METHODS: A retrospective study conducted between February 2015 and July 2016 at Chang Gung Memorial Hospital. The subjects had had symptomatic anterior or apical prolapse with stage III or IV and undergone pelvic reconstructive surgery using Uphold™ LITE. Patients completed a 3-day voiding diary, urodynamic study, real-time ultrasonography and validated quality-of-life questionnaires at baseline and 12-month follow-up. Primary outcome was the absence of USI. Secondary outcomes included the objective cure rate of POP, ≤ stage 1 at the anterior/apical vaginal wall, and the subjective cure rate, negative feedback to POPDI-6.
RESULTS: Ninety-five women were eligible. Six were excluded because of incomplete data. The postoperative de novo USI and SUI were 22.7 and 19.7%, respectively. There was significant improvement of USI in patients who had MUS insertion (93.8%) and bladder outlet obstruction (96.7%). The objective and subjective cure rate for prolapse was 95.5 and 94.3%, respectively. POP-Q measurements pre- and postoperatively were significantly improved at all points except for Gh and Pb. There was a significant difference in the distance between the bladder neck to the distal end of the mesh during straining both at both the postoperative 3rd month and 1 year.
CONCLUSIONS: Uphold™ mesh has a 20% incidence of de novo USI with acceptable objective and subjective cure rates at 1 year postoperatively. The de novo USI rate was high but not bothersome enough to require surgery.
OBJECTIVE: The objective of this study was to determine whether combined total intravenous anesthesia (TIVA) technique with propofol/remifentanil is associated with less SSEP suppression when compared to combined volatile agent desflurane/remifentanil anesthesia during corrective scoliosis surgery at a comparable depth of anesthesia.
DESIGN: It is a randomized controlled trial.
SETTING: The study was conducted at the Single tertiary University Hospital during October 2014 to June 2015.
PATIENTS: Patients who required SSEP and had no neurological deficits, and were of American Society of Anesthesiologist I and II physical status, were included. Patients who had sensory or motor deficits preoperatively and significant cardiovascular and respiratory disease were excluded. A total of 72 patients were screened, and 67 patients were randomized and allocated to two groups: 34 in desflurane/remifentanil group and 33 in TIVA group. Four patients from desflurane/remifentanil group and three from TIVA group were withdrawn due to decrease in SSEP amplitude to <0.3 µV after induction of anesthesia. Thirty patients from each group were analyzed.
INTERVENTIONS: Sixty-seven patients were randomized to receive TIVA or desflurane/remifentanil anesthesia.
MAIN OUTCOME MEASURES: The measurements taken were the amplitude and latency of SSEP monitoring at five different time points during surgery: before and after the induction of anesthesia, at skin incision, at pedicle screw insertion, and at rod insertion.
RESULTS: Both anesthesia techniques, TIVA and desflurane/remifentanil, resulted in decreased amplitude and increased latencies of both cervical and cortical peaks. The desflurane/remifentanil group had a significantly greater reduction in the amplitude ( p = 0.004) and an increase in latency ( p = 0.002) of P40 compared with the TIVA group. However, there were no differences in both amplitude ( p = 0.214) and latency ( p = 0.16) in cervical SSEP between the two groups.
CONCLUSIONS: Compared with TIVA technique, desflurane/remifentanil anesthesia caused more suppression in cortical SSEP, but not in cervical SSEP, at a comparable depth of anesthesia.
AIM: To determine the neighbourhood factors influencing the prevalence of abnormal mental health status among adolescents in an urban population.
METHOD: A cross-sectional study was conducted among adolescents aged 13, 14 and 16 years old from thirteen secondary schools in Kuala Lumpur using validated questionnaires. A total of 567 adolescents participated in this study.
RESULTS: The prevalence of abnormal mental health status in this study was 4.4%. In multivariable analysis, female (OR = 1.79, 95%CI: 1.11-2.89), having divorced parents (OR = 3.53, 95%CI: 1.96-6.36), high educational stress (OR = 8.18, 95%CI: 4.25-15.75), medium educational stress (OR = 2.99, 95%CI: 1.53-5.83), whose house has been broken in before (OR = 2.02, 95%CI: 1.11-3.68) and living in a neighbourhood with low socioeconomic status (OR = 2.09, 95%CI: 1.23-3.56) were more likely to have abnormal mental health status.
CONCLUSIONS: Neighbourhood factors were found to be significant in determining adolescents' mental health status. The findings emphasize the importance of those in the public health sector to highlight these significant neighbourhood factors to the Ministry of Housing and Local Government. Swift action needs to be taken by the Ministry to provide solutions related to the neighbourhood factors and this can contribute to improvement in the adolescents' mental health.