A Comparative Study of Surgical versus Medical Management of Cases of First Trimesteric Missed Abortion

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Hesham Mahmoud Harb ◽  
Dina Yahia Mansour ◽  
AbdelRhman Badawi Lethi Sayed
Keyword(s):  
Blood Pressure ◽  
Surgical Management ◽  
Medical Management ◽  
First Trimester ◽  
Maternity Hospital ◽  
Missed Abortion ◽  
Management Group ◽  
Significant Difference ◽  
Surgical Evacuation ◽  
Before And After

Abstract Background Missed abortion is a common obstetric problem constitutes approximately 15% of clinically diagnosed pregnancies and it was reported that about 80% of early pregnancy loss occurs in the first trimester. Missed abortion can be managed expectantly, surgically and medically. Surgical evacuation is the standard treatment for missed abortion with around 95% success rate and it had been widely performed all over the world in the last five decades, there are some complications associated with surgery such as higher cost, infection and bleeding. Medical management might be more suitable instead of surgical evacuation, it may be less costly than surgical treatment and consequently due to its lower complications most patients prefer it. Objective To compare the efficacy, safety and patient satisfaction of medical treatment of 1st trimestric missed abortion using misoprostol versus surgical evacuation. Patients and Methods Types of study: Randomized controlled open labelled clinical trial. Study setting: Maternity hospital, Ain Shams University. Study period: For six months from 1st of March 2019 to 31st of August 2019. Results The study shows no significant differences were found between groups regarding systolic blood pressure, diastolic blood pressure, pulse rate and body temperature before and after treatment. The results also show that occurrence of abdominal pain was frequent in both groups but, with no significant difference between groups but time needed to induce abortion was significantly higher in medical management group compared to surgical management one. Conclusion Medical management is found to be as effective as surgical management in the 1st trimesteric missed abortion, by using Misoprostol.

scholarly journals Effects of Aroma Massage on Home Blood Pressure, Ambulatory Blood Pressure, and Sleep Quality in Middle-Aged Women with Hypertension

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Myeong-Sook Ju ◽  
Sahng Lee ◽  
Ikyul Bae ◽  
Myung-Haeng Hur ◽  
Kayeon Seong ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Placebo Group ◽  
Sleep Quality ◽  
Nursing Intervention ◽  
Home Blood Pressure ◽  
Control Group ◽  
Middle Aged ◽  
Significant Difference ◽  
Before And After ◽  
Massage Group

The purpose of this study was to evaluate the effects of aroma massage applied to middle-aged women with hypertension. The research study had a nonequivalent control group, nonsynchronized design to investigate the effect on home blood pressure (BP), ambulatory BP, and sleep. The hypertensive patients were allocated into the aroma massage group (n=28), the placebo group (n=28), and the no-treatment control group (n=27). To evaluate the effects of aroma massage, the experimental group received a massage with essential oils prescribed by an aromatherapist once a week and body cream once a day. The placebo group received a massage using artificial fragrance oil once a week and body cream once a day. BP, pulse rate, sleep conditions, and 24-hour ambulatory BP were monitored before and after the experiment. There was a significant difference in home systolic blood pressure (SBP) (F=6.71,P=0.002) between groups after intervention. There was also a significant difference in SBP (F=13.34,P=0.001) and diastolic blood pressure (DBP) (F=8.46,P=0.005) in the laboratory between aroma massage and placebo groups. In sleep quality, there was a significant difference between groups (F=6.75,P=0.002). In conclusion, aroma massage may help improve patient quality of life and maintain health as a nursing intervention in daily life.

scholarly journals Perubahan antropometri, kalsium darah, tekanan darah, dan kebugaran fisik akibat asupan susu kambing pada olahragawan

2021 ◽  
Vol 17 (3) ◽  
pp. 133
Author(s):  
Yusni Yusni ◽  
Amiruddin Amiruddin
Keyword(s):  
Blood Pressure ◽  
Physical Fitness ◽  
Intervention Group ◽  
Goat Milk ◽  
Sports Nutrition ◽  
T Test ◽  
Muscle Endurance ◽  
Blood Calcium ◽  
Significant Difference ◽  
Before And After

Changes in anthropometry, blood calcium, blood pressure, and physical fitness due to goat's milk intake in athletesBackground: The intake of healthy-balanced nutrition is needed by athletes. The complex nutritional content of goat milk such as protein, fat, carbohydrate, vitamin, and mineral acts as sports nutrition during and after training. Objective: This study aims to analyze the effects of goat milk on physical fitness, anthropometrics, blood calcium, and blood pressure in athletes. Methods: A clinical trial was conducted using healthy human subjects. Subjects were runners (n=10 people) as the control group and gymnasts (n=19 people) as the treatment group, male, age 21-27 years, and healthy. Bodyweight (BW), Height, and Body Mass Index (BMI), blood calcium, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and physical fitness were examined two times, before and after consuming goat milk. Intervention: fresh goat milk, 250 mg/day (after dinner), and given for 90 days. Data were analyzed using a paired sample t-test and independent sample t-test. Results: There was no difference between BW (p=0.07), BMI (p=0.08), and DBP (p=0.24), but instead there was a significant difference in SBP (p=0.00) before and after goat milk intervention in the experimental group. Blood calcium was significantly increased (p=0.00) in the intervention group, whereas reverse decreased significantly (p=0.02) in controls. A significant difference before and after therapy was found in speed (p=0.00), arm muscle endurance (p=0.01), an-aerobic endurance (p=0.00), agility (p=0.02), however, there was no significant difference between leg muscle power (p=0.13), flexibility (p=0.23), an endurance of abdominal muscles (p=0.26), VO2 max (p=1.15) in the intervention group. Conclusions: Regular consumption of goat milk can reduce SBP, increase blood calcium levels, and improve physical fitness (speed, arm muscle endurance, anaerobic endurance, and agility) in athletes. Goat milk is an essential role in sports nutrition for physical fitness and athlete's health.

scholarly journals Dental anxiety in patients undergoing oral surgery and its effects on blood pressure and heart rate

2020 ◽  
Vol 9 (8) ◽  
pp. e316985536
Author(s):  
Jaqueline Oliveira Barreto ◽  
Julliana Cariry Palhano Freire ◽  
Arthur Willian de Lima Brasil ◽  
Cristian Statkievicz ◽  
Francisley Ávila Souza ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Oral Surgery ◽  
Dental Anxiety ◽  
Waiting Room ◽  
Demographic Questionnaire ◽  
Significant Difference ◽  
Before And After ◽  
Evaluation Anxiety

Objective: To assess dental anxiety in patients undergoing oral surgery, as well as its impact on blood pressure and heart rate. Material and Methods: A total of 233 patients answered a socio-demographic questionnaire and another one based on the Corah dental anxiety scale. Blood pressure and heart rate were assessed at three moments while: patients were in the waiting room, immediately before and after the procedure. Results: This study revealed a prevalence of anxiety of 77.3%. There was a statistically significant difference in mean systolic blood pressure and heart rate at the three moments of the evaluation. Anxiety was prevalent in the sample and was observed from the time in the waiting room until the time when local anesthesia was performed, causing variations in systolic blood pressure and heart rate, anxiety levels decreased after the end of the service. In conclusion, we observed that oral surgery is directly related to increased anxiety, and anxiety is mainly related to the change in heart rate.

scholarly journals Influence of surgical evacuation on pregnancy outcomes of subsequent embryo transfer cycle following miscarriage in an initial IVF cycle: a retrospective cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Junan Meng ◽  
Mengchen Zhu ◽  
Wenjuan Shen ◽  
Xiaomin Huang ◽  
Haixiang Sun ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Endometrial Thickness ◽  
Live Birth Rate ◽  
First Trimester ◽  
Miscarriage Rate ◽  
Significant Difference ◽  
Surgical Evacuation

Abstract Background It is still uncertain whether surgical evacuation adversely affects subsequent embryo transfer. The present study aims to assess the influence of surgical evacuation on the pregnancy outcomes of subsequent embryo transfer cycle following first trimester miscarriage in an initial in vitro fertilization and embryo transfer (IVF-ET) cycle. Methods A total of 645 patients who underwent their first trimester miscarriage in an initial IVF cycle between January 2013 and May 2016 in Nanjing Drum Tower Hospital were enrolled. Surgical evacuation was performed when the products of conception were retained more than 8 h after medical evacuation. Characteristics and pregnancy outcomes were compared between surgical evacuation patients and no surgical evacuation patients. The pregnancy outcomes following surgical evacuation were further compared between patients with ≥ 8 mm or < 8 mm endometrial thickness (EMT), and with the different EMT changes. Results The EMT in the subsequent embryo transfer cycle of surgical evacuation group was much thinner when compared with that in the no surgical evacuation group (9.0 ± 1.6 mm vs. 9.4 ± 1.9 mm, P = 0.01). There was no significant difference in implantation rate, clinical pregnancy rate, live birth rate or miscarriage rate between surgical evacuation group and no surgical evacuation group (P > 0.05). The live birth rate was higher in EMT ≥ 8 mm group when compared to < 8 mm group in surgical evacuation patients (43.0% vs. 17.4%, P < 0.05). Conclusions There was no significant difference in the pregnancy outcomes of subsequent embryo transfer cycle between surgical evacuation patients and no surgical evacuation patients. Surgical evacuation led to the decrease of EMT, especially when the EMT < 8 mm was association with a lower live birth rate.

scholarly journals Cardiovascular, lactate and appetite response to light and spicy music tempo after an endurance swimming protocol in young girls

2020 ◽  
Vol 24 (4) ◽  
pp. 195-202
Author(s):  
Javad Mehrabani ◽  
Soodabeh Bagherzadeh ◽  
Abuzar Jorbonian ◽  
Eisa Khaleghi-Mamaghani ◽  
Maryam Taghdiri ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Recovery Period ◽  
Young Girls ◽  
Significant Difference ◽  
Before And After ◽  
Lactate Levels ◽  
The Impact

Background and Study Aim. During exercise, the effects of music on the performance have been previously evaluated. However, the superiority of the type of music and during recovery is not yet clear. Therefore the aim of this study was to determine the impact of music with a spicy and light beat on changes in lactate levels, blood pressure, heart rate, and appetite during the recovery period after the endurance swimming. Material and Methods. Thirteen healthy young girls participate in three control and experimental sessions. The participants performed a swimming. Immediately after swimming, they listened to music. Also, evaluations before and after (several times) swimming were performed.Results. Five minutes after swimming there was also a significant difference between the non-sound group with the music groups (p<0.05). Two and 5 minutes after swimming, there was a significant difference between the spicy and light music groups compared to the non-sound group. There was a significant difference between spicy and light music groups at time 10, 15 and 25 minutes. In the 25 minutes after the swim, reducing the heart rate in light music was more than spicy. Also, 10 minutes after swimming, the spicy music group could not cope with the increase in heart rate (p<0.05). There was a significant difference between the two music groups in minutes 5, 10 and 15 after swimming (p<0.05).Conclusions. listening to light music during recovery from endurance swimming was associated with decreased lactate levels and heart rate, but listening to spicy music increased heart rate and desire for food.

Anticoagulation Effect and Safety Observation of Regional Citrate Anticoagulation for Double-Filtration Plasmapheresis in Critical Patients

2020 ◽  
Vol 49 (5) ◽  
pp. 542-549
Author(s):  
Xiaobei Peng ◽  
Xingmin Xie ◽  
Jun Yin ◽  
Saihong Yu ◽  
Chunyan Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Regional Citrate Anticoagulation ◽  
Transmembrane Pressure ◽  
Single Treatment ◽  
Citrate Anticoagulation ◽  
Double Filtration Plasmapheresis ◽  
Significant Difference ◽  
Before And After ◽  
Critical Patients ◽  
Double Filtration

Introduction: Double-filtration plasmapheresis (DFPP) is a semi-selective blood purification method based on dual filtration system. Regional citrate anticoagulation (RCA) is an appealing anticoagulation alternative in DFPP. However, there are still few reports on the safety of RCA in DFPP treatment. Objective: To investigate the anticoagulation effect and safety of RCA for DFPP in critical patients. Methods: A total of 34 critical patients treated with DFPP were retrospectively studied. The incidence of coagulation during extracorporeal circulation after single treatment was compared before and after treatment. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, blood routine indexes, blood gas analysis, peripheral ionic calcium (iCa), total peripheral calcium (TCa), TCa/iCa, and complications before and after single treatment were compared. The changes of transmembrane pressure, pressure drop were measured, and the indexes of coagulation before and after treatment were compared. Results: The blood coagulation <III class in plasma separator and vein ampulla after single DFPP procedure were 96.00 and 94.00%, respectively. There were no statistically significant changes regarding above parameters before and after treatment, except PH, base excess (BE), bicarbonate (HCO3–), and TCa. Compared with pretreatment levels, PH, BE, and HCO3– were significantly increased at 5 min and 6 h after treatment (p < 0.05) and restored to the pretreatment levels at 24 h after treatment (p > 0.05). Level of TCa was significantly decreased at 5 min after treatment (p < 0.05), but there was no statistically significant difference at 6 and 24 h (p > 0.05). No treatment-related serious complications were observed in any of the patients. Conclusions: For critical patients who underwent DFPP procedure, RCA is safety and had significant anticoagulation effects, which is worthy of clinical application.

Evaluation of the effects of the national diabetes control and prevention program on a sample of iranian people with type 2 diabetes

2021 ◽  
pp. 1-13
Author(s):  
Simin Haghravan ◽  
Fatemeh Mohammadi-Nasrabadi ◽  
Maryam Rafraf ◽  
Mohammad Asghari Jafarabadi
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Prevention Program ◽  
Time Effect ◽  
Anthropometric Indices ◽  
Hba1 C ◽  
Significant Difference ◽  
Before And After ◽  
Control And Prevention

Diabetes prevention programs have been developed in the different countries and it is therefore necessary to gain a better understanding of factors affecting the effectiveness of these programs for each society. Accordingly, the purpose of this study was to evaluate the effect of the National Diabetes Control and Prevention Program (NDCPP) on the biochemical and anthropometric indices among a sample of Iranian patients with type 2 diabetes mellitus (T2DM). A total of 384 patients with T2DM from the primary health care system of Tehran and Tabriz cities during January to June 2020, were included in the study. A two-part questionnaire consisting of items related to socio-economic and demographic characteristics was used and biochemical and anthropometric indices were measured at the beginning and the end of the 3-month intervention period. There was a significant difference in fasting blood sugar (FBS), hemoglobin glycosides (HbA1 C), systolic blood pressure (SBP) and weight before and after the NDCPP (P <  0.001). Also, there was significant improvement in carbohydrate (P = 0.015) and protein intake (P = 0.027) after the NDCPP compared to before the study. No significant difference was observed in waist circumference (WC) (P = 0.689), body mass index (P = 0.784), diastolic blood pressure (P = 0.647), and other dietary nutrient intake before and after the NDCPP. Repeated measure ANOVA revealed a significant decrease in FBS (Time effect P = 0.019) and weight (Time effect P = 0.006) after the NDCPP. Also, residing in different cities had a significant effect on FBS (time×city effect P <  0.001), HbA1 C (time×city effect P <  0.001), and SBP (time×city effect P = 0.037) after the NDCPP. The NDCPP resulted in weight loss, improved HbA1 C, and FBS. These findings suggested that NDCPP had a positive effect on controlling T2DM among Iranian population and can be considered as a way to prevent complications of T2DM.

Outcomes in Treatment of Rhinosinusitis in the Setting of Medication Induced Immunosuppression

2020 ◽  
pp. 194589242094793
Author(s):  
Rahul Alapati ◽  
Jayakar V. Nayak ◽  
Peter H. Hwang ◽  
Zara M. Patel
Keyword(s):  
Chronic Rhinosinusitis ◽  
Surgical Management ◽  
Medical Management ◽  
Care Center ◽  
Tertiary Care ◽  
Treatment Pathways ◽  
Acute Rhinosinusitis ◽  
Significant Difference ◽  
Immunosuppressed Patients ◽  
Snot 22

Background There is no data currently available to direct nuanced treatment for recurrent acute and chronic rhinosinusitis (RARS, CRS) in patients on daily, long term medications that suppress the immune system. Objective This study sought to evaluate the outcomes of different treatment pathways when treating immunosuppressed patients with chronic rhinosinusitis or recurrent acute rhinosinusitis. Methods A retrospective review of patients on immune suppressing medication presenting to a tertiary care center with RARS or CRS between the years 2014–2019 was completed. Patients were categorized into three groups based on treatment: medical management alone (MM), surgery after medical management (SAMM), or upfront surgery (US). Lund-Kennedy scores (LKS) and SNOT-22 scores were evaluated at baseline, 1 month, 3 months and 6 months from presentation. Results 68 patients met inclusion criteria, with no difference in demographics between groups. Patients who were treated with US and SAMM had significantly higher baseline LKS than those who were treated with MM alone (p = 0.050, p = 0.039). Once this difference was controlled for, there was no significant difference in overall change of LKS between the three groups over time. There was no significant disparity in baseline SNOT-22 scores between the three groups, but patients who underwent US had a significantly higher improvement in SNOT-22 from baseline compared to those undergoing MM alone (p = 0.013). Conclusion Patients experiencing chronic rhinosinusitis and recurrent acute rhinosinusitis who are taking immunosuppressive medication can significantly improve from both medical and surgical management, but upfront surgical management appears to result in greater disease resolution relative to medical management in those with CRS. More study is needed in the RARS patient population regarding upfront surgery versus medical management.

Comparing the effects of cold compress and Xyla-p cream on hemodynamic changes in hemodialysis patients during venipuncture

2019 ◽  
Vol 17 (2) ◽  
Author(s):  
Ziba Ghoreyshi ◽  
Monireh Amerian ◽  
Farzaneh Amanpour ◽  
Reza Mohammadpourhodki ◽  
Hossein Ebrahimi
Keyword(s):  
Blood Pressure ◽  
Physiological State ◽  
Vital Signs ◽  
Hemodialysis Patients ◽  
Control Group ◽  
Intermittent Hemodialysis ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
The Difference

AbstractBackgroundThe vital signs reflect the physiological state of patients in various clinical conditions. The purpose of this study was to compare the effects of cold compress and Xyla-P cream on hemodynamical changes during venipuncture in hemodialysis patients.Methods and MaterialIn this clinical trial study, 50 patients under hemodialysis were selected by simple random sampling. The patients were then randomly assigned to either Xyla-P cream, cold compress or placebo groups. The vital signs (blood pressure and pulse) were measured upon two intermittent hemodialysis sessions before and after venipuncture. Data were analyzed using repeated measures analysis of variance.ResultsThe mean alternation in systolic blood pressure was significantly different comparing the placebo and cold compress groups before and after intervention (p<0.001). However, the difference was not significant between the Xyla-P cream group and either placebo (p=0.402) or ice compress (p=0.698) groups. The difference of the mean diastolic blood pressure was significant comparing the placebo group with either the Xyla-P cream group (p=0.003) or cold compress group (p<0.001) before and after intervention. In addition, there was a significant difference in the mean number of heartbeats comparing the control group with either the Xyla-P cream group (p<0.001) or cold compress group (p<0.001) before and after the intervention.ConclusionsConsidering the beneficial effects of ice compress and the Xyla-P cream on reduction of cardiovascular parameters, it is recommended to use these methods in hemodialysis patients during venipuncture.

Medical and surgical management of spinal epidural abscess: a systematic review

2014 ◽  
Vol 37 (2) ◽  
pp. E4 ◽  
Author(s):  
Leopold Arko ◽  
Eric Quach ◽  
Vincent Nguyen ◽  
Daniel Chang ◽  
Vishad Sukul ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Management ◽  
Medical Therapy ◽  
Medical Management ◽  
Epidural Abscess ◽  
Nonoperative Treatment ◽  
Spinal Epidural Abscess ◽  
Nonsurgical Management ◽  
Significant Difference ◽  
Spinal Epidural

Object Spinal epidural abscess (SEA) is a rare condition that has previously been treated with urgent surgical decompression and antibiotics. Recent availability of MRI makes early diagnosis possible and allows for the nonoperative treatment of SEA in select patients. The first retrospective review of medically and surgically managed SEA was published in 1999, and since that time several other retrospective institutional reports have been published. This study reviews these published reports and compares pooled data with historical treatment data. Methods A PubMed keyword and Boolean search using (“spinal epidural abscess” OR “spinal epidural abscesses” AND [management OR treatment]) returned 429 results. Filters for the English language and publications after 1999 were applied, as the first study comparing operative and nonoperative management was published that year. Articles comparing operative to nonoperative treatment strategies for SEA were identified, and the references were further reviewed for additional articles. Studies involving at least 10 adult patients (older than 18 years) were included. Case reports, studies reporting either medical or surgical management only, studies not reporting indications for conservative management, or studies examining SEA as a result of a specific pathogen were excluded. Results Twelve articles directly comparing surgical to nonsurgical management of SEA were obtained. These articles reported on a total of 1099 patients. The average age of treated patients was 57.24 years, and 62.5% of treated patients were male. The most common pathogens found in blood and wound cultures were Staphylococcus aureus (63.6%) and Streptococcus species (6.8%). The initial treatment was surgery in 59.7% of cases and medical therapy in 40.3%. This represented a significant increase in the proportion of medically managed patients in comparison with the historical control prior to 1999 (p < 0.05). Patients with no neurological deficits were significantly more likely to be treated medically than surgically (p < 0.05). There was no statistically significant difference overall between surgical and nonsurgical management, although several risk factors may predict failure of medical management. Conclusions . Since the first reports of nonoperative treatment of SEA, there has been a substantial trend toward treating neurologically intact patients with medical management. Nevertheless, medical therapy fails in a fair number of cases involving patients with specific risk factors, and patients with these risk factors should be closely observed in consideration for surgery. Further research may help identify patients at greater risk for failure of medical therapy.

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