scholarly journals Comparison of Pipelle and Hysteroscopy with D&C in Postmenopausal Patients

2021 ◽  
Vol 5 (9) ◽  
pp. 01-06
Author(s):  
Elvin Piriyev ◽  
Sven Schiermeier ◽  
Thomas Römer
Keyword(s):  
Endometrial Carcinoma ◽  
Personal Data ◽  
High Sensitivity ◽  
Cost Effective ◽  
Endometrial Biopsy ◽  
Double Blind Study ◽  
Postmenopausal Bleeding ◽  
Double Blind ◽  
Informed Consent Form ◽  
Diagnostic Certainty

Objective: The aim of the study is to compare the pipelle method and hysteroscopy with D&C in postmenopausal patients Methods: In this prospective study, only those postmenopausal patients with postmenopausal bleeding and/or with a sonographically highly developed endometrium who were referred for hysteroscopy with D&C were included. A total of 92 patients were included in this study. Before each procedure, patients were explicitly informed about the study and gave consent. On the condition of anonymity of personal data (surname and first name, date of birth) and after signing a special informed consent form, the patients were allowed to be included in the study. The study was performed as a double-blind study. The obtained histologies (from pipelle and D&C) were sent separately to the same pathologist. Results: The group with malignant and premalignant findings has a central role in our study. After evaluation of the histologically malignant findings from the pipelle and the D&C, the sensitivity of the pipelle in our study was 82%. Conclusion: Endometrial biopsy is an important step to exclude endometrial carcinoma in postmenopausal bleeding. The aim is to minimize the burden and invasiveness of the procedure while maintaining a high degree of diagnostic certainty to avoid unnecessary invasive surgery. The pipelle sampling can be used as an outpatient method without anaesthesia during routine examination. Our study shows that this method of sampling is a safe, accurate and cost-effective outpatient procedure with high sensitivity for the detection of endometrial carcinoma.

scholarly journals Can head louse repellents really work? Field studies of piperonal 2% spray

2014 ◽  
Author(s):  
Ian F Burgess ◽  
Christine M Brown ◽  
Nazma A Burgess ◽  
Judith Kaufman
Keyword(s):  
Parental Monitoring ◽  
Head Louse ◽  
Cost Effective ◽  
Field Studies ◽  
Control Group ◽  
Double Blind Study ◽  
Louse Infestation ◽  
Double Blind ◽  
Head Louse Infestation ◽  
North London

Background: Many families find regular checking of children’s heads for head louse infestation too onerous and would prefer to be able to prevent infestation by use of a topical application that deters lice from infesting the head. Identification in the laboratory of a repellent activity for piperonal provided the basis for developing a spray product to repel lice. Methods: A proof of principle field study in Dhaka, Bangladesh, compared the effect of using 2% piperonal spray with that of a placebo in 105 children and adults from three communities with infestation levels close to 100%. All participants were treated for infestation and subsequent incidence of reinfestation monitored daily by investigators. A second randomised, controlled, double blind, study in North London, UK, evaluated the effect of the product in normal use. One hundred and sixty-three children from schools with a high level (20-25%) of infestation were treated and confirmed louse free and randomly divided between 2% piperonal, a placebo spray, and a control group for up to 22 weeks. Parents applied the spray and monitored for infestation. Regular investigator visits confirmed the parental monitoring and replenished supplies of spray. Results: In Dhaka, over 18 days there were only 4 infestations in the piperonal group and 8 in the placebo group. This difference was not significant (p = 0.312). In North London, there were 41 cases of infestation over the course of the study. Analysis of time to first infestation showed a non-significant (p = 0.4368) trend in favour of piperonal. Conclusion: Routine use of 2% piperonal spray in communities with a high prevalence of head louse infestation may provide some protection from infestation. However, the difference between use of the product and no active intervention was sufficiently small that regular checking for presence of lice is likely to be a more practical and cost effective approach to prevention of infestation.

scholarly journals Enzyme-linked immunosorbent assay (ELISA) immunoassaying versus microscopy: advantages and drawbacks for diagnosing giardiasis

2005 ◽  
Vol 123 (6) ◽  
pp. 282-285 ◽  
Author(s):  
Alaíde Mader Braga Vidal ◽  
Wilson Roberto Catapani
Keyword(s):  
Microscopic Examination ◽  
Giardia Lamblia ◽  
Specific Antigen ◽  
Significant Proportion ◽  
High Sensitivity ◽  
Laboratory Diagnosis ◽  
Elisa Test ◽  
Enzyme Linked Immunosorbent Assay ◽  
Double Blind Study ◽  
Double Blind

CONTEXT AND OBJECTIVE: Giardiasis is common in Brazil. For laboratory diagnosis, the method most utilized is microscopic examination of fecal samples, but the immunoenzymatic method is also available. The aim of this work was to verify the advantages and drawbacks of immunoassaying versus microscopy for diagnosing Giardia lamblia, when a single fecal sample is analyzed. DESIGN AND SETTING: Prospective, double-blind study at the parasitology laboratory of Faculdade de Medicina da Fundação ABC. METHODS: Samples were prepared according to the traditional sedimentation (Hoffman, Pons and Janer) and Faust methods. Results were deemed positive when Giardia lamblia was found by one or both methods. The Prospect ELISA kit was used for detecting Giardia lamblia-specific antigen, in accordance with the manufacturer's instructions. Results were expressed on a visual scale as negative or positive (+, ++, +++ or ++++). RESULTS: The ELISA test was positive even when a significant proportion of corresponding samples examined by microscopy were negative. This trend was statistically significant (p < 0.001). The overall concordance of results between the ELISA test and microscopic examination of single samples was only moderate (0.50 by kappa test). CONCLUSION: The ELISA test is useful when just searching for Giardia lamblia, because of its high sensitivity. For daily practice, we recommend microscopy, which is much cheaper and can also detect other parasites. The low positivity of single samples in this method can be overcome by using three samples, as recommended by most authors.

scholarly journals Effect of Periodontal Treatment on HbA1c among Patients with Prediabetes

2018 ◽  
Vol 98 (2) ◽  
pp. 171-179 ◽  
Author(s):  
T. Kocher ◽  
B. Holtfreter ◽  
A. Petersmann ◽  
P. Eickholz ◽  
T. Hoffmann ◽  
...  
Keyword(s):  
Controlled Trial ◽  
High Sensitivity ◽  
Periodontal Treatment ◽  
Double Blind Study ◽  
Double Blind ◽  
Reactive Protein ◽  
Probing Depth ◽  
Multicenter Randomized Controlled Trial ◽  
Post Hoc ◽  
Observation Period

Evidence is limited regarding whether periodontal treatment improves hemoglobin A1c (HbA1c) among people with prediabetes and periodontal disease, and it is unknown whether improvement of metabolic status persists >3 mo. In an exploratory post hoc analysis of the multicenter randomized controlled trial “Antibiotika und Parodontitis” (Antibiotics and Periodontitis)—a prospective, stratified, double-blind study—we assessed whether nonsurgical periodontal treatment with or without an adjunctive systemic antibiotic treatment affects HbA1c and high-sensitivity C-reactive protein (hsCRP) levels among periodontitis patients with normal HbA1c (≤5.7%, n = 218), prediabetes (5.7% < HbA1c < 6.5%, n = 101), or unknown diabetes (HbA1c ≥ 6.5%, n = 8) over a period of 27.5 mo. Nonsurgical periodontal treatment reduced mean pocket probing depth by >1 mm in both groups. In the normal HbA1c group, HbA1c values remained unchanged at 5.0% (95% CI, 4.9% to 6.1%) during the observation period. Among periodontitis patients with prediabetes, HbA1c decreased from 5.9% (95% CI, 5.9% to 6.0%) to 5.4% (95% CI, 5.3% to 5.5%) at 15.5 mo and increased to 5.6% (95% CI, 5.4% to 5.7%) after 27.5 mo. At 27.5 mo, 46% of periodontitis patients with prediabetes had normal HbA1c levels, whereas 47.9% remained unchanged and 6.3% progressed to diabetes. Median hsCRP values were reduced in the normal HbA1c and prediabetes groups from 1.2 and 1.4 mg/L to 0.7 and 0.7 mg/L, respectively. Nonsurgical periodontal treatment may improve blood glucose values among periodontitis patients with prediabetes (ClinicalTrials.gov NCT00707369).

scholarly journals Transvaginal ultrasound and lactate dehydrogenase isoenzyme activity profile in uterine aspirate for diagnosis of endometrial carcinoma in women with postmenopausal bleeding

2007 ◽  
Vol 17 (6) ◽  
pp. 1322-1326 ◽  
Author(s):  
O. Niklasson ◽  
G. Skude ◽  
G. Lingman ◽  
B. Casslén ◽  
K. Maršál
Keyword(s):  
Lactate Dehydrogenase ◽  
Endometrial Carcinoma ◽  
Endometrial Thickness ◽  
Transvaginal Ultrasound ◽  
High Sensitivity ◽  
Postmenopausal Bleeding ◽  
Activity Profile ◽  
Sampling Device ◽  
Uterine Fluid ◽  
The Cost

Postmenopausal patients with vaginal bleeding (n= 72) were evaluated with the combination of transvaginal ultrasonography (TVS) and analysis of the lactate dehydrogenase (LD) isoenzyme activity profile in uterine fluid aspirates. TVS evaluation of the endometrium was classified as <5 mm, ≥5 mm, or poorly defined. The LD isoenzyme activity profile was characterized as abnormal or normal. Pathologic findings were further evaluated with diagnostic curettage. TVS found the endometrium to be ≥5 mm or poorly defined in 44 patients (61%). Endometrial carcinoma was found in 6 of 72 patients (8%). They appeared in the TVS groups endometrium >5 mm (n= 2) and endometrium poorly defined (n= 4) but not in the endometrium <5 mm. The LD isoenzyme activity profile was abnormal in the six malignant cases and in ten benign cases. Thus, the need for further evaluation with hysteroscopy and curettage was reduced to 16 cases. Since TVS had 100% sensitivity but only 42% specificity, it is suitable for first-level examination in patients with postmenopausal bleeding. The second-level method should have similarly high sensitivity but much higher specificity. The LD isoenzyme activity profile in uterine fluid aspirates had 100% sensitivity and 85% specificity. Another important feature is that the method is not sensitive to endometrial thickness, amount of sample, sampling device, or dilution. Thus, it is more reliable than aspiration histology. For every hysteroscopy or curettage that can be replaced by LD analysis, the cost is reduced by approximately EUR 720 or 540, respectively.

scholarly journals Assessing the post-treatment therapeutic effect of pinaverium in irritable bowel syndrome: a randomized controlled trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Liang Zheng ◽  
Weimin Lu ◽  
Qi Xiao ◽  
Yaoliang Lai ◽  
Heng Fan ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Controlled Trial ◽  
Cost Effective ◽  
Gastrointestinal Disorder ◽  
Post Treatment ◽  
Therapeutic Effects ◽  
Double Blind Study ◽  
Double Blind ◽  
Pain Frequency ◽  
Irritable Bowel

AbstractIrritable bowel syndrome (IBS) is the most common gastrointestinal disorder significantly decreasing patients’ lives of quality and placing huge economic burden on our society. Existing studies indicated that the therapeutic effects maintained for a period of time after the treatments were discontinued. It is clinically important to assess these post-treatment therapeutic effects (PTTE), which prevent IBS from relapsing. To assess the PTTE in pinaverium treatment and obtain high-quality evidence to justify the use of PTTE for long-term IBS management, we performed this controlled, double blind study on patients with IBS who were randomized to pinaverium 50 mg (n = 132) or placebo (n = 132), three times daily, for 4 weeks, and were followed up for 57 weeks after the treatments. The primary endpoints were abdominal pain and stool consistency. The secondary endpoints were pain frequency and stool frequency. The tertiary endpoints were global overall symptom and adverse events. Three days after pinaverium was discontinued, endpoints rebounded only 23.2–42.8% (P < 0.015 cf. placebo). The PTTE (P < 0.05 cf. placebo) lasted 9–17 weeks, which is similar to other antispasmodics with a 15-week treatment in striking contrast to ≥ 1 year PTTE in cognitive behavior therapy and < 1 week PTTE in serotonin antagonist treatment indicating that PTTE length markedly depends on the medication class used for the treatment and less depends on treatment length. After 17 weeks, the stage could be considered as an IBS natural history [no significant differences between pinaverium and placebo (all endpoints’ P’s > 0.05)], during which an average of 51.5–56.4% of patients (pool pinaverium and placebo data together) had IBS symptoms. These results provide clinical insights into efficient and cost-effective management of refractory IBS, and lend support to the IBS management that the selection of a therapy should consider both its effectiveness during treatment and its PTTE after the treatment.Trial registration number: NCT02330029 (16/08/2016).

scholarly journals Diagnostic Strategies for Postmenopausal Bleeding

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
M. C. Breijer ◽  
A. Timmermans ◽  
H. C. van Doorn ◽  
B. W. J. Mol ◽  
B. C. Opmeer
Keyword(s):  
Endometrial Carcinoma ◽  
Diagnostic Procedures ◽  
Clinical Problem ◽  
Endometrial Biopsy ◽  
Diagnostic Workup ◽  
Transvaginal Sonography ◽  
Future Research ◽  
Diagnostic Strategy ◽  
Postmenopausal Bleeding ◽  
Diagnostic Strategies

Postmenopausal bleeding (PMB) is a common clinical problem. Patients with PMB have 10%–15% chance of having endometrial carcinoma and therefore the diagnostic workup is aimed at excluding malignancy. Patient characteristics can alter the probability of having endometrial carcinoma in patients with PMB; in certain groups of patients the incidence has been reported to be as high as 29%. Transvaginal sonography (TVS) is used as a first step in the diagnostic workup, but different authors have come to different conclusions assessing the accuracy of TVS for excluding endometrial carcinoma. Diagnostic procedures obtaining material for histological assessment (e.g., dilatation and curettage, hysteroscopy, and endometrial biopsy) can be more accurate but are also more invasive. The best diagnostic strategy for diagnosing endometrial carcinoma in patients with PMB still remains controversial. Future research should be focussed on achieving a higher accuracy of different diagnostic strategies.

scholarly journals DIAGNOSTIC ACCURACY OF SALINE HYSTEROSONOGRAPHY IN DETECTING ENDOMETRIAL HYPERPLASIA IN PATIENTS WITH POST MENOPAUSAL BLEEDING

2020 ◽  
Vol 11 (2) ◽  
pp. 1-8
Author(s):  
Benish Yousuf ◽  
Hira Ambreen ◽  
Tahira Mariam ◽  
Abdul Raouf ◽  
Ambreen Yaseen ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Endometrial Hyperplasia ◽  
Foley Catheter ◽  
High Sensitivity ◽  
Cost Effective ◽  
Postmenopausal Bleeding ◽  
Cost Effective Method ◽  
Post Menopausal ◽  
Sensitivity Specificity

BACKGROUND & OBJECTIVE: Saline hysterosonography is a simple and cost-effective method with high sensitivity to detect uterine abnormalities causing postmenopausal bleeding. The objective of this study was to evaluate the diagnostic accuracy of saline hysterosonography in detecting endometrial hyperplasia in women with postmenopausal bleeding by taking histopathology as a gold standard. METHODOLOGY: A hundred and twenty (120) cases were enrolled from the outpatient and inpatient department of obstetrics and gynecology. Proper history and relevant examination of the patient was done. Then preparations were made for the procedure. The patient was counseled and the technique explained to her. Then Foley catheter no 12 was passed in cervix and sonography was done while instilling normal saline through a cervical catheter and scan pictures were frozen and results were given by expert gynecologist of Allied Hospital, Faisalabad. Histopathology specimen was sent to the pathology lab. RESULTS: Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of saline hysterosonography in detecting endometrial hyperplasia was recorded as 96.15%,91,49%,75.76%,98.85%, and 92.5% respectively. CONCLUSION: Saline hysterosonography has high sensitivity to detect uterine hyperplasia. It can be used as a cost effective alternative to hysteroscopy in many units in Pakistan.

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