Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis

Introduction and hypothesis

One of the main outcomes in the assessment of the treatment of pelvic organ prolapse in women is quality of life. Using quality of life as an outcome measure is increasing in the majority of clinical trials. The aim of current study was to determine the effects of the treatment of pelvic organ prolapse on patients’ quality of life using systematic review and meta-analysis.

Methods

A systematic search for finding randomized controlled studies on pelvic organ prolapse published before October 2012 was conducted. The JAMA users’ guide to the medical literature quality assessment scales for randomized clinical trials was used to assess the quality of included articles. The mean difference in total quality of life score between before and after intervention (surgical or pelvic floor training) with 95 % confidence interval (CI) was considered as a primary summary measure. Egger’s test was used to evaluate the publication bias. Heterogeneity was assessed using I² Index.

Results

Fifty-seven RCT were critically appraised. Thirty-two articles were eligible after critical evaluation. Mean difference in change in the total quality of life score with 95 % CI for surgical treatment was 74.03 (66.3–81.6) by PFDI-20 and was 44.57 (22.53–66.65) by PFIQ-7. The mean difference in changed in the total quality of life score with 95 % CI was 1.32 (?2.8–5.4) for pelvic floor training (PFT).

Conclusion

We found that surgical interventions on prolapse can improve the quality of life of women. There was a relative effect of PFT on the quality of life of women with prolapse in systematic review. This effect was not seen in meta-analysis, probably because of finding few eligible studies to pool the effect size.     

Nutritional status and intestinal parasites among young children from pastoralist communities of the Ethiopian Somali region

Pastoralist children in the Ethiopian Somali Regional State (ESRS) are at high risk for undernutrition and intestinal parasitic infections (IPIs). We assessed the nutritional status and its association with IPIs in 500 children <5 years of age in a clustered cross‐sectional study in Adadle district, ESRS. Stool samples were microscopically examined for IPIs and biomarkers for iron and vitamin A status, anthropometry, and food variety score (FVS) were assessed. Median (interquartile range [IQR]) FVS was 2.0 (2.0, 4.0), and 35% of children were exclusively breastfed up to age 6 months. Prevalence of stunting, wasting, underweight and mid‐upper arm circumference (MUAC) <12.5 cm was 30, 34, 40, and 16%, respectively. Median (IQR) haemoglobin, ferritin, and retinol‐binding protein concentrations were 9.5 g dL^‐1 (8.2, 10.9), 6.2 μg L^‐1 (4.0, 10.2), and 0.8 μmol L^?1 (0.67, 0.91), respectively. Prevalence of anaemia, iron, and vitamin A deficiency was 75, 91, and 30%, respectively. IPIs' prevalence was 47%; the most prevalent IPIs were Giardia lamblia (22%) and Ascaris lumbricoides (15%). Giardial infections but not A. lumbricoides increased the risk for MUAC <12.5 cm (adjusted odds ratio [aOR]: 3.50, 95% confidence interval [CI] [2.21, 5.54]). The odds for anaemia were 97% (aOR: 0.03, 95% CI [0.03, 0.07]) and 89% (aOR: 0.11, 95% CI [0.11, 0.23]) less for children with FVS >2 or with exclusive breastfeeding up to 6 months, respectively. Undernutrition and IPIs are alarmingly high in <5 years of age children in ESRS. Giardial infections and low nutritional adequacy of the diet seem to be major contributing factors to the precarious nutritional status and should be addressed by appropriate interventions.     

Laser division of the aryepiglottic folds for severe laryngomalacia

Laryngomalacia is an entity of ill-defined etiology. The clinical situation is one of inspiratory stridor present at birth, or within the newborn period. The stridor may increase in severity for the first several months of life and thereafter spontaneously begins to resolve. In the majority of cases the condition resolves spontaneously by approximately two years of age. This report will present the surgical management of severe laryngomalacia in infants using the carbon dioxide laser to surgically divide the aryepiglottic fold with resolution of the laryngomalacia.     

The PedsQLTM 4.0 as a School Population Health Measure: Feasibility, Reliability, and Validity

Background: The application of health-related quality of life (HRQOL) as a school population health measure may facilitate risk assessment and resource allocation, the tracking of student health at the school and district level, the identification of health disparities among schoolchildren, and the determination of health outcomes from interventions and policy decisions at the school, district, and county level. Objective:To determine the feasibility, reliability, and validity of the 23-item PedsQL^TM 4.0 (Pediatric Quality of Life Inventory^TM) Generic Core Scales as a school population health measure for children and adolescents. Design: Survey conducted in 304 classes at 18 elementary schools, 4 middle schools, and 3 high schools within a large metropolitan school district. Methods:The PedsQL^TM 4.0 Generic Core Scales (Physical, Emotional, Social, School Functioning) were completed by 2437 children ages 8–18 and 4227 parents of children ages 5–18. Results:The PedsQL^TM 4.0 evidenced minimal missing responses, achieved excellent reliability for the Total Scale Score (α = 0.89 child, 0.92, parent report), and distinguished between healthy children and children with chronic health conditions. The PedsQL^TM 4.0 was related to indicators of socioeconomic status (SES) at the school and district level. The PedsQL^TM School Functioning Scale was significantly correlated with standardized achievement scores based on the Stanford 9. Conclusion: The results demonstrate the feasibility, reliability and validity of the PedsQL^TM 4.0 Generic Core Scales as a school population health measure. The implications of measuring HRQOL in schoolchildren at the school, district, and county level for identifying and ameliorating health disparities are discussed.     

Paradoxical reaction following intravenous midazolam premedication in pediatric patients - a randomized placebo controlled trial of ketamine for rapid tranquilization

BACKGROUND: Paradoxical reactions to benzodiazepines include restlessness, violent behavior, physical assault, act of self-injury and need for restraints. These may occur at variable times after administration. This study was designed to determine the incidence of paradoxical reactions following intravenous midazolam premedication in pediatric patients and to compare the efficacy of extra doses of midazolam with low-dose intravenous ketamine to rapidly tranquillize them. METHODS: A total of 706 ASA I, II children scheduled for elective surgery were given intravenous midazolam premedication. Children who developed a paradoxical reaction were randomly divided into three equal groups to receive: (i) extra midazolam, (ii) ketamine, or (iii) placebo as the test drug for treatment of paradoxical reaction. Ease of rapid tranquillization and need for a rescue tranquillizer (i.e. ketamine; irrespective of patient group) were compared among the three groups. RESULTS: Twenty-four (3.4%) children developed paradoxical reaction after midazolam premedication. Those who received ketamine as the test drug responded rapidly to ketamine. But the responses of the other two groups to their test drug were poor and the majority of them required ketamine as rescue tranquillizer (six in midazolam, seven in placebo, but no patient in the ketamine group; P < 0.05). CONCLUSIONS: The results of this study demonstrate that ketamine is an effective drug for the treatment of paradoxical reaction following intravenous midazolam premedication. The exact mechanisms of these reactions and how it is aborted by ketamine are not clear.     

Parents' perceptions of pediatric primary care quality: effects of race/ethnicity,language, and access

OBJECTIVE: To examine the effects of race/ethnicity, language, and potential access on parents' reports of pediatric primary care experiences. DATA SOURCES/STUDY SETTING: Primary survey data were collected (67 percent response rate) from 3,406 parents of students in kindergarten through sixth grade in a large urban school district in California during the 1999-2000 school year. DATA COLLECTION: The data were collected by mail, telephone, and in person. Surveys were administered in English, Spanish, Vietnamese, and Tagalog. STUDY DESIGN: Data were analyzed using multiple regression models. The dependent variable was parents' reports of primary care quality, assessed via the previously validated Parents' Perceptions of Primary Care measure (P3C). The independent variables were race/ethnicity, language, and potential access to care (insurance status, presence of a regular provider of care), controlling for child age, gender, and chronic health condition status, and mother's education. PRINCIPAL FINDINGS: Parents' reports of primary care quality varied according to race/ethnicity, with Asian and Latino parents reporting lower P3C scores than African Americans and whites. In multivariate analyses, both language and potential access exerted strong independent effects on primary care quality, reducing the effect of race/ethnicity such that the coefficient for Latinos was no longer significant, and the coefficient for Asians was much smaller, though still statistically significant. CONCLUSIONS: To reduce racial/ethnic disparities in primary care, attention should be paid both to policies aimed at improving potential access and to providing linguistically appropriate services.     

Panel discussion: The management of advanced laryngotracheal stenosis. Management of combined advanced glottic and subglottic stenosis in infancy and childhood

Severe glottic and subglottic stenosis in infants and children is a formidable disease for a child and a difficult reconstructive problem for the surgeon. Twelve consecutive patients are described in this series, 7 of whom had complete airway obstruction; 9 patients have been extubated with satisfactory voices. Long-term follow-up indicates no cases of decreased development of the larynx.     

Synthesis and characterization of a series of novel glutamic γ-15N-anilide dipeptides

The preparation of a series of novel Cbz–Gln–Gly dipeptide derivatives is reported, wherein the γ-carboxamide groups of the glutamine side chains have been modified to γ-¹⁵N-anilides which are substituted in the para position with -NO₂, -Cl, -H, -CH₃, -OCH₃, and -N(CH₃)₂. Characterization of the free anilines (pK_a values and ¹⁵N NMR chemical shifts) and corresponding γ-anilides (¹⁵N NMR chemical shifts and FTIR wavenumbers) is also reported. Correlation of these physicochemical data to Hammett substituent parameters (σ_para) is discussed. These novel dipeptide derivatives should prove to be generally useful for structure–function enzymology studies of γ-glutamyl transferring enzymes.     

Enhancement of murine tumor cell sensitivity to adriamycin by presentation of the drug in phosphatidylcholine-phosphatidylserine liposomes

In vitro incubation of mouse UV-2237M fibrosarcoma cells with liposomes containing Adriamycin (ADR) produced significant cytotoxicity in drug-sensitive cells and in multidrug-resistant variants of this tumor. ADR was encapsulated in the aqueous space of multilamellar liposomes composed of phosphatidylcholine and phosphatidylserine. The preparation was stable in medium at 37 degrees C for up to 7 days. Free unencapsulated ADR produced cytostasis in parental ADR-sensitive cells but not in variant lines selected for resistance to the drug. In contrast, ADR encapsulated in multilamellar liposomes (MLV) produced high levels of cytostasis in both ADR-sensitive and ADR-resistant cells. The phospholipid composition of the MLV influenced the outcome of ADR-mediated cytostasis. ADR encapsulated in MLV consisting of only phosphatidylcholine did not produce cytostasis. Increasing the proportion of phosphatidylserine in the MLV increased the level of ADR-mediated cytotoxicity in cells resistant to free ADR. This effect was not due to simple modification of tumor cell surface by liposomes since ADR added to resistant cells together with liposomes containing buffer produced less cytostasis. The cytostasis of resistant cells by ADR in liposomes was not due to appreciable changes in the intracellular ADR concentration or localization within the cells because ADR-induced DNA cleavage was not found in ADR-resistant cells treated with cytostatic amounts of liposomal ADR. Whether the enhanced sensitivity of tumor cells to ADR was due to localized damage to the plasma membrane through a phosphatidylserine-mediated release of the drug to the cell surface is now under active investigation.