Bethesda Hospital

About: Bethesda Hospital is a healthcare organization based out in Ambur, Tamil Nadu, India. It is known for research contribution in the topics: Population & Helicobacter pylori. The organization has 386 authors who have published 472 publications receiving 15193 citations.

Prenatal exposure to maternal stressful life events and earlier age at menarche: the Raine Study.

Abstract: STUDY QUESTION Is there an association between prenatal exposure to stressful life events and age at menarche, and does childhood BMI mediate this association? SUMMARY ANSWER Girls exposed to prenatal stress had a slightly earlier age at menarche, but this association did not show a dose-response effect and was not mediated by childhood offspring BMI. WHAT IS ALREADY KNOWN Prenatal stress may impact on reproductive function in females including age at menarche, but human data are very limited. High childhood BMI is known to be associated with earlier age at menarche. Only one small study has measured the association between maternal stress and age at menarche and reported that childhood BMI mediated the association between maternal stress and earlier age at menarche. However, neither maternal stress nor age at menarche was prospectively recorded and the study was limited to 31 mother-daughter pairs. STUDY DESIGN, SIZE, DURATION The Raine Study is a large prospective population-based pregnancy cohort study (n = 1414 mother-daughter pairs) continuously followed from prenatal life through to adolescence. In the present study, we examined the association between exposure to maternal stressful life events during early, late and total gestation and age at menarche in offspring using 753 mother-daughter pairs with complete case information. PARTICIPANTS/MATERIALS, SETTING, METHODS Mothers prospectively reported stressful life events during pregnancy at 18 and 34 weeks using a standardized 10-point questionnaire. Exact date of menarche was assessed using a purpose-designed questionnaire at 8, 10, 14 and 17 years of age. Complete information on exposure, outcome and confounding variables was obtained from 753 mothers-daughter pairs. Multivariate linear regression complete case analysis was used to examine associations between maternal stressful life event exposure and age at menarche. Potential selection bias was evaluated using multiple imputations (50 datasets). The mediating effects of offspring childhood BMI (ages 5, 8, or 10 years) on these associations were measured in separate sub-analyses. MAIN RESULTS AND ROLE OF CHANCE Most (580/753, 77%) daughters were exposed to at least one prenatal stressful life event. Exposure to maternal stressful life events during the entire pregnancy was associated with a non-linear earlier age at menarche. Exposure to one event and two or more psychological stressful events was associated with a 3.5 and 1.7-month earlier onset of puberty, respectively when compared to the reference group with no exposure maternal stressful life events. The estimates from multiple imputation with 50 datasets were comparable with complete case analysis confirming the existence of an underlying effect. No separate significant effects were observed for exposure during early or late gestation. The association between prenatal stressful events and age at menarche was not mediated by childhood BMI in the offspring. LIMITATIONS, REASONS FOR CAUTION Stressful life events may have affected pregnant women in different ways and self-perceived maternal stress severity may have provided a more precise estimate of gestational psychological stress. The observed non-linear U-shape of the association between maternal psychological stress and age at menarche did not reflect a dose-response. This suggests that the first exposure to prenatal stress exerts a greater effect on fetal reproductive development. A potential mechanism is via dramatic initial activation of the hypothalamic-pituitary-adrenal (HPA) axis following the first stressful life event which is greater than that observed following subsequent exposure to two or more maternal stressful life events. Whilst we adjusted for a priori chosen confounders, we cannot exclude residual confounding or confounding by factors we did not include. Maternal age at menarche was not available so the effects of familial history/genetics could not be assessed. There was a large loss due to the number of girls with no information on date of menarche and missing confounder information implying risk of selection bias and multiple imputation analyses did not fully exclude this risk (similar direction but slightly weaker estimate magnitude). WIDER IMPLICATIONS OF THE FINDINGS Menarche is a sentinel reproductive event and earlier age at menarche carries implications for psychological, social and reproductive health and for long-term risk of common non-communicable diseases. Understanding the factors regulating age at menarche has extensive health implications. This is the first population-based cohort study in humans to demonstrate that prenatal psychological stress might directly modify age at menarche. STUDY FUNDING/COMPETING INTEREST(S) Dr. Brauner and Trine Koch's salaries were supported by Doctor Sofus Carl Emil Friis and spouse Olga Doris Friis foundation, The Danish Cancer Society (Kraeftens Bekaempelse, RP15468, R204-A12636, Denmark) and The Danish Health Foundation (Helsefonden, F-22181-23, Denmark). Martha Hickey was funded by NHMRC Practitioner Fellowships. The funding bodies played no role in the design, collection, analysis, or interpretation of data; in the writing of the manuscript; or in the decision to submit the manuscript for publication. Dr. Hart has received personal fees in his function as the Medical Director of Fertility Specialists of Western Australia and received educational sponsorship grants from MSD, Merck-Serono and from Ferring Pharmaceuticals. Dr Hart has also received personal fees from Shareholders in Western IVF outside the submitted work. TRIAL REGISTRATION NUMBER NA.

Segmental Arterial Mediolysis of Omental Arteries with Haemoperitoneum: Case Report with Embolization of the Left Omental Artery and Brief Review of Literature.

Abstract: Segmental arterial mediolysis of an omental artery is an exceptionally rare condition. A 69-year-old man presented with haemoperitoneum six days after being hospitalized due to pneumogenic sepsis. Computed tomography of the abdomen showed a short segment dilatation of an omental artery in the left upper abdomen, compatible with segmental arterial mediolysis. Angiographic examination revealed alterations of omental branches of the right gastroepiploic artery and an aneurysm of the left omental artery, both characteristic of segmental arterial mediolysis. Embolization of the left omental artery with use of N-butyl-2-cyanoacrylate was performed. The postinterventional course was uneventful with increase of haemoglobin levels and without symptoms of omental infarction. Transcatheter embolization in the setting of haemoperitoneum due to segmental arterial mediolysis of an omental branch is technically feasible and a valuable alternative to emergency operation.

A polypharmacy intervention study on Dutch nursing home residents

Abstract: Objectives: This study firstly aimed to identify the percentage of nursing home patients who were prescribed more than nine drugs (polypharmacy) and compared prescribing patterns of this patient group to patients who were prescribed fewer drugs. Secondly, teams of hospital pharmacists and nursing home physicians aimed to identify the drug related problems of the polypharmacy patients and the extent to which it was feasible to optimise their medication profiles. Methods: Characteristics of the polypharmacy population were illustrated by retrospective point measurements in five Dutch nursing homes (total of 742 beds) over the years 2004, 2005 and 2006. Additionally, 91 polypharmacy patients in those nursing homes were included for a medication review by a hospital pharmacist and a nursing home physician. The appropiateness of each drug was discussed adressing indication, effectiveness and safety, as well as possible undertreatment. Drug related problems were accordingly (sub)categorised. The pharmacist and physician prioritised the problems and jointly preparared a plan who to optimise the medication profile. Six weeks later, the same pharmacist and physician met again and discussed for each patient the list of problems and the alterations in the medication profile. Results: We found an increase in the percentage polypharmacy patients over the years (14.6%, 2004; 17.5%, 2005; 19.8%, 2006). Drugs from the ATC-groups ‘alimentary tract and metabolism’, ‘cardiovascular system’ and ‘nervous system’ were prescribed most frequently in the polypharmacy population. The 91 reviewed polypharmacy patients used 1226 drugs. We registered 323 drug related problems (mean of 3.5 problems per patient). A decreased renal function (creatinin clearance < 40 ml/min) was observed in a high number of polypharmacy patients (at least 40%). The majority of drug related problems were in the category ‘indication’. In total, 62% of all drug related problems were subcategorised as ‘unclear or not confirmed indication’. These problems were observed in 87% of the polypharmacy patients. A mean of 1.7 (n=159) problems per patient were solved during the subsequent intervention period and the number of drugs per patients decreased statistically significantly from 13.5 to 12.7 (p < 0.0001). Conclusion: The percentage of nursing home patients meeting the polypharmacy definition ranged from 14,6% to 19,8% over 2004–2006. The majority of polypharmacy patients had at least one drug prescribed for which the indication was unknown. The intervention was accompanied with a significant decrease in the number of drugs per patient, but half of the drug related problems remained unsolved.

Intrathecal pump catheter-tip granuloma recurrence with associated myelomalacia - How safe is intrathecal analgesic infusion therapy? A case report.

Abstract: Background A serious complication of intrathecal (IT) infusion therapy for pain management is catheter-tip-associated granuloma. Catheter-tip granulomas can lead to permanent severe neurological sequelae if not promptly detected. Case description We report a patient with a recurrence of a catheter-tip granuloma causing a high-grade paresis of the lower extremities and we review briefly the literature. Conclusion Patients with IT pump therapy presenting new neurological findings need prompt imaging of the spinal axis to rule out a catheter-tip granuloma. In case of catheter-tip granuloma, early surgical decompression is important.