Uterine and tubal anatomical abnormalities in infertile women: diagnosis with routine hysterosalpingography prior to selective laparoscopy

Objective: To assess the findings and usefulness of hysterosalpingography as a routine investigation in the fertility workup prior to selective laparoscopy. Design: Descriptive retrospective study. Setting: A university hospital in the north of Jordan. Subjects: All hysterosalpingographies performed in the period between 1st January and 31 December 2008. Outcome measures: Detection of uterine and fallopian tube abnormalities and their correlation with laparoscopic findings. Results: During the study period, 281 infertile women underwent hysterosalpingography with no post procedural complications. The mean (SD) age was 31.5 (5.91) years. Mean (SD) duration of infertility was 4 (3.44) years. Infertility was reported as primary and secondary by 119 (42.3 %) and 162 (57.6 %), respectively. Altogether 281 patients and 562 tubes were examined. Of those, 402 were patent and 160 occluded. There was only one woman in whom peritubal adhesions were diagnosed. Because of hysterosalpingographically diagnosed tubal occlusion, 46 women (16.4 %) were referred for laparoscopy. Eight (17.3%) of them were treated with unilateral salpingectomy and 28 (60.8%) with bilateral salpingectomy. Salpingolysis was performed for 7 (15.2%) women, and 3 (6.7%) women had untreatable adhesions. The concordance was 71.7%. The sensitivity of HSG was 80%, the specificity 50%, the negative predictive value 61% and the positive predictive value 71%. Of the total of 281 women, 30 (10.7%) conceived within 1 - 11 months after the hysterosalpingography. Conclusions: The very high abnormal predictive value of hysterosalpingography in the diagnosis of tubal occlusion suggests that this procedure could be performed as a screening examination.

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Response of OCT Biomarkers Based on New Diabetic Macular Edema Classification TCED-HFV to Anti-VEGF Therapy and Its Prognostic Role in Vision Benefits

10.21203/rs.3.rs-1181453/v1 ◽

2021 ◽

Author(s):

Meng Yan ◽

Wenying Wang ◽

Zhaoxia Zheng ◽

Lu Li ◽

Duo Zhang ◽

...

Keyword(s):

Retrospective Study ◽

Macular Edema ◽

Predictive Value ◽

Prognostic Role ◽

Visual Effects ◽

Visual Prognosis ◽

Negative Factor ◽

Anti Vegf ◽

The Mean ◽

Better Than

Abstract Introduction. To investigate the association between OCT biomarkers and visual prognosis, based on TCED-HFV,and to explore whether these biomarkers have predictive value in visual prognosis of DME patients.Methods. The retrospective study included 166 eyes from 122 DME patients, who received 3 initial monthly intravitreal injections followed by PRN dosing. Results. The significant improvement of BCVA, as well as statistical decrement of CMT and HF, could be observed(p < 0.001, P=0.023, P=0.002, respectively). The BCVA in early and advanced DME is significantly better than that in severe DME in baseline (P=0.027, P=0.009, respectively) and 1 year (P=0.017, P=0.030, respectively). The broken EZ/ELM was generally accompanied by the existence of SF (P=0.032). The presence of DRIL and persistence SF were associated with negative visual effects (P＜0.001, P=0.045, respectively). At month 12 the mean BCVA was significantly improved in both intact and disrupted EZ/ELM groups (P=0.023, P=0.033, respectively). The number of the DME patients with ERM increases after treatment (P＜0.001).Conclusions. Intact EZ/ELM, the absence of DRIL and ERM might contribute to better response in patients. The persistence SF was a negative factor. Intravitreal anti-VEGF therapy was associated with ERM development and progression. It is not objective to consider only the OCT biomarkers but not the stages, and the indicators of different stages should be studied separately.

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Limited Mobility to the Bed Reduces the Chances of Discharge and Increases the Chances of Death in the ICU

Clinics and Practice ◽

10.3390/clinpract12010002 ◽

2021 ◽

Vol 12 (1) ◽

pp. 8-16

Author(s):

Talita Leite dos Santos Moraes ◽

Joana Monteiro Fraga de Farias ◽

Brunielly Santana Rezende ◽

Fernanda Oliveira de Carvalho ◽

Michael Silveira Santiago ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Medical Records ◽

High Mobility ◽

University Hospital ◽

Limited Mobility ◽

The Mean ◽

The University

Background: Progressive mobility in the ICU has been recommended; however, the definitions of low, moderate, and high mobility in the ICU still diverge between studies. Therefore, our objective was to classify the mobility of the sample from verticalization and active withdrawal from the bed, and from that, to analyze the chances of discharge, death, and readmission to the ICU. Materials and methods: This is an observational and retrospective study that consults the medical records of individuals admitted to the ICU of the University Hospital of Sergipe (HU/SE) between August 2017 and August 2018. Mobility level was classified based on the Intensive Care Unit Mobility Scale (IMS). Results: A total of 121 individuals were included. The mean age was 61.45 ± 16.45, being 53.7% female. Of these, 28 (23.1%) had low mobility, 33 (27.3%) had moderate mobility, and 60 (49.6%) had high mobility. Individuals with low mobility were 45 times more likely to die (OR = 45.3; 95% CI = 3.23–636.3) and 88 times less likely to be discharged from the ICU (OR = 0.22; 95% CI = 0.002–0.30). Conclusion: Those who evolved with low mobility had a higher chance of death and a lower chance of discharge from the ICU. Moderate and high mobility were not associated with the investigated outcomes.

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Sonographic and Hysteroscopic Assessment of Uterine Congenital Malformations: A Retrospective Study

Journal of Medical - Clinical Research & Reviews ◽

10.33425/2639-944x.1203 ◽

2021 ◽

Vol 5 (3) ◽

pp. 1-4

Author(s):

Orestis Tsonis ◽

Fani Gkrozou ◽

Evangelos Dimitriou ◽

Iordanis Navrozoglou ◽

Minas Paschopoulos

Keyword(s):

Retrospective Study ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Congenital Malformations ◽

Endometrial Thickness ◽

University Hospital ◽

Transvaginal Sonography ◽

Office Hysteroscopy ◽

Sonographic Assessment ◽

Uterine Malformations

Aim: Congenital uterine malformations are often diagnosed via Transvaginal Sonography (TVS) and/or office hysteroscopy. Few studies address the diagnostic accuracy of both techniques in detecting these abnormalities. The aim of this study is to evaluate sonographic and hysteroscopic findings in women with uterine congenital malformations. Methods and Materials: A nested retrospective study on 137 medical records of women with congenital malformations undergoing vaginoscopic office hysteroscopic and transvaginal sonographic assessment in the Endoscopic Unit, Department of Gynaecology, University Hospital of Ioannina, Greece was conducted. All women were examined initially via Transvaginal Sonography (TVS) and the sonographic findings were correlated with the hysteroscopic findings. Women with septate or bicornuate uteri confirmed their pathology through laparoscopy, a proposed gold standard technique. Result: Hysteroscopy was able to detect 136 out of 137 cases of congenital malformations with a false positive bicornuate uterus. Transvaginal sonography (TVS) showed moderate diagnostic accuracy accompanied by positive predictive value (PPV) at 79.79%, negative predictive value (NPV) at 99.17%, sensitivity at 79.79%, and finally specificity at 99.17%. Endometrial thickness assessed by TVS was found to be higher in cases of complete septate and bicornuate uteri. The incidence of congenital malformation within the total population was estimated at 4.56%. Conclusion: Diagnostic hysteroscopy is a reliable tool in detection uterine congenital malformations compared to two-dimensional sonography. Office hysteroscopy demonstrates high diagnostic accuracy and should replace traditional sonographic assessment in determining congenital uterine malformations. Clinical significance: Hysteroscopy is superior than TVS in detecting uterine congenital malformations.

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P–303 Similar long term recurrence rates with cystectomy and CO2-laser vaporization for endometrioma: a retrospective study

Human Reproduction ◽

10.1093/humrep/deab130.302 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

N Moura. Tawfic ◽

C Bafort ◽

C Meuleman ◽

A Laenen ◽

D Va. Schoubroeck ◽

...

Keyword(s):

Retrospective Study ◽

Co2 Laser ◽

Reproductive Age ◽

University Hospital ◽

Laser Vaporization ◽

Recurrence Rates ◽

Laparoscopic Excision ◽

Cyst Recurrence ◽

The Mean

Abstract Study question Is there a difference in recurrence rate of endometrioma(s) after cystectomy versus CO2-laser vaporization of the cyst wall? Summary answer Similar rates of imaging based recurrence or need for reintervention for endometrioma were observed after cystectomy versus CO2-laser vaporization. What is known already Surgical treatment of endometrioma(s) is mainly performed by 2 types of procedures: cystectomy and ablation. When performing surgery for endometrioma(s), a balance should be made between minimal destruction of normal ovarian cortex and maximal completeness to avoid (early) recurrence. Previous studies have shown that cyst recurrence rates were higher with ablation using bipolar current than after cystectomy. However, only 2 groups have evaluated recurrence rates after cystectomy versus CO2 laser vaporization and found no difference with extended follow-up. Furthermore, ablation with CO2 laser may be less invasive than conventional cystectomy with increased preservation of antral follicles in favor of ablation. Study design, size, duration Single-center retrospective study on data of 271 patients operated between January 2010 and December 2014. Participants/materials, setting, methods Women of reproductive age (18–45 years), undergoing CO2 laser laparoscopic excision of any rAFS-stage endometriosis with at least one endometrioma, were eligible for the study. All 271 included patients were treated in a tertiary referral center for endometriosis of a University Hospital, and underwent complete CO2-laser laparoscopic surgery for endometrioma(s). 155 underwent cystectomy, 77 CO2 laser vaporization, and 46 a mixed technique. Main results and the role of chance The mean duration of follow-up was 58 months. Primary outcome studied was the comparison of recurrence rates between cystectomy and vaporization; secondary outcomes included pregnancy rate and ovarian reserve testing. Recurrence was defined as either imaging based (i.e. cyst recurrence identified at ultrasound and/or MRI) or need for reintervention for suspected cyst recurrence. Imaging based recurrence was reported in 9.92% of patients (n = 12/121) treated with cystectomy and in 11.76% of patients (n = 6/51) who underwent a CO2 laser vaporization (p = .62). The need for reintervention for endometrioma(s) was also similar in both groups, with a rate of 3.23% (n = 5/155) after cystectomy and 4.29% (n = 3/70) after CO2 laser vaporization (p = .567). No difference was seen regarding AMH drop pre- versus postoperatively (p=.233). The 2 study groups were similar, except for the mean cyst diameter, which was higher in the cystectomy group (42.36 ± 25.49 mm) compared to the CO2 laser vaporization group (31.7 ± 26.98 mm) (p = <.001). This suggests that smaller endometriomas might be more likely to undergo CO2 laser vaporization. Limitations, reasons for caution The retrospective character of the study may induce information bias concerning the registration of recurrence. Moreover, regarding the evaluation of imaging-based recurrence, a selection bias cannot be excluded, because most likely only patients complaining about pain would be referred for an ultrasound or planned for a reintervention. Wider implications of the findings: In this study, similar rates of recurrence for endometrioma(s) were observed after cystectomy versus CO2-laser vaporization. Since previous studies suggested that CO2-laser vaporization may cause less damage to the adjacent ovarian tissue, we consider this a valuable alternative technique, especially for women with a future child wish. Trial registration number S59032

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Diagnostic value of lymphopaenia and elevated serum ACE in patients with uveitis

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316563 ◽

2020 ◽

pp. bjophthalmol-2020-316563

Author(s):

Philippine Cotte ◽

Pierre Pradat ◽

Laurent Kodjikian ◽

Yvan Jamilloux ◽

Pascal Seve

Keyword(s):

Retrospective Study ◽

Predictive Value ◽

Elevated Serum ◽

Diagnostic Value ◽

Granulomatous Uveitis ◽

Registration Number ◽

The Mean ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

AimTo evaluate the diagnostic worth of elevated serum ACE (sACE) and lymphopaenia, singly or combined, in diagnosing sarcoid uveitis.MethodsMonocentric retrospective study, on a cohort of 996 adult patients referred to our department between March 2001 and December 2018 for a diagnostic work-up of uveitis. The sensitivity (SE), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the two biomarkers were calculated in different contexts.ResultsEight hundred and sixty-eight patient cases were reviewed. The mean age at uveitis onset was 49.4 (±18.6) years. Of them, 144 patients had a diagnosis of sarcoid uveitis. An elevated sACE had SE of 45.8%, Sp of 88.8%, PPV of 44.9% and NPV of 89.2% in diagnosing sarcoid uveitis. For lymphopaenia, SE was 15.3%, Sp was 96.7%, PPV was 47.8% and NPV was 85.2%. For the combination of elevated sACE and lymphopaenia, SE was 18.9%, Sp was 99.0%, PPV was 73.9% and NPV was 89.5%. The value of this combination varied according to patient age at diagnosis plus anatomoclinical entities: for patients aged ≤50 years, SE was 31.3%, Sp was 99.7%, PPV was 90.9% and NPV was 94.3%. For granulomatous uveitis, SE was 26.2%, Sp was 97.3%, PPV was 73.3% and NPV was 82.5%.ConclusionA combination of elevated serum ACE and lymphopaenia more convincingly suggests sarcoid uveitis than these investigational tests used alone, especially in patients with granulomatous uveitis, while a lack of these markers corresponds to a high NPV.Trial registration numberNCT03863782.

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Confirmation of the Utility of the 4T Scoring System for HIT

Blood ◽

10.1182/blood-2018-99-119573 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5816-5816

Author(s):

Zachary Trisel ◽

Mark Maddox ◽

Ahmed Safa ◽

Thomas Bemis ◽

Kristine Ward ◽

...

Keyword(s):

Predictive Value ◽

Scoring System ◽

High Probability ◽

Time Course ◽

Conflicts Of Interest ◽

University Hospital ◽

Laboratory Studies ◽

Low Probability ◽

The Cost ◽

Very High

Abstract Background: Heparin-induced thrombocytopenia (HIT) is a complication of heparin-based anticoagulation (AC) resulting in thrombocytopenia and thrombosis. Laboratory testing can often be avoided as the 4T score (4TS) has a negative predictive value (NPV) of 0.998 for low risk patients. Despite this scoring system, which has been validated since 2006, physicians continue to send inappropriate studies despite a low probability of HIT. We sought to evaluate our academic institution's compliance, perform a cost analysis and determine if appropriate AC was initiated. By analyzing our data, we sought to educate our staff and implement measures to improve cost efficiency and quality of care. Methods: We performed a retrospective chart review of patients admitted to Hahnemann University Hospital (HUH) between November 1, 2016 and April 30, 2017 who had HIT antibodies (HITAb) and serotonin release assay (SRA) studies. These laboratory tests were performed at Quest Diagnostics. This data was compiled from the EMR at HUH. According to the 4TS, patients were assigned a score of 0-8: 0-3 for low, 4-5 for intermediate, 6-8 for high probability respectively. Laboratory results of HITAb and SRA were then compared to the calculated 4TS. We then investigated whether appropriate AC was initiated. Data on the cost associated with the inappropriate management of suspected HIT was compiled. Results: 72 patients had HITAb sent during the interval studied. Table 1 shows the 4TS and results of HITAb and SRA testing. Table 2 lists the AC used based on the 4TS. The NPV of not having HIT in the low probability group was 100%. The positive predictive value (PPV) of having HIT in the high probability group was 100%. At our institution, HITAb with reflex SRA costs $503. Expenditure due to inappropriate testing was estimated to be around $23,000 dollars over the study's time course. Inappropriately switching to argatroban cost up to $1,000 per day or fondaparinux $500 per day of overspending on anticoagulation per patient. Discussion: We found the majority of HITAb and SRA testing was unnecessary based on the 4TS. Our data showed a low 4TS had a very high NPV confirming the scoring system's utility. HIT testing was often overutilized as part of a general workup for thrombocytopenic patients who were often septic, on marrow suppressive medications and had multiple comorbidities such as hepatitis and HIV infections which confounded their clinical picture. Furthermore, this scoring system had a very high PPV in the high probability group. This study confirmed that HIT laboratory studies rarely change patient management in these scenarios. With the turnaround time of laboratory studies taking up to 4 days, there is a significant increase to the cost of patient care when solely relying on HITAb and SRA due to the use of expensive anticoagulants. In contrast, it remains unknown if HITAb and SRA could be useful in patients with an intermediate 4TS as our data is limited with no SRA results for patients with intermediate scores and a positive HITAb. To prevent unnecessary testing in the future and to improve the management of HIT, we propose to implement the following at our institution: 1. create a hard stop in our EMR which would prevent studies from being sent off inappropriately; 2. add a 4TS to the calculator section of the EMR and encourage collaboration with the hematology department if additional questions remain after calculating a 4TS; 4. start resident based educational sessions on the importance of calculating a 4TS and its significance prior to sending laboratory studies. In conclusion, the 4TS remains a useful tool to prevent unnecessary diagnostic testing and use of expensive therapeutic anticoagulants in patients with suspected HIT. Disclosures No relevant conflicts of interest to declare.

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Brain Abscess of Otorhinolaryngologic Origin: Study of 80 Cases in the Neurosurgery Department of Conakry University Hospital Center

Journal of Biomedical Research & Environmental Sciences ◽

10.37871/jbres1188 ◽

2021 ◽

Vol 2 (2) ◽

pp. 047-051

Author(s):

BL Fatoumata ◽

SI Sory ◽

AH Ghislain ◽

CA Youssouf ◽

DH Abdoul Bachir ◽

...

Keyword(s):

Retrospective Study ◽

Mortality Rate ◽

Sex Ratio ◽

Antibiotic Therapy ◽

University Hospital ◽

Entrance Door ◽

Life Threatening ◽

Brain Abscesses ◽

The Mean ◽

Hospital Center

Introduction: Brain abscesses are serious conditions that can be life-threatening if left untreated. The objective of our study was to determine the epidemiological, clinical, paraclinical, therapeutic and evolutionary characteristics of cerebral abscesses of otorhinolaryngological origin in our department. Methods and Materials: This was a retrospective study of 80 cerebral abscess files of otorhinolaryngological origin collected over a period of 5 years (January 2014-December 2018) at the neurosurgery department of Conakry University Hospital Center. Results: Abscesses of otorhinolaryngological origin represented 72% of all abscesses. The mean age was 14.7 years with a sex ratio of 4. The clinical picture was dominated by fever (92%), focal signs (55%) and intracranial hypertension (46%). The entrance door was 84% sinus. The frontal site was predominant, 44 cases. Eighty-two percent of patients underwent surgery and 18% were treated with antibiotic therapy alone. The evolution was favorable in 75% of the cases with a mortality rate of 15%. Conclusion: Brain abscesses are a medical-surgical emergency. The forms of otorhinolaryngologic origin are dominated by sinusitis. Despite the therapeutic difficulties, the prognosis remains acceptable in our study, 15% of deaths.

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Intraoperacinės parathormono koncentracijos matavimas pooperaciniam hipoparatiroidizmui numatyti po visiškosios tiroidektomijos

Lietuvos chirurgija ◽

10.15388/lietchirur.2007.4.2174 ◽

2007 ◽

Vol 5 (4) ◽

pp. 0-0

Author(s):

Algirdas Šlepavičius ◽

Virgilijus Beiša

Keyword(s):

Parathyroid Hormone ◽

Total Thyroidectomy ◽

Predictive Value ◽

University Hospital ◽

Endocrine Surgery ◽

Iopth Level ◽

Postoperative Hypoparathyroidism ◽

Symptomatic Hypocalcemia ◽

The Mean ◽

Intraoperative Parathyroid Hormone

Algirdas Šlepavičius1, Virgilijus Beiša21 Klaipėdos universitetinės ligoninės Pilvo ir endokrininės chirurgijos skyrius,Liepojos g. 41, LT-92288 KlaipėdaEl paštas: [email protected] Vilniaus universiteto ligoninės Santariškių klinikų Pilvo chirurgijos ir gastroenterologijos klinika,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Intaktinio intraoperacinio parathormono (IOPTH) koncentracija kaip prieskydinių liaukų funkcijos rodiklis dažnai nustatoma operuojant nuo pirminio ir antrinio hiperparatiroidizmo. Šio perspektyviojo tyrimo tikslas – išanalizuoti IOPTH galimybes pooperaciniam hipoparatiroidizmui prognozuoti skydliaukės chirurgijoje. Ligoniai ir metodai Klaipėdos ligoninės Pilvo ir endokrininės chirurgijos skyriuje ir Vilniaus universiteto ligoninės Santariškių klinikų Pilvo chirurgijos centre nuo 2005 m. birželio 1 d. iki 2006 m. sausio 1 d. 89 ligoniams, praėjus 10 minučių po tiroidektomijos, buvo tiriama IOPTH koncentracija kraujyje. Kalcio koncentracija kraujyje buvo tikrinama praėjus 24, 48 ir 72 val. po operacijos. Visi operuotieji suskirstyti į dvi grupes: ligoniai, kuriems po tiroidektomijos nebuvo hipoparatiroidizmo reiškinių (A grupė n = 78), ir ligoniai, kuriems po tiroidektomijos išsivystė hipoparatiroidizmo požymiai (B grupė n = 11). Palyginti abiejų gupių ligonių IOPTH ir kalcio koncentracijos kraujyje skirtumai bei hipoparatiroidizmo klinikinės išraiškos priklausomybė nuo IOPTH ir kalcio koncentracijos kraujyje. Rezultatai Iš 89 ligonių vienuolikai (12,4%) po visiškosios tiroidektomijos išsivystė pooperacinis hipoparatiroidizmas. Simptomai pasireiškė nuo 24 val. iki 52 val. po operacijos. Ligonių, kuriems po operacijos išsivystė hipoparatiroidizmo klinika, vidutinė IOPTH koncentracija kraujyje buvo daug mažesnė (7,2 ± 1,32 pg/ml) nei tų, kuriems hipoparatiroidizmo klinikos nebuvo (42 ± 2,79 pg/ml) (p < 0,05). Po tiroidektomijos mažesnė nei 10 pg/ml IOPTH koncentracija kraujyje turėjo 90,9% jautrumą ir 100% specifiškumą prognozuojant pooperacinį hipoparatiroidizmą. Teigiama numatymo vertė 100%, neigiama numatymo vertė 90%. Išvada Jei IOPTH koncentracija kraujyje praėjus 10 minučių nuo skydliaukės pašalinimo yra mažesnė nei 10 pg/ml, galime prognozuoti pooperacinį hipoparatiroidizmą. IOPTH tyrimas klinikinėje praktikoje leidžia laiku pradėti gydyti rizikos grupės ligonius kalcio preparatais, o jei reikia – ir vitaminu D, o ne rizikos grupės ligonius būtų galima gerokai anksčiau išleisti į namus. Pagrindiniai žodžiai: intraoperacinis parathormono matavimas, visiškoji tiroidektomija, pooperacinis hipoparatiroidizmas Intraoperative parathyroid hormone level monitoring for predicting postoperative hypoparathyroidism after total thyroidectomy Algirdas Šlepavičius1, Virgilijus Beiša21 Klaipėda University Hospital, Department of Abdominal and Endocrine Surgery,Liepojos str. 41, LT-92288 Klaipėda, LithuaniaE-mail: [email protected] Kaunas University of Medicine,Insitute for Biomedical Research,Eivenių g. 4, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Background / objective Intraoperative parathyroid hormone (IOPTH) levels are usually not monitored during thyroidectomy, although they are widely used during parathyroidectomy as an indicator of parathyroid gland function.This prospective study evaluated the occurrence of hypoparathyroidism after total thyroidectomy and the use of IOPTH levels for predicting the postoperative hypoparathyroidism and the need for postoperative vitamin D and Ca supplementation. Patients and methods Eighty nine patients underwent total thyroidectomy at the Department of Abdominal and Endocrine Surgery of Klaipėda University Hospital and at the Abdominal Center of Vilnius University Hospital Santariškių Klinikos from 01-06-2005 to 01-01-2006. The IOPTH was measured 10 min after thyroidectomy. Postoperative calcium levels were monitored 24, 48 and 72 hours after surgery. IOPTH levels were correlated with postoperative calcium levels and clinical symptoms of hypocalcemia. Patients with symptomatic hypocalcemia are compared with asymptomatic patients. Results Twelve patients developed hypocalcemia after thyroidectomy. The onset of symptomatic hypocalcemia ranged from 24 to 52 hours. The mean IOPTH level (7.2 ± 1.32 pg/ml) in patients who developed symptomatic hypocalcemia was significantly lower than the mean IOPTH level (42 ± 2.79 pg/ml) in patients without symptoms (p < 0.05). An IOPTH level less than 10 pg/ml had a sensitivity of 90%, a specifity of 100%, a positive predictive value of 100%, and a negative predictive value of 90% for the development of symptomatic hypocalcemia. Conclusion An IOPTH level less than 10 pg/ml 10 minutes after total thyroidectomy is a strong predictor of hypoparathyroidism. The incorporation of the IOPTH assay in the management of thyroid diseases is recommended to prevent and prospectively treat symptomatic hypocalcemia. Key words: Intraoperative parathyroid hormone monitoring, postoperative hypoparathyroidism, total thyroidectomy

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Trends in the Prescription of Benzodiazepine Receptor Agonists from 2009 to 2020: A Retrospective Study Using Electronic Healthcare Record Data of a University Hospital in Japan

Healthcare ◽

10.3390/healthcare9121724 ◽

2021 ◽

Vol 9 (12) ◽

pp. 1724

Author(s):

Tasuku Okui ◽

Jinsang Park ◽

Akie Hirata ◽

Naoki Nakashima

Keyword(s):

Retrospective Study ◽

Benzodiazepine Receptor ◽

University Hospital ◽

Receptor Agonists ◽

Electronic Healthcare Record ◽

Record Data ◽

The Mean

In recent years, the prescription trends of benzodiazepine receptor agonists (BZRAs) have not been investigated in Japan despite the publication of guidelines that promote cautious use of BZRAs. The prescription trend of BZRAs was assessed using the electronic healthcare records data of a University Hospital in Japan. The data from April 2009 to March 2021 were used. The following three types of outcomes were set: the proportion of patients who were prescribed with BZRAs within those prescribed hypnotics or anxiolytics; the mean number of the types of prescribed BZRAs, and the mean average daily doses of BZRAs. The same analysis was conducted for benzodiazepines (BZDs) and non-benzodiazepines (Z-drugs). As a result, we found that the proportions of patients prescribed BZRAs within those prescribed hypnotics or anxiolytics began to decrease, particularly from 2015 for patients aged <75 years and those aged ≥75 years. Further, the degree of decrease was larger in patients aged ≥75 years. The proportion for BZDs decreased particularly in the study period, and the proportion for Z-drugs also began to decrease approximately from 2016 in patients aged ≥75 years. The results suggest a possibility that guidelines affected the decreased prescriptions of BZRAs.

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Trends in bariatric surgery and incidentalomas at a single institution in Saudi Arabia: a retrospective study and literature review

Annals of Saudi Medicine ◽

10.5144/0256-4947.2020.389 ◽

2020 ◽

Vol 40 (5) ◽

pp. 389-395

Author(s):

Mohammed Nabil AlAli ◽

Fahad Bamehriz ◽

Hassan Arishi ◽

Mohammed K. Aldeghaither ◽

Fahad Alabdullatif ◽

...

Keyword(s):

Bariatric Surgery ◽

Saudi Arabia ◽

Retrospective Study ◽

Literature Review ◽

Incidental Findings ◽

Infection Type ◽

Tertiary Care ◽

University Hospital ◽

The Mean ◽

H Pylori

ABSTRACT BACKGROUND: Data are lacking on trends in bariatric surgery and the frequency of incidental findings in Saudi Arabia. OBJECTIVE: Report on trends in bariatric surgery as well as our experience in incidental findings along with a literature review (mainly on gastrointestinal stromal tumor). DESIGN: Retrospective chart and literature review. SETTINGS: Academic tertiary care center. PATIENTS AND METHODS: We conducted a retrospective study at King Khalid University Hospital and analyzed the data collected from 2009 to 2019. We collected data on age, body mass index (BMI), H pylori infection, type of bariatric surgery performed, and type and location of incidental findings. MAIN OUTCOME MEASURES: Incidental findings during or after bariatric surgery (in pathology specimen). SAMPLE SIZE: 3052 bariatric surgeries, 46 patients with incidentalomas. RESULTS: The mean and standard deviation for the age of the 46 patients with incidentalomas was 42.1 (13.9) years and the mean (SD) preoperative BMI was 43.4 (6.4) kg/m 2 . Of 3052 bariatric surgeries performed, the most common type was sleeve gastrectomy (93.9%), followed by gastric bypass surgery (4.58%) and gastric banding (1.47%). The total frequency of incidentalomas was 1.5%; 10.8% of patients had gastrointestinal stromal tumors (GIST), with the stomach being the commonest site for incidental findings. Eighty percent of the patients with GIST were positive for H pylori ( P =.01 vs negative patients). CONCLUSION: The number of incidentalomas and other findings were consistent with other reports. All these findings suggest that bariatric surgeons should take special care before, during, and after a laparoscopic operation in obese patients. LIMITATIONS: Since this is a single-center, retrospective study, we did not collect data on important variables such as gender, socioeconomic status of the patient, and family history of obesity, and we did not perform a preoperative esophagogastroduodenoscopy. CONFLICT OF INTEREST: None.

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