Department Of Obstetrics Research Articles

Psychiatric disorders among females with prolonged infertility with or without in vitro fertilization/intracytoplasmic sperm injection failure: a cross-sectional study

ObjectivesThe present study seeks to deepen understanding of the negative impacts of infertility, with a spotlight on the experiences of Egyptian women who faced prolonged periods of infertility, and emphasizing the role that faliures of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles may play in exacerbating their psychiatric disorders and impairing their sexual functions.MethodsEmbarking on a cross-sectional approach, this study was operationalized within the outpatient sectors of the Obstetrics and Gynecology Departments, synchronized with Psychiatry Departments, at Tanta University Hospitals from September 1, 2018, to December 31, 2022. The targeted population encompassed women experiencing prolonged infertility (≥ 5 years), categorically divided into two groups for meticulous analysis: Group I (with a history of IVF/ICSI failure) and Group II (without any IVF/ICSI attempts). Diagnostic tools, including the Arabic versions of the Hamilton Depression Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), and the Female Sexual Function Index (FSFI), were deployed to scrutinize the mental health and sexual function outcomes of the participants.ResultsA total of 236 women participated in this study (126 in Group I and 110 in Group II), with primary infertility prevalent in 73.31% of cases, averaging a duration of 9.28 ± 3.40 years. Our findings indicated a substantial presence of depression (58.47%), anxiety disorders (35.17%), and sexual dysfunctions (43.64%). Notably, significant differences (p < 0.0001) emerged between the groups on the HAM-D, HAM-A, and FSFI scales, with endometriosis showcasing the worst effects.ConclusionsThe findings conclusively pinpoint a pronounced link between prolonged infertility and exacerbated mental health conditions, alongside impaired sexual functions, thereby negatively affecting the quality of life of the affected women. This revelation underscores the pressing need for integrated psychiatric consultations in the therapeutic protocols of women grappling with infertility, particularly those with a history of endometriosis or failed IVF/ICSI cycles, to foster a more holistic approach to infertility management and care.

Trends in Indications, Intraoperative Findings and Outcome of Relaparotomy after Caesarean Section at a Tertiary Hospital in Eastern Zone Tanzania; Five Years’ Review

Background: The increased incidences of caesarean section rate is associated with a number of post-operative complications; one being re-laparotomy which is considered a maternal near-miss. The purpose of a re-laparotomy is to manage complications of the previous surgery such as unsecured hemostasis, manage intraabdominal infection, repairing of iatrogenic damaged organs like bowels, ureters and bladder, relieve intestinal obstruction and maintain intestinal continuity or to carry out delayed curative surgery. In general, second surgery increases not only the morbidity but also the risk of maternal mortality. Methods: The study was cross sectional, conducted at the Department of Obstetrics and Gynecology in MNH. It involved review of medical records of all women who necessitated re-laparotomy following Caesarean Section (CS) that was performed either at MNH or from referring health facilities during the study period. Results: There were 193 relaparotomy cases, 98% were referrals. Atonic uterus and sepsis (septic uterus, pelvic abscess and pus in peritoneal cavity) as intraoperative finding showed statistical significance in our study. Atonic uterus for those women who underwent relaparotomy due to post-partum hemorrhage (PPH) increase from 1(7.7%) in 2017 to 6(14%) in 2021 with an average increase of 2.31 % every year. Number of cases for sepsis (combination of septic uterus, pelvic abscess and pus in peritoneal cavity) was significant decreasing every year from 22(37.3%) in 2018 to 7(16.3%) 2021with an average decrease of 3.15% every year from 2017 to 2021. The number of cases who had hysterectomy as one of the post-operative outcomes was statistically significant decreasing from 44(74.6%) to 26(60.5%) over the study period with an average decrease of 5.89% every year from 2018 to 2021. Conclusion: The most frequent indication for relaparotomy after CS was a burst abdomen. For the women who had relaparotomy due to uncontrollable PPH, the main intraoperative .......

Development and validation of a technical skill score for internal version and total breech extraction of the second twin: An interventional prospective study.

To develop and test an Objective Structured Assessment of Technical Skills (OSATS) score for the internal version and total breech extraction of the second twin if in a non-engaged cephalic position. This prospective interventional study took place in a tertiary obstetrics department in France. An objective scoring system was developed, and a standardized simulation scenario was set up. Score evaluation was blinded and analyzed according to group and number of past successful vaginal twin deliveries in real life. A satisfaction evaluation was performed, based on the "Student Design Scale" questionnaire. Simulation was performed on 33 participants in three groups: novice group (15 first- and second-year residents), intermediate group (11 third- to sixth-year residents), and expert group (seven senior obstetricians). The total score obtained by experts was higher than that of the intermediate group (P = 0.001), which was higher than that of the novice group (P < 0.001). In the intermediate group, no correlation was found between OSATS score and number of past successful vaginal twin deliveries. Participants' satisfaction was excellent. The OSATS score developed was reliable and valid to evaluate an internal version and a total breech extraction of the second twin, and to differentiate novice, intermediate, and expert practitioners.

P-644 Effect of Letrozole co-stimulation with gonadotropin in women with normal ovarian reserve on oocyte maturation: a Randomized controlled trial

Abstract Study question To define whether letrozole co-stimulation with gonadotropin in normal-ovarian reserve women will improve the number of oocyte maturation. Summary answer Letrozole co-stimulation in normal ovarian reserve resulted in a reduced number of MII. What is known already Letrozole functions as an aromatase inhibitor. By inhibiting this enzyme, letrozole effectively lowers estrogen levels. Thus, letrozole prevents the estrogen-negative feedback to the HPO axis, which can increase the secretion of gonadotropins from the pituitary gland to promote folliculogenesis. The application of letrozole co-stimulation in women with a normal ovarian reserve is still debated. Study design, size, duration This study is an open-labeled, randomized controlled trial. Letrozole co-stimulation with gonadotropin in women with normal ovarian reserve. The RCT was conducted at the Fertility and Reproductive Biology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital in Thailand, from March 2023 to October 2023. Participants/materials, setting, methods One hundred forty-four infertile women 18-40 years old with normal ovarian reserve (AMH 1.2-7 ng/ml, AFC ≥ 5) were random to gonadotropin co-stimulation with letrozole 5 mg once daily (n = 72) and gonadotropin alone (n = 72). The number of MII oocytes, follicle-to-oocyte index, GDF-9 and BMP-15 in follicular fluid were assessed. Main results and the role of chance Letrozole co-stimulation resulted in a significantly reduced number of MII [8 (4,12) vs 9 (5, 15.8), p = 0.042] and the rate of MII [ 71.7(60, 83.8) vs 80 (66.7, 90), p = 0.013]. However, the number of retrieved oocytes [12 (6,16.8) vs. 12 (6,16), p = 0.335] and FOI [85.7 (57.4,107.5) vs 84.2 [61.8, 112.5], p = 0.396] remained unchanged. The total dose of gonadotropin in the letrozole group was no different from the control group [1,350 (1,200, 1,650) vs 1,500 (1,350, 1,718.8) I.U., p = 0.137]. The duration of ovarian stimulation was shortened in the letrozole group compared to the control group [9 (8, 10) vs 9 (8.3, 10) days, p = 0.027]. The letrozole and control group had a similar level of GDF-9 (0.036 ± 0.003 A.U. vs. 0.028 ± 0.004 A.U., p = 0.119, letrozole and control group, respectively) and BMP-15 (0.034 ± 0.002 A.U. vs. 0.033 ± 0.004 A.U., p = 0.923, letrozole and control group respectively) in follicular fluid. Limitations, reasons for caution This study was open-label, with limited generalizability due to 91% of ovarian stimulation being strict to the research protocol (r-FSH and antagonist protocol) and no pregnancy outcome. Wider implications of the findings The study showed no benefit of letrozole co-stimulation in women with normal ovarian reserve. Trial registration number TCTR20221125002

P-291 In women with endometriosis, effective treatment of chronic endometritis with antibiotics lowers serum CA-125 levels

Abstract Study question To evaluate the effect of chronic endometritis treatment on serum CA-125 levels in women with endometriosis. Summary answer Cure of chronic endometritis leads to a reduction in serum Ca-125 levels in women with endometriosis. What is known already Endometriosis is a chronic inflammatory disease characterized by the ectopic growth of endometrial tissue outside the uterine cavity. It is hypothesized that the disease exerts direct inflammatory effects on the ovaries, fallopian tubes, and the eutopic endometrium. In endometriosis, CA-125 levels are often elevated. Literature reports a frequent coexistence of endometriosis and chronic endometritis (CE) in women undergoing hysterectomy for benign indications. CE, characterized by macroscopic and histological alterations of the endometrium, was present in 38.5%-42.3% of women with endometriosis, compared to lower prevalence rates in controls infertile patients without endometriosis, supporting a potential etiopathogenic link between endometriosis and CE. Study design, size, duration This retrospective case-control study was conducted at the Department of Obstetrics and Gynecology, University of Bari. The study included 51 patients suffering of both ovarian endometriosis and CE. The primary objective was to investigate whether CE cure modifies serum CA-125 levels among women with ovarian endometriosis. The secondary objective was to assess any modifications in the size of endometriotic cysts following the cure of CE. Recruitment period was from September 2021 to February 2023. Participants/materials, setting, methods All patients received antibiotic therapy (100 mg of doxycycline, twice daily for ten days) and, the following month, hysteroscopy with control biopsy. Of these, 36 women were cured of chronic endometritis (Group A), while 15 women showed persistent disease (Group B). Endometriosis was diagnosed by transvaginal ultrasound and chronic endometritis through hysteroscopy, histology, and immunohistochemistry for CD138. Serum CA-125 levels were measured before antibiotic therapy and approximately 3 months later. Main results and the role of chance The primary outcome was to compare the change in CA-125 values between women cured of chronic endometritis and women with persistent disease. There were no statistically significant differences in baseline characteristics between the groups (p=ns). The majority of patients in both groups had a single ovarian endometrioma and the micropolypoid endometrial appearance was the predominant finding of chronic endometritis observed during hysteroscopy in both Groups. In Group A, the mean CA-125 value significantly decreased after antibiotic therapy from 58.56 U/mL (± 32.45) to 38.25 U/mL (± 17.31) (p &amp;lt; 0.001). No significant changes in CA-125 values were observed in Group B before and after antibiotic therapy (69.70 ± 27.42 versus 67.47 ± 24.52 U/mL, p=ns). The absolute change in CA-125 values was significantly greater in terms of reduction in Group A compared to Group B (-20.31 ± 27.09 versus -2.13 ± 12.51 U/mL; p = 0.02). Adjustment for confounders in a multivariable regression model revealed that the cure of chronic endometritis was independently associated with a significant decrease in absolute serum CA-125 levels (p = 0.006). Cyst size did not significantly change after antibiotic therapy in both groups (p=ns). Limitations, reasons for caution The main weakness of our study is that CA-125 was only measured once before and once after treatment of CE with a course of antibiotics. Moreover, our study does not allow for inferences regarding the impact of the observed reduction in serum CA-125 on the subjective symptoms related to endometriosis. Wider implications of the findings Our study constitutes the first demonstration that effective treatment of CE results in a significant decrease in a non-invasive marker of endometriosis, CA-125 supporting the emerging concept that the endometriosis might have an infectious origin. Trial registration number not applicable

P-640 Dynamics of IGF signalling during the ovulatory peak in women undergoing ovarian stimulation

Abstract Study question How is the IGF system expressed and regulated during the midcycle surge in women? Summary answer The IGF system becomes downregulated after ovulation trigger (OT) highlighted by a significant upregulation of the inhibitor, stanniocalcin-1, and a downregulation of protease-induced IGF release. What is known already IGF signalling is known to affect human ovarian follicular function during growth and development. Particularly during the preovulatory stage, IGF activity appears to be highly significant and has been proposed as one of the primary factors contributing to the remarkable mitotic activity observed in the granulosa cells (GCs). However, the role and regulation of the IGF system is unknown during the ovulatory peak, which is characterized by profound changes in GC function. Study design, size, duration Follicular fluid (FF) and GCs were collected from fifty women during the ovulatory peak from two specific time-points. One sample was obtained before oocyte pick up (OPU): before OT (T = 0 h (n = 23)), at 12 h (n = 10), 17 h (n = 6), or 32 h (n = 11) after OT, and one sample was obtained at OPU 36 h after OT (n = 50). Participants/materials, setting, methods Fifty women receiving fertility treatment at the Fertility Clinic, Department of Gynaecology and Obstetrics, Holbæk Hospital, Denmark, were included. For ethical reasons, only women who had developed more than eight mature follicles at their final control visit before OT were approached and asked for possible participation. Gene expression profiles were assessed by microarray analysis of GCs. Intrafollicular levels of IGF-related proteins were assessed with immunoassays and a proteinase assay was used to quantify activity. Main results and the role of chance This study presents a novel insight into the dynamics of IGF bioavailability within human ovarian follicles during the midcycle surge of gonadotropins. Notably, this investigation reports a significant downregulation of genes promoting IGF signalling, i.e., IGF-2, PAPPA, and IRS1, along with a concurrent upregulation of genes associated with IGF binding and inactivation, including IGFBPs, IGF2R, and STC1. Particularly, the substantial increase in the inhibitor, stanniocalcin-1 (STC1), at both gene and protein levels likely plays a key role in the downregulation of IGF signalling. Additionally, this study reveals a marked reduction in intrafollicular PAPP-A proteolytic activity after OT, further emphasizing the importance of PAPP-A within human ovaries. In addition, this study indicates a pronounced decline in GC mitotic activity during the midcycle surge, as evidenced by the downregulation of proliferation markers, including MKI67, E2F1, E2F8, and FOXM1, highlighting a substantial decrease in GC proliferation rate during this critical phase. Previous research has demonstrated that IGF signalling stimulates the proliferation and differentiation of cultured human GCs. Therefore, the significant changes in IGF bioavailability observed in human GCs during the ovulatory surge suggest an essential role of IGF signalling in controlling the proliferation and differentiation of GCs within the preovulatory follicle. Limitations, reasons for caution This study highlights the need for future functional studies to confirm a direct mechanism to account for the abrupt cessation of GC proliferation. Differences between using hCG or GnRH agonist for final maturation of follicles were not shown, thus future studies should be powered to reveal effects of the protocols. Wider implications of the findings These data suggest that downregulation of IGF signalling mediated by increased STC1 expression is instrumental for the sudden cessation in GC proliferation and onset of differentiation during the ovulatory peak. Furthermore, this study implies importance of IGF-independent functions of STC1, especially during the ovulatory peak, where elevated levels are observed. Trial registration number Not applicable

The Effect of Oral Isosorbide Mononitrate Therapy on Umbilical Artery Doppler Resistance Index in Pregnancies with Intrauterine Growth Restriction: A Prospective Randomized Control Trial

Abstract Background Intrauterine growth restriction (IUGR) is associated with impaired placentation. Patients who are at risk of developing IUGR can be identified by abnormal umbilical artery Doppler at mid-trimester pregnancy. Nitric oxide (NO)-donors like isosorbide mononitrate reduce the impedance in the uteroplacental vessels and possess protecting effects on the endothelium. Objective To evaluate the efficacy and tolerability of Isosorbide Mononitrate therapy in reducing umbilical artery Doppler resistance index (RI) in pregnancies with fetal growth restriction. Patients and Methods This prospective randomized control trial was conducted at Obstetric Outpatient Clinic – Obstetrics and Gynaecology Department, Faculty of Medicine, Ain Shams University Maternity Hospitals from February 2021 until February 2022 and performed on women who attended ASUMH ECDU with IUGR. Results Finally, as regard side effects of isosorbide mononitrate therapy, our study reported that headache and overall side effects were statistically significant higher compared with control group. Conclusion Evident from the current study, nitric oxide (NO)-donors like isosorbide mononitrate had no prophylactic or therapeutic effects in management of pregnant cases associated with IUGR. It had no improving effect on umbilical artery Doppler or placental circulation. On the other hand it had unfavorable maternal adverse effects.

P-323 Endometriosis and adenomyosis present lower expression in uterine natural killer cells

Abstract Study question Is there an association between endometriosis and uterine natural killer cells? Summary answer Decreasing level of uterine natural killer cells had positively associated with Endometriosis and Adenomyosis. What is known already Uterine natural killer cells (uNK) represent the predominant lymphocyte population within the decidua during implantation and in the initial stages of pregnancy. Dysregulation of uNK function has been associated with reproductive challenges, including recurrent miscarriage (RM) or recurrent implantation failure (RIF). This suggests an underlying disruption in immune activity during implantation. Endometriosis is a chronic and inflammatory disorder that usually affects the pelvic cavity and can cause severe pain during menstruation. However, there are paucity studies focus on the role of uNK in endometriosis and adenomyosis. The aim of this study was to identify the association between endometriosis and uNK. Study design, size, duration In this Prospective cohort study, 60 participants were recruited from May 2023 to January 2024 at the outpatient department of Obstetrics and Gynecology in Chang Gung Memorial Hospital, Kaohsiung Medical Center in Taiwan. The inclusion criteria were as follows: adult women of childbearing age were eligible to participate. Old age (&amp;gt;45 years old) patients, or patient with underlying medical disease, immune diseases and malignancy, or patient using immunosuppressant were excluded. Participants/materials, setting, methods Endometrial tissues were collected during the mid-luteal phase using an endometrial curette. The level of uNK were measured by immunohistochemistry with CD56+, and was presented in absolute number per high power filed. CD138 was also measured, and the level above 5 cell/HPF was defined as chronic endometritis. Endometriosis and adenomyosis were confirmed histologically. RM was defined as ≧2 previous miscarriages. RIF was defined as ≧2 previous failures to achieve clinical pregnancies after embryo transfer. Main results and the role of chance At least one uNK/HPF was revealed in 58 cases, 0-10uNK/HPF in 15 cases (24.5%), 11-20 uNK/HPF in 19 cases (31.6%) and above 20 uNK/HPF in 26 cases. After adjusting for covariates, patient with endometriosis and adenomyosis were positively associated with lower uNK level(low vs. high uNK(cut-off value: 20 uNK/HPF), odds ratio (OR) (95% confidence interval (CI)), 9.434 (1.101–83.33), p = 0.032; 2.000 (1.515–2.639), p = 0.015). Moreover, there are 14 patients with RM (23.3%), 26 patients with RIF (43.3%) and 7 patients with CE (11.7%). However, our study did not find significantly association between RM or RIF or CE with uNK levels. Limitations, reasons for caution Because of the single-center, Asian origin of our patients, and the sample size was relatively small. Further large-scale longitudinal studies are required to verify our findings and evaluate the underlying pathophysiology between endometriosis and uNK. Wider implications of the findings Our study highlights the significantly decreased uNK level in endometrium of women with endometriosis and adenomyosis, which may indicate some alteration in immune environment under endometriosis. Further research is warranted for understanding the immuno-modulation in endometriosis. Trial registration number not applicable

Biochemical and Oxidative Biomarkers in Preeclampsia.

To determine the biochemical and oxidative stress parameters as biomarkers in preeclampsia. Cross-sectional analytical study. Place and Duration of the Study: Departments of Obstetrics / Gynaecology and Biochemistry, Quaid-e-Azam Medical College, Bahawalpur, Pakistan, from September 2022 to February 2023. Women with preeclampsia were selected based on blood pressure exceeding 140/90 mmHg and proteinuria levels exceeding 300 mg/24 hours or showing a +1 on a dipstick test. Normotensive pregnant women were selected as controls. Venous blood was taken and centrifuged, and routine biochemical methods were used to estimate serum lipid profile levels and minerals. The estimation of oxidative stress enzymes was carried out manually using special chemicals. Student's t-test and Pearson's correlation were applied to analyse the result. The study included 228 subjects: 114 preeclampsia patients and 114 normal pregnant women as controls. The mean systolic blood pressure was measured at 166.25 mmHg and the diastolic blood pressure was 92.80 mmHg (p <0.001). All lipid profile estimations showed notable abnormalities, but the mean level of triglycerides (TGs) (214.90 ± 15.59 mg/dl) in preeclamptic patients was significantly elevated (p <0.05). In terms of minerals, all were deranged but magnesium (1.37 ± 0.35 mg/dl) and calcium (7.55 ± 0.45 mg/dl) were significantly decreased (p <0.05). All oxidative enzyme levels were increased (p <0.05) but malondialdehyde (MDA) with a mean level of 2.58 ± 0.40 nmol/ml was significantly elevated. The Pearson's correlation of these parameters with blood pressure also showed a positive association. Total cholesteroltriglyceride in the lipid profile, calcium and magnesium in minerals, and MDA in oxidative parameters were markedly deranged and exhibited significant associations with the severity of the disease, so could be used as disease biomarkers of preeclampsia. Preeclampsia, Gestational hypertension, Proteinuria, Lipid profile, Minerals, Oxidative stress.

Complex obstetrical surgery: building a team and defining roles

As the number of placenta accreta spectrum (PAS) cases continues to rise, the gap in surgical skills in labor and delivery units becomes more apparent. Recent scholarly work has highlighted the diminishing advanced surgical skills among obstetricians-gynecologists, particularly among new graduates. Therefore, it has become a practice in many institutions to refer complex cesarean deliveries (CD) and obstetrical hysterectomies to subspecialists, specifically gynecologic oncologists. Hence, in this commentary, we propose a process whereby key personnel within departments of obstetrics and gynecology are identified, and their appropriate level of involvement in cases of complex obstetrical surgery is delineated. In doing so, we describe the surgical skills expected from each provider level so that the CD complexity level can be matched to specific surgical expertise. Through this process, an obstetrician-led complex obstetrical surgery team is formed. Ultimately, the goal of this process is twofold: first, to return cases with higher levels of surgical complexity back to obstetricians, and second, to reduce the surgical back-up burden from gynecology subspecialists such as gynecologic oncologists.

Prevalence of Four Sexually Transmitted Infection Pathogens Detected in Urine and Genital Tract Secretion in Hangzhou, China.

Sexually transmitted infections (STIs) increase gradually and have become a public health problem in the world. UU, CT, NG, and MG are four common STI pathogens. Our retrospective study analyzed the clinical situation and the laboratory data of patients infected with the four pathogens. The prevalence of the four pathogens, detected in urine and genital tract secretion, was studied in Hangzhou, China. A total of 3,168 male and female patients were randomly selected from February 2023 to February 2024. Urine and genital secretions were collected, and four STI pathogens were controlled for detection. Data were collected from the hospital's electronic medical records, and SPSS 25.0 software was used to perform a statistical analysis. Among 3,168 patients, a total of 1,527 were detected as positive, and the positive rate was 48.20%. The age of patients ranged from 13 - 98 years, with an average age of 45.6. The total of patients consisted of 2,191 males and 977 females, which had a significant difference (p < 0.05). Specimens were mainly collected from the Department of Dermatovenerology, Urological Surgery, Obstetrics and Gynecology, and so on. The positive rate was statistically different between male and female patients (p < 0.05). Single infection performed a main role and accounted for 79.57% of all of the positive patients. In the ≤ 20 age group, the positive rate was the highest and was as high as 77.65%. In detail, single infection caused by UU dominated, especially in the 21 - 30 age group. Double infection caused by UU and CT and triple infection caused by UU, CT, and NG were the majority, both especially in the 21 - 30 age group. There were significant differences in the positive rates in the different age groups and in the four pathogens (p < 0.05). Quadruple infection was very rare and had only been detected in one patient. The prevalence of the four pathogens in Hangzhou was different from other regions. More male than female patients, more single than multiple infections, and more single and multiple infections occurring in young people were the features in Hangzhou. The study would provide reference for prevention, diagnosis, and treatment of STI.

Rational Use of Proton Pump Inhibitors among Patients Admitted in a Tertiary Care Hospital

Background: The prevalent usage of proton pump inhibitors (PPIs) is a testament to the effectiveness of this class of medications, but it also introduces risk associated with inappropriate prescriptive and consumptive practices. Because of the negative effect of incorrect usage and overdose of PPIs, it is very important for physicians to only prescribe these drugs when needed. However, recent studies showed some concerns about long-term PPIs consumption. The rational prescription of medications is vital to ensuring the optimal use of medical resources, providing effective therapy and minimizing adverse drug reactions. Methods: This observational study was conducted in the department of Pharmacology and therapeutics, Sylhet M.A.G. Osmani medical college, Sylhet, in collaboration with the department of Medicine, Surgery, Gastroenterology, Obstetrics and gynaecology, Sylhet M.A.G. Osmani medical college hospital, Sylhet, from July 2022 to June 2023. The sample size for this study was 600. Usage of PPIs was considered to be appropriate on the basis NICE guidelines and recommendations by Scarpignato et al. (2016) committees on behalf of three Italian scientific societies. Result: For 600 PPIs prescriptions, total 705 case sheets were reviewed. The mean age of the study patients was 42.94±17.16 years. Female were found more 359(59.8%) than male 241(40.2%). Out of 600 patients, based on the indications of PPI usage, 287 (47.8%) of prescriptions were found appropriate, whereas inappropriate prescriptions were found in 313 (52.2%) cases. Out of 287 patients who were prescribed PPIs in an appropriate indication, 175 (61%) patients were given PPIs in an appropriate dose, whereas inappropriate dose was found in 112 (39%) of patients. Again, among 175 patients who were prescribed PPIs for appropriate dose, 24 (13.7%) patients were given PPIs in an appropriate frequency, whereas inappropriate frequency was found in 151 (86.3%) of patients. Finally, 24/600 (4%) patients were prescribed in an appropriate indication with an appropriate dose and frequency, whereas inappropriate prescription were found in 576/600 (96%) patients. PPIs were used as prophylaxis for NSAIDs in highest number 147(51.2%) of patients. Oral was the most common 348(58%) route of prescribing PPIs. Omeprazole was the highest 577(96.2%) prescribed PPIs. Conclusion: Based on this study result, it could be concluded that in most of the patients PPIs prescriptions were not following appropriate indications, dose and frequency recommended by reference guidelines. Like any other drugs, PPIs should be prescribed for a clear indication, the minimum dose needed for the expected effect and medication halted when no longer necessary upon re-evaluation.

LUNG CANCER - RISK FACTORS AND PREVENTION STRATEGIES - OVERVIEW OF THE LITERATURE

Europäische Wissenschaftliche Gesellschaft Home About the Journal Peer Review Editorial Board For Authors Reviewer Recognition Archive Contact Impressum EWG e.V. Elektronische Zeitschriftbibliotek Logo Bielefeld Academic Search Engine Logo Erfolgreich durch internationale Zusammenarbeit ONCOLOGY Cite as: Archiv EuroMedica. 2024. 14; 3. DOI 10.35630/2024/14/3.344 Received 25 April 2024; Accepted 15 June 2024; Published 19 June 2024 LUNG CANCER - RISK FACTORS AND PREVENTION STRATEGIES - OVERVIEW OF THE LITERATURE Jakub Rybak1email orcid id logo, Barbara Magiera2orcid id logo, Karol Magiera1orcid id logo, Martyna Grabowska-Szczurek3orcid id logo, Alicja Grabarczyk4 orcid id logo, Piotr Bator1 orcid id logo, Michał Razik1 orcid id logo, Patrycja Rozwadowska1 orcid id logo, Karol Wielgus5 orcid id logo 1Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland 2Prof. K. Gibiński University Clinical Center of the Medical University of Silesia in Katowice, Poland 3The Hospital of the Bonifratres of St. John Grand in Cracow, Poland 4Students’ Scientific Society, Department of Gynecology and Obstetrics in Katowice, Medical University of Silesia, Katowice, Poland 5Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland download article (pdf) rybakjak@gmail.com ABSTRACT Introduction and purpose: Lung cancer is the second most common cancer worldwide. The aim of this study is to analyze the key modifiable and non-modifiable risk factors associated with the development of lung cancer and to discuss existing prevention strategies. Materials and methods: A literature review was conducted using the "PubMed" database with the keywords "lung cancer", "lung cancer risk factors", "lung cancer prevention”. Results: Lung cancer risk factors can be divided into two groups: modifiable and non-modifiable. Modifiable risk factors include: smoking, radon, diet, chronic lung diseases, asbestos and diesel fumes. Non-modifiable risk factors include: age, race, genetic factors and gender. In primary prevention of lung cancer it is important to reduce exposure to risk factors, especially cigarette smoke. Screening using low-dose computed tomography plays a major role in secondary prevention. Conclusion: Lung cancer is one of the most frequent malignant tumors. Over the years, enormous progress has been made in the fight against lung cancer. Despite a large reduction in smoking prevalence, cigarette smoking remains the most important risk factor of lung cancer. Several other factors have been identified, with e.g. asbestosis exposure and air pollutants being among top-5 risk factors with the highest impact. Effective methods of primary and secondary prevention such as health campaigns and screening tests have led to a reduction in the incidence of lung cancer. Smoking cessation and low-dose chest CT screening were proven to be the most effective in the lung cancer prevention. However, lung cancer remains the most common cause of death in cancer patients so further research and effective and practical public health policy are crucial in decreasing incidence and mortality.

Pregnancy-Related-Acute Kidney Injury in Jigawa, Nigeria

Introduction: Pregnancy-related acute kidney injury (PR-AKI) is a significant cause of maternal morbidity and mortality. Objective: This study aimed to determine the causes and outcomes of PR-AKI management. Methods: This was a two-year retrospective review of patients managed for PR-AKI between 1 October 2021 and 31 September 2023 in the Department of Obstetrics and Gynaecology of Rasheed Shekoni Federal University Teaching Hospital Dutse. Patients’ data were obtained from their case files. Results: One hundred and three women were diagnosed with PR-AKI out of 1,647 admissions during the review period. The mean age of the patients was 27 7.5 years, with an age range of 15 to 48 years. The mean parity was 4.513.2 and most (47.6%) patients were grand-multipara. The majority (70.7%) booked for antenatal care in primary healthcare centres, and only 2(3.1%) booked in tertiary hospitals. The commonest cause of PRAKI was obstetric haemorrhage (48.5%), with postpartum haemorrhage and antepartum haemorrhage accounting for 72% and 28%, respectively. Seventy-five (72.8%) patients received a blood transfusion, while 28 (27.2%) had haemodialysis. Thirty-five (33.9%) deaths were recorded. Conclusion: This study revealed that PRAKI was common, and obstetric haemorrhage, hypertensive disorders and sepsis were the leading causes.

Safety of Long Acting Reversible Contraception (LARC) during 3 Months of Follow up At Civil Hospital, Karachi

Contraception counseling is an essential component of family planning services. It provides the foundation for delivering correct information on contraceptive methods and eliminating myths regarding risks and negative effects. Objectives: To determine the Safety of Long-Acting Reversible Contraception (LARC) for postpartum contraception during 3 months of follow-up. Methods: A cross sectional descriptive study comprised on total of 108 women aged 25-35 years who accepted LARC in the postpartum period at Department of Obstetrics and Gynaecology, Civil Hospital, Karachi from 22nd February 2021 to 21st August 2021, were included. Females with uterine abnormalities and severe anemia were excluded. The demographic information (name, age, registration number) was taken. The women were counseled regarding postpartum contraception LARC such as IUD or Jedelle (implant) during the antenatal period and LARC was placed within 30 minutes of placental delivery. Those women who selected LARC were called for follow-up for 3 months in OPD and at follow-up visits, patients were assessed for their safety of this method. Results: The age range in this study was from 25 to 35 years with a mean age of 28.81 ± 3.27 years. The majority of the patients 80 (74.07%) were between 25 to 30 years of age. The mean parity was 3.10 ± 0.72. In this study, the safety of Long Acting Reversible Contraception (LARC) for postpartum contraception during 3 months of follow-up was found in 91 (84.26%) women. Conclusions: This study concluded that long acting reversible contraceptives in the immediate postpartum period are very safe.

Promoting Reproductive Justice in the Office: LARC Removal Counseling at Time of Insertion

Purpose: While access to receiving LARC devices is increasing, it is not apparent if there is an infrastructure for providing equal access to LARC removal. The purpose of this study was to assess how patients perceive LARC counseling by providers at the time of insertion. In addition, explore the information that providers include in their LARC removal counseling at the time of insertion. Methods: The study population included participants of both patients and providers. Our patient participants included people between the ages of 18 to 50 years old who have or previously have had any form of intrauterine contraceptive device or subdermal contraceptive implant. Subjects will be recruited from the Texas Tech El Paso Obstetrics and Gynecology Clinics. The provider participants included residents, attending OB/GYNs, and nurse-midwives in the Texas Tech Health Science Center at El Paso Department of Obstetrics and Gynecology. Patients completed an anonymous survey depending on which type of device they had. If they have had both the intrauterine contraceptive device and the subdermal contraceptive implant, they were eligible to complete one survey for each device. Participants completed surveys on an iPad. Providers were surveyed once, either through paper surveys or emailed surveys. Survey responses were anonymous. Data was analyzed using SAS 9.4 software. Results: Overall, 246 participants reported having a subdermal implant (45.5%) or IUD (54.5%), majority of the participants were between the ages of 18-30 (72.8%), Hispanic (78.9%), had insurance or grant accessibility (67.5%). There were 17 providers consisting of medical residents, physicians, and nurse midwives who completed the survey. Based on provider surveys, 80.0% of providers counseled patients at 100% of visits about getting device removed. In addition, 80.0% of providers informed their patients to return to the office for device removal. About 93.3% of providers never discuss the cost of removing the device. Regarding the patient surveys, in response to the question, “How well do you understand the process of getting the device removed,” results were reported into two groups: ’extremely poorly/poorly/neutral” and “somewhat well/very well.” There was no statistically significant difference among the patients with an IUD who either poorly understood the process or understood the process as least somewhat well. For patients with a subdermal implant, 73.68% of those who poorly understood the process of removal stated that providers did not discuss the cost of removing the device versus 37% of those who understood the process well where providers did not discuss the cost of device removal (p &lt; 0.001). About 68.42% of patients with a subdermal implant who poorly understood the process of device removal stated that providers did tell them they needed to come back to the office for device removal; 94.62% of patients with a subdermal implant who understood the process of device removal well stated that providers told them to return to the office for removal (p &lt; 0.001). On whether providers discussed insurance coverage for device removal, 63.44% of patients who understood the process well states yes versus only 21.44% of patients who poorly understood the process of device removal. Conclusions: In patients with subdermal implants, a low percentage of providers discussed the cost of removal and whether or not insurance covered the cost of removal. Results implicate a need for an infrastructure to increase access for LARC removal services. However, further studies with larger patient and provider pools would be necessary for statistically significant results, particularly for IUDs.

Pattern of Medical Comorbidities among Patients of Postpartum Psychosis at a Tertiary Care Center of Central India

Abstract Background and Aim: The reproductive age group is vulnerable to various preexisting psychiatric disorders as well as newly diagnosed illnesses. The stress associated during pregnancy increases the likelihood of developing psychiatric comorbidities even more. Of importance are postpartum blues, depression, and psychosis. The presence of various medical comorbidities may be a contributing factor for the development of psychiatric illnesses. This study was done to find the pattern of medical comorbidities among patients of postpartum psychosis. Materials and Methods: The study was carried out at the Department of Psychiatry and Department of Obstetrics and Gynecology, Shyam Shah Medical College, Rewa (Madhya Pradesh). Total duration of the study was 1 year, all patients diagnosed with postpartum psychosis (n = 88) were segregated using simple random sampling and every 2nd patient was included in the study (n = 44). Further, necessary assessments were carried out and patients were discharged postrecovery. Results: In the present study, 59.09% of patients (26) belonged to the age group 25–35 years, 81.81% of patients (36) were from lower socioeconomic status, housewives 79.54% (35), and 36.36% (16) were middle school educated. About 63.63% of patients (28) females were nulliparous. About 59.09% of patients (26) were delivered through cesarean section. The most prevalent medical comorbidity was postpartum infection which was present in 50% of the patients (22), followed by hypothyroidism in 43.18% of patients (19). Conclusion: Various medical comorbidities may precipitate, maintain, or aggravate underlying postpartum psychosis which may alter their course progression and outcome.

Clinical case of delivery of a pregnant woman with Placenta previa/percreta 3с by modified cesarean section technique

Placenta accreta spectrum (PAS) is a severe obstetric pathology, in which placental tissue invades the myometrium. According to the current classification of FIGO (2019), depending on the depth of placental tissue invasion, PAS is divided into Placenta accreta – about 75% of cases, Placenta increta – 15% and Placenta percreta – up to 10% of all cases.The most severe cases associated with the delivery of pregnant women with Placenta percreta, especially with placental tissue sprouting not only the myometrium of the front wall of the uterus, but also the back wall of the urinary bladder or parametrial and paracervical tissue, which according to the FIGO classification are defined as cases of Placenta percreta with a degree of severity 3b and 3c. These are the most dangerous cases of the development of severe hemorrhagic complications, coagulopathic disorders, and the occurrence of intraoperative complications with damage to adjacent organs, primarily the bladder and intestines due to hysterectomy.This article presents for the general public of obstetricians and gynaecologists the analysis of a clinical case in a pregnant woman with complete presentation and placental ingrowth into the prostatic parametrial tissue and partial adhesion to the posterior bladder wall (Placenta previa/percreta 3c).The use of a modified interiliac incision of the anterior abdominal wall, medical and technical support with the use of modern energies (radio wave scalpel, argon plasma tissue coagulation) to minimize the volume of blood loss were described. The intervention was carried out at the main clinical base of the Department of Obstetrics and Gynaecology No. 1, the Kyiv Regional Perinatal Centre.

Efficacy of 10 IU Syntocinon versus 800 µg Misoprostol Sublingual in Active Management of 3rd Stage of Labour

Background: The active management of the third stage of labor is crucial for preventing postpartum hemorrhage (PPH), a leading cause of maternal mortality. Syntocinon (oxytocin) and Misoprostol are prominent pharmacological agents used to manage this stage by inducing uterine contractions and minimizing blood loss. Objective: This study aimed to compare the efficacy of 10 IU intravenous Syntocinon and 800 µg sublingual Misoprostol in the active management of the third stage of labor, focusing on maternal outcomes, blood loss, side effects, and the need for additional interventions. Methods: A randomized controlled trial was conducted in the Department of Obstetrics and Gynaecology at Hayatabad Medical Complex from August 1, 2021, to February 1, 2022. A total of 284 women aged 18-40 years with singleton pregnancies were enrolled and randomized into two groups of 142 each. Group A received 800 µg of sublingual Misoprostol, while Group B received 10 IU intravenous Syntocinon at the delivery of the anterior shoulder of the baby. The third stage of labor was managed with early cord clamping and controlled cord traction. Blood loss was meticulously recorded, and patients were monitored for 24 hours postpartum. Data were analyzed using IBM SPSS Statistics version 25, with continuous variables expressed as mean ± standard deviation and categorical variables as frequencies and percentages. Post-stratification analysis utilized an independent sample t-test, with a p-value of ≤ 0.05 considered statistically significant. Results: The mean age of participants was 29.507±3.24 years in the Misoprostol group and 28.352±3.77 years in the Syntocinon group. Blood loss was slightly lower in the Misoprostol group (242.4 ± 3.72 ml) compared to the Syntocinon group (249.176 ± 4.07 ml). The majority of participants were aged 18-30 years (69.7% in Group A and 71.1% in Group B). No statistically significant differences were observed in blood loss based on age, gestational age, or parity. Conclusion: Misoprostol offers practical advantages in terms of ease of administration and stability at room temperature, making it a viable alternative, especially in low-resource settings. Both Misoprostol and Syntocinon are effective in managing the third stage of labor, with comparable efficacy in reducing blood loss.

The association between BMI, episiotomy, and obstetric anal sphincter injuries (OASIS) in singleton vaginal deliveries

ObjectivePrevalence of obesity in reproductive age and pregnant women has been on the rise during the past several decades. The relationship between body mass index (BMI) and obstetric anal sphincter injuries (OASIS) or episiotomy has not yet been thoroughly investigated. The objective of this study was to shed light on this issue. MethodsThis retrospective cohort study was performed using electronic database of an obstetrics department at a university-affiliated tertiary medical center. All spontaneous singleton vaginal deliveries at term between January 2015 and December 2021 were included. The primary outcome was the incidence of OASIS (third- and fourth-degree perineal tears) and obesity. These were compared across three BMI categories: normal (BMI below 25 kg/m2), overweight (BMI 25.0–29.9 kg/m2), and obesity (BMI of 30 kg/m2 and over). ResultsOf the overall 13,932 spontaneous vaginal deliveries identified, 34.7 % had BMI in the normal range, 43.1 % were overweight, and 25.4 % were obese. Multivariate analysis demonstrated lower rates of OASIS in obese (OR 0.2, 95 %CI 0.04–0.9) and in overweight (OR 0.3, 95 %CI 0.1–0.99) women, as compared to the normal-weight cohort. In addition, lower rates of episiotomy were noted in the obese cohort (OR 0.7, 95 %CI 0.6–0.8). ConclusionsDecreased incidence of OASIS was noted in women with obesity, in conjunction with lower use of episiotomy. These findings imply that obstetrics clinics might consider a more conservative approach to episiotomy in obese patients.