scholarly journals Fetal Reduction in High Order Pregnancy; A Retrospective Observational Study

2021 ◽  
Author(s):  
Manal shaker taha ◽  
Abdullah Al Ibrahim ◽  
Olubusola Amu ◽  
Sawsan Al-Obaidly ◽  
Prem Chandra ◽  
...  
Keyword(s):  
Blood Loss ◽  
Preterm Labour ◽  
Financial Burden ◽  
High Order ◽  
P Value ◽  
Fetal Reduction ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Reduced Group ◽  
The Impact

Abstract Background:High order multiple pregnancy (HOMP), is considered a high-risk pregnancy as it has many complications on the mother and the fetuses, with a huge financial burden on the hospitals. Therefore avoiding HOMP is important, however, if this fails, fetal reduction is an acceptable alternative procedure to reduce maternal complications and improve fetal outcome.Our aim to study the impact of a fetal reduction on the risk of preterm labour and postpartum hemorrhage in HOMP (More than Triplet).Methods:This is a retrospective study of all HOMPs seen during the period from July 2007 to July 2017 at Women’s Hospital- Hamad General Hospital, Doha, Qatar. We examined records of 50 women diagnosed with HOMP, incomplete records, and triplet pregnancies were excluded from the study. the data were collected from the ultrasound software as well as maternal files. Results:Of the 50 women diagnosed with HOMP, 39 quadruplets, 7 quintuplets.2 sextuplets and 2 septuplets. 56% had an ovulation induction, 26% had an IVF, 14% had an IUI, and 2 cases (4%) were spontaneous pregnancies.(28%) had a fetal reduction, with a mean gestation age of 12.64 ± 0.74 weeks of gestation, and with no immediate complications. Our study showed that there is no significant difference at time of delivery between reduced and non reduced group mean gestational age at the time of delivery for the reduced group was 30.26 ± 4.38, and 29.39 ± 4.78 weeks for the non-reduced group. P-value of 0.565 , 95% CI (-2.159-3.90). 44.9% had postpartum haemorrhage with a mean estimated blood loss of 1659.1 ± 958.5 mls. Our study showed that there is significant decrease in estimated blood loss in reduced group compared with non-reduced group with p-value of 0.047 ConclusionHigh order multiple pregnancies are a result of modern infertility treatments has significant serious adverse effects on the mother and the babies. Although fetal reduction reduced the rate of PPH but did not significantly improve the rate of preterm labour, hence prevention of HOMP is the primary goal.

Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽  
2017 ◽  
Vol 80 (3) ◽  
pp. 489-497 ◽  
Author(s):  
Juan S. Uribe ◽  
Joshua Beckman ◽  
Praveen V. Mummaneni ◽  
David Okonkwo ◽  
Pierce Nunley ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Loss ◽  
Clinical Outcomes ◽  
Spinal Deformity ◽  
Lumbar Lordosis ◽  
Adult Spinal Deformity ◽  
Radiographic Parameters ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

scholarly journals The Use of Tranexamic Acid in Total Ankle Arthroplasty

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0028
Author(s):  
Laura Luick ◽  
Vytas Ringus ◽  
Garrett Steinmetz ◽  
Spencer Falcon ◽  
Shaun Tkach ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
P Value ◽  
Ankle Arthroplasty ◽  
Estimated Blood Loss ◽  
Number Of Patients ◽  
Significant Difference

Category: Ankle Arthritis Introduction/Purpose: The number of total ankle arthroplasties (TAA) is on the rise. Complications associated with TAA include need for blood transfusion, deep vein thrombosis, hematoma, infection, and wound complications. Tranexamic acid (TXA) use in the total knee and total hip population has been found to decrease the rate of blood transfusion. The rate of infections and blood transfusions in TAA was reported to be 3.2% and 1.3%, respectively. In calcaneal fractures TXA was found to decrease wound complications. Our goal was to evaluate the use of TXA in the TAA population to see if its use decreases blood loss or wound complications. Methods: This is a retrospective review of two patient cohorts operated on by a single surgeon from 2010 to 2016. We compared a group of TAA patients that did not receive TXA versus a subsequent group that received TXA. Patients received 1 g IV TXA before tourniquet was inflated and another 1 g following the release of the tourniquet. Pre-operative hemoglobin and hematocrit levels were compared to postoperative levels. Post-operative complications were compared between the two groups. Results: 87 patients were included in the study. 35 patients (40%) received TXA. In patients that received TXA, 18 had postoperative hemoglobin levels available. These patients were compared to a control cohort of 52 patients that did not receive TXA. No significant difference existed between the two groups in gender or age (p=0.9; p=0.7 respectively). Mean estimated blood loss was the same between the two groups. Overall postoperative complications, including wound complications, were higher in the TXA group at 26% vs 12% but this was not statistically significant (p-value = 0.086). The preoperative to postoperative change in hemoglobin/hematocrit levels was not statistically significant between groups (p-value = 0.78). There was one transfusion required in the non-TXA group and no transfusions required in the TXA group (p=0.9). Conclusion: The use of TXA was not found to provide a beneficial effect in total ankle arthroplasty in either decreasing wound complications or blood loss. Given these results, TXA use might not be cost effective in total ankle arthroplasty as opposed to other total joint arthroplasties. Further higher levels studies with increased number of patients are required to further evaluate TXA effectiveness in TAA.

Robotic-assisted Ivor-Lewis esophagectomy in the elderly patient.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 93-93
Author(s):  
Andrea M. Abbott ◽  
Tobin Joel Crill Strom ◽  
Nadia Saeed ◽  
Ravi Shridhar ◽  
Sarah E. Hoffe ◽  
...  
Keyword(s):  
Blood Loss ◽  
The Elderly ◽  
Separate Analysis ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Ivor Lewis Esophagectomy ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

93 Background: Esophageal cancer continues to increase in incidence worldwide with the age of diagnosis continuing to move towards an older onset. Robotic assisted approaches to esophagectomy have demonstrated decreased complications and length of hospitalization (LOH). We sought to examine the impact of age on outcomes in patients undergoing robotic assisted esophagectomy (RAIL). Methods: From 2009-2013, we identified patients undergoing robotic assisted Ivor Lewis esophagectomy. Patients were then stratified according to 3 age groups. Cohort 1, age less then 50, cohort 2, age 50-70, and cohort 3 >70. Statistical comparisons between LOH, operative time (OT), estimated blood loss (EBL), adverse events (AE) and mortality were made with Kruskal-Wallis and Chi-square tests. Results: We identified 134 patients who underwent RAIL and found no statistically significant difference between the three cohorts for OT, LOH, days spent in intensive care, AE or mortality. There was a difference in EBL with higher median blood loss (150 cc) seen in cohort 1 (50-600cc) and 3 (50-400cc) compared to cohort 2 (100 cc, (25-400cc)), p < 0.01. The most common AE were arrhythmia and pneumonia but this was not significantly different between the cohorts. The overall AE rate was 10% (cohort 1), 21% (cohort 2), 34% (cohort 3), p=0.14. There were 4 leaks (p =0.38) and 2 deaths (p=0.90) in the entire cohort. A separate analysis was done to compare elderly (>70) to the non-elderly (<70). Median EBL was higher in the elderly cohort (100cc (25-600) vs 150cc (50-400), p <0.01). There was a trend towards longer LOH in the elderly (9 (4-35) vs 11 (6-38) days, p =0.06). AE and mortality were not significantly different, although there was a trend toward increased AE (19.8% vs 34%, p=0.07) in the elderly, with arrhythmia being the most common AE. Conclusions: RAIL is a safe surgical technique for use in an aging patient population. We demonstrated there was no increased risk of LOH, AE or death in the elderly patients compared to their younger cohort.

scholarly journals Efficacy of balloon tamponade in control of primary postpartum haemorrhage (PPH).

2020 ◽  
Vol 27 (04) ◽  
pp. 717-720
Author(s):  
Kashfa Tasnim Akhtar ◽  
Sobia Tabassum ◽  
Shazia Siddique
Keyword(s):  
Blood Loss ◽  
Gestational Age ◽  
Postpartum Haemorrhage ◽  
Ease Of Use ◽  
P Value ◽  
Balloon Tamponade ◽  
Products Of Conception ◽  
Estimated Blood Loss ◽  
Increased Risk ◽  
Significant Difference

Objectives: Primary postpartum haemorrhage (PPH) refers to excessive blood loss (>500ml) during 3rd stage of labour in the 1st 24 hours after delivery, thereafter, significant bleeding is referred to as secondary PPH. Its incidence is about 5% of deliveries. This study was conducted to note the efficacy of balloon tamponade in the control of PPH. Study Design: Experimental study. Setting: Department of Obstetrics and Gyne, Civil Hospital, Bahawalpur. Period: 1st January 2018 to 30th June 2018. Material & Methods: A total of 80 cases with Primary PPH after vaginal delivery were considered for this study. Cases with Bleeding disorders, ruptured uterus, retained products of conception, genital tract injuries or on anticoagulant therapy were excluded. All patients received balloon tamponade. Failure of control of bleeding was observed amongst all the patients. Results: Mean age, gestational age and parity were 24.54 years, 37.88 weeks and 3.17 respectively. Mean estimated blood loss was found to be 1125+320 ml, SBP 90.10+20.6 mmHg, DBP 57+7.2 mmHg and pulse 106+9.2 bpm. As far efficacy of balloon tamponade is concerned, it was noted in 71 (88.8%) women. When women were analyzed for maternal age, gestational age and parity status, no significant difference was found (P value > 0.05). Conclusion: Balloon tamponade has good efficacy (88.8%) in controlling PPH. Its ease of use in cases at increased risk of PPH makes it a suitable option.

scholarly journals The Impact of an Educational Program on Medical Students’ Knowledge and Awareness of Elder Abuse

2021 ◽  
Vol 8 ◽  
pp. 238212052110164
Author(s):  
Abbie West ◽  
Cara Cawley ◽  
Elizabeth Crow ◽  
Alexis M. Stoner ◽  
Natalie M. Fadel ◽  
...  
Keyword(s):  
Medical Students ◽  
Educational Program ◽  
Survey Methodology ◽  
Elder Abuse ◽  
P Value ◽  
Significant Difference ◽  
Survey Results ◽  
Second Year ◽  
College Of Osteopathic Medicine ◽  
The Impact

Objective: Approximately 1 in 6 adults 60 and older have experienced a form of abuse in the past year. Many cases remain under-reported due to lack of knowledge and awareness. This study created an educational program on elder abuse for medical students to determine if participation would increase knowledge and awareness of elder abuse. Methods: This study used a pre and post survey methodology to evaluate students’ knowledge and awareness of elder abuse before and after participating in this educational program. Sixty first and second year osteopathic medical students at the Edward Via College of Osteopathic Medicine, Carolinas Campus participated in this study. Students were emailed a pre-survey to evaluate their pre-existing knowledge and awareness. The survey was, previously created by the Student Training on Preventing Domestic Violence (STOP-DV) team using validated measures. Participants then attended educational events about various forms of elder abuse and recognizing its associated signs, and afterward completed the post-survey. The results were compared using t-tests to determine if there was a significant difference. Results: First and second year students differed significantly in pre-survey results of knowledge but not post-survey results. The results showed a significant difference in overall mean knowledge ( P-value < .001) and awareness scores ( P-value < .001) in all students. Conclusion: These results suggest education on elder abuse can enable future physicians to better recognize, understand, and support older adults regarding elder maltreatment.

617 Who Benefits the Most from Burn Camps?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S162-S163
Author(s):  
Jennifer B Radics-Johnson ◽  
Daniel W Chacon ◽  
Li Zhang
Keyword(s):  
Retrospective Review ◽  
Burn Injury ◽  
Statistical Significance ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Self Evaluation ◽  
Significant Difference ◽  
Return Home ◽  
The Impact

Abstract Introduction Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child. Methods A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value&lt; 0.5. Results Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32). There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confidents in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?” Conclusions In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.

The Impact of Obesity on the Management and Outcomes of Postpartum Hemorrhage

2020 ◽  
Author(s):  
Aleksandra Polic ◽  
Tierra L. Curry ◽  
Judette M. Louis
Keyword(s):  
Interventional Radiology ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Postpartum Hemorrhage ◽  
Tertiary Care ◽  
P Value ◽  
Obese Women ◽  
Severe Morbidity ◽  
The Impact ◽  
To Receive

Objective The study aimed to evaluate the impact of obesity on the management and outcomes of postpartum hemorrhage. Study Design We conducted a retrospective cohort study of women who delivered at a tertiary care center between February 1, 2013 and January 31, 2014 and experienced a postpartum hemorrhage. Charts were reviewed for clinical and sociodemographic data, and women were excluded if the medical record was incomplete. Hemorrhage-related severe morbidity indicators included blood transfusion, shock, renal failure, transfusion-related lung injury, cardiac arrest, and use of interventional radiology procedures. Obese (body mass index [BMI] ≥ 30 kg/m2) and nonobese women were compared. Data were analyzed using Chi-square, Student's t-test, Mann–Whitney U test, and linear regression where appropriate. The p-value <0.05 was significant. Results Of 9,890 deliveries, 2.6% (n = 262) were complicated by hemorrhage. Obese women were more likely to deliver by cesarean section (55.5 vs. 39.8%, p = 0.016), undergo a cesarean after labor (31.1 vs. 12.2%, p = 0.001), and have a higher quantitative blood loss (1,313 vs. 1,056 mL, p = 0.003). Both groups were equally likely to receive carboprost, methylergonovine, and misoprostol, but obese women were more likely to receive any uterotonic agent (95.7 vs. 88.9%, p = 0.007) and be moved to the operating room (32.3 vs. 20.4, p = 0.04). There was no difference in the use of intrauterine pressure balloon tamponade, interventional radiology, or decision to proceed with hysterectomy. The two groups were similar in time to stabilization. There was no difference in the need for blood transfusion. Obese women required more units of blood transfused (2.2 ± 2 vs. 2 ± 5 units, p = 0.023), were more likely to have any hemorrhage-related severe morbidity (34.1 vs. 25%, p = 0.016), and more than one hemorrhage related morbidity (17.1 vs. 7.9, p = 0.02). After controlling for confounding variables, quantitative blood loss, and not BMI was predictive of the need for transfusion. Conclusion Despite similar management, obese women were more likely to have severe morbidity and need more units of blood transfused. Key Points

Blood, Sweat, Toil, and Tears of Surgical Training. Part I: Blood

2007 ◽  
Vol 15 (4) ◽  
pp. 307-309 ◽  
Author(s):  
Andrew J Drain ◽  
Jonathon I Ferguson ◽  
Sharon Wilkinson ◽  
Samer AM Nashef
Keyword(s):  
Adverse Effect ◽  
Blood Loss ◽  
Operating Room ◽  
Clinical Outcomes ◽  
Surgical Training ◽  
Clinical Service ◽  
Significant Difference ◽  
Potential Impact ◽  
The Impact ◽  
Cardiac Operations

There may be conflict between the requirements of surgical training and those of the clinical service if training has an impact on clinical outcomes. One area of potential impact is perioperative blood loss. We compared total and 12-hour blood loss after 2,079 consecutive cardiac operations performed over 2 years by trainees and consultants. One- and two-way analyses of variance with EuroSCORE and surgeon status as factors were carried out to evaluate the impact of surgeon status on blood loss. There was no difference in blood loss between consultants and trainees. We also compared the rates between consultants and trainees of patients returning to the operating room due to bleeding. This showed a significant difference, with trainees having a higher rate of investigation for bleeding. Cardiac surgical training can be achieved without an adverse effect on blood loss, but it may be associated with a higher rate of re-intervention for bleeding.

A Randomized, Double Blind Clinical Study to Assess the Effects of a Gamma-oryzanol-enriched Rice Bran Oil on Lipid Profile in the Hypercholesterolemic Patients

2021 ◽  
Vol 104 (Suppl. 1) ◽  
pp. S64-S69
Keyword(s):  
Risk Factor ◽  
Cholesterol Level ◽  
Rice Bran ◽  
Serum Cholesterol ◽  
Disease Risk ◽  
Rice Bran Oil ◽  
P Value ◽  
Significant Difference ◽  
Gamma Oryzanol ◽  
The Impact

Background: Hypercholesterolemia is a risk factor for developing coronary artery disease. Lifestyle modification including an intake of healthy food as well as medication have approved effect in lowering serum cholesterol. Objective: The primary objective of the present study was to determine the impact of a gamma-oryzanol-enriched rice bran oil, a product of Thailand, on serum cholesterol level. Materials and Methods: A total of in 54 hypercholesterolemic patients were divided into two groups; RBOh (20,000 ppm of gammaoryzanol, n = 27), and RBOn (5,000 ppm gamma-oryzanol, n = 27). The assigned RBO (15 ml) was intake each day for 8 weeks. Fasting serum lipids were measured at baseline and at the 4th and 8th weeks of the intervention. All patients were advised about lifestyle modifications. Results: When compared to the baseline, subjects received RBOh showed a significant difference in 2 parameters including a reduction of cholesterol level at 8th weeks (p-value = 0.0101), and decrease in LDL-C level at the end of 8th weeks (p-value = 0.0013). In the group treated with RBOn, a significant increase in HDL-C level at the end of 8th weeks (p-value = 0.0303) without any effect on total cholesterol or LDL was observed. No sign of toxic effect on liver or renal functions was seen in both treatment groups. Conclusion: RBO with gamma-oryzanol-enriched could decrease cholesterol and LDL-C level in hypercholesterolemic patients. Therefore, gamma-oryzanol-enriched RBO is a functional food that may reduce cardiovascular disease risk factor. Keywords: Hypercholesterolemia, Rice bran oil, Gamma-oryzanol, Oryza sativa

scholarly journals Clinical significance of prostatic-urethral angulation on the treatment outcome of patients with symptomatic benign prostatic hyperplasia treated with tamsulosin hydrochloride

2015 ◽  
Vol 87 (3) ◽  
pp. 238
Author(s):  
Hassan El-Tatawy ◽  
Tarek Gameel ◽  
Mohammed Abo El-enen ◽  
Ayman Hagras ◽  
Ayman Mousa ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Clinical Significance ◽  
Treatment Efficacy ◽  
Specific Antigen ◽  
Prostatic Hyperplasia ◽  
Final Conclusion ◽  
P Value ◽  
Significant Difference ◽  
Group A ◽  
The Impact

Objectives: To evaluate the impact of the prostatic-urethral angulation (PUA) on the treatment efficacy of selective alpha-1A receptor blocker in male patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH). Materials and methods: A total of 80 patients with LUTS/BPH and with mean age 53.3 ± 6.3 (range 47-70) were included in our prospective comparative study. The patients were classified into 2 groups as a consecutive cases 40 in each one depending on the PUA either ≤ 35° (group A) or &gt; 35° (group B). PUA and different prostatic parameters were measured using transrectal ultrasound. Prostate-specific antigen (PSA), the International Prostate Symptom Score and quality of life score (IPSS/QoL score), maximum flow rate (Q<sub>max</sub>), and postvoid residual (PVR) volume were compared between the groups. The clinical significance of PUA was evaluated after 8 weeks of medical treatment with tamsulosin hydrochloride 0.4 mg daily. Results: Baseline evaluation (pre-treatment) for both groups were comparable to each other with no clinically significant difference regarding age, PSA, IPSS/QoL score, Qmax and PVR volume (P-value &gt; 0.05). Comparison of parameters after 8 weeks showed that tamsulosin hydrochloride improved the total IPSS and all subscores (P &lt; 0.001), QoL (P = 0.001), Q<sub>max</sub> (P = 0.002), and PVR (P = 0.04) in group A (Table 1). Conclusion: Tamsulosin hydrochloride appears to be less effective in improving IPSS/Qol score, Qmax and PVR in patients with lager PUA. The PUA might be a predictor for the treatment efficacy of α-blockers and more studies are warranted in the future before the final conclusion.

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