Average Bleeding Research Articles

The Effect of Visual Feedback on Plaque Control: An RCT Comparing Toothbrushing Methods in Periodontitis Patients.

Background/Objectives: As gingivitis prevalence is closely related to plaque accumulation, effective oral hygiene is mandatory for maintaining healthy gingival tissues. The aim of this study was to evaluate the impact of different toothbrushing methods (a manual toothbrush (group 1 = MTB, the control); an electric toothbrush (group 2 = ETB); and an electric toothbrush with daily visual feedback (group 3 = ETBV)) on the plaque levels and periodontal health in patients after receiving initial periodontal treatment. Methods: A total of 67 patients were initially screened in this study, and 60 patients were randomly allocated into 1 of the 3 groups, with 53 patients completing this study. At baseline, the average probing depth across all groups was 3.60 mm, with an average bleeding on probing (BoP) score of 69,15%. Clinical parameters were assessed at multiple time points over 12 weeks. Results: The plaque levels reduced significantly in all groups: MTB decreased from 65,57% to 33.26%, ETB from 64,17% to 31.49%, and ETBV from 63,04% to 26.25% (p < 0.001 for all groups). Furthermore, a significant improvement for BoP was recorded across all groups: BoP decreased to 25.68% (MTB), 22.32% (ETB), and 23.14% (ETBV) (p < 0.001 for all groups). However, no significant difference in the plaque removal efficacy was observed between manual and electric toothbrushes, irrespective of visual feedback (p > 0.190). A linear mixed model analysis showed a significant overall group effect on the periodontal health parameters (p = 0.041) but no interaction with time (p = 0.965). Conclusions: These findings emphasize the importance of consistent oral hygiene in reducing periodontal disease. Further research is necessary to explore effective strategies for enhancing patient adherence and optimizing health outcomes.

Comparison Between Oral and Intravenous Tranexamic Acid in Endoscopic Sinus Surgery

Background: The goal of this study is to assess oral and intravenous administration of tranexamic acid's (TXA) on intra-operative bleeding during endoscopic sinus surgery and to compare with control group. Methods: Forty-eight patients who were scheduled for endoscopic sinus surgery were chosen and randomly assigned to three groups. In first group 20mg/kg intravenous tranexamic acid, in second group 1000 mg 4 times daily for 48 hours and in third group 10 ml of normal saline were administered. The quality of the surgical field was estimated every 15 minutes by Boezaart scale. Volume of bleeding, pre and postoperative hematocrit, surgeon’s satisfaction by likert scale and duration of the surgical procedure were evaluated. Data was analyzed by SPSS v21 and P&lt;0.05 was significant. Results: Demographic parameters were not different among three groups. The surgical field quality at 15th minute was grade I-II in 25, 68.75 and 75 percent of the patients in the control, intravenous and oral groups, respectively. And also, no patients in the intervention groups and 42% of the patients in the control group were in grade IV. At 15 minute following surgery, there was a significant difference between the tranexamic groups and the control group (P = 0.002). at 30th minute 25, 50 and 56% of the patients in the control intravenous and oral groups, respectively were in grade I-II and difference was significant (P = 0.003). But at 45th minutes quality of surgical field was not different significantly (P = 0.163). The intraoperative average bleeding was 95.46, 94.32 and 190.64 ml for intravenous, oral and control patients that difference was significant (P = 0.001). The satisfaction of the surgeon was higher in the intravenous and oral TXA groups than the control group (P = 0.012). In comparison to the control group, the tranexamic group's surgical time were considerably lower (P 0.001). Hematocrits and drug side effects did not differ significantly among groups. Conclusion: Systemic tranexamic acid (intravenous or oral) during endoscopic sinus surgery enhances surgical field quality, decreases intra-operative hemorrhage, and shortens operation duration.

Elastic and recoverable sponges based on collagen/yeast β-glucan for quick hemostasis

In this investigation, we aimed to engineer sponges with exceptional mechanical and hemostatic capabilities for effective wound healing. By combining collagen, a stiff fibril protein in ECM, with β-glucan, an elastic and triple-helical polysaccharide from yeast cell wall, we prepared a series of composite sponges, designated as CY sponges. This material exhibited a uniform pore structure, displaying enhanced elasticity and shape recovery ability compared to pure collagen sponges. Also, the incorporation of Yeast β-glucan (YG) significantly improved the fluid absorption ability and stability of the sponges. In vitro hemostasis tests demonstrated that the CY sponges exhibited a notably lower in vitro coagulation index (19.21%) compared to the collagen control (64.84%), accompanied by superior erythrocyte (64.64%) and platelet (64.95%) adhesion properties. Animal studies further substantiated the sponge's hemostatic efficacy, as CY40 led to a reduction in average bleeding volume by 25.26% and 28.97%, and a shorter hemostatic time by 31.70% and 30.77% compared to collagen, indicating accelerated wound healing. These findings suggest that the addition of yeast β-glucan into collagen sponges can improve their elasticity, shape recovery ability, hemostatic performance and wound repair ability.

Comparison of gauze packing, sponge-based, and hemostatic surgicel wound stasis dressings to treat hemorrhages from grade IV liver injuries: An experimental study

Uncontrolled bleeding is still the major factor leading to preventable deaths following trauma. This study sought to assess the effectiveness of mini sponge-based wound stasis, cellulose-based local hemostatic, and traditional gauze dressings for the control of hemorrhages resulting from grade 4 liver injuries in rats. Thirty Sprague-Dawley rats were divided into three equal groups. In the first group, a liver laceration was treated with gauze packing. The second group received XStat minisponge dressing (MDS), and the third group was administered a combination of MDS dressing and Surgicel hemostatic agent. After gaining access to the intra-abdominal cavity, a liver laceration measuring 10mm in length, 5mm in depth, and extending to the middle lobe was created. The dressings were removed after 2 and 10min to assess the amount of bleeding, and any bleeding was documented again after 48h. Intraperitoneal adhesions were evaluated during euthanasia. At 2min post-injury, the gauze packing group had an average bleeding volume of 0.97±0.15mL, compared to 1.08±0.25mL in the MDS group (P=0.26) and 1.02±0.18mL in the MDS+Surgicel group (P=0.69). At 10min, the bleeding volumes were 0.13±0.05mL, 0.22±0.01mL(P=0.09), and 0.14±0.05mL(P=0.19), respectively. At 48h, significant differences were observed in bleeding volumes (gauze: 0.55±0.18mL, MDS: 1.15±0.21mL, MDS+Surgicel: 0.82±0.06mL, P<0.001). Mortality rates after 14 days were 0% in the gauze packing group, 60% in the MDS group (P=0.001), and 60% in the MDS+Surgicel group (P=0.001). The gauze packing group displayed no adhesions, while the other groups exhibited adhesions in the liver, bowel, omentum, and abdominal wall. Our results indicate that, when it comes to managing bleeding in severe liver injuries, traditional gauze packing remains the tried-and-true method, showing superior effectiveness in terms of blood loss and mortality when compared to XStat minisponge dressings and the fibrillar Surgicel hemostatic agents.

Laparoscopic Non-Mesh Cerclage Pectopexy with Uterine Preservation for Pelvic Organ Prolapse.

Pelvic organ prolapse (POP) affects millions of women globally and carries a significant socioeconomic burden. Adequate apical support is essential for treating POP. Recent research has increasingly validated the efficacy and safety of laparoscopic pectopexy (LP) for addressing apical POP. However, the cost of synthetic mesh and associated complications restrict the widespread use of this technique. Our team previously published a study describing a novel, non-mesh procedure called laparoscopic non-mesh cerclage pectopexy (LNMCP), demonstrating successful outcomes with satisfactory objective and subjective success rates. Many patients express a preference for retaining their uterus during prolapse surgery due to considerations related to sexuality, partnership, and body image. The present research introduces a novel approach known as laparoscopic non-mesh cerclage pectopexy with uterine preservation (LNMCPUP) for POP, wherein the uterus is suspended to the iliopectineal ligament through the round ligament using permanent cerclage sutures. We successfully performed this procedure in 14 cases at our hospital, six of whom still had menstruation, and the remaining eight were postmenopausal, with a mean operation time of 54.43 min (± 10.18 min) and an average bleeding volume of 53.57 mL (± 48.77 mL). The mean follow-up duration was 19.71 ± 15.87 months. The objective success rate of LNMCPUP was 100%, with a subjective success rate of 92.86%. No significant complications were observed during or after surgery. LNMCPUP integrates cervical cerclage and shortening of the round ligament, as well as LP without using mesh, thereby eliminating the risk of mesh erosion and lowering healthcare costs. Moreover, this novel technique is relatively easy to master, making it accessible even in rural and underdeveloped areas where synthetic mesh is unavailable. Therefore, it is worthwhile to adopt LNMCPUP in POP patients who desire the preservation of their uterus.

Meta-analysis of the comparison of laparoscopic pectopexy and laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse.

The effectiveness and safety of laparoscopic pectopexy (LP) in the treatment of female pelvic organ prolapse (POP) have recently gained significant interest. This study aimed to compare the outcomes and effectiveness of LP and laparoscopic sacrocolpopexy (LSC). A comprehensive literature search was conducted across multiple databases, including PubMed, MEDLINE, Embase, Web of Science, Cochrane Library, Clinical Trials, and CNKI. No language restrictions were applied in the search. The search encompassed the entire period from the inception of the respective databases to April 2023. All randomized controlled trials and comparative studies were included. A cumulative analysis was conducted on 10 studies, accounting for 15% of the overall research pool. The sample sizes of these studies were 760. Two researchers independently evaluated the eligibility of the studies, collected the relevant data, and evaluated their potential bias. Compared with LSC, the average operation time for LP in the simple surgery group was shorter (standardized mean difference [SMD] -2.14, 95% CI -2.68 to -1.60, P < 0.001). The average bleeding volume was lower (SMD -3.17, 95% CI -5.22 to -1.12, P = 0.002), the postoperative indwelling catheterization time was shorter (SMD -0.35, 95% CI -0.67 to -0.02, P = 0.040), and there were fewer total postoperative complications (odds ratio [OR] 0.53, 95% CI 0.30-0.94, P = 0.030). In terms of effectiveness, the LP group had fewer postoperative prolapse recurrences than the LSC group (OR 0.33, 95% CI 0.14-0.77, P = 0.010). LP demonstrates a comparable surgical efficacy to LSC. However, the surgical safety of LP is significantly improved. These findings should be validated by including additional randomized controlled trials.

Utility of 2.0 mm diameter Kirschner wires assembled with Wu’s Tension Traction Bows in calcaneal skeletal traction

The 3.5 mm diameter or thicker Steinmann pins were commonly used in skeletal traction, which are so highly invasive that may result in severe complications such as pin tract infection and iatrogenic calcaneus fractures. Accordingly, Xirui Wu designed a new type of tension traction bow that can be assembled with 2.0 mm diameter Kirschner wires, but its effectiveness is unclear. We aim to evaluate the effectiveness of 2.0 mm diameter Kirschner wires assembled with Wu’s Tension Traction Bows in calcaneal skeletal traction. Data of 65 patients who were admitted to our department with tibia fractures from January 2021 to June 2022 and underwent preoperative calcaneal skeletal traction were collected retrospectively. 36 patients treated with 2.0 mm diameter Kirschner wires assembled with Wu’s Tension Traction Bows were assigned into Group 1, and 29 patients treated with 3.5 mm diameter Steinmann pins assembled with Bohler’s traction bows were assigned into Group 2. Pins loosening, breakage, and calcaneus fractures occurred in neither group. No statistical differences were observed in traction weight, swelling reduction efficacy, and traction duration (P > 0.05). Statistically significant differences were found between the two groups in term of post-traction bleeding incidence, average bleeding duration, and mean size and healing time of traction wounds (P < 0.05). Though VAS pain score before traction and on the first two days after traction in Group 1 didn't differ from Group 2 (P > 0.05), it was significantly lower in Group 1 compared to Group 2 on the third day after traction (P = 0.030). This study demonstrates that 2.0 mm diameter Kirschner wires assembled with Wu’s Tension Traction Bows produce satisfied traction outcomes with less invasion and are recommended in calcaneal skeletal traction.

Early Outcomes of Hirschsprung's Disease after Definitive Surgery: A Ten-Year Experience.

This study aimed to examine the characteristics of Hirschsprung's Disease (HD) in patients aged<18 who underwent surgical procedure at Dr. Zainoel Abidin (RSUDZA) General Hospital, Banda Aceh, Indonesia, between January 2010 and December 2020. This retrospective study collected and analyzed data from medical records of 18-yearold or younger children (n = 180) diagnosed with HD at RSUDZA. The surgical procedures included the Duhamel procedure, Soave procedure, the Soave Transanal Endorectal Pull-through (TEPT) procedure, and the Swenson TEPT procedure. Early outcomes of the surgery were then compared between males and females. The comparrative analysis was determined based on Chisquare analysis, where p&#60; 0.05 was considered significant. There were 111 (61.7%) male patients and 69 (38.3%) female patients, with a mean age of 15.2 months. The Soave TEPT is the most frequently performed procedure (91.7%). Emerging clinical manifestations include constipation (176; 97.8%) and soiling (171; 95%). Preoperative barium enema and postoperative pathological examination confirmed that almost all patients (99.4%) had an aganglionic segment confined to the rectosigmoid area. The average length of operation was 69.7 ± 65 minutes and average bleeding time was 5.4 ± 34 mL. The average discharge time was 3.3 ± 73.3 days. No significant difference was found in post-surgery complications between males and females (p&#60;0.5). The immediate complications were not associated with surgical methods (p = 0.83). Our descriptive study has suggested the Soave TEPT technique as appropriate to manage HD.

Retroauricular endoscopic thyroidectomy: initial single-institution experiences.

Conventional thyroidectomy often results in visible scarring postoperatively. Endoscopic thyroidectomy offers the advantage of scarless surgery, especially beneficial for young adult women. The retroauricular approach uses a facelift incision well-known among surgeons and eliminates the need for gas insufflation due to the large working space. An early retrospective analysis was conducted on thirty-one individuals who underwent gasless retroauricular endoscopic thyroidectomy approach, focusing on isthmolobectomies (n = 26) and lobectomies (n = 5), with one case necessitating conversion to open thyroidectomy, from January 2016 to April 2017. Physical examination, laboratory, and histopathology findings were collected. The scar was evaluated using the Vancouver Scale System, while other surgical and oncological outcomes were documented and assessed. The average operative time was 154.2 ± 21.3min, with an average bleeding volume of 69.2 ± 52.1mL. The average length of stay was 4.7 ± 2.2days. All complications occurred were temporary and all subjects remained in good condition throughout the follow-up period. Most subjects (65.6%) were very satisfied with the scar concealed in the retroauricular area. Retroauricular endoscopic thyroidectomy is a safe and feasible remote access technique with excellent postoperative results.

Clinical analysis of complete uterine rupture during pregnancy

BackgroundUterine rupture in pregnant women can lead to serious adverse outcomes. This study aimed to explore the clinical characteristics, treatment, and prognosis of patients with complete uterine rupture.MethodsData from 33 cases of surgically confirmed complete uterine rupture at Chenzhou No.1 People’s Hospital between January 2015 and December 2022 were analyzed retrospectively.ResultsIn total, 31,555 pregnant women delivered in our hospital during the study period. Of these, approximately 1‰ (n = 33) had complete uterine rupture. The average gestational age at complete uterine rupture was 31+4 weeks (13+1–40+3 weeks), and the average bleeding volume was 1896.97 ml (200–6000 ml). Twenty-six patients (78.79%) had undergone more than two deliveries. Twenty-five women (75.76%) experienced uterine rupture after a cesarean section, two (6.06%) after fallopian tube surgery, one (3.03%) after laparoscopic cervical cerclage, and one (3.03%) after wedge resection of the uterine horn, and Fifteen women (45.45%) presented with uterine rupture at the original cesarean section incision scar. Thirteen patients (39.39%) were transferred to our hospital after their initial diagnosis. Seven patients (21.21%) had no obvious symptoms, and only four patients (12.12%) had typical persistent lower abdominal pain. There were 13 cases (39.39%, including eight cases ≥ 28 weeks old) of fetal death in utero and two cases (6.06%, both full term) of severe neonatal asphyxia. The rates of postpartum hemorrhage, blood transfusion, hysterectomy were 66.67%, 63.64%, and 21.21%. Maternal death occurred in one case (3.03%).ConclusionsThe site of the uterine rupture was random, and was often located at the weakest point of the uterus. There is no effective means for detecting or predicting the weakest point of the uterus. Rapid recognition is key to the treatment of uterine rupture.

Microdrill Versus Diode Laser in Endoscopic Stapedotomy: A Comparative Study.

Microdrill and diode laser are two different methods used in endoscopic stapedotomy for otosclerosis. These two methods have not been compared in endoscopic stapedotomy. To analyze the differences between microdrill and diode laser in endoscopic stapedotomy for otosclerosis. This is a randomized clinical trial; patients with otosclerosis were randomly divided into microdrill group (group A: n = 69) and diode laser group (group B: n = 62). Differences between the two groups were then compared. The preoperative air-bone gap (ABG) was 25.40 ± 10.88 dBHL in group A and 24.84 ± 12.23 dBHL in group B, with no significant between-group difference ( p > 0.05). The postoperative ABG in group A was 13.27 ± 9.91 dBHL versus 11.79 ± 10.82 dBHL in group B, and there was no significant difference between the groups ( p > 0.05). The surgical time in group B (64 ± 31.23 minutes) was significantly longer than that in group A (48 ± 25.62 minutes) ( p = 0.02). There were no significant between-group differences in basic patient-related data, preoperative air conduction (AC), preoperative bone conduction (BC), postoperative AC, distribution of postoperative ABG, preoperative ABG at different frequencies, and postoperative ABG at different frequencies. There was also no significant between-group difference in the average bleeding volume or number of patients with postoperative dizziness. The postoperative improvement in hearing level in the two group was equivalent, but group A had the advantage of a shorter operation time. 4.

Evaluation of Extraction of Teeth without Alteration in Aspirin Therapy: A Cross Sectional Study

ABSTRACT Aim: The study was done to evaluate extraction of teeth without altering the aspirin therapy. Materials and Method: Hundred patients taking aspirin therapy requiring extraction of teeth were separated into two groups with 50 samples in each. Group I continued the aspirin therapy during extraction of teeth on one occasion, and the same patients who discontinued the aspirin therapy 72 hours before extraction of teeth on another occasion become Group II. Result: The mean blood loss showed slightly increased bleeding in Group I in comparison to Group II. The average bleeding time and mean INR was statistically significant among both groups. The mean clotting time and mean platelet count were not statistically significant among groups. Conclusion: There was no alteration in bleeding after extraction in patients with low doses of aspirin therapy.

Advanced repair of recurrent and low-large hysterotomy defects using a myometrial glide flap

Background The resolution of factors linked to the recurrence of cesarean section defects can be accomplished through a comprehensive technique that effectively addresses the dehiscent area, eliminates associated intraluminal fibrosis, and establishes a vascularized anterior wall by creating a sliding myometrial flap. Objective Propose a comprehensive surgical repair for recurrent and large low hysterotomy defects in women seeking pregnancy or recurrent spotting. Study design A retrospective cohort analysis included 54 patients aged 25–41 with recurrent large cesarean scar defects treated at Otamendi, CEMIC, and Valle de Lili hospitals. Comprehensive surgical repair was performed by suprapubic laparotomy, involving a wide opening of the vesicouterine space, removal of the dehiscent cesarean scar and all intrauterine abnormal fibrous tissues, using a glide myometrial flap, and intramyometrial injection of autologous platelet-rich plasma. Qualitative variables were determined, and descriptive statistics were employed to analyze the data in absolute frequencies or percentages. The data obtained were processed using the InfostatTM statistic program. Results Following the repair, all women experienced normal menstrual cycles and demonstrated an adequate lower uterine segment thickness, with no evidence of healing defects. All patients experienced early ambulation and were discharged within 24 h. Uterine hemostasis was achieved at specific points, minimizing the use of electrocautery. The standard duration of the procedure was 60 min (skin-to-skin), and the average bleeding was 80–100 ml. No perioperative complications were recorded. A control T2-weighted MRI was performed six months after surgery. All patients displayed a clean, unobstructed endometrial cavity with a thick anterior wall (Median: 14.98 mm, IQR 13–17). Twelve patients became pregnant again, all delivered by cesarean between 36.1 and 38.0 weeks, with a mean of 37.17 weeks. The thickness of the uterine segment before cesarean ranged between 3 and 7 mm, with a mean of 3.91 mm. No cases of placenta previa, dehiscence, placenta accreta spectrum (PAS), or postpartum hemorrhage were reported. Conclusions The comprehensive repair of recurrent low-large defects offers a holistic solution for addressing recurrent hysterotomy defects. Innovative repair concepts effectively address the wound defect and associated fibrosis, ensuring an appropriate myometrial thickness through a gliding myometrial flap.

The application of mixed reality technique in oromaxillo-facial reconstruction with the perforator flap for malignant tumor patients.

The integration of quantitative imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) with mixed reality (MR) technology holds promise for enhancing the diagnosis, prognosis, and treatment monitoring of cancer. This study compares the characteristics and effects of MR and color Doppler ultrasound (CDU) in the localization of perforator blood vessels in the lower extremities. Two techniques were used to locate the perforator vessels in 40 cases of maxillofacial defect repair using perforator flaps from the lower extremities. The number of perforator vessels located in the flap area and the actual number of perforator vessels explored during the surgery were recorded. The recognition rate was calculated and the operation time and blood loss were recorded for each case. The recognition rates of MR technology and CDU in perforating vessels of the lower limbs were 93.9% and 97.2%, respectively (p > 0.05). The operation time was 52-74 minutes, 65-88 minutes (p > 0.05). The average bleeding volumes were 24 and 56ml (p < 0.05), respectively. All perforator flaps were alive. One flap had a crisis and recovered after emergency exploratory treatment. Thirty donor sites of the lower extremities were directly sutured, and wounds were closed by abdominal skin grafting in 10 cases. MR technology for successfully identifying perforator vessels can shorten the operation time, reduce the amount of bleeding in the donor site, and reduce trauma to the donor site.

A comparative study of the local effect of tranexamic acid and phenylephrine on the amount of bleeding in rhinoplasty: A randomized clinical trial.

Bleeding during nose surgery is very important, because it can cause a problem in the surgeon's field of view and lead to an increase in the probability of surgical complications. The aim of this study was to compare the local effects of tranexamic acid and phenylephrine on bleeding in rhinoplasty. The present study is a double-blind clinical trial in which 98 patients who were candidates for rhinoplasty Shiraz were randomly divided into 49 groups of phenylephrine and tranexamic acid. In the first group, 1 cc of phenylephrine and in the second group, 1 cc of tranexamic acid was used locally and then the variables in the two groups were compared. The current study was approved by the Iranian Clinical Trial Registration Center with code IRCT20201205049602N1. The average blood pressure and heart rate in the phenylephrine group first increased and then decreased, but in the tranexamic acid group decreased from the beginning to 30 minutes. Based on the results of the test, there was a difference between the two groups in terms of the amount of bleeding, and a statistically significant relationship was observed. The average bleeding volume was lower in the phenylephrine group (p<0.0001). Results of this study showed that the amount of bleeding in the phenylephrine group was lower than that of tranexamic acid. It is recommended to use phenylephrine in rhinoplasty surgery to reduce bleeding and improve the surgeon's vision.

Efficacy, Safety, and Acceptability of Manual Vacuum Aspiration with Para Cervical Block as a Management of Incomplete Abortion

Limited access to safe abortion is a leading cause of maternal mortality and morbidity in the developing world, overwhelming hospitals with a large number of women seeking treatment for complications of unsafe abortion. In many cases, more than half of all gynecological admissions are due to incomplete or septic abortions. The primary aims were to assess the efficacy and cost-effectiveness of the manual vacuum aspiration (MVA) procedure for managing incomplete abortion, considering completeness, procedure, duration, and hemorrhage. Additionally, safety aspects, such as complications (hemorrhage, perforation, and cervical injury), pain relief, patient satisfaction, and factors like reduced hospital stays and waiting times, were evaluated. This descriptive cross-sectional study was conducted at Dhaka Medical College and Hospital, focusing on women with incomplete abortions up to 12 weeks of gestation. It took place over six months from July to December 2013, with a purposive sample of 100 cases selected based on specific criteria to represent the study's objectives. Statistical analysis was done by using SPSS (version 16.0, SPSS Inc., Chicago, Illinois, USA). Out of 100 respondents, more than two-third of the patients (68%) were in 21-30 years age group. Half of the patients (50%) came from lower middle class family and most of them were housewives (80%). Majority (58%) of the patients had average gestational age 6-10 weeks. More than two-third (70%) of the patients had incomplete abortion, with 47% having attempted to terminate pregnancy. Abdominal pain was reported among 64% of patients, and the average bleeding period was 5-7 days for 62% of them. More than two-third (68%) of patients had no palpable uterus, and active bleeding was also found among two-third 66.0% of cases. Nearly one-third of the patients (32%) received injectable oxytocin and 13% received blood transfusion. Method of para-cervical block was applied for pain management in all patients (100%), while pethidine was used in only 3% of cases. Almost all of the patients 97%) were given sedatives (diazepam) and oral non-steroidal anti-inflammatory drugs (NSAIDs). Duration for the procedure was 10-15 minutes for 46% of patients, and excessive hemorrhage was found in 2% of cases. The average hospital stay ranged from 2-11 hours. Treatment cost in the majority of cases was only 75-150 Bangladeshi taka (BDT), which was statistically significant. The MVA with paracervical block was found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with few complications. MVA procedure had less blood loss, less time consuming, safe and effective with shorter hospital stay. Bangladesh Med J. 2022 May; 51(2): 21-29

Improved first-pass effect in acute stroke thrombectomy using Solitaire-X compared to Solitaire-FR.

In acute ischemic stroke (AIS), successful endovascular thrombectomy (EVT) of large vessel occlusion (LVO) necessitates the most suited device. Solitaire-X has longer and larger diameter pusher wires than Solitaire-FR.As the role of a larger pusher-wire diameter is uncertain, we aim to compare procedural, clinical, and radiological outcomes for AIS patients undergoing EVT using either type of Solitaire device. Procedures were performed using the Solumbra technique, which combines a large-bore aspiration catheter with a stentriever. The primary outcome was to compare rates of successful first-pass recanalization (defined as TICI 2b/3 score). The secondary objectives were procedural (rates of successful recanalization), clinical (post-procedural NIHSS and days of hospitalization), and radiological (post-procedural ASPECT score and hemorrhagic transformation) outcome measures. Consecutive AIS patients undergoing EVT for LVO were recruited into a prospective multicenter database at our academic center. We have used Solitaire-FR until October 2020 and Solitaire-X ever since. We retrospectively analyzed our prospective consecutive registry. Included in our analysis are patients undergoing EVT using Solitaire only; patients with tandem lesions or underlying stenosis requiring emergent stenting during the procedure were excluded. The cohort of patients treated with Solitaire-X was compared with a cohort consisting of the most recent consecutive cases undergoing EVT with the Solitaire-FR. A total of 182 (71.9 ± 14, 61% male patients) AIS patients were included in the analysis with both groups (n = 91 each) sharing similar demographic characteristics, premorbid conditions, and stroke characteristics (time from symptom-onset, NIHSS, ASPECTS, occlusion site, and rates of intravenous-tPA treatment). The Solitaire-X group had a higher rate of first-pass recanalization (65.9% vs. 50.5%, p = 0.049). On 24-h post-procedural head-CT, the Solitaire-X group had higher ASPECT scores (6.51 ± 2.9 vs. 5.49 ± 3.4, p = 0.042) and lower post-procedural average bleeding volumes (0.67 ± 2.1 vs. 1.20 ± 3.4 mL, p = 0.041). The Solitaire-X group had shorter duration of hospitalization (16.6 ± 13.1 days vs. 25.1 ± 23.2, p = 0.033). On multivariate analysis, using Solitaire-X was the sole independent predictor of first-pass recanalization (OR 2.17, 95% CI 1.12-4.26, p = 0.023). In our study, the use of the Stentriever-X with a larger pusher-wire diameter was associated with a higher likelihood of first-pass effect and improved procedural, clinical, and radiological outcomes in AIS patients.

Vaginal Birth after Caesarean Section: A Study of 60 Patients with Spontaneous Onset of Labor Pain

Background: Most women with a singleton pregnancy of cephalic presentation at 37+ weeks or later who have had a single prior lower segment cesarean delivery, with or without a history of prior vaginal birth, are candidates for planned VBAC and may be offered it for a trial of VBAC. Objective: The objective of this study is to determine the outcome of vaginal birth after caesarean section (VBAC) in a tertiary care hospital in Sylhet. Methods: This prospective study took place between April 2022 and February 2023 and lasted for a total of eleven months. A total of sixty patients were hospitalized in the gynecology and obstetrics department at North East Medical College, all of whom had a history of either one or two previous cesarean sections and were experiencing labor pain. 43 of these patients had their deliveries through the vaginal route. The remainder of the patients had cesarean sections because of fetal distress, scar tenderness, and the patient's wish during 1st stage of labor. Results: The VBAC success rate in this study was 71.67%. Among the 43 patients, the highest number of patients, 51.2%, came from the age range of 28-37 years, followed by 21 patients (48.8%), who were in the age category of 18-27 years. The majority of the patients (24, 55.82%) were in their second pregnancy, with 10 (23.25%) in their third pregnancy and 9 (20.93%) in their more than third pregnancy. Among the 43 patients, 42 (97.7%) had a previous caesarean section, while the remaining 1 patient (2.3%) had two previous caesarean sections. Most patients (58.14%) were admitted to the hospital between 35 and 38 weeks of pregnancy. Among the participants, 97.7% had normal placenta size, 88.4% had average bleeding, 79.1% had clear liquor and 97.7% had no scar rapture. The study shows an extremely low level of complication in VBAC. Conclusion: This study identified that, the success rate of vaginal birth after one caesarean section is very high. An evidence-based systematic review suggested that planned VBAC is a safe and appropriate mode of delivery for the majority of pregnant women with a single previous lower-segment caesarean delivery.

The application of transcervical non-inflatable endoscopic posterior inferior sternocleidomastoid approach in thyroid surgery

Objective:To investigate the clinical efficacy and safety of transcervical non-inflatable endoscopic thyroidectomy through the posterior inferior sternocleidomastoid approach. Methods:From December 2022 to May 2023, the clinical data of 35 patients with papillary thyroid carcinoma treated by transcervical non-inflatable endoscopic surgery via posterior inferior sternocleidomastoid approach were retrospectively analyzed. There were 14 males and 21 females, with an average age of 44.7 years. The operation time, bleeding volume, postoperative recovery, complications and follow-up were recorded. Results:All 35 patients successfully completed the surgery, with an average operation time of 4 hours and 7 minutes, an average bleeding volume of 14 ml, and an average postoperative hospital stay of 3.5 days. There were no serious complications and no obvious neck discomfort during postoperative follow-up. Conclusion:Transcervical non-inflatable endoscopic thyroidectomy via posterior inferior sternocleidomastoid approach is safe and effective, with fast postoperative recovery,high appearance satisfaction and good neck comfort.

EVALUATION OF THE EFFICACY OF CHLORHEXIDINE-BASED MEDICATIONS IN PATIENTS WITH CHRONIC GENERALIZED PERIODONTITIS

The treatment of periodontal diseases remains a relevant issue today, as there is a wide range of therapeutic agents available for this pathology. Local therapeutic agents are commonly used in the oral cavity. Chlorhexidine is considered the gold standard in periodontology. The aim of this study was to evaluate the efficacy of chlorhexidine-based medications in patients with chronic generalized periodontitis: Dentaid PerioAid Gel and Perio-Aid Protect. The study included 40 patients, with 20 diagnosed with chronic generalized periodontitis stage I-II and the other 20 with chronic generalized periodontitis stage II-III. All patients were further divided into 4 subgroups, with 10 patients in each subgroup.&#x0D; After 2 months of clinical research and patient examination, the following data were obtained for subgroup A1: the average plaque index (PI) was 31.82±0.96%, and the average bleeding on probing (BOP) was 18.67±2.47%. Among the patients in subgroup A1, the average depth of gingival sulcus was 96.41±0.76% for depths of 1-3 mm and 3.59±0.76% for periodontal pockets with depths of 4-5 mm.&#x0D; The measurements for subgroup A2 after 2 months of clinical research were as follows: the average PI was 32.16±1.10%, and the average BOP was 14.70±0.79%. Among the patients in subgroup A2, the average depth of gingival sulcus was 97.14±0.69% for depths of 1-3 mm and 2.74±0.68% for periodontal pockets with depths of 4-5 mm.&#x0D; The measurements for subgroup B1 after 2 months of clinical research were as follows: the average PI was 46.44±2.65, and the average BOP was 28.79±3.66%. Among the patients in subgroup B1, the average depth of gingival sulcus was 81.19±7.90% for depths of 1-3 mm, 14.06±5.50% for periodontal pockets with depths of 4-5 mm, and 4.55±3.13% for pockets with depths ≥ 6 mm.&#x0D; The measurements for subgroup B2 after 2 months of clinical research were as follows: the average PI was 44.09±1.00%, and the average BOP was 25.97±2.28%. Among the patients in subgroup B2, the average depth of gingival sulcus was 81.61±4.83% for depths of 1-3 mm, 15.96±4.90% for periodontal pockets with depths of 4-5 mm, and 1.18±0.52% for pockets with depths ≥ 6 mm.&#x0D; Comparing the obtained results of the clinical study in patients with chronic generalized periodontitis, it can be concluded that the treatment of this pathology with local application of chlorhexidine-based agents contributed to the improvement of clinical parameters after 2 months compared to the initial situation.