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BMC Pregnancy and Childbirth Mar 2022The aim of the present study was to clarify fetal heart rate (FHR) evolution patterns in infants with cerebral palsy (CP) according to different types of umbilical cord...
BACKGROUND
The aim of the present study was to clarify fetal heart rate (FHR) evolution patterns in infants with cerebral palsy (CP) according to different types of umbilical cord complications.
METHODS
This case-control study included children born: with a birth weight ≥2000 g, at gestational age ≥33 weeks, with disability due to CP, and between 2009 and 2014. Obstetric characteristics and FHR patterns were compared among patients with CP associated with (126 cases) and without (594 controls) umbilical cord complications.
RESULTS
There were 32 umbilical cord prolapse cases and 94 cases with coexistent antenatal umbilical cord complications. Compared with the control group, the persistent non-reassuring pattern was more frequent in cases with coexistent antenatal umbilical cord complications (p = 0.012). A reassuring FHR pattern was observed on admission, but resulted in prolonged deceleration, especially during the first stage of labor, and was significantly identified in 69% of cases with umbilical cord prolapse and 35% of cases with antenatal cord complications, compared to 17% of control cases (p < 0.001).
CONCLUSION
Hypercoiled cord and abnormal placental umbilical cord insertion, may be associated with CP due to acute hypoxic-ischemic injury as well as sub-acute or chronic adverse events during pregnancy, while umbilical cord prolapse may be characterized by acute hypoxic-ischemic injury during delivery.
Topics: Adult; Birth Injuries; Case-Control Studies; Cerebral Palsy; Female; Heart Rate, Fetal; Humans; Hypoxia-Ischemia, Brain; Infant, Newborn; Infant, Newborn, Diseases; Male; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Prolapse; Umbilical Cord
PubMed: 35241026
DOI: 10.1186/s12884-022-04508-2 -
BMC Neurology Mar 2021Polish physicians and researchers lack an extensive and precise instrument in their native language for evaluating sexual dysfunction in individuals with neurogenic...
The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15): translation, adaptation and validation of the Polish version for patients with multiple sclerosis and spinal cord injury.
BACKGROUND
Polish physicians and researchers lack an extensive and precise instrument in their native language for evaluating sexual dysfunction in individuals with neurogenic disorders. The aim of this study was to create a culturally adapted, validated, Polish language version of the Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15) for persons with multiple sclerosis (MS) and spinal cord injury (SCI).
METHODS
International recommendations and standardized methods for instrument validation were followed. Sexually active patients with MS and SCI completed the MSISQ-15, International Index of Erection Function (IIEF-15, men), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-31, women). IIEF-15 and PISQ-31 were used as reference questionnaires. Responses were collected at baseline (test) and after 2 weeks (re-test).
RESULTS
We recruited 299 Polish-speaking patients with MS or SCI. Interviews disclosed that the translated questionnaire had optimal content validity/cross-cultural adaptation. MSISQ-15 scores correlated significantly with the severity of sexual dysfunction as evaluated by IIEF-15 (r = - 0.487) and PISQ-31 (r = - 0.709). These correlations substantiated the high quality construct/criterion validity. An analysis of reliability presented good internal consistency (Cronbach's alpha of 0.93 for the total score of MS patients and 0.86 for the total score of SCI patients) and reproducibility (intraclass correlation coefficients of 0.91 for the total score of MS patients and 0.92 for the total score of SCI patients). There were no ceiling or floor effects.
CONCLUSIONS
The Polish version of MSISQ-15 exhibited excellent measurement properties. It is a suitable and reliable instrument to assess sexual dysfunction in MS and SCI individuals. The Polish MSISQ-15 will enhance routine clinical practice and assist research for neurogenic patients in Poland.
Topics: Adult; Female; Humans; Language; Male; Middle Aged; Multiple Sclerosis; Poland; Psychometrics; Reproducibility of Results; Sexual Dysfunction, Physiological; Spinal Cord Injuries; Surveys and Questionnaires; Translating; Translations
PubMed: 33685399
DOI: 10.1186/s12883-021-02132-9 -
Cureus Mar 2023Lumbar disc herniation (LDH) is prevalent among adults aged 25-55 years who spend a considerable proportion of their time sitting or standing with heavy workloads. We...
Lumbar disc herniation (LDH) is prevalent among adults aged 25-55 years who spend a considerable proportion of their time sitting or standing with heavy workloads. We report the case of a 33-year-old male waiter with severe LDH, causing compression of the nerve roots and spinal cord with neurological dysfunction, who presented to a chiropractic clinic. Magnetic resonance imaging (MRI) revealed a radiological differential diagnosis comprising LDH and an epidural mass lesion. To rule out serious pathology, a second MRI with contrast was ordered, which confirmed the diagnosis of severe LDH. Diagnosing large LDH may be challenging, and severe disc herniation often mimics spinal tumors. This study offers insights into the differential diagnosis of LDH and spinal tumors, as well as the design of a treatment strategy for severe LDH in the chiropractic clinic.
PubMed: 36968683
DOI: 10.7759/cureus.36545 -
BMC Pregnancy and Childbirth Feb 2022In twin pregnancies, the cord prolapse of either fetus during the pre-viable period leads to fetal death but can also cause an intrauterine infection, leading to...
BACKGROUND
In twin pregnancies, the cord prolapse of either fetus during the pre-viable period leads to fetal death but can also cause an intrauterine infection, leading to death or prematu-re birth of the remaining fetus. However, there are no validated protocols to prolong the gestational period or decrease the morbidity and mortality of the remaining fetus.
CASE PRESENTATION
The present cases were PPROM and cord prolapse very early during the second trimester (around 17 weeks in the first case and 19 weeks in the second case). The first fetus was evacuated, and cervical cerclage was performed at 23 and 20 weeks in the two cases, respectively. After maintaining the pregnancy, the second baby was born around 27 and 39 weeks in the first and second cases, respectively. The delivery interval between the first and second fetuses was 46 days in the first case and 126 days in the second case.
CONCLUSION
If cord prolapse is identified at a pre-viable time in twin fetuses, evacuation and cerclage should be performed as soon as possible after the cord prolapse to reduce intrauterine infection and increase the survival chances of the remaining fetus.
Topics: Adult; Cerclage, Cervical; Delivery, Obstetric; Female; Fetal Membranes, Premature Rupture; Humans; Live Birth; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Pregnancy, Twin; Prolapse; Umbilical Cord
PubMed: 35144573
DOI: 10.1186/s12884-022-04438-z -
The Neuroradiology Journal Jun 2023Neonatal strokes constitute a major cause of pediatric mortality and morbidity. Neuroimaging helps in its diagnosis as well as prognostication. However, advanced... (Review)
Review
Neonatal strokes constitute a major cause of pediatric mortality and morbidity. Neuroimaging helps in its diagnosis as well as prognostication. However, advanced imaging, including magnetic resonance imaging (MRI), carries multiple challenges. Limited data exists in the literature on imaging-based predictors of neurological outcomes in neonatal stroke in the Indian population. In this study, we reviewed our available data on neonatal stroke patients between 2015 and 2020 for clinico-radiological patterns. During this period, 17 neonatal strokes were admitted and the majority were term births with a slight male preponderance. Seizures and encephalopathy were the most common presentation. Multiple maternal risk factors such as gestational diabetes, meconium-stained liquor, APLA syndrome, fever, deranged coagulation profile, oligohydramnios, cord prolapse, and non-progressive labor were seen. Cardiac abnormalities were seen in only less than half of these patients with the most common finding being atrial septal defects (ASD). Transcranial ultrasound was performed in eight neonates and the pick-up rate of ultrasound was poor. MR imaging showed large infarcts in 11 patients. The MCA territory was most commonly involved. Interestingly, five neonates had venous thrombosis with three showing it in addition to arterial thrombosis. Associated ictal, as well as Wallerian changes, were noted in 10. Although large territorial infarcts were the most common pattern, non-contrast MR angiography did not show major vessel occlusion in these cases. Outcomes were fairly good and only three patients had a residual motor deficit at 1 year. No recurrence of stroke was seen in any of the neonates.
Topics: Infant, Newborn; Humans; Male; Child; Tertiary Care Centers; Magnetic Resonance Imaging; Neuroimaging; Stroke; Magnetic Resonance Spectroscopy; Infarction
PubMed: 36170618
DOI: 10.1177/19714009221130488 -
Heliyon Feb 2022Birth asphyxia is a condition of impaired gas exchange in newborns when the Apgar score is < 7 in the first 5 min. It accounts 31.6% of all neonatal deaths, and the...
INTRODUCTION
Birth asphyxia is a condition of impaired gas exchange in newborns when the Apgar score is < 7 in the first 5 min. It accounts 31.6% of all neonatal deaths, and the leading causes of neonatal mortality in Ethiopia. Identifying its determinant factors is very important to prevent the problem.Therefore, this study was aimed at identifying the determinant factors of birth asphyxia among newborns at Benishangul Gumuz region hospital.
METHODS AND MATERIALS
The hospital-based unmatched case-control study was done from March 04 to July 16, 2019 in Benishangul Gumuz Region Hospitals. Total sample size is 275 with 69 cases and 206 controls. Newborns with an Apgar score of less than 7 at 5 min were taken as cases, and those with greater or equal to 7 were taken as controls. All asphyxiated newborns were enrolled as cases, where as in every three-step non-asphyxiated newborns were taken as controls. The data was entered into Epi Info 7 and exported to SPSS for analysis. Bivariable logistic regression analysis was used. Those variables with a p-value <0.05 were identified as significant determinants of birth asphyxia.
RESULTS
In the current study, anemia during pregnancy [AOR = 2.95, 95% CI: (1.02, 8.54)], no ANC visit at all [AOR = 4.26, 95% CI: (1.23,14.7)], prolapsed cord [AOR = 4.52, 95% CI: (1.3, 21)], and low birth weight [AOR = 4.1, 95% CI: (1.11, 15.36] were all determinant factors for birth asphyxia.
CONCLUSION
and Recommendations: The identified determinants of birth asphyxia were anemia during pregnancy, no ANC visit at all, prolapsed cord, cesarean birth, and low birth weight.Based on our study, most of identified determinant factors of birth asphyxia were preventable so, policy makers, clinicians, and other stakeholders need to invest their maximum effort on prevention of birth asphyxia.
PubMed: 35198758
DOI: 10.1016/j.heliyon.2022.e08875 -
International Journal of Surgery Case... Jan 2022With the widespread use of laparoscopic inguinal hernia repair, it is known that some clinically evident inguinal hernias lack a peritoneal sac and are referred to as...
INTRODUCTION AND IMPORTANCE
With the widespread use of laparoscopic inguinal hernia repair, it is known that some clinically evident inguinal hernias lack a peritoneal sac and are referred to as "sacless hernias".
PRESENTATION OF CASE
A 61-year-old man presented with a left inguinal bulge. On physical examination, the diagnosis of bilateral inguinal hernias was made, and laparoscopic transabdominal repair was performed. Intraoperatively, the left peritoneal hernia orifice was not identified from the peritoneal cavity and there was only a lipoma. Pressing the lipoma with forceps from inside the peritoneum confirmed the presence of a hernia. The preperitoneal space was opened and the hernia orifice revealed.
DISCUSSION
The terminology and definition of sacless hernias are poorly defined, even though this is not a rare condition. Consistent with Russell's dogma, there are arguments that any prolapse can only be called a hernia if there is an accompanying peritoneal sac. The proportion of patients with sacless hernias and pure cord lipomas are very similar and these conditions are often confused. Detailed and repeated physical examination may distinguish a sacless hernia from a pure lipoma. A watchful waiting strategy is useful and ensures safety.
CONCLUSION
Once the diagnosis of inguinal hernia is made on physical examination, open the preperitoneal cavity if a peritoneal hernia orifice was not identified during laparoscopy.
PubMed: 34902700
DOI: 10.1016/j.ijscr.2021.106667 -
Neurology India 2022'White-cord syndrome' is an extremely rare entity following decompression of cervical cord in which post-operative reperfusion injury results in worsening of patient's...
BACKGROUND
'White-cord syndrome' is an extremely rare entity following decompression of cervical cord in which post-operative reperfusion injury results in worsening of patient's neurology and MRI reveals signal changes in spinal cord in absence of cord compression. We wish to report a case of 'white-cord syndrome' following a 'routine' ACDF.
CASE DESCRIPTION
A 39-year-old woman with paresthesias and spastic quadriparesis was found to have C5-C6 PIVD on MRI. ACDF was performed at C5-C6, after which worsening of quadriparesis was noted, for which intravenous high-dose steroids were started. An urgent MRI was done, which revealed findings of white-cord syndrome, without compression on underlying cord. With conservative management, her ASIA grade improved from C to D and the features of white-cord syndrome disappeared on follow-up imaging.
CONCLUSION
It is important for surgeons and patients to be aware of this rare but potentially catastrophic entity as this needs to be discussed while taking consent for surgery.
Topics: Adult; Female; Humans; Cervical Vertebrae; Decompression, Surgical; Diskectomy; Glucocorticoids; Magnetic Resonance Imaging; Paresthesia; Quadriplegia; Reperfusion Injury; Spinal Cord; Spinal Cord Diseases; Spinal Fusion; Syndrome
PubMed: 36412386
DOI: 10.4103/0028-3886.360940 -
Journal of Obstetrics and Gynaecology... Feb 2018The timeline between a decision made and delivery of the baby is termed decision delivery interval (DDI). According to current recommendations, an emergency caesarean...
INTRODUCTION
The timeline between a decision made and delivery of the baby is termed decision delivery interval (DDI). According to current recommendations, an emergency caesarean section must be performed within 30 min of the decision. The present study was conducted with an objective to assess DDI in a busy obstetric unit in India and its impact on obstetric outcome.
MATERIAL AND METHOD
A total of 480 women with indications of category I (emergency): Immediate threat to life of woman or foetus ( = 66), and category II (urgent): Maternal or foetal compromise but not immediately life-threatening ( = 414), were studied in the context of DDI and composite adverse perinatal outcomes including fresh stillbirth, 5-min Apgar score <7 and NICU admission.
RESULT
Recommended DDI of <30 min could be achieved in 30% cases of emergency CS only. Sixty-three per cent with prolapsed cord could be delivered within 30 min. The composite neonatal outcomes were not significantly increased up to DDI of 60 min for category I (emergency) (except in prolapsed cord) and up to 90 min in category II (urgent) caesarean sections.
CONCLUSION
Authors propose reconsideration of the present recommendations of DDI in categories I and II, while Crash CS (cord prolapse or catastrophic antepartum haemorrhage) should be a separate group with recommended DDI of 30 min. For the remaining cases in the present emergency CS group, the suggested DDI of 60 and, for urgent group, 90 min may be made following further studies to prevent this DDI yardstick from becoming a rod at our back.
PubMed: 29391671
DOI: 10.1007/s13224-017-0991-6