bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Uterine Fibroid Disease Burden in a Tertiary Care Setting in Ghana: Prevalence, Cost, and Policy Implications [7C]
Authors: Ofori-Dankwa Zenobia , Ibine Bolade , Ganyaglo Gabriel Y. K. 
Published: May 2019

INTRODUCTION:
Over 20,000 publications examine uterine fibroids, however only few originate from West Africa. More research from this region is warranted because African-American women, many with ethnic origins to this region, are three times more likely to develop fibroids than other races in the United States.

METHODS:
This study was conducted through the Department of Obstetrics and Gynecology at Korle Bu Teaching Hospital in Accra, Ghana. It examined the prevalence, cost, and policy implications of fibroids through a retrospective chart review of all 656 women reporting from January 1, 2017 to June 30, 2017. The study divided women into two categories based on admission diagnoses: fibroid and non-fibroid.

RESULTS:
The results highlight the prevalence of fibroids given that 175 women (26.68%) were fibroid, 431 women (65.70%) were non-fibroid, 49 women (7.47%) were excluded due to ambivalent admission diagnoses, and one woman (0.15%) had no admission diagnosis. There were no significant differences within key demographics such as religion, occupation, and marital status. In addition, 78% of fibroid underwent surgical treatment compared to 64% of non-fibroid. After surgery, most women stayed 1 week (77.21% fibroid vs 77.26% non-fibroid), however within that week, 94.3% fibroid vs 50% non-fibroid stayed 4-7 days.

CONCLUSION:
These findings suggest the high disease burden of fibroids in Ghana due to the prevalence and likely increased medical cost given the amount of surgical treatment and length of stay. Policy implications to consider include further research, establishment of a robust database, and screening protocols.
Transverse Versus Vertical Skin Incision for Planned Cesarean Hysterectomy: Does It Matter? [12S]
Authors: Szlachta-McGinn Alec W. , Mei Jenny Y. , Tabsh Khalil , Afshar Yalda 
Published: May 2019

INTRODUCTION:
To investigate differences in perioperative outcomes by type of skin incision, transverse versus vertical, for planned cesarean hysterectomy for morbidly adherent placentation.

METHODS:
A retrospective cross-sectional study of women who underwent planned cesarean hysterectomy for abnormal placentation at a large academic hospital over five years (IRB#18-000872). Demographic data were chart abstracted and analyzed. The Student t-test compared continuous variables and Fisher exact test compared categorical variables. Continuous data were presented as median and compared using the Wilcoxon-rank sum test.

RESULTS:
42 planned cesarean hysterectomies were identified. Median gestational age at birth was 34.8 weeks. A transverse skin incision was made in 43% (n=18); a vertical skin incision was made in 57% (n=24), independent of placental location (P=0.82). Median estimated blood loss (EBL) was 1950 milliliters (mL) with a mean transfusion of 3 units of packed red blood cells (range 0-21). EBL was not associated with transverse versus vertical skin incision (2727 mL vs 2741 mL, P=0.8). There was significantly shorter operative time with transverse skin incision (180 vs 238 minutes, P=0.03), with no difference in intraoperative complications (RR 1.55; 95% CI 0.52-4.62, P=0.42). Postoperatively there was no difference in length of stay (4.75 vs 4.47 days, P=0.74) or opioid use (128 vs 179 morphine equivalents, P=0.31).

CONCLUSION:
Transverse skin incision is associated with shorter length of surgery for patients undergoing planned cesarean hysterectomy. There was no difference in EBL, intraoperative complications, postoperative length of stay, or opioid use. Given an increasing rate of cesarean hysterectomy, we must identify variables that optimize outcomes and resource utilization.
Accurate Gestational Dating at 12–14 Weeks: Crown-Rump Length Versus Composite Biometry [29S]
Authors: Khandelwal Meena , Kaigh Caroline , Safronova Elena , Gaughan John 
Published: May 2019

INTRODUCTION:
Determining accurate gestational age (GA) is an essential for decision making in obstetrics. Fetus folds around 12 weeks. We wanted to determine whether crown-rump length (CRL) or a composite biometric measurement (CBM) including head, abdominal and femur measurements, or a combination of CRL and CBM, provides a more accurate GA estimation between 12.0 weeks to 13.9 weeks gestation.

METHODS:
Fetal biometry data on singleton pregnancies was collected from a retrospective well-dated pregnancy cohort. All CRL images were reviewed for accuracy. GA by both CRL and CBM was compared to the certain GA using the Bland-Altman test to assess regression to the mean, limits of agreement, and bias.

RESULTS:
Included 1716 pregnancies revealed an average bias of +0.7 (-9.95 to 11.4) days with CRL; +3.37 (-3.82 to 10.6) with CBM between 12w0d-13w6d. GA is overestimated by both methods at 12 weeks. CRL underestimates GA after 13weeks, while CBM underestimates after 14weeks. The true GA estimation for 13.1-14.0 weeks is a combination of CRL (negative bias) and CBM (positive bias). Results were not altered by body mass index nor by fetal position of CRL measurement (midsagittal, coronal or prone).

CONCLUSION:
Given the larger bias of composite biometry dating, CRL-based dating is more accurate up to 13 weeks. The ACOG Committee Opinion number 611 (2014) should be modified to reflect measurement of CRL till 13w, but composite of CRL and CBM between 13w1d to 14 weeks. In addition, for pragmatic reasons, CRL measurement in any feasible plane should be acceptable.
Spontaneous Uterine Artery Rupture Following an Uncomplicated Vaginal Delivery [33P]
Authors: Jones Sarah Brown 
Published: May 2019

INTRODUCTION:
Spontaneous rupture of the uterine vessels is a rare and potentially fatal complication of pregnancy with maternal mortality rates reported between 30-40%. The signs and symptoms can be vague but rapid diagnosis is critical in reducing maternal morbidity and mortality.

METHODS:
This case report outlines a 44-year-old female who had a spontaneous vaginal delivery. Two hours after delivery she developed signs of severe anemia and abdominal pain and had significant deviation of the uterus to the left. CT revealed a hematoma in the right broad ligament greater than the size of the uterus. CT angiography showed that the right uterine artery had spontaneously ruptured and immediate uterine artery embolization was performed. The patient stabilized and was discharged home. 3 weeks later, the patient presented with abdominal pain and fevers. An exploratory laparotomy was performed that showed an infected hematoma and uterus. The hematoma was evacuated and the uterus was removed. The patient recovered well from this procedure and has had no further complications. Patient informed consent was obtained for submission of a case report.

CONCLUSION:
This case report highlights the presenting features of an unusual retroperitoneal hematoma from the spontaneous rupture of the uterine artery after a routine vaginal delivery. This scenario has not previously been reported. It illustrates not only the effectiveness of embolization for treatment of retroperitoneal hematoma, but also the risks.
Hemoglobinopathies and Maternal Outcomes: Retrospective Analysis of National Data [24K]
Authors: Emezienna Nkechinyere , Ranjit Anju , Lambert Calvin E. , Bada Oluwafunmilola T. 
Published: May 2019

INTRODUCTION:
This study aims to evaluate maternal outcomes amongst pregnant patients with sickle cell disease, sickle cell trait, and thalassemias.

METHODS:
2013-2014 National Readmission Database was queried to identify all deliveries, women with sickle cell disease (SCD), sickle cell trait (SCT) and thalassemia using ICD-9 codes. Demographic and clinical characteristics along with maternal outcomes such as pregnancy induced hypertension (PIH), gestational diabetes, preterm delivery, postpartum hemorrhage (PPH) and severe acute maternal outcomes (SAMM) were compared between women with and without SCD, SCT and thalassemia using Chi Square test. Multivariable logistic regressions were used to determine the odds of listed maternal outcomes in mothers with SCD, SCT and thalassemia compared to mothers without SCT, SCD and thalassemia. IRB approved study.

RESULTS:
A total of 1,376,903 deliveries were identified representing 3,113,047 deliveries nationwide. Among them, 16,825 (0.5%) women had SCT, 1668 (0.05%) had SCD and 5546 (0.2%) had diagnosis of thalassemia. When compared to control group, women with SCT were more likely to have PIH (12.89 vs. 8.49%, aOR [CI]: 1.33 [1.22-1.44], p=<.001), and PPH (3.59 vs. 2.78%, aOR [CI]: 1.27 [1.11-1.47], p=<.001). When adjusted for patient demographic, clinical and hospital level characteristics, women with SCD (26.7% vs. 1.8%, aOR [CI]: 11.02 [9.04-13.4], p=<.001), SCT (3.8% vs. 1.8%, aOR [CI]: 1.56 [1.36-1.79], p=<.001) and thalassemia (4.84% vs. 1.8%, aOR [CI]: 2.40 [2.02-2.85], p=<.001) were more likely to have SAMM complications compared to the control group.

CONCLUSION:
Patients with SCD, SCT, and thalassemia have an increased risk of maternal morbidity. Appropriate screening methods for adequate diagnosis is essential for the prevention and mitigation of these outcomes.
Minimizing Trendelenburg Position for Laparoscopic Gynecologic Surgery [6L]
Authors: Wagner Elena , Chandler Jessica Nicole , Mihalov Linda S. 
Published: May 2019

INTRODUCTION:
Trendelenburg position is needed for adequate exposure of pelvic anatomy during gynecologic surgery. Steep Trendelenburg can be associated with anesthetic challenges, physiologic changes and rare complications that increase risk. The degree of Trendelenburg for optimal exposure has not been described.

METHODS:
A single surgeon at our institution routinely placed patients in the minimal amount of Trendelenburg necessary to expose the anatomy measuring the degree with a smart phone app and documenting in the operative reports. All of the robotic cases from November 1, 2011 through July 31, 2018 performed by the surgeon were identified and operative notes and charts from each case were reviewed.

RESULTS:
Results: 338 out of 380 cases were identified that had degree of Trendelenburg dictated. Mean Trendelenburg was 15.4 degrees (range from 7 to 31) with a median of 15. 85% of cases (287/338) were completed 18 degrees or less of Trendelenburg. Addition of Modifier 22 to the case was associated with higher mean Trendelenburg from 15.2 (n= 255; range 7-31) to 16.0 (n=83; range 9-30) (p=0.05). BMI >30 was associated with higher mean Trendelenburg from 15.0 (n=218; range 7-25) to 16.3 (n=120; range 9-31) (p=0.001). Surgeries that included hysterectomy (mean Trendelenburg 15.4, n=309, range 7-31) showed no difference compared with other gynecologic procedures (mean Trendelenburg of 15.3; n=29, range 10-30) (p=0.9).

CONCLUSION:
Traditional “steep” Trendelenburg is not always needed to adequately expose anatomy for surgery. BMI and case difficulty were associated with requiring steeper Trendelenburg.
Improved Birth Outcomes Through Health Plan and Community Hub Partnerships [18L]
Authors: Lucas Brad , Detty Amber 
Published: May 2019

INTRODUCTION:
An analysis to determine if Medicaid health plan clinical program activity combined with community based care coordination (community hubs) can improve birth outcomes by reducing non-clinical/social determinant barriers to care.

METHODS:
We conducted a retrospective cohort study of 3702 deliveries in Lucas County, Ohio. All deliveries in these areas between March 2013-February 2017 were included. Outcomes were derived from medical claims. Levels of community-based social services were obtained from our community hub partner. We used bivariate and multivariate analysis to identify Odds Ratios for Neonatal/NICU Admission by select predictors for all deliveries and separately for deliveries to high-risk, moderate-risk, low-risk, and unknown risk mothers in the service area.

RESULTS:
High-risk mothers in these service areas where the member was not exposed to any community hub activity were 1.55 times more likely to deliver a baby needing Special Care Nursery or NICU care when compared to high risk members who received hub services through delivery.

CONCLUSION:
Medicaid health plan care management alone can be insufficient in helping high risk pregnant women and their providers in reducing their risks of preterm delivery. Partnerships with community hubs reduces non-clinical/social determinant barriers in high-risk pregnancy. This data shows Community Hub activity combined with Medicaid health plan clinical program/care management activity improves birth outcomes in high risk pregnancies compared to high risk pregnancies that are not exposed to this intervention.
Fertility Knowledge of Women in the United States [6M]
Authors: Zinaman Michael J. , Johnson Sarah , Foster Lesley , Zanzi Giulia , Mollard Celine 
Published: May 2019

INTRODUCTION:
The demographics of women seeking to conceive has changed, with many women now seeking pregnancy when older. This can lead to disappointment, with the sentiment “I wish I had known more about fertility”. This study sought to assess US women basic understanding of fertility.

METHODS:
On behalf of SPD, Ipsos Suisse SA interviewed a representative sample of 1,000 US women aged from 20 to 45 years old who are able to have children (with quotas set upon age and region). Interviews were conducted online (computer assisted web interview) via online Panel.

RESULTS:
When asked “what would you say is the most accurate description, for you personally, of a menstrual cycle?”, only 14% selected the right answer from the five options presented, with 16% selecting “the days on which there is bleeding”. Only 20% knew there were fertile 3-6 days during a menstrual cycle, with 25% thinking pregnancy was possible following intercourse on any day of the cycle; for the 20-24 age group 38% thought pregnancy possible on any day. Only 27% of women could correctly state when the fertile days were in a cycle.

CONCLUSION:
This survey found a basic gap in fertility knowledge for many US women. Especially worrying was the proportion of these women who believed that pregnancy was possible following intercourse on any day of the cycle, as this could hinder conception chances.
The Fatty Acid Composition of Vegetable Oils and Their Potential Use in Wound Care
Authors: Alves Anselmo Queiroz , da Silva Valdemiro Amaro , Góes Alexandre José Silva , Silva Mariza Severina , de Oliveira Gibson Gomes , Bastos Isla Vanessa Gomes Alves , de Castro Neto Antonio Gomes , Alves Antonio José 
Published: May 2019

ABSTRACT

OBJECTIVE
To evaluate the similarities among fatty acid compositions of vegetable oils sold in the Brazilian market and those present in a reference health product used to treat wounds.

METHODS
The relative amounts of fatty acids in 21 types of vegetable oils, purchased in the Brazilian market, were assessed using gas chromatography-mass spectrometry and flame ionization detection.

MAIN RESULTS
The studied oils had similar fatty acid compositions to the reference product (caprylic acid, 18.8%; capric acid, 17.4%; oleic acid, 27.5%; and linoleic acid, 28.1%). The presence of caprylic acid (10.45% ± 0.07%), capric acid (5.8% ± 0.75%), lauric acid (45.63% ± 0.93%), and myristic acid (16.33% ± 2.23%) were detected in all the vegetable oils tested. Oleic acid (52.94% ± 12.54%) was present in andiroba, avocado, canola, copaiba, olive, palm, pequi, and pracaxi oils and featured prominently in olive oil (75.8%). Linoleic acid (57.09% ± 8.47%) was present in corn, cottonseed, grapeseed, passion fruit, and sunflower oils and in mixed oils (olive with soybean and sunflower with corn and canola).

CONCLUSIONS
Most of the vegetable oils tested are products of plants from tropical climates, where they are abundant and easy to cultivate. It is possible that a balanced composition of fatty acids obtained from natural sources could be an effective alternative treatment for wounds.
Types, Frequency, Duration, and Dosage of Probiotics to Prevent Necrotizing Enterocolitis in Preterm Infants Among Countries
Authors: Kutylowksi Julie , Yahia Najat 
Published: May 2019

Background:
Probiotic use in the neonatal intensive care unit (NICU) has been linked to reduced rates of necrotizing enterocolitis in preterm infants. Currently, in the United States, probiotic use within the NICU is limited despite being commonly used in other countries.

Purpose:
To provide an overview of the current practices of using probiotics in preterm infants for the prevention of NEC in the NICU in preselected countries.

Methods:
A comprehensive literature search was conducted on PubMed and clinicaltrials.gov. Also, studies from 2 recent meta-analyses on the topic were reviewed for inclusion. Selection criteria were as follows: studies involving preterm infants using probiotics in the NICU, reporting on the impact of probiotic use on the incidence of necrotizing enterocolitis, published within the last 10 years and in the English language, and originating from the United States, Canada, or any European country.

Results:
Twenty-three studies were selected. The most common types of probiotics used were Bifidobacterium infantis and Lactobacillus rhamnosus. The most common frequency of administration was daily or twice day. Duration ranged from 10 days to the entire NICU stay. The dosage was commonly 1 billion colony-forming units daily but ranged from 12 million daily to 12 billion per kilogram daily.

Implications for Practice:
Examining the current practices of probiotic use in the NICU provides useful information as this adjunctive therapy rises in popularity.

Implications for Research:
Refining methods of probiotic research for necrotizing enterocolitis prevention will improve safety and effectiveness and provide a framework for future clinical trials.
Neonatal Abstinence Syndrome
Authors: Jackson Heather J. , López Cristina , Miller Sarah , Englehardt Barbara 
Published: May 2019

Background:
The current opioid epidemic in the United States has given rise to a growing incidence of neonatal abstinence syndrome (NAS). Treatments for this condition optimize nonpharmacologic therapies in an effort to improve withdrawal symptoms and reduce or eliminate the need for opioid medications, thereby reducing hospital length of stay and improving healthy neonatal outcomes.

Purpose:
The purpose of this review was to evaluate the current evidence for neonatal acupuncture treatments and identify essential characteristics that must be included in a treatment protocol for NAS.

Methods/Search Strategy:
An integrative review was conducted under the guidance of the Whittemore and Knafl methodology and near-term infant conceptual framework. An evaluation of the quality and levels of evidence was also included.

Findings/Results:
A total of 10 studies were identified in this review. Four of these studies were randomized controlled trials, and utilized acupuncture in the neonatal population to evaluate impact on pain, NAS, and weight gain.

Implications for Practice:
This review provided the essential elements for the development of a complementary acupuncture treatment protocol for the management of NAS.

Implications for Research:
Future research should include the identified essential characteristics in high-quality, blinded, randomized controlled trials to assess the treatment effect of acupuncture on neonates experiencing withdrawal symptoms.
Cutaneous manifestations of pediatric lupus
Authors: Arkin Lisa M. , Nguyen Cordellia , Klein-Gitelman Marisa 
Published: May 2019

Purpose of review
To review recent evidence on cutaneous manifestations of lupus, with a focus on evidence for pediatric patients.

Recent findings
Cutaneous manifestations of SLE are common and may precede signs or symptoms of systemic disease. Early recognition and initiation of therapy improves quality of life by reducing cutaneous disease activity. Antimalarials are first line for moderate-to-severe disease. Photo protection is a critical component of therapy and perhaps the only modifiable risk factor for SLE. Recognition of cutaneous vasculopathy may reduce mortality from vascular occlusion.

Summary
There is a critical need for better understanding of pathogenesis, risk factors and outcomes in cutaneous lupus to determine optimal treatment and surveillance strategies. Correlation of clinical phenotypes with biomarkers may help to stratify patients, optimize targeted interventions, and influence prognosis.
Clinical Features of Rituximab-associated Gastrointestinal Toxicities
Authors: Mallepally Niharika , Abu-Sbeih Hamzah , Ahmed Osman , Chen Ellie , Shafi Mehnaz A. , Neelapu Sattva S. , Wang Yinghong 
Published: May 2019

Background:
Rituximab is effective in treating several cancers. Little is known about gastrointestinal adverse events associated with rituximab. We describe the clinical, endoscopic, and histologic features of rituximab-associated colitis (RC) at a tertiary care cancer center.

Methods:
We conducted a retrospective study of cancer patients who had received rituximab and had undergone a colonoscopy between 2000 and 2018. Patients with competing etiologies for colitis were excluded.

Results:
Of the 13,717 patients who had received rituximab during the study period, 1660 had undergone colonoscopy. Among them, 70 (4%) had RC. Median time from rituximab treatment to RC onset was 181 days. Fifty-three patients had clinical gastrointestinal symptoms: 39 had diarrhea, 19 had abdominal pain, 11 had blood per rectum, and 5 had a concurrent fever. The median duration of symptoms was 21 days. Fifty patients (71%) received treatment for RC: immunosuppressive therapy in 12, antimicrobial agents in 21, antimotility agents in 42, and supportive care in 42. Nine patients had mucosal ulceration on endoscopy, and 52 had features of active inflammation on histology. Thirty-nine patients needed hospital admission, and 2 needed intensive care unit admission. One patient had colonic perforation that required surgical intervention. Patients who had abnormal endoscopic findings needed more frequent hospitalization (P=0.024) and more treatment for RC (P=0.001).

Conclusions:
RC is usually a mild disease requiring supportive care only. Nonetheless, on rare occasions, it can be severe enough to lead to colonic perforation and intensive care unit admission. Steroids used with the chemotherapeutic regimen can hamper RC severity.