Intrauterine growth restriction (IUGR) is a condition which has been difficult to assess at an early stage, resulting in the delivery of children who have poor genetic growth potential. Currently, IUGR classification is based upon the system of ultrasound biometry. Doppler velocimetry allows the measurement of hemodynamic flow of major fetal vessels, comparing the flow indices and patterns of normal and IUGR cases. In this review, the effectiveness of Doppler velocimetry in assessing blood flow in major vessels including the umbilical artery, ductus venosus, and middle cerebral artery was studied for both diagnostic and prognostic screening of IUGR. The umbilical artery is the most frequently studied vessel in Doppler velocimetry due to its accessibility and the strength of its associations with fetal outcomes. Abnormalities in the ductus venosus waveform can be indicative of increased resistance in the right atrium due to placental abnormalities. The middle cerebral artery is the most studied fetal cerebral artery and can detect cerebral blood flow and direction, which is why these three vessels were selected to be examined in this context. A potential mathematical model could be developed to incorporate these Doppler measurements which are indicative of IUGR, in order to reduce perinatal mortality. The purpose of the proposed algorithm is to integrate Doppler velocimetry with biophysical profiling in order to determine the optimal timing of delivery, thus reducing the risks of adverse perinatal outcomes.
The general management for chronic kidney disease (CKD) includes treating reversible causes, including obesity, which may be both a driver and comorbidity for CKD. Bariatric surgery has been shown to reduce the likelihood of CKD progression and improve kidney function in observational studies. We performed a systematic review and meta-analysis of patients with at least stage 3 CKD and obesity receiving bariatric surgery. We searched Embase, MEDLINE, CENTRAL and identified eligible studies reporting on kidney function outcomes in included patients before and after bariatric surgery with comparison to a medical intervention control if available. Risk of bias was assessed with the Newcastle-Ottawa Risk of Bias score. Nineteen studies were included for synthesis. Bariatric surgery showed improved eGFR with a mean difference (MD) of 11.64 (95%CI: 5.84 to 17.45, I 2 = 66%) ml/min/1.73m 2 and reduced SCr with MD of À0.24 (95%CI À0.21 to À0.39, I 2 = 0%) mg/dl after bariatric surgery. There was no significant difference in the relative risk (RR) of having CKD stage 3 after bariatric surgery, with a RR of À1.13 (95%CI: À0.83 to À2.07, I 2 = 13%), but there was reduced likelihood of having uACR >30 mg/g or above with a RR of À3.03 (95%CI: À1.44 to À6.40, I 2 = 91%). Bariatric surgery may be associated with improved kidney function with the reduction of BMI and may be a safe treatment option for patients with CKD. Future studies with more robust reporting are required to determine the feasibility of bariatric surgery for the treatment of CKD.
ObjectivesTo systematically review and meta-analyse the impact of bariatric surgery on obese patients with urinary incontinence (UI).
MethodsA search of the Medical Literature Analysis and Retrieval System Online (MEDLINE), the Excerpta Medica dataBASE (EMBASE), Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed to June 2018 was performed using methods pre-published on the International Prospective Register of Systematic Reviews (PROSPERO). Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Studies comparing UI status in obese patients before and after bariatric surgery were included. Primary outcomes were the improvement or complete resolution of any UI, stress UI (SUI), and urgency UI (UUI). Secondary outcomes were validated UI questionnaire scores. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach assessed overall quality of evidence.
ResultsIn all, 33 cohort studies (2910 patients) were included (median follow-up 12 months). Bariatric surgery resulted in improvement or resolution of any UI in 56% (95% confidence interval [CI] 48-63%), SUI in 47% (95% CI 34-60%), and UUI in 53% (95% CI 32-73%) of patients. Moreover, bariatric surgery significantly decreased (P < 0.001) questionnaire scores such as: the Urogenital Distress Inventory by 13.4 points (95% CI 7.2-19.6), International Consultation on Incontinence Questionnaire by 4.0 points (95% CI 2.3-5.7), and Incontinence Impact Questionnaire by 5.3 points (95% CI 3.9-6.6). However, worsening or new onset of UI was present in 3% of patients. The quality of evidence was very low for all outcomes.
ConclusionHalf of obese patients report improvement or resolution of UI after bariatric surgery, but overall the quality of evidence is very low. Comparative studies examining the benefits of bariatric surgery in obese patients with UI are warranted.Keywords bariatric surgery, obesity, urinary incontinence, stress urinary incontinence, urge urinary incontinence, #Incontinence
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