scholarly journals Transmigration of copper T presenting as abdominal wall mass: a case report

2021 ◽  
Vol 10 (4) ◽  
pp. 1729
Author(s):  
T. Ramani Devi ◽  
S. Shameema Banu ◽  
T. Harini ◽  
P. Kanimozhi
Keyword(s):  
Abdominal Wall ◽  
Post Partum ◽  
Broad Ligament ◽  
Cost Effective ◽  
Uterine Perforation ◽  
Inflammatory Reactions ◽  
Contraceptive Devices ◽  
Number Of Patients ◽  
Pouch Of Douglas ◽  
Peritoneal Space

Copper T is one of the widely used intra uterine contraceptive devices due to its safe, effective and reversible nature. It has also been widely used as it is cost effective too. Copper T is usually inserted immediate post-partum, post abortal, during the proliferative phase of any menstrual cycle or 6 to 8 weeks following post-partum. Complications associated with use of Copper T include heavy menstrual bleeding, pelvic inflammatory disease, uterine perforation, displacement and rarely, transmigration. Post-insertion of copper T, women need to have regular follow up visits to prevent such complications. Patients should be advised to check for the presence of threads periodically. Considerable number of patients with transmigration of copper T has been reported in literature. Sites into which transmigration has been reported include broad ligament, ovarian fossa, urinary bladder, sigmoid colon, rectum, peritoneum, omentum, pouch of douglas, retro peritoneal space, iliac veins, ovaries, appendix and rarely in the abdominal wall. Transmigrated copper T may be diagnosed with ultrasonogram, X-ray and CT scan. Copper containing intra-uterine devices are known to provoke inflammatory reactions and symptoms depending upon the sites to which they have been transmigrated. Hence, we should resort to early intervention and remove the misplaced copper IUCD at the earliest. Here, we are reporting a rare case of transmigration of copper T into the anterior abdominal wall elaborating on various facets of copper T including its advent, incidence of use, efficient diagnosis and well-planned retrieval. 

Cost Avoidance and Clinical Benefits Derived from a Pharmacy-Managed Anemia Program

2000 ◽  
Vol 35 (2) ◽  
pp. 169-175 ◽  
Author(s):  
Robert A. Quercia ◽  
Ronald Abrahams ◽  
C. Michael White ◽  
John D'Avella ◽  
Mary Campbell
Keyword(s):  
Cost Savings ◽  
Cost Effective ◽  
Hemodialysis Patients ◽  
Cost Avoidance ◽  
Number Of Patients ◽  
Epoetin Alpha ◽  
Clinical Benefits ◽  
Unit Dose ◽  
One Year ◽  
Alpha Therapy

A pharmacy-managed anemia program included distribution and clinical components, with the goal of making epoetin alpha therapy for hemodialysis patients more cost-effective. The Pharmacy Department prepared epoetin alpha doses for patients in unit-dose syringes, utilizing and documenting vial overfill. Pharmacists dosed epoetin alpha and iron (oral and intravenous) per protocol for new and established patients. Baseline data were obtained in 1994, one year prior to implementation of the program, and were re-evaluated in 1995 and 1998. Cost avoidance from utilization of epoetin alpha vial overfill in 1995 and 1998 was $83,560 and $91,148 respectively. In 1995 and 1998, cost avoidance from pharmacy management of anemia was $191,159 and $203,985 respectively. The total cost avoidance from 1995 through 1998 was estimated at $1,018,638. The number of patients with hematocrits under 31% decreased from 32% in 1994 to 21% and 14% in 1995 and 1998 respectively. We conclude that a pharmacy-managed anemia program for hemodialysis patients results in significant cost savings and better achievement of target hematocrits.

POST‐PARTUM BROAD LIGAMENT HÆMATOMA

1960 ◽  
Vol 1 (26) ◽  
pp. 1025-1026 ◽  
Author(s):  
Jean Murray‐Jones
Keyword(s):  
Post Partum ◽  
Broad Ligament

scholarly journals Autologous Platelet-Rich Fibrin (PRF) as an Adjunct in the Management of Osteoradionecrosis and Medication-Related Osteonecrosis of Jaws. Case Series in A Single Centre

2021 ◽  
Vol 11 (8) ◽  
pp. 3365
Author(s):  
Benjie Law ◽  
Hui Yuh Soh ◽  
Syed Nabil ◽  
Rama Krsna Rajandram ◽  
Abd Jabar Nazimi ◽  
...  
Keyword(s):  
Case Series ◽  
Cost Effective ◽  
Control Group ◽  
Platelet Rich Fibrin ◽  
Tissue Healing ◽  
Number Of Patients ◽  
Short Period ◽  
Oral And Maxillofacial Region ◽  
Surgical Adjunct ◽  
Autologous Platelet

Osteoradionecrosis (ORN) of the jaws and medication-related osteonecrosis of the jaws (MRONJ) are uncommon but serious diseases affecting the oral and maxillofacial region with clinically similar appearance but distinct pathophysiology. Management of ORN and MRONJ is inherently challenging and the treatment outcomes are unpredictable. The use of autologous platelet concentrates (APCs) to promote hard and soft tissue healing is well described in the literature, and the efficacy of leucocyte and platelet-rich fibrin (L-PRF) has been well documented in a number of clinical studies. The aim of this study was to present our treatment strategy and the outcomes of incorporating L-PRF as a surgical adjunct in management of ORN and MRONJ in our centre. Methods: eight cases of ORN and MRONJ were treated with a combination of sequestrectomy and L-PRF as a surgical adjunct. Results: the overall success was 87.5%. Using L-PRF as an adjunct, we were able to predictably manage ORN and MRONJ without causing significant morbidity. Conclusion: our experience shows that L-PRF may be used as a valuable and cost-effective adjunct to surgical management of ORN and MRONJ. However, due to a limited number of patients, and a short period of review, the true effectiveness of the method is yet to be demonstrated in a longer follow-up study including a greater number of patients, besides the inclusion of a control group.

Altered Fibrinolysis during and after Surgery

2021 ◽  
Author(s):  
Maria J. Colomina ◽  
Esther Méndez ◽  
Antoni Sabate
Keyword(s):  
Surgical Stress ◽  
Point Of Care ◽  
Vena Cava ◽  
Coagulation Factors ◽  
Major Surgery ◽  
Fibrinogen Concentration ◽  
Tissue Destruction ◽  
Inflammatory Reactions ◽  
Hematological Disorders ◽  
Number Of Patients

AbstractMajor surgery induces hemostatic changes related to surgical stress, tissue destruction, and inflammatory reactions. These changes involve a shift of volume from extravascular space to intravascular and interstitial spaces, a “physiologic” hemodilution of coagulation proteins, and an increase of plasmatic fibrinogen concentration and platelets. Increases in fibrinogen and platelets together with a simultaneous dilution of pro- and anticoagulant factors and development of a hypofibrinolytic status result in a postoperative hypercoagulable state. This profile is accentuated in more extensive surgery, but the balance can shift toward hemorrhagic tendency in specific types of surgeries, for example, in prolonged cardiopulmonary bypass or in patients with comorbidities, especially liver diseases, sepsis, and hematological disorders. Also, acquired coagulopathy can develop in patients with trauma, during obstetric complications, and during major surgery as a result of excessive blood loss and subsequent consumption of coagulation factors as well as hemodilution. In addition, an increasing number of patients receive anticoagulants and antiplatelet drugs preoperatively that might influence the response to surgical hemostasis. This review focuses on those situations that may change normal hemostasis and coagulation during surgery, producing both hyperfibrinolysis and hypofibrinolysis, such as overcorrection with coagulation factors, bleeding and hyperfibrinolysis that may occur with extracorporeal circulation and high aortic-portal-vena cava clamps, and hyperfibrinolysis related to severe maintained hemodynamic disturbances. We also evaluate the role of tranexamic acid for prophylaxis and treatment in different surgical settings, and finally the value of point-of-care testing in the operating room is commented with regard to investigation of fibrinolysis.

DO TRANSVERSE SKIN INCISION & ADHESION AT POST CAESAREAN DELIVERY DELAY DELIVERY OF NEONATES & INCREASE MATERNAL MORBIDITY: A COHORT STUDY

2021 ◽  
pp. 65-70
Author(s):  
Bibekananda Das ◽  
Abhijit Pahari ◽  
Kajal Kumar Patra
Keyword(s):  
Cohort Study ◽  
Caesarean Section ◽  
Abdominal Wall ◽  
Skin Incision ◽  
Categorical Variables ◽  
Number Of Patients ◽  
Vertical Incision ◽  
Tertiary Teaching ◽  
Transverse Skin Incision ◽  
Vertical Skin Incision

Background: The most common major abdominal operation done on women is Caesarean section. Over the past century delivery by Caesarean section has been increased in both developed and developing countries. Various abdominal incisions have been used for Cesarean delivery. Today most of the caesarean section are performed with either a vertical infra umbilical midline incision [VIUI] or pfannenstiel incision. Both the skin incisions possess some benets and drawbacks. Methods: This study was a prospective cohort study conducted in the department of Gynaecology & Obstetrics, Burdwan Medical College & Hospital, Burdwan, West Bengal a tertiary teaching institute, from July, 2017 to November, 2018. 142 mothers were included in the study after informed consent from the patient about being a part of this study. Among them, 37 were with midline vertical skin incision, 51 were with transverse skin incision, and 54 were primigravida. Categorical variables are expressed as Number of patients and percentage of patients and compared across the groups using Pearson's Chi Square test for Independence of Attributes/ Fisher's Exact Test as appropriate. Results: 57.41% of primigravida are in 18 to 20 years age group, 42.59 % in 21-25 years, no women was over 25 years. women with previous vertical incision 27.03% have no adhesion, 59.46 % have mild adhesion, and 13.51% have severe adhesion. In women with previous transverse incision 21.57% have no adhesion, 47.06% have mild adhesion and 31.37%have severe adhesion. 34.7% adhesion are between uterus and bladder, 26.5% adhesion are between uterus and omentum, 20.4% adhesion are between uterus and abdominal wall, 12.2% adhesion between omentum and abdominal wall, 6.2% adhesion are in others organ Conclusions: There was signicant delay in delivery of neonates in post caesarean mothers with previous transverse skin incision than vertical incision. Previous transverse skin incision is associated with more severe adhesion than vertical skin incision

scholarly journals Telemedicine Strategy to Rescue CPAP Therapy in Sleep Apnea Patients with Low Treatment Adherence: A Pilot Study

2021 ◽  
Vol 10 (18) ◽  
pp. 4123
Author(s):  
Onintza Garmendia ◽  
Ramon Farré ◽  
Concepción Ruiz ◽  
Monique Suarez-Girón ◽  
Marta Torres ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Cost Effective ◽  
Smartphone Application ◽  
Poor Adherence ◽  
Therapeutic Effects ◽  
Cpap Adherence ◽  
Included Patient ◽  
Number Of Patients ◽  
Nasal Pressure ◽  
Voice Recorder

Patients with sleep apnea are usually treated with continuous positive airway pressure (CPAP). This therapy is very effective if the patient′s adherence is satisfactory. However, although CPAP adherence is usually acceptable during the first months of therapy, it progressively decreases, with a considerable number of patients accepting average treatment duration below the effectiveness threshold (4 h/night). Herein, our aim was to describe and evaluate a novel telemedicine strategy for rescuing CPAP treatment in patients with low adherence after several months/years of treatment. This two-week intervention includes (1) patient support using a smartphone application, phone and voice recorder messages to be answered by a nurse, and (2) daily transmission and analysis of signals from the CPAP device and potential variation of nasal pressure if required. On average, at the end of the intervention, median CPAP adherence considerably increased by 2.17 h/night (from 3.07 to 5.24 h/night). Interestingly, the procedure was able to markedly rescue CPAP adherence: the number of patients with poor adherence (<4 h/night) was considerably reduced from 38 to 7. After one month, adherence improvement was maintained (median 5.09 h/night), and only 13 patients had poor adherence (<4 h/night). This telemedicine intervention (103€ per included patient) is a cost-effective tool for substantially increasing the number of patients with CPAP adherence above the minimum threshold for achieving positive therapeutic effects.

scholarly journals Economic Evaluations of Cabazitaxel for Treatment of Post-docetaxel Metastatic Castration-resistant Prostate Cancer: Evidence from a Systematic Review

2019 ◽  
pp. 1-8
Author(s):  
Nikinaz Ashrafi Shahmirzadi ◽  
Pardis Zaboli ◽  
Monireh Afzali ◽  
Bereket Molla Tigabu ◽  
Mirhamed Hajimiri ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Cost Effective ◽  
Bibliographic Databases ◽  
Economic Evaluations ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Radium 223 ◽  
Number Of Patients ◽  
Effective Option

Background and Objectives: Prostate cancer is an ever-increasing global incidence and has become the fifth leading cause of cancer-related mortality in men. A significant number of patients with prostate cancer develop metastatic castration-resistant prostate cancer (mCRPC). There are a few second-line treatment options for patients with post-docetaxel mCRPC. This systematic review aimed to assess the cost-effectiveness of cabazitaxel for the treatment of mCRPC. Materials and Methods: Electronic bibliographic databases including: PubMed/Medline, NICE, CRD, and Scopus were searched in January 2018 for identifying full economic evaluations published in English and Persian. The risk of assessment bias and descriptive analyses of individual studies’ findings were presented. Results: Three articles that fulfilled the inclusion criteria were included in the current study. All the included records had a reasonable quality. Cabazitaxel was not recommended as the most cost-effective option for the treatment of docetaxel-refractory mCRPC. Abiraterone acetate and radium-223 were the recommended cost-effective treatments for mCRPC treatment. Conclusion: We found that, in general, while cabazitaxel had equal or slightly higher improvement in Quality-adjusted Life Year (QALY) as compared to the alternatives, it incurred a high cost. Despite the inclusion of a few studies in this review, cabazitaxel was not found to be a cost-effective option. Therefore, we recommend full economic evaluations to be conducted in this area.

Abstract 3772: Alternate Listing Transplantation is a Cost-Effective Treatment for End-Stage Heart Failure Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Mark J Russo ◽  
Jonathan M Chen ◽  
Kimberly N Hong ◽  
Michael Argenziano ◽  
Ryan R Davies ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Cost Model ◽  
Case Series ◽  
Cost Effective ◽  
Intention To Treat ◽  
Cost Effective Treatment ◽  
Number Of Patients ◽  
Transplant Candidates ◽  
End Stage

BACKGROUND: In order to offer the benefit of heart transplantation to a greater number of patients some centers match high-risk recipients (HR) with non-standard or ”marginal” donors (MD) in a strategy known as Alternate Listing Transplantation (ALT). However, pairing sicker recipients with lower quality donor organs remains both clinically and ethically controversial. The purpose of this study was to determine the cost-effectiveness of this strategy. METHODS: The United Network of Organ Sharing provided deidentified patient-level data. UNOS data was used to determine clinical outcomes, including waiting time, post-transplant survival, length of stay, re-hospitalizations, episodes of rejection, and infection, based on all adult heart transplant candidates (age [gt] 18 yo) and listed between 1995–2005 (n=35,049). Through a systematic literature review of randomized controlled trials and case series that estimated related costs, a cost model (see Table ) using an intention-to-treat assumption was developed to calculate the incremental cost-effectiveness ratio (ICER) for HR candidates who subsequently received marginal donor hearts (HTR) compared with candidates who were not transplanted (NTXP). High-risk recipient criteria included age [gt] 65yo, retransplantation, HepC+, HIV+, CrCl <30 ml/min, DM with PVD, DM with Crcl <40 ml/min. MD criteria included age [gt] 55yo, DM, HIV+, HepC+, EF<45%, and donor:recipient weight <0.7. RESULTS: Median survival from listing was 0.55 yrs and 5.1 yrs in the HTR and NTXP groups, respectively. The estimated ICER was $66,645($34,046–$127,491) ICER varied by HR recipient criteria. CONCLUSIONS: The ICER for ALT falls at the upper limits acceptability for being cost-effective. However, stratified analysis by HR group suggests that this strategy is not appropriate for all groups. Cost Model Assumptions

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