scholarly journals Transvaginal Hybrid-NOTES procedures—do they have a negative impact on pregnancy and delivery?

2021 ◽  
Author(s):  
Panagiotis Thomaidis ◽  
Niklas J. Weltermann ◽  
Claudia S. Seefeldt ◽  
Dana C. Richards ◽  
Axel Sauerwald ◽  
...  
Keyword(s):  
Negative Impact ◽  
Male Partner ◽  
Current Data ◽  
Reproductive Age ◽  
Negative Effects ◽  
Desire For Children ◽  
Pregnancy And Delivery ◽  
Hybrid Notes ◽  
Type Of Delivery

Abstract Purpose We conducted a retrospective observational study in order to identify negative effects of NOTES procedures (Natural Orifice Transluminal Endoscopic Surgery) with transvaginal specimen removal on pregnancy and delivery. Methods From the total population of 299 patients in our NOTES registry, we tried to contact the 121 patients who were of reproductive age (≤ 45 years) at the time of a transvaginal NOTES procedure. They were interviewed by telephone regarding their desire for children, post NOTES-operation pregnancies, and type of delivery using a structured questionnaire. The collected data was analyzed and compared with current data. Results We were able to contact 76 patients (follow-up rate: 62.8%) with a median follow-up of 77 months after surgery (33–129 months). Twenty of 74 participating patients had a desire for children (27.0%). One of them and another's male partner were diagnosed as infertile. Regarding the remaining 18 patients, 14 became pregnant, and three of them became pregnant twice. Considering these 17 pregnancies, there was one miscarriage (5.9%) and one twin birth (5.9%). On average, childbirth occurred 44 months after the NOTES procedure. With regard to the type of delivery, 10 vaginal births (58.8%) and 7 caesarean sections (41.2%) occurred. Thus, the rate of fulfilled desire for children was 77.8%. Compared with the literature, no difference to the normal course could be detected. Conclusion There is no sign that the transvaginal approach in Hybrid-NOTES, with removal of the specimen through the vagina, has a negative effect on conception, the course during pregnancy, or the type of delivery.

scholarly journals MANAGEMENT OF GARBHASHAYGATA ARBUD IN AYURVEDA W.R.T. UTERINE FIBROID – A SINGLE CASE STUDY

2021 ◽  
Vol 9 (7) ◽  
pp. 1544-1548
Author(s):  
Deepali J Agrawal ◽  
Ashish C Zanwar
Keyword(s):  
Uterine Fibroid ◽  
Coming Out ◽  
Negative Impact ◽  
Single Case ◽  
Negative Effects ◽  
Successful Management ◽  
Non Invasive ◽  
Basic Line

Uterine fibroid is the most common solid benign tumour which affects merely pre-menopause age. It is 3rd leading cause of hysterectomy. It gives a negative impact on women’s physical and social activities. A 45-year-old female patient approached the OPD complaining of heavy menstrual bleeding, heaviness in the abdomen, something coming out of the vagina. USG abdomen scan revealed a big myometrium fibroid in the fundus. She was suggest- ed a hysterectomy for the same. However, due to its complications patient was not willing for surgery. So, she was treated as per Ayurvedic basic line of treatment of Yoni Vyapad. She was administered Ashokarista and Chandraprabha Vati for 2 months along with two cycles of Yogbasti Chikitsa. After 2 months all symptoms were subsided. In follow up scan after 6 months revealed an absence of fibroid. During this treatment, the patient did not report any negative effects suggesting the progression of the disease. An attempt has been made for successful management of fibroid of the uterus in premenopausal age to relieve her symptoms. After menopause, the fibroid may be automatically shrinking due to a lack of oestrogen and progesterone. The case study will build confidence among ayurvedic practitioners to treat a fibroid of the uterus in premenopausal age with safe, non-invasive and non-hormonal management fibroid through Ayurveda, Keywords: uterine fibroid, garbhashaygata arbud, basti, yoni vyapad

scholarly journals Negative Effects of a Multimodal Inpatient CBASP Program: Rate of Occurrence and Their Impact on Treatment Outcome in Chronic and Treatment-Resistant Depression

2021 ◽  
Vol 12 ◽  
Author(s):  
Philipp Herzog ◽  
Sophia Häusler ◽  
Claus Normann ◽  
Eva-Lotta Brakemeier
Keyword(s):  
Treatment Outcome ◽  
Treatment Program ◽  
Large Scale ◽  
Negative Impact ◽  
Chronic Depression ◽  
Systematic Research ◽  
Negative Effects ◽  
Negative Effect ◽  
Impact On Treatment

Background: A growing number of studies indicate that the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is effective in treating chronic depression. However, there is no systematic research into possible negative effects. Therefore, the objectives of the study were to investigate the rate of occurrence of negative effects of an inpatient CBASP program and their impact on treatment response.Methods: Patients with chronic depression and treatment resistance who completed the 12-week multimodal inpatient CBASP treatment program in an open trial (N = 52) retrospectively completed the Inventory for the Assessment of Negative Effects of Psychotherapy (INEP) during follow-up data collection. Severity of depressive symptoms was assessed self- and observer-rated at admission, discharge, and 6 months follow-up. Rates of occurrence of negative effects were calculated and binary logistic regression analyses were conducted to determine the relationship to treatment outcome.Results: The results indicate that 92.3% of patients reported having experienced at least one negative effect and 45.2% indicated dependence on their therapist. Stigmatization and financial concerns as well as intrapersonal changes were reported by about one-third. Only dependence on the therapist negatively impacted treatment outcome in both outcome measures.Conclusions: While almost all patients reported at least one negative effect of a multimodal inpatient CBASP treatment program, most of the reported negative effects appear to be benign. However, dependence on the therapist seems to have a negative impact on treatment outcome. If these results can be replicated in future large-scale, randomized controlled prospective studies, CBASP therapists should be aware of possible dependence and consciously address it during treatment.

Problems of Development of Small and Medium Russian Towns

2019 ◽  
pp. 24-29
Author(s):  
V V. Kafidov ◽  
V. N. Filippov ◽  
I. P. Filippova
Keyword(s):  
Urban Development ◽  
Urban Areas ◽  
Negative Impact ◽  
Physical Space ◽  
Living Environment ◽  
Transport Infrastructure ◽  
Negative Effects ◽  
Conceptual Approach ◽  
Fundamental Factor ◽  
New Buildings

The presented study addresses the problems of development of small and medium towns in Russia. Aim. The study aims to examine a town as a socio-economic environment where its residents exist and as the fundamental factor for the development of society.Tasks. The authors identify key problems in the development of small and medium Russian towns, which interferes with the historical appearance and has a negative impact on the living environment.Methods. Problems in the development of small and medium towns in Russia are examined using theoretical methods: systematic approach, statistical analysis, social and philosophical analysis.Results. The study identifies the main negative effects of the existing model of development of small and medium Russian towns, such as destruction of their historical and cultural appearance, distortion of the overall architectural motif, increased load on communications, and congestion of the transport infrastructure.Conclusions. At the current stage, efficient development of small and medium towns in Russia is impossible within the framework of the existing infill development. This chaotic process cannot be stopped without a new conceptual approach and changes in the legislative and normative framework of urban development. The only factor that determines the boundaries of the existing approach to urban development is the lack of physical space for new buildings in urban areas. The authors formulate proposals that would help to solve the problems of development of small and medium towns in Russia. 

scholarly journals Primary breast tuberculosis: imaging findings of a rare disease

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Ali H. Baykan ◽  
Hakan S. Sayiner ◽  
Ibrahim Inan ◽  
Elcin Aydin ◽  
Sukru M. Erturk
Keyword(s):  
Differential Diagnosis ◽  
Rare Disease ◽  
Extrapulmonary Tuberculosis ◽  
Reproductive Age ◽  
Malignant Diseases ◽  
Imaging Findings ◽  
Granulomatous Mastitis ◽  
Rare Form ◽  
Breast Tuberculosis

AbstractBreast tuberculosis is a rare form of extrapulmonary tuberculosis which tends to affect females of reproductive age, and is much rarer in males, postmenopausal women, and pre-pubescent girls. It is difficult to diagnose because it can mimic benign conditions such as a fibroadenoma, as well as malignant diseases like a carcinoma. It is also particularly difficult to distinguish breast tuberculosis from granulomatous mastitis, so other possible diagnoses should be ruled out first. The diagnosis of breast tuberculosis has three essential pillars: clinical examination, radiological evaluations, and histopathological sampling. Radiological evaluations are not only critical in diagnosis but are also important in the planning of the treatment and during the follow-up. This paper aims to review the imaging findings and the differential diagnosis of breast tuberculosis.

scholarly journals Anti-adhesion Gel versus No gel following Operative Hysteroscopy prior to Subsequent fertility Treatment or timed InterCourse (AGNOHSTIC), a randomised controlled trial: protocol

2021 ◽  
Vol 2021 (1) ◽  
Author(s):  
S van Wessel ◽  
T Hamerlynck ◽  
V Schutyser ◽  
C Tomassetti ◽  
C Wyns ◽  
...  
Keyword(s):  
Live Birth ◽  
Financial Support ◽  
Controlled Trial ◽  
Reproductive Age ◽  
Fertility Treatment ◽  
Control Group ◽  
Women Of Reproductive Age ◽  
Operative Hysteroscopy ◽  
Randomised Controlled

Abstract STUDY QUESTIONS Does the application of anti-adhesion gel, compared to no gel, following operative hysteroscopy to treat intrauterine pathology in women wishing to conceive increase the chance of conception leading to live birth? WHAT IS KNOWN ALREADY Intrauterine adhesions (IUAs) following operative hysteroscopy may impair reproductive success in women of reproductive age. Anti-adhesion barrier gels may decrease the occurrence of IUAs, but the evidence on their effectiveness to improve reproductive outcomes is sparse and of low quality. STUDY DESIGN, SIZE, DURATION This multicentre, parallel group, superiority, blinded and pragmatic randomised controlled trial is being carried out in seven participating centres in Belgium. Recruitment started in April 2019. Women will be randomly allocated to treatment with anti-adhesion gel (intervention group) or no gel (control group). Sterile ultrasound gel will be applied into the vagina as a mock-procedure in both treatment arms. The patient, fertility physician and gynaecologist performing the second-look hysteroscopy are unaware of the allocated treatment. Power analysis, based on a target improvement of 15% in conception leading to live birth using anti-adhesion gel, a power of 85%, a significance level of 5%, and a drop-out rate of 10%, yielded a number of 444 patients to be randomised. The baseline rate of conception leading to live birth in the control group is expected to be 45%. PARTICIPANTS/MATERIALS, SETTING, METHODS Women of reproductive age (18–47 years), wishing to conceive (spontaneously or by fertility treatment) and scheduled for operative hysteroscopy to treat intrauterine pathology (endometrial polyps, myomas with uterine cavity deformation, uterine septa, IUAs or retained products of conception) are eligible for recruitment. Women may try to conceive from 3 to 6 weeks after receiving allocated treatment with follow-up ending at 30 weeks after treatment. If the woman fails to conceive within this timeframe, a second-look hysteroscopy will be scheduled within 2–6 weeks to check for IUAs. The primary endpoint is conception leading to live birth, measured at 30 weeks after randomisation. The secondary endpoints are time to conception, clinical pregnancy, miscarriage and ectopic pregnancy rates, measured at 30 weeks after receiving allocated treatment. The long-term follow-up starts when the patient is pregnant and she will be contacted every trimester. STUDY FUNDING/COMPETING INTEREST(S) This work is funded by the Belgian Healthcare Knowledge Centre (KCE). The anti-adhesion gel is supplied at no cost by Nordic Pharma and without conditions. Dr. Tomassetti reports grants and non-financial support from Merck SA, non-financial support from Ferring SA, personal fees and non-financial support from Gedeon-Richter, outside the submitted work. None of the other authors have a conflict of interest.

Predictors of Discontinuation of Modern Spacing Contraceptives in India

2020 ◽  
pp. 101053952098314
Author(s):  
Shahina Begum ◽  
Himanshu Chaurasia ◽  
Kusum V. Moray ◽  
Beena Joshi
Keyword(s):  
Contraceptive Use ◽  
Oral Contraceptive Pill ◽  
Family Health ◽  
Reproductive Age ◽  
Health Priorities ◽  
Unintended Pregnancies ◽  
Reproductive Age Women ◽  
One Year ◽  
Women In India

Data from National Family Health Survey (2015-2016) was analyzed to examine the contraceptive acceptance, discontinuation rates, and associated factors among reproductive age women in India over one year. Findings revealed that 11.7% accepted modern methods of which 68% were for spacing. Only 5% switched to other methods. Discontinuation rate was high among condom (56.8%) and oral contraceptive pill users (34.5%), among women aged less than 25 years, with parity less than 2, belonging to rural area, and having no education. Health concerns/side effects, husband’s disapproval, or method failure were most common reasons cited for discontinuation. The data show high discontinuation rates among some subgroups of women and for certain methods. Hence, women need to be provided options to switch methods to meet changing contraceptive needs and health priorities. Continuum of care with follow-up and counselling can facilitate sustained contraceptive use to avert unintended pregnancies.

scholarly journals Ovarian Dysgerminoma in Pregnant Women with Viable Fetus: A Rare Case Report

2021 ◽  
pp. 141-146
Author(s):  
Reda Youssef ◽  
Gamal Sayed Ahmed ◽  
Samir Alhyassat ◽  
Sanaa Badr ◽  
Ahmed Sabry ◽  
...  
Keyword(s):  
Gestational Age ◽  
Ovarian Neoplasms ◽  
Imaging Modality ◽  
Reproductive Age ◽  
Diagnostic Challenge ◽  
Short Period ◽  
Ovarian Dysgerminoma ◽  
The Impact ◽  
In Pregnancy

Dysgerminoma is an uncommon malignant tumor arising from the germ cells of the ovary. Its association with pregnancy is extremely rare, with a reported incidence of about 0.2–1 per 100,000 pregnancies. Women in the reproductive age group are more commonly affected. It can be extremely rare to conceive naturally, without assisted reproductive interventions, in cases with ovarian dysgerminoma. If a pregnancy does occur with a concurrent dysgerminoma, it is even more unusual to carry the pregnancy to viability or childbirth without fetal or maternal compromise. We report a case of right ovarian dysgerminoma in a young female with a viable intrauterine pregnancy at 10 weeks, which is rarely diagnosed and managed at this gestational age. Numerous factors played a role in her favorable outcome, including early suspicion by ultrasound and presenting history, surgery, histopathological assessment, imaging, and involvement of the multidisciplinary oncology team. Ovarian neoplasms may rapidly increase in size within a short period with little or no symptoms. This poses a diagnostic challenge for obstetricians and oncologists. Hence, we aimed to evaluate the role of imaging in pregnancy using ultrasound as an imaging modality for both early detection of ovarian neoplasms and for follow-up. In conclusion, patients with ovarian dysgerminoma in pregnancy can have favorable outcomes. Treatment should be individualized on a case-to-case basis, depending on many factors; cancer stage, previous reproductive history, the impact of imaging in staging or follow-up of tumor on the fetus, fetal gestational age, and whether termination of the pregnancy can improve survival or morbidity for the mother.

scholarly journals In the Same Boat, but not Equals: The Heterogeneous Effects of Indirect Taxation on Child Health in Punjab-Pakistan

2020 ◽  
Vol 11 (3) ◽  
Author(s):  
Faiz Ur Rehman ◽  
Muhammad Nasir
Keyword(s):  
Negative Impact ◽  
Income Group ◽  
Z Score ◽  
Negative Effects ◽  
Indirect Taxation ◽  
Nutrition Survey ◽  
Lower Income Group ◽  
Food Items ◽  
Heterogeneous Effects ◽  
The Impact

AbstractThe 2011 National Nutrition Survey of Pakistan revealed that 51% of the country’s population was consuming less than 2,100 calories a day. In the backdrop of rising food insecurity, hunger, and malnutrition in Pakistan, this study aims to measure the effects of indirect taxation on health outcomes of children (<5 years). More specifically, the impact of the incidence of General Sales Tax (GST) in the province of Punjab has been estimated on a child’s height and weight. The proponents of the uniform GST argue that the tax would not affect children because most food items consumed by children are exempted from the GST. However, the opponents believe that households, especially those belonging to the lower-income group, would reallocate resources away from children in the face of higher GST. To study these effects, we utilized three different waves (2007–08, 2011 & 2014) of Multiple Indicators Cluster Surveys (MICS). The results show that the tax incidence, and not the GST rate, has a significantly negative impact on children’s height-for-age Z-score (HAZ). No effect was found on the weight-for-age-z-score (WAZ). These results are robust to different specifications and exhibit considerable heterogeneity across different income groups. These findings suggest that the exemption of certain food items for children from the GST may not eliminate the negative effects of this tax on a child’s health. Thus, our study raises concerns about the long term welfare consequences of GST.

scholarly journals Surgical treatment of recalcitrant gastroesophageal reflux disease in patients with systemic sclerosis: a systematic review

2021 ◽  
Author(s):  
Alberto Aiolfi ◽  
Mario Nosotti ◽  
Kazuhide Matsushima ◽  
Carolina Perali ◽  
Cristina Ogliari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systemic Sclerosis ◽  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Current Data ◽  
Current Evidence ◽  
Increased Risk

Abstract Introduction Gastroesophageal reflux disease (GERD) is frequently seen in patients with systemic sclerosis (SSc). Long-standing GERD may cause esophagitis, long-segment strictures, and Barrett’s esophagus and may worsen pre-existing pulmonary fibrosis with an increased risk of end-stage lung disease. Surgical treatment of recalcitrant GERD remains controversial. The purpose of this systematic review was to summarize the current data on surgical treatment of recalcitrant GERD in SSc patients. Materials and methods A systematic literature review according to PRISMA and MOOSE guidelines. PubMed, EMBASE, and Web of Science databases were consulted. Results A total of 101 patients were included from 7 studies. The age ranged from 34 to 61 years and the majority were females (73.5%). Commonly reported symptoms were heartburn (92%), regurgitation (77%), and dysphagia (74%). Concurrent pulmonary disease was diagnosed in 58% of patients. Overall, 63 patients (62.4%) underwent open fundoplication, 17 (16.8%) laparoscopic fundoplication, 15 (14.9%) Roux en-Y gastric bypass (RYGB), and 6 (5.9%) esophagectomy. The postoperative follow-up ranged from 12 to 65 months. Recurrent symptoms were described in up to 70% and 30% of patients undergoing fundoplication and RYGB, respectively. Various symptoms were reported postoperatively depending on the type of surgical procedures, anatomy of the valve, need for esophageal lengthening, and follow-up. Conclusions The treatment of recalcitrant GERD in SSc patients is challenging. Esophagectomy should be reserved to selected patients. Minimally invasive RYGB appears feasible and safe with promising preliminary short-term results. Current evidence is scarce while a definitive indication about the most appropriate surgical treatment is lacking.

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