scholarly journals Tubo-Ovarian Abscesses: Epidemiology and Predictors for Failed Response to Medical Management in an Asian Population

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Grace Ming Fen Chan ◽  
Yoke Fai Fong ◽  
Kai Lyn Ng
Keyword(s):  
Medical Treatment ◽  
Medical Therapy ◽  
Medical Management ◽  
Asian Population ◽  
Tertiary Hospital ◽  
Reproductive Age ◽  
Multivariate Logistic Regression Model ◽  
Prolonged Hospitalization ◽  
Intravenous Antibiotics ◽  
Invasive Intervention

Pelvic inflammatory disease (PID) complicated by tubo-ovarian abscesses (TOA) has long-term sequelae in women of reproductive age. Consensus on the optimal treatment of TOA remains lacking. Most clinicians utilize antibiotics as a first-line conservative approach, failing which invasive intervention is adopted. Our aim is to identify risk factors predicting failed response to conservative medical management for TOA in an Asian population. A retrospective cohort study of 136 patients admitted to a tertiary hospital in Singapore for TOA between July 2013 and December 2017 was performed. Patients were classified into 2 groups: successful medical treatment with intravenous antibiotics and failed medical treatment requiring invasive intervention. 111 (81.6%) of patients were successfully treated with conservative medical approach using intravenous antibiotics; 25 (18.4%) required invasive intervention having failed medical therapy. Multivariate logistic regression model adjusted for age, ethnicity, C-reactive Protein (CRP), TOA size, and body mass index (BMI) showed the odds ratio (OR) of each centimetre increase in TOA size to be 1.28 (95% confidence interval (CI) 1.03-1.61; P=0.030) and every kg/m2 increase in BMI to be 1.10 (95% CI 1.00-1.21; P=0.040). Failed medical management was predicted by a cutoff of TOA size ≥ 7.4 cm and ≥ BMI 24.9 kg/m2. Patients who failed medical treatment received a mean of 4.0±2.1 days of antibiotics before a decision for invasive intervention was made, with a significantly longer intravenous antibiotic duration (9.4±4.3 versus 3.6±2.2 days; P <0.001) and prolonged hospitalization (10.8± 3.6 versus 4.5 ± 2.0 days; P <0.001) compared to the medical group. Patients with higher BMI and larger TOA size were associated with failed response to conservative medical management in our study population. Early identification of these patients for failed medical therapy is imperative for timely invasive intervention to avoid prolonged hospitalization, antibiotic usage, and patient morbidity.

Chronic kidney disease, pregnancy and haemodialysis: Case reports from a single centre in Kenya and literature review

2021 ◽  
pp. 1753495X2098540
Author(s):  
Samuel K Kabinga ◽  
Jackline Otieno ◽  
John Ngige ◽  
Seth O Mcligeyo
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Case Reports ◽  
Tertiary Hospital ◽  
Reproductive Age ◽  
Review Of Literature ◽  
Single Centre ◽  
End Stage Kidney Disease ◽  
Women Of Reproductive Age ◽  
End Stage

Chronic kidney disease (CKD) and end stage kidney disease are prevalent even in women of reproductive age. These are known to reduce fertility and successful pregnancy. There are chances of conception even in advanced CKD, though laden with complications. We present two cases of women who conceived in advanced CKD and are on haemodialysis in a tertiary hospital in Kenya and review of literature.

scholarly journals Medical management of deeply infiltrating endometriosis - 7 year experience in a tertiary endometriosis centre in London

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Marianne Wild ◽  
Tariq Miskry ◽  
Asmaa Al-Kufaishi ◽  
Gillian Rose ◽  
Mary Crofton
Keyword(s):  
Medical Management ◽  
Obstructive Uropathy ◽  
Intrauterine Device ◽  
Secondary Analysis ◽  
Surgical Excision ◽  
Hormonal Contraceptive ◽  
Reproductive Age ◽  
Deeply Infiltrating Endometriosis ◽  
Hormonal Therapies ◽  
Infiltrating Endometriosis

Abstract Background Deeply infiltrating endometriosis has an estimated prevalence of 1% in women of reproductive age. Ninety percent have rectovaginal lesions but disease may also include the bowel, bladder and ureters. Current practice often favours minimally invasive surgical excision; however, there is increasing evidence that medical management can be as effective as long as obstructive uropathy and bowel stenosis are excluded. Our objective was to establish the proportion of women with deeply infiltrating endometriosis successfully managed with hormonal therapies within our tertiary endometriosis centre in West London. Secondary analysis was performed on anonymised data from the Trust’s endometriosis database. Results One hundred fifty-two women with deeply infiltrating endometriosis were discussed at our endometriosis multidisciplinary meeting between January 2010 and December 2016. Seventy-five percent of women underwent a trial of medical management. Of these, 44.7% did not require any surgical intervention during the study period, and 7.9% were symptomatically content but required interventions to optimise their fertility prospects. Another 7.0% were successfully medically managed for at least 12 months, but ultimately required surgery as their symptoms deteriorated. 26.5% took combined oral contraceptives, 14.7% oral progestogens, 1.5% progestogen implant, 13.2% levonorgestrel intrauterine device, 22.1% gonadotrophin-releasing hormone analogues, and 22.1% had analogues for 3–6 months then stepped down to another hormonal contraceptive. All women who underwent serial imaging demonstrated improvement or stable disease on MRI or ultrasound. Conclusions Medical treatments are generally safe, well tolerated and inexpensive. More than half (52.6%) of women were successfully managed with medical therapy to control their symptoms. This study supports the growing evidence supporting hormonal therapies in the management of deeply infiltrating endometriosis. The findings may be used to counsel women on the likely success rate of medical management.

Five-Year Follow-Up of the Medicine, Angioplasty, or Surgery Study (MASS)

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Whady A. Hueb ◽  
Paulo Rogério Soares ◽  
Sérgio Almeida de Oliveira ◽  
Shiguemituzo Ariê ◽  
Rita Helena A. Cardoso ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Medical Treatment ◽  
Medical Therapy ◽  
Stable Angina ◽  
Coronary Angioplasty ◽  
Bypass Surgery ◽  
Random Assignment

Background —Although coronary angioplasty and myocardial bypass surgery are routinely used, there is no conclusive evidence that these interventional methods offer greater benefit than medical therapy alone. This study is intended to evaluate, in a prospective, randomized, and comparative analysis, the benefit of the 3 current therapeutic strategies for patients with stable angina and single proximal left anterior descending coronary artery stenosis. Methods and Results —In a single institution, 214 patients with stable angina, normal ventricular function, and severe proximal stenosis (>80%) on the left anterior descending artery were selected for the study. After random assignment, 70 patients were referred to surgical treatment, 72 to angioplasty, and 72 to medical treatment. The primary end points were the occurrence of acute myocardial infarction or death and presence of refractory angina. After a 5-year follow-up, these combined events were reported in only 6 patients referred to surgery as compared with 29 patients treated with angioplasty and 17 patients who only received medical treatment ( P =0.001). However, no differences were noted in relation to the occurrence of cardiac-related death in the 3 treatment groups ( P =0.622). No patient assigned to surgery needed repeat operation, whereas 8 patients assigned to angioplasty and 8 patients assigned to medical treatment required surgical bypass after the initial random assignment. Surgery and angioplasty reduced anginal symptoms and stress-induced ischemia considerably. However, all 3 treatments effectively improved limiting angina. Conclusions —Bypass surgery for single-vessel coronary artery disease is associated with a lower incidence of medium-term and long-term events as well as fewer anginal symptoms than that found in the patients who underwent angioplasty or medical therapy. In this study, coronary angioplasty was only superior to medical strategies in relation to the anginal status. However, the 3 treatment regimens yielded a similar incidence of acute myocardial infarction and death. Such information should be useful when choosing the best therapeutic option for similar patients.

scholarly journals Medical Management of Ectopic Pregnancy: An Observational Study

2016 ◽  
Vol 29 (1) ◽  
pp. 32-36
Author(s):  
Shahana Begum ◽  
Rowshan Akhtar
Keyword(s):  
Single Dose ◽  
Observational Study ◽  
Medical Treatment ◽  
Ectopic Pregnancy ◽  
Medical Management ◽  
Progesterone Level ◽  
Fertility Treatment ◽  
Intrauterine Pregnancy ◽  
College Hospital ◽  
Serum Progesterone

Objectives: The aim of this study was to explore the safety and efficacy of medical management of ectopic pregnancy.Materials and methods: This prospective observational study was conducted between February 2011 to August 2013 in Chittagong Medical College Hospital (CMCH) and in different private clinics of Chittagong city. Twenty-seven patients of ectopic pregnancy conceived by fertility treatment were recruited for medical treatment after proper evaluation. Ectopic pregnancy was diagnosed by serum ?-hCG and progesterone level but missing intrauterine pregnancy by transabdominal sonography (TAS). Serum ?-hCG was repeated after 48 hours to observe doubling of the level. If level was not doubled or increment was not at least 66% and serum progesterone level was less than 15ng/ml then it was considered as ectopic pregnancy. Patients were treated with Injection methotrexate 50 mg intramuscularly either by single dose or two doses. After 4 days of 1st injection ?-hCG was repeated and if level decreased > 15% then patients were assessed weekly till ?-hCG fell to <5lU/L. If drop was <15% after 4 days a second dose of methotrexate was given.Results: Overall success rate was 66.66% . Surgical intervention was needed in 22.22% patients. All patients were treated after hospitalization in CMCH and different private clinics of Chittagong. They got injection methotrexate, antibiotic, antispasmodic and analgesics for abdominal pain. Single dose cured 55.55% patients and 11.11% patients needed second dose, another 11.11% patients were misdiagnosed –later on they were diagnosed as intrauterine pregnancy and medical termination was done. Within one year of treatment 33.33% patients conceived again. There was no side effect or complications of the treatment.Conclusion: This small trial gave a good impression about medical treatment in selective cases. The efficacy should be assessed in a randomized clinical trial with a different set of populationBangladesh J Obstet Gynaecol, 2014; Vol. 29(1) : 32-36

scholarly journals Stereotactic aspiration for hypertensive intracerebral haemorrhage in a Chinese population: a retrospective cohort study

2019 ◽  
Vol 4 (1) ◽  
pp. 14-21
Author(s):  
Xuyang Zhang ◽  
Shaolong Zhou ◽  
Qiang Zhang ◽  
Xudong Fu ◽  
Yuehui Wu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Medical Treatment ◽  
Intracerebral Haemorrhage ◽  
Medical Management ◽  
Favourable Outcome ◽  
Rank Test ◽  
Therapeutic Effects ◽  
Stereotactic Aspiration ◽  
Conservative Group ◽  
Kaplan Meier

ObjectiveWe aimed to compare the therapeutic effects of stereotactic aspiration and best medical management in patients who developed supratentorial hypertensive intracerebral haemorrhage (HICH) with a volume of haemorrhage between 20 and 40 mL.MethodsThe clinical data of 220 patients with supratentorial HICH with a volume between 20 and 40 mL were retrospectively analysed. Among them, 142 received stereotactic aspiration surgery (stereotactic aspiration group) and 78 received best medical management (conservative group). All were followed up for 6 months. Multivariate logistic regression and Kaplan-Meier survival curves were used to compare the outcome between the two groups.ResultsThe rebleeding rate was lower in the group that had stereotactic aspiration when compared with the group with medical treatment (6 [4.2%] vs 9 [11.5%], χ2=4.364, p=0.037). After 6 months, although the mortality rate did not differ significantly between the two groups (8 cases [5.6%] vs 10 cases [12.8%], χ2=3.461, p=0.063), the rate of a favourable outcome was higher in the group who received stereotactic aspiration (χ2=15.870, p=0.000). Logistic regression identified that medical treatment (OR=1.64, p=0.000) was an independent risk factor for an unfavourable outcome. The Kaplan-Meier curves indicated that the median favourable outcome time in the stereotactic aspiration group was 59.5 days compared with that in the medically treated group (87.0 days). The log-rank test indicated that the prognosis at 6 months was better for those treated with stereotactic haematoma aspiration (χ2=29.866, p=0.000). However, the 6-month survival rate was similar between the two groups (χ2=3.253, p=0.068).ConclusionsStereotactic haematoma aspiration significantly improved the quality of life, although did not effectively reduce the rate of mortality. When selected appropriately, patients with HICH may benefit from this type of surgical intervention.

scholarly journals Prevalence of sexually transmitted infections at a tertiary hospital in Tamil Nadu

2017 ◽  
Vol 6 (8) ◽  
pp. 3573
Author(s):  
Durga K. ◽  
Karthika K.
Keyword(s):  
Risk Factors ◽  
Sexually Transmitted Infections ◽  
Tamil Nadu ◽  
Tertiary Hospital ◽  
Good Evidence ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Asymptomatic Group ◽  
Major Health Problem ◽  
Sexually Transmitted

Background: Sexually transmitted infections (STIs) present a huge burden of disease and adversely affect the reproductive health of people. The disease prevalence is about 6% in India. This study is done to determine the prevalence of STIs in women of reproductive age (15-49yrs) attending gynaec outpatient block at Institute of Obstetrics and Gynaecology, Chennai and to identify the risk factors.Methods: It is a prospective analytical study conducted at IOG from Febraury 2010 to January 2011 where 1000 women of reproductive age attending gynec op were included of which 500 women were asymptomatic and 500 women were symptomatic for STIs. A well-structured proforma was prepared for selection of women, history, examination, investigations and treatment. Asymptomatic women were also screened and treated. Partners were also screened and treated. Depending upon the statistical data, the risk factors were identified and analysed.Results: Overall prevalence of STI was 27.2% of which 22.5% was in symptomatic group and 4.7% in asymptomatic group. Bacterial vaginosis was the commonest STI. The important risk factors identified were age group between 26-30 years, high risk sexual behaviours, poor socioeconomic factors, poor menstrual hygiene and lack of contraception.Conclusions: STIs cause major health problem and it is important to diagnose and treat them at the earliest. The importance of STIs has been more widely recognised since the advent of the HIV/AIDS epidemic, and there is good evidence that their control can reduce HIV transmission. Women diagnosed with one STI should be screened for other STI due to coexistant infections. Screening and treatment of partners and follow-up tests of cure should be performed wherever possible.

Medical management of appendicitis in early-term pregnancy

2020 ◽  
Vol 13 (8) ◽  
pp. e234252
Author(s):  
Amin Tavakoli ◽  
Paul Wadensweiler ◽  
Elizabeth Blumenthal ◽  
Eric Kuncir ◽  
Roozbeh Houshyar ◽  
...  
Keyword(s):  
Medical Management ◽  
Evidence Base ◽  
Surgical Anatomy ◽  
Clinical Scenario ◽  
Term Pregnancy ◽  
Limited Evidence ◽  
Future Studies ◽  
Early Term ◽  
Additional Information ◽  
Intravenous Antibiotics

A 19-year-old G1 at 37 weeks presented with acute non-ruptured appendicitis. Her advanced gestational age and surgical anatomy presented a complex surgical scenario. She was treated with intravenous antibiotics and induction of labour, which resulted in resolution of the appendicitis and an uncomplicated vaginal delivery at early term. This case is an example that appendicitis occurring in early-term pregnancy can be successfully managed with intravenous antibiotics, but this is a complex clinical scenario with a limited evidence base to make management decisions. Future studies of medical management of appendicitis in pregnancy, specifically in later gestation, are needed to provide additional information to guide clinicians.

scholarly journals Application of the 2017 McDonald criteria in a Chinese population with clinically isolated syndrome

2020 ◽  
Vol 13 ◽  
pp. 175628641989808
Author(s):  
Yang Zheng* ◽  
Chun-Hong Shen* ◽  
Sa Wang ◽  
Fan Yang ◽  
Meng-Ting Cai ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Diagnostic Performance ◽  
Age Of Onset ◽  
Asian Population ◽  
Tertiary Hospital ◽  
Clinically Isolated Syndrome ◽  
Chinese Patients ◽  
Mcdonald Criteria ◽  
Lower Specificity ◽  
Higher Sensitivity

Background: Diagnostic criteria for multiple sclerosis have evolved over time, with the most recent being the 2017 McDonald criteria. Evidence is lacking regarding the validity of the 2017 McDonald criteria among the Asian population. Therefore, this study aims to evaluate the diagnostic performance of the 2017 McDonald criteria in Chinese patients with clinically isolated syndrome (CIS). Methods: A total of 93 patients with initial findings suggestive of CIS in a tertiary hospital in China from 2012 to 2017 were included in this retrospective study. Baseline and follow-up data were reviewed. Diagnostic performance (sensitivity, specificity, accuracy), was assessed and survival analysis was performed for the 2017 and 2010 McDonald criteria respectively. Results: Among the 93 Chinese patients with CIS, 57 were female (61.3%) and the median (interquartile range) age of onset was 37 (31.3–41.8) years. The 2017 McDonald criteria displayed a higher sensitivity (75.0% versus 14.6%, p < 0.0001), lower specificity (47.1% versus 100.0%, p < 0.05) but an overall higher accuracy (67.7% versus 36.9%, p < 0.0001) when compared with the 2010 iteration. The novel criteria allow for a better detection of MS at baseline (40.8% versus 9.9%, p < 0.0001). Conclusion: The 2017 McDonald criteria had a higher sensitivity but lower specificity than the 2010 iteration. Overall it facilitated an earlier and more accurate diagnosis of multiple sclerosis in Chinese patients with CIS.

scholarly journals Symptomatic intracranial arterial disease: incidence, natural history, diagnosis, and management

2011 ◽  
Vol 30 (6) ◽  
pp. E14 ◽  
Author(s):  
Ananth K. Vellimana ◽  
Andria L. Ford ◽  
Jin-Moo Lee ◽  
Colin P. Derdeyn ◽  
Gregory J. Zipfel
Keyword(s):  
Natural History ◽  
Medical Therapy ◽  
Endovascular Therapy ◽  
Medical Management ◽  
Surgical Intervention ◽  
Disease Incidence ◽  
Arterial Disease ◽  
High Rate ◽  
Diagnosis And Management ◽  
Ischemic Events

Symptomatic intracranial arterial disease is associated with a high rate of recurrent ischemic events. The management of this condition is controversial, with some advocating medical therapy as a sole means of treatment and others recommending endovascular therapy in addition to best medical management. In rare cases, surgical intervention is considered. A thorough review of the available literature was performed, and treatment recommendations based on these data are provided.

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