3rd Visit Research Articles

Phacoemulsification vs Manual Small Incision Cataract surgery in eyes affected by pseudo exfoliation syndrome with grade II and III Cataracts

PurposeTo compare the postoperative alteration of central corneal thickness (CCT) and visual outcomes between phacoemulsification (group A) and manual small incision cataract surgery (MSICS) (group B) in grade II and III nuclear cataracts (NS II & III) with pseudoexfoliation syndrome (PXF). MethodsIt is a double masked prospective randomised interventional study. A total of 60 eyes of 60 patients were assigned randomly to either the phacoemulsification (group A) or MSICS (group B) groups. All eyes had nuclear sclerosis grade II and III (LOCS II grading system) with pseudoexfoliation material either over the pupillary margin, anterior lens capsule, or both. All surgeries were done by a single surgeon. Postoperative evaluation was scheduled on the 1st, 30th, 90th, and 180th-day. Statistical analyses were done using appropriate methods. Outcome of the study were measured with changes in central corneal thickness (CCT), Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) and the spherical equivalent in the operated eye up to 6 months post surgery. ResultsThe mean preoperative CCT showed no difference between the groups (0.9659). The mean rise in CCT on the 1st postoperative day (POD) showed a significant difference between the groups {24.65 (SD 9.32) [group A (Phacoemulsification)] and 33.34 (SD11.68) [group B (MSICS)] (p < 0.0023)}. At the 1st, 3rd, and 6th month postoperative visits, there was no significant difference. The mean uncorrected distance visual acuity (UDVA) on the 1st POD was 0.189 (SD 0.118) in Group A and 0.302 (SD 0.121) in group B (p < 0.0005) which was significantly better with the phacoemulsification procedure. At the 1st month it was 0.039 (SD 0.084) in group A and 0.148 (SD 0.089) in group B (p < 0.004), which remained almost stable after that. The mean corrected distance visual acuity (CDVA) at the 1st, 3rd, and 6th-month postoperative visits showed no significant difference (p 0.8). The mean spherical equivalent was 0.29 in group A and 0.8 in group B. ConclusionIn moderately hard nuclear cataracts with PXF, phacoemulsification provides better unaided visual outcomes with less endothelial dysfunction than MSICS in the immediate and subsequent postoperative period.

1390-P: Maternal Plasma Ceramides Predict Preeclampsia in Women with Type 1 Diabetes

The risk for preeclampsia (PE) is increased 4-fold in women with type 1 diabetes (T1D), in whom we previously demonstrated that elevated cholesterol-rich lipoproteins confer risk at the 1st trimester. Sphingolipids, including ceramides (Cer) and glycosphingolipids (hexosyl- (HexCer) and lactosyl-ceramides (LacCer)), are lipoprotein constituents that regulate cell signaling. We propose that these bio-active lipids could be modulators of PE risk. In a prospective T1D pregnancy cohort (studied at 12, 22, 32 weeks’ gestation), we used liquid chromatography/electrospray ionization-tandem mass spectrometry to determine plasma levels of 12 species of Cer, HexCer, and LacCer in 23 women with T1DM who did vs. 24 who did not develop PE, and in 19 normotensive nondiabetic pregnant women. All were free of microalbuminuria and hypertension at enrolment; all visits preceded clinical PE onset. Results: Plasma levels of C22-Cer (1st and 3rd study visits); C26:1-Cer (1st and 2nd visits); C26-Cer (1st visit); C18-Cer and C18:1-Cer (2nd visit) were significantly higher in women with T1DM who did vs. did not develop PE. C22-Cer and C26-Cer were significantly lower in T1DM vs. non-T1DM (1st visit). There were no overall PE- or diabetes-related differences in any HexCer- or LacCer species. Longitudinally, most Cer and HexCer species increased throughout pregnancy in all groups (except C14- and C18-Cer; and C14 and C26-HexCer). C16-LacCer increased, while C22:1-, C26-, and C26:1-LacCer decreased as pregnancy advanced, independent of PE status. Independent of LDL-C, total Cer increased throughout pregnancy in all groups. Conclusions: Maternal Cer species may serve as early biomarkers for PE in women with T1DM. T1DM was associated with lower levels of two Cer species. Like cholesterol-rich lipoproteins, Cer, HexCer and some LacCer species increase as pregnancy advances in all groups, but other LacCer species decrease: the significance of these findings requires further study. Disclosure C.B. Kelly: None. S.M. Hammad: None. R.L. Klein: None. M.F. Lopes-Virella: None. M.J. Leyva: None. J. Yu: None. A.J. Jenkins: Advisory Panel; Self; Abbott, Australian Diabetes Society, Medtronic. Research Support; Self; Abbott, GlySens Incorporated, Medtronic, Mylan. Speaker's Bureau; Self; Eli Lilly and Company, Novo Nordisk Inc. A.J. Nankervis: None. K.F. Hanssen: None. S.K. Garg: Advisory Panel; Self; Eli Lilly and Company, Roche Pharma, Sanofi-Aventis, Zealand Pharma A/S. Research Support; Self; Eli Lilly and Company, WebMD. J.A. Scardo: None. C.E. Aston: None. T. Lyons: None. Funding JDRF; Novo Nordisk; National Institutes of Health

The influence of endodontic treatment on blood pressure reduction in patients with vital irreversible pulpitis.

BackgroundDuring endodontic treatment, endodontists must be aware of the various factors that may decrease or increase blood pressure. This study aimed to assess the mean percentages of systolic, diastolic, and arterial blood pressure (MSBP, MDAP, MABP) reduction in patients with vital irreversible pulpitis in teeth and who were treated at three visits to endodontists in three age groups (20–34 years, 35–50 years, 51–65 years).Materials and methodsA total of 100 teeth with vital irreversible pulpitis from 100 patients were included. All patients underwent 3 visits for endodontic treatment. The 1st visit included removal of vital pulp tissue and a determination of working length, the 2nd visit included canal preparation and widening, and at the 3rd visit the canal was obturated and sealed by gutta percha and sealer. Blood pressure for all patients was checked and documented once before starting treatment and three times during treatment at different intervals during all visits.ResultsThere were significantly higher percentage reductions in MSBP, MDBP, and MABP at the 1st visit for endodontic treatment in comparison to other visits (2nd and 3rd) for all patients. Additionally, there were significantly higher percentage reductions in MSBP, MDBP, and MABP at the 1st visit for endodontic treatment in comparison to other visits in males and females, for all age groups, both anesthesia injection-type groups (infiltration and block), and all treated tooth types except mandibular anterior teeth, and there were nonsignificant differences among groups. However, there were nonsignificant differences in MSBP, MDBP, and MABP between males and females, between infiltration and block injection groups and in relation to teeth types at all visits.ConclusionsThe reduction of blood pressure in patients undergoing endodontic treatment of vital teeth with irreversible pulpits is common, especially at the 1st visit for pulp extirpation.

ЭФФЕКТИВНОСТЬ ПРИМЕНЕНИЯ БАЛЬЗАМА ДЛЯ ГУБ В КАЧЕСТВЕ МЕТОДИКИ ЛЕЧЕНИЯ ЭКСФОЛИАТИВНОГО ХЕЙЛИТА

Importance. Exfoliative cheilitis is an inflammatory disease accompanied by damage to the red border of the lips. With dry exfoliative cheilitis, scales form on the lips, which are densely soldered to the underlying tissue in the center, and along the periphery, on the contrary, are raised. At the same time, patients indicate a feeling of dryness, burning. When the exudative form of cheilitis is observed puffiness, sore lips. Diagnosis of exfoliative cheilitis is reduced to the collection of complaints, the preparation of anamnesis of the disease, physical examination. For the treatment of exfoliative cheilitis, Bucca rays, moisturizing creams, acupuncture techniques, as well as agents that increase body resistance are used. As it turned out, in practice, all existing methods of treatment are ineffective, and the disease is manifested by frequent relapses. Pathology is more common in women. The dry form of the disease is mainly detected at the age of 16-40 years. Exudative cheilitis is diagnosed in patients aged 16-65 years.&#x0D; Objectives ― evaluate the effectiveness of lip balm based on lamb fat, and make a conclusion based on the clinical data and patient's subjective sensations.&#x0D; Methods. Twenty patients aged from 18 to 45 years with a diagnosis of exfoliative cheilitis were selected for work. All patients were divided into two groups: control (10 people) and main (10 people). Local therapy in both groups began according to the generally accepted scheme: sanation of the oral cavity, treatment of periodontal diseases according to indications, selective grinding off of the sharp edges of the teeth. In the main group, patients received treatment in the form of an application with a cool furatsilina solution, and applying the dosage form in the form of lip balm., Consisting of red-hot lamb fat and filtered through gauze, lanolin, pumpkin oil, ylang ylang oil, geranium oil, and also vitamins oil A and E and medical paraffin, this dosage form was prepared in paraffin and sterilized, after complete cooling it was applied to the lips with a spatula, and the patients easily used it at home as a balm for K in the morning and evening. Patients of the control group received the traditional treatment of cheilitis, anestezin applications, lip treatment with an antiseptic solution and keratoplasty applications - vitamin A and E oil. The results of the treatment were evaluated according to the clinical examination of patients, as well as taking into account the subjective feelings of the patients.&#x0D; Results. Based on the schemes of complex treatment of exfoliative cheilitis in patients of the main group, a positive result was obtained after the 3rd visit. A decrease in pain syndrome, a decrease in lesion elements (flakes), epithelization of cracks, a decrease in pain syndrome, a decrease in complaints of dryness of the red border of the lips were revealed.&#x0D; Conclusions. The development of this algorithm for treating ecfoliative cheilitis, including a mutton fat lip balm, has reduced the treatment time for this pathology.

Evaluation of Effect of Melatonin on Hematological Parameters in Patients of Periodontitis

Introduction: Considering the immunity enhancing property of melatonin, a study on the evaluation of the effect of melatonin on the hematological parameters in patients suffering from Periodontitis. Methods: This study was conducted in the Department of Periodontics, Rural Dental College, Loni. Patients of chronic Periodontitis, of age between 18 to 65 years of either gender ready to give informed consent to participate in the study were included. Postoperative patients, patients having night duties, drivers and those using heavy machinery, pregnant women, lactating mothers, patients with any clinically significant systemic disease and patients on any other drugs were excluded from the study. Patients were divided into two Groups. Group B received scaling and root planning (SRP) and melatonin 3 mg per day were compared to Group A which received SRP only. The Total Leukocyte count, Differential Leukocyte count and Erythrocyte sedimentation rate of each patient was studied at a baseline, 1st (30 days) visit, 2nd (60 days) visit and 3rd (90 days) visit. Results: Both the groups consisted of 80 subjects each. Group A consisted of 71.25% male and 28.75% female patients. There were 56.25% male and 43.75% female patients in Group B. With respect to visit 3, the TLC was statistically lower in Group B. The neutrophil count of Group B was significantly lower during visit 3 as compared to Group A. The lymphocyte count of Group B was significantly lower than that of Group A during the visit 1, and also significantly higher during visit 3 on comparison with Group A. There was no statistically significant difference in the groups with respect to eosinophil and basophil count. The Monocyte count of Group B was statistically lower when compared to that of Group A. There was no statistically significant difference between ESR of Group A &amp; Group B. Conclusions: It can be concluded that melatonin has a positive effect on TLC and differential count of patients of periodontitis, conferring a new facet to the management of periodontitis and an attempt to impede the disease progression.&#x0D; Keywords: Melatonin; Hematological parameters; Periodontitis; Total Leukocyte count; Differential Leukocyte count; Erythrocyte sedimentation rate; Scaling and Root Planning.

Prevalence and risk factors for hypertension among school children in Ilorin, Northcentral Nigeria.

BACKGROUND:The global prevalence of childhood hypertension has increased from 1% to 2% to 4%–5%, with a value as high as 9.8% reported in Nigeria. However, the various risk factors associated with childhood hypertension in Nigeria are less explored. The aim of this study was to determine the prevalence of hypertension and related risk factors (sociodemographic, family history of hypertension, history of snoring, birth order, and anthropometric indices) in primary school children in Nigeria.MATERIALS AND METHODS:A total of 1745 school children aged 6-12 years were selected using systematic random sampling method. Blood pressure (BP) was measured using the fourth report guideline. Those with BP higher than 90th percentile had repeated BP measurements on two more occasions (2 and 4 weeks after initial measurement). Relevant history was obtained, and anthropometric measurements were taken by the standard methods. Data were analyzed using SPSS version 20.RESULTS:Prevalence of systolic and or diastolic hypertension at the third visit was 3.0%. Prevalence of systolic hypertension (3rd visit) was more in females (3.3%) than males (1.3%), P = 0.004. Prevalence of diastolic hypertension (3rd visit) was higher in females (1.4%) than males (0.3%), P = 0.019. Hypertension showed no significant relationship with socioeconomic class, family history of hypertension, birth order, and history of snoring. Of the anthropometric indices (weight, height, body mass index (BMI), hip circumference, waist circumference, waist-to-hip ratio, and waist-to-height ratio, and only obesity (BMI ≥ 95th centile) was related with hypertension (odd ratio 8.3, 95% confidence interval 1.7, 40.3).CONCLUSIONS:Prevalence of hypertension is low (3.0%), and only obesity (BMI ≥ 95th centile) is associated with hypertension.

Predictive value of the immediate effect of first dose of tamsulosin on lower urinary tract symptoms improvement in benign prostatic hyperplasia patients.

Objectives:The objective is to study the effect of tamsulosin within hours after the first dose and its prediction of the future improvement of LUTS.Materials and Methods:From May 2016 until August 2017, 340 patients aged over 40 years with benign prostatic hyperplasia (BPH)-related symptoms were prospectively enrolled; 0.4 mg tamsulosin for 3 months was given. The first visit was before beginning of tamsulosin; uroflowmetry (UFM), postvoid residual urine volume (PVR), international prostate symptom score (IPSS), and quality of life (QoL) were measured. The second visit was after 6 h from the administration of tamsulosin. UFM and PVR were measured. The third visit was after 1 month and the fourth visit was after 3 months, on which UFM, PVR, IPSS, and QoL were also measured.Results:The mean patients’ age was 63 ± 6.18 and the mean prostate volume was 52.23 ± 24.59 cc. The mean Qmax at 1st, 2nd, 3rd, and 4th visits was 10.28 ± 3.06 s, 14.58 ± 4.84 s, 14.46 ± 4.94 s, and 14.28 ± 5.07 s, respectively, P = 0.04. The mean voiding time at 1st, 2nd, 3rd, and 4th visits was 41.24 ± 27.18 s, 33.84 ± 18.14 s, 31.96 ± 22.02 s, and 30.14 ± 17.52 s, respectively, P = 0.03. The mean PVR at 1st, 2nd, 3rd, and 4th visits was 46.40 ± 22.14 ml, 27.76 ± 26.10 ml, 25.16 ± 28.36 ml, and 25.58 ± 28.10 ml, respectively, P = 0.001. The first dose of tamsulosin significantly increases Qmax and decreases voiding time and residual urine (RU); there was no statistical significant difference between 1st dose, 1 and 3 months in Qmax, voiding time, and RU. QOL and IPSS were significantly improved after 1 and 3 months, P < 0.001.Conclusion:The first dose of tamsulosin improves UFM and predicts the mid-term change in UFM as well as IPSS and QoL indices in the treatment of BPH-related LUTS.

Evaluation of ECAP thresholds, T and C levels in children with sequential bilateral cochlear implants

Aim: The aim of the present study was to compare the values in threshold (T) and comfortable (C) stimulation levels as well as the neural response telemetry (NRT) measurements obtained on the first and the second cochlear implant in children with sequential bilateral cochlear implantation (CI). Material and Methods: Thirty children with sequential bilateral CI between February 2007 and July 2018 were randomly selected. The mean age of the subjects was 7.0 years (age range: 3.3–15.2 years). The NRT thresholds, T levels, and C levels in the electrode (E) 22, E16, E11, E6, and E1 were retrospectively compared for the latest program on the first CI (CI1), and the second CI (CI2) in the postoperative 1st, 3rd, and 6th-month follow-up visits. The duration of daily use of the speech processor on both side was also compared.Results: Twelve male and eightteen female subjects with sequential bilateral CI, were participated in the present study. The median age at CI1 was 15 months and 5 years 5 months for CI1 and CI2 respectively. There was no significant difference between the threshold NRT (tNRT) levels between two ears. The mean tNRT levels were obtained 166 CL and 179 CL in E22 and E1 respectively. The tNRT levels were found higher on the basal electrode rather than the apical electrode (p=0.02). The changes in the T and C levels were significant in 1st, 3rd, and 6th-month follow-up visits on the CI2 side (p=0.000). The mean daily usage time of the sound processor was found 12.05 and 9.62 hours on CI1 and CI2 respectively. Conclusion: In children with sequential CI, the electrical stimulation levels were similar between ears. The present study shows the programming outcomes during the follow-up in children with sequential bilateral CI. Keywords: Hearing loss; cochlear implant; sequential surgery; bilateral cochlear implantation; neural response telemetry.

Comparative study between usage of topical azithromycin versus conventional therapy in treatment of posterior blepharitis causing dry eye

Background: blepharitis is an inflammatory condition of the eyelid that is usually associated with bacterial infection or some skin conditions (such as dandruff on the scalp, or acne rosacea). Aim of the Work: this study aimedto compare the outcome of using topical azithromycin and conventional therapy in improving signs and symptoms of posterior blepharitis causing dry eye.Patients and Methods: this comparative study was done between usage of conventional therapy and topical azithromycin in treatment of posterior blepharitis causing dry eye. One hundred and twenty eyes of sixty patients of both sexes above age of 18 diagnosed with posterior blepharitis causing dry eye disease are recruited from the ophthalmological clinic of Al-Azhar university Hospitals. Results: the azithromycin group showed a significant improvement of sign, symptoms and investigations over the conventional group in the 2nd visit (after 1 week) while, there was a non significance regarding the 3rd visit after one month of treatment and 3rd after one month of stoppage of treatment. Conclusion: conventional therapy and topical azithromycin are effective on posterior blepharitis causing dry eye disease, azithromycin has more compliance and better tolerability to the patients with sustained effect on the ocular tissue that give it a preference over the conventional therapy.

Effect of Fluoride-releasing Elastomers on Mutans Streptococci in Dental Plaque: An In Vivo Study

The purpose of this study was to evaluate the effect of fluoride-releasing elastomeric modules in the control of Streptococcus mutans levels in the oral cavity. The study consisted of 30 patients, with two experimental periods of three weeks and a three-week washout period between experimental periods. At the first visit, fluoridated modules were placed around brackets on 12 11 33 and non-fluoridated ones on 21 22 43. During the 2nd visit, the modules were removed and sent for a microbiological analysis. Non-fluoridated modules were placed on all brackets for one visit to allow for a washout period. At the 3rd visit, fluoridated elastomeric modules were placed around brackets on 21 22 43 and non-fluoridated on 12 11 33. At the 4th visit, the procedures at the 2nd visit were repeated. A mean comparison between bacterial counts of fluoride-releasing and non-fluoridated elastomeric modules in both the trials were done by the Mann-Whitney U test, which showed the result to be significant (p < 0.001). The mean comparison of bacterial counts between fluoride-releasing and non-fluoridated elastomeric modules in a specific area was done by the Wilcoxon signed rank test, which showed the result to be significant (p < 0.001). A comparison between bacterial counts of fluoride-releasing elastomeric modules in both trials were done by the Mann-Whitney U test, which also showed a significant result (p < 0.001). The sustained-release fluoridated elastomeric modules are effective in reducing the levels of Streptococcus mutans in dental plaque around the brackets for a time period of 21 days. The sustained-release fluoridated modules were effective in reducing the CFU of S. mutans and are also stable at the end of 21 days of the experimental period. But the action of fluoride released from the modules is localized, temporary, and requires constant maintenance of these modules over the brackets throughout the treatment period.

Опыт применения препарата Арника монтана С9 (БУАРОН) у детей после операции аденотомии

The efficacy of Arnica Montana C9 (BOIRON) during the recovery period after adenotomy in 60 children aged 3 to 10 years was evaluated. All patients were randomly divided into 2 groups for further comparison. Each was composed of 30 patients. Patients of the control group were prescribed standard therapy: a sparing diet and regimen for 5 days, nasal vasoconstrictor drugs (nazivin 0.025% – 0.05%) at an age dosage of 5 days, inside-Nurofen at an age dosage (with pain in the throat and increased body temperature). Children of the main group received standard therapy + Arnica Montana C9 (BOIRON). Reception of the drug Arnica Montana C9 (Boiron) began from the second day after adenotomy with a dosage of 5 granules 4 times a day, from the 3rd to the 10th day-5 granules 3 times a day. Complaints and objective examination data were analyzed during 4 visits-observation by a doctor: on the second day after adenotomy (1st visit), on the 4th day (2nd visit) and on the 10th day after surgery (3rd visit), as well as 1 month after the end of therapy (4th visit). The study made it possible to draw a conclusion about the manifestation of positive changes in clinical indicators in children of the main group (reduction of pain intensity and intoxication, improvement of nasal breathing) on the 4th day after adenotomy relative to the control group. There was a significant decrease in the intake of painkillers in the group of children receiving Arnica Montana C9 (BOIRON). Given the result, we can talk about the possibility of reducing the drug load in patients. Thus, the inclusion Of Arnica Montana C9 (BOIRON) in the therapy of patients after adenotomy can lead to a significant reduction in the recovery period.

Effect of Intravenous Methylprednisolone on the Signs &amp;amp; Symptoms of Graves’ Ophthalmopathy

Background: Graves’ ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves’ disease (GD). The effect of intravenous methylprednisolone on the signs and symptoms of GO has not been evaluated in the Bangladeshi population. Objective: To observe the effect of intravenous methylprednisolone in active Graves’ ophthalmopathy. Materials/Methods: This prospective study conducted in a tertiary hospital of Bangladesh from May 2009 to November 2010 included 30 patients having moderate to severe ophthalmopathy. In addition to the clinical activity score (CAS), eye involvement was assessed by using the “NOSPECS” scoring system. Results: The mean (±SD) age of the patients was 38.1 ± 10.6 years and male-female ratio was 1.2:1. NOSPECS eye findings before treatment and during the final (3rd) visit of the patients were observed. It was found that lid retraction or lid lag was improved in 21 (70%) of the patients during the final visit. All of the patients had soft tissue swelling initially and all of them improved at the final visit. Bilateral proptosis was present in 19 patients before treatment and improved in 12 (62%) patients during the final visit. Right eye proptosis was present in 9 patients before treatment and improved in 5 (60%) patients during final visit. Extraocular muscle involvement (Diplopia) was present in 15 patients before treatment but improved in 13 (86.0%) patients during the final visit. A significant number of subjects showed significant improvement in all of the NOSPECS eye findings (except unilateral right eye proptosis) during the final visit; all had inactive GO (CAS < 2) at the end of the 3rd visit. Conclusion: Intravenous methylprednisolone appears to be an effective treatment option for active Graves’ ophthalmopathy.

Comparative study between usage of topical azithromycin versus conventional therapy in treatment of posterior blepharitis causing dry eye

Background: blepharitis is an inflammatory condition of the eyelid that is usually associated with bacterial infection or some skin conditions (such as dandruff on the scalp, or acne rosacea). Aim of the Work: this study aimedto compare the outcome of using topical azithromycin and conventional therapy in improving signs and symptoms of posterior blepharitis causing dry eye.Patients and Methods: this comparative study was done between usage of conventional therapy and topical azithromycin in treatment of posterior blepharitis causing dry eye. One hundred and twenty eyes of sixty patients of both sexes above age of 18 diagnosed with posterior blepharitis causing dry eye disease are recruited from the ophthalmological clinic of Al-Azhar university Hospitals. Results: the azithromycin group showed a significant improvement of sign, symptoms and investigations over the conventional group in the 2nd visit (after 1 week) while, there was a non significance regarding the 3rd visit after one month of treatment and 3rd after one month of stoppage of treatment. Conclusion: conventional therapy and topical azithromycin are effective on posterior blepharitis causing dry eye disease, azithromycin has more compliance and better tolerability to the patients with sustained effect on the ocular tissue that give it a preference over the conventional therapy.

Role of ultrasound in the diagnosis and management of gestational trophoblastic disease in Rwanda Rural health facilities- A case report

Introduction Gestational trophoblastic disease (GTD) is a rare kind of proliferative disorder of trophoblastic cells which develops from the placenta in early pregnancy and the complete hydatidiform mole (CHM) sub-type which limited to endometrium is most common. It has excellent prognosis if early appropriate diagnosis and management are done. A well performed ultrasound(US) play a primordial role in the diagnosis of maternal health disorders during routine prenatal care. This helps in avoiding complications and consequently aids in achieving the objectives of the Millennium Development Goals (MDGs) in Rwanda. Aim To understand the definition of Gestational trophoblastic disease(GTD); To recognize key diagnostic findings of complete molar pregnancy on ultrasound and appropriate management in maternal follow up and To review the differential diagnosis for ultrasound findings seen with GTD. Methods The case has been referred in ultrasound unit for scan from outpatient department and follow up US was ordered and done during management period while the patient lies on a bed while operator moves the 3,5 MHz lubricated transducer of frequency with gel on the abdomino- pelvic region with full urinary bladder and Mindray ultrasound Machine has been used. Results There was a large moderately hyperechogenic mass completely filling the endometrial cavity with numerous small cystic spaces of different size. Post 5 days under treatment, anechoic area within endometrial cavity and myometrium well outlined was discharged and in 3rd medical visit after 2 weeks, US were normal. Conclusion Ultrasound is the first modality to be used in all rural health facilities for diagnosis of suspected Gestational trophoblastic disease (GTD) for better results. It is available and free of radiation. Recommendation -The US is the baseline modalities to be used in 1st trimester in pregnancy women with GTD suspicion bleeding. -All rural health facilities should have empowered and capable trained Medical imaging practitioners for appropriate carrying out the ultrasonographic investigation for better care service delivery on GTD(Medical imaging practitioners Role extension project after formal training by Prof. Kawooya).

РЕШЕНИЕ ПРОБЛЕМЫ ЛЕЧЕНИЯ НЕЙТРОПЕНИЧЕСКИХ АФТ СЛИЗИСТОЙ ОБОЛОЧКИ ПОЛОСТИ РТА

Importance. A comparative analysis of the application of methods for the treatment of neuropenic aft mucous membranes with the use of injection techniques of a homeopathic preparation, which includes ascorbic acid and echinacea extract, has been carried out. stimulating oral immunity, helps faster epithelization of neutropenic aft on the oral mucosa Objectives ― evaluate the effectiveness of using the composition of homeopathic dosage forms in the general scheme of treatment of neuropenic aft. Methods. Under our supervision there were 10 patients aged from 18 to 60 years with a diagnosis of neuropenic aphthae. All surveyed were divided into two groups: main (5 people) and control (5 people). In the main group, patients received therapy according to the generally accepted scheme: oxygen therapy, applications for neuropenic aphtha keratoplasty in combination with anesthesin. Under the base, the aphta was injected with homeopathic preparation No. 7. Then the afta was left under the film with solcoseryl. Results. It has been established that its use allows one to achieve epithelization of aphtha in a shorter period, to prolong the remission of the disease, to arrest the pain syndrome. Clinical well-being came already on the 5th visit, pain syndrome and inflammation phenomena on the mucous membrane of the tongue were removed at the 3rd visit. When applying the traditional method of treatment, clinical well-being was achieved at the 10th visit. Conclusions.The combination of the traditional treatment regimen with the use of homeopathic medicine No. 7 provides a high therapeutic effect, accelerates the process of rehabilitation of the patient and prolongs the periods of remission within 12 months. The data we obtained allow us to introduce this treatment regimen into the clinic of therapeutic dentistry for the conservative treatment of neuropenic aft.

570: Cardiac disease in pregnancy: do standardized protocols and risk stratification improve outcomes?

To establish a prospective standardized protocol for the clinical evaluation of pregnant women with cardiovascular disease (CVD), create a standardized risk assessment tool and assess outcomes of women undergoing the standardized protocol compared with women who did not. The Standardized Outcomes in Reproductive Cardiovascular Care (STORCC) initiative prospectively enrolled pregnant women with CVD to a standardized diagnostic testing and assessment protocol. (Figure 1) Specific detailed cardiac and obstetric data were collected during the antepartum, intrapartum and postpartum periods. Each woman was assigned a STORCC color code of perceived risk at a monthly multidisciplinary conference comprised of representatives from cardiology, maternal fetal medicine and obstetric anesthesia. In 250 pregnancies of women with CVD, the standardized care protocol was followed in 136 and routine care in 114. The median age of the subjects was 32 years, and the most common form of heart disease was congenital heart disease (77%). Of the 136 standardized care patients, 22% were classified as high-risk, and 78% as low-risk. Among the high-risk group, 12% experienced a prior adverse cardiac event, 8% had a resting left ventricular outflow tract gradient ≥ 30 mm Hg and one had cyanosis (room air oxygen saturation <90%). Women enrolled in standardized care protocol had high compliance with 2nd and 3rd trimester visits (93%) and post-partum visits (76%). Maternal cardiac complications occurred in 10%. Outcomes did not differ between the standardized care and routine care cohorts; this remained true after adjusting for type of heart disease or disease complexity. The STORCC cardiac and obstetric color codes were predictive for adverse outcomes within each respective category (p = 0.02, 0.01). (Figure 2) The STORCC protocol for prospective diagnostic testing and follow-up of pregnant women with CVD was successfully established and compliance was high. The strength of a standardized testing and care protocols as well as detailed classification of labor and delivery characteristics allows for robust analyses into specific questions regarding mode and timing of delivery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Evaluation of episcleral venous fluid wave during gonioscopy assisted transluminal trabeculotomy in patients with advanced glaucoma.

To evaluate episcleral venous fluid wave (EVFW) during GATT surgery in patients with advanced stage open angle glaucoma and to investigate its relationship with the severity of glaucoma. In all, 34 eyes of 28 open angle glaucoma patients who underwent GATT surgery were included into study. The extent of EVFW was evaluated using surgical records of patients and it was defined as number of clock hours. Correlations between the extent of EVFW and GAAT surgical outcomes as determined by intraocular pressures (IOP) and postoperative antiglaucoma medication needs were investigated. The impact of preoperative maximum IOP on EVFW was also evaluated. There was a significant correlation between IOPs and the extent of the EVFW at 1st, 3rd, 6th and 12th months follow-up visits. 10 of (%29.4) 34 eyes required antiglaucoma medications after the surgery. Mean extents of EVFW in patients who needed and did not need medications during follow-ups were 2.6 ± 1.0 (1-4) and 5.9 ± 1.5 (3-8) clock hours and the difference was statistically significant. Cutoff value of <4.5 clock hours for the EVFW (sensitivity 79.2%, specifity 100%) was found to be associated with the need for additional antiglaucoma medication. The extent of EVFW might be a valuable prognostic indicator for the surgical success of GATT since trabeculotomy is circumferential in this surgical technique making all collector channels accessible.

PREVALENCE OF SURGICAL SITE INFECTION AND ASSOCIATED FACTORS AMONG MOTHERS AFTER CESAREAN DELIVERY IN ZEWDITU MEMORIAL HOSPITAL

ABSTRACTBACKGROUND: Cesarean delivery is the most common major operation carried out in obstetrics; constituting about 15% of all deliveries worldwide. Surgical site infections (SSIs) are among the most common infectious complications after cesarean delivery; which increase maternal morbidity and mortality, hospital stay and the cost of treatment. Hence, the aim of this study was to determine the prevalence of SSIs and associated factors among mothers after cesarean delivery.METHODS: Institution based cross-sectional study was conducted in Zewditu Memorial Hospital from December, 2017 to April, 2018. A semi-structure questionnaire was used to collect data. Wound site was examined on the 3rd postoperative day and 1st postnatal visit. On the 14th and 30th postoperative day, each participant was contacted through telephone for any signs of wound infection. Bivariate and multivariate logistic regression analysis were done to identify the association between predictors and SSIs. A level of P&lt;0.05 was considered statistically significant.RESULTS: A total of 474 pregnant women were included in this study. The prevalence of SSIs was 8.4%. About 95% of SSIs were developed within two weeks after caesarean section and 70% of them were developed after discharge from the hospital. In this study, SSIs were significantly associated with; contaminated wound (AOR=5.64; ; 95%CI, 2.45-10.60; p=0.028), multiple vaginal examination (AOR=5.24; 95%CI, 10.5 -36.2; p=0.001), rupture of membrane more than 12 hours (AOR=7.84; 95%CI, 4.25 -12.34; p=0.002), labor more than 12 hours (AOR=3.57; 95%CI, 1.92 -9.42; p=0.023) and anemia (AOR=16.34 ; 95%CI, 12.9 -30.4; p =0.024).CONCLUSION: In this study post-cesarean SSI was found to be high; and contaminated wound, multiple vaginal examination, rupture of membrane (&gt;12 hours), prolonged labor (&gt;12 hours) and anemia were significant predictors of SSIs.KEYWORDS: Cesarean section, Postpartum, Surgical site infection(Ethiopian Journal of Reproductive Health; 2018; 10; 4: 21-32)

Wet-Cupping Is Effective on Persistent Nonspecific Low Back Pain: A Randomized Clinical Trial.

To compare the possible effects of wet-cupping therapy with conventional therapy on persistent nonspecific low back pain (PNSLBP). In this randomized clinical trial, 180 participants with the mean age of 45±10 years old, who had been suffering from PNSLBP were randomly assigned to wet-cupping and conventional groups. The wet-cupping group was treated with two separate sessions (4 weeks in total) on the inter-scapular and sacrum area. In the conventional group, patients were conservatively treated using rest (6 weeks) and oral medications (3 weeks). The primary and the secondary outcome were the quantity of disability using Oswestry Disability Index (ODI), and pain intensity using Visual Analogue Scale (VAS), respectively. There was no significant difference in demographic characteristics (age, gender, and body mass index) between the two groups (P>0.05). Therapeutic effect of wet-cupping therapy was comparable to conventional treatment in the 1st month follow-up visits (P<0.05). The functional outcomes of wet-cupping at the 3rd and 6th month visits were significantly increased compared to the conventional group. Final ODI scores in the wet-cupping and conventional groups were 16.7 ± 5.7 and 22.3 ± 4.5, respectively (P<0.01). Wet-cupping may be a proper method to decrease PNSLBP without any conventional treatment. The therapeutic effects of wet-cupping can be longer lasting than conventional therapy. (Registration No. IRCT2013021672741)).

Abstracts from the NIH Office of Research on Women's Health 2018 Annual BIRCWH Meeting – Building Interdisciplinary Research Careers in Women's Health November 28, 2018

Abstracts from the NIH Office of Research on Women's Health 2018 Annual BIRCWH Meeting – Building Interdisciplinary Research Careers in Women's Health November 28, 2018