Incomplete miscarriage during the first trimester: a comparison of indoor versus outdoor procedure

2020 ◽  
Vol 24 (3) ◽  
pp. 235-239
Author(s):  
Faiza Iqbal ◽  
Sadia Azmat ◽  
Rabia Jamshaid ◽  
Zunaira Arshad ◽  
Anum Saqib
Keyword(s):  
Controlled Trial ◽  
First Trimester ◽  
P Value ◽  
Vacuum Aspiration ◽  
Manual Vacuum Aspiration ◽  
Group A ◽  
First Trimester Of Pregnancy ◽  
The Mean ◽  
Group B ◽  
Incomplete Miscarriage

Introduction: Miscarriage is defined as the natural death of a fetus inside the uterus. To remove complete conception material after a miscarriage, vacuum aspiration or dilatation & curettage are methods to remove uterine contents. Controversies exist regarding both procedures. So we conducted this study to confirm the more successful method. Objective: To compare the effectiveness of manual vacuum aspiration versus traditional evacuation and curettage (E & C) among females presenting with incomplete miscarriage during the first trimester of pregnancy Materials and Methods: This randomized controlled trial was done at the Department of Obstetrics & Gynecology, Shalamar Hospital, Lahore for 6 months. Then the selected females were divided randomly into 2 equal groups. In group A, females had manual vacuum procedure while in group B, females had evacuation & curettage under general anesthesia. After 12 hours of the procedure, ultrasonography was done to confirm complete evacuation. Results: The mean age of the patients was 29.87 ± 6.71 years, the mean gestational age was 8.06 ± 2.82 weeks. The effectiveness was noted in 248 (91.85%) patients. Statistically, manual vacuum showed significantly more effective as compared to evacuation & curettage procedure in the management of incomplete miscarriage i.e. p-value = 0.008. Conclusion: It has been proved that manual vacuum aspiration is more effective than traditional evacuation & curettage in the management of incomplete miscarriage.

Comparison of letrozole and clomiphene citrate efficacy in terms of ovulation induction and pregnancy rate.

2021 ◽  
Vol 28 (05) ◽  
pp. 749-754
Author(s):  
Nadia Sharif ◽  
Uzma Manzoor ◽  
Saadia Bano ◽  
Uzma Shahzaad
Keyword(s):  
Pregnancy Rate ◽  
Ovulation Induction ◽  
Endometrial Thickness ◽  
Controlled Trial ◽  
Clomiphene Citrate ◽  
Epidemiological Data ◽  
P Value ◽  
Group A ◽  
The Mean ◽  
Group B

Objective: To compare the efficacy of Letrozole and clomiphene citrate in Patients of Anovulation polycystic ovarian syndrome with Infertility. Study Design: Randomized Controlled Trial Setting: Department of Obstetrics and Gynecology Independent Medical College Faisalabad. Period: 30-09-2019 to 29-6-2020. Material & Methods: This study included 100 patients with 50 patients in each group. Group A received 2.5 to 5mg letrozole in each cycle from day 3 to 7. Group B received clomiphene citrate 50 to 100 mg incremental dose depending on ovarian response. Both Drugs were given for consecutive 3 to 6 cycles to see response. Main outcome Measure included optimal follicle size (> 18mm), endometrial thickness, and pregnancy rate. Epidemiological data and efficacy outcome measures were recorded on a Performa. Statistical analysis was done using SPSS version 13. Chi-square test applied and p-value <o.o5 was considered significant. Both group included primary infertility patients. Results: The mean age of patients was 28.03+ 3.02 years. Mean age of group A patients was 29.04+3.44 and 28.47+3.90 group B patients. Mono ovulation in group A patients (88.9%) and 27 in group b patients (60.0%). The mean endometrial thickness was 9.6mm + 1.6 in letrozole group and 6.9mm + 1.2 in clomiphene citrate group A. In group A 18% got pregnant from Letrozole group and 1.1% from the group B. Conclusion: Efficacy was significantly higher in group A Patients received letrozole as compared to patients echo received clomiphene citrate. The effects of Letrozole showed better outcome in terms of Ovulation Induction Endometrial Thickness and Pregnancy rate.

Comparison of harmonic scalpel versus Milligan Morgan technique in haemorrhoidectomy patients

2021 ◽  
Author(s):  
Muhammad Ahmad ◽  
Syed Tatheer Abbas ◽  
Amna Javaid ◽  
Naveed Arshad ◽  
Falak Shair
Keyword(s):  
Wound Healing ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Controlled Trial ◽  
P Value ◽  
Randomized Controlled ◽  
Group A ◽  
The Mean ◽  
Complete Wound Healing ◽  
Group B

Objectives: To assess the comparison of harmonic scalpel versus Milligan Morgan technique in patients undergoing haemorrhoidectomy. Methodology: This randomized controlled trial study was conducted at General Hospital, Lahore, from March 2019 to September 2019. Informed consent was obtained from eligible 60 patients. Patients were randomly divided into two equal groups. In group-A, haemorrhoidectomy was conducted according to the harmonic scalpel method. In group-B, open haemorrhoidectomy was performed by the Milligan Morgan procedure. Data was assembled through a designed questionnaire and investigated via SPSS version 25. Data were stratified for descriptive statistics, level of haemorrhoids and period of haemorrhoids. Post-stratification, independent sample t-test was used. Results: Mean age of both groups patients were 44.6±7.6 and 43.8±8.2 years, respectively. In group-A, mean operative time was 20.8±2.8 minutes, while 26.5±2.8 minutes in group-B, which was statistically significant with p-value of 0.001. In group-A, mean convalescence period was 9.7±2.9 days, while 13.4±3.7 days in group-B, which was statistically significant with p-value of 0.001. The mean convalescence period with harmonic scalpel method was 7.4 days (range 5–14, SD 3.6) versus 18.6 days (range 7–30, SD 5.4) with Milligan Morgan technique (P?0.001). This research observed that harmonic scalpel method required almost six weeks for complete wound healing, whereas in  Milligan Morgan technique, complete wound healing was achieved after three months (P<0.05). Conclusion: Harmonic scalpel haemorrhoidectomy found an advantageous method when assessing the operative time and convalescence period. Hence, Harmonic scalpel haemorrhoidectomy can be adapted as a safe and effective alternative method for treating symptomatic haemorrhoids. Continuous...

scholarly journals LOWER URETERIC STONES EXPULSION;

2017 ◽  
Vol 24 (09) ◽  
pp. 1331-1335
Author(s):  
Khalid Hussain ◽  
Maria Tarique ◽  
Attiq ur Rehman Khan ◽  
Asim Bukhari ◽  
Bilal Akhter ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Oral Treatment ◽  
P Value ◽  
X Rays ◽  
Female Ratio ◽  
Group A ◽  
Insignificant Difference ◽  
The Mean ◽  
Group B ◽  
Trial Setting

Objectives: To compare Tamsulosin versus ESWL for lower ureteric stonesexpulsion. Study Design: Randomized controlled trial. Setting: Outpatient Department ofUrology at Services Hospital, Lahore. Period: January 2015 to December 2015. Material& Methods: Total 50 patients were enrolled in study. Patients were divided into 2 groups.In group A, 25 patients received daily oral treatment of 0.4mg Tamsulosin for 28 days, andin group B, 25 patients were treated with ESWL. A stone-free condition, was defined as thecomplete absence of any stone based on plain abdominal X-rays observed and during followupvisits at the time of treatment of stone was noted. Results: The mean age of the patientswere recorded as 33.20±9.23 years. There were 40(80%) males and 10(20%) females with maleto female ratio of 4:1. Out of 50 patients, 16(32%) presented with hematuria, 3(6%) had feverwhile 31(62%) appeared with no complication status. Out of 50 patients, 21(42%) presentedwith expulsion time 08-14 days in which 14(28%) were from tamsulosin group and 07(14%)were from ESWL group, similarly 19(38%) patients appeared with expulsion time of 15-28 daysin which 10(20%) were from tamsulosin group and 09(18%) were from ESWL group. Statisticallythere is insignificant difference between the groups i.e. p-value=0.28 Ns. Conclusion: Thisstudy suggests that the tamsulosin helps in the earlier clearance of stone fragments andreduces the complications as compared to ESWL.

scholarly journals COMPARISION OF CEMENTED VERSUS UNCEMENTED HEMIARTHOROPLASTY OF THE HIP.

2019 ◽  
Vol 26 (07) ◽  
pp. 1057-1061
Author(s):  
Dr. Hafiz Salman Saeed ◽  
Farhad Alam ◽  
Muhammad Yousaf ◽  
Iqra Fayyaz
Keyword(s):  
Controlled Trial ◽  
P Value ◽  
Orthopaedic Department ◽  
Residual Pain ◽  
Uncemented Hemiarthroplasty ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Trial Setting

The objective of this study was to compare the mean residual pain after cemented versus uncemented hemiarthroplasty of hip. Study Design: Randomized Controlled Trial. Setting: Orthopaedic Department, Allied Hospital, Faisalabad. Period: September 2016 to October 2017. Materials and Methods: Total 150 patients were admitted in orthopedic Department of Allied Hospital Faisalabad according to inclusion & exclusion criteria. After taking informed written consent, all patients were divided into two groups randomly. Cementedhemiarthroplasty was done in Group A patients and uncemented hemiarthroplasty was done in group B patient. All procedures were done by surgeon who has minimum 5yrs post fellowship experience. Monthly Follow up was done and residual pain was noticed at the end of 6th month. All the data was analyzed by using SPSS version 20.0. Results: In this study, in Group-A the patients between 65-75 years of age were 57.33% (n=43) and between 76-85 of age were 42.67% (n=32). In Group B the patients between 65-75 years of age were 56%(n=42) and between 76-85 years were 44% (n=33). The mean+sd was calculated and it is 73.49+4.99 years in Group-A patients and 73.73+4.74 years in Group-B patients. In Group A, males were 61.33% (n=46) and female were 38.67% (n=29). In Group B, males were 57.33% (n=43) and female were 42.67% (n=32). When we compared the residual pain after cemented versus uncemented hemiarthroplasty of the hip, it shows 1.69+0.35 in Group-A patients and 2.62+0.30 in Group-B patients. When we calculated p-value it was 0.0001 showing a significantdifference. Conclusion: It is concluded that residual pain in cemented hemiarthroplasty is lower than uncemented hemiarthroplasty. 

Outcome Of Manual Vacuum Aspiration Vs Surgical Evacuation

2019 ◽  
Vol 09 (04) ◽  
pp. 303-307
Author(s):  
Fozia Akmal ◽  
Sadia Suboohi ◽  
Saba Pario ◽  
Sugra Abbasi ◽  
Shahanaz Hassan Siddiqui
Keyword(s):  
Patient Satisfaction ◽  
Operating Time ◽  
P Value ◽  
Uterine Perforation ◽  
Excessive Bleeding ◽  
Vacuum Aspiration ◽  
Manual Vacuum Aspiration ◽  
Surgical Evacuation ◽  
Group A ◽  
Group B

Objective: To compare the safety, efficacy and complications of manual vacuum aspiration (MVA ) versus surgical evacuation in low resource set up. Study Design and Setting: This crossectional study conducted at Department of Obstetrics & Gynaecology at Kulsoom Bai Valika Social Security SITE Hospital Karachi from January to June 2017. Methodology: A total of one hundred patients with less than 12 weeks of gestation and diagnosis of missed miscarriage, incomplete miscarriage, blighted ovum or with retained products of conception (RPOCs) were recruited and randomly allocated to MVA without anesthesia (Group A) and surgical evacuation under general Anesthesia in Operation theatre (Group B).Both groups were compared in terms of demographic and obstetric data, clinical course (need of anaesthesia, operating time, approximate blood loss and stay in hospital) ,complications(excessive bleeding, uterine perforation, need for re-evacuation/ failed procedure, sepsis and maternal death ) and patient satisfaction. Results: Mean age of patients was 28.68 in Group A and 26.90 in Group B ( P value-0.136). Average gestational age in weeks at which procedure was performed in Group A found to be 8.32 and 9.546 for Group B ( P value-0.007 ). Parity was comparable in both groups (P value-0.746). Most of the patients were literate. Mean operating time and amount of blood loss comparison among groups had no statistical difference. Average hospital stay was significantly short in MVA Group ( P value-0.001). No maternal death or uterine perforation observed in both the groups,6% and 8% of patients had excessive bleeding in Group A & Group B respectively, one patient underwent re-evacuation in MVA group and one had sepsis after surgical evacuation. Post procedure satisfaction was comparable in both the groups. Conclusion: Manual Vacuum Aspiration is comparable to surgical evacuation in terms of safety, efficacy, complications, patient satisfaction and superior in shorter hospital stay, no need of anesthesia and access to operation theater

To Compare the Mean Decrease in Respiratory Distress Assessment Score after Nebulization With Salbutamol Vs Epinephrine in Children With Acute Bronchiolitis

2021 ◽  
Vol 15 (8) ◽  
pp. 1834-1835
Author(s):  
Faheem Ullah ◽  
Syed Sajid Munir ◽  
Maimoona Saeed
Keyword(s):  
Respiratory Distress ◽  
Controlled Trial ◽  
P Value ◽  
Acute Bronchiolitis ◽  
Group 13 ◽  
Assessment Score ◽  
Randomized Controlled ◽  
Group A ◽  
The Mean ◽  
Group B

Aim: To compare the mean decrease in respiratory distress assessment score after nebulization with salbutamol vs epinephrine in children with acute bronchiolitis. Study Settings: Department of Pediatrics, Khyber Teaching Hospital Peshawar. Study design & duration: Randomized Controlled Trial for six months from 13/6/2018 to 13/12/2018. Methodology: In this study, 105 patients in each group were studied. Baseline RDAI score was calculated. All the patients were randomly divided in two groups. Children in group A were Nebulized with Epinephrine (0.1 ml/kg) while children in group B were with salbutamol nebulization (5mg/ml solution) ½ml+3ml normal saline repeated every hour. All children were reassessed at the end of 4th dose (4th hour) and RDAI were recalculated for all patients. Results: In age of 2-12 months, 63% infants have nebulization with epinephrine and 70% cases with salbutamol while in age group 13-18 months, 37% cases nebulized with epinephrine and 30% infants with salbutamol. Mean±SD was 10.57±4.22 and 11.63±3.14 months respectively. Regarding sex, 60% males were nebulized with epinephrine and 53.3% with salbutamol while 40% females were nebulized with epinephrine and 46.7% cases with salbutamol. Mean RDAI at baseline was calculated as 11.57+2.21 with epinephrine and 11.3+2.14 with salbutamol and P value was 0.3695. Conclusion: Mean reduction in RDAI with epinephrine nebulization is more as compared to nebulization with salbutamol in children of acute bronchiolitis. Keywords: RDAI, nebulization, salbutamol, epinephrine, acute Bronchiolitis

scholarly journals Comparison of efficacy of intramyometrial versus intramuscular prostaglandin F2α (PGF2α) in the management of primary postpartum hemorrhage due to uterine atony.

2021 ◽  
Vol 28 (11) ◽  
pp. 1656-1663
Author(s):  
Saira Kanwal ◽  
Aisha Javed ◽  
Sidra Saba ◽  
Afifa Batool Gillani
Keyword(s):  
Intervention Study ◽  
Controlled Trial ◽  
Prostaglandin F2α ◽  
Uterine Atony ◽  
P Value ◽  
Randomized Controlled ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Ruptured Uterus

Objective: To determine the better route of prostaglandin F2α either intramyometrial or intramuscular for the management of uterine atony and to prevent surgical intervention. Study Design: Randomized Controlled Trial. Settings: Bahawal Victoria Hospital. Period: Feb 2018 to July 2018. Material & Method: A total of 266 patients with primary PPH due to uterine atony of 20 to 39 years of age were enrolled in the study. Patients of primary PPH due to bleeding disorders, ruptured uterus, on anticoagulant therapy and hypersensitivity to prostaglandin were excluded. Patients were divided randomly into two groups i.e. Group A (for intramyometrial injection) & Group B (for intramuscular injection). Outcome variables like arrest of bleeding within 30 minutes after start of treatment (efficacy) were noted for successful or unsuccessful outcome. Results: The mean age of women in group A was 26.94 ± 4.43 and in group B was 26.21 ± 4.09 years (p=0.005). The mean parity in group A was 2.92 ± 0.87 and in group B was 2.93 ± 0.98 (p=0.8579). Efficacy was 82.71% in group A (Intramyometrial group) and 91.73% in group B (Intramuscular group) with p-value of 0.0276. Conclusion: This study concluded that intramuscular prostaglandin F2α has better efficacy i.e. 91.73% in a patient of uterine atony for management of primary PPH as compared to intramyometrial rout of administration for prostaglandin F2α.

scholarly journals A comparison of manual vacuum aspiration with medical method of abortion in termination of pregnancy up to 9 weeks of gestational age

2017 ◽  
Vol 6 (9) ◽  
pp. 3813
Author(s):  
Pramod Garhwal ◽  
Lata Rajoria ◽  
Manju Sharma
Keyword(s):  
Success Rate ◽  
Gestational Age ◽  
Vaginal Bleeding ◽  
Termination Of Pregnancy ◽  
P Value ◽  
Vacuum Aspiration ◽  
Manual Vacuum Aspiration ◽  
Surgical Evacuation ◽  
Group A ◽  
Group B

Background: Objective of present study was to compare efficacy and complications of medical method versus manual vacuum aspiration in early pregnancy termination and to determine whether medical method of termination of pregnancy represent a reasonable alternative to surgical method (MVA) in terms of complete evacuation of products of conception and their side effects.Methods: A comparative study was carried out on 184 pregnancies in women who were willing for termination of pregnancy up to 9 weeks (63 days) of gestational age, in Group A: women who opted for medical method for termination, Group B: women who opted for manual vacuum aspiration for termination.Results: Mean age of Group A was 27.63±3.60 years and Group B was 26.87±3.83 years. Majority 169 (92%) of women were Hindu. 165 (90%) of the patients lived in urban area and 176 (96%) were married women. Majority 130 (71%) of them were para 2 and more. Average age of gestation at which termination was performed was 46.79±6.29 days in Group A and 49.13±6.67 days in Group B. Average duration of vaginal bleeding among Group A was found to be 8.9±3.5 days (p value<0.05) and in Group B was 6.837+2.928 days which was significantly longer in Group A. 72 (78.3%) patients considered vaginal bleeding to be heavier than their normal period in Group A where as in Group B 8 (8.7%)perceived it to be heavier (p value <0.001). Incidence of pain, nausea, vomiting, diarrhea and incomplete abortion (78.26%, 32.60%, 16.3%, 19.56% and 4.43%) in group A and (52%, 7.6% ,4.3%, nil and 2.17%) in group B which were found to be higher in Group A as compare to Group B. Patient satisfaction was 95.65% in medical method and 84.78% in MVA group. Success rate was 95.65% for medical and 97.82% for MVA group.Conclusions: Duration and amount of bleeding per vaginum is more in medical method as compare to surgical method. Side effects like pain, nausea, vomiting and diarrhea were more in medical group, but majority of these symptoms were self-limiting. There was high satisfaction rate (95.65%) among medical abortion group because less surgical and anaesthetic complication, offer them more privacy and treatment is taken at home. The effectiveness of medical method of abortion in present study was 95.65% and success rate in MVA was 97.82%. Medical method of abortion for first trimester termination of pregnancy upto 9 weeks of gestation can be better alternative method to surgical evacuation. Medical method of abortion proves to be more effective, safe and economical method that avoid complication associated with surgical evacuation like uterine perforation, cervical laceration and anaesthtic complication. The only disadvantage with medical method of abortion is lack of predictability and variable success rate.

scholarly journals To Study Association between upper Gastrointestinal Symptoms and Body Mass Index in First Trimester of Pregnancy

2016 ◽  
Vol 8 (2) ◽  
pp. 127-129
Author(s):  
Ashish Gautam ◽  
Asha Nigam ◽  
Ruchi Rani
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Gastrointestinal Symptoms ◽  
First Trimester ◽  
P Value ◽  
Group A ◽  
Upper Gastrointestinal Symptoms ◽  
First Trimester Of Pregnancy ◽  
Group B ◽  
Upper Gastrointestinal

ABSTRACT Aims To study the association between upper gastrointestinal symptoms and body mass index (BMI) in the first trimester of pregnancy. Objectives To determine common upper gastrointestinal tract symptoms among women during their first trimester and to determine any association with the maternal BMI for their occurrence. Materials and methods Three hundred and forty-eight pregnant females during their first trimester who visited the outpatient department or causality were evaluated for their upper gastrointestinal symptoms. Their weight, height, and obstetric history were noted. Patients were evaluated for the presence of epigastric pain, nausea, vomiting, acid regurgitation, heart burn, early satiety, and loss of appetite after conception. Patients were grouped into three categories: Group A, with low BMI (< 20 kg/m2); group B, with average BMI (20—22.9 kg/m2); and group C, with high BMI (> 22.9 kg/m2). Symptoms were correlated with BMI. Results Patient were divided as follows: 26.6% (n = 92) were in group A, 53.6% (n = 185) were in group B, and 20.5% (n = 71) were in group C. In group A, 56 (60.8%) out of 92 developed new gastrointestinal symptoms and 51 out of 56 developed vomiting. In group B, 77 (41.6%) out of 185 developed new gastrointestinal symptoms and 40 out of 77 developed vomiting. In group C, 45 (63.3%) out of 71 developed new gastrointestinal symptoms and 29 out of 45 developed vomiting. Group A women are more prone to developing upper gastrointestinal symptoms than group B women, p-value being 0.003245 (< 0.05). Group C patients were more prone to developing upper gastrointestinal symptoms than group B patients. There is no statistical difference between groups A and C, p-value being 0.870 (> 0.05). Statistical analysis used Chi-square test. Conclusion Both high and low BMI are associated with more risk of development of upper gastrointestinal symptoms. Key message: Weight management prior to conception can reduce upper gastrointestinal symptoms during the first trimester. Key message Weight management prior to conception can reduce upper gastrointestinal symptoms during the first trimester. How to cite this article Gautam A, Nigam A, Agrawal P, Rani R. To Study Association between upper Gastrointestinal Symptoms and Body Mass Index in First Trimester of Pregnancy. J South Asian Feder Obst Gynae 2016;8(2):127-129.

PRECIPITATING FACTORS AND EFFICACY OF COMBINING LACTULOSE PLUS RIFAXIMIN IN THE TREATMENT OF HEPATIC ENCEPHALOPATHY DUE TO CIRRHOSIS AT CHO RAY HOSPITAL

2020 ◽  
pp. 63-68
Author(s):  
Phat Ho Tan ◽  
Tam Vu Thi Minh ◽  
Trong Huynh Nguyen Dang ◽  
Phuong Tran Nhat Thi Anh ◽  
Ngan Tran Thi Kim ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Gastrointestinal Bleeding ◽  
Clinical Symptoms ◽  
Controlled Trial ◽  
P Value ◽  
Precipitating Factors ◽  
Overt Hepatic Encephalopathy ◽  
Group A ◽  
Group B ◽  
Male To Female

Background: Hepatic encephalopathy is an important evidence that confirms impairment of liver function, may occur in about 40% of cirrhotics. Data about efficacy of rifaximin plus lactulose in the treatment of Vietnamese patients was still limited. This study aimed to determine the precipitating factors and to access the efficacy of lactulose plus rifaximin in overt hepatic encephalopathy. Patients and Methods: The prospective single-blind randomized controlled trial, 43 cirrhotics with overt hepatic encephalopathy without portal systemic shunting addmitted to gastroenterology department of Cho Ray Hospital from March 2019 to August 2019, were randomized into two groups (group A lactulose plus rifaximin 1.100 mg/day, n = 21; and group B only lactulose; n = 22). All patients were recorded for onset factors, clinical characteristics and assessing the recovery of hepatic encephalopathy. Results: The mean age of patients in this study was 54.8 ± 12.1 years (the ratio of male to female patients is 4.38 : 1). The leading cause of cirrhosis was alcohol (39.5%). The most common clinical symptoms were jaundice (83.7%), spider naevi (41.9%) and ascites (37.2%). The most common triggers were infection (51.2%), gastrointestinal bleeding (37.2%) and constipation (25.6%). The percentage of patients with complete improvement after treatment with lactulose plus rifaximin was 81% compared to 63.6% in the lactulose-treated patients only (95% CI: 0.539 - 1.147, p value = 0.206). Conclusion: Our data revealed that common triggers of hepatic encephalopathy were infections, gastrointestinal bleeding and constipation. The combination of lactulose plus rifaximin was more effective than rifaximin alone in the treatment of overt hepatic encephalopathy. Key words: hepatic encephalopathy, precipitating factor, lactulose, rifaximin

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