Important Factor For Good Outcome Research Articles

The Outcome of Planned Breech Vaginal Delivery among Obstetrics Patients Presenting at Tertiary Care Hospital, Karachi

Background: Vaginal breech delivery (VBD) is known to be associated with more perinatal and maternal complications. The safest mode of delivery in case of breech presentation has long been a debate in obstetrics. Selective vaginal breech deliveries, proper technique of breech delivery, rigorous intrapartum monitoring and presence of experienced obstetrician and pediatricians are most important factors for good outcome in vaginal breech delivery without affecting the maternal and fetal well-being and helps in decreasing the caesarean section rate. Very few studies on the subject have been carried out in poor-resource settings. The aim of the study was to determine the outcome of planned breech vaginal delivery among obstetrics patients presenting at Tertiary Care Hospital, Karachi. Study Design: This Cross sectional study was conducted at Department of Gynaecology and Obstetrics, Civil Hospital, Karachi for the duration of Six months from November, 2019 to May, 2020. Subjects and Methods: Data was prospectively collected from patients after taking a verbal consent. 89 pregnant who met the diagnostic criteria were included. Quantitative data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables was presented as frequency and percentages. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification chi square test was applied taking p-value of ≤0.05 as significant. Results: A total of 89 patients were included in this study. Mean age, gestational age and duration of labour in our study was 31.78±2.81 years, 37.72±1.58 weeks and 10.72±1.56 hours. Out of 89 patients, 11.2%, 23.6%, 12.4% neonates had had APGAR score < 7, NICU admission and brachial plexus injury. Conclusion: Vaginal delivery of term breech fetus is a safe option in a carefully selected group of women. Pre-delivery assessment, vigilant labour monitoring and delivery by trained doctors can minimize poor feto-maternal outcome. Keywords: Pregnancy, planned breech vaginal delivery, APGAR score.

Analysis of clinical characteristics and surgical results of upper lumbar disc herniations

BackgroundUpper lumbar disc herniation (ULDH) is described mostly in levels L1-2, L2-3 and L3-4 of the lumbar spine in the literature and accounts for less than 10% of all disc herniations. The aim of our study was to evaluate the clinical characteristics and surgical results of ULDH. MethodsIn all, 367 patients treated for upper lumbar disc herniation and 2137 treated for lower lumbar disc herniation (LLDH) between January 2008 and January 2017 were included. They were followed up postoperatively at 12 months by radiological investigations, back and leg pain Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI). Preoperative data comprised age group (20–40, 40–60, 60–80 years), gender (male, female), lumbar level (L1-2, L2-3, L3-4), side of disc herniation (left, right) and symptom duration (0–3, 3–6, 6–9 months). ResultsODI and VAS scores improved significantly postoperatively for all patients. Of the 367 ULDH patients, 169 were female (54%) and 198 male (46%), with a mean age of 55.8±10.1 years (range, 35–71). In 174 (47.4%) patients symptom duration was 3 months, in 99 (27.0%) 3–6 months, and in 94 (25.6%) 6–9 months. At 12 months, ODI, back and leg pain VAS scores showed a significant difference in improvement according to ULDH symptom duration<3 months and to LLDH symptom duration<6 months. ConclusionMicrodiscectomy in ULDH provided sufficient and safe decompression of neural structures, with significant reduction in symptoms and disability. We suggest that early surgical treatment is an important factor for good outcome in ULDH.

Cancer during pregnancy - clinical characteristics, treatment outcomes and prognosis for mothers and infants.

To assess which obstetrical characteristics and treatment improved outcomes and prognosis of pregnant women with malignancy. A prospective study, undertaken between 2005 and 2014, involving 35 pregnant women who were diagnosed with malignant tumors during pregnancy. Patients were followed-up for 1 year after delivery. The pregnancy course and outcome and parameters that could influence the condition of mother and fetus were evaluated. Most malignancies were hematological, diagnosed in the second trimester and treated with combined therapy (surgery/adjuvant) after pregnancy. Most fetuses were in good state throughout pregnancy, but were delivered by caesarean section (CS) before term. Adjuvant therapy during pregnancy mostly caused transitory deterioration of fetal conditions. The majority of both mothers and infants were in a good state 12 months postpartum, although numerous mothers were still ill and on therapy. Surviving pregnancy and preventing tumors progression during pregnancy were the best predictors of mothers' future condition (P=0.022). High birthweight and term delivery were the most important factors for good outcome of the infants (P=0.001). If the tumor is not progressing, pregnancy should be continued as long as possible to obtain adequate birthweight of the infant. Second trimester surgery is safe, while other therapies should preferably be applied after delivery.

Increased Range of Motion Is Important for Functional Outcome and Satisfaction After Total Knee Arthroplasty in Asian Patients

BackgroundAlthough range of motion (ROM) is considered as an important factor for good outcome after total knee arthroplasty (TKA), the association of the degree of ROM with functional outcome and patient satisfaction is debated. We, therefore, investigated whether increased ROM would affect functional outcome and patient satisfaction after TKA in Asian patients. MethodsWe reviewed 630 patients who underwent primary TKA with minimum 2-year follow-up. Clinical outcomes were evaluated by Knee Society (KS) score, Western Ontario and McMaster Universities osteoarthritis index, and high-flexion knee score. Patient satisfaction was evaluated using a validated questionnaire. The association of ROM and change in ROM (cROM) with clinical outcomes and satisfaction were analyzed using partial correlation analysis and multiple median regression analysis. ResultsAll functional scores showed significant correlation with postoperative ROM (r = 0.129, P = .001 in Knee Society score; r = −0.101, P = .012 in Western Ontario and McMaster Universities osteoarthritis index; r = 0.183, P < .001 in high-flexion knee score). cROM correlated with satisfaction (r = 0.192, P = .005). Postoperative ROM and cROM were revealed as predisposing factors affecting function outcome using multivariable regression analysis. cROM was found as a predisposing factor affecting satisfaction. ConclusionsBased on the results of this study, ROM positively associated with functional outcome and cROM positively associated with patient satisfaction after TKA. These findings suggest that increased ROM after TKA is an important factor for functional outcome and satisfaction in Asian patients.