroinflammation and neurogenesis might contribute to the antidepressant effects of FGF-21 during exercise. In conclusion, FGF-21 is a liver-derived exercise responsive factor mediating the anti-depressant effect of exercise in mice. Disclosure Y. Liu: None. S. Yau: None. Y. Wang: None. A. Xu: None.

Maternal Outcomes Associated with Caesarean versus Vaginal Delivery.

To choose the best mode of delivery (vaginal versus caesarean section) still remains a contentious issue. Caesarean section is a major abdominal surgery with its related medical, anesthetic and surgical complications. Maternal mortality and morbidity is higher in caesarean section compared with vaginal delivery. The most common causes of maternal mortality during caesarean section are due to anesthesia, bleeding and infection. The aim of this study was to determine the mode of delivery and maternal outcomes in Sanandaj's hospital, Iran, during one year. The study population included all women who were admitted for delivery in Sanandaj's Hospital. Data collection instrument was a researcher made questionnaire. Data were entered into SPSS version 20.0 and analyzed using Chi-square test. Desired outcomes were entered into multiple logistic regression models. For estimating the parameters and increasing the level of significance we used bootstrap to generate 1000 samples. During the study, a total of 5984 deliveries were conducted in Sanandaj Hospital, of which 3423 (57.20%) were vaginal (vaginal, vaginal + episiotomy, instrumental delivery) and 2561 (42.80%) were caesarean section. The results showed a statistically significant association between delivery mode and demographic variables such as age, occupation and level of education; whereas, no significant association was found between place of residence and parity. The finding of this study showed that caesarean section delivery rate in Sanandaj was 42.80% in 2012-2013 which is higher than caesarean section rate recommended by WHO. Also, there was a relationship between mode of delivery and maternal outcomes.

Alcohol Misuse is an Independent Risk Factor for Poorer Postoperative Outcomes Following Primary Total Hip and Total Knee Arthroplasty

The influence of alcohol misuse on outcomes following primary total hip (THA) or knee (TKA) arthroplasty is poorly understood. Using the National Hospital Discharge Survey, a cohort representative of 8,372,232 patients (without cirrhosis) who underwent THA or TKA between 1990 and 2007 was identified and divided into two groups: (1) those who misused alcohol (n=50,861) and (2) those who did not (n=8,321,371). Differences in discharge status, comorbidities and perioperative complications were analyzed. Compared to patients with no diagnosis of alcohol misuse, alcohol misusers were nine times more likely to leave against medical advice and had longer hospital stays (P<0.001). Alcohol misuse was independently associated with higher odds of in hospital complications (OR: 1.334, range: 1.307–1.361), surgery related complications (OR: 1.293, range: 1.218–1.373) and general medical complications (OR: 1.300, range: 1.273–1.327).

Acceptance-Based Therapy, Mindfulness, and Modification of Environmental Risk Factors for Weight Control

lthough people are often successful in losing weight, sustaining weight loss and healthy eating over the long term is challenging for many. New behavioral strategies can be used to help patients use acceptance and mindfulness to improve decision making. Additionally, behavioral strategies can help to promote a healthy environment for children, reducing the risk of obesity and related medical complications.

Increase in Perioperative Complications Following Primary Total Hip and Knee Arthroplasty in Patients With Hepatitis C Without Cirrhosis

The effects of hepatitis C on primary total hip (THA) and knee (TKA) arthroplasties are poorly understood. The National Hospital Discharge Survey was used to identify patients who underwent THA or TKA between 1990 and 2007 without a diagnosis of cirrhosis, HIV, or hepatitis A, B, D or E virus infection. Patients were split into two groups: 1) hepatitis C (n=26,444) and 2) non-hepatitis C (n=8,336,882) and analyzed for differences in length of hospital stay, discharge status and perioperative complications. Those with hepatitis C had shorter hospital stays, higher rates of nonroutine discharge and higher odds of in-hospital complications (OR: 1.686, range: 1.645–1.727), surgery related complications (OR: 1.559, range: 1.516–1.603) and general medical complications (OR: 2.012, range: 1.961–2.064) (P<0.001).

Durotomy repair in minimally invasive transforaminal lumbar interbody fusion by nonpenetrating clips.

Background:Closure of the dura defect may be easy to perform in open lumbar surgery but could be difficult in minimally invasive transforaminal lumbar interbody fusions (MIS-TLIF) since MIS-TLIF was done through a small tube, which limited the use of standard dural repair instruments. We used nonpenetrating titanium clips that were originally designed for the vascular anastomoses to repair the dura defect, which is never described in the literature.Methods:We presented a case of spinal stenosis with incidental durotomy while performing MIS-TLIF. We closed the dura laceration with three medium-sized nonpenetrating titanium clips (AnastoClip Vessel Closure System, LeMaitre Vascular, Inc., Burlington, MA).Results:Nonpenetrating titanium clips have the benefits of being technically easy to use, reduced durotomy repair time, decreased bed rest due to related medical complications, superior postoperation with immediate hydrostatic strength, and better reapproximation if it fails to clip successfully. As for the postoperation follow up, clips are tiny and reveal no obvious artifact, especially in cases where the pedicle screws are already causing much artifact.Conclusion:Primary dural closure during MIS-TLIF with clips is an effective way in cases that involve limited tubular space.

Trends in less-lethal use of force techniques by police services within England and Wales: 2007–2011

The aim of this study was to determine the incidence of, and any changes in, usage patterns of the less-lethal forms of Use of Force (UoF) modalities--incapacitant spray, impact rounds, and Taser(R)--between 2007 and 2011 by English and Welsh police services. Additional information regarding the deployment and discharge of firearms was also sought. Two thousand Freedom of Information Act applications were made to 50 police services in England and Wales and related jurisdictions requesting the provision of: (a) the total number of deployments of incapacitant sprays, Taser(R), impact (baton) rounds, and armed response units (ARU); (b) the numbers and types of any resulting medical complications; and (c) the details of any local policies requiring assessment by a healthcare professional following a deployment. Responses were received from 47 police services, with only 10 of these supplying complete data. The remainder supplied incomplete data or refused to supply any data under s12 of the Freedom of Information Act (time and cost restrictions). From 2007 to 2011, the use of incapacitant sprays, Taser, and firearms have increased (incapacitant sprays deployed: 3496, 3976, 6911, 6679, 6853; Taser deployed: 499, 2659, 4560, 6943, 7203; Taser discharged: 15, 85, 161, 338, 461; firearms: 0, 7, 4, 19, 32). Baton rounds and ARU use showed greater variability over the same time period (baton rounds: 1007, 1327, 1123, 1382, 1278; ARUs: 11688, 13652, 13166, 13959, 12090). Only two services could provide details of medical consequences from use of incapacitant sprays, Taser, and baton rounds. No service could provide details of any related medical complications following use of firearms. Data collection and release are variable and inconsistent throughout English and Welsh police services and thus caution is needed in determining trends of UoF techniques. Deaths or injuries inflicted using UoF techniques result in much public scrutiny and the low level of data recorded in these cases is of concern. Common systems for recording use and adverse outcomes of UoF techniques are needed to inform the public and others who have concerns about such techniques.

A Call for Improved Prevention and Reduction of Obesity Among Persons With Serious Mental Illness

The primary purpose of this Open Forum is to alert the psychiatric community to a recently published policy paper by the National Association of State Mental Health Program Directors (NASMHPD), Obesity Reduction and Prevention Strategies for Individuals With Serious Mental Illness. The report was developed through a comprehensive review of materials and extensive discussions in an expert panel meeting held August 9-10, 2007. The report indicates that psychiatrists who disregard the physical health of their patients and focus only on treating the patient's psychiatric condition are not only neglectful but are also contributing to the epidemic of obesity among people with serious mental illness. The NASMHPD Medical Directors Council has concluded that psychiatrists in the public mental health system are doing far too little to prevent and reduce obesity among patients the system serves.

Classification of eating disturbance in children and adolescents: Proposed changes for the DSM‐V

Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The consensus opinion of an international workgroup of experts on the diagnosis and treatment of child and adolescent eating disorders is that (a) lower and more developmentally sensitive thresholds of symptom severity (e.g. lower frequency of purging behaviours, significant deviations from growth curves as indicators of clinical severity) be used as diagnostic boundaries for children and adolescents, (b) behavioural indicators of psychological features of eating disorders be considered even in the absence of direct self-report of such symptoms and (c) multiple informants (e.g. parents) be used to ascertain symptom profiles. Collectively, these recommendations will permit earlier identification and intervention to prevent the exacerbation of eating disorder symptoms.

Current trends in drug abuse associated fatalities – Jordan, 2000–2004

This study is the first study that addresses drug abuse associated fatalities in Jordan. It is aimed to give a close picture to the demography, toxicological data, manner, cause of death and other associated findings in such cases. Postmortem forensic pathology reports for all autopsies examined in the National Institute of Forensic Medicine were reviewed over a 5-year period and drug abuse associated deaths were selected. The study revealed that 44 cases (0.76%) out of the 5789 total autopsies were attributed to drug abuse associated deaths. The age range was from 20 to 60 years (mean ± S.D. = 32.7 ± 7.2). More than 80% of cases were Jordanian males. The reported abuse substances as single drug or in combination were alcohol in 56.8%, morphine 36.4%, heroin 15.9%, benzodiazepines in 11.4% and cocaine in one body packer case. Surprisingly, neither a case with amphetamine or amphetamine analogue, nor with marijuana or methadone was recorded. In 75% of cases the death was accidental and only one case was reported to be suicidal, while in 18.2% and 4.5% death was due to sudden death and road traffic accidents, respectively. Regarding the cause of death, it was related to drug overdose in 50% of cases and in 34.1%, 11.4% and 4.5% of cases it was attributed to drug related medical complications, non-drug related complications, and trauma, respectively. Alcohol was mainly associated with accidental death; morphine and heroin were associated with drug overdose and abused through intravenous route. Injection marks were reported in 56.8% of cases and in 52.3% death occurred at home. This study confirmed the variation in the incidence and type of abused substances in Jordan compared with different countries.

Leptin intake during lactation prevents obesity and affects food intake and food preferences in later life

Breast milk is practically the only food ingested during the first months of life in fully breastfed infants and it is assumed to match the infant's nutritional needs. Epidemiological data suggest that breastfeeding compared with infant formula feeding confers protection against several chronic diseases later on in life and, particularly, against obesity and related medical complications. However, causality has not been related to any specific compound of breast milk. Recent data in our laboratory have identified leptin as the specific compound that is responsible for some of these beneficial effects of breastfeeding. The hormone leptin was identified as a key candidate because it is present in breast milk, but is not present in infant formula, and when ingested during the suckling period can be absorbed by the immature stomach exerting biological effects. Evidence of the beneficial effects of breast milk leptin was obtained from human studies, showing that milk-borne maternal leptin appeared to give moderate protection to infants from excess weight gain. Direct cause-effect evidence was obtained in rats, where oral leptin supplementation during the suckling period resulted in a decrease in food intake, affected food preferences in favour of carbohydrates versus fat, and protected against overweight in adulthood, with an improvement of related parameters such as leptin and insulin sensitivity. These findings open a new area of research on the use of leptin in the design of more appropriate infant formula, which is significant considering the increasing incidence of obesity and its associated medical complications.

Moderate Wine Consumption in the Prevention of Metabolic Syndrome and its Related Medical Complications

The metabolic syndrome (MetS) encompasses a constellation of cardio-metabolic abnormalities associated with a high risk of developing type 2 diabetes and cardiovascular disease (CVD), the top killer in the ageing population. Recent studies have demonstrated multiple beneficial effects of moderate wine consumption in the protection against development of the MetS and its related medical complications. The association of moderate wine consumption with lower incidence of the MetS and atherosclerotic heart disease has been repeatedly documented in numerous epidemiological studies on diverse ethnic groups. In addition to the favorable effects of moderate ethanol intake on lipid profiles, polyphenols enriched in red wine possess multiple benefits on the MetS beyond alcohol through their anti-oxidant, anti-inflammatory, vascular-protective and insulin-sensitizing properties. Notable among these red wine polypheolic compounds is resveratrol, a phytoalexin that has recently attracted great attention due to its role in mimicking calorie restriction. This compound can act as a potent activator of the NAD(+)-dependent deacetylases sirtuins to expand the life span and to prevent the deleterious effects of excess intake on insulin resistance and metabolic derangement. In addition, resveratrol exerts its multiple protective effects against the MetS through stimulating AMP-activated protein kinase and promoting mitochondria biogenesis. In this review, we highlight the recent epidemiological and experimental evidences supporting the protective effects of moderate wine intake against the MetS and its associated cardio-metabolic complications, and discuss the molecular mechanisms underlying the multiple beneficial actions of red wine polyphenols with the focus on resveratrol.

Babies With Tracheostomies

Babies With Tracheostomies

Implementing breastfeeding education in the academic setting.

It is well known in the lactation community that many of our generalist health care providers are inadequately prepared to manage breastfeeding dyads. In response to the need for skilled health care providers, a breastfeeding course was developed and implemented. The course was offered within a school of nursing, but open to all interested participants. Course content included the physiology of the mammary glands and related anatomy, breastfeeding support, medical complications, research, legislation, and technologies. In addition to obtaining critical-thinking skills to manage breastfeeding mothers and infants, students also developed a supportive network of colleagues with whom they can collaborate and to whom they can refer families. In the future we are considering expanding the curriculum to include more practical and community experiences.

Criteria for enrolling dementia patients in hospice.

Because survival time varies greatly, it is difficult for dementia patients to meet a key criterion for eligibility for the Medicare hospice benefit: a 6-month survival time. We have developed criteria for the Medicare hospice benefit that include the characteristics of advanced dementia and related medical complications. The purpose of the study was to determine survival time among dementia patients who met these criteria. Additionally, because the National Hospice Organization (NHO) developed its own guidelines while the study was in progress, we retrospectively examined the application of these guidelines to our sample. Two cohorts of hospice patients were studied longitudinally, each for 2 years. Nine Midwestern hospice programs. Forty-seven patients were enrolled in home hospice and institutional hospice settings. Survival time consisted of the number of days between enrollment in the hospice program and death or the end of the study. Other measures included Activities of Daily Living, ratings of Appetite, Nourishment, and Mobility, Functional Assessment Staging (FAST), a Medical Complications Checklist, and a care plan concerning the use of medications for acute illness. Our hospice enrollment criteria predicted a median survival time of 4 months and a mean survival time of 6.9 months; 38% of patients survived for more than 6 months. FAST scores and Mobility ratings were significantly related to survival time. However, 41% could not be scored on the FAST as their disease progression was not ordinal. Among patients who could be scored on the FAST and who had reached Stage Seven C, their mean survival time was 3.2 months compared with 18 months among those who could be scored and had not reached this stage and 8.6 months among patients whose disease progression was not ordinal, P < .001. When the palliative care plans were examined, less aggressive care plans resulted in shorter survival times, P < .01. Our hospice enrollment criteria identified a group with a median survival time of 4 months and a mean survival time of 6.9 months. Using NHO criteria relying on the FAST allows the identification of a subgroup with very high mortality and a short time until death. Although the FAST can identify a subgroup of appropriate candidates for hospice, sole reliance on this measure might decrease access to hospice care for many dementia patients.

Animal-Assisted Enhancement of Speech Therapy: A Case Study

SUMMARYThis report assesses the impact of Animal-Assisted Therapy (AAT) as it applies to speech/language pathology. It is a case study of a 72-year-old female who had experienced multiple strokes and other related medical complications. Treatment utilizing two canine therapists, Charlie and Josh, increased one-word answers and object identification tasks, as well as verbalization behaviors in the subject.

Cocaine abuse and its treatment.

Widespread use and abuse of cocaine have increased the frequency with which health professionals must manage acute and chronic intoxication and the complications stemming from drug ingestion. Acute intoxication from catecholamine excess progresses through three stages, affecting the cardiovascular, respiratory, and central nervous systems. Management is to support or return these systems to normal with sedation, beta blockade, and antiarrhythmics. Casual cocaine use is no longer considered benign, and numerous related medical complications are now recognized. Dopaminergic systems are the principal sites of reward and participate in abstinence symptomatology, putatively through depletion of dopamine and changes in receptor sensitivity and responsiveness. Long-term treatment approaches have focused on psychologic strategies of behavior modification and supportive psychotherapy. Pharmacotherapy with desipramine, amantadine, and bromocriptine was shown in preliminary studies to minimize the symptoms of cocaine withdrawal when used adjunctively with psychotherapy. The response to treatment may depend on the patient's premorbid psychiatric status.

A scheme for determining the prevalence of alcoholism in hospitalized patients.

As a part of an on-going effort to assess the prevalence of alcoholism among hospitalized patients, a structured technique was devised to document the prevalence of alcoholism in a large teaching hospital. A system of inpatient chart audit classification was developed to assess direct evidence of patient alcoholism. In addition, the reported prevalence of alcoholism as a discharge diagnosis was determined. An assessment of the degree of alcoholism was used to classify patients into severity levels. A determination was made of the relationship of hospital chart data classification level to other medical problems or treatments directly addressed by the physician(s) that would indicate that the alcohol abuse, if present, was considered. A retrospective chart audit was conducted for 809 consecutive adult admissions to a 350-bed urban university teaching hospital using a specific classification scheme for determining evidence of alcoholism. This technique revealed a reported prevalence of alcoholism in 4.3% of all nonobstetric admissions to this university hospital. However, a chart review technique using specific criteria for the diagnosis of probable alcoholism raised the estimated prevalence to 15.9%. When the chart contained a primary diagnosis of alcoholism, physicians' responses reflected treatment plans that addressed acute management of alcohol related medical complications but often did not document efforts to assist the patient with the underlying alcoholism/substance abuse.