Patients In Restrictive Group Research Articles

Restrictive v/s Routine episiotomy in Primigravida

Introduction: Episiotomy is the surgical enlargement of the vaginal orifice by an incision on the perineum during the last part of the second stage of labour or delivery. Episiotomy is the most common surgical procedure experienced by women. In near past there were many studies pointed out its disadvantages like more post-delivery pain, wound complications and dyspareunia. So, this study was done to compare use of restrictive episiotomy and routine episiotomy in primigravidae undergoing vaginal birth. Aims and objectives: To assess the effects of restrictive use of episiotomy in comparison with routine episiotomy in primigravida during vaginal birth in terms of - (1) No. of episiotomies can be avoided (2) Perineal tear (3) Blood loss (4) Hematoma & Healing complications (5) Faecal & urinary incontinence (6) Dyspareunia. Material and methods: This study was descriptive analytic study conducted in the Department of Obstetrics and Gynecology, Surat municipal institute of medical education and research (SMIMER), Surat from January 2017 to June 2019 with sample size of 148 patients. Results: This study included total 148 patients, where 74 were selected randomly in each group. In Restrictive Episiotomy group, out of 74 patients, Episiotomy was required in 18 (24.32%) patients. Thus, Episiotomy was avoided in 56 (75.68%) patients. Mean duration of second stage of labour in Routine Episiotomy group was 31.88 ± 5.37min and in Restrictive Episiotomy group it was 32.35 ± 3.73min, which was suggestive of no statistically significant difference. (p value = 0.5375). Total 4.05% patients in Routine group and 13.51% patients in Restrictive group suffered from anterior vaginal tear which was statistically significant (p value = 0.021). There were 2 cases (18%) of 2nd degree perineal tear in routine episiotomy group which were 8(40%) in restrictive episiotomy group. The difference was statistically assessed by Chi-square and found to be significant (p value=0.2399). Not a single case of 3rd & 4th degree perineal tear in either group. In Routine Episiotomy group, suturing was done in 100% patients. While restricted episiotomy group only 44.59% needed suturing which was statistically significant (p value:<0.0001). Average blood loss in Routine group was 341.89 ± 49.33ml and in Restrictive group was 301.01 ± 52.41ml. So, there was significantly higher blood loss in Routine Episiotomy group. (p value= 0.000002). Complications rate in the form of episiotomy wound gap and hematoma was higher in routine group in 5.41% patients as compared to 1.35% patients in Restrictive group. Postpartum perineal pain at 1 week (14 v/s 5) and 2 weeks (5 v/s 1) was significantly higher in routine group as compared to the restrictive group. Postpartum perineal pain at 1 week and 2 weeks was significantly higher in routine group as compared to the restrictive group. Conclusion: In conclusion on the basis of our study, the immediate outcomes of routine episiotomy are no better than the restrictive use of episiotomy. Indeed, routine use is harmful to the degree that some proportion of women who would have had lesser injury instead had a surgical incision. The routine use of episiotomy has higher incidence of peripartum blood loss, requirement of suturing, postpartum perineal pain and healing complications. The policy of restrictive use of episiotomy is not associated with any third and fourth degree perineal tear or adverse neonatal outcomes.

Restrictive vs liberal blood transfusion strategy in patients with symptomatic coronary artery disease: meta-analysis from randomized controlled trials

Abstract Background Anemia is common in patients with symptomatic coronary artery disease. Observational studies investigated blood transfusion threshold in symptomatic coronary artery disease but results were conflicting. Meta-analyses evaluating transfusion threshold utilized data mainly from observational trials but no meta-analysis, to our knowledge, used data solely from randomized clinical trials. Objective The goal of our study is to evaluate efficacy and safety outcomes in anemic patients presenting with symptomatic coronary artery disease using pooled data from randomized clinical trials. Methods We queried Medline, Embase and Cochrane data bases for randomized clinical trials comparing restrictive blood transfusion (defined as transfusion when hemoglobin is less than 8 gm/dl) vs liberal blood transfusion (transfusion when hemoglobin is less than 10 gm/dl) in patients presenting with symptomatic artery disease or acute coronary syndrome. We identified 3 randomized controlled trials; MINT, CRIT and REALITY trials. Data were pooled from 3 trials. Efficacy outcomes evaluated were all-cause mortality and New or recurrent myocardial infarction. Safety outcomes were congestive heart failure at 30-day follow up. Results A total of 820 patients were included in our meta-analysis; 420 patients in restrictive blood transfusion protocol and 400 in liberal blood transfusion protocol There was no difference between two groups at 30-day follow up in all identified outcomes (all-cause mortality, new or recurrent myocardial infarction, and Congestive heart failure). 55 patients died (22/420 in restrictive group and 33/400 in liberal group). Risk ratio of all-cause mortality in restrictive group was 0.63 [95% CI (0.38–1.07), P=0.09, I2=30%]. 15/420 in restrictive group and 16/400 in liberal group had new or recurrent myocardial infarction. Risk ratio of myocardial infarction in restrictive group was 0.91 [95% CI (0.46–1.80), P=0.78, I2=0%]. 20/420 patients in restrictive group and 24/400 in liberal group had congestive heart failure with risk ratio of 0.80 [95% CI (0.19–3.37), P=0.30, I2=76%] in restrictive group. Conclusion Our meta-analysis showed similar outcomes between restrictive and liberal transfusion policies in patients presenting with symptomatic coronary artery disease of acute myocardial infarction. Our findings are consistent with available data about restricting transfusion in general population. Restricting blood transfusion might be cost-effective. Further studies are warranted to evaluate long term safety and efficacy of such approach. Funding Acknowledgement Type of funding sources: None.

Fluidoterapia perioperatoria y complicaciones post pancreatectomía distal videolaparoscópica

Despite mortality in pancreatic surgery has decreased over the last decade, morbidity remains high. One of the most important causes is pancreatic fistula. Recent studies have demonstrated the importance of fluid therapy management during the perioperative period in major abdominal surgeries. This finding was observed first in colonic surgery, demonstrating that overload of fluids increases postoperative complications. Objective. To evaluate the impact of fluid management on postoperative complications after laparoscopic distal pancreatectomy. Material and methods. Descriptive, retrospective study of a prospective database of patients whom underwent laparoscopic distal pancreatectomy from November 2011 to September 2018. Thirty patients were evaluated and divided in two groups depending on the fluid management (restrictive, or liberal). The data were collected from the anesthesia protocols and nursery reports (until 3rd postoperative day). Demographics, length of stay, kind of fluid management and complications were analyzed. For statistical analysis SPSS®v.21 was used (p < 0.05 was considered significant). Results. Out of 30 patients, 17% were male, mean age was 55 ± 18 years (r 19-82); 17 patients (57%) were included in the liberal group and 13 (43%) in the restrictive group. Twenty-three patients developed complications; 16 (53%) belonged to liberal group whereas 7 (23%) to restrictive group. (p = 0.01). Fourteen patients of liberal group vs. 6 patients of restrictive group had postoperative pancreatic fistula (p = 0.04). There were 7 patients (23%) in liberal group. and 4 (13%) patients in restrictive group with clinically relevant pancreatic fistula (13%, p = NS). Ninety day-mortality was 3.3, with no differences between groups. Conclusion. After laparoscopic distal pancreatectomy, liberal fluid administration at the perioperative period is associated with an increase in the incidence of complication, specially favoring the development of pancreatic fistula.

Perioperative fluid managment and postoperative complications after laparoscopic distal pancreatectomy

Presenter: Pablo Barros | Hospital Universitario Fundación Favaloro Background: Despite mortality in pancreatic surgery has decreased over the last decade, morbidity still remains high. One of the most important causes for this is the occu pancreatic fistula. Recent studies have demonstrated the importance of fluid management during the post-operative period in major abdominal surgeries. This finding was observed in colonic surgery as well, demonstrating that the overcharge of fluids increases post-operative complications. We aime to evaluate the impact of fluid management on post-operative complications after videolaparoscopic distal pancreatectomy (VDP). Methods: Descriptive, retrospective study of a prospective database of patients who underwent VDP from November 2011 to September 2018. Thirty patients were evaluated and divided into two different groups according to the fluid management protocol used (restrictive or liberal). The data were collected from the anesthesia`s protocols and nursery reports (until 3rd post-operative day). Demographics, length of stay, kind of fluid management and complications were analyzed. For statistical analysis SPSS®v.21 was used (p= < 0.05 was considered significant) Results: Out of 30 patients, 17 (%) were male, mean age was 55 years(r 19-82); 17 patients (57%) were included in liberal group (LG) and 13 (43%) in restrictive group (RG). Twenty-three patients developed complications;16 (53 %) belonged to LG whereas7 (23 %) to RG(p=0,01). Fourteen patients of LG vs. 6 patients of RG had post-operative pancreatic fistula (p=0.04). There were 7 patients (23 %) in LG and 4 (13 %) patients in RG with POPF-CS (13 %, p=ns). 90-day-mortality was 3.3 % Conclusion: After videolaparoscopic distal pancreatectomy, liberal fluid administration at the perioperative period is associated with an increase in the incidence of complication, specially the development of POPF.

Pulmonary Function Tests Abnormalities Predictors In Smoker Patients

Background: Smoking remains the most preventable cause of premature death and morbidity in the US and the developed world. Cigarette smoking is the most well known risk factor for accelerating lung function decline in adults. This study aimed to evaluate pulmonary function tests abnormalities predictors in smoker patients Materials and methods: This case-control study was done in Merjan teaching Hospital, Babylon, Iraq, in the period from December 2010 to March 2012. The study included 182 patients who were divided into 114 patients in obstructive group and 68 patients in restrictive group. Duration and amount of smoking were evaluated by pack years. Spirometry was done for each patient. The effects of smoking were compared between obstructive and restrictive chronic lung diseases.&#x0D; Results: The ages of patients in both groups ranged from 31-70 years. Most of patients were males (65% in obstructive group while 58% in restrictive group). There was significant correlation between pack years and degree of dyspnea (functional state),in addition there was significant correlation between pack years and severity of obstructive and restrictive diseases.&#x0D; Conclusions: The results of this study indicate that effects of smoking were more in obstructive group than restrictive group. It was established that lung function (FEV1,FVC and FEV1%FVC) decreases with increasing number of pack years. Lung function was related inversely to pack years of cigarette use.

Relationship between restrictive Doppler mitral inflow pattern and myocardial viability after a first acute myocardial infarction

Abstract Objective This study was designed to evaluate the relation between restrictive Doppler mitral inflow pattern and echocardiographic indices of myocardial viability in patients with first acute myocardial infarction undergoing dobutamine stress echocardiography to determine the extent of infract zone viability. Methods Fifty-six consecutive patients were studied 7 days after first ST-elevation acute myocardial infarction with high dose dobutamine stress echocardiography. A score model based on 16 segments and four grades was used to assess the left ventricular function. Viability was defined as an improvement in wall motion by at least one grade in two or more dysfunctional segments during any stage of the dobutamine infusion compared with the baseline. Pulsed-wave Doppler mitral inflow velocity was obtained at baseline (prior to dobutamine infusion) and restrictive pattern defined as E/A ratio ⩾ 2 and E-wave deceleration time ⩽ 140 ms. Results Restrictive mitral inflow pattern was detected in 25 (45%) patients. Seventeen (68%) patients in restrictive group received thrombolytic therapy while 26 (84%) in the non-restrictive group received this therapy (P = 0.001). Viability in the infracted territory was detected in 17 (54%) out of 31 patients in non-restrictive group, while only 3 (12%) out of 25 patients in restrictive group showed evidence of contractile reserve (P = 0.0001). Conclusions This study showed a strong association between restrictive Doppler mitral inflow pattern and lack of myocardial contractile reserve during dobutamine stress echocardiography in patients with a first acute myocardial infraction.