Publications by authors named "Haleh Sangi-Haghpeykar"

150 Publications

Disparities between US Hispanic and non-Hispanic women in obesity-related perinatal outcomes: a prospective cohort study.

J Matern Fetal Neonatal Med 2021 Apr 11:1-8. Epub 2021 Apr 11.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.

Background: Mortality figures and national health surveillance data have demonstrated that Hispanics have a 24% lower risk of all-cause mortality compared to their non-Hispanic counterparts despite increased rates of obesity and related illnesses.

Objective: The aim of this study is to evaluate if this paradox exists for obesity-related perinatal outcomes in otherwise low-risk Hispanic women.

Materials And Methods: A prospective cohort study of low-risk women across all BMI classes with a singleton, non-anomalous term pregnancy admitted in active labor or undergoing induction of labor between May 2014 and April 2017. All demographic, obstetric, and neonatal outcomes were recorded, and the body mass index (BMI) closest to delivery was used for analysis. Data including composites of adverse maternal and neonatal outcomes were compared across BMI classes and between individuals of Hispanic and non-Hispanic ethnicity. Women with antenatal complications, prior cesarean delivery, and cesarean for non-reassuring fetal status were excluded.

Results: Of the 11,369 women who met inclusion criteria, 6303 (55%) were Hispanic. Eight percent of Hispanic women were normal weight (BMI: 18.5-24.9), 34% were overweight (BMI: 25-29.9), and 58% were obese (BMI > 30). Fourteen percent of non-Hispanic women were normal weight, 42% were overweight, and 44% were obese. The majority (65%) of women were multiparous. Rate of induction and birthweight increased across BMI for Hispanic and non-Hispanic groups, however the route of delivery was not significantly different ( = .22, 0.16, respectively). Although the association between BMI and composite perinatal complications did not differ by BMI class and ethnicity, the newborns of non-Hispanic women were more likely to be admitted to the neonatal intensive care unit with increasing maternal weight class (<0.001), even after adjusting for age, parity, marital status, prenatal visits, current tobacco use, type of labor, mode of delivery, and birthweight.

Conclusion: There were no demonstrable differences in composite adverse maternal or neonatal outcomes between Hispanic and non-Hispanic obese women. However, newborns of non-Hispanic obese women were more likely to be transferred to the neonatal intensive care unit with increasing maternal BMI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/14767058.2021.1909559DOI Listing
April 2021

Reproducibility of Lung and Liver Volume Measurements on Fetal Magnetic Resonance Imaging in Left-Sided Congenital Diaphragmatic Hernia.

Fetal Diagn Ther 2021 Mar 23:1-7. Epub 2021 Mar 23.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA,

Introduction: Congenital diaphragmatic hernia (CDH) affects 1 in 3,000 live births and is associated with significant morbidity and mortality.

Methods: A review of fetal magnetic resonance imaging (MRI) examinations was performed for fetuses with left CDH and normal lung controls. Image review and manual tracings were performed by 4 pediatric radiologists; right and left lung volumes in the coronal and axial planes as well as liver volume above and below the diaphragm in the coronal plane were measured. Intra- and interreviewer reproducibility was assessed using intraclass correlation coefficient (ICC) and Bland-Altman analysis.

Results: Excellent intra- and interreviewer reproducibility of the right and left lung volume measurements was observed in both axial planes (interreviewer ICC: right lung: 0.97, 95% CI: 0.95-0.99; left lung: 0.97, 95% CI: 0.95-0.98) and coronal planes (interreviewer ICC: right lung: 0.97, 95% CI: 0.95-0.98; left lung: 0.96, 95% CI: 0.93-0.98). Moderate-to-good interreviewer reproducibility was observed for liver volume above the diaphragm (ICC 0.7, 95% CI: 0.59-0.81). Liver volume below the diaphragm had a good-to-excellent interreviewer reproducibility (ICC 0.88, 95% CI: 9.82-0.93).

Conclusions: The present study demonstrated an excellent intra- and interreviewer reproducibility of MRI lung volume measurements and good-to-moderate inter- and intrareviewer reproducibility of liver volume measurements after standardization of the methods at our fetal center.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000512491DOI Listing
March 2021

Clinical characteristics and outcomes of combined thrombolysis and anticoagulation for pediatric and young adult lower extremity and inferior vena cava thrombosis.

Pediatr Hematol Oncol 2021 Mar 1:1-16. Epub 2021 Mar 1.

Department of Radiology, Section of Interventional Radiology, Texas, Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.

Effective treatment for acute, extensive, symptomatic lower extremity (LE) thrombosis involves thrombolysis in addition to anticoagulation. There is limited available data on the outcomes and safety of thrombolysis to help guide its use in pediatrics and young adults. A retrospective study of children and young adults (<21 years of age) that received catheter directed thrombolysis (CDT) for LE and inferior vena cava (IVC) thrombosis was performed over a 5-year span at a pediatric tertiary care center. A total of 29 patients were identified for inclusion in the study, 76% ( = 22) received overnight CDT while 24% ( = 7) received tissue plasminogen activator as a bolus dose during a single interventional procedure. The median age of the cohort was 15.8 years (range 0-19.1). All patients were treated with a course of therapeutic anticoagulation. The thromboses represented were extensive, with 93% ( = 27) being occlusive and affecting multiple venous segments. Thrombus resolution occurred in 35% ( = 10) of patients. Rivaroxaban use ( < 0.01) during the course of anticoagulation and estrogen-containing hormonal therapy (p = 0.01) use prior to diagnosis were associated with thrombus resolution, while Hispanic ethnicity ( = 0.06) had a trend toward thrombus persistence. There were one major and 3 minor bleeding events that occurred as complications of thrombolysis and no treatment related deaths. This study provides baseline information that can be used to help guide clinicians treating similar patients and suggests the need to develop an improved, uniform treatment approach for superior resolution rates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08880018.2021.1889729DOI Listing
March 2021

Vestibular Impairments on Objective Diagnostic Tests in HIV+ Women and Control Men and Women.

Laryngoscope 2021 Mar 1. Epub 2021 Mar 1.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, U.S.A.

Objective: To describe the value of two vestibular test batteries across ages in healthy men and women for detecting vestibular disorders and to compare the occurrence of vestibular disorders in the healthy adult population and women with human immunodeficiency virus (HIV) disease.

Study Design: Two groups were tested on the battery of objective diagnostic tests of the vestibular system.

Setting: Two tertiary care centers.

Subjects: Healthy controls (284 women and 105 men) and women (63) with HIV/AIDS (HIV+) who are being followed up in a longitudinal study of HIV. They were tested on objective diagnostic tests of the vestibular system.

Results: In all age decades, healthy controls had evidence of vestibular impairment, significantly more in older adults. HIV+ subjects, all females, did not differ from healthy control females.

Conclusion: These data suggest that at all ages, people do have decreased vestibular function, even young, asymptomatic, and apparently healthy adults. HIV disease, itself, does not cause an increased prevalence of peripheral vestibular disorders when HIV is controlled on antiretroviral medication.

Level Of Evidence: 2 Laryngoscope, 2021.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lary.29466DOI Listing
March 2021

Usefulness of Exam Questions and Vital Signs for Predicting the Outcome of Objective Vestibular Tests.

Laryngoscope 2021 Feb 26. Epub 2021 Feb 26.

Bobby R Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A.

Objectives/hypothesis: To determine the value of standard clinic screening questions and vital signs in predicting abnormal vestibular function, indicated by standard objective diagnostic tests.

Study Design: Retrospective records review.

Methods: We reviewed electronic medical records of 150 patients seen by the neurotologists or the physician assistant they supervised, in an out-patient tertiary care clinic, between June 2018 and March 2020, and subsequently referred for the complete objective vestibular test battery (VB).

Results: Of standard questions asked during the initial exam about vertigo, disequilibrium, lightheadedness and oscillopsia, only vertigo predicted an abnormal response on the VB. More males than females had abnormal VB responses, P < .05. Pulse was not related to VB score. Significantly more subjects with blood pressure in the range for stage 2 hypertension (blood pressure [BP] stage 2) had abnormal than normal results on the VB, P < .00001. Subjects with BP stage 2 had high rates of diabetes (34.2%) and hypertension (68.4%) as diagnosed by their primary care physicians or cardiologists.

Conclusion: Complaints of subjective vertigo and BP in the range of hypertension stage 2 are most likely to predict abnormal findings on the VB. Therefore, during an examination of a patient who comes in complaining of dizziness, two measures may be the most useful for screening: BP in the range of hypertension type 2, when BP is taken by a nurse, and a question to determine whether or not the patient has true vertigo.

Level Of Evidence: 3. Laryngoscope, 2021.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/lary.29487DOI Listing
February 2021

HIV-Adapted Group Prenatal Care: Assessing Viral Suppression and Postpartum Retention in Care.

AIDS Patient Care STDS 2021 02;35(2):39-46

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.

Viral suppression and postpartum retention in care have far-reaching health implications for pregnant women living with HIV and their children, yet remain public health challenges. Prenatal care presents a unique opportunity to engage pregnant women in care. The purpose of this study is to evaluate whether group prenatal care is effective in impacting these outcomes for pregnant women living with HIV. A retrospective cohort study was performed of all women living with HIV who obtained prenatal care from a community-based health center between 2013 and 2019. Women who spoke English or Spanish, remained within the system, and had not participated in group prenatal care previously were included. Women self-selected a prenatal care model: 85 selected group care and 109 elected individual care. Group prenatal care followed a standard Centering Pregnancy curriculum with the addition of HIV-related topics. The primary outcomes of the study were viral suppression (viral load <20 copies/mL) and postpartum retention in care (attending at least one or two visits with HIV primary care within 12 months postpartum). After adjusting for potential confounding factors, women who participated in group prenatal care were significantly more likely to have at least one HIV primary care visit postpartum {adjusted odds ratio (aOR) = 2.71 [95% confidence interval (CI 1.14-6.46)];  = 0.024}, and had a trend for achieving viral suppression by the time of delivery [aOR = 2.29 (95% CI 0.94-5.55);  = 0.068]. We have demonstrated that group prenatal care for pregnant women living with HIV is feasible and effective, with positive impacts on retention in care and viral suppression, factors that affect long-term outcomes from patients living with HIV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/apc.2020.0249DOI Listing
February 2021

The timing of aspirin administration in pregnancy is important to prevent preeclampsia.

Am J Obstet Gynecol MFM 2021 Jan 18;3(3):100314. Epub 2021 Jan 18.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX; Department of Molecular and Human Genetics, Department of Molecular and Cell Biology, Baylor College of Medicine, 1 Baylor Plaza, Jesse H. Jones Hall, Room 314C, Houston, TX 77030. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajogmf.2021.100314DOI Listing
January 2021

Incomplete Records as a Leading Cause of Missed Opportunity for Human Papillomavirus Vaccine Initiation in a Safety Net Health System.

Acad Pediatr 2020 Dec 21. Epub 2020 Dec 21.

Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex.

Objective: The goal of this study was to categorize reasons behind missed opportunities for human papillomavirus (HPV) vaccine initiation in an under-resourced population and to identify associated patient and clinic characteristics.

Methods: Manual chart review was performed for patients aged 11 to 18 years who visited a primary care clinic in a health system in Texas, USA between 06/01/18 and 08/31/18 and were due for an initial HPV vaccine dose but did not receive it. Reasons for HPV vaccine noninitiation were categorized as follows: incomplete immunization record, no documentation of discussion (no documentation that the HPV vaccine was offered or ordered), refusal, staff/provider error, and medical. Multinomial logistic regression was used to examine factors associated with each category.

Results: Of 4467 adolescents seen in the study period, 575 (12.9%) were due for the first dose of HPV vaccine but did not receive it. The most common reason for noninitiation was incomplete immunization record (37%), followed by no documentation of discussion (24%), refusal (20%), staff/provider error (15%), and medical (4%). The highest odds of incomplete immunization were among older adolescents. The highest odds of no documentation of discussion were during sick visits. The highest odds of staff/provider error were among patients with commercial insurance. The lowest odds of refusal were in patients with county/indigent insurance.

Conclusions: The most common reason for missed opportunity visits for HPV vaccine initiation was lack of adequate immunization records. Our study highlights the importance of immunization record access and bidirectional reporting as important targets for future interventions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.acap.2020.12.003DOI Listing
December 2020

Low-dose aspirin for preeclampsia prevention: efficacy by ethnicity and race.

Am J Obstet Gynecol MFM 2020 11 21;2(4):100184. Epub 2020 Jul 21.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX; Department of Molecular and Cell Biology, Baylor College of Medicine, Houston, TX. Electronic address:

Background: Low-dose aspirin is recommended for the prevention of preeclampsia among women at a high risk of developing the disease. Aspirin undergoes polymorphic metabolism, and it is well known that common genetic polymorphisms are related to aspirin intolerance. We hypothesized that the efficacy of aspirin prophylaxis may differ by ethnicity and race.

Objective: This study aimed to compare the rates of preeclampsia among low- and high-risk women who received aspirin compared with placebo, stratifying results by ethnicity and race as a first-pass approximation of genomic polymorphisms.

Study Design: This is a secondary analysis of 2 randomized controlled trials previously performed by the Maternal-Fetal Medicine Units Network: the Low-Risk Aspirin trial and the High-Risk Aspirin trial. For the Low-Risk Aspirin trial, normotensive, nulliparous women were enrolled between 13 and 26 weeks' gestation and randomized to 60 mg aspirin daily or placebo. For the High-Risk Aspirin trial, women with pregestational insulin-treated diabetes mellitus, chronic hypertension, multiple gestations, or a history of preeclampsia in a previous pregnancy were enrolled between 13 and 26 weeks' gestation and randomized to 60 mg aspirin daily or placebo. The primary outcome of our secondary analysis was preeclampsia. Secondary outcomes included gestational age at delivery, preterm delivery, placental abruption, small for gestational age, stillbirth, and neonatal death. Outcomes were stratified by ethnicity and race (Hispanic, non-Hispanic white, non-Hispanic black, or other).

Results: In the Low-Risk Aspirin trial of 3135 women, the risk of preeclampsia was significantly reduced among non-Hispanic white women who received aspirin compared with non-Hispanic white women who received placebo (relative risk, 0.19; 95% confidence interval, 0.06-0.63; P=.007). The risk of preeclampsia was not different when comparing the aspirin and placebo groups among the Hispanic, non-Hispanic black, or other ethnicity and race groups. The efficacy among non-Hispanic white women persisted after consideration of compliance and gestational age at randomization (relative risk, 0.07; 95% confidence interval, 0.009-0.51; P=.009). As noted in the original trial, there was an increased risk of placental abruption in the aspirin group overall compared with placebo (P=.025). The risk of stillbirth was significantly increased among non-Hispanic black women who received aspirin compared with non-Hispanic black women who received placebo (P=.048). In the High-Risk Aspirin trial of 2539 women, 269 were Hispanic (10.6%), 832 were non-Hispanic white (32.8%), 1426 were non-Hispanic black (56.2%), and 12 were categorized as other (0.5%). Stratification by ethnicity and race did not reveal a decreased incidence of preeclampsia for any of the subgroups (P>.05). Moreover, there was no significant difference in other measured outcomes including preterm delivery at <37 weeks' gestation, placental abruption, small for gestational age, stillbirth, or neonatal death.

Conclusion: The incidence of preeclampsia was significantly reduced among low-risk non-Hispanic white women who received aspirin compared with placebo (P=.007), but not overall or among Hispanic or non-Hispanic black women. The analysis of high-risk women did not indicate a difference in the efficacy of aspirin by ethnicity and race.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajogmf.2020.100184DOI Listing
November 2020

Brief high fat high sugar diet results in altered energy and fat metabolism during pregnancy in mice.

Sci Rep 2020 11 30;10(1):20866. Epub 2020 Nov 30.

Basic Sciences Perinatology Research Laboratories, Department of Obstetrics and Gynecology, Baylor College of Medicine, 1102 Bates Street, Room #1850.36, Houston, TX, 77030, USA.

During pregnancy several maternal adaptations occur in order to support the growing fetus which are further exacerbated by gestational diabetes mellitus (GDM). Previously we developed a mouse model of GDM, however we did not evaluate alterations to energy and fat metabolism. We have also shown that alterations in lipid metabolism are mediated by adrenomedullin (ADM) in normal and GDM pregnancies. Our objectives were: (1) evaluate energy and fat homeostasis in our GDM mouse model and (2) determine if ADM may play a role in these changes. Female mice were placed on either control (P-CD) or high fat, high sucrose diet (P-HFHS) 1 week prior to and throughout pregnancy. Mice were placed into comprehensive lab animal monitoring system (CLAMS) chambers throughout pregnancy. Visceral adipose tissue (VAT) was collected at d17.5 of pregnancy for analysis. Energy Expenditure was significantly increased (p < 0.05) in P-HFHS dams compared to all other groups. VAT ex-vivo lipolysis was increased (p < 0.05) in P-HFHS compared to P-CD dams. VAT gene expression of ADM receptors Crlr, Ramp2, and Ramp3 was increased (p < 0.05) in P-HFHS dams. ADM dose dependently increased ex vivo lipolysis. This data further validates our animal model of GDM and is usefulness in investigating the pathophysiology of GDM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-020-77529-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7705687PMC
November 2020

Rates of Intrauterine Device Expulsion Among Adolescents and Young Women.

J Pediatr Adolesc Gynecol 2020 Nov 13. Epub 2020 Nov 13.

Baylor College of Medicine, Houston, Texas; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Division of Pediatric and Adolescent Gynecology, Baylor College of Medicine, Houston, Texas.

Study Objective: The objective of our study was to determine the rate of intrauterine device (IUD) expulsion and risk factors for expulsion among adolescents and young adults.

Design: Retrospective chart review.

Setting: IUD insertions were performed at a single children's hospital.

Participants: Eligible adolescent and young adult patients who underwent IUD insertion between August 2009 and March 2019.

Interventions: IUD insertion.

Main Outcome Measures: Primary outcome was the incidence of IUD expulsion in adolescents and young women. Secondary outcomes were risk factors for IUD expulsion including heavy menstrual bleeding, abnormal uterine bleeding (AUB), anemia, or a bleeding disorder diagnosis.

Results: Six hundred forty-two eligible patients underwent IUD insertion. The incidence of first IUD expulsion in this population was 58/642 (9.03%). Among those who chose to have a second IUD placed (n = 29), 8/29 (27.6%) had a second expulsion. Patients who expelled their IUD were more likely to have a history of AUB, heavy menstrual bleeding, anemia, or a bleeding disorder. When controlled for body mass index and age at insertion, history of AUB and anemia remained significant risks for IUD expulsion.

Conclusion: This study similarly showed a higher risk of primary and secondary IUD expulsion in adolescents and young women. A history of AUB, anemia, bleeding disorder, and elevated body mass index are associated with higher risk for IUD expulsion. This population should be counseled that these conditions might place them at higher risk for expulsion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpag.2020.11.003DOI Listing
November 2020

Prediction of Functional Limitations in Balance after Tests of Tandem Walking and Standing Balance in Older Adults.

South Med J 2020 09;113(9):423-426

From the Departments of Otolaryngology - Head and Neck Surgery, Obstetrics and Gynecology, and Medicine, Baylor College of Medicine, Houston, Texas.

Objective: Older adults who may not complain of balance problems may nevertheless be developing subtle balance problems that may affect future functioning. This study sought to determine whether subtle problems could be predicted by standard balance testing.

Methods: At the geriatric medicine clinic at an academic tertiary-care center, geriatricians referred 27 people who were ambulatory without gait aids and had no apparent neurologic or musculoskeletal impairments affecting their balance or gait performance. Initially, subjects were screened with some questions about vertigo, tests of standing balance on foam with eyes closed (Romberg tests) with head still, and head nodding (pitch) and shaking (yaw) at 0.3 Hz, and tandem walking with eyes closed (TW). Approximately 2 years later, 22 subjects were available to be rescreened.

Results: At the second test date subjects' scores declined slightly but significantly on all three variations of the Romberg tests: with head still, head pitch, and head yaw, ≥ 0.02, but TW did not change significantly. TW was the best predictor of balance performance; the lowest-scoring subjects at the second test used a cane, had undergone hip surgery, or were scheduled for hip surgery: sensitivity 1.0, specificity 0.84. The second-best predictor was Romberg on foam with eyes closed and head still.

Conclusions: The data suggest that some older adults may have subtle musculoskeletal impairments that may be indicated by simple balance tests. A finding on these tests may indicate the need for further workup for balance-related problems. These quick, inexpensive tests can be administered by ancillary staff and may add important information to the initial visit and annual follow-up visits.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.14423/SMJ.0000000000001138DOI Listing
September 2020

Differences in Responses on the Modified Clinical Test of Sensory Interaction and Balance on Medium Firm and Medium Density Foam in Healthy Controls and Patients with Vestibular Disorders.

Biomed Hub 2020 Jan-Apr;5(1):1548-1555. Epub 2020 Apr 14.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.

Purpose: To determine whether foam density affects modified Romberg balance test performance.

Materials And Methods: Controls and patients with vestibular disorders performed Romberg tests on medium and medium firm foam, with their eyes closed and the head still and moving in yaw and pitch. The trial duration and number of head movements were measured.

Results: Subjects aged >60 years performed longer and with more head movements on medium firm foam than on medium foam. Older controls did not differ between medium firm and medium foam. Older patients had higher scores on head-still and head-yaw trials on medium firm foam versus medium foam but pitch trials did not differ. Females, controls, and patients had longer trial durations and more head movements on medium firm foam than on medium density foam; male controls did not differ by foam density. Male patients differed in yaw trials.

Conclusion: Foam density affects scores. Clinical decision-making may be adversely affected if the clinician uses foam of a density that is not the same as that of the foam that was used in the studies that developed descriptive statistics, sensitivity, and specificity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000507180DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383259PMC
April 2020

Paratubal Cyst Recurrence in Children and Adolescents.

J Pediatr Adolesc Gynecol 2020 Dec 24;33(6):649-651. Epub 2020 Jul 24.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; Division of Pediatric and Adolescent Gynecology, Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Texas Children's Hospital, Houston, Texas; Department of Obstetrics and Gynecology, Division of Pediatric and Adolescent Gynecology, Houston, Texas; Department of Pathology and Immunology, Department of Pediatrics, Houston, Texas.

Study Objective: To examine the association between patient characteristics and risk for recurrence risk of paratubal cysts (PTC) in children and adolescents.

Design: Retrospective chart review at a single institution.

Setting: Single academic children's hospital.

Participants: Pediatric patients presenting to Texas Children's Hospital between July 2007 and March 2019. Patients were identified for the study by reviewing pathology reports and were included if they met inclusion criteria of a pathologic diagnosis of a paratubal or paraovarian cyst removed during any surgical procedure between July 2007 and March 2019.

Interventions: Subjects with pathologic diagnoses of a paratubal cyst during the study period underwent chart review for the following data points: age at presentation, ethnicity, pathologic recurrence of paratubal cysts, pubertal status, body mass index (BMI), diagnosis of polycystic ovary syndrome (PCOS), size of cyst, laterality of cysts, and number of cysts.

Main Outcome Measure(s): Recurrence, Pathology types.

Results: Of the 627 patients that met inclusion criteria, the incidence of recurrence was 11.3%. Group 1 included those with recurrence of PTC (N = 70). Group 2 was identified as those without recurrence of PTC (N = 557). There were no differences related to age, BMI, ethnicity, history of PCOS, cyst size, laterality or number of cysts present. PTC NOS and serous PTC occurred most frequently. Of the unique cases involving recurrence, 70.1% recurred on the ipsilateral side. There were no cases of paratubal cyst malignancies in this cohort. The range of pathology diagnoses included pathologies that may occur in ovarian cysts. This is particularly interesting, given the known origins of ovarian cancer from fallopian tube transformations. Rare pathology diagnoses likely did not occur with frequency to determine definitive risks of recurrence in these cases.

Conclusions: There appears to be a baseline recurrence risk for PTC, for which patients can be counseled. Recurrence does not appear to be associated with any particular pathology type, cyst size, number of cysts, BMI, PCOS, or puberty stage. Recurrence, should it occur, appears to occur more commonly on the ipsilateral side.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpag.2020.07.008DOI Listing
December 2020

Fetal Weight Estimation Using Automated Fractional Limb Volume With 2-Dimensional Size Parameters in Diabetic Pregnancies.

J Ultrasound Med 2021 Feb 25;40(2):279-284. Epub 2020 Jul 25.

Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Pavilion for Women, Houston, Texas, USA.

Objectives: To examine the effect of adding automated fetal fractional limb volume (FLV) with conventional 2-dimensional (2D) fetal weight estimation procedures in a cohort of diabetic pregnancies.

Methods: A pilot study of diabetic pregnancies measured standard fetal biometry within 7 days of delivery. Fractional arm volume (AVol) and fractional thigh volume (TVol) soft tissue parameters were measured with a commercially available automated software utility (5D Limb Vol; Samsung Medison Co, Ltd, Seoul, Korea). Three conventional weight prediction models that included only 2D size parameters were compared to FLV models that included AVol or TVol. Estimated and actual birth weight (BW) were assessed for the mean percent difference ± standard deviation of the percent differences. Systematic errors were evaluated by the Student t test, and random errors were compared by the Pitman test for correlated variances. The proportion of neonates with estimated fetal weight within 10% of BW was compared between groups by the McNemar test.

Results: Ninety gravid women were enrolled with pregestational (26.7%) or gestational (73.3%) diabetes. All prediction models were accurate, with the exception of small underestimations by the model of Schild et al (-3.8%; Ultrasound Obstet Gynecol 2004; 23:30-35). Random errors for the AVol (6.2%) and TVol (6.9%) models were significantly more precise than the other 3 prediction models: Hadlock et al (7.8%; Am J Obstet Gynecol 1985; 151:333-337), INTERGROWTH-21st (8.0%; Ultrasound Obstet Gynecol 2017; 49:478-486), and Schild et al (8.6%; P < .01). The greatest proportion of cases with BW ±10% was also classified by the AVol (91.1%) and TVol (91.1%) models, followed by Hadlock (83.3%), INTERGROWTH-21st (78.9%), and Schild (76.7%) predictions.

Conclusions: The addition of automated FLV measurements to conventional 2D biometry was associated with improved weight predictions in this cohort of diabetic pregnancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jum.15397DOI Listing
February 2021

Kinetics of maternal pertussis-specific antibodies in infants of mothers vaccinated with tetanus, diphtheria and acellular pertussis (Tdap) during pregnancy.

Vaccine 2020 08 21;38(37):5955-5961. Epub 2020 Jul 21.

Departments of Pediatrics, Infectious Disease Section, Baylor College of Medicine, Houston, TX, United States; Currently at: Department of Pediatrics, Division of Infectious Diseases, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, United States.

Background: Kinetics of Tdap-induced maternally-derived antibodies in infants are poorly understood. Pre-Tdap era data suggest that maternal pertussis antibodies in infants have a half-life of approximately 5-6 weeks.

Methods: 34 mother-infant pairs had blood collected before maternal Tdap vaccination, 4 weeks later, at delivery (maternal and cord), and at infant ages 3 and 6 weeks from June 2014-March 2015. Immunoglobulin G (IgG) to pertussis toxin (PT), filamentous hemagglutinin (FHA), fimbrial proteins (FIM) and pertactin (PRN) was quantified by multiplex luminex assay (IU/ml). Geometric mean concentrations (GMCs) with 95% confidence intervals (C.I.) and half-life of pertussis antibodies were calculated.

Results: Tdap was administered to 34 women (mean age 31.1 years) at mean gestation 30.7 weeks (28-32.7). Mean neonatal gestation was 39.1 weeks (36-41.1) and mean birthweight was 3379 g (2580-4584). Four weeks post-Tdap vaccination, maternal pertussis-specific IgG GMCs increased ≥4-fold in 59%, 41%, 29% and 44% of women for PT, FHA, FIM and PRN, respectively, and then waned. The transplacental transport ratio of pertussis antibodies was 1.35 for PT, 1.41 for FHA, 1.31 for FIM and 1.36 for PRN. Between birth and age 6 weeks, infant serum GMC for PT-specific IgG decreased from 55.1 IU/mL (38.6-78.6) to 21.1 IU/ml (14.7-30.2), and the proportion of infants with PT levels ≥10 IU/ml fell from 97% to 67%. Half-life of pertussis-specific IgG in infants in days was 29.4 (95% CI 27.3-31.7) for PT, 29.8 (95% CI 27.7-32.2) for FHA, 31.2 (95% CI 28.9-33.7) for PRN, and 35.8 (95% CI 30.1-44.3) for FIM.

Conclusion: The half-life of pertussis-specific antibodies in infants induced by maternal Tdap vaccination (29-36 days) is shorter than previously reported. Understanding how the durability of passively-acquired antibodies impacts infant susceptibility to pertussis and response to primary vaccination is critical to refine prevention strategies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.vaccine.2020.06.050DOI Listing
August 2020

Intravenous labetalol versus oral nifedipine for acute hypertension in pregnancy: effects on cerebral perfusion pressure.

Am J Obstet Gynecol 2020 09 13;223(3):441.e1-441.e8. Epub 2020 Jun 13.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.

Background: Pregnant women with preeclampsia have been found to have elevated cerebral perfusion pressure and impaired cerebral autoregulation compared with normal pregnant women. Transcranial Doppler is a noninvasive technique used to estimate cerebral perfusion pressure. The effects of different antihypertensive medications on cerebral perfusion pressure in preeclampsia are unknown.

Objective: To compare the change in cerebral perfusion pressure before and after intravenous labetalol vs oral nifedipine in the setting of acute severe hypertension in pregnancy.

Study Design: This is a prospective cohort study of pregnant women between 24 and 42 weeks' gestation with severe hypertension (systolic blood pressure ≥160 mm Hg and/or diastolic blood pressure ≥110 mm Hg). Women who consented to the study and received either intravenous labetalol or oral nifedipine were included. Exclusion criteria included active labor or receipt of any antihypertensive medication within 2 hours of initial cerebral perfusion pressure measurement. Peripheral blood pressure and transcranial Doppler studies for middle cerebral artery hemodynamics were performed prior to the administration of antihypertensive medications and repeated 30 minutes after medication administration.

Results: A total of 16 women with acute severe hypertension were enrolled; 8 received intravenous labetalol and 8 received oral nifedipine. There were no significant differences between the labetalol and nifedipine groups in baseline characteristics such as maternal age, race and ethnicity, payment, hospital site, body mass index, nulliparity, gestational age, preexisting diabetes mellitus or chronic hypertension, fetal growth restriction, magnesium sulfate administration, and symptomatology (P>.05). When examined 30 minutes after the administration of either intravenous labetalol or oral nifedipine, there was a significantly greater decrease in systolic blood pressure (-9.8 mm Hg vs -39 mm Hg; P=.003), mean arterial pressure (-7.1 mm Hg vs -22.3 mm Hg; P=.02), and cerebral perfusion pressure (-2.5 mm Hg vs -27.7 mm Hg; P=.01) in the nifedipine group. There was no statistically significant decrease in diastolic blood pressure (-12.9 mm Hg vs -5.4 mm Hg; P=.15). The change in middle cerebral artery velocity by transcranial Doppler was compared between the groups and was not different (0.07 cm/s vs 0.16 cm/s; P=.64).

Conclusion: Oral nifedipine resulted in a significant decrease in cerebral perfusion pressure, whereas labetalol did not, after administration for acute severe hypertension among women with preeclampsia. This decrease seems to be driven by a decrease in peripheral arterial blood pressure rather than a direct change in cerebral blood flow.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajog.2020.06.018DOI Listing
September 2020

Midtrimester Ultrasound Predictors of Small-for-Gestational-Age Neonates.

J Ultrasound Med 2020 Oct 18;39(10):2027-2031. Epub 2020 May 18.

Baylor College of Medicine, Houston, Texas, USA.

Objectives: To determine whether a specific estimated fetal weight (EFW) or abdominal circumference (AC) measurement percentile at the 18-to 24-week ultrasound (US) examination is associated with a small-for-gestational-age (SGA) neonate.

Methods: A retrospective case-control study was conducted including women with uncomplicated singleton gestations who delivered a term SGA neonate identified as having a birth weight (BW) below the 10th percentile on the Olsen growth curve and had an 18- to 24-week US examination in our database. The study period was October 2011 to January 2018. A similar number of control charts were requested randomly over the same time with BW in the 10th to 90th percentiles, all which had an 18-to 24-week US examination in our database. After all neonates meeting BW criteria were identified, a chart review was performed to specifically evaluate biometric parameters from the US at 18 to 24 weeks to determine a potential correlation with the EFW percentile and AC percentile. Pregnancy, neonatal outcomes, and maternal demographic characteristics were collected.

Results: A total of 549 term neonates with a BW below the 10th percentile, and 593 control term neonates with BW in the of 10th to 90th percentiles were reviewed. Our analyses revealed that the AC and EFW percentiles were poor predictors of BW (<10th percentile; areas under the receiver operating characteristic curves, 0.68 and 0.69, respectively). A similar low ability of AC and EFW to predict BW below the 5th percentile was noted.

Conclusions: (1) No tipping point or cutoff for the EFW or AC percentile at the 18- to 24-week US examination was identified to predict a term SGA neonate. (2) These data are helpful when counseling women in midgestation about specific parameters, their importance, and the potential need for follow up imaging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jum.15310DOI Listing
October 2020

Reducing abdominal hysterectomy surgical site infections: A multidisciplinary quality initiative.

Am J Infect Control 2020 11 8;48(11):1292-1297. Epub 2020 May 8.

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, TX.

Background: To investigate abdominal hysterectomy surgical site infection (SSI) rates before and after implementation of an SSI care bundle.

Methods: An SSI bundle for abdominal hysterectomies was introduced in our hospital in April 2014 to reduce the SSI rate. The practices were divided into bundle elements around preoperative, intraoperative, and postoperative care. We conducted a retrospective cohort study around implementation of the SSI care bundle. Women were included if they underwent abdominal hysterectomy between 2012 and 2015. They were then divided into 2 study groups: prebundle and postbundle. The primary study outcome was SSI rate. The superficial SSI rate was the secondary outcome.

Results: The overall SSI rate was 6.18% in the prebundle group, with a median monthly SSI rate of 7.03%. After bundle implementation, the overall SSI rate declined to 2.51% (P = .02). The reduction remained significant after multivariate analysis (adjusted odds ratio 0.38; 95% confidence interval 0.15-0.88; P = .03) indicating a 62% reduction in SSI postbundle as compared to prebundle.When comparing rates based on infection classification, superficial SSIs declined significantly from 3.73% in the prebundle group to 0.90% in the postbundle group (P = 0.02). Patient demographics and pre-existing medical conditions were similar pre- and postbundle. Compliance with bundle elements was high.

Conclusions: A significant reduction in SSI rate in abdominal hysterectomies was seen following implementation of an infection prevention bundle.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajic.2020.05.001DOI Listing
November 2020

Fetal Weight Estimation Using Automated Fractional Limb Volume With 2-Dimensional Size Parameters: A Multicenter Study.

J Ultrasound Med 2020 Jul 5;39(7):1317-1324. Epub 2020 Feb 5.

Diakovere Krankenhaus, Hannover, Germany.

Objectives: To develop new fetal weight prediction models using automated fractional limb volume (FLV).

Methods: A prospective multicenter study measured fetal biometry within 4 to 7 days of delivery. Three-dimensional data acquisition included the automated FLV that was based on 50% of the humerus diaphysis (fractional arm volume [AVol]) or 50% of the femur diaphysis (fractional thigh volume [TVol]) length. A regression analysis provided population sample-specific coefficients to develop 4 weight estimation models. Estimated and actual birth weights (BWs) were compared for the mean percent difference ± standard deviation of the percent differences. Systematic errors were analyzed by the Student t test, and random errors were compared by the Pitman test.

Results: A total of 328 pregnancies were scanned before delivery (BW range, 825-5470 g). Only 71.3% to 72.6% of weight estimations were within 10% of actual BW using original published models by Hadlock et al (Am J Obstet Gynecol 1985; 151:333-337) and INTERGROWTH-21st (Ultrasound Obstet Gynecol 2017; 49:478-486). All predictions were accurate by using sample-specific model coefficients to minimize bias in making these comparisons (Hadlock, 0.4% ± 8.7%; INTERGROWTH-21st, 0.5% ± 10.0%; AVol, 0.3% ± 7.4%; and TVol, 0.3% ± 8.0%). Both AVol- and TVol-based models improved the percentage of correctly classified BW ±10% in 83.2% and 83.9% of cases, respectively, compared to the INTERGROWTH-21st model (73.8%; P < .01). For BW of less than 2500 g, all models slightly overestimated BW (+2.0% to +3.1%). For BW of greater than 4000 g, AVol (-2.4% ± 6.5%) and TVol (-2.3% ± 6.9%) models) had weight predictions with small systematic errors that were not different from zero (P > .05). For these larger fetuses, both AVol and TVol models correctly classified BW (±10%) in 83.3% and 87.5% of cases compared to the others (Hadlock, 79.2%; INTERGROWTH-21st, 70.8%) although these differences did not reach statistical significance.

Conclusions: In this cohort, the inclusion of automated FLV measurements with conventional 2-dimensional biometry was generally associated with improved weight predictions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jum.15224DOI Listing
July 2020

Balance and sound conditions in adults with bilateral cochlear implants.

Biomed Hub 2019 Jan-Apr;4(1)

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.

Purpose: Determine if 1) balance is impaired in patients with bilateral cochlear implants compared to healthy controls; 2) the presence of sound, non-speech or speech, affects standing balance.

Materials And Methods: Four patients with bilateral cochlear implants were tested on three balance conditions on Romberg tests on medium density compliant foam with eyes closed, with head stationary or moving in yaw or pitch, under 5 sound conditions: no sound, ambient background noise, pink noise, foreign language, English language.

Results: Dependent measure were duration of standing and kinematics. Three of four subjects performed well with head still and no sound, background noise, or pink noise. All subjects performed poorly during the head movement conditions in the presence of either a foreign language or English words. Subjects could not perform enough head movements during yaw and pitch conditions for accurate kinematic measurements.

Conclusion: The no-sound condition did not influence standing balance skills. The addition of ambient or pink noise also did not affect their balance. When they were distracted by attending to words, however, regardless whether or not they understood the words, standing balance skills deteriorated. Thus, distracted attention in these patients leads to impaired balance, which may impair functional motor skills.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000499074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6855668PMC
November 2019

Pregnancy Outcomes among Hispanics Stratified by Country of Origin.

Am J Perinatol 2021 Apr 26;38(5):497-506. Epub 2019 Oct 26.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.

Objective:  This study aimed to compare the perinatal outcomes among U.S.-born and foreign-born Hispanics and Caucasians and ascertain if length of time in the US was associated with the rate of adverse outcomes.

Study Design:  Retrospective cohort analysis of gravidae enrolled in our institutional perinatal database. Women delivering a non-anomalous, singleton, at 24 weeks or more and self-identified as Caucasian or Hispanic were included. Women were stratified by country of birth and ethnicity into U.S.-born Caucasian, U.S.-born Hispanic, and U.S. foreign-born Hispanic. Composite maternal (CMM) and neonatal (CNM) morbidity was assessed.

Results:  Of 20,422 women, 21% were Caucasian, 15% were U.S.-born Hispanics, and 64% were U.S. foreign-born Hispanics. Compared to Caucasians, U.S.-born and foreign-born Hispanic were older, more likely to be a grand multiparous, obese and less likely to be married. Compared to Caucasians, foreign-born Hispanics had a 1.42-fold increased risk of CMM (95% CI 1.26-1.30). Paradoxically, the rate of CNM was 40% lower among neonates born to foreign-born Hispanics (95% CI 0.51-0.74). A significant direct relationship was noted between time in the USA and CMM but not CNM among foreign-born Hispanics.

Conclusion:  Despite less favorable baseline characteristics, U.S. foreign-born Hispanics have 40% less CNM compared to both Caucasians and U.S.-born Hispanics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1055/s-0039-1698835DOI Listing
April 2021

Peripartum Outcomes Before and After Hurricane Harvey.

Obstet Gynecol 2019 11;134(5):1005-1016

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine, and the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.

Objective: To evaluate the association between Hurricane Harvey landfall with maternal and neonatal morbidity.

Methods: Using an institutional perinatal database from two hospitals in Houston, Texas, women with nonanomalous singletons delivering after 24 weeks of gestation between August 2011 and June 2018 were included. To evaluate the possible association of hurricane landfall with pregnancy outcomes, gravid women delivering within 280 days (40 weeks of gestation) on or after August 25, 2017 (the day of hurricane landfall) were categorized as exposed, and women who delivered before August 25, 2017, were the reference group. Composite maternal morbidity included any of the following: hypertensive disorders of pregnancy, chorioamnionitis, endometritis, blood transfusion, peripartum hysterectomy, maternal critical care admission, pulmonary edema, or maternal death. Composite neonatal morbidity included any of the following: 5-minute Apgar score 3 or less, respiratory distress syndrome, use of ventilator or continuous positive airway pressure, suspected newborn sepsis, seizure, stillbirth, or neonatal death. Adjusted odds ratios (aORs) were calculated after correcting for possible confounders identified on univariate analysis. Disruption in outcome trends were measured in time series analyses.

Results: Of 40,502 deliveries in our database, 29,179 (72%) met the inclusion criteria, with 3,842 (13.2%) delivering within 280 days of Hurricane Harvey landfall. Women delivering after Hurricane Harvey were on average less likely to be obese and more likely to be older, Caucasian, married, have a household income higher than $75,000, a high school education, and private insurance. However, compared with the cohort of gravid patients who delivered before Hurricane Harvey, composite maternal morbidity increased by 27% (11.5% vs 14.7%, aOR 1.27, 95% CI 1.14-1.42) after the storm. Composite neonatal morbidity increased by 50% (7.8% vs 11.9%, aOR 1.52, 95% CI 1.34-1.71). In time series analyses, we observed a significant shift in composite maternal morbidity specific to women of low socioeconomic status (estimate 2.87, P=.028).

Conclusion: Despite having fewer at-risk baseline characteristics, gravid patients delivering after landfall by Hurricane Harvey had a significantly higher likelihood of adverse outcomes as did their neonates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/AOG.0000000000003522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6814565PMC
November 2019

Standardization and reproducibility of sonographic stomach position grades in fetuses with congenital diaphragmatic hernia.

J Clin Ultrasound 2019 Nov 16;47(9):513-517. Epub 2019 Jul 16.

Maternal-Fetal Medicine Division, Department of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, United States.

Objectives: The purpose of this study was to evaluate the reproducibility of stomach position grading in congenital diaphragmatic hernia (CDH) as proposed by Cordier et al and Basta et al after standardization of the methods at our center.

Methods: We collected sonographic images from 23 fetuses with left-sided CDH at our center from 2010 to 2018. Nine operators (one maternal fetal medicine expert and eight sonographers) reviewed the selected images and graded the stomach position according to the methods of Cordier et al and Basta et al. We assessed the interoperator agreement with Fleiss's kappa statistics.

Results: Overall agreement amongst all operators was moderate for both methods proposed by Cordier et al (k = 0.60, SE 0.07, 95% CI 0.47-0.73, P < .0001) and Basta et al (k = 0.60, SE 0.06, 95% CI 0.47-0.73, P < .0001). Interoperator agreement was moderate for grade 3 with the method by Cordier et al (k = 0.45, SE 0.09, 95% CI 0.27-0.64, P < .0001) and fair for grade 4 with the method by Basta et al (k = 0.33, SE 0.08, 95% CI 0.18-0.49 P < .0001).

Conclusions: Our study demonstrates a fair to moderate interoperator agreement of the stomach position grading methods proposed in the literature after standardization of the methods at our center. Further multicenter studies are needed to confirm our results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jcu.22759DOI Listing
November 2019

Screening for Vestibular Disorders Using the Modified Clinical Test of Sensory Interaction and Balance and Tandem Walking With Eyes Closed.

Otol Neurotol 2019 06;40(5):658-665

Neuroscience Laboratories, NASA/Johnson Space Center, Houston, Texas.

Objectives: Determine accurate cut-points and optimal combinations of screening tests of balance to detect patients with vestibular disorders.

Study Design: Case-control study.

Setting: Out-patient tertiary care.

Subjects And Methods: Community-dwelling adults, without known neurological deficits or significant musculoskeletal disorders, including patients with vestibular disorders and healthy controls without vestibular disorders were tested while standing on medium density compliant foam with feet together and eyes closed under three head movement conditions, head stationary, and head moving in yaw and pitch at 0.33 Hz, for up to 30 seconds per trial. Dependent measures were trial duration, number of head movements during head movement trials, trunk kinematic measures, and number of correct tandem steps during tandem walking trials.

Results: Receiver operator characteristics (ROC), sensitivity and specificity, and specific cut-points were calculated. Individual tests had moderate ROC values, from 0.67 to 0.84. ROC values were higher in the head moving trials than the head stationary trial and best for subjects aged 40 to 79. Using combined analyses of two or more tests, including published data on tandem walking, ROC values were higher, 0.80 to 0.90. Age- and sex-related performance differences were found.

Conclusion: Balance skills in standing and walking differ, so testing both skills is optimal and increases the likelihood of finding a deficit. Patients should be compared to age-appropriate norms. Kinematics and number of head movements were not very useful. This combined set of rapid, low-tech balance tests is useful in an initial approach to screening patients who may have vestibular disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/MAO.0000000000002173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530479PMC
June 2019

Evaluating medically underserved gynecologic oncology patient survivors' interest in participating as a volunteer mentor in a peer support group.

Psychooncology 2019 05 16;28(5):1153-1156. Epub 2019 Apr 16.

Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Baylor College of Medicine, Houston, Texas.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pon.5074DOI Listing
May 2019

Predictors of Urinary Retention After Vesicovaginal Fistula Surgery: A Retrospective Case-Control Study.

Female Pelvic Med Reconstr Surg 2020 Dec;26(12):726-730

International Training and Education Center for Health, University of Washington, Seattle, WA.

Objective: The objective of this study is to determine the predictors for urinary retention after vesicovaginal fistula surgery.

Methods: This was a retrospective case-control study of women who underwent vesicovaginal fistula repair between January 2014 and December 2017 at the Fistula Care Centre in Lilongwe, Malawi. Cases were defined as patients with documented urinary retention, defined as a postvoid residual that is 50% greater than the total void of at least 100 mL. The cases and controls were matched by the 3 components of the Goh classification system in a ratio of 1:5. Univariate analysis was used to detect differences between demographic, clinical characteristics, and operative techniques between cases and control. Logistic regression analysis was performed for estimation of odds ratios (ORs).

Results: There were no statistically significant differences between the 40 cases and 187 controls, when comparing age, gravidity, parity, body mass index, and length of postoperative catheterization. The median amount of postvoid residual noted at the time of diagnosis was 240 mL (range, 55-927 mL). Odds for urinary retention was 3 times higher among those with vertical closure than patients with horizontal closure of the bladder (OR, 2.91; 95% confidence interval, 1.35-6.20). Patients with prior fistula repairs were significantly less likely to develop urinary retention compared to those receiving surgery for the first time (OR, 0.27; 95% confidence interval, 0.10-0.67).

Conclusions: Vertical closure of the bladder and patients without a history of prior fistula repairs are predictors for developing urinary retention after fistula repair surgery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SPV.0000000000000694DOI Listing
December 2020

Reproducibility of fetal lung-to-head ratio in left diaphragmatic hernia across the North American Fetal Therapy Network (NAFTNet).

Prenat Diagn 2019 02 29;39(3):188-194. Epub 2019 Jan 29.

Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA.

Objective: To determine the antenatal sonographic lung area measurement method in left congenital diaphragmatic hernia (CDH) with the highest interrater agreement among North American Fetal Therapy Network (NAFTNet) centers within and outside the fetoscopic tracheal occlusion (FETO) consortium and in comparison with a European "expert" reviewer (ER).

Methods: Nineteen members from nine FETO consortium centers and 29 reviewers from 17 non-FETO centers reviewed ultrasound clips of the chest from 13 fetuses with isolated left CDH and were asked to select a static plane for lung area measurement using anteroposterior (AP), longest, and trace methods. Interrater agreement in lung area measurements was determined using intraclass correlation coefficient (ICC). Bland-Altman analysis was used to evaluate mean difference (bias) between NAFTNet reviewers and ER.

Results: Among FETO centers, agreement was highest using trace (ICC 0.94; 95% CI, 0.83-0.98), followed by longest (ICC 0.89; 95% CI, 0.75-0.97) and lowest for A-P (ICC 0.83; 95% CI, 0.67-0.94). Similar trends were noted in non-FETO centers. When compared with ER, bias was lowest for trace: 14 ± 38 mm and 19 ± 36 mm for FETO and non-FETO centers, respectively.

Conclusion: The trace method demonstrated the highest interrater agreement and lowest bias for lung area estimation in left CDH across NAFTNet.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/pd.5413DOI Listing
February 2019

Estimated energy requirements increase across pregnancy in healthy women with dichorionic twins.

Am J Clin Nutr 2018 10;108(4):775-783

USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX.

Background: Estimated energy requirement (EER) has not been defined for twin pregnancy. This study was designed to determine the EER of healthy women with dichorionic-diamniotic (DCDA) twin pregnancies.

Objectives: We aimed to estimate energy deposition from changes in maternal body protein and fat; to measure resting energy expenditure (REE), physical activity level (PAL), and total energy expenditure (TEE) throughout pregnancy and postpartum; and to define the EER based on the sum of TEE and energy deposition for twin gestation.

Design: This is a prospective study of 20 women with DCDA twin gestations. Maternal EER, energy deposition, REE, TEE, and PAL were obtained during the first, second, and third trimesters of pregnancy and immediately postpartum. A mixed-effects linear regression model for repeated measures with random intercept was used to test for the effects of BMI groups and time.

Results: Gains in total body protein (mean ± SD: 2.1 ± 0.7 kg) and fat mass (5.9 ± 2.8 kg) resulted in total energy deposition of 67,042 ± 25,586 kcal between 0 and 30-32 weeks of gestation. REE increased 26% from 1392 ± 162 to 1752 ± 172 kcal/d across the 3 trimesters, whereas TEE increased 17% from 2141 ± 283 to 2515 ± 337 kcal/d. Physical activity decreased steadily throughout pregnancy. Reductions in physical activity did not compensate for the rise in REE and energy deposition, thus requiring an increase in dietary energy intake as pregnancy progressed. EER increased 29% from 2257 ± 325 kcal/d in the first trimester to 2941 ± 407 kcal/d in the second trimester, and stayed consistent at 2906 ± 350 kcal/d in the third trimester.

Conclusion: Increased energy intake, on average ∼700 kcal/d in the second and third trimesters when compared with the first trimester, is required to support gestational weight gain and the rise in energy expenditure of DCDA twin pregnancies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ajcn/nqy184DOI Listing
October 2018

Impact of changes in maternal body composition on birth weight and neonatal fat mass in dichorionic twin pregnancies.

Am J Clin Nutr 2018 10;108(4):716-721

USDA/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX.

Background: Although the impact of gestational weight gain (GWG) on birth weight in twin pregnancies has been demonstrated, the specific components of GWG have not been delineated for twin gestations. Fetal body composition has been shown to be modifiable in singleton gestations based on nutritional intervention strategies and may prove to have similar modifications in twin gestations.

Objective: We aimed to determine the relation of maternal body composition changes to birth weight, birth length, and neonatal fat mass (FM) in dichorionic-diamniotic twin pregnancies.

Design: This is a prospective study of 20 women with twin gestations. Comparisons were made between body composition variables during each trimester and for the entire pregnancy and compared with the outcomes of birth weight, neonatal fat percentage, and birth length.

Results: GWG within or above compared with below the IOM recommendations was associated with higher birth weights (P = 0.03, P = 0.04, respectively), but also with higher postpartum weight retention (P = 0.001). Total maternal protein gain over the pregnancy was positively associated with birth weight (P = 0.03). Changes in maternal fat-free mass (FFM), total body water (TBW), and FM from the first to the third trimester were not associated with either birth weight or neonatal FM percentage. However, maternal FM change from the second to the third trimester was significantly correlated to neonatal FM percentage (P = 0.02). Third trimester GWG and total protein gain were positively correlated with neonatal birth length (P = 0.02 and 0.03, respectively). Maternal FFM over all 3 trimesters showed a positive relation with neonatal birth length (P = 0.01).

Conclusions: Significant increases in maternal protein are associated with greater birth weight and neonatal birth length. Protein accretion, in contrast to TBW and FM gains, may be the most critical component of maternal GWG in dichorionic twin gestations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ajcn/nqy180DOI Listing
October 2018