Objective To estimate the risk for stress urinary incontinence and pelvic organ prolapse surgery related to vaginal birth or cesarean delivery. Study Design A cohort study of all women having their ...first and all subsequent deliveries by cesarean (n = 33,167), and an age-matched sample of women only having vaginal deliveries (n = 63,229) between 1973 and 1983. Hazard ratios were calculated using Cox regression models with 95% confidence intervals. Results Women only having vaginal deliveries had increased overall risks of incontinence (hazard ratio, 2.9; 95% confidence interval, 2.4–3.6) and prolapse surgery (hazard ratio, 9.2; 95% confidence interval, 7.0–12.1) compared with women only having cesarean deliveries. Conclusion Having only vaginal childbirths was associated with a significantly increased risk of stress urinary incontinence and pelvic organ prolapse surgery later in life compared with only having cesarean deliveries.
Objective The purpose of this study was to compare the risk of surgically treated stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in relation to mode of delivery and age at first ...childbirth. Study Design This was a cohort study. Data from the Swedish Medical Birth Register on women with only cesarean delivery (n = 30,880 women) or only vaginal delivery (n = 59,585 women) were compared with the Swedish Patient Register to calculate incidence rates and hazard ratios (95% confidence interval CI) for SUI and POP surgery. Results In analyses that were stratified by age, vaginal delivery consistently increased the risks of SUI and POP surgery. Among vaginally delivered women who were ≥30 years old, incidence rates of POP surgery were 13.8 (95% CI, 12.7–15.1), and for younger women were 6.4 (95% CI, 6.0–6.8) per 10,000 person-years. Exclusion of instrumental vaginal delivery did not alter the conclusions. Conclusion Increasing age at first delivery increased the risk of subsequent SUI and POP surgery after both vaginal and cesarean delivery.
Objective The objective of the study was to determine the risk for pelvic organ prolapse surgery attributed to hysterectomy on benign indications Study Design In a nationwide longitudinal study, ...162,488 women with hysterectomy from 1973 through 2003 were matched to 470,519 population-based control women. Hazard ratios (HR) with 95% confidence interval (CI) were calculated using Cox regression analyses. Results In all, 3.2% (n = 5270) of women with hysterectomy had pelvic organ prolapse surgery, compared with 2.0% (n = 9437) in nonhysterectomized controls. Compared with nonhysterectomized controls, the overall HR for prolapse surgery was 1.7 (95% CI, 1.6 to 1.7) with the highest risks observed in women having had a vaginal hysterectomy (HR 3.8; 95% CI, 3.1 to 4.8). Compared with hysterectomized women with no vaginal births, the HR for prolapse surgery was 2.0 (95% CI, 0.9 to 4.1) among women with 1 vaginal childbirth and 11.3 (95 % CI, 6.0. to 21.1) among women with at least 4 vaginal births. Conclusion Hysterectomy is associated with an increased risk for subsequent pelvic organ prolapse surgery with multiparous women at particular risk.
Objective The objective of the study was to compare the prevalence of incontinence disorders in relation with spontaneous vaginal delivery or cesarean section. Study Design Two hundred women with ...spontaneous vaginal deliveries only were compared with 195 women with cesarean deliveries only 10 years after first delivery. Results When compared with cesarean section, vaginal delivery was associated with an increased frequency of stress urinary incontinence ( P = .006) and an increased use of protective pads ( P = .008) as well as an increased frequency of fecal urgency ( P = .048) and gas incontinence ( P = .01). At multivariate regression analysis, mode of delivery showed no significant association with incontinence symptoms other than an increased risk for flatus incontinence in women with a history of obstetric anal sphincter injury (odds ratio 3.1; 95% confidence interval, 1.5 to 8.9). Conclusion Incontinence symptoms are more common following spontaneous vaginal delivery when compared with cesarean section 10 years after first delivery. However, cesarean section is not associated with a major reduction of anal and urinary incontinence.
Adverse drug reactions (ADRs) to antibiotics in patients with cystic fibrosis (CF) are common and often mislabeled as allergies. The labeling of an antibiotic reaction as an allergy can lead to the ...use of antibiotics that are less efficacious, are more expensive, or have a greater risk of adverse effects.
To establish a safe approach for the evaluation of ADRs to antibiotics in patients with CF to help clarify future use of these medications.
Patients with CF whose antibiotic allergies were causing difficulty in their medical management were referred for an allergy evaluation that consisted of a thorough drug allergy history and antibiotic testing if appropriate. If the history was not consistent with a true hypersensitivity reaction (HSR) and test results were negative, the patient underwent a challenge to the offending agent(s) to rule out an HSR. Challenges were only performed if the medication was indicated for future use.
A total of 17 patients (mean age, 32.4 years) underwent a thorough allergy evaluation. A total of 17 antibiotic challenges were performed in 11 patients without a reaction consistent with an HSR or severe delayed reaction. Only 2 medications had a history consist with an HSR, and it was recommended that they undergo a desensitization procedure if the drug was required.
If treatment with appropriate antibiotics becomes difficult in patients with CF because of drug allergies, then referral to an allergist can help safely identify treatment options. Our findings suggest that a thorough evaluation by an allergy specialist can lead to more appropriate treatment options in patients with CF.
Aspiration risk from dysphagia increases with central and peripheral neurologic disease. Stroke, microvascular ischemic disease, a spectrum of neurodegenerative diseases, and advancing dementia all ...have unique aspects. However, there are distinct commonalities in this population. Increasing nutritional requirements to stave off oropharyngeal muscular atrophy and a sedentary lifestyle further tax the patient's abilities to safely swallow. This article reviews stroke, muscular dystrophy, myasthenia gravis, multiple sclerosis, amyotrophic lateral sclerosis, Parkinson's disease, and advanced dementia. Approaches to screening and evaluation, recognizing sentinel indicators of decline that increase aspiration risk, and options for managing global laryngeal dysfunction are also presented.
Cardiac resynchronization therapy (CRT) nonresponders have poor outcomes. The significance of progressive ventricular dysfunction among nonresponders remains unclear.
We sought to define predictors ...of and clinical outcomes associated with progressive ventricular dysfunction despite CRT.
We conducted an analysis of 328 patients undergoing CRT with defibrillator for standard indications. On the basis of 6-month echocardiograms, we classified patients as responders (those with a ≥5% increase in ejection fraction) and progressors (those with a ≥5% decrease in ejection fraction), and all others were defined as nonprogressors. Coprimary end points were 3-year (1) heart failure, left ventricular assist device (LVAD), transplantation, or death and (2) ventricular tachycardia (VT) or ventricular fibrillation (VF).
Multivariable predictors of progressive ventricular dysfunction were aldosterone antagonist use (hazard ratio HR 0.23; P = .008), prior valve surgery (HR 3.3; P = .005), and QRS duration (HR 0.98; P = .02). More favorable changes in ventricular function were associated with lower incidences of heart failure, LVAD, transplantation, or death (70% vs 54% vs 33%; P < .0001) and VT or VF (66% vs 38% vs 28%; P = .001) for progressors, nonprogressors, and responders, respectively. After multivariable adjustment, progressors remained at increased risk of heart failure, LVAD, transplantation, or death (HR 2.14; P = .0029) and VT or VF (HR 2.03; P = .046) as compared with nonprogressors. Responders were at decreased risk of heart failure, LVAD, transplantation, or death (HR 0.44; P < .0001) and VT or VF (0.51; P = .015) as compared with nonprogressors.
Patients with progressive deterioration in ventricular function despite CRT represent a high-risk group of nonresponders at increased risk of worsened clinical outcomes.
Allergy and the Heart Buchanan, Cullen E.; Kakkar, Ekta; Dreskin, Stephen C. ...
JACC. Case reports,
October 2020, 2020-10-00, 2020-10-01, Letnik:
2, Številka:
12
Journal Article
Recenzirano
Odprti dostop
A 40-year-old woman with history of atopy and peripheral eosinophilia presented with clinical signs of heart failure. Echocardiography revealed a restrictive cardiomyopathy with biventricular ...thrombi. Hypereosinophilic syndrome resulting in eosinophilic myocarditis (Loeffler’s syndrome) was diagnosed. This case highlights the workup, diagnosis, and management of hypereosinophilic syndrome with eosinophilic myocarditis. (Level of Difficulty: Advanced.)
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Both anatomic and electrical locations of the left ventricular (LV) lead have been identified as important predictors of clinical outcomes in cardiac resynchronization therapy (CRT). The impact of LV ...lead location on incident device-treated ventricular arrhythmia (VA), however, is not well understood.
To assess the relationship between electrical and anatomic LV lead location and device treated VAs in CRT.
Sixty-nine patients undergoing CRT implantation for standard indications were evaluated. Anatomic LV lead location was assessed by means of coronary venography and chest radiography and categorized as apical or nonapical. Electrical LV lead location was assessed by LV electrical delay (LVLED) and was calculated as the time between the onset of the native QRS on the surface electrocardiogram and sensed signal on the LV lead during implantation and corrected for native QRS. Incident appropriate device-treated VA was assessed via device interrogation.
Apical lead placement was an independent predictor of VAs (hazard ratio 5.29; 95% confidence interval 1.69-16.5; P = .004). Among patients with a nonapical lead, LVLED<50% native QRS was an independent predictor of VAs (hazard ratio 6.90; 95% confidence interval 1.53-31.1; P = .012). Those with a nonapical lead and LVLED ≥ 50% native QRS were at substantially lower risk for first incident and recurrent VAs when compared to all other patients.
The apical lead position is associated with an increased risk of VAs in CRT patients. Among patients with a nonapical lead position, an LVLED of<50% of the native QRS is associated with an increased risk of VAs.
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