Higher Expulsion Rate Research Articles

Correlation between Expulsion of Distal Ureteric Calculus with CRP Level, WBC Count and Neutrophil Percentage among the Patients attending on Manipal Teaching Hospital, Pokhara (Retrospective Study)

Introduction: Urolithiasis is a common medical diagnosis that doctor encounters in the outpatients and emergency departments. The prevalence of renal stone disease has increased steadily over the past decades. There are different modalities of treatment of ureteric calculus. However, most of the distal ureteric calculus passes spontaneously thus the application of invasive procedure at the early stage can be considered overtreatment.Methods: The 68 patients of the surgical department, Manipal teaching hospital, Pokhara, with distal ureteric calculus of ≤ 8mm, who were under the treatment Tamsulosin Hydrochloride 0.4mg once daily for 2 weeks or till the expulsion of stone from 1st October 2017 to 30th September 2018 (one year period) were retrospectively evaluated for the spontaneous stone expulsion rate and its association with serum CRP level, WBC count and Neutrophil percentage. The patients were divided into 2 groups i.e. spontaneously ureteric stone expelled group and non expelled group. Furthermore, for statistical analysis, each group were subdivided according to normal and elevated serum CRP level, white blood cell count and neutrophil percentage. The associations between these factors and ureteral stone passage were then examined.Results: Most of the cases were in the age group of 21-40 years with the mean age of 40.09 ± 16.11, where 57.4% of patients were male. Among all mean duration of symptoms was 6 days. The ratio of left to right stone was 1.26:1. Out of 68 patients, 80.9% of the patient’s distal ureteric stone was passed out spontaneously with medical expulsion therapy. There were statistically significant (p<0.001) association between normal serum CRP level, White cell counts and neutrophil percentage with the expulsion of distal ureteric calculus with size ≤ 8mm.Conclusion: There is a higher expulsion rate of distal ureteric calculus of size ≤ 8mm with the patient of the normal level of serum CRP level, White cell counts and neutrophil percentage than that of abnormal level.

Geochemical studies on high-efficiency hydrocarbon expulsion of Triassic lacustrine shale in the Ordos Basin, China: implications for tight and shale oil accumulation

The organic-rich sediments developed at the bottom of Chang7 Member of the Upper Triassic Yanchang formation, which can be divided into oil shale and black mudstones, are dominate source rocks for low permeability and tight oil reservoirs in Mesozoic petroleum system of Ordos Basin. The hydrocarbon expulsion characteristics of the organic-rich sediments have been investigated by geology and geochemistry data. By comparison with the geochemical parameters of crude oil samples and mudstone extracts, Chang7 shale has many geochemical evidences on high rates of hydrocarbon expulsion. Lower conversion rate of chloroform extracted bitumen “A”, especially for the samples with TOC higher than 10%; lower productivity indexes and lower hydrogen indexes reducing with TOC increasing; lower ratios of saturates/aromatics but higher contents of polar components for residual bitumen “A”; heavier stable carbon isotopes of residual hydrocarbons. It should be noted that the source rock evaluation and oil-source correlation would be misunderstood based on these abnormal geochemical data caused by high-efficiency hydrocarbon expulsion. Calculation for rock samples have shown that the expelled rates of the shale samples averaging 70% are significantly higher than those of the mudstone samples. Chang 7 shale with large amounts of hydrocarbons generated and expelled is critical for hydrocarbon accumulation in low-permeability and tight oil reservoirs. Also, Chang7 organic-rich rocks is an important exploration field of shale oil in the future.

P49 First year expulsion rates and timing in obese and non-obese women after levonorgestrel 52 mg IUS placement

Objectives: Because obese women have higher expulsion rates than non-obese women with intrauterine contraceptive use, we investigated expulsion timing and rates in obese and non-obese women during the first year after levonorgestrel 52 mg intrauterine system (IUS) placement.

Postplacental placement of intrauterine devices: A randomized clinical trial

ObjectiveTo compare the expulsion rate of the TCu380A intrauterine device (IUD) or levonorgestrel (LNG) 52 mg intrauterine system (IUS) up to 90 days after postplacental placement (10 min after delivery of the placenta). Study designRandomized trial (1:1) of women aged 18–43 years and ≥37 weeks pregnant enrolled during early or prodromal labor at the University of Campinas, Brazil. Follow-up was scheduled at 42 and 90 days after device placement. We confirmed the IUD or IUS location using ultrasonography. Multivariate logistic regression was used to assess variables associated with expulsion. ResultsWe enrolled 140 women, and assigned 70 to the TCu380A IUD and 70 to the IUS groups. By the 90-day follow-up visit, 22/60 women (36.7%) in the TCu380A IUD group had expelled the device, as had 12/60 women in the IUS group (20%). Thirty-three of the 34 expulsions had occurred by the 42-day visit. Multivariate analysis demonstrated that the expulsion odds ratio ([OR]; 95% confidence interval [CI]) was higher after vaginal delivery than after Cesarean delivery (OR 5.60; 95% CI 2.08–15.10; P < 0.00) and higher among women with one (OR 4.38; 95% CI 1.33–14.43; P 0.00) or three or more deliveries (including the present one) (OR 6.08; 95% CI 1.78–20.77; P 0.00) than those with two deliveries. ConclusionsPostplacental TCu380A IUD placement had a higher expulsion rate than the IUS, and the expulsion rate was higher among women who had a vaginal delivery than those who had a Cesarean delivery. Most of the expulsions occurred within 42 days. ImplicationsPolicy makers should increase the availability of both the TCu380A and the LNG intrauterine devices for the immediate postpartum period, even though the expulsion rate is higher than that after interval placement.

Provision of immediate postpartum intrauterine contraception after vaginal birth within a public maternity setting: Health services research evaluation.

IntroductionExpanding access to postpartum intrauterine contraception (PPIUC) can reduce unintended pregnancies and short inter‐pregnancy intervals; however, provision across Europe is limited. Our aim was to determine the feasibility, clinical outcomes and patient satisfaction of providing immediate PPIUC after vaginal birth using a health services research model.Material and methodsPhased introduction of PPIUC across two Lothian maternity hospitals; all women intending vaginal birth during the study period without a contraindication to use of the method were eligible to receive PPIUC. Midwives and obstetric doctors were trained in vaginal PPIUC insertion using Kelly forceps. Women received information antenatally and had PPIUC insertion of either a levonorgestrel intrauterine system or a copper intrauterine device within 48 hours of vaginal birth. Follow‐up was conducted in‐person at 6 weeks postpartum and by telephone at 3, 6 and 12 months. Primary outcomes were: uptake, complications (infection, uterine perforation), expulsion and patient satisfaction at 6 weeks; and method of continuation up to 12 months. Secondary outcomes included hazard ratio for expulsion adjusted for demographic and insertion‐related variables.ResultsUptake of PPIUC was 4.6% of all vaginal births; 465/447 (96.1%) of those requesting PPIUC successfully received it and most chose a levonorgestrel intrauterine system (73%). At 6 weeks postpartum, the infection rate was 0.8%, there were no perforations and 98.3% of women said they would recommend the service. The complete expulsion rate was 29.8% (n = 113) and most had symptoms (n = 79). Of the additional 121 devices removed, 118 were because of partial expulsion. The rate of complete/partial expulsion was higher for insertions by midwives compared with those by doctors. The re‐insertion rate after expulsion/removal was 87.6% and method continuation at 12 months was 79.6%.ConclusionsRoutine PPIUC at vaginal birth is feasible. Complications were extremely rare. High expulsion rates may be observed in early stages of service introduction and with inexperienced providers. Re‐insertion and therefore longer‐term continuation rates of intrauterine contraception were very high. In settings with low rates of attendance for interval postpartum intrauterine contraception insertion, PPIUC could be a useful intervention to prevent unintended and closely spaced pregnancies.

Serum C - Reactive Protein, White Cell Counts and Neutrophil Percentage are Predictors For Distal Ureteric Calculus Expulsion Rate: A Prospective Study

Background: To determine the relationship between expulsion rate of distal ureteric calculus less than orequal to 10mm in size and C reactive protein (CRP) level, white cell count and neutrophil percentage.&#x0D; Materials and Methods: A total of 186 patients with distal ureteric calculus of ≤10mm were evaluated for stone expulsion rate and its correlation with serum CRP, white cell count and neutrophil percentage. All patients received tablet Tamsulosin 0.4mg for 4 weeks or till the expulsion of stone. Patients were called weekly till 4 weeks, or early if there was history of stone expulsion. Patients were divided in two groups according to normal and elevated CRP levels, white cell count and neutrophil percent age at baseline for statistical analysis.&#x0D; Results: The patients had an average age of 35.6 } 13.9 years. 52.2% were male. Ratio of right to left was1.58:1. Majority of the patients with distal ureteric calculus ≤ 10mm passed their stone (74.7 %) with medical expulsion therapy. Expulsion of stone less than 5mm was statistically significant (p0.017). Patients with normal neutrophil percentage and normal CRP level had higher stone expulsion rate than elevated neutrophil or CRP (85.2% vs. 40.9, 91.8% vs. 30.8% respectively).In patients with normal white cell count, 86.4% passed their stone while in elevated white cellcount group 39.1% passed their stone.&#x0D; Conclusion: This study showed patients with distal ureteric calculus of ≤10mmwith normal CRP level and normal neutrophil count had higher expulsion rate while WBC count showed no statistically significant association.

A comparative study for the effectiveness of Tamsulosin alone versus Tamsulosin plus Tadalafil combination as an expulsive medical treatment in the management of lower ureteric calculous in Al-Diwaniyah teaching hospital

To evaluate the efficacy &amp; safety of tamsulosin alone versus tamsulosin plus tadalafil combination as expulsive medical treatment of distal ureteric calculus. From March 2015 utile March 2017, two hundred patients (one hundred thirty males and seventy females), who attended the outpatient urology clinic and presented with stones size 5 to 10 mm in distal ureteric part, have been randomly allocated into two equal treatment groups. Group A treated with tamsulosin alone, and group B treated with tamsulosin plus tadalafil. Both treatments were given for a maximum of six weeks’ duration. The rate and time to the calculous passage, type of analgesic use, adverse effects of the drugs, number of outpatient urology clinic visits for pain, and follow-up were noted. Both treatment groups have higher expulsion rate with a lower time to expulsion with no statistically significant differences between them (p=0.350, p=0.074, respectively). Group B showed a significantly lower rate in admission to the hospital for pain and need for analgesia than in group A. no dangerous adverse events had been observing in both groups. Additional benefit seen in group B was the improvement in erectile function regarding male patients. Using tamsulosin and tadalafil as an expulsive medical treatment for distal ureteric calculous is safe and efficacious. Such combination therapy may provide additional advantages in cases of erectile dysfunction co-exist with distal ureteric calculi.

Efficacy and safety of PDE5-Is and \u03b1-1 blockers for treating lower ureteric stones or LUTS: a meta-analysis of RCTs

BackgroundLower ureteric stones and lower urinary tract symptoms are common in urology.Drug treatment is one of standard therapy,but the efficacy was controversial.Thus we aimed to investigate the efficacy and safety of monotherapy or combination therapy of adrenoceptor1 blockers and phosphodiesterase5 inhibitors for treatment.MethodsRandomized controlled trials up to November 2016 were retrieved from PubMed, the Cochrane Library, Web of Science and Embase. A total of 17 studies were included. We analyzed data through random or fixed effect models. The heterogeneity between studies was assessed by the I2 test statistic.ResultsAs for lower ureter stones, our analysis demonstrated tadalafil had a significantly lower incidence of abnormal ejaculation than adrenoceptor1 blockers (2.31 95%CI 0.22to0.84, P = 0.01),while combination therapy had a higher expulsion rate (2.49 95%CI 1.44to4.29, P = 0.001) and shorter expulsion time (− 1.98 95%CI -3.08to0.88, P = 0.0004) than tamsulosin. As for lower urinary tract symptoms, our analysis indicated adrenoceptor1 blockers was more effective than phosphodiesterase5 inhibitors on decreasing International Prostate Symptom Score (1.96 95%CI 0.03to3.89, P = 0.05) and Post-Void Residual (9.41 95%CI 1.40to14.41, P = 0.02) and phosphodiesterase5 inhibitors showed a greater effect than adrenoceptor1 blockers on improving Erectile Dysfunction (2.23 95%CI 1.24to3.22, P<0.0001).Combination therapy had a significantly better effect on International Prostate Symptom Score (1.47 95%CI 1.25to1.69, P<0.0001), Maximum flow rate (0.87 95%CI 0.71to1.04, P<0.0001), Post-Void Residual (10.74 95%CI 3.53to17.96,P = 0.004) and Quality of life (0.59 95%CI 0.22to0.97, P = 0.002) but was associated with higher incidences of adverse events (3.40 95%CI 1.82to6.36, P = 0.0001) than adrenoceptor1 blockers. Combination therapy had a significantly better effect on International Prostate Symptom Score (4.19 95%CI 3.34to5.04, P<0.0001), Maximum flow rate (1.86 95%CI 1.32to2.39, P<0.0001), Post-Void Residual (22.58 95%CI 9.13to36.04, P = 0.001) and Quality of life (0.68 95%CI 0.37to1.00, P<0.0001) without higher incidences of adverse events than PDE5-Is.ConclusionsIn conclusion, this meta-analysis suggested combination therapy had a best efficacy of therapy for lower ureteric stones or lower urinary tract symptoms correlated with benign prostatic hyperplasia than monotherapy. Adrenoceptor1 blockers was more effective than phosphodiesterase5 inhibitors on International Prostate Symptom Score and Post-Void Residual. Both monotherapy and combination therapy were safe.

The Safety, Acceptability and Continuation Rate of Immediate Versus Delayed Insertion of Levonorgestrel Releasing Intrauterine System Following First Trimester Surgical Abortion: An Observational Study

Objective: To assess the safety, acceptability and six-month continuation rate of immediate versus delayed insertion of the levonorgestrel releasing intrauterine system (LNG-IUS) following surgical termination of first trimester pregnancy. Methods: This prospective observational study was conducted on 180 patients who underwent surgical abortion and opted for LNGIUS and divided into two groups; immediate group=86 and delayed group=94. Pain scores, adverse effects, acceptability and continuation rate were recorded. Results: More patients in the delayed insertion group exhibited higher perception of pain (p&lt; 0.001) and requested additional analgesia upon LNG-IUS insertion (p&lt; 0.05) with no significant difference between the two groups regarding other adverse effects (fainting, abnormal vaginal bleeding, expulsion and pelvic infection), request for removal and re-insertion of LNG-IUS (p&gt;0.05). The continuation rate and patient acceptability in terms of overall satisfaction and recommendation to other women, were comparable between the two groups (p&gt;0.05) while overall discomfort was higher in the delayed group at one, three and six months after insertion (p&lt; 0.05) Conclusion: Although immediate insertion of LNG-IUS after first trimester surgical abortion has higher expulsion rate, yet it has lower pain intensity, request for additional analgesia and overall discomfort compared to delayed insertion of LNG-IUS with comparable continuation and acceptability rates at 6 months after insertion. Keywords: levonorgestrel releasing intrauterine system; abortion; post abortive contraception

Immediate postpartum levonorgestrel intrauterine device insertion and breast-feeding outcomes: a noninferiority randomized controlled trial

Immediate postpartum levonorgestrel intrauterine device insertion is increasing in frequency in the United States, but few studies have investigated the effect of early placement on breast-feeding outcomes. This study examined the effect of immediate vs delayed postpartum levonorgestrel intrauterine device insertion on breast-feeding outcomes. We conducted this noninferiority randomized controlled trial at the University of Utah and the University of New Mexico Health Sciences Centers from February 2014 through March 2016. Eligible women were pregnant and planned to breast-feed, spoke English or Spanish, were aged 18-40 years, and desired a levonorgestrel intrauterine device. Enrolled women were randomized 1:1 to immediate postpartum insertion or delayed insertion at 4-12 weeks' postpartum. Prespecified exclusion criteria included delivery <37.0 weeks' gestational age, chorioamnionitis, postpartum hemorrhage, contraindications to levonorgestrel intrauterine device insertion, and medical complications of pregnancy that could affect breast-feeding. We conducted per-protocol analysis as the primary approach, as it is considered the standard for noninferiority studies; we also report the alternative intent-to-treat analysis. We powered the study for the primary outcome, breast-feeding continuation at 8 weeks, to detect a 15% noninferiority margin between groups, requiring 132 participants in each arm. The secondary study outcome, time to lactogenesis, used a validated measure, and was analyzed by survival analysis and log rank test. We followed up participants for ongoing data collection for 6 months. Only the data analysis team was blinded to the intervention. We met the enrollment target with 319 participants, but lost 34 prior to randomization and excluded an additional 26 for medical complications prior to delivery. The final analytic sample included 132 in the immediate group and 127 in the delayed group. Report of any breast-feeding at 8 weeks in the immediate group (79%; 95% confidence interval, 70-86%) was noninferior to that of the delayed group (84%; 95% confidence interval, 76-91%). The 5% difference in breast-feeding continuation at 8 weeks between the groups fell within the noninferiority margin (95% confidence interval, -5.6 to 15%). Time to lactogenesis (mean ± SD) in the immediate group, 65.3 ± 25.7 hours, was noninferior to that of the delayed group, 63.6 ± 21.6 hours. The mean difference between groups was 1.7 hours (95% confidence interval, -4.8 to 8.2 hours), noninferior by log-rank test. A total of 24 intrauterine device expulsions occurred in the immediate group compared to 2 in the delayed group (19% vs 2%, P < .001), consistent with the known higher expulsion rate with immediate vs delayed postpartum intrauterine device insertion. No intrauterine device perforations occurred in either group. Our results of noninferior breast-feeding outcomes between women with immediate and delayed postpartum levonorgestrel intrauterine device insertion suggest that immediate postpartum intrauterine device insertion is an acceptable option for women planning to breast-feed and use the levonorgestrel intrauterine device. Expulsion rates are higher with immediate postpartum levonorgestrel intrauterine device insertion compared to delayed insertion, but this disadvantage may be outweighed by the advantages of immediate initiation of contraception. Providers should offer immediate postpartum intrauterine device insertion to breast-feeding women planning to use the levonorgestrel intrauterine device.

Postplacental intrauterine device expulsion by 12 weeks: a prospective cohort study

An intrauterine device placed immediately following a delivery can serve as an effective and safe contraceptive strategy in the postpartum period. There is limited evidence that the levonorgestrel intrauterine system may have a higher rate of expulsion compared to the copper intrauterine device; however, rates of expulsion for these 2 intrauterine device types have not been compared directly. We sought to compare expulsion rates by 12 weeks' postpartum for the levonorgestrel intrauterine system and copper intrauterine device. We enrolled women who received postplacental intrauterine devices at 2 urban hospitals. Eligible women were ≥18 years old, English- or Spanish-speaking, with singleton vaginal delivery at ≥35 weeks' gestation. Intrauterine devices were inserted within 10 minutes of placental delivery by trained providers using ring forceps or the operator's hand. Intrauterine device location was evaluated via abdominal ultrasound at 24-48 hours' postpartum, and via transvaginal ultrasound 6 and 12 weeks later, categorizing position of the intrauterine device at the fundus, below the fundus but above the internal os, any part of the intrauterine device below the internal os (partial expulsion), or no intrauterine device visualized. Outcomes included intrauterine device expulsion and method continuation. We used multivariable logistic regression to identify factors associated with expulsion. We enrolled 123 women ages 18-40 years. Of these, 68 (55%) initiated levonorgestrel intrauterine system and 55 (45%) initiated copper intrauterine device. Groups were similar except more copper intrauterine device users were Hispanic (66% vs 38%) and fewer were primiparous (16% vs 31%). Among the 96 (78%) with 12-week follow-up, expulsion was higher for levonorgestrel intrauterine system users (21/55 or 38%) than for copper intrauterine device users (8/41 or 20%) (odds ratio, 2.55; 95% confidence interval, 0.99-6.55; P= .05). At 24 hours' postpartum, there was no significant difference in median distance from the intrauterine device to the fundus between intrauterine device types or between those who did or did not experience expulsion. Of expulsions, 86% occurred ≤6 weeks' postpartum. All complete expulsions were clinically identified, but of the partial expulsions, only 4/10 (40%) were clinically suspected prior to ultrasound. The only independent predictor of expulsion was intrauterine device type. Including reinsertions, intrauterine device use at 12 weeks was not significantly different for levonorgestrel intrauterine system and copper intrauterine device users (80% vs 93%; P= .14). Women initiating postplacental levonorgestrel intrauterine system are more likely to experience complete expulsion than those initiating copper intrauterine device. Using sonographic criteria results in higher expulsion rates than previously reported. It is unclear if such high expulsion rates would be identified following standard clinical practice.

Immediate postpartum intrauterine device and implant program outcomes: a prospective analysis

In-hospital placement of intrauterine devices and contraceptive implants following vaginal and cesarean delivery is increasingly popular and responds to maternal motivation for highly effective postpartum contraception. Immediate postpartum intrauterine device insertion is associated with higher expulsion than interval placement, but emerging evidence suggests that the levonorgestrel intrauterine device may have a higher expulsion rate than the copper intrauterine device. This study evaluated in-hospital provision, expulsion, and 6-month continuation of immediate postpartum copper T380 intrauterine devices, levonorgestrel intrauterine devices, and contraceptive implants. We offered enrollment in this prospective observational trial to women presenting to the University of Utah labor and delivery unit from October 2013 through February 2016 who requested an intrauterine device or implant for postpartum contraception during prenatal care or hospitalization at the time of delivery. Following informed consent, participants completed questionnaires prior to hospital discharge and at 3 and 6 months postpartum. Data on expulsions at 6 months were validated by chart abstraction. During the study period, 639 patients requested a postpartum intrauterine device or implant and 350 patients enrolled in prospective follow-up prior to discharge from the hospital. Among enrollees, 325 (93%) received their preferred contraceptive device prior to hospital discharge: 88 (27%) copper intrauterine device users, 123 (38%) levonorgestrel intrauterine device users, and 114 (35%) implant users. Participants predominantly were Hispanic (90%), were multiparous (87%), reported a household income <$24,000 per year (87%), and underwent a vaginal delivery (77%). At 6 months postpartum, 289 of 325 device recipients (89%) completed follow-up. Among levonorgestrel intrauterine device users 17% reported expulsions relative to 4% of copper intrauterine device users. The adjusted hazard ratio for expulsion was 5.8 (confidence interval, 1.3-26.4). There was no statistically significant difference in expulsions by delivery type or continuation by device type. Among the 21 women who experienced intrauterine device expulsions, 14 (67%) requested a replacement long-acting reversible contraception device for contraception. The 6-month device continuation was ≥80% for all device types. An immediate postpartum long-acting reversible contraception program effectively provides women who desire highly effective reversible contraceptive devices with their method of choice prior to hospital discharge. Immediate postplacental levonorgestrel intrauterine device users have higher expulsion rates than copper intrauterine device users, but >8 of 10 women initiating an intrauterine device or implant continue use at 6 months postpartum.

Intra-cesarean insertion and fixation of frameless intrauterine devices

Various contraceptive methods are available to postpartum women including hormonal and nonhormonal barriers, as well as injectable forms. Of all the available birth control methods, intrauterine devices (IUD) are felt by many to be the near-ideal form of contraception, and are recommended by advocacy groups, physicians, and gynecological organizations worldwide. Immediate postpartum IUD insertion deserves greater attention because it can provide immediate contraception, prevents repeat unintended pregnancies, and may serve to reduce the incidence or need for secondary cesarean delivery; however, insertion of conventional T-shape IUDs immediately post placenta delivery is limited by their high expulsion and displacement rates. Anchoring of frameless-design IUDs that lack conventional cross-arms to the uterine fundal surfaces has been medically and commercially available throughout Europe for many years. The placement technique is simple, has minimal patient discomfort, and high long-term patient acceptance due to its high degree of uterine compatibility as a consequence of its small size and segmented design. Frameless-design IUD implantation appears to represent a major advance, suitable for general use, due to its lack of timing restraints and its simplicity of attachment, which only requires limited training.

One State’s Systems Change Efforts to Reduce Child Care Expulsion

This article describes the efforts funded by the state of Colorado to address unacceptably high rates of expulsion from child care. Based on the results of a 2006 survey, the state of Colorado launched two complementary policy initiatives in 2009 to impact expulsion rates and to improve the use of evidence-based practices related to challenging behavior. The primary policy initiative involved the funding of a center to develop model sites, a state-level planning team, ongoing practitioner training, and certification of coaches and trainers all built around the Pyramid Model. The secondary initiative involved expanding the number of early childhood mental health consultants and modifying their reimbursement/payment formula such that direct preventative work with adult providers, consistent with the Pyramid Model, was reimbursable. A follow-up survey in 2011 showed a dramatic reduction in expulsion rates and a corollary increase in providers’ teaching of prosocial skills to children with challenging behavior.

Patient Uptake and Outcomes

INTRODUCTION: In-hospital placement of long-acting reversible contraception (LARC) is increasingly popular after vaginal and cesarean delivery and responds to maternal motivation for highly effective postpartum contraception. The present study assessed in-hospital provision and expulsion of immediate postpartum copper T380 IUD (Cu IUD), levonorgestrel (LNG) IUDs, and contraceptive implants. METHODS: Women presenting to the University of Utah Labor and Delivery Unit between October 2013 and March 2015 who requested an IUD or implant were offered enrollment in this prospective observational trial. Eligible patients received devices through the Ryan Residency Training LARC program. Data on expulsions and discontinuations at 3 months was obtained via patient report and supplemented with chart abstraction. Predictors of IUD expulsion were assessed. RESULTS: During the study period, 404 patients requested a postpartum IUD or implant during prenatal care and 358 devices were placed (88% uptake) prior to discharge from the hospital. A total of 246 women enrolled in the prospective observational outcome study: 73 (30%) Cu IUD users, 93 (38%) LNG IUD users, and 80 (33%) implant users. To date, 85% (n=209) have reached 3 months postpartum and 89% (n=185) have completed follow-up. Three months postpartum, 15/67 (22%) of the LNG IUD users and 3/60 (5%) of the Cu IUD users had an expulsion (P<.01). Among LNG IUD users, primiparity and vaginal delivery were predictors of expulsion (P<.05). CONCLUSION: Immediate postpartum LNG IUD users have higher expulsion rates than Cu IUD users. LNG IUD expulsion rates are highest for primiparous women having a vaginal delivery.

Multi-layered Migration Deterrence and Technology in Spanish Maritime Border Management

ABSTRACTUntil 2006 Spain witnessed growing irregular maritime immigration from the African continent. This intensification in irregular migration has led to the design and application of a migration control policy whose instrumental and institutional structures are becoming increasingly complex. Irregular immigration at maritime borders has been addressed through what we have referred to and characterized as a multi-layered deterrence strategy which has been gradually implemented and upgraded along the main entry points and migration corridors. The Spanish strategy is tightly intertwined with the unfolding of the EU Integrated Border Management approach and combines higher inputs of surveillance and border control technologies with multilateral cooperation agreements reached with transit and origin countries. High-tech border surveillance increases interception probabilities, but effective migration deterrence is conditioned by high expulsion rates once the border has been crossed. It is in the task of border implementation that technology appears as one of the pillars of the control structure and where its effect on deterrence depends on its embeddedness in a mix of instruments and actions.

Are IUDs an effective and safe form of birth control for teen patients?

Evidence-based answer Yes. Contraceptive failure rates are similar among those who use intrauterine devices (IUDs), implants, or depot medroxyprogesterone acetate (DMPA) injections, while pill, patch, or ring (PPR) methods have higher failure rates (SOR: B, cohort study). When compared with oral contraceptives, IUDs in adolescents have similar or better continuation rates (SOR: B, systematic review of cohort studies). Adolescents receiving IUDs have similar risk of infection but higher expulsion rates than women receiving IUDs who are 18 to 21 years old (SOR: B, retrospective cohort study).

Medical expulsion therapy for ureteric calculus - possible!

Background: Objective of the study was to compare the efficacy of combination of Tamsulosin and Deflazacort with that of analgesics alone, in medical expulsive therapy (MET) of solitary ureteric calculus ≤1 cm.Methods: A prospective randomized study was conducted in 100 patients of Chennai medical college hospital &amp; Research centre from General Surgery and Urology Out-Patient Department (OPD). Patients with symptomatic, solitary ureteric calculus ≤10mm were included. Patients with solitary functioning kidney, history of prior urinary surgery or endoscopic treatment, any associated complication or any contraindications of steroid usage were excluded. Patients were divided into two groups: Group I received Diclofenac 50mg on demand and Group II received Tamsulosin with Deflazacort (0.4mg+30mg respectively) along with analgesic for a maximum of 2weeks.Results: Calculus expulsion was significantly higher in Group II (84%) compared to that in Group I (60%) (p=0.008). Higher expulsion rate in Group II was primarily seen in the patients with a calculus size of ≥5 mm. There was no difference in stone expulsion rates in patients with stones less than 5mm. 19 patients in group II were free of pain compared to 7 patients in group I (p= 0.006). Group II patients had significant reduction in expulsion time and analgesic requirement.Conclusions: MET with alpha blocker and steroid combination is effective, safe and economical treatment for symptomatic urolithiasis and scores over treatment with analgesics, alone. This combination can be used as initial therapy for stone expulsion and symptomatic relief, thereby avoiding or delaying surgical intervention in selected patients.

Discontinuation rates and acceptability during 1 year of using the intrauterine ball (the SCu380A)

ObjectiveTo characterize method-related discontinuation rates and acceptability over 1year of SCu380A use. Study designWomen enrolled into this prospective pilot study underwent SCu380A placement by a single clinician with follow-up at 6–8weeks and at 3, 6, 9 and 12months. Outcome measures included reasons for discontinuation and satisfaction. ResultsFifty-one women had a 12-mm-diameter intrauterine ball (IUB; SCu380A) inserted by a single clinician (EW). Postinsertion ultrasonography showed all the devices to be correctly placed. By 8weeks, there were 9 expulsions and 2 removals for symptoms. By 12months, there were 14 expulsions (27%), 8 removals for symptoms (16%), 1 pregnancy and 7 lost to follow-up. Of the remaining 21 women, 15 said that they were satisfied. ConclusionThe high rate of expulsions and removals for symptoms in the first year indicates that this device, as presently designed, is unacceptable as an alternative to the currently available copper intrauterine devices. ImplicationsMore research is needed before we know if it is the spherical design, the size of the device or some other factor that led to the high expulsion rate. There are currently three different IUBs (12, 15 and 18mm) approved and being investigated.

Tamsulosin versus nifedipine for the management of lower ureteral stones: a meta-analysis

Objective To compare the efficacy and safety of tamsulosin with nifedipine for medical expulsive therapy (MET) in patients with lower ureteral stones (LUS). Methods Randomized controlled trials(RCTs)in comparison of tamsulosin and nifedipine in treatment of LUS published in Pubmed, Cochrane Library, Embase, CNKI, CBM, Wanfang and VIP from databases establishment to July 2015 were retrieved. According to Cochrane handbook, the quality of included RCTs were assessed, and the relevant data including the number of participants, stone size, stone expulsion rate, time to stone expulsion, drug-related side effect, the incidence of ESWL or ureteroscopy lithotripsy (URSL) after MET and analgesic dose were extracted by two reviewers independently. The statistical software RevMan 5.2 was used for meta-analysis with regard to the stone expulsion rate, the incidence of ESWL or URSL and adverse effects. This study lasted more than one month from June to July 2015. Results A total of 13 RCTs with 4 831 patients were eligible. The results showed that the stone expulsion rate and the incidence rate of ESWL or URSL after MET were 92%(2 221/2 423) and 8%(27/333) in the tamsulosin group, and 73%(1 748/2 408) and 20%(67/328) in the nifedipine group. There are statistically significant differences(RR=1.24, 95% CI 1.13-1.37, P<0.05; RR=0.40, 95% CI 0.27-0.60, P<0.05, respectively). The subgroup analysis indicated no statistically significant differences in drug-related adverse effects between tamsulosin and nifedipine with 5%(99/1 804)and 7% (117/1 796) minor adverse effects respectively and less than 1% severe adverse effects in both groups(RR=0.85, 95% CI 0.65-1.10, P=0.21; RR=0.49, 95% CI 0.09-2.59, P= 0.40). Conclusion Compared to nifedipine, tamsulosin has higher stone expulsion rate and lower incidence rates for ESWL or URSL. Since there was no obvious adverse effects, tamsulosin could be considered as a preferable option for patients with LUS. Key words: Tamsulosin; Nifedipine; Medical expulsive therapy; Ureteral stones; Meta-analysis