scholarly journals Expectant versus surgical management of incomplete abortions caused by self-intake of abortifacient drugs: results from a randomized controlled trial

2021 ◽  
Vol 10 (6) ◽  
pp. 660
Author(s):  
Ankita Singh ◽  
Devendra Singh Kushwah ◽  
Neha Khatik ◽  
Beenu Kushwah
Keyword(s):  
Success Rate ◽  
Controlled Trial ◽  
Expectant Management ◽  
Successful Outcome ◽  
Controlled Study ◽  
Self Administration ◽  
Randomized Controlled ◽  
Number Of Patients ◽  
Group 2 ◽  
Group 1

Background: Termination of unwanted pregnancies with medical method using recommended protocol based abortifacient drugs is a standard practice followed by obstetricians and gynaecologists worldwide which has a very successful outcome. However, self-administration of these drugs has become rampant because of certain social and practical issues resulting in complications and incomplete abortions as when these drugs are self-administered, recommended protocol is not generally followed. Traditionally incomplete abortions are managed by surgical curettage which itself is associated with procedure related complication and has been challenged by recent studies. Based on these studies many international guidelines have come out in support of expectant management of incomplete abortions. This study compared both of these management protocols to treat incomplete abortions caused by unprescribed intake of abortifacient drugs.Methods: This was a one-year long prospective randomized controlled study in which total 782 females were randomized into two groups of 371 and 411. Group 1 was offered expectant management while group 2 was offered surgical curettage. Results were analysed using appropriate statistical tests.Results: Group 1 showed a success rate of 86% while group 2 showed a success rate of 90% which was comparable. Overall complication rate was found to be higher in Surgical curettage group than in the group which underwent expectant management group.Conclusions: Considering a very high number of patients coming with incomplete abortions caused by self-medication in present practice, expectant management seems to be a safer and more effective method and should be practice more widely.

Comparison of Incidence of Neonatal Anemia in Different Timing of Delayed Cord Clamping; at 30 Seconds, 1 Minute and 2 Minutes in Term Vaginal Delivery: A Randomized Controlled Trial

2020 ◽  
Vol 103 (12) ◽  
pp. 1255-1261
Keyword(s):  
Blood Loss ◽  
Controlled Trial ◽  
Controlled Study ◽  
Delayed Cord Clamping ◽  
Randomized Controlled ◽  
Cord Clamping ◽  
Estimated Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: To compare the effect of cord clamping time on the incidence of neonatal anemia, clinical outcomes, and maternal and neonatal complications in term vaginal delivered newborns. Materials and Methods: A randomized controlled study was undertaken. Two hundred forty healthy full term vaginal delivered newborns were randomly allocated to either 30-seconds, 1-minute, or 2-minutes groups (group 1, 2, and 3) of umbilical cord clamping. During the interval between delivery and cord clamping, the attendant held the neonate supine at the level of the introitus. Neonatal venous hematocrit (Hct) was measured at 48 to 72 hours after birth. Results: Two hundred thirty newborns completed the present study. Neonatal anemia (Hct less than 45%) was detected in six of 77 cases (7.8%) in group 1, five of 76 cases (6.6%) in group 2, and three of 77 case (3.9%) in group 3, and there were no significant differences among the groups. Mean venous hematocrit values at 48 to 72 hours of life ± standard deviations were 53.1±6.4% in group 1, 53.0±5.5% in group 2, and 53.0±5.7% in group 3. The incidence of polycythemia (hematocrit more than 65%) and neonatal jaundice were similar among all the groups. There were no significant differences in the estimated postpartum blood loss and other neonatal outcomes. Conclusion: Neonatal hematocrit was not significantly different following delayed cord clamping (DCC) at 30-seconds, 1-minute, and 2-minutes, but the incidence of neonatal anemia decreased with the longer timing of DCC. The estimated blood loss and other complications were not different between the groups. Therefore, a minimum of a one minute DCC should be considered for neonatal anemic prevention when compared with the 30-seconds DCC. Keywords: Delayed cord clamping, Timing, Hematocrit, Neonatal anemia

scholarly journals Effect of vitamin D supplementation on growth parameters of children with vitamin D deficiency: a community based randomized controlled trial

2017 ◽  
Vol 4 (6) ◽  
pp. 2070
Author(s):  
Sagul R. Mugunthan ◽  
Yashwant K. Rao ◽  
Tanu Midha ◽  
Anurag Bajpai
Keyword(s):  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Vitamin D Deficiency ◽  
Growth Parameters ◽  
Controlled Trial ◽  
Vitamin D Supplementation ◽  
Community Based ◽  
Randomized Controlled ◽  
Group 2 ◽  
Group 1

Background: Vitamin D deficiency remains the most common cause of rickets globally and is highly prevalent in developing countries including India. This study aimed to compare the efficacy of vitamin D and calcium together with calcium alone on growth parameters of children with vitamin D deficiency in community based setting.Methods: A randomized controlled trial was conducted in community based setting in Kanpur district. Multistage random sampling technique was used to select a total of 395 children between 2 years to 5 years from 5 villages of block Vidhunu. Of these, 138 children were randomized into two groups using balanced block randomization technique. Group 1 received vitamin D with calcium together and group 2 received calcium alone for a period of 12 months. Anthropometry, serum vitamin D, calcium, alkaline phosphatase levels were estimated at baseline and after 12 months. Data was analyzed using SPSS 20. Student’s t test was used to analyze the differences in growth and laboratory parameters in the two groups. Multiple linear regression analysis was used to assess the effect of various factors on the growth parameters.Results: Prevalence of vitamin D deficiency was 78.7%. Baseline characteristics of both groups were similar. After 12 months, group 1 demonstrated significantly greater improvement in weight SD score (21.4%) and height SD score (10.3%) and growth velocity (9.1 cm/year) compared to group 2 (14.3%, 7.8% and 6.9 cm/ year respectively). Also subjects in group 1 showed significantly greater improvement in serum levels of vitamin D, calcium and alkaline phosphatase than group 2.Conclusions: Vitamin D supplementation along with calcium improves the growth of children. Regular supplementation of all children with vitamin D can be considered as a policy for prevention of malnutrition. 

scholarly journals A randomized, controlled study to compare the effects of intravenous labetalol and esmolol on haemodynamic changes during laryngoscopy and intubation

2017 ◽  
Vol 5 (9) ◽  
pp. 4003
Author(s):  
Atit Kumar ◽  
Prashant Kumar Mishra ◽  
Saurabh Shukla
Keyword(s):  
Randomized Controlled Study ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Cardiovascular Stress ◽  
Significant Difference ◽  
Haemodynamic Changes ◽  
Β Blocker ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Direct laryngoscopy and endotracheal intubation frequently induce cardiovascular stress response characterised by hypertension and tachycardia due to reflex sympathetic stimulation. Considering the clinical significance of these changes stress attenuation is needed to blunt these responses. β- blockers are used to reduce the unwanted hemodynamic responses. Esmolol is ultra-short acting cardio selective β blocker. Labetalol is useful in not only attenuating the response to laryngoscopy and intubation but also in preventing perioperative cardiovascular events. Present study compared the efficacy of esmolol and labetalol for attenuation of sympathomimetic response to laryngoscopy and intubation.Methods: It was a prospective, randomized, controlled study carried out in 75 adult patients with ASA 1 and ASA 2 posted for elective surgeries. Patients were allocated randomly into Group-1 (esmolol) and Group-2 (labetalol) and Group-3 (placebo) of 25 patients each. Inj. esmolol (1mg/kg) or Inj. labetalol (0.4 mg/kg) or placebo (0.9NS) dissolved up to 5 ml in distilled water was injected intravenously 5 minutes prior to intubation. All patients premeditated with Inj. glycopyrrolate (4µg/kg). Patient were then induced with Inj. propofol (2mg/kg), Inj. scoline (2mg/kg) given followed by laryngoscopy and intubation. Haemodynamic readings were noted at T0 (baseline before injecting the drug), T1 (1 minute after injecting the drug), T2 (after intubation), T3 (2 minutes after intubation), T4 (4 minutes after intubation), T5 (6 minutes after intubation), T6 (8 minutes after injection), T7 (10 minutes after injection).Results: Gr-1, Gr-2 and Gr-3, when compared with each other for systolic BP, diastolic BP, mean BP, and HR, showed a statistically significant difference at different intervals.Conclusions: Both the drugs are found to be effective in attenuation of hemodynamic reflex without any side effects. Further studies are recommended to substantiate the findings in present study.

P-681 Will the hCG trigger dose used for final oocyte maturation in IVF impact endogenous progesterone during the luteal phase? - A randomized controlled trial

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
L Svenstrup ◽  
J Fedder ◽  
S Möller ◽  
D Pedersen ◽  
K Erb ◽  
...  
Keyword(s):  
Oocyte Maturation ◽  
Luteal Phase ◽  
Controlled Trial ◽  
University Hospital ◽  
Final Oocyte Maturation ◽  
Randomized Controlled ◽  
Number Of Patients ◽  
Significant Difference ◽  
Hcg Trigger ◽  
Group 1

Abstract Study question Is there an association between the hCG dose used for ovulation trigger and the endogenous progesterone production during the luteal phase? Summary answer Increased hCG dosing significantly increased the endogenous progesterone level during the luteal phase. What is known already During the luteal phase of an IVF treatment, the endogenous progesterone (P4) production is negatively impacted due to reduced circulating endogenous LH, caused by negative feed-back of elevated steroids; thus, luteal phase support (LPS) with exogenous P4 remains mandatory in IVF. Apart from inducing final oocyte maturation, the gold standard HCG trigger also functions as an early LPS, boosting P4 production by the corpora lutea (CL). P4 plays a pivotal role for embryo implantation and pregnancy, and an optimal P4 level around peri-implantation seems to be essential for the reproductive outcomes of fresh and frozen/thaw embryo transfer cycles. Study design, size, duration A randomized controlled 4-arm study, including a total of 127 IVF patients, enrolled from January 2015 until September 2019 at the Fertility Clinic, Odense University Hospital, Denmark. Participants/materials, setting, methods IVF patients with ≤ 11 follicles ≥ 12 mm were randomized to four groups. Groups 1-3 were triggered with: 5.000 IU, 6.500 IU or 10.000 IU, hCG, respectively, receiving a LPS consisting of 17-α-hydroxy-progesterone (17α OH P4) to distinguish the endogenous P4 from the exogenous supplementation. Group 4 (control) was randomized to a 6.500 IU hCG trigger and standard LPS. A total of eight blood samples were drawn during the early luteal phase. Main results and the role of chance A total of 94 patients completed the study: 21, 22, 25 and 26 patients in each group, respectively. Baseline characteristics were similar, except for the endogenous LH level and cycle lengths. There were no significant differences between groups regarding ovarian stimulation, number of oocytes and embryos. The median number of follicles ≥ 12mm on the day of trigger was 8.5, resulting in 6.6 oocytes being retrieved. Significant differences in P4 levels were seen at OPU+8 (p < 0.001), OPU+10 (p < 0.001) and OPU+14 (p < 0.001), with positive correlations between P4 level and hCG dose. Groups compared individually showed significant difference in P4 between low and high trigger dose at OPU+4 group 1 and 3 (p = 0.037) and OPU+8 group 1 and 3 (p = 0.007) and between all the three groups around implantation at OPU+6 group 1 and 2 (p = 0.011), group 2 and 3 (p = 0.042) and group 1 and 3 (p < 0.001). Higher P4 levels around implantation were related to follicle count and to pregnancy. After logistic regression analyses there were still significant individual differences between the groups. Limitations, reasons for caution Although patients were randomized and strict inclusion and exclusion criteria were used, the RCT was un-blinded, including a relatively small number of patients. Moreover, for dosing purposes urinary hCG as well as recombinant hCG was used and pharmacokinetics differ. Finally, the P4 level could be influenced by circadian fluctuations. Wider implications of the findings This is the first study to explore dose-responses in circulating P4 after hCG trigger in IVF patients. Increasing the hCG trigger dose increased the endogenous P4 around peri-implantation. Personalizing the hCG trigger dose could be a key point to secure the most optimal P4 mid-luteal phase P4 level. Trial registration number Eudract 2013-003304-39

scholarly journals Comparison of intrauterine insemination and timed intercourse following controlled ovarian hyperstimulation in unexplained infertility: a randomized controlled trial

2019 ◽  
Vol 8 (3) ◽  
pp. 1035
Author(s):  
Sayanti Paul ◽  
Saumen Mandal ◽  
Arghya Pal ◽  
Sumit Ranjan Pramanik
Keyword(s):  
Randomized Controlled Trial ◽  
Intrauterine Insemination ◽  
Controlled Trial ◽  
Controlled Ovarian Hyperstimulation ◽  
Unexplained Infertility ◽  
Clinical Pregnancy ◽  
Ovarian Hyperstimulation ◽  
Randomized Controlled ◽  
Group 2 ◽  
Group 1

Background: Being a diagnosis of exclusion the treatment options of unexplained infertility are often empiric. There is significant dilemma regarding the superiority of one over another. Despite increasing use of intrauterine insemination (IUI) in adjunct to controlled ovarian hyperstimulation (COH) there is scarcity of randomized controlled trials (RCT) from developing countries. Objective was to compare IUI and timed intercourse (TI) in super ovulated cycles among couples with unexplained infertility over one year.Methods: In this prospective randomized controlled trial total 85 patients were randomly assigned into group 1 (COH with IUI, N= 44) and group 2 (COH with TI, N=41). Patients underwent COH using sequential Clomiphene Citrate and injection human menopausal gonadotrophin followed by IUI in group 1 and timed intercourse in group 2. Either protocol was repeated for three consecutive cycles. Finally, both groups were compared for clinical pregnancy rate, adverse effects and acceptability of the treatment process and outcome. Comparison was done by Student’s unpaired t test for continuous and 2-tailed chi square test for categorical variables.Results: Clinical pregnancy rates following COH/IUI and COH/TI were 13.64% and 19.51% respectively. There was observable difference in the acceptability of the outcome (38.64% in IUI and 56.09% in TI group). All the results including complications and side effect rates were statistically insignificant.Conclusions: Present study failed to show any improvement of pregnancy rates following addition of IUI over TI and it raised the probability that the outcome of the procedure may not be well accepted.

Effect of Chlorhexidine Cleansing of Umbilical Cord for Prevention of Infection

2018 ◽  
Vol 4 (2) ◽  
pp. 35-39
Author(s):  
Md Khairuzzaman ◽  
MA Mannan ◽  
Abdul Matin ◽  
Mst Monjuman Ara Sarker ◽  
Nihar Ranjan Sarker ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Controlled Trial ◽  
Care Group ◽  
Cord Care ◽  
Randomized Controlled ◽  
Group 3 ◽  
Group 2 ◽  
To Receive ◽  
Level Hospital ◽  
Group 1

Background: Chlorhexidine cleansing of the cord can reduce neonatal mortality among newborns.Objective: The aim of study was to determine the effect of cord cleansing with chlorhexidine in reduction of umbilical infection among newborns in hospital settings.Methodology: This randomized controlled trial was carried out between April 2013 to July 2014 and 510 newborns were randomly assigned within a tertiary level hospital in Bangladesh to receive 1 of 3 cord care regimens single cord cleansing with 4% chlorhexidine(Group-1), multiple cord cleansing with 4% chlorhexidine (Group-2)  and clean and dry cord care (Group-3 : control).Results: The risk of umbilical cord infection (omphalitis) was significantly reduced in both the single (Relative risk [RR] 0.15 [95% CI] 0.008-0.93) and multiple chlorhexidine cleansing group (RR 0.37 [95% CI] 0.04- 0.99) compared to the dry cord care group.  The risk of omphalitis was not significantly different between multiple and single chlorhexidine cleansing group (RR 3.14 [0.13-76.54]). Conclusion: Chlorhexidine significantly reduce the risk of umbilical infection in both single and multiple cord cleansing neonates.Bangladesh Journal of Infectious Diseases 2017;4(2):35-39

Single versus repetitive injection of lignocaine in the management of carpal tunnel syndrome – a randomized controlled trial

2014 ◽  
Vol 40 (2) ◽  
pp. 179-183 ◽  
Author(s):  
S. Akarsu ◽  
Ö. Karadaş ◽  
F. Tok ◽  
H. Levent Gül ◽  
E. Eroğlu
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Carpal Tunnel ◽  
Controlled Trial ◽  
Post Treatment ◽  
Randomized Controlled ◽  
Electrophysiological Findings ◽  
Tunnel Syndrome ◽  
Group 2 ◽  
Single Versus ◽  
Group 1

The aim of this study was to determine the efficacy of single versus repetitive injection of lignocaine into the carpal tunnel for the management of carpal tunnel syndrome. The 42 patients included were randomly assigned to two Groups: group 1 was injected with 4 mL of 1% lignocaine once and Group 2 was injected with 4 mL of 1% lignocaine twice a week for 2 weeks. Clinical and electrophysiological evaluations were performed at the study onset, and at 6 and 12 weeks following the final injection. Initially, the groups were similar with respect to clinical and electrophysiological findings. All parameters in Group 2 improved 6 weeks post treatment ( p < 0.05), and these improvements persisted at 12 weeks post treatment ( p < 0.05). Repetitive local lignocaine injection was effective in reducing the symptoms of carpal tunnel syndrome and improving electrophysiological findings.

scholarly journals Effects of Water Restriction and Supplementation on Cognitive Performances and Mood among Young Adults in Baoding, China: A Randomized Controlled Trial (RCT)

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3645
Author(s):  
Jianfen Zhang ◽  
Guansheng Ma ◽  
Songming Du ◽  
Shufang Liu ◽  
Na Zhang
Keyword(s):  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Hydration Status ◽  
Water Restriction ◽  
Operation Span ◽  
Randomized Controlled ◽  
Baseline Test ◽  
Group 2 ◽  
Water Supplementation ◽  
Group 1

The brain is approximately 75% water. Therefore, insufficient water intake may affect the cognitive performance of humans. The present study aimed to investigate the effects of water restriction and supplementation on cognitive performances and mood, and the optimum amount of water to alleviate the detrimental effects of dehydration, among young adults. A randomized controlled trial was conducted with 76 young, healthy adults aged 18–23 years old from Baoding, China. After fasting overnight for 12 h, at 8:00 a.m. of day 2, the osmolality of the first morning urine and blood, cognitive performance, and mood were measured as a baseline test. After water restriction for 24 h, at 8:00 a.m. of day 3, the same indexes were measured as a dehydration test. Participants were randomly assigned into four groups: water supplementation group (WS group) 1, 2, or 3 (given 1000, 500, or 200 mL purified water), and the no water supplementation group (NW group). Furthermore, participants were instructed to drink all the water within 10 min. Ninety minutes later, the same measurements were performed as a rehydration test. Compared with the baseline test, participants were all in dehydration and their scores on the portrait memory test, vigor, and self-esteem decreased (34 vs. 27, p < 0.001; 11.8 vs. 9.2, p < 0.001; 7.8 vs. 6.4, p < 0.001). Fatigue and TMD (total mood disturbance) increased (3.6 vs. 4.8, p = 0.004; 95.7 vs. 101.8, p < 0.001) in the dehydration test. Significant interactions between time and volume were found in hydration status, fatigue, vigor, TMD, symbol search test, and operation span test (F = 6.302, p = 0.001; F = 3.118, p = 0.029; F = 2.849, p = 0.043; F = 2.859, p = 0.043; F = 3.463, p = 0.021) when comparing the rehydration and dehydration test. Furthermore, the hydration status was better in WS group 1 compared to WS group 2; the fatigue and TMD scores decreased, and the symbol search test and operation span test scores increased, only in WS group 1 and WS group 2 (p < 0.05). There was no significant difference between them (p > 0.05). Dehydration impaired episodic memory and mood. Water supplementation improved processing speed, working memory, and mood, and 1000 mL was the optimum volume.

scholarly journals A randomized controlled study on expectant management of incomplete abortions caused by self medication

2019 ◽  
Vol 8 (6) ◽  
pp. 1409
Author(s):  
Beenu Kushwah ◽  
Devendra Singh Kushwah
Keyword(s):  
Surgical Management ◽  
Expectant Management ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Complication Rates ◽  
Self Administration ◽  
Self Medication ◽  
Chi Square ◽  
Randomized Controlled ◽  
Incomplete Abortion

Background: Medical method of termination of pregnancy is a very effective method when used as per recommended regimen and under proper supervision. Self-administration of these drugs has become a very common practice these days, resulting in incomplete abortion because of improper use. Traditionally surgical curettage has been the preferred mode of treatment for these cases but is associated with very high complication rates. Expectant management of incomplete abortion has been recently adopted as a better method of management of incomplete abortions worldwide. Present study compares expectant management with surgical curettage in cases of incomplete abortions caused by self medication.Methods: It was one-year prospective randomized controlled study. Total of 220 patients were recruited for the study out of which 103 were randomized to undergo expectant management while 117 to undergo surgical curettage. Results were compared using chi square test..Results: Success rate of expectant and surgical management was found to be 82% and 95% respectively. Complication rate was found to be comparable in both the group while acceptability of expectant management was found to be much higher in expectant group. However, significantly more unplanned admissions and unplanned surgical curettage occurred after expectant management than surgical management.Conclusions: Expectant management is a safe and efficacious option in carefully selected cases. If used properly it can avoid complications associated with surgical management and therefore should be utilized whenever suitable.

scholarly journals Comparison of Single Antibiotic Paste Nitrofurantoin and Calcium Hydroxide Paste as Intracanal Medicaments in Alleviating Post-Operative Pain in Patients with Symptomatic Irreversible Pulpitis -A Randomized Controlled Trial

2021 ◽  
pp. 484-494
Author(s):  
Hira Abbasi ◽  
Abhishek Lal ◽  
Ammara Shamim Jaffrani
Keyword(s):  
Randomized Controlled Trial ◽  
Calcium Hydroxide ◽  
Controlled Trial ◽  
Control Group ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Group 2 ◽  
Irreversible Pulpitis ◽  
Group 1

Aims: This study aims to compare the efficacy in alleviating pain between intracanal medicaments, namely Nitrofurantoin and Calcium Hydroxide Paste. Study Design:  Randomized Controlled Trial. Place and Duration of Study: Sample: Department of Operative Dentistry, Sir Syed College of Medical Sciences, Pakistan, between January 2021 and May 2021. Methodology: 60 patients were randomly divided into 3 groups, each group having 20 patients as following: Group 1: Nitrofurantoin, Group 2: Calcium Hydroxide and Group 3: Control. Preoperative pain was recorded using a numerical pain scale. After access preparation, chemomechanical preparation was performed with subsequent placement of intracanal medicaments. Pre-operative pain score was initially recorded, followed by post-operative pain at 12, 24, 48, and 72 hours, respectively. Root canal treatment was performed in single rooted teeth with patients suffering from symptomatic irreversible pulpitis Results: Majority of the patients in all 3 groups were initially presented with moderate to severe pre-operative pain. After 72 hours post-operatively, 50% patients in Group 1 reported no pain, while 5% patients in both Group 2 and 3 had no pain. Pain significantly subsided in Group 1 as compared to Group 2 and 3. Regarding age and gender, both had no significant relationship with the pain scores in all of the 3 groups Conclusion: Nitrofurantoin has been proven to be an effective intracanal medicament in alleviating immediate post-operative pain in patients with symptomatic irreversible pulpitis as compared to calcium hydroxide. While the control group with no intracanal medicament showed little reduction in pain scores. So, nitrofurantoin can be used as a substitute to currently available standard intracanal medicaments.

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