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unclear.Prune belly syndrome (PBS) results in a total lack of abdominal musculature. Abdominal muscles have an important function during inspiration and expiration. This puts the patient at risk for respiratory complications since they have a very limited ability to cough up secretions. Patients in an intensive care unit (ICU) with PBS who receive mechanical ventilation are at even greater risk for respiratory complications. We review the function of the abdominal muscles in breathing and delineate why they are important in the ICU. We include an illustrative case of a long-term ventilated patient with PBS and offer respiratory management options.
The antepartum oral glucose tolerance test (OGTT) has re-emerged as associated with risk of diabetes among women with gestational diabetes (GDM). This systematic review summarized evidence on associations between antepartum OGTT and risk of diabetes in GDM (PROSPERO CRD42018100316).
MEDLINE, EMBASE, Web of Science, and CENTRAL were searched from January 1, 1982 to February 2020. Studies assessing associations between antepartum OGTT and risk of diabetes among women with GDM were included. Data on study characteristics, participants, OGTT values, and diabetes outcomes were extracted. Estimates on the association between antepartum OGTT and diabetes at follow-up were recorded. Pooled odds ratios for developing diabetes were calculated by study design.
Of 6423 citations, 17 studies were included. Both elevated fasting blood glucose (FBG; OR 3.62 ([95% CI 1.30, 10.12], I
= 36%, p < 0.05)) and 2 h OGTT (OR 3.96 [1.17, 13.40], I
= 87%, p < 0.05) were associated with diabetes. These associations were attenuated (FBG OR 1.91 ([95% CI 0.80, 24.54], I
= 83%, p = NS) and 1.58 ([95% CI 0.92, 2.74] I
= 83%, p = NS) for prospective and retrospective data, respectively; 2 h OGTT ORa 1.95 ([95% CI 0.43, 8.93], I
= 94%, p = NS)) after adjustments for common confounders. Further research is needed before clinical recommendations can be made.
Of 6423 citations, 17 studies were included. Both elevated fasting blood glucose (FBG; OR 3.62 ([95% CI 1.30, 10.12], I2 = 36%, p less then 0.05)) and 2 h OGTT (OR 3.96 [1.17, 13.40], I2 = 87%, p less then 0.05) were associated with diabetes. These associations were attenuated (FBG OR 1.91 ([95% CI 0.80, 24.54], I2 = 83%, p = NS) and 1.58 ([95% CI 0.92, 2.74] I2 = 83%, p = NS) for prospective and retrospective data, respectively; 2 h OGTT ORa 1.95 ([95% CI 0.43, 8.93], I2 = 94%, p = NS)) after adjustments for common confounders. Further research is needed before clinical recommendations can be made.
The COVID-19 pandemic raises a major concern about its severity in pregnancy, maternal-fetal outcomes, and risk of vertical transmission. We report a retrospective descriptive study of the clinical course and maternal-fetal outcomes of pregnant women with COVID-19.
This is a single-centre, retrospective study performed in a tertiary care hospital for pregnant women with COVID-19 in India. The medical records of all women who delivered in the COVID19 facility from May 5, 2020, to June 5, 2020, were reviewed independently. Data extracted from the records included demographic characteristics, obstetric details, comorbidities, disease severity, investigations, management, and information on neonates (birthweight, Apgar score, and perinatal complications).
Among 348 women tested for SARS-CoV-2, 57 women (16.3%) were confirmed as positive based on quantitative reverse transcriptase polymerase chain reaction of the nasopharyngeal specimen. Most women (45; 78.9%) had a mild infection with favourable maternal-fetal outcomes. Three maternal deaths were associated with comorbidities. Five neonates tested positive for SARS-CoV-2, remained hemodynamically stable, and were subsequently discharged.
A majority of pregnant women with COVID-19 had mild disease and recovered with good perinatal outcomes. Women with comorbidities may have an increased risk of severe morbidity and mortality. The cycle threshold signifying the viral load and degree of infectivity can modify management during pregnancy. Long-term outcomes and the potential mother-to-child vertical/horizontal transmission need further study.
A majority of pregnant women with COVID-19 had mild disease and recovered with good perinatal outcomes. Women with comorbidities may have an increased risk of severe morbidity and mortality. The cycle threshold signifying the viral load and degree of infectivity can modify management during pregnancy. Long-term outcomes and the potential mother-to-child vertical/horizontal transmission need further study.
Although LC is a common operation, difficult cases are still challenging. Several studies have identified factors for the difficulty and conversion. Many scoring systems have been established for pre-operative prediction. This study aimed to investigate significant factors and validity of Randhawa's model in our setting.
This prospective study enrolled LC patients in Hepato-Pancreato-Biliary Surgery unit between March 2018 and October 2019. The difficulty of operation was categorized into 3 groups by intra-operative grading scale. Multivariate analysis was performed to define significant factors of very-difficult and converted cases. The difficulty predicted by Randhawa's model were compared with actual outcome. Area under ROC curve was calculated.
Among 152 patients, difficult and very-difficult groups were 59.2% and 15.1%, respectively. Sixteen cases needed conversion. Four factors (cholecystitis, ERCP, thickened wall, contracted gallbladder) for very-difficult group and 3 factors (obesity, biliary inflammation or procedure, contracted gallbladder) for conversion were significant. Alpelisib After some modification of Randhawa's model, the modified scoring system provided better prediction in terms of higher correlation coefficient (0.41 vs 0.35) and higher AUROC curve (0.82 vs 0.75) than original model.
Randhawa's model was feasible for pre-operative preparation. The modification of this model provided better prediction on difficult cases.
Randhawa's model was feasible for pre-operative preparation. The modification of this model provided better prediction on difficult cases.
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