scholarly journals Effects of hormone therapy on the endometrium in postmenopausal women: a one year randomized trial of low dose oral estradiol in association with a levonorgestrel-releasing intrauterine system or drospirenone

2013 ◽  
Vol 13 (3) ◽  
pp. 259-266
Author(s):  
Luiza Schvartzman ◽  
José Antônio Magalhães ◽  
Fernando Monteiro de Freitas ◽  
Carolina Pereira ◽  
Julia Azevedo ◽  
...  
Keyword(s):  
Low Dose ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
Histological Evaluation ◽  
Categorical Variables ◽  
Kupperman Index ◽  
Dose Oral ◽  
Student’S T ◽  
One Year ◽  
Student’S T Test

OBJECTIVES: to compare the endometrial effects and uterine bleeding patterns associated with treatment using (1) levonorgestrel-releasing intrauterine system (LNG-IUS) and estradiol (1 mg/day, p.o.) or (2) orally administered drospirenone (2 mg/day) andestradiol (1 mg/day). METHODS: thirty-four patients (aged 52.53 ± 4.44 in the LNG-IUS group and 53.15 ± 4.018 in the DRSP group) were randomized. The severity of menopausal symptoms was evaluated using the Kupperman index every three months. Transvaginal ultrasound, hysteroscopy and histological evaluation were repeated after 12 months. During this period, patients kept menstrual calendars. All categorical variables were described as percentages. Variables were tested for normal distribution and Student's t test was applied for independent samples and ANOVA forrepeated measures when appropriate. Data were considered to be significant when p<0.05. RESULTS: slight vaginal bleeding was reported in the first month of treatment by 53.3% of patients from the LNG-IUS/estradiol group compared with 7.7% of patients from the drospirenone/estradiol group. There were no differences in endometrial thickness between the two groups throughout the study period. End-of-study histological findings showed atrophic endometrium in 53.3% of patients in the LNG-IUS/estradiol group compared with 76.9% of patients in the drospirenone/estradiol group. CONCLUSIONS: our results suggest good endometrial protection with both HT regimens.

scholarly journals Characteristics of Down syndrome subjects in a Saudi sample

2013 ◽  
Vol 84 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Mohammed A. Korayem ◽  
Eman A. AlKofide
Keyword(s):  
Down Syndrome ◽  
Normal Subjects ◽  
Cranial Base ◽  
Effective Length ◽  
Categorical Variables ◽  
Mean Values ◽  
Nasolabial Angle ◽  
The Mean ◽  
Student’S T ◽  
Student’S T Test

ABSTRACT Objective: To compare the cephalometric characteristics of Down syndrome (DS) subjects with those of normal subjects. Materials and Methods: Cephalometric radiographs of 60 Saudi DS subjects and 60 controls with specific inclusion criteria were used. Descriptive statistics were used to describe the quantitative and categorical variables, and the Student's t-test for two independent samples was used to compare the mean values of quantitative variables. Results: SBa and SN were higher in controls than in DS subjects, whereas the NSBa was significantly higher in DS subjects than in controls. SNA, Co-A, ANB, and A-Na perp of controls were higher than the DS subjects. However, SN-MP, PP-MP, ANS-Me/N-Me, Y-axis, and Ar-Go-Me of the DS subjects were higher than those of the controls. In addition, U1-NA, U1-NA mm, L1-NB, and L1-NB mm of the DS subjects were also higher than the controls with a more acute U1-L1 angle in DS. NLA was larger in controls than in DS, whereas LL-E and UL-E of the DS subjects were higher than the controls. Conclusions: Differences between DS subjects and controls can be found when examining cephalometric radiographs. Anterior and posterior cranial base lengths are shorter with a backward inclination of the posterior cranial base in DS subjects. DS subjects present with a retrognathic maxilla and shorter effective length, with an increased LFH and a hyperdivergent mandible. Bimaxillary dental protrusion can also be expected in DS subjects with prominent lips and a reduced nasolabial angle.

scholarly journals MP01: Retention and treatment outcomes for patients with substance use disorders treated in a rapid access to addiction medicine clinic

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S42
Author(s):  
D. Wiercigroch ◽  
H. Sheikh ◽  
J. Hulme
Keyword(s):  
Substance Use ◽  
Retention Rates ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Opioid Use ◽  
Addiction Medicine ◽  
Microsoft Excel ◽  
Student’S T ◽  
Withdrawal Management ◽  
Student’S T Test

Introduction: Substance use is prevalent in Canada yet treatment for alcohol use disorder (AUD) and opioid use disorder (OUD) is often inaccessible. Consequently, alcohol and opioid-related diagnoses such as intoxication, withdrawal, and overdose are a major reason for frequent emergency department (ED) visits. The Rapid Access to Addiction Medicine (RAAM) Clinic opened at the University Health Network (UHN) in January 2018 as part of a larger network of clinics in Toronto, and provides rapid, low barrier access to medical treatment for substance use disorder (SUD). Patients attended via self-referral, peer-referral, or referral by the ED, primary care, internal medicine or withdrawal management services. This study describes the demographic profile and short-term outcomes for patients attending a new RAAM clinic in its first 26 weeks of operation, including substance use and treatment retention for AUD and OUD. Methods: We reviewed the electronic medical record at the clinic over its first 26 weeks of operation. We assessed SUD diagnoses, referral source, prescribed medications, self-reported outcomes and retention rates. We calculated descriptive statistics using proportions for categorical variables and means with standard error for continuous variables. A student's t-test was used for all statistical analyses using Microsoft Excel. We reviewed the electronic medical record at the clinic over its first 26 weeks of operation. We assessed SUD diagnoses, referral source, prescribed medications, self-reported outcomes and retention rates. We calculated descriptive statistics using proportions for categorical variables and means with standard error for continuous variables. A student's t-test was used for all statistical analyses using Microsoft Excel. Results: The clinic saw 64 unique patients: 66% had an AUD, 39% had an OUD and 20% had a stimulant use disorder. 55% of patients were referred from outpatient care providers, 30% from the emergency department and 11% from withdrawal management services. 42% remained ongoing patients, 23% were discharged to other care and 34% were lost to follow-up. Gabapentin (38%), naltrexone (33%), and acamprosate (20%) were most frequently prescribed for AUD. Patients with AUD reported a significant decrease (p &lt; 0.05) in alcohol consumption at their most recent visit compared to their initial visit. Most patients (78%) with OUD were prescribed buprenorphine, and most (89%) patients with OUD on buprenorphine had a negative urine screen at their most recent visit. Conclusion: A new RAAM outpatient clinic demonstrates the early success of a low-barrier addictions model in addressing unmet needs in substance use treatment. We see a reduction in both alcohol consumption and opioid use, and increased access to evidence-based pharmacotherapy for SUDs.

Assessment of the quality of mobile applications created for arbovirus prevention in Brazil using the Mobile Apps Rating Scale (MARS): review and analysis of content (Preprint)

2019 ◽  
Author(s):  
Victor Albino ◽  
Izabelly Dutra Fernandes ◽  
Ricardo Gomes ◽  
Tais Acácia Santos-Silva ◽  
Roberta Smania-Marques ◽  
...  
Keyword(s):  
Health Promotion ◽  
Rating Scale ◽  
T Test ◽  
Categorical Variables ◽  
Cronbach’S Alpha ◽  
Cronbach's Alpha ◽  
Significant Difference ◽  
Student’S T ◽  
Student’S T Test

BACKGROUND In Brazil, the prevalence of diseases caused by arboviruses has increased alarmingly in recent years. Information and communication technologies, especially mobile technologies, has been used to engage the population and to change their practices in order to control the rising of mosquitos. OBJECTIVE The objective of this study was to perform a survey of the applications (apps) created for prevention and health promotion in relation to arbovirus diseases transmitted by Aedes Aegypti – such as dengue, zika and chikungunya – as well as classify the quality of these apps based on the Mobile App Rating Scale (MARS). The assessment also investigated whether these apps were elaborated considering the theories of behaviour change. METHODS The analysis of the apps for mobile devices was performed using the Android operating system and the Google’s app store. The search terms used were "Chikungunya", "Dengue" and "Zika". The apps were independently analysed by two researchers after a period of training using the MARS scale. Student's T-test was performed to compare the means obtained by the two researchers in order to evaluate if they had a significant difference at the 5% level. The Kappa test was used to evaluate the interobserver agreement for binary categorical variables and for variables using Likert scale. The reliability of the scale was estimated using the Cronbach's alpha coefficient. RESULTS Many of the evaluated apps accomplish their goals of transmitting information in an interactive way, but they do not necessarily have the purpose of influencing their users to change behaviours related to the control of disease-vector mosquitoes. Student's T-test did not show significant differences in scores of the different sections of the MARS except for the engagement. Three variables had an almost perfect or strong agreement using Kappa (above 0.61): whether the apps could be classified as informative, had a geolocation feature and were used to entertainment. Cronbach’s Alpha showed good reliability of the MARSs. This study also showed that it is necessary to create and regulate evaluation, dissemination and storage policies for these apps so that, over the years, a deeper analysis of the role of these tools in health promotion can be investigated and better understood. CONCLUSIONS In Brazil, the vast majority of apps, created to prevent arboviroses, were developed for informational or entertainment purposes and they were not explicitly based on health behaviour theories.

Sonographic Correlation between Endometrial Thickness and Infertility - A systematic review

2021 ◽  
Vol 15 (6) ◽  
pp. 1145-1148
Author(s):  
Z. Siddique ◽  
S. K. T. S. Murrium ◽  
S. Sana ◽  
R. Bacha ◽  
S. Sana ◽  
...  
Keyword(s):  
Endometrial Thickness ◽  
Imaging Modality ◽  
Transvaginal Ultrasound ◽  
Diagnostic Techniques ◽  
Unprotected Sex ◽  
Transvaginal Sonography ◽  
Diagnostic Features ◽  
Electronic Database Search ◽  
One Year ◽  
High Level

Background: Infertility is defined as not conceiving after one year of unprotected sex. Apart from age, physical and hormonal misbalance, and lifestyle or environmental factors for infertility; Endometrial thickness has an important role in conception. Females with the 8-12mm endometrial thickness in the late proliferative phase had great chances to get conceive. Aim: To determine the sonographic diagnostic features of the endometriumthickness with Transvaginal high-resolution ultrasound are predictive of infertility. Methods: An electronic database search was performed (Google Scholar, Science Direct, and PubMed) with the data range from 1988 to 2020.All studies, fully-available in English, assessing the endometrial thickness in the gray-scale image on TAS/TVs. Results: Thirty-three articles were found, we evaluated the performance of ultrasound diagnostic techniques, for the measurement of endometrial thickness, our results showed that ultrasound had a high level of diagnostic capability for measuring endometrial thickness. If endometrial thickness is more than 14mm or less than 7mm then chances of pregnancy were zero, so high chances of pregnancy when the endometrial thickness is 8mm to 11mm. Conclusion: We concluded that when the endometrial thickness was increased from 8 mm to 11 mm the chances of pregnancy were maximum, and when the thickness of endometrium was more than 14 mm or, less than 7 mm the pregnancy ratio was almost zero. Transvaginal ultrasound is an excellent imaging modality and its sensitivity is high for the measurement of endometrial thickness Keyword: Transvaginal sonography, endometrial thickness, Infertility

Cytrulline as a marker of complete or partial weaning off parenteral nutrition in adult patients – observatory pilot study

2018 ◽  
Vol 54 (1) ◽  
pp. 11-15
Author(s):  
Sylwia Osowska ◽  
Marek Kunecki ◽  
Wojciech Hilgier ◽  
Mohammad Omidi ◽  
Joanna Tokarczyk ◽  
...  
Keyword(s):  
Pilot Study ◽  
Parenteral Nutrition ◽  
Adult Patients ◽  
Plasma Samples ◽  
Plasma Citrulline ◽  
Significant Difference ◽  
Student’S T ◽  
One Year ◽  
And Function ◽  
Student’S T Test

Aim of the study: Citrulline is a recognized marker of small bowel mass and function. The aim of this study was to identify plasma citrulline concentration that permitted adult patients to be partially or completely weaned off total parenteral nutrtion (TPN).<br>Materials and Methods: We measured plasma citrulline in 29 adult TPN patients in Warsaw hospital in 2014 and 2015. We evaluated how many of those patients were weaned from TPN or whether there was a decrease in the frequency of parenteral nutrition (PN) over the following year. Citrulline was assayed in deproteinised plasma samples using HPLC with fluorescence detection after derivatization in a timed reaction with o-phtalaldehyde and mercaptoethanol as described by Kilpatric. The group of weaned patients were compared to the TPN-dependent using Student’s t-test.<br>Results: Citrulline levels among the 29 patients ranged from 6.1 to 44.9 μmol/L (average 19.9 μmol/L). Six patients were completely weaned off PN over one year. Their citrulline levels were between 19,5 and 44.9 (average 28,7) μmol/L and were the highest measured in the patient population. Four patients with citrulline levels between 19.0 and 30.6 (average 23.8) μmol/L) had PN 5 days each week. The 19 patients who were totally dependent on PN had citrulline levels between 6.1 and 18.8 (average 15.3) μmol/L. There was a statistically significant difference between weaned and dependent on parenteral nutrition patients (p=0.0001).<br>Conclusions: Patients receiving TPN who have a high blood citrulline level may be able to be weaned off PN. This may reflect better intestinal mass and function. Citrulline levels may be a good predictor for weaning patients off PN or diminishing the frequency of PN.

scholarly journals FC 035VOCLOSPORIN INCREASES RENAL RESPONSE AT COMMONLY USED UPCR THRESHOLDS IN PATIENTS WITH LUPUS NEPHRITIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Maria Dall'Era ◽  
Paola Mina-Osorio ◽  
Vanessa Birardi ◽  
Simrat Randhawa
Keyword(s):  
Lupus Nephritis ◽  
Primary Endpoint ◽  
Low Dose ◽  
Therapeutic Drug ◽  
Phase 3 ◽  
Renal Response ◽  
Dose Concentration ◽  
Dose Oral ◽  
One Year ◽  
Post Hoc

Abstract Background and Aims Voclosporin is a novel calcineurin inhibitor with a favorable metabolic profile and a consistent dose-concentration relationship, potentially eliminating the need for therapeutic drug monitoring. We have previously reported the primary endpoint of the Phase 3 AURORA trial showing the addition of voclosporin to mycophenolate mofetil (MMF) and a low-dose glucocorticoid regimen results in significantly higher renal response (RR) rates at one year of treatment compared to MMF and low-dose glucocorticoids alone in patients with lupus nephritis (LN). For the primary endpoint, RR was defined as ≤0.5 mg/mg UPCR with stable renal function in the presence of low-dose glucocorticoids and no use of rescue medication. Several studies have demonstrated that proteinuria represents the best single predictor for long-term renal outcomes.1,2 Given the efficacy of voclosporin in terms of proteinuria reduction, we conducted a sensitivity analysis evaluating RR with additional UPCR targets. Method A total of 179 participants in the voclosporin (23.7 mg BID) arm and 178 participants in the control arm from the AURORA trial were included in this analysis. All participants received MMF (target 1 g BID) and low-dose oral glucocorticoids (initiated at 20-25 mg/day and tapered to 2.5 mg/day at 16 weeks). For this post hoc analysis, the UPCR component of RR was revised to include UPCR targets at 0.2 mg/mg intervals above and below the original ≤0.5 target used for the primary endpoint in AURORA (i.e., ≤0.7 mg/mg or ≤0.3 mg/mg, respectively). Odds ratios for RR at six months and one year of treatment were analyzed using a logistic regression model with terms for treatment, baseline UPCR, biopsy class, and MMF use at baseline and region. Results RR with UPCR ≤0.7 mg/mg was achieved by 46.9% of participants in the voclosporin arm vs 32.0% of participants in the control arm at one year of treatment (OR 2.07, p&lt;0.0014) and 39.1% of participants in the voclosporin arm vs 24.7% of participants in the control arm at six months of treatment (OR 2.10, p=0.0020). RR with UPCR ≤0.3 mg/mg was achieved by 28.5% of participants in the voclosporin arm vs 15.7% of participants in the control arm at one year (OR 2.27, p=0.0023 and 22.9% of participants in the voclosporin arm vs 14.0% of participants in the control arm at six months of treatment (OR 1.90, p=0.0238; Table 1). Conclusion Participants treated with voclosporin in addition to MMF and low-dose glucocorticoids achieved statistically significantly increased renal response rates regardless of the level of UPCR used, including at an even more stringent ≤0.3 mg/mg target. This analysis further supports the efficacy observed with voclosporin in the Phase 3 AURORA and the prior Phase 2 AURA-LV global trials.

The Effectiveness of Misoprostol Single Dose Oral for Evacuation of Incomplete Abortion

2019 ◽  
Vol 16 (2) ◽  
pp. 159
Author(s):  
Eka Rusdianto Gunardi ◽  
Affan Solihin
Keyword(s):  
Single Dose ◽  
Side Effects ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
P Value ◽  
Operative Method ◽  
Incomplete Abortion ◽  
Oral Misoprostol ◽  
Significant Difference ◽  
Dose Oral

This study is aimed to find out the effectiveness of oral 600 mcg single dose misoprostol for the evacuation of conception remnant in cases of incomplete abortion. This research is done by quasi experimental method with one group pretest – posttest design. The population of the study is all women who were diagnosed with incomplete abortion in less than 12 weeks of gestation in Cipto Mangunkusumo National general Hospital and affiliations hospital from June 2018 to June 2019. Women who met the study criteria, was treated with oral misoprostol 600 mcg single dose and then undergo conception evacuation evaluation and side effects evaluation. Effectiveness evaluation was seen after 7 days of single dose 600 mcg of misoprostol by measuring <15 mm endometrial thickness on transvaginal ultrasound. The effectiveness of using single dose oral misoprostol 600 mcg in the study participants was 93.55%, which were 29 out of a total of 31 participants. The side effects experienced after being given misoprostol were bleeding with less than the same amount as menstruation (71.0% and 9.0%), diarrhea (6.5%), and shivering (67.7%), and not found side effects of vomiting. Based on data analysis using paired T test before and 24 hours after administration of misoprostol, there was a significant difference between endometrial thickness (p value <0.001). Misoprostol 600 mcg per oral dose is effective for the evacuation of retained conception tissue of incomplete abortion at less than 12 weeks gestation, so that it can be an alternative non-operative method of evacuating retained conception tissue in incomplete abortion cases other than the operative method. Side effects found were bleeding, diarrhea, and chills. Side effects of vomiting were not found in this study.

Use of a low-dose oral contraceptive containing norethindrone acetate and ethinyl estradiol in the treatment of moderate acne vulgaris

2001 ◽  
Vol 1 (3) ◽  
pp. 123-131 ◽  
Author(s):  
J. Michael Maloney ◽  
Deborah I. Arbit ◽  
Mary Flack ◽  
Constance McLaughlin-Miley ◽  
Cynthia Sevilla ◽  
...  
Keyword(s):  
Oral Contraceptive ◽  
Low Dose ◽  
Ethinyl Estradiol ◽  
Acne Vulgaris ◽  
Dose Oral ◽  
Dose Oral Contraceptive ◽  
Norethindrone Acetate

Ongoing randomized clinical trials for the treatment of thrombosis in the antiphospholipid syndrome

2001 ◽  
Vol 21 (02) ◽  
pp. 77-81 ◽  
Author(s):  
G. Finazzi
Keyword(s):  
Clinical Trials ◽  
Large Scale ◽  
Low Dose ◽  
Randomized Clinical Trials ◽  
Oral Anticoagulants ◽  
Collaborative Study ◽  
Clinical Problem ◽  
Vascular Events ◽  
Dose Oral ◽  
Adverse Pregnancy

SummaryThrombotic events are a major clinical problem for patients with antiphospholipid antibodies (APA). However, current recommendations for their prevention and treatment are still based on retrospective studies. Data from large scale, prospective clinical trials are required to ultimately identify the optimal management of these patients. To date, at least four randomized studies are underway. The WAPS and PAPRE clinical trials are aimed to establish the correct duration and intensity of oral anticoagulation in APA patients with major arterial or venous thrombosis. The WARSS-APASS is a collaborative study to evaluate the efficacy and safety of aspirin or low-dose oral anticoagulants in preventing the recurrence of ischemic stroke. The recently announced UK Trial compares low-dose aspirin with or without low-intensity anticoagulation for the primary prevention of vascular events in APA-positive patients with SLE or adverse pregnancy history, but still thrombosis-free. It is hoped that the results of these trials will be available soon since clinicians urgently need more powerful data to treat their patients with the APA syndrome.

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