Purpose: To evaluate the association of hypertensive disorders of pregnancy with SARs-CoV-2 infection in pregnant women.Methods: We conducted a retrospective cohort study of all pregnant patients with positive SARs-CoV-2 molecular test at four participating hospitals located in a large metropolitan city and who delivered between February 1 st and November 24 th , 2020. Patients who tested positive during their pregnancy and delivered (index cases) were compared to the three subsequent deliveries of patients who tested negative (controls) at the same institution. We evaluated the impact of COVID-19 on the development of hypertensive disorders of pregnancy.Results: A total of 280 patients were included in the study: 70 patients who tested positive for Coronavirus Disease-2019 and 210 matched controls. Compared with pregnancies negative for SARS-CoV-2 infection, COVID-19 was associated with an increased risk of developing a hypertensive disorders of pregnancy (OR 3.68, 95% CI 1.67 -8.10). Overall rates of preeclampsia with severe features were signi cantly higher in patients with a COVID-19 diagnosis (18.6% vs 7.1%, p=0.006). Of COVID-19 positive patients, an early SARS-CoV-2 infection (prior to 32 week's gestation) conferred a higher risk of hypertensive disorders in pregnancy (OR=6.29, CI 1.64-24.07; p=0.007). There was no difference in route of delivery, preterm birth, intrauterine growth restriction, intrauterine fetal demise, or pregnancy and fetal outcomes.Conclusion: COVID-19 is a risk factor for hypertensive disorders of pregnancy.
Importance:The retropubic midurethral sling (rMUS) and sacrocolpopexy are treatments for stress urinary incontinence (SUI) and pelvic organ prolapse, respectively, which are often performed concomitantly. Objective:The purpose of this study was to identify whether a difference exists in the failure rates of rMUS when placed alone or at the time of robotic sacrocolpopexy (RSC). Study Design:We conducted a single-center retrospective cohort study of patients who underwent rMUS placement between December 2015 and March 2020. The primary outcome was rMUS failure defined as additional treatment for SUI at any point.Results: There were 160 patients who underwent isolated rMUS and 175 patients who underwent rMUS and RSC. Patients who underwent isolated rMUS were more likely to be obese ( P < 0.01). Patients who underwent RSC were older (63.3 ± 9.9 vs 57.7 ± 13.7 years, P < 0.0001) and more likely to be White ( P = 0.02). Follow-up ranged from 0 to 46 months (median, 3 months; interquartile range, 3 months). Failure was observed in 2.3% of rMUS placed alone and 8.6% of rMUS with RSC. Patients who underwent rMUS and RSC had an odds ratio of 3.63 for rMUS failure ( P = 0.03; 95% confidence interval, 1. 16-11.38). Hypertension was associated with 4 times higher rMUS failure (odds ratio, 4.18; P = 0.02; 95% confidence interval, 1.29-13.58). Conclusions:We observed a significantly increased rate of rMUS failure from those placed alone to those placed at the time of RSC. Retropubic midurethral sling at the time of RSC was 4 times more likely to result in additional SUI treatment.
BACKGROUND It has been theorized that 75%-80% of febrile neutropenia (FN) is caused by endogenous pathogens, while up to 20% of cases are thought to be caused by a viral infection. It is unknown if precautions such as masking and social distancing reduce the risk of FN in susceptible populations. AIM To determine whether coronavirus disease 2019 (COVID-19) infection mitigation efforts, namely masking and social distancing, were associated with a reduction in the incidence of FN. METHODS This was a retrospective population based cohort study comparing the incidence of FN in the 13 mo prior to (Year 0) and 13 mo following (Year 1) the public health executive orders (PHEO) in Michigan. Data was queried for all emergency department (ED) visits from April 1, 2019 to March 31, 2021 from the National Syndromic Surveillance Program, a program which collects data that is voluntarily submitted by approximately 89% of Michigan EDs. The primary study outcome was the incidence of FN as a proportion of ED visits in the 13-mo before and 13-mo after COVID-19 mitigations efforts, namely masking and social distancing. We hypothesized that there would be a significant decrease in the incidence of FN in the period following the PHEO aimed at reducing the spread of the severe acute respiratory syndrome coronavirus 2 virus. RESULTS There was a total of 8979221 total ED visits captured during the study period. In Year 0 there were 5073081 recorded ED visits and 3906140 in Year 1. There was a significant reduction in the proportion of total ED visits with a diagnosis of FN, decreasing 13.3% across periods (0.15% vs 0.13%, P = 0.036). In patients with a hematologic malignancy a more impressive reduction in the incidence of FN was evident following PHEO (22% vs 17%, P = 0.02). CONCLUSION We found a significant association between social distancing and mask guidelines implemented on a large public scale with decreased rates of FN, particularly in those with a hematologic malignancy. These findings may be useful in the design of future research and recommendations regarding the prevention of FN.
Objective: To determine whether ventral mesh rectopexy at the time of sacrocolpopexy reduces the rate of future posterior wall prolapse. Material and Methods: This was a retrospective cohort study of women with pelvic organ prolapse (POP) who underwent sacrocolpopexy or without concomitant rectopexy at a single community hospital from December 1, 2015 to June 30, 2019. Preoperative pelvic organ prolapse quantification (POP-Q) and urodynamic testing was used in evaluation of POP. Patients were followed for 12-weeks postoperatively and a 12-week postoperative POP-Q assessment was completed. The incidence of new or recurrent posterior prolapse was compared between cohorts. Results: Women with POP (n=150) were recruited, of whom 41 (27.3%) underwent sacrocolpopexy while the remainder (n=109, 72.7%) did not receive rectopexy. Patient demographics did not statistically differ between cohorts. Post-surgical posterior wall prolapse was reduced in the robotic assisted sacrocolpopexy (RASC) + rectopexy group compared to RASC alone, however this did not reach statistical significance. There were no patients who underwent concomitant rectopexy and RASC that needed recurrent posterior wall prolapse surgery, compared to eight-percent of patients that underwent isolated RASC procedures. Conclusion: Our findings suggest a reduction in the need for subsequent posterior wall surgery when rectopexy is performed at the time of sacrocolpopexy. In our study, no future surgery for POP was found in the concomitant sacrocolpopexy and rectopexy group, while a small proportion of the RASC only group required future POP surgery. Our study, however, was underpowered to elucidate a statistically significant difference between groups. Future larger studies are needed to confirm a reduced risk of posterior wall prolapse in patients who undergo concomitant RASC and rectopexy.
Paratubal cysts are fluid-filled sacs that grow adjacent to the fallopian tube which can rarely result in torsion. Isolated fallopian tube torsion (IFTT) is a gynaecological emergency that warrants urgent laparoscopic detorsion to salvage the affected tube. IFTT has a proclivity to affect adolescents between the ages of 12 and 15 years and is rarely seen in premenarchal or perimenopausal women. Due to a lack of pathognomonical features, IFTT is difficult to diagnose. Adnexal torsion, including IFTT is a surgical diagnosis and no clinical or imaging criteria is sufficient to diagnose IFTT. Urgent laparoscopy and detorsion are required for preservation of the affected fallopian tube. However, given the diagnostic ambiguity, IFTT diagnosis is often delayed. IFTT should be included in the differential diagnoses for adolescent patients with acute abdomen when imaging demonstrates a normal appendix and ovaries. We report a 15-year-old girl with a 4-day history of abdominopelvic pain and bilateral paratubal cysts resulting in right IFTT.
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