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Heller C, Kraft M, Martinez M, Mirmajlesi AS, Janecka M, McCormack C, Thomason ME, Weiss T, Arciniega H. Complications After Maternal Traumatic Brain Injury During Pregnancy: A Systematic Review. JAMA Netw Open 2025; 8:e2459877. [PMID: 39960671 PMCID: PMC11833521 DOI: 10.1001/jamanetworkopen.2024.59877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Accepted: 12/08/2024] [Indexed: 02/20/2025] Open
Abstract
Importance General trauma is the leading cause of nonobstetric maternal morbidity and mortality, affecting approximately 8% of all pregnancies. Pregnant women with traumatic brain injury (TBI) face high morbidity and mortality rates, requiring complex management due to physiological changes, teratogenic risks of treatments, and the need for fetal monitoring. Objectives To assess the consequences of TBI during pregnancy on maternal and fetal outcomes and to evaluate management strategies to inform clinical decision-making. Evidence Review A systematic literature search was conducted on January 12, 2024, in PubMed, Web of Science, and PsycInfo to identify articles published in English, German, or Spanish between January 1, 1990, and December 31, 2023, that included at least 1 pregnant individual with TBI. Peer-reviewed, human-based studies with original data on maternal and fetal outcomes were included. Reviews, meta-analyses, and nonhuman studies were excluded. Two independent reviewers screened abstracts and full-text articles. Study characteristics, pregnancy outcomes (maternal and fetal), management methods, and authors' conclusions were extracted. Risk of bias was assessed by 2 reviewers, with interrater agreement measured using Cohen κ. Disagreements were resolved through discussion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was followed. Findings This systematic review included 16 articles involving a total of 4112 individuals (mean maternal age, 26.9 years; range, 16-47 years) who experienced TBI during pregnancy (mean gestational age at injury, 24 weeks; range, 3-38 weeks). The articles comprised 10 case reports, 2 case series, and 4 cohort studies. Motor vehicle crashes were the most common cause of injury, reported in 12 articles. The average Glasgow Coma Scale score ranged from 3 to 15 across all individuals. Conservative management was reported in 7 case patients, whereas surgery was performed in 6 case patients. Maternal outcomes ranged from functional recovery to severe cognitive impairment, and fetal outcomes varied from stable to severe adverse outcomes, including stillbirth and death. Risk of bias assessment indicated moderate to good methodological validity overall, but most articles demonstrated poor quality of evidence. Conclusions and Relevance In this review, no definitive association between TBI during pregnancy and maternal or fetal outcomes was found owing to conflicting findings, poor to moderate study quality, and limited evidence. Although some articles suggested increased risks such as placental abruption and cesarean delivery, the findings remained inconclusive. The findings of this review underscore the need for high-quality research, standardized reporting, and rigorous methodology to improve data reliability. Future research should focus on developing consensus-driven, multidisciplinary management strategies to improve maternal and fetal outcomes.
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Affiliation(s)
- Carina Heller
- Masonic Institute for the Developing Brain, Institute of Child Development, University of Minnesota, Minneapolis
- Department of Pediatrics, University of Minnesota, Minneapolis
- Department of Psychological and Brain Sciences, University of California, Santa Barbara
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
- German Center for Mental Health, Partner Site Jena-Magdeburg-Halle, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health, Partner Site Jena-Magdeburg-Halle, Jena, Germany
| | - Mathilda Kraft
- Department of Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Margaret Martinez
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, New York
- NYU Langone Concussion Center, NYU Langone Health, New York, New York
| | - Anya S. Mirmajlesi
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, New York
- NYU Langone Concussion Center, NYU Langone Health, New York, New York
| | - Magdalena Janecka
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Clare McCormack
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York
| | - Moriah E. Thomason
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York
- Department of Population Health, NYU Grossman School of Medicine, New York, New York
| | - Thomas Weiss
- Department of Clinical Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Hector Arciniega
- Department of Rehabilitation Medicine, NYU Grossman School of Medicine, New York, New York
- NYU Langone Concussion Center, NYU Langone Health, New York, New York
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Priyadarshini A, Kalola P, Patadia H, Shah J, Gangawane A. Prevalence, aetiology and antimicrobial resistance profile of diabetic individuals suffering from community-acquired urinary tract infection. J Med Microbiol 2025; 74. [PMID: 39874074 DOI: 10.1099/jmm.0.001962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2025] Open
Abstract
Introduction. The rise in antimicrobial resistance poses a significant threat to global health, particularly among diabetic patients who are prone to urinary tract infections (UTIs).Hypothesis. Pathogens that cause UTI among diabetic patients exhibit significant multidrug resistance (MDR) patterns, necessitating more precise empirical treatment strategies.Aim. This study aimed to determine the prevalence of UTI among diabetic patients and study the antimicrobial susceptibility profiles of uropathogens, detected and identified the potential differences in age groups and between genders, focusing on MDR and gender-based variations, causing a global concern in deciding empirical treatment.Methodology. A prospective study was conducted from August 2021 to December 2023 in Gujarat, India. During the period, 1023 diabetic patients with symptoms of UTI were diagnosed by urine culture and 280 individuals tested positive for UTIs. Antibiotic susceptibility testing was carried out on these 280 micro-organism isolates.Results. Among the 280 UTI-positive patients, 166 (59.29%) were females and 114 (40.71%) were males, with the prevalence of UTI in diabetic females being 27.34% (166/607) and males being 27.40% (114/416). Among the isolated uropathogens, Escherichia coli (56.78%) was the predominant organism followed by Pseudomonas aeruginosa (13.57%) and Klebsiella (13.21%). High resistance was noted to various antibiotics in Gram-negative bacteria including both genders. In E. coli, resistance was predominantly high against the penicillin sub-class of the beta-lactam group (70.23%, 69.58%), cephalosporins (66.23%, 76.52%) and least against nitrofurans (30.10%, 40%) in males and females, respectively. Klebsiella has shown higher resistance to cephalosporins (66.23%, 76.52%) and aminoglycosides (60.92%, 62.66%) and least resistance to carbapenem (41.67%) and phosphonic (33.33%) in males and females, respectively. A high proportion of isolates, ~82.5%, exhibited MDR. Among these MDR isolates, those from female patients accounted for a higher percentage (58.44%) compared with males (41.55%). The highest prevalence of MDR was observed in the 41-60-year age group. This pattern highlights notable differences in MDR prevalence across gender and age groups.Conclusion. The high prevalence of UTI caused by MDR organisms based on gender and age group highlights the need for clinicians to choose antibiotics more judiciously for empirical treatment, thereby reducing misuse and overuse in the community. For diabetic UTI patients in this region, nitrofurantoin may be recommended for uncomplicated cases due to low resistance in E. coli, while fosfomycin could be a viable alternative for Klebsiella-related infections. Carbapenems may be reserved for severe cases with MDR pathogens, and combination therapy could be considered for complicated infections, particularly in high-risk age groups.
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Affiliation(s)
- Ankita Priyadarshini
- Parul Institute of Paramedical and Health Sciences, Faculty of Medicine, Parul University, Vadodara, Gujarat 391760, India
- Parul Institute of Applied Sciences, Faculty of Applied Sciences, Parul University, Vadodara, Gujarat 391760, India
| | - Priyal Kalola
- Parul Institute of Paramedical and Health Sciences, Faculty of Medicine, Parul University, Vadodara, Gujarat 391760, India
| | - Hemantkumar Patadia
- Parul Institute of Paramedical and Health Sciences, Faculty of Medicine, Parul University, Vadodara, Gujarat 391760, India
| | - Janvi Shah
- Parul Institute of Paramedical and Health Sciences, Faculty of Medicine, Parul University, Vadodara, Gujarat 391760, India
- Product Performance and Engineering (Clinical Research), Meril Life Sciences Pvt. Ltd., Vapi, Gujarat 396191, India
| | - Ajit Gangawane
- Parul Institute of Applied Sciences, Faculty of Applied Sciences, Parul University, Vadodara, Gujarat 391760, India
- Swaminarayan University, Gandhinagar 382725, Gujarat, India
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Kulbay A, Joelsson-Alm E, Amilon K, Tammelin A. Asymptomatic bacteriuria and urinary tract infection in geriatric inpatients after indwelling urinary catheter removal: a descriptive two-centre study. Infect Prev Pract 2024; 6:100411. [PMID: 39583881 PMCID: PMC11582739 DOI: 10.1016/j.infpip.2024.100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 09/26/2024] [Indexed: 11/26/2024] Open
Abstract
Background Patients with indwelling urinary catheters (IUC) are common in geriatric care. Catheterization increases the risk of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI). The prevalence of ASB after IUC-removal is only sparsely studied. This study aimed to compare the occurrence of ASB and UTI in geriatric patients with and without a history of catheterization and to explore factors associated with ASB. Methods Patients were included at two geriatric rehabilitation wards in Stockholm, Sweden. Data were collected about history of catheterization, antibiotic treatment, and diabetes mellitus. Urine samples were analysed. Occurrence of UTI during inpatient care was identified by patient records. Results In total 196 asymptomatic patients were included in the analysis. Asymptomatic bacteriuria was significantly more common in patients with a history of catheterization (38/104, 36.5%) compared to those without IUC during the past four weeks (19/92, 20.6%, P=0.018). Enterococci were more commonly found in patients with a history of catheterization. Of 124 patients possible to follow up, five UTI-cases were found during hospital stay. All cases had had ASB and 4/5 had had an IUC on admission.Catheterization was significantly associated with ASB after adjustment for confounders (OR 2.79, CI 1.31-5.91, P=0.008). Conclusions Catheterization is associated with ASB, this persists after IUC-removal. The results indicate that colonisation by Enterococcus species linked to catheterization may persist for at least four weeks after IUC-removal. Trial registration The study is registered at clinicaltrials.gov with the identification number NCT05039203 (09/09/2021).
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Affiliation(s)
- Aysel Kulbay
- Department of Medicine, Solna (MedS), Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Eva Joelsson-Alm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Anaesthesiology and Intensive Care, Södersjukhuset, Stockholm, Sweden
| | - Karin Amilon
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ann Tammelin
- Department of Medicine, Solna (MedS), Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
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Kumar J, Rehman T, Barkat R, Shah BL, Sindhu L, Husnain M, Siddiqui MJ, Hashmi AA. A Comparative Analysis of Clinical Features of Diabetes Mellitus Type 2 With Respect to Duration of Diabetes. Cureus 2024; 16:e74849. [PMID: 39737321 PMCID: PMC11684537 DOI: 10.7759/cureus.74849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2024] [Indexed: 01/01/2025] Open
Abstract
Objectives Diabetes mellitus type 2 is a chronic metabolic disorder characterized by insulin resistance and progressive beta-cell dysfunction. As diabetes persists over time, more pronounced symptoms like polyuria, polydipsia, fatigue, and complications like neuropathy, retinopathy, and cardiovascular issues may develop. Therefore, this study assessed the clinical symptoms associated with type 2 diabetes regarding the duration of diabetes. Methodology This cross-sectional study was conducted in a secondary care hospital, using a non-probability convenient sampling method. Patients visiting the outpatient clinics were recruited in the study after obtaining informed written consent from them. The duration of the study was about six months from March 1, 2024, to August 31, 2024. A sample of 450 type 2 diabetic patients, aged 40-65 years, was included in this study. The study identified patients with type 2 diabetes by using their altered glycosylated hemoglobin (HbA1c) level recorded within the last 30 days, which reflects glycemic control. The demographic information, including age, gender, socioeconomic status, health condition, co-existing illnesses, and diabetes-related symptoms was also collected from the patients. SPSS software was used for data analysis. A chi-square and one-way analysis of variance (ANOVA) were employed to determine the association of clinical symptoms in type 2 diabetes mellitus. Results The study findings showed that the mean age was significantly higher in patients with diabetes for less than one year (60.44±15.88 years) compared to those with diabetes for one to five years (52.26±14.37 years) and more than five years (53.95±14.28 years) (p<0.001). The association of gender, comorbidities, and socioeconomic status with the duration of diabetes revealed a significant difference (p<0.001). Frequent urination was significantly more common in the less than one-year group 89(59.3%) compared to the one to five years 54(36.0%) and more than five years 11(7.3%) (p<0.001). Conclusion Diabetes mellitus is a very prevalent systemic disease, with various musculoskeletal and psychosocial symptoms. The frequency of these symptoms varies with respect to the duration of diabetes. In this study, we outlined the various symptoms of diabetes and their relation to the duration of diabetes. Among various symptoms, dyspnea, chest tightness, and muscle cramps increase with increasing duration of diabetes.
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Affiliation(s)
- Jai Kumar
- Internal Medicine, Hamdard College of Medicine and Dentistry, Karachi, PAK
| | - Talha Rehman
- Internal Medicine, Hamdard College of Medicine and Dentistry, Karachi, PAK
| | - Rifa Barkat
- Internal Medicine, Ziauddin University, Karachi, PAK
| | - Bibi Laraib Shah
- Internal Medicine, Hamdard College of Medicine and Dentistry, Karachi, PAK
| | - Lareb Sindhu
- Internal Medicine, Hamdard College of Medicine and Dentistry, Karachi, PAK
| | - Muhammad Husnain
- Internal Medicine, Hamdard College of Medicine and Dentistry, Karachi, PAK
| | - Mohsin Jamil Siddiqui
- Family Medicine, Sindh Healthcare Commission, Karachi, PAK
- Internal Medicine, Anabiya General Hospital, Karachi, PAK
| | - Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
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Dey R, Saha S, Molla SH, Nandi S, Samadder A. Structure-based drug design of pre-clinical candidate nanopiperine: a direct target for CYP1A1 protein to mitigate hyperglycaemia and associated microbes. SAR AND QSAR IN ENVIRONMENTAL RESEARCH 2024; 35:1071-1093. [PMID: 39629730 DOI: 10.1080/1062936x.2024.2434934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Accepted: 11/21/2024] [Indexed: 01/04/2025]
Abstract
Diabetes is attributed to an increased vulnerability to bacterial infection linked to unregulated hyperglycaemia. The present study highlights the formulation of nanoparticles with phyto-compound piperine (PIP) encapsulated within non-toxic biodegradable polymer poly-lactide co-glycolide (PLGA) which showed a variety in surface functionality, biocompatibility, and the ability to tailor an optimized release rate from its polymeric enclosure. The observations revealed that nanopiperine (NPIP) pre-treatment in mice inhibited alteration in hepatic tissue architecture and hepato-biochemical parameters in diabetes and its associated bacterial infections. NPIP also decreased the propensity of lipids to undergo an oxidation process and stabilized the membrane lipids in vivo, thereby lowering oxidative stress and preventing enzymatic activation of CYP1A1. This result is corroborated with the in silico molecular docking study where PIP binding with CYP1A1 gave -11.32 Kcal/mol dock score value. The antibacterial activity of PIP was further demonstrated by the in silico PIP and Ef-Tu protein-binding efficacy revealing -6.48 Kcal/mol score value which was coupled with the results of in vitro studies where the zone of inhibition assay with NPIP against Staphylococcus aureus and Escherichia coli. Thus, NPIP could serve as a potential drug candidate in modulating targeted proteins to inhibit the progression of hyperglycaemia and its associated microbes.
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Affiliation(s)
- R Dey
- Cytogenetics and Molecular Biology Lab., Department of Zoology, University of Kalyani, Kalyani, India
- Department of Pharmaceutical Chemistry, Global Institute of Pharmaceutical Education and Research (GIPER) (Affiliated to Veer Madho Singh Bhandari Uttarakhand Technical University), Kashipur, India
| | - S Saha
- Parasitology Laboratory, Department of Zoology, University of Kalyani, Kalyani, India
| | - S H Molla
- Parasitology Laboratory, Department of Zoology, University of Kalyani, Kalyani, India
| | - S Nandi
- Department of Pharmaceutical Chemistry, Global Institute of Pharmaceutical Education and Research (GIPER) (Affiliated to Veer Madho Singh Bhandari Uttarakhand Technical University), Kashipur, India
| | - A Samadder
- Cytogenetics and Molecular Biology Lab., Department of Zoology, University of Kalyani, Kalyani, India
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Hough M, Nahmias J, Santos J, Swentek L, Bristow R, Butler J, Grigorian A. Emergency cesarean section in pregnant trauma patients presenting after motor vehicle collision. Heliyon 2024; 10:e38707. [PMID: 39435102 PMCID: PMC11491900 DOI: 10.1016/j.heliyon.2024.e38707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 09/27/2024] [Indexed: 10/23/2024] Open
Abstract
Background Most pregnant trauma patients (PTPs) present after motor vehicle collision (MVC). The national rate and risk factors for emergency cesarean section (ECS) during the index hospitalization for pregnant trauma patients (PTPs) are unknown. We sought to investigate the national rate of ECS in PTPs presenting after MVC, hypothesizing a higher risk of ECS among those with severe injuries or elevated shock index (SI). Methods The 2020-2021 TQIP was queried for PTPs presenting after MVC. PTPs that underwent ECS were compared to patients that did not undergo ECS. Elevated SI was defined as ≥1. Severe injury was defined by abbreviated injury scale grade ≥3. Bivariate and multivariable logistic regression analyses were performed. Results From 1183 PTPs, 95 (8.0 %) underwent ECS. The median time to ECS was 115 min. The ECS group had higher rates of lung (27.4 % vs. 12.2 %, p < 0.001) injury, spleen (18.9 % vs. 5.5 %, p < 0.001) injury, and elevated SI (22.1 % vs. 9.8 %, p < 0.001). ECS patients had higher rates of complication (9.5 % vs. 2.1 %, p < 0.001) and death (4.2 % vs. 1.1 %, p = 0.012). Independently associated risk factors for ECS included severe head (OR 2.65, CI 1.14-6.17, p = 0.023) or abdominal (OR 2.07, CI 1.08-3.97, p = 0.028) injuries and elevated SI (OR 2.17 CI 1.25-3.79, p = 0.006). Conclusion The national rate of ECS among PTPs presenting after MVC is 8 % with most occurring within the first 2 hours of arrival. Severe head and abdominal injuries as well as elevated SI are risk factors for ECS.
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Affiliation(s)
- Michelle Hough
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Jeffrey Santos
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Lourdes Swentek
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Robert Bristow
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Jennifer Butler
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
| | - Areg Grigorian
- University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA
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Chang YH, Chien YW, Chang CH, Chen PL, Lu TH, Yen CF, Chiou HY, Tsai KS, Li CY. Neurodevelopmental disorders in children born to mothers involved in maternal motor vehicle crashes. Pediatr Res 2024:10.1038/s41390-024-03608-3. [PMID: 39349820 DOI: 10.1038/s41390-024-03608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 09/06/2024] [Accepted: 09/07/2024] [Indexed: 11/14/2024]
Abstract
BACKGROUND To evaluate the association between maternal MVCs during pregnancy and neurodevelopmental disorders (NDDs, including intellectual disability, ADHD, ASD, and infantile cerebral palsy) in children. METHODS This population-based cohort of live births in Taiwan was analyzed, comparing children born to mothers involved in MVCs during pregnancy with those without such exposure. Children were linked to the insurance database to identify the possible diagnosis of NDDs. The Cox proportional hazards regression model was used to estimate the relative hazards. RESULTS A total of 19,277 children with maternal MVCs and 76,015 children without exposure were included. Children exposed to maternal MVCs during the first two trimesters or whose mothers sustained mild to severe injuries showed a higher risk of intellectual disability. Severe maternal injuries also increased the risk of infantile cerebral palsy (aHR = 3.86; 1.27-11.78). MVCs in the third trimester, or mild maternal injuries, were associated with a higher risk of ASD (third trimester: aHR = 1.40; 1.04-1.87; mild injuries: aHR = 1.38; 1.09-1.74). CONCLUSION Children exposed to maternal MVCs with severe injuries had a higher risk of intellectual disability and cerebral palsy. Third-trimester exposure may increase the risk of ASD. However, these findings should be interpreted cautiously as genetic factors may contribute to the observed association. IMPACT There is some evidence linking maternal MVCs during pregnancy to the development of neurodevelopmental disorders in children. Children of mothers with severely injured were more likely to suffer from infantile cerebral palsy and intellectual disability. The risk of autism spectrum disorder is higher in children whose mothers are involved in MVCs during the late stage of pregnancy, and there is also an increased risk of intellectual disability during the first two trimesters.
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Affiliation(s)
- Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Emergency Department, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Hung-Yi Chiou
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Kuo-Sheng Tsai
- Department of Pediatrics, Tainan Sinlau Hospital, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Chang YH, Chien YW, Chang CH, Chen PL, Lu TH, Li CY. Pregnancy is associated with more severe injuries from motor vehicle crashes. J Formos Med Assoc 2024; 123:849-853. [PMID: 38129265 DOI: 10.1016/j.jfma.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/21/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE Whether pregnancy is associated with severe injuries from motor vehicle crashes (MVCs) remains unclear. This study aimed to investigate the potential relationship between pregnancy and severity of injuries from MVCs. METHODS We identified a total of 23,559 pregnant women victims who encountered MVCs during pregnancy as well as 94,236 age- and calendar year-at MVC matched non-pregnant women victims that are also involved in MVCs. Injury severity was assessed using the Maximum Abbreviated Injury Scale (MAIS) based on the diagnosis of medical claims after MVCs. Multinomial logistic regression models were used to estimate the odds ratio and corresponding 95 % CI of injury severity levels associated with pregnancy. RESULTS Pregnant women had a significantly higher risk of both severe (adjusted odds ratio, aOR = 1.79, 95 % CI = 1.54-2.08) and mild injuries (aOR = 8.63, 95 % CI = 8.21-9.07) following MVCs as compared to non-pregnant women victims. Particularly, pregnant women who were riding scooters had an increased risk of severe injury (aOR = 4.25, 95 % CI = 3.58-5.04). In addition, pregnant women who experienced MVC but without any injury were more likely to visit a clinic than non-pregnant MVC victims. CONCLUSION Pregnant women victims, particularly those who were riding scooters involved in MVCs suffered from a higher risk of severe injury as compared to their non-pregnant counterparts. Our findings suggest that women should consider avoiding riding a scooter and must use restrictive devices during pregnancy, which would help reduce the severity of injuries sustained following an MVC.
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Affiliation(s)
- Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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Kyung D, Park KS, Koo JE, Kim S, Park J, Bae JH, Bae J, Kim S, Lee YJ, Ha IH. Safety and effectiveness of integrative Korean medicine for the management of patients sustaining injuries in traffic accidents during pregnancy: A retrospective chart review and questionnaire survey. Medicine (Baltimore) 2024; 103:e38250. [PMID: 38787995 PMCID: PMC11124594 DOI: 10.1097/md.0000000000038250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
The number of traffic accidents (TAs) is rising each year, and the severity of injuries can vary. Many people experience limitations in activities of daily living following TAs, affecting their quality of life. In pregnant women, even simple injuries caused by a TA could lead to unfavorable obstetric outcomes. Thus, we conducted a retrospective chart review and follow-up questionnaire survey to assess the safety and effectiveness of integrative Korean medicine (KM) treatment for pregnant women injured in TAs. To assess integrative KM effectiveness, the numeric rating scale (NRS) for TA-related symptoms, neck disability index (NDI) score, Oswestry disability index (ODI) score, shoulder pain and disability index score, Western Ontario and McMaster Universities Arthritis Index score, EuroQol 5-dimension 5-level (EQ-5D-5L) score, and patient global impression of change score were investigated for pregnant women injured in TAs. Additionally, for safety evaluation, obstetric and neonatal outcomes, as well as symptoms related to pregnancy, were assessed. At the end of treatment and follow-up, there were significant reductions in NDI and ODI scores, as well as NRS for neck pain, lower back pain, and headache, compared to scores at baseline. EQ-5D-5L scores significantly increased. A follow-up of 50 patients showed no major differences in obstetric and neonatal outcomes compared to the typical outcomes that occur in pregnant women and neonates. Major improvements were observed in the symptoms of patients who underwent integrative KM treatment after being injured in TAs. The symptoms occurred at a rate similar to those in typical pregnant women, while causality with integrative KM treatment was assessed to be unlikely or unclear. Therefore, integrative KM treatment may be considered an alternative treatment option for pregnant women who currently have limited treatment options.
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Affiliation(s)
- Dahyun Kyung
- Daejeon Jaseng Hospital of Korean Medicine, Seo-gu, Daejeon, Republic of Korea
| | - Kyoung Sun Park
- Jaseng Hospital of Korean Medicine, Gangnam-gu, Seoul, Republic of Korea
| | - Ji-Eun Koo
- Daejeon Jaseng Hospital of Korean Medicine, Seo-gu, Daejeon, Republic of Korea
| | - Sujin Kim
- Daejeon Jaseng Hospital of Korean Medicine, Seo-gu, Daejeon, Republic of Korea
| | - Jiwon Park
- Daejeon Jaseng Hospital of Korean Medicine, Seo-gu, Daejeon, Republic of Korea
| | - Jun-Hyo Bae
- Daejeon Jaseng Hospital of Korean Medicine, Seo-gu, Daejeon, Republic of Korea
| | - Jieun Bae
- Daejeon Jaseng Hospital of Korean Medicine, Seo-gu, Daejeon, Republic of Korea
| | - Suna Kim
- Daejeon Jaseng Hospital of Korean Medicine, Seo-gu, Daejeon, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Gangnam-gu, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Gangnam-gu, Seoul, Republic of Korea
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Akkuş E, Gökçay Canpolat A, Demir Ö, Çorapçıoğlu D, Şahin M. Asymptomatic pyuria and bacteriuria are not risk factors for urinary tract infection in women with type 2 diabetes mellitus initiated SGLT2 inhibitors. Int Urol Nephrol 2024; 56:1165-1172. [PMID: 37715859 DOI: 10.1007/s11255-023-03798-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Asymptomatic pyuria and bacteriuria are more prevalent in diabetic patients and may be associated with urinary tract infection (UTI). The aim of this study is to investigate the association between asymptomatic pyuria/bacteriuria at the initiation of SGLT2 inhibitor and UTI risk in female patients with type 2 diabetes. METHODS The study was designed as a practical, single-center, prospective, cohort study. The female outpatients with type 2 diabetes initiated SGLT2 inhibitor were included. Patients who were symptomatic or treated in the past 3 months for urinary or genital tract infection, had a high risk for UTI were excluded. Hospitalization/antibiotic use for indications other than UTI were exclusion criteria during follow-up. All patients were followed up for 3 months. Pyuria and bacteriuria were exposure and, UTI was the outcome. Cumulative incidence and relative risk of UTI were analyzed for pyuria and bacteriuria. RESULTS 143 female patients were included among 1132 female type 2 diabetic patients. 13 patients were excluded during follow-up. 41.5% of the patients (n = 54) had pyuria and 28.5% (n = 37) had bacteriuria. The cumulative incidence of UTI was 20% in the whole cohort, 25,9% (n = 14/54) in the pyuria group and 18.9% (n = 7/37) in the bacteriuria group. The relative risk of UTI was 1.64 (95% CI: 0.82-3.26, p = 0.15) for pyuria, 0.92 (95% CI: 0.42-2.01, p = 0.84) for bacteriuria, and 1.2 (95% CI: 0.47-3.08, p = 0.69) for pyuria plus bacteriuria. Adjusted odd ratios revealed similar results. CONCLUSIONS Asymptomatic pyuria/bacteriuria at the initiation of SGLT2 inhibitors are not risk factors for UTI in women with type 2 diabetes.
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Affiliation(s)
- Erman Akkuş
- Department of Internal Medicine, Trabzon Araklı Public Hospital, Trabzon, Turkey.
- Department of Internal Medicine, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Asena Gökçay Canpolat
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özgür Demir
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Demet Çorapçıoğlu
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Şahin
- Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey
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11
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Santos JW, Grigorian A, Lucas AN, Fierro N, Dhillon NK, Ley EJ, Smith J, Burruss S, Dahan A, Johnson A, Ganske W, Biffl WL, Bayat D, Castelo M, Wintz D, Schaffer KB, Zheng DJ, Tillou A, Coimbra R, Tuli R, Santorelli JE, Emigh B, Schellenberg M, Inaba K, Duncan TK, Diaz G, Tay-Lasso E, Zezoff DC, Nahmias J. Predictors of fetal delivery in pregnant trauma patients: A multicenter study. J Trauma Acute Care Surg 2024; 96:109-115. [PMID: 37580875 DOI: 10.1097/ta.0000000000003964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
BACKGROUND Pregnant trauma patients (PTPs) undergo observation and fetal monitoring following trauma due to possible fetal delivery (FD) or adverse outcome. There is a paucity of data on PTP outcomes, especially related to risk factors for FD. We aimed to identify predictors of posttraumatic FD in potentially viable pregnancies. METHODS All PTPs (≥18 years) with ≥24-weeks gestational age were included in this multicenter retrospective study at 12 Level-I and II trauma centers between 2016 and 2021. Pregnant trauma patients who underwent FD ((+) FD) were compared to those who did not deliver ((-) FD) during the index hospitalization. Univariate analyses and multivariable logistic regression were performed to identify predictors of FD. RESULTS Of 591 PTPs, 63 (10.7%) underwent FD, with 4 (6.3%) maternal deaths. The (+) FD group was similar in maternal age (27 vs. 28 years, p = 0.310) but had older gestational age (37 vs. 30 weeks, p < 0.001) and higher mean injury severity score (7.0 vs. 1.5, p < 0.001) compared with the (-) FD group. The (+) FD group had higher rates of vaginal bleeding (6.3% vs. 1.1%, p = 0.002), uterine contractions (46% vs. 23.5%, p < 0.001), and abnormal fetal heart tracing (54.7% vs. 14.6%, p < 0.001). On multivariate analysis, independent predictors for (+) FD included abdominal injury (odds ratio [OR], 4.07; confidence interval [CI], 1.11-15.02; p = 0.035), gestational age (OR, 1.68 per week ≥24 weeks; CI, 1.44-1.95; p < 0.001), abnormal FHT (OR, 12.72; CI, 5.19-31.17; p < 0.001), and premature rupture of membranes (OR, 35.97; CI, 7.28-177.74; p < 0.001). CONCLUSION The FD rate was approximately 10% for PTPs with viable fetal gestational age. Independent risk factors for (+) FD included maternal and fetal factors, many of which are available on initial trauma bay evaluation. These risk factors may help predict FD in the trauma setting and shape future guidelines regarding the recommended observation of PTPs. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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Affiliation(s)
- Jeffrey W Santos
- From the Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, (J.W.S., A.G., A.N.L., E.T.-L., D.C.Z., J.N.), University of California, Irvine, Orange; Department of Surgery (N.F., N.K.D., E.J.L.), Cedars-Sinai Medical Center, Los Angeles; Division of Trauma and Critical Care (J.S.), Harbor-UCLA Hospital, Torrance; Department of Trauma, Acute Care Surgery, Surgical Critical Care (S.B.), Loma Linda Medical Center, Loma Linda; Riverside School of Medicine (A.D.), University of California, Riverside; Cottage Health Research Institute (A.J., W.G.), Santa Barbara Cottage Hospital, Santa Barbara; Trauma and Acute Care Surgery, Scripps Memorial Hospital (W.L.B., D.B., M.C.), La Jolla; Department of Surgery (D.W., K.B.S.), Sharp Memorial Hospital, San Diego; Department of Surgery (D.J.Z., A.T.), UCLA David Geffen School of Medicine, Los Angeles; Department of Surgery, Comparative Effectiveness and Clinical Outcomes Research Center-CECORC (R.C., R.T.), Riverside University Health System Medical Center, Moreno Valley; Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery (J.E.S.), University of California San Diego School of Medicine, San Diego; Division of Acute Care Surgery (B.E., M.S., K.I.), LAC+USC Medical Center, University of Southern California, Los Angeles; and Department of Trauma (T.K.D., G.D.), Ventura County Medical Center, Ventura, California
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12
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Chang YH, Chien YW, Chang CH, Chen PL, Lu TH, Hsu IL, Li CY. Associations of maternal motor vehicle crashes during pregnancy with offspring's neonatal birth outcomes. Int J Epidemiol 2023; 52:1774-1782. [PMID: 37738433 DOI: 10.1093/ije/dyad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Adverse events in fetuses are well researched but studies on the follow-up health outcomes of infants exposed to maternal motor vehicle crashes (MVCs) during pregnancy have yielded inconsistent results. This study aimed to investigate the association of maternal exposure to MVCs during pregnancy with the risk of adverse neonatal outcomes. METHODS This population-based cohort study used data from birth notifications in Taiwan. A total of 19 277 offspring with maternal exposure to MVCs during pregnancy and 76 015 randomly selected comparison offspring without such exposure were selected. Neonatal adverse outcomes were identified from National Health Insurance medical claims data. Conditional logistic regression was used to estimate the unadjusted and adjusted odds ratios (aORs) of neonatal adverse outcomes. RESULTS Offspring exposed to maternal MVCs during pregnancy had a higher risk of birth defects (aOR, 1.21; 95% CI, 1.04-1.41) than offspring without such exposure. This positive association was sustained with exposure to an MVC during the first or second trimester. A dose-response relationship (P = 0.0023) was observed between the level of injury severity and the risk of birth defects. CONCLUSIONS In the early stages of pregnancy, maternal exposure to MVCs may entail a risk of birth defects in the offspring. The potential mechanisms for the associations of maternal exposure to MVCs with birth defects need further investigation.
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Affiliation(s)
- Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Lin Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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13
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Chang YH, Chien YW, Chang CH, Chen PL, Lu TH, Li CY. Risks of motor vehicle crash before and during pregnancy: A population-based controlled study in Taiwan. Injury 2023; 54:111094. [PMID: 37845171 DOI: 10.1016/j.injury.2023.111094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Changes in risk of motor vehicle crashes (MVCs) during pregnancy are less known, and very few studies have assessed this issue by using unselected population-based datasets and adopting a before-and-during design. The study aimed to address the risk of MVC events in association with pregnancy using a national pregnant women cohort in Taiwan. METHODS We conducted a self-matched design in which each woman served as a driver before and during pregnancy. A total of 1,372,664 pregnant women with live birth(s) at 18-50 years of age between 2008 and 2017 were identified from the Birth Notification dataset. MVC events as a driver were ascertained from the Police-reported Traffic Accident Registry dataset. We calculated the rate ratio (RR) with a 95 % confidence interval (CI) using the conditional Poisson regression model to compare the MVC event rates between pre-pregnancy and pregnancy periods. RESULTS The overall rate of MVC events was significantly reduced during pregnancy (RR = 0.69, 95 % confidence interval (CI) = 0.68-0.71). Mothers with alcoholism during pregnancy were associated with an increased RR at 2.00 but with a very wide CI. Reduction in RR was primarily attributed to the reduced MVC event rate involving scooter crashes (0.60, 95 % CI = 0.58-0.62). CONCLUSION Although MVC event rates decreased during women became pregnant, many women drivers were still involved in MVCs during pregnancy. Their potential maternal and perinatal conditions along with their offspring's health outcomes need further investigations.
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Affiliation(s)
- Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
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14
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Bodke H, Wagh V, Kakar G. Diabetes Mellitus and Prevalence of Other Comorbid Conditions: A Systematic Review. Cureus 2023; 15:e49374. [PMID: 38146555 PMCID: PMC10749406 DOI: 10.7759/cureus.49374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by elevated blood glucose levels, severity continues to rise worldwide. This systematic review seeks to examine the prevalence of diabetes and its associated comorbid conditions, aiming to provide insights into the multifaceted impact of diabetes on a broader scale. DM exhibits a positive correlation with advancing age, and it's strongly influenced by genetic predisposition. In recent years, there has been a discernible global increase in the prevalence of type 1 diabetes (T1D), as evidenced by extensive epidemiological studies. Individuals with DM frequently have a positive familial history, and the presence of DM in both parents or solely the mother significantly amplifies genetic susceptibility. Moreover, non-genetic factors, such as acute psychological stressors, obesity, pregnancy, and smoking play a pivotal role in the development of DM. Notably, urinary tract infections (UTIs) are a common comorbidity in patients with type 2 diabetes (T2D) and all patients with T1D. T2D is prevalent, particularly among females, and its incidence rises with age. UTIs are prevalent among individuals with diabetes, particularly females, with Escherichia coli (E. coli) isolates being the primary etiological agents responsible for UTI inflammation. Insulin resistance is a common feature in both prediabetes and prehypertension, serving as a precursor to these conditions. The increasing incidence of T2D in regions with high tuberculosis (TB) prevalence emphasizes the significance of understanding DM as a substantial TB risk factor. DM is associated with a threefold elevation in TB risk and a twofold increase in unfavorable outcomes during TB treatment. Notably, the global prevalence of DM has led to a larger population of TB patients with comorbid DM than TB patients coinfected with HIV. Diabetes and sepsis contribute significantly to worldwide morbidity and mortality, with diabetic individuals experiencing more post-sepsis complications and increased mortality. The coexistence of hypertension and T2D is a common comorbidity, with hypertension incidence being twice as high among individuals with diabetes compared to those without, often linked to insulin resistance and a heightened risk of diabetes onset.
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Affiliation(s)
- Harsh Bodke
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vasant Wagh
- Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gauri Kakar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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15
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Chang YH, Chien YW, Chang CH, Chen PL, Lu TH, Hsu IL, Li CY. Maternal outcomes in association with motor vehicle crashes during pregnancy: a nationwide population-based retrospective study. Inj Prev 2023; 29:166-172. [PMID: 36941051 DOI: 10.1136/ip-2022-044810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/29/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Limited studies have assessed the association of motor vehicle crashes (MVCs) during pregnancy with adverse maternal outcomes using a population-based nationwide dataset that covers all MVCs. METHODS A total of 20 844 births from women who had been involved in MVCs during pregnancy were obtained from the National Birth Notification (BN) Database in Taiwan. We randomly selected 83 274 control births from women in the BN matched on age, gestational age and crash date. All study subjects were linked to medical claims and the Death Registry to identify the maternal outcomes after crashes. Conditional logistic regression models were used to estimate the adjusted odds ratio (aOR) and 95% CI of adverse outcomes associated with MVCs during pregnancy. RESULTS Pregnant women involved in MVCs had significantly higher risks of placental abruption (aOR=1.51, 95% CI 1.30 to 1.74), prolonged uterine contractions (aOR=1.31, 95% CI 1.11 to 1.53), antepartum haemorrhage (aOR=1.19, 95% CI 1.12 to 1.26) and caesarean delivery (aOR=1.05, 95% CI 1.02 to 1.09) than the controls. Such elevated risks tended to be higher in the MVCs with greater severity. Scooter riders had higher ORs of various adverse maternal outcomes than car drivers. CONCLUSIONS Women involved in MVCs during pregnancy were at increased risk of various adverse maternal outcomes, especially in those with severe MVCs and riding scooters at MVCs. These findings suggest that clinicians should be aware of these effects, and educational materials that include the above information should be provided as part of prenatal care.
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Affiliation(s)
- Ya-Hui Chang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Wen Chien
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Lin Hsu
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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16
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Ahmed A, Rosella LC, Oskoui M, Watson T, Yang S. In Utero Exposure to Maternal Injury and the Associated Risk of Cerebral Palsy. JAMA Pediatr 2023; 177:53-61. [PMID: 36441546 PMCID: PMC9706397 DOI: 10.1001/jamapediatrics.2022.4535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022]
Abstract
Importance Although maternal unintentional injury during pregnancy has shown negative impacts on the mother and fetus, the evidence on its long-term associations with children's neurodevelopment is limited. Objective To examine the association between maternal unintentional injury and cerebral palsy (CP) in offspring. Design, Setting, and Participants This was a population-based, longitudinal, cohort study of all in-hospital live births born between April 1, 2002, and March 31, 2017, in a publicly funded health care system setting of Ontario, Canada. Infants born more than 20 weeks' gestation were included and followed up until March 31, 2018. Excluded from the analysis were stillbirths, infants with missing or invalid records, and births with missing or invalid birth characteristics. Data were analyzed from March 1 to June 30, 2021. Exposures Maternal unintentional injury during pregnancy ascertained based on inpatient or emergency department diagnoses. Main Outcomes and Measures CP diagnosis between birth and the end of follow-up in 2018 with the CP case definition of a single inpatient or 2 or more outpatient diagnoses at least 2 weeks apart between birth and age 16 years. Results Of 2 110 177 children included in this study (mean [SD] gestational age, 38.8 [1.9] weeks; 1 082 520 male [51.3%]), 81 281 (3.9%) were exposed in utero to maternal unintentional injury. During a median (IQR) follow-up time of 8 (4-12) years, 5317 children (0.3%) were diagnosed with CP (292 CP cases [5.5%] were exposed to maternal unintentional injury). The mean incidence rates of CP were 4.36 and 2.93 per 10 000 child-years in the exposed and the unexposed group, respectively. Children exposed to maternal unintentional injury had a modest increase in the risk of CP, compared with those unexposed (hazard ratio [HR], 1.33; 95% CI, 1.18-1.50) after adjusting for maternal sociodemographic and clinical characteristics. Severe injuries that resulted in hospitalization and delivery within 1 week from the injury conferred higher risks of CP (adjusted HR, 2.18; 95% CI, 1.29-3.68 and adjusted HR, 3.40; 95% CI, 1.93-6.00, respectively). Results were robust in multiple bias analyses. Conclusions and Relevance In this Canadian population-based birth cohort study, in utero exposure to maternal unintentional injury was associated with an increased risk of CP, with a higher risk with more severe injuries. These findings fill an important gap in knowledge on the potential role of maternal injury on children's neurodevelopment outcomes. Public health professionals and stakeholders should be aware of these potential long-term consequences on offspring when designing programs and providing recommendations about safety during pregnancy. Early monitoring and developmental assessment of children exposed to maternal injury might be warranted.
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Affiliation(s)
- Asma Ahmed
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Laura C. Rosella
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Temerty Faculty of Medicine, Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Oskoui
- McGill University Health Center Research Institute, Child Health and Human Development Program, Centre for Outcomes Research and Evaluation, Montreal, Quebec, Canada
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Department of Neurology & Neurosurgery, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Tristan Watson
- Dalla Lana School of Public Health, Division of Epidemiology, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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Tung KTS, Wong RS, Ho FK, Chan KL, Wong WHS, Leung H, Leung M, Leung GKK, Chow CB, Ip P. Development and Validation of Indicators for Population Injury Surveillance in Hong Kong: Development and Usability Study. JMIR Public Health Surveill 2022; 8:e36861. [PMID: 35980728 PMCID: PMC9437780 DOI: 10.2196/36861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/26/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Injury is an increasingly pressing global health issue. An effective surveillance system is required to monitor the trends and burden of injuries. OBJECTIVE This study aimed to identify a set of valid and context-specific injury indicators to facilitate the establishment of an injury surveillance program in Hong Kong. METHODS This development of indicators adopted a multiphased modified Delphi research design. A literature search was conducted on academic databases using injury-related search terms in various combinations. A list of potential indicators was sent to a panel of experts from various backgrounds to rate the validity and context-specificity of these indicators. Local hospital data on the selected core indicators were used to examine their applicability in the context of Hong Kong. RESULTS We reviewed 142 articles and identified 55 indicators, which were classified into 4 domains. On the basis of the ratings by the expert panel, 13 indicators were selected as core indicators because of their good validity and high relevance to the local context. Among these indicators, 10 were from the construct of health care service use, and 3 were from the construct of postdischarge outcomes. Regression analyses of local hospitalization data showed that the Hong Kong Safe Community certification status had no association with 5 core indicators (admission to intensive care unit, mortality rate, length of intensive care unit stay, need for a rehabilitation facility, and long-term behavioral and emotional outcomes), negative associations with 4 core indicators (operative intervention, infection rate, length of hospitalization, and disability-adjusted life years), and positive associations with the remaining 4 core indicators (attendance to accident and emergency department, discharge rate, suicide rate, and hospitalization rate after attending the accident and emergency department). These results confirmed the validity of the selected core indicators for the quantification of injury burden and evaluation of injury-related services, although some indicators may better measure the consequences of severe injuries. CONCLUSIONS This study developed a set of injury outcome indicators that would be useful for monitoring injury trends and burdens in Hong Kong.
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Affiliation(s)
- Keith T S Tung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Rosa S Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Frederick K Ho
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Ko Ling Chan
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Wilfred H S Wong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Hugo Leung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Ming Leung
- Accident and Emergency Department, Princess Margaret Hospital, Hong Kong, Hong Kong
| | - Gilberto K K Leung
- Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong
| | - Chun Bong Chow
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, Hong Kong
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Jagadeesan S, Tripathi BK, Patel P, Muthathal S. Urinary tract infection and Diabetes Mellitus-Etio-clinical profile and antibiogram: A North Indian perspective. J Family Med Prim Care 2022; 11:1902-1906. [PMID: 35800584 PMCID: PMC9254764 DOI: 10.4103/jfmpc.jfmpc_2017_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/02/2022] Open
Abstract
Context A complex dysregulation of glucose homeostasis, Diabetes Mellitus (DM) is an iceberg disease with an ever-rising global (8.5%, 2018) and national prevalence (7.3% - ICMR-INDIAB study, 2017) amidst adults. Besides the micro and macrovascular complications, in virtue of diverse mechanisms that downplay the immune system culminating in an array of infections especially UTIs are commoner in routine diabetic clinics. The spectrum of UTI ranges from asymptomatic bacteriuria (ASB) to serious complications such as emphysematous pyelonephritis, renal abscesses that are encountered frequently among Diabetics than the general population. The risk stratification and varying modalities of presentation of UTIs in diabetics in contrast with non-diabetics are being studied. Methods and Material A prospective comparative cross-sectional study was conducted in 250 adult consenting participants with equal diabetics and non-diabetics with culture-proven UTI, at the Department of Internal Medicine in a tertiary care hospital of National Capital Territory (NCT) of India, after fulfilling appropriate criteria. Alongside socio-demographic details and vitals parameters, glycaemic status assessment and relevant investigations were done in either group. Results Mean age of the participants was 52.18 ± 9.06 with age and gender being reasonably distributed in both the groups. Fever (P <0.01), dysuria (P <0.01), urgency (P <0.01) and urinary frequency (P <0.01) found frequently among non-diabetics wherein vomiting (P <0.01) and incontinence (P <0.01) relatively commoner among diabetics. E. coli, Klebsiella sp., were the most common organisms in both groups with Proteus sp., and Pseudomonas sp., higher among diabetics. Severe infection and Pyelonephritis were frequent (AOR 2.64, 95% CI- 2.01-3.27, P <0.05) among diabetics. Antimicrobial sensitivity patterns were not significantly different among both groups. Conclusions Primary care physicians are to be acquinted with the possibility that UTI in diabetics could exhibit relatively lesser symptoms or more severe forms of UTI at presentation and less favorable outcomes. Further validation from a larger cohort of diabetics is warranted in terms of symptomatology, diagnostic approach, and sensitivity patterns.
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Affiliation(s)
| | | | - Pranav Patel
- Department of Internal Medicine, VMMC and Safdarjung Hospital, New Delhi, India
| | - Subramanian Muthathal
- Department of Community Medicine, Panimalar Medical College Hospital and Research Institute, Chennai, Tamil Nadu, India
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Risk of Mortality in Association with Pregnancy in Women Following Motor Vehicle Crashes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020911. [PMID: 35055738 PMCID: PMC8775890 DOI: 10.3390/ijerph19020911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/08/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023]
Abstract
The aim of the study was to provide a systematic review and meta-analysis of studies examining the association between mortality risk and motor vehicle crashes (MVCs) in pregnant women compared with nonpregnant women. We used relevant MeSH terms to identify epidemiological studies of mortality risk in relation to MVCs from PubMed, Embase, and MEDLINE databases. The Newcastle–Ottawa Scale (NOS) was used for quality assessment. For comparison of mortality from MVCs between pregnant and nonpregnant women, the pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using a random effects model. The eight studies selected met all inclusion criteria. These studies included 14,120 injured victims who were pregnant at the time of the incident and 207,935 victims who were not pregnant. Compared with nonpregnant women, pregnant women had a moderate but insignificant decrease in mortality risk (pooled OR = 0.68, 95% CI = 0.38–1.22, I2 = 88.71%). Subgroup analysis revealed that the pooled OR significantly increased at 1.64 (95% CI = 1.16–2.33, I2 < 0.01%) for two studies with a similar difference in the mean injury severity score (ISS) between pregnant and nonpregnant women. Future studies should further explore the risk factors associated with MVCs in pregnant women to reduce maternal mortality.
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Tanaka K, Motozawa Y, Takahashi K, Maki T, Hitosugi M. Factors Affecting the Severity of Placental Abruption in Pregnant Vehicle Drivers: Analysis with a Novel Finite Element Model. Healthcare (Basel) 2021; 10:healthcare10010027. [PMID: 35052190 PMCID: PMC8775634 DOI: 10.3390/healthcare10010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 11/25/2022] Open
Abstract
We clarified factors affecting the severity of placental abruption in motor vehicle collisions by quantitively analyzing the area of placental abruption in a numerical simulation of an unrestrained pregnant vehicle driver at collision velocities of 3 and 6 m/s. For the simulation, we constructed a novel finite element model of a small 30-week pregnant woman, which was validated anthropometrically using computed tomography data and biomechanically using previous examinations of post-mortem human subjects. In the simulation, stress in the elements of the utero–placental interface was computed, and those elements exceeding a failure criterion were considered to be abrupted. It was found that a doubling of the collision velocity increased the area of placental abruption 10-fold, and the abruption area was approximately 20% for a collision velocity of 6 m/s, which is lower than the speed limit for general roads. This result implies that even low-speed vehicle collisions have negative maternal and fetal outcomes owing to placental abruption without a seatbelt restraint. Additionally, contact to the abdomen, 30 mm below the umbilicus, led to a larger placental abruption area than contact at the umbilicus level when the placenta was located at the uterus fundus. The results support that a reduction in the collision speed and seatbelt restraint at a suitable position are important to decrease the placental abruption area and therefore protect a pregnant woman and her fetus in a motor vehicle collision.
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Affiliation(s)
- Katsunori Tanaka
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.T.); (Y.M.)
| | - Yasuki Motozawa
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.T.); (Y.M.)
| | | | - Tetsuo Maki
- Department of Mechanical Engineering, Tokyo City University, Tokyo 158-8557, Japan;
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu 520-2192, Japan; (K.T.); (Y.M.)
- Correspondence: ; Tel./Fax: +81-77-581-2200
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21
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Trauma and pregnancy: Is flow cytometry detection and quantification of fetal red blood cells useful? Eur J Obstet Gynecol Reprod Biol 2021; 266:48-54. [PMID: 34592649 DOI: 10.1016/j.ejogrb.2021.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/19/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess whether positive flow cytometry quantification of fetal red blood cells is associated with adverse maternal and neonatal outcomes in cases of mild trauma during pregnancy. STUDY DESIGN A retrospective database study was conducted at a single tertiary center between 2013 and 2019. All pregnant women with viable gestation involved in trauma who underwent flow cytometry quantification of fetal red blood cells were included in the study. Flow cytometry was considered positive (≥0.03/≥30 ml). Composite adverse maternal and neonatal outcome was defined as one or more of the following: intrauterine fetal death, placental abruption, pre-term birth <37 weeks of gestation, immediate premature rupture of the membranes, and immediate delivery following trauma. Univariate analysis was performed followed by multivariate logistic regression analysis controlling for potential confounders, to assess the role of flow cytometry in predicting adverse maternal and neonatal outcome. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS During the study period 1023 women met inclusion and exclusion criteria. The mechanisms of injury were motor vehicle accident in 387 women (38%), falls in 367 (36%), direct abdominal injury in 353 (35%) and in 14 women (1%) other mechanism of injury. Flow cytometry was considered positive (≥0.03/≥30 ml) in 119 women (11.6%) with median result of 0.03 [0.03-0.04], and negative in 904 women (88.4%) ((≤0.03/≤30 ml) with median result of 0.01 [0.01-0.02]. Composite adverse outcome occurred in 8% of the women involved in trauma during pregnancy, with no difference between the groups with vs. without positive flow cytometry (4.2% vs. 8.5%; p = 0.1). Positive flow cytometry was not associated with any adverse maternal or neonatal outcome. This was confirmed on multivariate analysis controlling for potential confounders. CONCLUSION Flow cytometry result is not related to adverse maternal and fetal/neonatal outcome of women involved in minor trauma during pregnancy. We suggest that flow cytometry should not be routinely assessed in pregnant women involved in minor trauma.
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Owattanapanich N, Lewis MR, Benjamin ER, Wong MD, Demetriades D. Motor vehicle crashes in pregnancy: Maternal and fetal outcomes. J Trauma Acute Care Surg 2021; 90:861-865. [PMID: 33496550 DOI: 10.1097/ta.0000000000003093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Motor vehicle crashes (MVCs) are a leading cause of death in pregnant women. Even after minor trauma, there is risk of fetal complications. The purpose of this study was to compare injuries and outcomes in pregnant with matched nonpregnant women after MVC and evaluate the incidence and type of pregnancy-related complications. METHODS Retrospective study at a Level I trauma center included pregnant MVC patients, admitted 2009 to 2019. Pregnant patients were matched for age, seatbelt use, and airbag deployment with nonpregnant women (1:3). Gestation-related complications included uterine contractions, vaginal bleeding, emergency delivery, and fetal loss. RESULTS During the study period, there were 6,930 MVC female admissions. One hundred forty-five (2%) were pregnant, matched with 387 nonpregnant. The seat belt use (71% in nonpregnant vs. 73% in pregnant, p = 0.495) and airbag deployment (10% vs. 6%, p = 0.098) were similar in both groups. Nonpregnant women had higher Injury Severity Score (4 vs. 1, p < 0.0001) and abdominal Abbreviated Injury Scale (2 vs. 1, p < 0.001), but a smaller proportion sustained abdominal injury (18% vs. 53%, p < 0.0001). Mortality (1% vs. 0.7%, p = 0.722), need for emergency operation (6% vs. 3%, p = 0.295) or angiointervention (0.3% vs. 0%, p = 0.540), ventilator days (3 vs. 8, p = 0.907), and intensive care unit (4 vs. 4, p = 0.502) and hospital length of stay (2 vs. 2, p = 0.122) were all similar. Overall, 13 (11.1%) patients developed gestation-related complications, most commonly uterine contractions (6.3%), need for emergency delivery (3.5%), and vaginal bleeding (1.4%). CONCLUSION Most pregnant patients hospitalized for MVC suffered minor injuries. Pregnant women had lower Injury Severity Score and abdominal Abbreviated Injury Scale than matched nonpregnant women. However, there was still a considerable incidence of gestation-related complications. It is imperative that pregnant patients be closely monitored even after minor trauma. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
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Affiliation(s)
- Natthida Owattanapanich
- From the Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
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Pai CW, Wiratama BS, Lin HY, Chen PL. Association of Traumatic Injury With Adverse Pregnancy Outcomes in Taiwan, 2004 to 2014. JAMA Netw Open 2021; 4:e217072. [PMID: 33877308 PMCID: PMC8058639 DOI: 10.1001/jamanetworkopen.2021.7072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Literature has suggested that trauma among pregnant women is associated with an increased risk of adverse pregnancy outcomes. However, limited research has investigated the association of trauma with adverse pregnancy outcomes by using a national data set. OBJECTIVE To investigate the association between traumatic injury and adverse pregnancy outcomes. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study of pregnant women in Taiwan linked 3 data sets, the Taiwan Birth Registry, Household Registration Information, and National Health Insurance Research Database, from January 1, 2004, through December 31, 2014. Data, including the characteristics of pregnant women and infants, were extracted from the Taiwan Birth Registry data set; to obtain trauma data, this data set and the Household Registration Information data set were collectively linked to National Health Insurance Research Database data. The combined data set was analyzed from January to July 2019. Adverse pregnancy outcomes and premature delivery were defined using International Classification of Diseases, Ninth Revision, Clinical Modification codes. EXPOSURES The primary exposures of this study were 2 clinical variables related to injury during pregnancy: medical treatment in the emergency department (yes or no) and hospitalization (yes or no). MAIN OUTCOMES AND MEASURES The main outcome variable was adverse pregnancy outcomes, and the secondary outcome variable was premature delivery. Multivariate logistic regression models were used to investigate the association of injuries with adverse pregnancy outcomes after controlling for demographic characteristics and other pregnancy-related variables. RESULTS A total of 2 973 831 pregnant women (2 475 805 [83.3%] aged 20-34 years) were enrolled between 2004 and 2014, of whom 59 681 (2.0%) sought medical treatments due to injuries. Results of multivariate logistic regression models showed that women receiving emergency treatments more than once were 1.08 times as likely (adjusted odds ratio, 1.08; 95% CI, 1.05-1.10) to have adverse pregnancy outcomes than women who received no emergency treatment. Women with injury-related hospitalization were 1.53 times more likely (adjusted odds ratio, 1.53; 95% CI, 1.41-1.65) to have adverse pregnancy outcomes than women who did not sustain injuries. Furthermore, recurrent injuries were associated with a 572% increase in odds of premature delivery (adjusted odds ratio, 6.72; 95% CI, 2.86-15.80). CONCLUSIONS AND RELEVANCE In this study, trauma among pregnant women was associated with an increased risk of adverse pregnancy outcomes, as were hospitalization and emergency department visits due to injury.
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Affiliation(s)
- Chih-Wei Pai
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Bayu Satria Wiratama
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Department of Epidemiology, Biostatistics and Population Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta City, Indonesia
| | - Hsiao-Yu Lin
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
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Hattori S, Hitosugi M, Moriguchi S, Baba M, Takaso M, Nakamura M, Tsujimura S, Miyata Y. Factors Influencing Pregnant Women's Injuries and Fetal Loss Due to Motor Vehicle Collisions: A National Crash Data-Based Study. Healthcare (Basel) 2021; 9:healthcare9030273. [PMID: 33802545 PMCID: PMC8001010 DOI: 10.3390/healthcare9030273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
To examine the factors that influence substantial injuries for pregnant women and negative fetal outcomes in motor vehicle collisions (MVCs), a retrospective analysis using the National Automotive Sampling System/Crashworthiness Data System was performed in Shiga University of Medical Science. We analyzed data from 736 pregnant women who, between 2001 and 2015, had injuries that were an abbreviated injury scale (AIS) score of one or more. The mean age was 25.9 ± 6.4 years and the mean gestational age was 26.2 ± 8.2 weeks. Additionally, 568 pregnant women had mild injuries and 168 had moderate to severe injuries. Logistic regression analysis revealed that seatbelt use (odds ratio (OR), 0.30), airbag deployment (OR, 2.00), and changes in velocity (21–40 km/h: OR, 3.03; 41–60 km/h: OR, 13.47; ≥61 km/h: OR, 44.56) were identified as independent predictors of having a moderate to severe injury. The positive and negative outcome groups included 231 and 12 pregnant women, respectively. Injury severity in pregnant women was identified as an independent predictor of a negative outcome (OR, 2.79). Avoiding moderate to severe maternal injuries is a high priority for saving the fetus, and education on appropriate seatbelt use and limiting vehicle speed for pregnant women is required.
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Affiliation(s)
- Shinobu Hattori
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan; (S.H.); (S.M.); (M.T.); (M.N.)
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan; (S.H.); (S.M.); (M.T.); (M.N.)
- Correspondence: ; Tel./Fax: +81-77-548-2200
| | - Shingo Moriguchi
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan; (S.H.); (S.M.); (M.T.); (M.N.)
| | - Mineko Baba
- Center for Integrated Medical Research, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan;
| | - Marin Takaso
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan; (S.H.); (S.M.); (M.T.); (M.N.)
| | - Mami Nakamura
- Department of Legal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, Shiga 520-2192, Japan; (S.H.); (S.M.); (M.T.); (M.N.)
| | - Seiji Tsujimura
- Joyson Safety Systems Japan K.K. Echigawa Plant, 658 Echigawa, Aisho-cho, Echi-gun, Shiga 529-1388, Japan; (S.T.); (Y.M.)
| | - Yasuhito Miyata
- Joyson Safety Systems Japan K.K. Echigawa Plant, 658 Echigawa, Aisho-cho, Echi-gun, Shiga 529-1388, Japan; (S.T.); (Y.M.)
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Mashraqi MM, Chaturvedi N, Alam Q, Alshamrani S, Bahnass MM, Ahmad K, Alqosaibi AI, Alnamshan MM, Ahmad SS, Beg MMA, Mishra A, Shaikh S, Rizvi SMD. Biocomputational Prediction Approach Targeting FimH by Natural SGLT2 Inhibitors: A Possible Way to Overcome the Uropathogenic Effect of SGLT2 Inhibitor Drugs. Molecules 2021; 26:582. [PMID: 33499241 PMCID: PMC7866138 DOI: 10.3390/molecules26030582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 01/05/2023] Open
Abstract
The Food and Drug Administration (FDA) approved a new class of anti-diabetic medication (a sodium-glucose co-transporter 2 (SGLT2) inhibitor) in 2013. However, SGLT2 inhibitor drugs are under evaluation due to their associative side effects, such as urinary tract and genital infection, urinary discomfort, diabetic ketosis, and kidney problems. Even clinicians have difficulty in recommending it to diabetic patients due to the increased probability of urinary tract infection. In our study, we selected natural SGLT2 inhibitors, namely acerogenin B, formononetin, (-)-kurarinone, (+)-pteryxin, and quinidine, to explore their potential against an emerging uropathogenic bacterial therapeutic target, i.e., FimH. FimH plays a critical role in the colonization of uropathogenic bacteria on the urinary tract surface. Thus, FimH antagonists show promising effects against uropathogenic bacterial strains via their targeting of FimH's adherence mechanism with less chance of resistance. The molecular docking results showed that, among natural SGLT2 inhibitors, formononetin, (+)-pteryxin, and quinidine have a strong interaction with FimH proteins, with binding energy (∆G) and inhibition constant (ki) values of -5.65 kcal/mol and 71.95 µM, -5.50 kcal/mol and 92.97 µM, and -5.70 kcal/mol and 66.40 µM, respectively. These interactions were better than those of the positive control heptyl α-d-mannopyranoside and far better than those of the SGLT2 inhibitor drug canagliflozin. Furthermore, a 50 ns molecular dynamics simulation was conducted to optimize the interaction, and the resulting complexes were found to be stable. Physicochemical property assessments predicted little toxicity and good drug-likeness properties for these three compounds. Therefore, formononetin, (+)-pteryxin, and quinidine can be proposed as promising SGLT2 inhibitors drugs, with add-on FimH inhibition potential that might reduce the probability of uropathogenic side effects.
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Affiliation(s)
- Mutaib M. Mashraqi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia; (M.M.M.); (S.A.); (M.M.B.)
| | - Navaneet Chaturvedi
- Biomolecular Engineering Laboratory, School of Biochemical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi 221005, India; (N.C.); (A.M.)
- Department of Molecular and Cell Biology, Leicester Institute of Structural and Chemical Biology, University of Leicester Henry Wellcome Building, Lancaster Road Leicester, Leicester LE1 7HB, UK
| | - Qamre Alam
- Medical Genomics Research Department, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh 11426, Saudi Arabia;
| | - Saleh Alshamrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia; (M.M.M.); (S.A.); (M.M.B.)
| | - Mosa M. Bahnass
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia; (M.M.M.); (S.A.); (M.M.B.)
- Department of Animal Medicine (Infectious Diseases), Faculty of Veterinary Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Khurshid Ahmad
- Department of Medical Biotechnology, Yeungnam University, Gyeongsan 38541, Korea; (K.A.); (S.S.A.); (M.M.A.B.)
| | - Amany I. Alqosaibi
- Department of Biology, College of Science, Imam Abdulrahman bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (A.I.A.); (M.M.A.)
| | - Mashael M. Alnamshan
- Department of Biology, College of Science, Imam Abdulrahman bin Faisal University, P.O. Box 1982, Dammam 31441, Saudi Arabia; (A.I.A.); (M.M.A.)
| | - Syed Sayeed Ahmad
- Department of Medical Biotechnology, Yeungnam University, Gyeongsan 38541, Korea; (K.A.); (S.S.A.); (M.M.A.B.)
| | - Mirza Masroor Ali Beg
- Department of Medical Biotechnology, Yeungnam University, Gyeongsan 38541, Korea; (K.A.); (S.S.A.); (M.M.A.B.)
| | - Abha Mishra
- Biomolecular Engineering Laboratory, School of Biochemical Engineering, Indian Institute of Technology, Banaras Hindu University, Varanasi 221005, India; (N.C.); (A.M.)
| | - Sibhghatulla Shaikh
- Department of Medical Biotechnology, Yeungnam University, Gyeongsan 38541, Korea; (K.A.); (S.S.A.); (M.M.A.B.)
| | - Syed Mohd Danish Rizvi
- Department of Pharmaceutics, College of Pharmacy, University of Hail, P.O. Box 2440, Hail 81451, Saudi Arabia
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Lee YC, Chen TH, Hsiao MC, Hung PH, Tung SH, Hsiao CY. Glycated Hemoglobin < 6.5% Is Associated With Uroseptic Shock in Diabetic Patients With Urinary Tract Infection. Front Med (Lausanne) 2020; 7:515506. [PMID: 33344465 PMCID: PMC7748060 DOI: 10.3389/fmed.2020.515506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 11/02/2020] [Indexed: 11/18/2022] Open
Abstract
This study aimed to compare the clinical characteristics and treatment outcomes of diabetic and non-diabetic individuals with urinary tract infection (UTI) and determine whether glycated hemoglobin (HbA1c) levels <6. 5% leads to uroseptic shock in diabetic individuals. We retrospectively collected and analyzed the clinical data of 1,363 individuals with UTIs in Taiwan from January 2006 to January 2018. Of the 345 diabetic individuals, 61 (17.7%) developed uroseptic shock. Diabetic patients who developed uroseptic shock tended to be older and males and, had a history of congestive heart failure, urolithiasis, higher serum creatinine level during hospitalization, lower serum HbA1c level, bacteremia, and acute kidney injury. Backward stepwise multivariate logistic regression analysis showed that male gender [odds ratio (OR), 1.861; 95% confidence interval (CI), 1.009–3.433; P = 0.047], congestive heart failure (OR, 4.036; 95% CI, 1.542–10.565; P = 0.004), bacteremia (OR, 2.875; 95% CI, 1.539–5.370; P = 0.001), and HbA1c level <6.5% (OR, 2.923; 95% CI, 1.580–5.406; P = 0.001) were associated with an increased risk of developing uroseptic shock among diabetic patients during hospitalization due to UTI. HbA1c level <6.5% is independently associated with uroseptic shock in diabetic patients with UTI.
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Affiliation(s)
- Yi-Chien Lee
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Tsung-Hsien Chen
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | | | - Peir-Haur Hung
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Department of Applied Life Science and Health, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Shao-Hsien Tung
- Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan
| | - Chih-Yen Hsiao
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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Abstract
BACKGROUND Trauma is the leading cause for nonpregnancy-linked maternal mortality in pregnant women, even though the exact incidence for accidents in pregnancy is unknown. Trauma management concepts applied for nonpregnant adult patients are just as valid for injured and severely injured pregnant women but in addition trauma management has to consider the unique physiological and pathophysiological conditions for a favorable maternal and fetal outcome. OBJECTIVE Overview of current data about the epidemiology, injury mechanisms, maternal and fetal outcome and recommendations on the management of injured pregnant women based on a systematic literature search. RESULTS Currently, there is no evidence indicating an association between maternal injury severity, the physiological condition and the fetal outcome. Practice guidelines for trauma management in pregnancy recommend prioritization of maternal treatment and resuscitation for optimal initial treatment of the fetus. The current recommendations for trauma room management in pregnancy, surgical treatment, including damage control surgery, are based on weak evidence. CONCLUSION The examination, stabilization and treatment of injured pregnant women has priority for fetal survival and outcome. The management of severe trauma in pregnancy requires a multidisciplinary expertise and team approach consisting of surgeons, anesthetists, radiologists, obstetricians and neonatologists, so that for a severely injured gravida, the decision for admission to designated trauma centers is already preclinically made. The principles of management and treatment of severely injured pregnant women should adhere to the treatment principles of nonpregnant trauma victims.
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Weißleder A, Kulla M, Annecke T, Beese A, Lang P, Beinkofer D, Lefering R, Trentzsch H, Jost C, Treffer D. [Acute treatment of pregnant women after severe trauma-a retrospective multicenter analysis]. Unfallchirurg 2020; 123:944-953. [PMID: 33180155 DOI: 10.1007/s00113-020-00915-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND For the medical team, the management of pregnant trauma patients is a particular challenge. The aim of this study is to compile this data and to determine differences between pregnant and not pregnant trauma patients. MATERIALS AND METHODS We carried out a retrospective data analysis from the TraumaRegister DGU® with a comparison of 102 pregnant and 3135 not pregnant women of child-bearing age (16-45 years) from 2016-2018 who were treated in a trauma center. All patients were delivered to the resuscitation room and received intensive care treatment. RESULTS In Germany, Austria and Switzerland 3.2% of all trauma patients (102 women) were pregnant. Women with an average age of 29 years suffered most often trauma as a result of a road traffic accident. Major trauma (Injury Severity Score [ISS] ≥16 points) was seen in 24.5% of the pregnant women and 37.4% of the nonpregnant women. A computer tomography (whole body computer tomography) was carried out in 32.7% of all pregnant women but in 79.8% of the nonpregnant women. As a result of the trauma, 2.9% of the pregnant and 3.5% of the not pregnant women died. The standardised mortality rate (SMR) was 0.42 in pregnant women and 0.63 in nonpregnant women. CONCLUSION For the first time there is data regarding incidence, trauma mechanism, prehospital and in-hospital care as well as intensive care of pregnant trauma patients in Germany, Austria and Switzerland. Further research regarding foetal outcome and trauma-related injuries in pregnant women is needed to develop an adjusted management for these patients ready to implement in trauma centres. Gynaecologists and obstetricians should be implemented in the trauma room team when needed.
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Affiliation(s)
- A Weißleder
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
- Klinik XX Gynäkologie, Bundeswehrkrankenhaus Westerstede, Westerstede, Deutschland.
| | - M Kulla
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - T Annecke
- Universität zu Köln, Medizinische Fakultät und Uniklinik, Klinik für Anästhesiologie und Operative Intensivmedizin, Kerpener Straße 62, 50937, Köln, Deutschland
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke - Krankenhaus Köln-Merheim, Köln, Deutschland
| | - A Beese
- Praxis für Frauenheilkunde & Geburtshilfe Jena, Jena, Deutschland
| | - P Lang
- Klinik für Unfallchirurgie und Orthopädie, Septische und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke am Campus Köln-Merheim, Köln-Merheim, Deutschland
| | - D Beinkofer
- Klinik XX Gynäkologie, Bundeswehrkrankenhaus Westerstede, Westerstede, Deutschland
| | - R Lefering
- Klinik für Unfallchirurgie und Orthopädie, Septische und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke am Campus Köln-Merheim, Köln-Merheim, Deutschland
| | - H Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstraße 53, 80336, München, Deutschland
| | - C Jost
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - D Treffer
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
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Nabi T, Rafiq N, Rahman MHU, Rasool S, Wani NUD. Comparative study of emphysematous pyelonephritis and pyelonephritis in type 2 diabetes: a single-centre experience. J Diabetes Metab Disord 2020; 19:1273-1282. [PMID: 33553028 DOI: 10.1007/s40200-020-00640-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 09/17/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Emphysematous pyelonephritis (EPN) patients with type 2 diabetes (T2D) have severe complications and high morbidity with poor prognosis as compared to Pyelonephritis. The aim was to study clinical features, microbiological profile, complications of EPN and pyelonephritis in T2D patients. METHODS This was a hospital-based prospective study done on 200 T2D patients with upper UTI. Various clinical, biochemical parameters and urine examination and culture were monitored. Patients were followed up for 6 months with respect to number of UTIs, glycemic control and renal parameters. RESULTS Pyelonephritis was present in 180(90%) and EPN in 20(10%) of upper UTI patients. Longer duration of diabetes, presence of nephropathy, chronic kidney disease (CKD), hypertension (HTN), history of symptomatic UTI in a prior year, renal calculi and obstruction increase the risk of EPN. Patients with EPN commonly present with vomiting, flank pain altered sensorium and renal tenderness. Complications like diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar state (HHS), multiorgan dysfunction syndrome (MODS), acute kidney injury (AKI) and hypotension occur frequently in EPN as compared to pyelonephritis in T2D patients. Patients with EPN had poor glycemia and lower estimated glomerular filtration rate (eGFR) as compared to pyelonephritis. Bacteriuria was present in 90% and 66.7% of EPN and pyelonephritis patients respectively. E. coli was the most common isolate in both UTI groups. A significant number of EPN patients develop recurrent UTI. Patients with EPN have an improvement in glycemia on follow up, but renal parameters do not improve on follow up, while as pyelonephritis patients have an improvement in glycemia and renal parameters with intensive treatment. Recurrent UTI in upper UTI patients leads to worsening of glycemia and renal parameters. CONCLUSION Complications frequently occur in EPN patients as compared to pyelonephritis.
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Affiliation(s)
- Tauseef Nabi
- Department of Endocrinology, MMIMSR, Ambala, Haryana India
| | - Nadeema Rafiq
- Department of Physiology, Govt. Medical College, Baramulla, J&K India
| | | | - Shahnawaz Rasool
- Department of Urology, Govt. Medical College, Srinagar, J&K India
| | - Nayeem U Din Wani
- Department of Microbiology, Govt. Medical College, Srinagar, J&K India
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Amezcua-Prieto C, Ross J, Rogozińska E, Mighiu P, Martínez-Ruiz V, Brohi K, Bueno-Cavanillas A, Khan KS, Thangaratinam S. Maternal trauma due to motor vehicle crashes and pregnancy outcomes: a systematic review and meta-analysis. BMJ Open 2020; 10:e035562. [PMID: 33020077 PMCID: PMC7537450 DOI: 10.1136/bmjopen-2019-035562] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 07/09/2020] [Accepted: 08/04/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To systematically review and quantify the effect of motor vehicle crashes (MVCs) in pregnancy on maternal and offspring outcomes. DESIGN Systematic review and meta-analysis of observational data searched from inception until 1 July 2018. Searching was from June to August 2018 in Medline, Embase, Web of Science, Scopus, Latin-American and Caribbean System on Health Sciences Information, Scientific Electronic Library Online, TRANSPORT, International Road Research Documentation, European Conference of Ministers of Transportation Databases, Cochrane Database of Systematic Reviews and Cochrane Central Register. PARTICIPANTS Studies were selected if they focused on the effects of exposure MVC during pregnancy versus non-exposure, with follow-up to verify outcomes in various settings, including secondary care, collision and emergency, and inpatient care. DATA SYNTHESIS For incidence data, we calculated a pooled estimate per 1000 women. For comparison of outcomes between women involved and those not involved in MVC, we calculated ORs with 95% CIs. Where possible, we statistically pooled the data using the random-effects model. The quality of studies used in the comparative analysis was assessed with Newcastle-Ottawa Scale. RESULTS We included 19 studies (3 222 066 women) of which the majority was carried out in high-income countries (18/19). In population-level studies of women involved in MVC, maternal death occurred in 3.6 per 1000 (95% CI 0.25-10.42; 3 studies, 12 000 women; Tau=1.77), and fetal death or stillbirth in 6.6 per 1000 (95% CI 3.81-10.12; 8 studies, 47 992 women; I2=92.6%). Pooled incidence of complications per 1000 women involved in MVC was labour induction (276.43), preterm delivery (191.90) and caesarean section (166.65). Compared with women not involved in MVC, those involved had increased odds of placental abruption (OR 1.43, 95% CI 1.27-1.63; 3 studies, 1 500 825 women) and maternal death (OR 202.27; 95% CI 110.60-369.95; 1 study, 1 094 559 women). CONCLUSION Pregnant women involved in MVC were at higher risk of maternal death and complications than those not involved. PROSPERO REGISTRATION NUMBER CRD42018100788.
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Affiliation(s)
- Carmen Amezcua-Prieto
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Andalucía, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
| | - Jennifer Ross
- Centre for Trauma Sciences, Queen Mary University of London, London, UK
| | - Ewelina Rogozińska
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK
- Meta-analysis Group, MRC Clinical Trials Unit, University College London, London, UK
| | - Patritia Mighiu
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK
| | - Virginia Martínez-Ruiz
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Andalucía, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
| | - Karim Brohi
- Centre for Trauma Sciences, Queen Mary University of London, London, UK
| | - Aurora Bueno-Cavanillas
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Andalucía, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
- Instituto de Investigación Biosanitaria, ibs.GRANADA, Granada, Spain
| | - Khalid Saeed Khan
- Preventive Medicine and Public Health, University of Granada Faculty of Medicine, Granada, Andalucía, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Granada, Spain
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK
| | - Shakila Thangaratinam
- Women's Health Research Unit, Barts and the London School of Medicine and Dentistry, London, UK
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Bryant MK, Roy S, Purcell LN, Porras KL, Spencer A, Udekwu P. Trauma in Pregnancy: The Relationship of Trauma Activation Level and Obstetric Outcomes. Am Surg 2020. [DOI: 10.1177/000313481908500742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Trauma in pregnancy is a leading cause of poor fetal and obstetric outcomes. Trauma team activation (TTA) criteria include injury with ≥ 20 weeks gestational age (GA). A retrospective analysis was performed on pregnant patients evaluated at a Level 1 trauma center. Patients were characterized by TTA: full, partial, or non-TTA, and TTA criteria independent of pregnancy. Index trauma and delayed delivery hospitalization outcomes were examined. Bivariate analysis, t test, and logistic regression were used when appropriate. From 2010 to 2015, 216 full, 50 partial, and 50 non-TTAs presented. Independent of pregnancy, 79 per cent of patients did not meet the TTA criteria. Fourteen (4%) had a pregnancy-related complication during index hospitalization (eight fetal and two maternal deaths). Nine of ten deaths occurred in patients meeting TTA independent of pregnancy. Delivery complications were greater in the index (52%, 13/25) versus subsequent (5%, 17/155) hospitalizations and were predicted by the respiratory rate ( P = 0.016) and injury severity score ( P < 0.001). Poor delayed delivery outcomes were associated with earlier GA ( P < 0.002) and longer index hospitalization ( P < 0.024). Odds of complication are higher in patients meeting the physiologic and anatomic criteria criteria for TTA versus GA criteria alone, signifying overtriage. Trauma activation protocols should be adapted based on the physiologic and anatomic criteria criteria in pregnant patients.
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Affiliation(s)
- Mary K. Bryant
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Sara Roy
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Laura N. Purcell
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Kristina L. Porras
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Alex Spencer
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
| | - Pascal Udekwu
- Department of General Surgery/Trauma, WakeMed Health & Hospitals, Raleigh, North Carolina
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Mulder MB, Quiroz HJ, Yang WJ, Lasko DS, Perez EA, Proctor KG, Sola JE, Thorson CM. The unborn fetus: The unrecognized victim of trauma during pregnancy. J Pediatr Surg 2020; 55:938-943. [PMID: 32061362 DOI: 10.1016/j.jpedsurg.2020.01.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Trauma is the leading cause of non-obstetric death in pregnancy. While maternal management is defined, few studies have examined the effects on the fetus. METHODS Following IRB approval, all pregnant females (2010-2017) at a level-1 trauma center were retrospectively reviewed. Maternal and fetal demographics, interventions, and clinical outcomes were analyzed. RESULTS There were 188 pregnancies in 5654 females. Maternal demographics were 26 ± 7 years old, gestational age at trauma 21 ± 12 weeks, 81% blunt mechanism, and maternal mortality 6%. Forty-one (22%) fetuses were immediately affected by the trauma including 20 (11%) born alive, 12 (7%) fetal demise, and 9 (5%) stillbirths. Of those that initially survived (n = 20), 5 (25%) expired during neonatal hospitalization. Two mothers returned immediately after trauma discharge with stillbirths for an overall infant mortality of 14% (n = 26). There were 84 patients with complete data to delivery including the 41 born at trauma and 43 born on a subsequent hospitalization. Those born at the time of trauma had significantly more delivery/neonatal complications and worse outcomes. Overall trauma burden to the fetus (preterm delivery, stillbirth, delivery/neonatal complication, or long-term disability) was 66% (56/84). CONCLUSIONS Trauma during pregnancy has significant immediate mortality and delayed effects on the unborn fetus. This study has uncovered a previously hidden burden and mortality of trauma during pregnancy. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Michelle B Mulder
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Hallie J Quiroz
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Wendy J Yang
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Davis S Lasko
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Eduardo A Perez
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Kenneth G Proctor
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Juan E Sola
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136
| | - Chad M Thorson
- Dewitt-Daughtry Family Department of Surgery, Divisions of Pediatric Surgery and Trauma, Critical Care and Burn Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center, 1800 NW 10th Ave. Miami, FL, USA 33136.
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Diabetes-associated infections: development of antimicrobial resistance and possible treatment strategies. Arch Microbiol 2020; 202:953-965. [PMID: 32016521 PMCID: PMC7223138 DOI: 10.1007/s00203-020-01818-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 12/25/2022]
Abstract
Diabetes mellitus is associated with various types of infections notably skin, mucous membrane, soft tissue, urinary tract, respiratory tract and surgical and/or hospital-associated infections. The reason behind this frequent association with infections is an immunocompromised state of diabetic patient because uncontrolled hyperglycemia impairs overall immunity of diabetic patient via involvement of various mechanistic pathways that lead to the diabetic patient as immunocompromised. There are specific microbes that are associated with each type of infection and their presence indicates specific type of infections. For instance, E. coli and Klebsiella are the most common causative pathogens responsible for the development of urinary tract infections. Diabetic-foot infections commonly occur in diabetic patients. In this article, we have mainly focused on the association of diabetes mellitus with various types of bacterial infections and the pattern of resistance against antimicrobial agents that are frequently used for the treatment of diabetes-associated infections. Moreover, we have also summarized the possible treatment strategies against diabetes-associated infections.
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Bacteriuria and vitamin D deficiency: a cross sectional study of 385 nursing home residents. BMC Geriatr 2019; 19:381. [PMID: 31888514 PMCID: PMC6937784 DOI: 10.1186/s12877-019-1400-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background Up to half of elderly people at nursing homes have asymptomatic bacteriuria, and concentrations of 25-hydroxyvitamin D (25OHD) are generally low. Vitamin D is a modulator of the immune system and involved in protection of the epithelium in the urinary tract as well. The objective was to determine a possible association between bacteriuria and vitamin D deficiency among elderly people at nursing homes. Methods Cross-sectional study: Voided urine specimens and blood samples for cultivation and analysis of 25OHD were collected from elderly people at nursing homes in Sweden. Exclusion criteria were: urinary catheter, ongoing antibiotic treatment, incontinence or dementia too severe to provide a voided urine specimen or leave a blood sample, unwillingness to participate or terminal illness. Urine cultures and serum 25OHD concentrations were outcome measures and the association of bacteriuria with vitamin D deficiency was determined by logistic regression. Results Twenty-two nursing homes participated and 385 of 901elderly people provided voided urine specimens and blood samples. The mean age was 87 (SD 6.7), 69% women, 19% received vitamin D supplement, 13% had diabetes mellitus, and 54% were diagnosed with dementia. There was significant growth of potentially pathogenic bacteria in 32% (123/385) of voided urine specimens. Escherichia coli were present in 83% of positive urine cultures. The mean concentration of 25OHD in serum was 35 nmol/L (SD 21). Thirty-seven per cent (143/385) had 25OHD < 25 nmol/L, and 3.1% (12/385) 25OHD < 12.5 nmol/L. No association between bacteriuria and 25OHD < 25 nmol/L, OR 1.4 (0.86–2.3; p = 0.18) adjusted for age, gender, diabetes mellitus and dementia was found. However, if using 25OHD < 12.5 nmol/L as a cut-off for vitamin D deficiency the adjusted odds-ratio was 4.4 (1.1–17; p = 0.031). Conclusions Bacteriuria and vitamin D deficiency was common. No association between bacteriuria and 25OHD < 25 nmol/L was found. If using 25OHD < 12.5 nmol/L as cut-off for vitamin D deficiency there was an association. However, this has to be interpreted with caution as causality cannot be evaluated as well as only few residents had 25OHD < 12.5 nmol/L.
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Greco PS, Day LJ, Pearlman MD. Guidance for Evaluation and Management of Blunt Abdominal Trauma in Pregnancy. Obstet Gynecol 2019; 134:1343-1357. [PMID: 31764749 DOI: 10.1097/aog.0000000000003585] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Blunt abdominal trauma is the leading type of traumatic injury in pregnancy, with motor vehicle crashes, falls, and assault being the most common etiologies. Several adverse outcomes can occur in pregnancy, including placental abruption, preterm labor and preterm delivery, uterine rupture, and pelvic fracture. Understanding and integration of key anatomic and physiologic changes in pregnancy are key when evaluating a pregnant trauma patient. Pregnant women should be managed in a medical center with the ability to provide adequate care to both trauma patients-the pregnant woman and fetus. Multiple clinical providers are usually involved in the care of pregnant trauma patients, but obstetric providers should play a central role in the evaluation and management of a pregnant trauma patient given their unique training, knowledge, and clinical skills. An algorithm for management of trauma in pregnancy should be used at all sites caring for pregnant women. An alignment of policies within each system optimizes appropriate triage, integration of care, management, and monitoring of pregnant trauma patients and their fetuses. Ensuring effective protocols for prehospital and hospital treatment, as well as thorough training of involved health care providers, is essential in ensuring that optimal care is provided.
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Affiliation(s)
- Patricia S Greco
- University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, Michigan
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Chauhan V, Chauhan A. Traumatic injury in female Drosophila melanogaster affects the development and induces behavioral abnormalities in the offspring. Behav Brain Funct 2019; 15:11. [PMID: 31653253 PMCID: PMC6815055 DOI: 10.1186/s12993-019-0163-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/09/2019] [Indexed: 12/26/2022] Open
Abstract
Traumatic injury (TI) during pregnancy increases the risk for developing neurological disorders in the infants. These disorders are a major concern for the well-being of children born after TI during pregnancy. TI during pregnancy may result in preterm labor and delivery, abruptio placentae, and/or fetomaternal hemorrhage. Drosophila melanogaster (fruit fly) is a widely used model to study brain and behavioral disorders in humans. In this study, we analyzed the effects of TI to female fruit flies on the development timing of larvae, social interaction and the behavior of offspring flies. TI to the female flies was found to affect the development of larvae and the behavior of offspring flies. There was a significant increase in the length of larvae delivered by traumatically injured maternal flies as compared to larvae from control maternal flies (without TI). The pupae formation from larvae, and the metamorphosis of pupae to the first generation of flies were faster in the TI group than the control group. Negative geotaxis and distance of the fly to its nearest neighbor are parameters of behavioral assessment in fruit flies. Negative geotaxis significantly decreased in the first generation of both male (p = 0.0021) and female (p = 0.0426) flies. The distance between the first generation of flies to its nearest neighbor was shorter in both male and female offspring flies in the TI group as compared to control group flies. These results indicate that TI to the female flies affected the development of larvae and resulted in early delivery, impaired social interaction and behavioral alterations in the offspring.
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Affiliation(s)
- Ved Chauhan
- Department of Neurochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY, 10314, USA.
| | - Abha Chauhan
- Department of Neurochemistry, New York State Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY, 10314, USA
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Kiranmala K, Johnson R, Savio J, Idiculla J. Microbiologic profile and clinical practices in urinary tract infections in a tertiary care center in Southern India. J Family Med Prim Care 2019; 8:2888-2892. [PMID: 31681661 PMCID: PMC6820372 DOI: 10.4103/jfmpc.jfmpc_346_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 04/29/2019] [Accepted: 06/10/2019] [Indexed: 01/04/2023] Open
Abstract
Context: Studies reported differences in clinical profiles of urinary tract infections (UTIs) in patients with and without type 2 diabetes mellitus (T2DM). Studies on the impact of the pattern of antibiotic resistance of organisms causing UTI on actual clinical practice are lacking. Objectives: 1. To study the clinical and microbiologic profiles of UTIs. 2. To compare treatment given with the prevailing antimicrobial sensitivity. Settings and Design: This is a cross-sectional study conducted in a tertiary care hospital. Methods and Materials: Retrospective chart review of inpatients with UTI (N = 200, 100 each of patients with and without T2DM), aged >18 years with a positive urine culture. Statistical Analysis: We used the statistical package SPSS version 17. The categorical variables were analyzed by the Chi-square test. Data were considered significant if P value was less than 0.05. Results: Similar to previous Indian studies, T2DM patients with UTI had significantly more asymptomatic bacteriuria, asymptomatic bacteriuria (32% vs. 6%), previous history of UTI (25% vs. 2%), and prior catheterization (16% vs. 1%). Escherichia coli (E. coli) was the most common organism isolated and showed sensitivity pattern of meropenem > netilmicin > amikacin > nitrofurantoin. Ceftriaxone was the most common empirical therapy given in spite the prevailing low sensitivity of E. coli to it. All ASB cases were treated unlike recommendations. Conclusions: Ceftriaxone is the most common empirical therapy given in spite the prevailing low sensitivity of E. coli to it. Cases of ASB were treated unlike recommendations.
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Affiliation(s)
| | - Reuben Johnson
- Department of Orhopedics, St. John's Medical College, Bengaluru, Karnataka, India
| | - Jayanthi Savio
- Department of Microbiology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Jyothi Idiculla
- Department of General Medicine, St. John's Medical College, Bengaluru, Karnataka, India
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No. 197a-Fetal Health Surveillance: Antepartum Consensus Guideline. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:e251-e271. [PMID: 29680082 DOI: 10.1016/j.jogc.2018.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This guideline provides new recommendations pertaining to the application and documentation of fetal surveillance in the antepartum period that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. Pregnancies with and without risk factors for adverse perinatal outcomes are considered. This guideline presents an alternative classification system for antenatal fetal non-stress testing to what has been used previously. This guideline is intended for use by all health professionals who provide antepartum care in Canada. OPTIONS Consideration has been given to all methods of fetal surveillance currently available in Canada. OUTCOMES Short- and long-term outcomes that may indicate the presence of birth asphyxia were considered. The associated rates of operative and other labour interventions were also considered. EVIDENCE A comprehensive review of randomized controlled trials published between January 1996 and March 2007 was undertaken, and MEDLINE and the Cochrane Database were used to search the literature for all new studies on fetal surveillance antepartum. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care (Table 1). SPONSOR This consensus guideline was jointly developed by the Society of Obstetricians and Gynaecologists of Canada and the British Columbia Perinatal Health Program (formerly the British Columbia Reproductive Care Program or BCRCP) and was partly supported by an unrestricted educational grant from the British Columbia Perinatal Health Program. RECOMMENDATION 1: FETAL MOVEMENT COUNTING: RECOMMENDATION 2: NON-STRESS TEST: RECOMMENDATION 3: CONTRACTION STRESS TEST: RECOMMENDATION 4: BIOPHYSICAL PROFILE: RECOMMENDATION 5: UTERINE ARTERY DOPPLER: RECOMMENDATION 6: UMBILICAL ARTERY DOPPLER.
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Liston R, Sawchuck D, Young D. N° 197a-Surveillance du bien-être fœtal : Directive consensus d'antepartum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:e272-e297. [PMID: 29680083 DOI: 10.1016/j.jogc.2018.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Ramos-Ramirez MJ, Surani S. Asymptomatic bacteriuria among hospitalized diabetic patients: Should they be treated? World J Meta-Anal 2019; 7:339-342. [DOI: 10.13105/wjma.v7.i7.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023] Open
Abstract
Diabetes Mellitus is a significant health care challenge in the United States. The Center for Disease Control and Prevention estimates approximately 9.4% of patients in the United States are afflicted by diabetes. The Infectious Disease Society of America asymptomatic bacteriuria in women as two consecutive clean-catch voided urine specimens with isolation of the same bacterial strain in counts ≥ 105 cfu/mL It is understood that diabetic patients tend to be at higher risk for infections than non-diabetics. Urinary tract infections (UTIs) tend to be the most common infection contracted by this population. UTIs are not only a significant cause of morbidity and mortality, they are also a significant financial burden. The data are conflicting, in regard to treating asymptomatic bacteriuria in diabetic patients to avoid hospital complications and ultimately decrease healthcare costs associated with these complications. However, clinicians continue to prescribe antibiotics empirically. Further randomized controlled study looking into the specific population as immunocompromised diabetic patients, patient with diabetic ketoacidosis and patient in intensive care unit needs to be undertaken.
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Affiliation(s)
| | - Salim Surani
- Medical Critical Care Services, Christus Spohn Hospitals-Corpus Christi, Corpus Christi, TX 78413, United States
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Al-Thani H, El-Menyar A, Sathian B, Mekkodathil A, Thomas S, Mollazehi M, Al-Sulaiti M, Abdelrahman H. Blunt traumatic injury during pregnancy: a descriptive analysis from a level 1 trauma center. Eur J Trauma Emerg Surg 2019; 45:393-401. [PMID: 29589039 DOI: 10.1007/s00068-018-0948-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/22/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The precise incidence of trauma in pregnancy is not well-known, but trauma is estimated to complicate nearly 1 in 12 pregnancies and it is the leading non-obstetrical cause of maternal death. METHODS A retrospective study of all pregnant women presented to national level 1 trauma center from July 2013 to June 2015 was conducted. Descriptive and inferential statistics applied for data analysis. RESULTS Across the study period, a total of 95 pregnant women were presented to the trauma center. The average incidence rate of traumatic injuries was 250 per 1000 women of childbearing age presented to the Hamad Trauma Center. The mean age of patients was 30.4 ± SD 5.6 years, with age ranging from 20 to 42 years. The mean gestational age at the time of injury was 24.7 ± 8.7 weeks which ranged from 5 to 37 weeks. The majority (47.7%) was in the third trimester of the pregnancy. In addition, the large majority of injuries was due to MVCs (74.7%) followed by falls (15.8%). CONCLUSIONS Trauma during pregnancy is not an uncommon event particularly in the traffic-related crashes. As it is a complex condition for trauma surgeons and obstetrician, an appropriate management protocol and multidisciplinary team are needed to improve the outcome and save lives of both the mother and fetus.
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Affiliation(s)
- Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, P.O Box 3050, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Trauma & Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar.
- Clinical Medicine, Weill Cornell Medical School, Doha, Qatar.
| | - Brijesh Sathian
- Department of Surgery, Trauma & Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Ahammed Mekkodathil
- Department of Surgery, Trauma & Vascular Surgery, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Sam Thomas
- Department of Surgery, Trauma Surgery, Trauma Registry, Hamad General Hospital, Doha, Qatar
| | - Monira Mollazehi
- Department of Surgery, Trauma Surgery, Trauma Registry, Hamad General Hospital, Doha, Qatar
| | - Maryam Al-Sulaiti
- Department of Surgery, General Surgery, Hamad General Hospital, Doha, Qatar
| | - Husham Abdelrahman
- Department of Surgery, Trauma Surgery, Hamad General Hospital, P.O Box 3050, Doha, Qatar
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van der Knoop BJ, van der Voorn JP, Nikkels PGJ, Zonnenberg IA, van Weissenbruch MM, Vermeulen RJ, de Vries JIP. Placental Histology After Minor Trauma in Pregnancy: A Pilot Study. Pediatr Dev Pathol 2019; 22:221-228. [PMID: 30208758 PMCID: PMC6604405 DOI: 10.1177/1093526618799292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Trauma in pregnancy may cause placental abruption. Consequences of moderate placental injury on neurodevelopment are unknown. The aim was to evaluate placental histology after maternal trauma. METHODS A prospective study was conducted at 2 tertiary medical centers in the Netherlands. Placentas from women exposed to maternal trauma ≥ 20 weeks' gestational age were histologically examined. Neurological follow-up of the infants was performed at 1 year of age by means of Alberta Infant Motor Scale. Histological findings were compared to placentas from pregnancies without trauma. PRINCIPAL RESULTS Thirteen placentas were investigated in the trauma group. The control group consisted of 15 placentas. Placental pathology was seen more often in the trauma cases (11 of the 13) than in the controls (6 of the 15), P = .024. Neurological follow-up was normal. CONCLUSIONS In this small population, majority of the placentas showed pathology after minor trauma in pregnancy without consequences for neurodevelopment at 1 year.
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Affiliation(s)
- BJ van der Knoop
- Department of Obstetrics and
Gynaecology, VU University Medical Center, Amsterdam, the Netherlands,BJ van der Knoop, Department of Obstetrics
and Gynaecology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam,
the Netherlands.
| | - JP van der Voorn
- Department of Pathology, VU University
Medical Center, Amsterdam, the Netherlands
| | - PGJ Nikkels
- Department of Pathology, University
Medical Center Utrecht, Utrecht, the Netherlands
| | - IA Zonnenberg
- Department of Neonatology, VU University
Medical Center, Amsterdam, the Netherlands
| | - MM van Weissenbruch
- Department of Neonatology, VU University
Medical Center, Amsterdam, the Netherlands
| | - RJ Vermeulen
- Department of Child Neurology, VU
University Medical Center, Amsterdam, the Netherlands
| | - JIP de Vries
- Department of Obstetrics and
Gynaecology, VU University Medical Center, Amsterdam, the Netherlands
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Abstract
Although trauma in pregnancy is rare, it is one of the most common causes of morbidity and mortality to pregnant women and fetus. Pathophysiology of trauma is generally time sensitive, and this is still true in pregnant patients, with the additional challenge of rare presentation and balancing the management of two patients concurrently. Successful resuscitation requires understanding the physiologic changes to the woman throughout the course of pregnancy. Ultimately, trauma management is best approached by prioritizing maternal resuscitation.
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Affiliation(s)
- Jeffrey Sakamoto
- Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA 94304, USA
| | - Collin Michels
- Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA 94304, USA
| | - Bryn Eisfelder
- Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA 94304, USA
| | - Nikita Joshi
- Alameda Health Systems, 490 Grand Avenue, Oakland, CA 94610, USA.
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Bharti A, Chawla SPS, Kumar S, Kaur S, Soin D, Jindal N, Garg R. Asymptomatic bacteriuria among the patients of type 2 diabetes mellitus. J Family Med Prim Care 2019; 8:539-543. [PMID: 30984669 PMCID: PMC6436301 DOI: 10.4103/jfmpc.jfmpc_403_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Asymptomatic bacteriuria (ASB) is common in neonates, preschool children, pregnant women, elderly, diabetics, catheterized patients, and patients with abnormal urinary tracts or renal diseases. Though there is currently no consensus on treatment of ASB in various population groups, it is advisable to treat the same in patients with diabetes mellitus (DM). Aims: To determine the prevalence of ASB in patients with type 2 DM and to study the spectrum of uro-pathogens causing ASB along with their antibiotic susceptibility profile. Settings and Design: This prospective, observational study was conducted in the department of Medicine of a tertiary care teaching hospital. Methods: The study was conducted on 100 patients with type 2 DM. Urine wet mount and gram stain examination was done for all to detect the presence of pus cells and bacteria in urine. Antibiotic sensitivity testing was performed in patients with significant bacteriuria to determine the sensitivity profile of isolated uro-pathogens. The data were analyzed to determine the association between diabetes and ASB. Results: ASB was common among diabetics, as evident by a prevalence of 21%. Presence of ASB showed positive correlation with poor glycemic control. Escherichia coli (E. coli) was the most common organism causing ASB followed by Candida, Pseudomonas, Klebsiella, and Citrobacter. E. coli isolated from study patients was most sensitive to imipenem and nitrofurantoin (NFT). Conclusions: ASB is common among diabetics, with poor glycemic control being a significant risk factor. E. coli is the most common organism causing ASB in diabetics, and it is most sensitive to imipenem and NFT.
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Affiliation(s)
- Aman Bharti
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sumit Pal Singh Chawla
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sandeep Kumar
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Sarabjot Kaur
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Divya Soin
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Neerja Jindal
- Department of Microbiology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Ravinder Garg
- Department of Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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Hitosugi M, Koseki T, Hariya T, Maeda G, Moriguchi S, Hiraizumi S. Shorter pregnant women restrained in the rear seat of a car are at risk for serious neck injuries: Biomechanical analysis using a pregnant crash test dummy. Forensic Sci Int 2018; 291:133-137. [PMID: 30196117 DOI: 10.1016/j.forsciint.2018.08.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/07/2018] [Accepted: 08/25/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION When considering seat belt contacts to the neck in pregnant woman of shorter height sitting in the rear seat of a vehicle, subsequent injuries after a collision must be understood in the context of both maternal and fetal outcomes. To determine likely injuries to a pregnant woman sitting in the rear seat, we determined the kinematics of a "pregnant" crash test dummy by measuring neck compression forces and biomechanical parameters acting on the head and neck. METHODS Sled tests using a shorter-height pregnant woman crash test dummy (Maternal Anthropometric Measurement Apparatus, ver. 2B) were performed at the HYGE sled test facility representing full frontal impact at target velocities of 29km/h and 48km/h. Kinematics of the dummy and biomechanical parameters of the head, neck, and chest were measured. Pressure to the neck was measured using Prescale (Fujifilm, Tokyo, Japan). RESULTS During frontal collision tests, the shoulder belt compressed the neck at a pressure >12.8MPa, even during the low-velocity impact. In addition to neck flexion, right side bending and the head and chest moving in opposite directions were observed, with maximum differences of 42.4mm at high velocity and 33.7mm at low velocity. CONCLUSIONS This study provides data on the kinematics of pregnant women of short height sitting in the rear seat during a frontal collision using a pregnant woman crash test dummy. The knowledge gathered from this study should be useful for determining pregnant women passengers' kinematics at the time of collision and evaluating the relationship between the vehicle collision and fetal outcomes.
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Affiliation(s)
- Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan.
| | - Takeshi Koseki
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan; Department of Obstetrics and Gynecology, Tsukuba Memorial Hospital, Tsukuba, Ibaraki 300-2622, Japan
| | - Tomokazu Hariya
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Genta Maeda
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Shingo Moriguchi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Shiho Hiraizumi
- Department of Legal Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
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He K, Hu Y, Shi JC, Zhu YQ, Mao XM. Prevalence, risk factors and microorganisms of urinary tract infections in patients with type 2 diabetes mellitus: a retrospective study in China. Ther Clin Risk Manag 2018. [PMID: 29520146 PMCID: PMC5834170 DOI: 10.2147/tcrm.s147078] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Urinary tract infections (UTIs) occur more frequently in diabetic patients. This study was conducted to investigate the prevalence, risk factors and microorganisms of UTIs in Chinese patients with type 2 diabetes (T2D). Patients and methods A total of 3,652 Chinese inpatients with T2D were reviewed and data on their clinical characteristics, symptoms of UTIs, random blood glucose, HbA1c, glutamic acid decarboxylase antibody, insulin autoantibody, albumin excretion rate in 24-hour urine, urine culture and susceptibility to antibiotics, and so on were collected. Binary logistic analysis was performed to look for risk factors of UTIs. Results There were 409 (11.2%) patients suffering from UTIs. Gender, age, random blood glucose, insulin autoantibody and albumin excretion rate in 24-hour urine were the risk factors of UTIs in diabetic patients. The percentage of positive urine cultures was higher in the asymptomatic bacteriuria patients than in symptomatic patients (P<0.001). The incidence of septicemia was considerable in the UTIs and asymptomatic bacteriuria groups. Escherichia coli was the most common pathogenic microorganism isolated in diabetic patients with UTIs, and one-half of the E. coli infections were multidrug resistant. Furthermore, meropenem was the most effective antibiotic on E. coli. Conclusion We suggest that a routine urine analysis or urine culture should be conducted in patients with T2D diabetes who have the identified risk factors. The UTIs might affect the islet function or blood glucose control in patients with T2D. Before a doctor decides to prescribe antibiotics to a diabetic patient with UTIs, the drug sensitivity test should be performed.
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Affiliation(s)
- Ke He
- Department of Endocrinology, Wuxi Hospital of Traditional Chinese Medicine, Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China.,Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yun Hu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jun-Cheng Shi
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yun-Qing Zhu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Ming Mao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Abu-Ashour W, Twells LK, Valcour JE, Gamble JM. Diabetes and the occurrence of infection in primary care: a matched cohort study. BMC Infect Dis 2018; 18:67. [PMID: 29402218 PMCID: PMC5800043 DOI: 10.1186/s12879-018-2975-2] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/23/2018] [Indexed: 02/07/2023] Open
Abstract
Background People with diabetes may be at higher risk for acquiring infections through both glucose-dependent and biologic pathways independent of glycemic control. Our aim was to estimate the association between diabetes and infections occurring in primary care. Methods Using the Newfoundland and Labrador Sentinel of the Canadian Primary Care Sentinel Surveillance Network, patients with diabetes ≥18 years between 1 January 2008 and 31 March 2013 were included with at least 1-year of follow-up. We randomly matched each patient with diabetes on the date of study entry with up to 8 controls without diabetes. Primary outcome was the occurrence of ≥1 primary care physician visits for any infectious disease. Secondary outcomes included primary visits for head & neck, respiratory, gastrointestinal, genitourinary, skin and soft tissue, musculoskeletal, and viral infections. Using multivariable conditional logistic regression analysis, we measured the independent association between diabetes and the occurrence of infections. Results We identified 1779 patients with diabetes who were matched to 11,066 patients without diabetes. Patients with diabetes were older, had a higher prevalence of comorbidities, and were more often referred to specialists. After adjusting for potential confounders, patients with diabetes had an increased risk of any infection compared to patients without diabetes (adjusted odds ratio = 1.21, 95% confidence interval 1.07–1.37). Skin and soft tissue infections had the strongest association, followed by genitourinary, gastrointestinal, and respiratory infections. Diabetes was not associated with head and neck, musculoskeletal, or viral infections. Conclusion Patients with diabetes appear to have an increased risk of certain infections compared to patients without diabetes. Electronic supplementary material The online version of this article (10.1186/s12879-018-2975-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Waseem Abu-Ashour
- School of Pharmacy, Health Sciences Centre, Memorial University of Newfoundland, St. John's, A1B 3V6, Newfoundland and Labrador, Canada
| | - Laurie K Twells
- School of Pharmacy, Health Sciences Centre, Memorial University of Newfoundland, St. John's, A1B 3V6, Newfoundland and Labrador, Canada.,Faculty of Medicine, Health Sciences Centre, Memorial University of Newfoundland, St. John's, A1B 3V6, Newfoundland and Labrador, Canada
| | - James E Valcour
- Faculty of Medicine, Health Sciences Centre, Memorial University of Newfoundland, St. John's, A1B 3V6, Newfoundland and Labrador, Canada
| | - John-Michael Gamble
- School of Pharmacy, Health Sciences Centre, Memorial University of Newfoundland, St. John's, A1B 3V6, Newfoundland and Labrador, Canada. .,School of Pharmacy, Faculty of Science, University of Waterloo, Kitchener, N2G 1C5, ON, Canada.
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Kobayashi M, Uematsu T, Nakamura G, Kokubun H, Mizuno T, Betsunoh H, Kamai T. The Predictive Value of Glycated Hemoglobin and Albumin for the Clinical Course Following Hospitalization of Patients with Febrile Urinary Tract Infection. Infect Chemother 2018; 50:228-237. [PMID: 30270582 PMCID: PMC6167507 DOI: 10.3947/ic.2018.50.3.228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/27/2018] [Indexed: 01/04/2023] Open
Abstract
Background Diabetes is considered a risk factor for acquisition of febrile urinary tract infection (f-UTI), but information on the association of diabetes with subsequent course of the disease is lacking. Thus, we investigated the clinical variables including diabetic status which determined the clinical course in patients with community-acquired f-UTI. Materials and Methods Patients hospitalized consecutively for f-UTI between February 2016 and January 2018 were used for this single center study. The routine laboratory tests including blood glucose and glycated hemoglobin (HbA1c) were done and empiric treatment with parenteral antibiotics was commenced on admission. The clinical course such as duration of fever (DOF) and length of hospital stay (LOS) were compared among groups classified by the clinical variables. Results Among the101 patients admitted for f-UTI, 15 patients with diabetes (14.9%) experienced significantly longer febrile period and hospitalization compared to those with hyperglycemia (n = 18, 17.8%) or those without diabetes and hyperglycemia (n = 68, 67.3%). Of the laboratory parameters tested on admission and several clinical factors, the presence of diabetes and risk factors for severe complicated infection (hydronephrosis, urosepsis, and disseminated intravascular coagulopathy) as well as HbA1c and albumin were identified as predictors for LOS by univariate analysis, whereas none of the variables failed to predict DOF. In the subsequent multivariate analysis, HbA1c levels and albumin levels were isolated as independent predictors of LOS. Conclusion Patients with higher HbA1c and lower albumin levels required the longest period of hospitalization. Thus, an evaluation of diabetic and nutritional status on admission will be feasible to foretell the clinical course and better manage the subset of patients at risk of prolonged hospitalization.
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Affiliation(s)
- Minoru Kobayashi
- Department of Urology, Utsunomiya Memorial Hospital, Tochigi, Japan.
| | | | - Gaku Nakamura
- Department of Urology, Dokkyo Medical University, Tochigi, Japan
| | | | - Tomoya Mizuno
- Department of Urology, Nasu Red Cross Hospital, Tochigi, Japan
| | | | - Takao Kamai
- Department of Urology, Dokkyo Medical University, Tochigi, Japan
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Donnelly JP, Nair S, Griffin R, Baddley JW, Safford MM, Wang HE, Shapiro NI. Association of Diabetes and Insulin Therapy With Risk of Hospitalization for Infection and 28-Day Mortality Risk. Clin Infect Dis 2017; 64:435-442. [PMID: 28174913 DOI: 10.1093/cid/ciw738] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 11/18/2016] [Indexed: 01/07/2023] Open
Abstract
Background Epidemiologic and experimental evidence suggests that individuals with diabetes are at increased risk of infection. We sought to examine the association of diabetes and insulin therapy with hospitalization for infection and 28-day mortality. Methods We performed a prospective cohort study using data from 30 239 community-dwelling participants aged ≥45 years enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. We defined diabetes as a fasting glucose level ≥126 mg/L (or ≥200 mg/L for those not fasting), the use of insulin or oral hypoglycemic agents, or self-reported history. We identified infection-related hospitalizations over the years 2003–2012. We fit Cox proportional hazards models to assess the association of diabetes with hazard rates of infection and logistic regression models for 28-day mortality. Results Among 29 683 patients from the REGARDS study with complete follow-up, 7375 had diabetes. Over a median follow-up period of 6.5 years, we identified 2593 first and 3411 total infection hospitalizations. In adjusted analyses, participants with diabetes had an increased hazard of infection (hazard ratio, 1.50; 95% confidence interval [CI], 1.37–1.64) compared with those without diabetes. Participants with diabetes hospitalized for infection did not have an increased odds of death within 28 days (odds ratio, 0.94; 95% CI, .67–1.32). Participants receiving insulin therapy had greater hazard of infection (hazard ratio, 2.18; 95% CI, 1.90–2.51) but no increased odds of mortality (odd ratio, 1.07; 95% CI, .67–1.71). Conclusions Diabetes is associated with increased risk of hospitalization for infection. However, we did not find an association with 28-day mortality. Insulin therapy conferred an even greater risk of hospitalization, without increased mortality.
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Affiliation(s)
- John P Donnelly
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama, United States of America,Division of Preventive Medicine, Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama, United States of America.,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Sunil Nair
- Department of Internal Medicine, University of Alabama School of Medicine, Birmingham, Alabama, United States of America
| | - Russell Griffin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - John W Baddley
- Division of Infectious Disease, Department of Medicine, University of Alabama School of Medicine, Birmingham, Alabama, United States of America
| | - Monika M Safford
- Department of Medicine, University of Alabama at Birmingham,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Henry E Wang
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Nathan I Shapiro
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center,Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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50
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Distelhorst JT, Soltis MA, Krishnamoorthy V, Schiff MA. Hospital trauma level's association with outcomes for injured pregnant women and their neonates in Washington state, 1995-2012. Int J Crit Illn Inj Sci 2017; 7:142-149. [PMID: 28971027 PMCID: PMC5613405 DOI: 10.4103/ijciis.ijciis_17_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Trauma occurs in 8% of all pregnancies. To date, no studies have evaluated the effect of the hospital's trauma designation level as it relates to birth outcomes for injured pregnant women. Methods: This population-based, retrospective cohort study evaluated the association between trauma designation levels and injured pregnancy birth outcomes. We linked Washington State Birth and Fetal Death Certificate data and the Washington State Comprehensive Hospital Abstract Recording System. Injury was identified using the International Classification of Diseases, Ninth Revision injury diagnosis and external causation codes. The association was analyzed using logistic regression to estimate odds ratios and 95% confidence intervals (CIs). Results: We identified 2492 injured pregnant women. Most birth outcomes studied, including placental abruption, induction of labor, premature rupture of membranes, cesarean delivery, maternal death, gestational age <37 weeks, fetal distress, fetal death, neonatal respiratory distress, and neonatal death, showed no association with trauma hospital level designation. Patients at trauma Level 1–2 hospitals had a 43% increased odds of preterm labor (95% CI: 1.15–1.79) and a 66% increased odds of meconium at delivery (95% CI: 1.05–2.61) compared to those treated at Level 3–4 hospitals. Patients with an injury severity score >9, treated at trauma Level 1–2 hospitals, had an aOR of low birth weight, <2500 g, of 2.52 (95% CI: 1.12–5.64). Conclusions: The majority of birth outcomes for injured patients had no association with hospitalization at a Level 1–2 compared to a Level 3–4 trauma center.
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Affiliation(s)
- John Thomas Distelhorst
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Preventive Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Michele A Soltis
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Preventive Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
| | - Vijay Krishnamoorthy
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, Seattle, Washington, USA
| | - Melissa A Schiff
- Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Harborview Injury Prevention and Research Center, Seattle, Washington, USA.,Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA
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