Neuraxial analgesia in early labor did not increase the rate of cesarean delivery, and it provided better analgesia and resulted in a shorter duration of labor than systemic analgesia.
Introduction The COVID-19 pandemic has put significant stress on healthcare systems globally. This study focuses on emergency general surgery services at a major trauma centre and teaching hospital. We aimed to identify whether the number of patients and the severity of their presentation has significantly changed since the implementation of a national lockdown. Materials and methods This study is a retrospective review of acute referrals (from general practice and accident and emergency) to the emergency general surgery team over a 14-day period before (group 1) and during (group 2) lockdown. Results A total of 151 patients were reviewed by the general surgical team in group 1 and 75 in group 2 (a 50.3% reduction). The number of days with symptoms prior to presentation was significantly shorter in group 1 compared with group 2 (3 vs 4, p = 0.04). There was no significant difference in the National Early Warning Score, white blood cell count, lymphocytes and C-reactive protein on admission between the two groups of patients. There were significantly fewer patients admitted after lockdown compared with pre-lockdown (66% vs 48%, p = 0.01). Length of hospital stay was significantly shorter during lockdown compared with pre-lockdown (5 days vs 4 days, p = 0.04). Conclusion Fewer patients were referred and admitted during lockdown compared with pre-lockdown, and the length of stay was also significantly reduced. There was also a delay in presentation to hospital, although these patients were not more unwell based on the scoring criteria used within this study.
Septic arthritis is a potentially devastating condition. Early and aggressive joint lavage and debridement combined with appropriate antimicrobial therapy is imperative. A high index of suspicion is necessary in haemodialysis patients; the diagnosis of septic arthritis must be presumed until proven otherwise.
BackgroundFaecal calprotectin (FC) is one of the most widely used non-invasive tests for the diagnosis and assessment of Crohn’s disease (CD) activity. Despite this, factors other than disease activity which affect levels have not been extensively reviewed. This is of importance when using FC in the diagnostic setting but also may be of utility in studying the aetiology of disease.ObjectivesOur review outlines environmental risk factors that affect FC levels influencing diagnostic accuracy and how these may be associated with risk of developing CD. FC as a surrogate marker could be used to validate risk factors established in case control studies where prospective studies are not feasible. Proof of this concept is provided by our identification of obesity as being associated with elevated FC, our subsequent confirmation of obesity as risk factor for CD and the subsequent verification in prospective studies, as well as associations of lack of physical activity and dietary fibre intake with elevated FC levels and their subsequent confirmation as risk factors in prospective studies.ConclusionWe believe that FC is likely to prove a useful surrogate marker for risk of developing CD. This review has given a theoretical basis for considering the epidemiological determinants of CD which to date has been missing.
An estimated 6% to 8% women develop hypertension during pregnancy, which has been linked with asthma, through either the condition itself or treatment such as oral corticosteroids. Steroid use also has been linked with an increased risk of preeclampsia. This large population-based case-control study was planned to determine whether inhaled steroids increase the risk of either pregnancy-induced hypertension or preeclampsia in asthmatic women. Participants were 3505 women with asthma, 14-44 years of age, who had 4593 pregnancies in the years 1990-2000. As many as 10 control women at 30 or more weeks gestation were selected for each case. Sociodemographic factors were similar in the case and control groups.There were 302 cases of pregnancy-induced hypertension, representing 6.6% of the study population. They included 128 cases of gestational hypertension, 165 cases of preeclampsia, and 9 cases of eclampsia. More case women than controls were prescribed inhaled corticosteroids before and during pregnancy, and more were taking oral steroids. Case women who took more than 3 doses of a short-acting  2 agonist per week before pregnancy were at increased risk of pregnancy-induced hypertension, but this level of treatment during pregnancy correlated with a lower risk. Cases more often visited an emergency department for asthma. Using inhaled steroids while pregnant was not associated with the risk of either preeclampsia or pregnancy-induced hypertension. There was no dose-response relationship with inhaled steroids for either of these conditions. Oral steroids were, however, significantly associated with pregnancy-induced hypertension; the adjusted odds ratio was 1.57, and the 95% confidence interval was 1.02-2.41.This study failed to significantly relate the use of inhaled corticosteroids to either pregnancy-induced hypertension or preeclampsia in asthmatic women. These women should be encouraged to continue using inhaled steroids while pregnant to control their asthma. ABSTRACTThere is limited evidence that periodontitis is associated with preterm birth, but why it might induce inflammation and premature termination of pregnancy remains uncertain. The investigators evaluated periodontal status in 36 women at risk of miscarriage or preterm delivery. Amniocentesis was carried out at 15-20 weeks gestation, and a full-mouth periodontal examination was done at approximately the same time. The criterion for periodontitis was at least 1 site with a probing depth of 5 mm or greater in each quadrant. The 2 sites with the deepest pockets were chosen for microbial sampling of intraoral plaque. Vaginal smears also were obtained and cytokine levels estimated in amniotic fluid samples.Chronic periodontitis was diagnosed in 20% of women delivering within the normal period and in 83% of those who had a preterm delivery and an infant with low birth weight. All women with preterm gestations had regularly received dental care. Probing depths differed significantly in the preterm and full-term cases. In no case was the amniotic fluid infec...
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