Days Of Bleeding Research Articles

0737 Age, menstrual phase, and circadian preference impact sleep in menstruating individuals

Abstract Introduction An eveningness chronotype is generally associated with reduced sleep continuity and quality, as well as social jetlag. Changes in hormones and menstrual phase similarly impact sleep, although research on the chronobiological effects of these changes are equivocal. This study aimed to examine the role of menstrual cycle in daily self-report and actigraphy-assessed sleep in two consecutive menstrual cycles. Methods Participants (n=51; 43% Caucasian), 18-35 years (23.67±4.68) completed actigraphy and daily sleep diaries over two menstrual cycles (m days=51.29). Four menstrual phases were identified via dates of menstrual bleeding and urinary ovulation testing: perimenstrual (±3 days of bleeding), mid-follicular, periovulatory, and mid-luteal. Relationships between menstrual phase and sleep parameters were estimated using multistep hierarchical linear modeling. Subjective and objective measures yielded the following sleep variables: Total Wake Time (TWTsub and TWTobj), Sleep Efficiency (SEsub and SEobj), and mid-sleep point (MSP). Participants completed the Morning-Eveningness Questionnaire (MEQ) at baseline. Results Mean cycle length was 28.61 days±2.69. Age was significantly associated with TWTobj (r=-.32, p <.001); SEobj (r=.34, p <.001), and MSP (r=-.42, p <.001) such that older participants had shorter TWT, higher SE, and earlier MSP. TWTobj was 4-7 minutes lower during the mid-follicular (61.54±3.37) and mid-luteal phases (63.11±3.29) compared to the perimenstrual phase (67.54±3.37; p <.001). SEobj was higher in the mid-luteal phase (82.50±0.79) vs. the perimenstrual phase (80.71±0.82, p =.006). Perimenstrual women reported 8-16 minutes longer awake (TWTsub=52.23±5.01, p <.001) and had 1-3% reduction in SEsub (89.70±0.10, p <.001). MEQ negatively predicted TWTobj (p=.004) and SEobj (p=.003), but did not vary across menstrual phase. In morning-type individuals, TST was significantly higher in the periovulatory (b =1.81, p=.01) and mid-luteal phases (b=2.03, p<.001) compared to the perimenstrual phase. Conclusion With increasing age, women experienced reduced time awake, higher sleep efficiency, and earlier sleep timing. Eveningness predicted greater total wake time and lower sleep efficiency. With menstrual phase considered, disturbed sleep was highest in the perimenstrual phase and women reporting a stronger preference for eveningness reported shorter TST during the perimenstrual phase. These findings highlight the importance of considering the menstrual cycle in the sleep health of menstruating individuals. Support (if any)

Relationship between ambient temperature at sampling and the interferon gamma test result for bovine tuberculosis in cattle

Bovine tuberculosis (bTB) is a disease of significant economic and zoonotic importance, therefore, optimising tests for the identification of Mycobacterium bovis infected cattle is essential. The Interferon Gamma (IFN-γ) Release Assay (IGRA) can diagnose M. bovis infected cattle at an early stage, is easy to perform and can be used alongside skin tests for confirmatory purposes or to increase diagnostic sensitivity. It is known that IGRA performance is sensitive to environmental conditions under which samples are taken and transported. In this study, the association between the ambient temperature on the day of bleeding and the subsequent IGRA result for bTB was quantified using field samples from Northern Ireland (NI). Results of 106,434 IGRA results (2013–2018) were associated with temperature data extracted from weather stations near tested cattle herds. Model dependent variables were the levels of IFN-γ triggered by avian purified protein derivative (PPDa), M. bovis PPD (PPDb), their difference (PPD(b-a)) as well as the final binary outcome (positive or negative for M. bovis infection). IFN-γ levels after both PPDa and PPDb stimulation were lowest at the extremes of the temperature distribution for NI. The highest IGRA positive probability (above 6%) was found on days with moderate maximum temperatures (6–16 °C) or moderate minimum temperatures (4–7 °C). Adjustment for covariates did not lead to major changes in the model estimates. These data suggest that IGRA performance can be affected when samples are taken at high or low temperatures. Whilst it is difficult to exclude physiological factors, the data nonetheless supports the temperature control of samples from bleeding through to laboratory to help mitigate post-collection confounders.

Prophylaxis with low dose tranexamic acid in acute myeloid leukemia patients undergoing intensive chemotherapy.

Patients suffering from acute myeloid leukemia (AML) carry a high risk of serious bleeding complications due to severe thrombocytopenia for long periods of time during treatment. Prior to prophylactic platelet transfusion becoming the standard of care, intracranial bleeding was a major contributor to death in AML patients. However, despite prophylactic platelet transfusions, up to 79% of patients with AML experience clinically significant bleeding during treatment. Antifibrinolytics are effective and well tolerated hemostatic agents widely used in many patient groups, and in this study, we investigated the effect of low dose tranexamic acid (TXA) in patients with AML and thrombocytopenia. We compared bleeding and thrombosis between 113 thrombocytopenic AML patients receiving TXA 500mg three times daily (n=36) versus no-TXA (n=77). Clinical information was obtained systematically from electronic medical records, and laboratory data were collected from the laboratory information system. No difference was demonstrated in number of patients with at least one bleeding episode (TXA: 89%vs. no-TXA: 93%, p=0.60), median number of bleeding days (TXA: 2.5 days vs. no-TXA 2.0 days, p=0.30), bleeding location or transfusion needs between the two groups. However, platelet count was found to be a significant risk factor for bleeding, with a probability of bleeding of 35% with a platelet count below 5×109/L (logistic regression, p<0.01). We found no difference in thromboembolic events between the two groups (TXA: 8%vs. no-TXA 10%, p=0.99). In conclusion, treatment with low dose TXA is safe, but we found no evidence to suggest that it reduces bleeding in AML patients with thrombocytopenia.

Bleeding Patterns With Relugolix Combination Therapy in Women With Endometriosis-Associated Pain [ID: 1345374

INTRODUCTION: Relugolix combination therapy (Relugolix-CT: relugolix 40 mg, estradiol 1 mg, norethindrone acetate 0.5 mg) significantly improved endometriosis-associated pain versus placebo in the SPIRIT 1&amp;2 studies. Efficacy was maintained over 104 weeks in the long-term extension (LTE) study. Bleeding patterns in women treated up to 104 weeks with Relugolix-CT are reported. METHODS: SPIRIT 1&amp;2 were IRB-approved phase 3, 24-week, randomized studies of Relugolix-CT, delayed Relugolix-CT (relugolix 40 mg monotherapy followed by Relugolix-CT; 12 weeks each), or placebo in premenopausal women (age 18–50 years) with moderate-to-severe endometriosis-associated pain. Eligible women completing SPIRIT 1&amp;2 could enroll in the open-label LTE with once-daily Relugolix-CT. Bleeding days per cycle and bleeding patterns were recorded on eDiaries. Amenorrhea was defined as no bleeding over 28 consecutive days. RESULTS: Of 1,261 women originally randomized, 501 completed week 104. Baseline demographics and characteristics were balanced across treatment groups. The proportion of women achieving amenorrhea increased over time: 74.4% (95% CI 68.8–79.4) at week 24, and 82.3% (95% CI 74.6–88.4) at week 104. The average number of bleeding days per cycle (standard deviation) decreased over time from 5.8 (2.4) at baseline to 1.2 (3.3) at week 104. The number of heavy or extremely heavy bleeding days decreased from 1.9 at baseline to 0.0 at week 104. CONCLUSION: Treatment with Relugolix-CT in women with endometriosis-associated pain resulted in high rates of amenorrhea and complete elimination of heavy bleeding, thus demonstrating sustained benefit through 2 years. Findings may support patient counseling.

Comparative effects of treatment with ferric carboxymaltose versus ferric derisomaltose in a murine model of iron-deficiency anemia

Intravenous (IV) iron preparations like ferric carboxymaltose (FCM) and ferric derisomaltose (FDI) are used to treat iron deficiency anemia (IDA) due to heavy uterine bleeding, inflammatory bowel disease, and chronic kidney disease. These preparations greatly differ in terms of their side-effect profiles (e.g, hypophosphatemia). However, studies that directly compare FCM and FDI are limited. The objective of this study was to compare the effects of FCM and FDI in a mouse model of IDA and investigate changes in blood parameters and mineral homeostasis. Female C57Bl/6J mice were fed iron-deficient diet for 5 weeks followed by IV bleeding (0.7% of body weight [b.w.]) for 3 consecutive days. On day 0 (last day of bleeding), baseline blood and urine were analyzed for hematocrit, CBC, P i and Ca 2+ . Mice were randomized to vehicle (saline, 2 μl/g b.w.; n=16), FCM (20 mg/kg; n=12), or FDI (20 mg/kg; n=12) treatment via retroorbital injection on day 0 and 7. On day 14, terminal blood, urine, spleen, and heart were collected. At baseline, compared with pre-bleeding, all mice had low hematocrit (22±1 vs 48±0.3%; P&lt;0.05) and microcytic hypochromic anemia. After 14 days, mice treated with FCM and FDI had higher hematocrit compared with vehicle (47±0.4 and 46±0.3 vs 25±1%; P&lt;0.05). WBC were similar on day 14 compared with day 0 for mice treated with FCM (8±1 vs 7±1 x10 9 /L; NS) or FDI (7±1 vs 7±1 x10 9 /L; NS); however, WBC were decreased in vehicle-treated mice (4±1 vs 6±1 x10 9 /L; P&lt;0.05). Thrombocytes were increased in vehicle-treated mice on day 14 compared with day 0 (1405±55 vs 795±23 x10 9 /L; P&lt;0.05); while there was no change in thrombocytes in mice treated with FDI (706±16 vs 831±29 x10 9 /L; NS), they were decreased in FCM-treated mice (583±41 vs 771±30 x10 9 /L; P&lt;0.05). Both FCM and FDI prevented splenomegaly that was seen in vehicle-treated mice (88±3 and 87±20 vs 263±40 mg; P&lt;0.05). Similarly, FCM and FDI prevented greater heart weight that was seen in vehicle-treated mice (0.43±0.01 and 0.45±0.01 vs 0.48±0.01 g/b.w. %; P&lt;0.05). After 14 days, mice treated with FCM and FDI had lower plasma P i compared with vehicle (1.9±0.1 and 2.1±0.1 vs 2.4±0.1 mmol; P&lt;0.05); although FCM-treated mice showed greater hypophosphatemia compared with FDI ( P&lt;0.05). There were no differences between groups for urinary P i . Plasma Ca 2+ was similar between groups on day 14; but compared with day 0, it was higher in vehicle (2.7±0.1 vs 2.5±0.1 mmol; P&lt;0.05) and FCM-treated mice (2.8±0.1 vs 2.5±0.1 mmol; P&lt;0.05). Urinary Ca 2+ /creatinine was higher in mice treated with vehicle compared with day 0 (0.4±0.04 vs 0.1±0.01 mmol/mmol; P&lt;0.05) but was lower with FCM (0.09±0.03 vs 0.14±0.04 mmol/mmol; P&lt;0.05) and FDI (0.08±0.01 vs 0.3±0.06 mmol/mmol; P&lt;0.05). In summary, our study shows that both iron preparations have similar effects on blood parameters, but mice were more hypophosphatemic when treated with FCM vs FDI. We speculate this may be due to variations in PTH and FGF23 levels. This work was supported by 1R01DK110621, VA Merit Award IBX004968A, NIDDK Diabetic Complications Consortium RRID:SCR_001415, DK076169 and DK115255 (all to TR). LT was supported by an AHA Postdoctoral Fellowship (828731). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

PREVALENCE OF MENSTRUAL CHANGES FOLLOWING COVID -19 VACCINATION AMONG THE WOMEN ATTENDING THE MCH , AL AHSA SAUDI ARABIA

Background: Coronavirus disease (COVID-19), a highly infectious disease caused by the SARS-CoV-2 virus has taken the form of pandemic throughout the world and is a major public health problem. The effect of COVID-19 infection on menstruation cycle might be the adverse effect on the complex interplay of hormones that interact with immune, vascular and coagulation systems whose interaction can influence menstrual bleeding and severity of menstruation symptoms. However with the roll out of the COVID 19 vaccine among the younger age group, many complaints were received at the health centers regarding the change to their menstruation cycle. The present study was conducted to assess the effect of different types of Covid-19 vaccine on the menstruation cycle of the women. Material and Methods: It was a cross sectional prospective study in which data were collected by interviewing the women attending the MCH hospital and who are vaccinated by COVID 19 vaccination. The study sample contained 344 women. The sampling was done randomly by selecting every second eligible patient attending the out-patient department of Obs. and Gynaecology.The data were collected in the data collection form specially designed for this study. The data were entered and analyzed by using the SPSS, version 21.Descriptive statistics were presented using counts, proportions (%), mean ± standard deviation whenever appropriate. Descriptive statistics (e.g. number, percentage) and analytic statistics using Chi Square tests (?2) to test for the association and/or the difference between two categorical variables were applied. A p-value equal to or less than 0.05 was considered statistically significant. Results: A total of 314 subjects participated in study. The mean age of the participants was 29.56 years± Std. Dev. 8.29 years. Majority of the participants (67.5%) were married. Eighty six percent of the participants were immune by third dose while only 1% was immune by first dose and 7.6% by 2 doses of Covid-19 Vaccine. Almost forty six percent (45.9%) of the participants did not experience any change in their menstruation cycle after vaccination while 21.7% experienced irregular menstruation cycle and 15.9% experienced severe pain during the menstruation period. Minority of the participants complained about the heavy bleeding (7.6%), light bleeding and fewer days of period time (6.7%) and missed period without pregnancy (2.2%). Menstrual changes was significantly higher among the age group of 45-54 years of age as compared to 35-44 years , 25-34 years and 15-24 years of age group (90% vs. 51.95% vs.52.63%vs.52.69%, P=0.042). The menstrual cycle change was significantly more prevalent among the unmarried participants than married and divorced participants (60.42% vs. 50.94% vs.50%, P=0.045).Menstrual change was also significantly more among the participants with Type 2 diabetes as compared to those with no disease , hypertension and hypothyroidism (75% vs.50.57 vs.69.23 vs. 50%, P=0.043). The menstrual change was significantly more among the participants who were immune by first dose than those with second and third dose (80.0%vs.51.28% vs.53.70%, P=0.038). Conclusion: The present study has shown that there was evidence to support that following vaccination for COVID-19, menstrual disturbance do occur. Except Moderna vaccine the subjects in the present study had menstrual cycle irregularities regardless of the vaccine type. The presence of Type 2 Diabetes, hypertension, immunity by one dose, unmarried women and those with already irregular period were found to be the possible associated factors for the menstrual irregularities in our study. However, more specific studies such as case control are needed to validate the results of the present study.

Treatment of unfavorable bleeding patterns in contraceptive implant users: a randomized clinical trial of curcumin

Some users of the etonogestrel contraceptive implant experience bothersome bleeding, which can reduce contraceptive satisfaction and continuation. Few strategies exist to manage this bleeding. The exact mechanism of progestin-induced bleeding is unknown, but it is likely multifactorial (eg, impaired angiogenesis, "leaky" fragile vasculature, and inflammation). Curcumin, the active ingredient in turmeric, has anti-inflammatory, antiproliferative, and antiangiogenic properties, which may make it a useful agent for implant-associated bothersome bleeding. This study aimed to evaluate whether curcumin decreases frequent or prolonged bleeding or spotting in contraceptive implant users. The study was a randomized, double-blind, placebo-controlled trial. Here, etonogestrel implant users with frequent or prolonged bleeding or spotting were enrolled and randomized to either 600-mg Theracurmin HP (Immunovites, Las Vegas, NV) or placebo daily for 30 days. The term "frequent" was defined as ≥2 independent bleeding or spotting episodes, and the term "prolonged" was defined as ≥7 consecutive days of bleeding or spotting in a 30-day interval. Implant use was confirmed by clinical examination and negative gonorrhea and chlamydia and pregnancy tests. Enrolled participants initiated study treatment after 3 consecutive days of bleeding or spotting; if no bleeding or spotting occurred within 30 days of enrollment, the participants were withdrawn from the study. Study treatments were encapsulated to maintain a similar appearance. Participants used text messages to record daily bleeding patterns and study drug compliance. Bleeding was defined as a day that required the use of protection with a pad, tampon, or liner, and spotting was defined as a day with minimal blood loss that did not require the use of any protection. Our primary outcome was the total number of days without bleeding or spotting during the 30 days of study drug or placebo exposure. The secondary outcomes included total number of bleeding-free days, bleeding episodes, and satisfaction. A sample size of 22 per group provided 80% power at an alpha level of .05 to demonstrate a 6-day difference between groups. From February 2021 to November 2022, 58 individuals enrolled in the study with 54 participants (93%) completing 30 days of treatment (26 in the curcumin group and 28 in the placebo group). Of note, 1 individual in the curcumin arm did not experience a qualifying bleeding event and, thus, never initiated treatment and, per protocol, was withdrawn from the study. Participant characteristics did not differ between groups, including length of implant use at study enrollment (placebo, 521±305 days; curcumin, 419±264 days). The study groups did not differ concerning any bleeding-related outcome (mean days without bleeding or spotting: curcumin, 16.7±6.9; placebo, 17.5±4.8; P=.62; mean bleeding-free days: curcumin, 23.4±4.9; placebo, 22.4±4.5; P=.44; bleeding episodes: curcumin, 2.0±0.8; placebo, 2.1±0.8; P=.63). In addition, satisfaction with the implant as contraception and acceptability of bleeding over the study period did not differ by study group (P=.54 and P=.30, respectively). Daily use of curcumin did not improve bleeding patterns in users of the etonogestrel contraceptive implant experiencing frequent or prolonged bleeding patterns.

Serum Phoenixin-14 levels of women with polycystic ovary syndrome increase proportionally with BMI.

This study aimed to compare serum PNX-14 values of women with PCOS classified as lean or overweight according to the BMI values. Fifty lean or overweight women diagnosed with PCOS according to the revised Rotterdam criteria were included in the study. They were divided into two groups according to their BMI values. Thirty patients with BMI values of 18.5-24.9 kg/m2 constituted the normal-weight PCOS group. Twenty patients with BMI values of 25-29.9 kg/m2 formed the overweight PCOS group. Thirty patients with regular menstrual cycles who did not exhibit clinical and laboratory findings of PCOS were selected as the control group. The patients in the control group were also divided into two different groups as normal weight (n=17) and overweight (n=13). In anovulatory PCOS group, blood samples were collected on the third day of progesterone withdrawal bleeding. Both in ovulatory PCOS and control groups, blood samples were collected on the third day of spontaneous menstrual cycle. In addition to basal hormonal parameters, serum phoenixin-14 concentrations were measured by enzyme-linked immunosorbent assay. LH values of the overweight or lean PCOS group were significantly higher than the overweight or lean non-PCOS group (p<0.01). The LH/FSH ratios of the lean and obese PCOS groups were significantly higher than the non-PCOS control group (p<0.01). Testosterone levels of both lean and obese PCOS groups were significantly higher than non-PCOS groups (p<0.02). The HOMA-IR value of the obese PCOS group was significantly higher than the lean PCOS group (p<0.03). The HOMA-IR values of the patients in the PCOS group were significantly higher than the non-PCOS controls. Phoenixin-14 levels of the obese PCOS group were approximately three times higher than the lean PCOS group (p<0.01). Phoenixin-14 levels of the obese non-PCOS group were also three times higher than the lean non-PCOS group (p<0.01). Serum Phoenixin-14 levels of patients in the lean PCOS group were significantly higher than in the lean non-PCOS group (9.11±2.09 pg/mL vs. 2.04±0.11 pg/mL, p<0.01). Serum Phoenixin-14 levels of the patients in the obese PCOS group were significantly higher than in the obese non-PCOS group (27.4±3.04 pg/mL vs. 6.44±1.09 pg/mL, p<0.01). A positive and significant correlation was found between serum PNX-14 levels and BMI, HOMA-IR, LH, and testosterone levels in both lean and obese PCOS patients. This study showed for the first time that serum PNX-14 levels are significantly increased in lean and obese PCOS patients. The increase in PNX-14 showed a proportional trend with BMI levels. Serum PNX-14 levels were correlated positively with serum LH, testosterone, and HOMA-IR.

Comparing levonorgestrel intrauterine system with hysteroscopic niche resection in women with postmenstrual spotting related to a niche in the uterine cesarean scar: a randomized, open-label, controlled trial

Postmenstrual spotting and chronic pelvic pain after cesarean delivery are associated with the presence of niches. Levonorgestrel intrauterine system (52 mg) and hysteroscopic niche resection have been shown to relieve niche-related symptoms at 6 months after the intervention. This trial aimed to compare the effectiveness of 52-mg levonorgestrel intrauterine system with that of hysteroscopic niche resection in reducing niche-related postmenstrual spotting. This randomized, open-label, controlled trial was conducted at a medical center in Shanghai, China. Women with symptoms of postmenstrual spotting after cesarean delivery, with a niche depth of at least 2 mm and residual myometrium of at least 2.2 mm on magnetic resonance imaging, and no intention to conceive within the next year were randomly assigned to receive treatment with 52-mg levonorgestrel intrauterine system or hysteroscopic niche resection. The primary outcome was the reduction in postmenstrual spotting at 6 months after randomization, defined as the percentage of women with a reduction of at least 50% in spotting days relative to baseline. Efficacy and safety were assessed using intention-to-treat analysis. Between September 2019 and January 2022, 208 women were randomized into the levonorgestrel intrauterine system group (N=104) or the hysteroscopic niche resection group (N=104). At the 6-month follow-up, a 50% reduction in spotting had occurred in 78.4% (80/102) of women in the levonorgestrel intrauterine system group and in 73.1% (76/104) of women in the hysteroscopic niche resection group (relative risk, 1.07 [95% confidence interval, 0.92-1.25]; P=.370). Spotting decreased over time (Ptrend=.001), with a stronger reduction observed in the levonorgestrel intrauterine system group (P=.001). There was also a significant interaction between time and treatment (P=.007). From 9 months onward, a more significant reduction in spotting was observed in the levonorgestrel intrauterine system group than in the hysteroscopic niche resection group (9 months, 89.2% vs 72.1%; relative risk, 1.24 [95% confidence interval, 1.08-1.42]; 12 months, 90.2% vs 70.2%; relative risk, 1.29 [95% confidence interval, 1.12-1.48]). Moreover, compared with the hysteroscopic niche resection group, the levonorgestrel intrauterine system group had significantly fewer postmenstrual spotting days and total bleeding days from 6 months onward (all P<.001), and less pelvic pain from 3 months onward (all P<.010). No intervention-related complications were reported in any group. During follow-up, 11 (10.8%) women reported hormone-related side effects, and 2 women (2.0%) in the levonorgestrel intrauterine system group had spontaneous partial expulsion. Meanwhile, 3 unintended pregnancies were reported in the hysteroscopic niche resection group. In women with niche-related postmenstrual spotting, the levonorgestrel intrauterine system was not more effective than hysteroscopic niche resection in reducing the number of spotting days by at least 50% at 6 months. However, the levonorgestrel intrauterine system was superior in reducing spotting from 9 months onward, and it reduced the absolute number of spotting days from 6 months onward and pelvic pain from 3 months onward.

Time course of ischemic and bleeding burden in consecutive patients undergoing transcatheter aortic valve replacement (FOCUS-ONE Registry)

Background and aimsIschemic or bleeding events might occur after transcatheter aortic valve replacement (TAVR), with the potential to hamper clinical outcomes. This study aimed to characterize the average daily ischemic risks (ADIRs) and the average daily bleeding risks (ADBRs) over 1-year in all consecutive patients undergoing TAVR. MethodsADBR included all bleeding events according to VARC-2 definition, and ADIR included cardiovascular deaths, myocardial infarction and ischemic stroke. ADIRs and ADBRs were assessed within different timeframes post TAVR: acute (0–30 days), late (31–180 days), and very late (>181 days). Generalized estimating equations were used to test the least squares mean differences for the pairwise comparison of ADIRs and ADBRs. Our analysis was performed in the overall cohort and according to antithrombotic strategy (LT-OAC vs No LT-OAC). ResultsIschemic burden was higher than bleeding burden, independently from the indication to LT-OAC, and in all timeframes examined. In the overall population, ADIRs were three-fold ADBRs (0.0467 [95% CI, 0.0431–0.0506] vs 0.0179 [95% CI, 0.0174–0.0185]; p < 0.001*). While ADIR was significantly higher in the acute phase, ADBR was relatively stable in all timeframes analysed. Of note, in LT-OAC population, OAC + SAPT group showed lower ischemic risk and higher bleeding events compared with OAC alone (ADIR: 0.0447 [95% CI: 0.0417–0.0477] vs 0.0642 [95% CI: 0.0557–0.0728]; p < 0.001*, ADBR 0.0395 [95% CI: 0.0381–0.0409] vs 0.0147 [95% CI: 0.0138–0.0156]; p < 0.001*). ConclusionsIn patients undergoing TAVR Average daily risk fluctuates over time. However, ADIRs overcome ADBRs in all timeframes, especially in the acute phase and regardless of antithrombotic strategy adopted.

Progestin intrauterine devices versus copper intrauterine devices for emergency contraception.

The copper intrauterine device (Cu-IUD) is a highly effective method of contraception that can also be used for emergency contraception (EC). It is the most effective form of EC, and is more effective than other existing oral regimens also used for EC. The Cu-IUD provides the unique benefit of providing ongoing contraception after it is inserted for EC; however, uptake of this intervention has been limited. Progestin IUDs are a popular method of long-acting, reversible contraception. If these devices were also found to be effective for EC, they would provide a critical additional option for women. These IUDs could not only provide EC and ongoing contraception, but additional non-contraceptive benefits, including a reduction in menstrual bleeding, cancer prevention, and pain management. To examine the safety and effectiveness of progestin-containing IUDs for emergency contraception, compared with copper-containing IUDs, or compared with dedicated oral hormonal methods. We considered all randomized controlled trials and non-randomized studies of interventions that compared outcomes for individuals seeking a levonorgestrel IUD (LNG-IUD) for EC to a Cu-IUD or dedicated oral EC method. We considered full-text studies, conference abstracts, and unpublished data. We considered studies irrespective of their publication status and language of publication. We included studies comparing progestin IUDs with copper-containing IUDs, or oral EC methods for emergency contraception. We systematically searched nine medical databases, two trials registries, and one gray literature site. We downloaded all titles and abstracts retrieved by electronic searching to a reference management database, and removed duplicates. Three review authors independently screened titles, abstracts, and full-text reports to determine studies eligible for inclusion. We followed standard Cochrane methodology to assess risk of bias, and analyze and interpret the data. We used GRADE methodology to assess the certainty of the evidence. We included only one relevant study (711 women); a randomized, controlled, non-inferiority trial comparing LNG-IUDs to Cu-IUDs for EC, with a one-month follow-up. With one study, the evidence was very uncertain for the difference in pregnancy rates, failed insertion rates, expulsion rates, removal rates and the difference in the acceptability of the IUDs. There was also uncertain evidence suggesting the Cu-IUD may slightly increase rates of cramping and the LNG-IUD may slightly increase bleeding and spotting days. AUTHORS' CONCLUSIONS: This review is limited in its ability to provide definitive evidence regarding the LNG-IUD's equivalence, superiority, or inferiority to the Cu-IUD for EC. Only one study was identified in the review, which had possible risks of bias related to randomization and rare outcomes. Additional studies are needed to provide definitive evidence related to the effectiveness of the LNG-IUD for EC.

Does Covid-19 vaccination affect menstruation pattern?

Background: As Millions of people are receiving COVID-19 vaccine around the world, a number of side effects are being reported. Menstrual cycle disturbance is also a side effect reported by hundreds of women on social media. The objective of this study was to assess the association of menstrual abnormalities with COVID-19 vaccination.&#x0D; Subjects and methods: This descriptive cross sectional study was conducted in Obstetrics and Gynecology OPD of Mufti Mehmood Hospital D.I. Khan from March 2021 to June 2021. The health care workers who received Sinopharm COVID-19 vaccine and consented were included. Data was collected about change in menstrual cycle pattern after COVID-19 vaccination.&#x0D; Results: A total of 80 subjects were included in the study with mean age of 32.6 +7.89 years. There were 36 (45.0%) doctors, 33 nurses (41.25%), 6 (7.5%) paramedics and 5 (6.25%) medical students. According to their marital status, 51 (63.75%) were married and 29 (36.25%) were unmarried. Out of 80 subjects, 16 (20%) reported disturbance in menstrual cycle pattern, 13 (81.2%) after first dose and 3 (18.75%) after both first and second dose. Among these 9 (56.25%) reported heavy menstrual bleeding, 4 (25%) had prolonged bleeding days while 3 (18.75%) had irregular bleeding pattern.&#x0D; Conclusion: Menstrual cycle disturbance is a reported side effect of COVID-19 vaccination. It is more commonly reported after first dose and heavy menstrual bleedings is the most common pattern followed by prolonged/irregular bleeding.

Predictive factors analysis of cesarean scar pregnancy treated by local injection of Lauromacrogol combined with curettage.

To explore factors related to local injection of Lauromacrogol combined with curettage in the treatment of cesarean scar pregnancy. A total of 24 successful and 8 unsuccessful cases were included. The age, gravidity, parity, times of cesarean section, interval from the last cesarean section, preoperative human chorionic gonadotropin (HCG), HCG on the first day after operation, decreasing rate of HCG on the first day after operation, average diameter of gestational sac, and preoperative vaginal bleeding days were analyzed. There were no significant differences of age, gravidity, parity, previous cesarean section times between groups. The differences of preoperative HCG, HCG on the first day after operation, the decreasing rate of HCG, gestational sac diameter, preoperative vaginal bleeding days were statistically significant between groups. The interval from the last cesarean section and the decreasing rate of HCG were protective factors, while the mean diameter of gestational sac and period of vaginal bleeding before operation were risk factors for the success of the treatment. The mean diameter of gestational sac owned the best predictive value.

Is Continued Perioperative Antithrombotic Therapy Safe When Performing Open Tracheostomy?

To date, there are no specific guidelines on antithrombotic therapy (ATT) management, which includes both anticoagulation and antiplatelet medications, for open tracheostomy. The objective of this study was to evaluate whether the use of perioperative antithrombotic medication during open tracheostomy influences the incidence of perioperative or postoperative complications. A retrospective review was conducted of all patients who underwent open tracheostomies at a tertiary care medical center from January 2015 to December 2019. Charts were reviewed for demographics, comorbidities, indication for tracheostomy, ATT use, operative details, and complications. A total of 217 tracheostomies were evaluated for this study, of which 148 (68.2%) were not on ATT and 69 (31.8%) were on ATT during surgery. No significant difference was observed based on ATT status in perioperative bleeding (P = .983), postoperative bleeding (P = .24), or median days to decannulation (P = .5986). ATT patients were 2.67 times more likely to experience 30-day mortality than those non-ATT patients (P = .035). There was only one death due to hemorrhage in the ATT group. This was unrelated to the tracheostomy. This compares to 2 hemorrhage-related deaths in those not on ATT. There was no significant difference in perioperative or postoperative bleeding based on ATT use. Patients on ATT were significantly more likely to experience 30-day mortality, however only one death was due to hemorrhage in the ATT group and was unrelated to tracheostomy. Therefore, continued perioperative ATT use appears to be safe when performing open tracheostomy. 4.

To Study the Efficacy and Safety of Diosmin with Tranexamic Acid and Mefenamic Acid Versus only Tranexamic Acid and Mefenamic Acid in Medical Management of Abnormal Uterine Bleeding: A Randomized Controlled Trial.

Abnormal uterine bleeding (AUB) is a common problem in reproductive age group and perimenopausal age group being responsible for many outpatient visits. Traditional management of AUB consists of giving mefenamic acid, tranexamic acid, or their combination with progestogens or hormonal intrauterine deviced levonorgestrel intrauterine system (LNG-IUS) for severe or nonresponsive cases. The objective of the current study was to study the efficacy and safety of adding diosmin along with tranexamic acid and mefenamic acid in reducing menstrual blood loss in AUB patients. It was a prospective double-blind randomized controlled trial in which 900 mg of diosmin was given once daily along with 500 mg tranexamic acid and 250 mg mefenamic acid during menstruation (Group I-92 patients), or only tranexamic acid and mefenamic acid during menstruation (Group II-92 patients). Mean age, parity, body mass index, and socioeconomic status were similar in the two groups. It was 35.68 years versus 36.78 years, 2.2 versus 2.3, 23.68 kg/m2 versus 24.62 kg/m2 respectively. Mean days of bleeding before this treatment were 6.8 versus 6.6 (P = 0.33) and were 3.5 versus 5.2 (P = 0.02) after treatment. There was a significant reduction in both groups as compared to before treatment (P = 0.021 in Group I, 0.027 in Group II) but the reduction was greater in Group I (P = 0.02). The amount of blood loss was 385 ml versus 390 ml (P = 0.7) before treatment which was significantly reduced in both groups to 68 ml versus 112 ml (P = 0.02 in Group I, 0.03 in Group II) with more decrease in Group I than in Group II (P = 0.01). Mean hemoglobin at beginning of the study was 8.4 versus 8.5 g/dl in Group I and Group II (P = 0.02) and significantly increased in both groups posttreatment to 10.9 and 9.8 g/dl in Group I and Group II (P = 0.012 in Group I, 0.011 in Group II) with increase being more in Group I than Group II (P = 0.03). Pictorial blood assessment chart score was 398 versus 406 (P = 0.35) before treatment and decreased significantly to 86.5 and 110.5 (P = 0.001 in Group I, 0.001 in Group II) with more decrease being in Group I than II (P = 0.01). There was significant decrease in dysmenorrhea with both treatments with no difference in the two groups. Various adverse effects such as nausea, vomiting, abdominal pain, diarrhea, constipation, and headache were equal in the two groups. Both the group's diosmin with tranexamic acid and mefenamic acid (Group I) and tranexamic acid and mefenamic acid (Group II) were efficacious in reducing menstrual blood loss, number of menstrual days and dysmenorrhea with effect being more by addition of diosmin. Adverse effects were equal in both the two groups.

COVID-19-associated mental health impact on menstruation physiology: A survey study among medical students in Jordan.

The coronavirus disease 2019 pandemic has been an extraordinarily stressful situation in recent years. Stress is a physiological reaction to negative stimuli that is regulated by different neuroendocrine pathways. The female reproductive function is maintained by the menstrual cycle, which is negatively affected by hyperstimulation of stress signals. This study evaluates the effect of the coronavirus disease 2019 outbreak on menstrual function and mental health, exploring the relationship between them. The current study uses a cross-sectional, survey-based design. During this cross-sectional study, an online self-completion questionnaire was conducted among a sample of 385 Jordanian female medical students during the pandemic. The survey compared menstrual characteristics, depression, anxiety, and stress 10 months after the coronavirus disease 2019 pandemic with 10 months prior. Paired t-test, McNemar's test, Pearson's correlation, and multiple linear regression model were employed to analyze data using SPSS software. The mean age of female medical student respondents was 19.89 years. Data showed that the menstrual cycle length significantly increased during the coronavirus disease 2019 pandemic compared with 10 months prior (32.23 days versus 30.02 days, p = 0.019). The average number of heavy bleeding days also increased during the coronavirus disease 2019 pandemic (2.82 days versus 2.42 days, p = 0.002). The proportion of females with heavy bleeding amount was more than doubled during the pandemic of coronavirus disease 2019 compared with before (27.3% versus 10.4%, p = 0.000). Unpleasant menstrual signs such as nausea and/or vomiting, breast pain, and urinary urgency were significantly increased during the pandemic (p = 0.000, p = 0.008, and p = 0.024, respectively). During coronavirus disease 2019, a positive association between total Depression, Anxiety, and Stress Scale-21 Questionnaire score and heavy bleeding was identified (p < 0.05). The findings also indicated that mental disorders and the incidence of amenorrhea, nausea and/or vomiting, and urinary urgency were positively correlated during the coronavirus disease 2019 pandemic. The multiple regression analysis revealed associations between several menstrual characteristics such as amenorrhea and severity of bleeding with coronavirus disease 2019-related depression, anxiety, and stress. This study revealed that the stress related to the pandemic of coronavirus disease 2019 could affect the female menstrual cycle and hence the quality of women's life. Therefore, this study could serve as a baseline for planning and introducing stress mitigation interventions in crisis situations to improve the physiological and mental well-being of females and improve their quality of life.

Role of Vitamin E in the Treatment of Primary Dysmenorrhea

Background: Primary dysmenorrhea is the common gynecologic problems, particularly among adolescent girls. The pain is severe during the first and/or second day of bleeding &amp; usually lasts up to 72 hours. More than 55 to 80% of post-menarche women are thought to experience primary dysmenorrhea. Both vitamin E and a placebo may lessen dysmenorrhea-related pelvic pain, although vitamin E appears to do more significantly Objective: To find the role of vitamin E in the treatment of Primary dysmenorrhea Methodology: This randomized placebo-controlled trial was conducted at JankiDevi Jamiat Singh Maternity Hospital Lahore and Sir Syed Hospital Karachi from 1stJune 2021 to 31stMay 2022. Sample size 70 with age 16-28 years with unmarried women; regular menstrual cycles; no urogenital disorders; no previous history of abdominal or pelvic surgery. To check severity of pain we used Visual Analog Scale (VAS) &amp; Cox Menstrual Symptom Scale (CMSS) was used for grading the pain duration. Pain duration was categorized as follows: score 1: ≤0-0.5 hours of pain; score 2: 0.5-1 hours of pain; score 3:&gt;1 hour of pain; score 4: &gt;1 day of pain. Two groups were formed from the sample. Vitamin E 400 units/day in two divided doses was prescribed for the first group to begin the treatment course (5 days in a month,), and Placebo was given to the second. Data was entered and analyzed in SPSS. Result: Total 70 were enrolled. There were 35 women given Vitamin E and 35 were given placebo. In Group 1, the mean age was 21.57+ 3.35 and in Group 2, the mean age was 22.0+3.05.Before treatment, the mean of VAS pain score was 49.29 in Vitamin E group ad placebo group was 58.71mm and after treatment, the mean of Vas pain score was reduce to 34.60 in vitamin E group and placebo group was 44.48. A significant difference was found the severity of pain and duration between the pre- and post treatment in both groups. Table: 2,3 As the comparison indicates, no significant differences were found regarding severity of pain and duration between the groups. ( p &lt; 0.05). This study will help the practioners,gynecologist for in the treatement of primary dysmenorrheal further this will also open the doors for further researches in this field. Conclusion: Vitamin E helps to relieve pain in primary dysmenorrhea. It can be considered as a universal medicine in the treatment of primary dysmenorrhea since it is a very simple way for pain control with fewer side effects and is cost-effective. Keywords: Dysmenorrhoea, Vitamin-E, nausea, vomiting, gastrointestinal symptoms

Effect of COVID-19 vaccine on menstrual experience among females in six Arab countries: A cross sectional study.

There have been varying reports on the potential occurrence and severity of changes to menstruation including the median cycle length, days of bleeding, bleeding heaviness, and menstrual pain, following receipt of COVID-19 vaccinations. We aimed to assess potential postvaccination menstrual changes in women residing in the Middle East. We implemented a cross-sectional online survey-based study. Data about the participants' demographic characteristics, menstruation experience, and vaccination status were collected and analyzed among six Arab countries. Among 4942 menstruating females included in this study, females who had received one or more doses of COVID-19 vaccination reported a higher frequency of back pain, nausea, tiredness, pelvic pain with periods, unprescribed analgesics use, and passage of loose stools. They also reported higher scores describing average and worst menstrual pain. Fully vaccinated females reported heavier flow and more days of bleeding. Our findings indicate that COVID-19 vaccine may have an effect on menstruation in terms of menstrual pain and bleeding heaviness. The evidence needs to be further investigated in longitudinal studies.

Effects of Covid Vaccination on Menstrual Cycle: A Novel Study

COVID-19 vaccination is widely regarded as safe. Still, the immune response or the associated stress may link the vaccine with certain temporary menstrual changes. A Total of 100 women met the inclusion criteria. 23 experienced irregular bleeding following the vaccine. The most predominant menstrual changes were more menstrual bleeding (43%), more menstrual pain (41%), delayed menstruation (38%), fewer days of menstrual bleeding (34.5%), and shorter cycle length (32%). Menstrual cycle change following COVID-19 vaccination appears small and temporary and should not discourage individuals from becoming vaccinated. Keywords: Covid vaccination, Menstrual cycle, Abnormal uterine bleeding

Predicting serum hormone concentration by estimation of urinary hormones through a home-use device.

Can a home-use device be used to predict serum hormone levels? A home-use device can predict urinary hormone values which are well-correlated to serum concentrations of respective hormones and hence can be used as a proxy for serum measurements. Home-use devices that predict ovulation are calibrated against the actual day of ovulation. However, the correlation of any quantitative system to serum hormone concentrations has not been established. A total of 73 data points obtained from 20 participants across different phases of the menstrual cycle, i.e. bleeding days, follicular phase and luteal phase were used to establish the correlation between serum hormones and urinary metabolite values. Single data points from 20 random users were used to assess the correlation established. Participants were women in the fertile age groups and only current users of the home-use device. Selection was done based on inclusion and exclusion criteria. Blood hormones were tested using chemiluminescent immunoassays and urinary measurements were taken on the home-use device at home. Serum estradiol (E2), progesterone (P4) and LH were correlated with urinary estrone-3-glucuronide (E3G), pregnanediol glucuronide (PdG) and LH with an R 2 of 0.96, 0.95 and 0.98, respectively. Repredicted serum concentration obtained by using the correlation equation had a correlation of 0.92, 0.94 and 0.93 in unknown samples. The study was designed to include women who have normal cycle lengths regularly; therefore, the values obtained were in the normal range. Certain infertility conditions may cause the values to be higher and correlation in such cases needs to be established. The results of this study imply a new tool that can be used by fertility specialists as a proxy for blood tests whenever required. Extended study on this system can enable its use in assisted reproductive techniques as well. No funding was received for this study. S.P. and D.D. are employees of the research and development division of Samplytics Technologies Pvt. Ltd. which is a forwarder for Inito Inc., USA. A.R. and V.A.V. are co-founders of Inito Inc., USA. The trial was registered at the International Standard Randomised Controlled Trial Number (ISRCTN) registry (Identifier: ISRCTN15534557).