Considerations in Adolescent Use of the Etonogestrel Subdermal Implant: A Cohort Study

Objectives: To describe bleeding patterns and other side effects in adolescent implant users and characterize their impact on early discontinuation of the implant.Study Design: This is a retrospective cohort study of female patients under 18 years who had an implant placed from 2013 to 2018. Data were collected on demographics, medical history, and side effects.Results: Of 212 adolescents, the average age at insertion was 16 years and 84% desired placement for contraception. Common side effects included AUB (80%), mood changes (10%), and perceived weight gain (9%). Most (76%) used the implant for at least 12 months. Average time to removal was 22.1 months (SD 13.0 months) and this did not depend on presence of side effects. Twenty-seven percent of teens were able to achieve amenorrhea. Adolescents with frequent or prolonged bleeding were more likely to have implant removal prior to 12 months than those with other bleeding patterns (p = 0.003). Early removal was also more common in girls reporting weight or mood issues than those who did not (p < 0.001 and p = 0.045, respectively). BMI increased in 64% of adolescents. Average percentage change in BMI was 3.2% (0.87 kg/m2). There was no difference in baseline use of any mood-modulating medications in patients who did and did not complain of mood side effects following implant placement (p = 0.801).Conclusion: Characterization of bleeding patterns following implant placement in adolescents have not previously been reported. Prolonged or heavy bleeding, mood issues, and perceived weight gain were associated with earlier removal of the implant. A relatively small number had early removal of the implant due to weight or mood complaints. Therefore, a history of obesity, depression, or other mood disorders should not be a deterrent to implant placement.

Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Ovarian Teratoma Improved by Prompt Surgery

Anti-N-methyl-D aspartate receptor (NMDAR) encephalitis is often accompanied with ovarian teratomas. It has a variety of clinical manifestations including psychiatric symptoms, seizure, and motor dysfunctions. The diagnosis can be definite when clinical symptoms are present and anti-NMDAR antibodies in cerebrospinal fluid are detected. However, in patients with suspected anti-NMDAR encephalitis with teratomas, early surgery may help the clinical outcome even if the antibodies are initially negative. The authors report a patient whose clinical symptoms improved significantly after early removal of teratoma.

Early and Standard Urinary Catheter Removal After Gynecological Surgery for Benign Lesions: A Quasi-Experimental Study

Patients undergoing gynecological surgery commonly receive indwelling transurethral Foley catheters, however duration of catheterization is associated with risk of urinary tract infections and other adverse effects. Early removal of catheters is encouraged, however optimal timing postsurgery remains unclear. This quasi-experimental study compared outcomes for women after removal of a Foley catheter at two different times following benign gynecological surgery. Participants received either early catheter removal, within 6 hours of surgery ( n = 38) or standard catheter removal, within 12 to 24 hours of surgery ( n = 45). There were no significant differences in outcomes for discomfort scores or re-catheterization rates between groups. However, the early removal group had a significantly shorter time to first ambulation and shorter hospital stays. Early removal of Foley catheters in patients who underwent gynecological surgery did not increase adverse events. Early removal of catheters after gynecological surgery may decrease re-catheterization rates and increase patient satisfaction.

Measures of Encouragement and Penalties Applied to Convicts Registered with Probation Inspectorates

The article discusses the results of a study conducted in May 2021 by the Research Institute of the Federal Penitentiary Service of Russia on the application of incentive and penalty measures against individuals sentenced to non-custodial punishments. In order to streamline the measures of disciplinary responsibility in relation to those sentenced to compulsory labor we suggest that the Penal Enforcement Code of the Russian Federation should contain a measure of punishment in the form of a warning, and for positive stimulation of lawabiding conduct – measures of encouragement in the form of gratitude and early removal of a previously imposed penalty in the form of a warning. In relation to those sentenced to restriction of liberty we propose to establish a provision in the law that they are maliciously evading from serving a sentence if they have committed a violation of the order and conditions of serving a sentence within one year after the application of a penalty in the form of an official warning, repeated punishment in the form of an official warning. Only after that, it is advisable to submit to the court a presentation about replacing the unserved term with a punishment in the form of imprisonment. It is proposed to provide for the use of release on parole as the main type of encouragement.

Median Duration of Hospital Stay after Early Removal of Foley’s Catheter among Patients Undergoing Transurethral Resection of Prostate: A Descriptive Cross-sectional Study

Introduction: Transurethral resection of the prostate requires a catheter in situ post-surgery. Early removal of catheter can reduce the length of hospital stay reducing the healthcare cost. It can also reduce the risk of infection due to prolonged catheterization. Our aim was to determine the median duration of hospital stay after early foley’s removal after transurethral resection of prostate among patients in a tertiary care hospital. Methods: A descriptive cross-sectional study was done in a tertiary care hospital from July 2019 to December 2020 and ethical clearance was obtained from the institutional review committee. Foley’s catheter were removed on the first post-operative day, who met the criteria of catheter removal. Convenience sampling was done. After foley’s removal patients were observed for spontaneous voiding. Patients with complications like hematuria, clot retention, urinary retention were recatherized. The data were expressed in mean with standard deviation, median with interquartile range and frequency and percentage as applicable using Statistical Package for the Social Sciences version 16. Results: Out of the 150 participants included in the study, the median duration of hospital stay after the early removal of foley's catheter was 3 days (interquartile range 2-4 days). A total of 20 (13.3%) patients underwent recatherization. Nine (6%) patients had to be recatheterized due to clot retention, and 11 (7.3%) were due to urinary retention. Conclusions: This study showed that the median duration of hospital stay after early removal of foley's catheter among patients undergoing transurethral resection of the prostate was similar to studies done in national/international settings.