Percent Of Women In Group Research Articles

CLINICAL EFFICACY OF TREATMENT OF WOMEN WITH CHRONIC RECURRENT UROGENITAL CHLAMYDIA INFECTION.

Aim: To to increase the efficacy of the treatment of women diagnosed with complicated urogenital chlamydia infection based on the study of the immune status, clinical and pathogenetic features of the course, development and implementation of pathogenetically substantiated therapy methods. Materials and methods: Laboratory diagnostics of chlamydia infection was conducted with the use of direct immunofluorescence, enzyme immunoassay and cytological method. The dynamics of clinical symptoms was studied in the patients of Group I (64 women) who received Wobenzym in combination with Doxycycline and Group II (64 women) who were treated with conventional therapy (CT). Results: Clinical effectiveness of the treatment of women in Groups I and II was analyzed. The treatment according to our developed method was well tolerated by all the patients. No manifestations of the disease exacerbation which could be associated with the inclusion of these drugs in the comprehensive treatment were noted. The insignificant effectiveness of our treatment in the examined patients with complicated urogenital chlamydia infection in Groups I and II was distributed as follows: only 1 (1.56%) woman (Group I) had an insignificant improvement in clinical manifestations after the treatment according to our method. An insignificant improvement in the clinical manifestations after the treatment with conventional therapy (Group II) was observed in 4 women constituting 6.25%. Unfortunately, a small percentage of women in Groups I and II with no changes in clinical symptoms after the treatment was observed. In particular, the absence of treatment effectiveness was noted in 3 (4.69%) women after the application of our method and in 6 women (9.38%) who were treated by the conventional therapy. Therefore, these women were prescribed an additional course of treatment. Conclusions: The dynamics of clinical symptoms was found to be significantly more pronounced and fast in the patients of Group I compared to the patients in Group II who were treated with conventional therapy.

Outcome of aortic dissection affecting the descending aorta in Marfan Syndrome

Abstract Introduction Marfan syndrome (MFS) is a connective tissue disorder related to FBN1 mutations. The main cardiac feature of this syndrome is the enlargement and the dissection of the ascending aorta. Close monitoring of the aortic root diameters and its preventive replacement has allowed improving life expectancy of these patients in the last decades. However, there is paucity of data about the outcome of aortic dissection affecting the descending aorta and its markers of poor evolution. Purpose To characterize patients with MFS and dissection involving the descending aorta. To compare baseline characteristics and the clinical outcome between patients with isolated type B dissection (Group B) and patients with type A dissection with residual B dissection (Group A). Methods Retrospective longitudinal analysis of patients that attended our Marfan unit between 2001 and 2021 with an aortic event involving the descending aorta. Clinical data were collected from electronic health records. Results From the global cohort of adults with Marfan syndrome seen at our centre, we identified a total of 37 adults (11.5% of the overall cohort) that had an acute aortic event with involvement of the descending aorta. 20 (54.1%) were type A aortic events and 17 (45.9%) were isolated type B dissections. Cardiovascular risk factors were similarly distributed in both groups but there was a significant higher percentage of women in Group B (35.0% vs 76.5%, p=0.012) (Figure 1). Acute management of the aortic event implied surgery in 17 (85.0%) patients in Group A and in 5 (29.4%) patients in Group B (p=0.001). In Group B, interventions were 3 TEVAR and 2 open surgeries. 2 (5.4%) patient died during the acute phase, 1 (5.0%) in Group A and 1 (5.9%) in Group B (p=ns).The remaining 35 patients (19 in Group A, 16 in Group B) were followed-up for 10.4±6.7 years. 10 patients died during follow-up (6 in Group A, 4 in Group B). In Group A, 2 patients died of sudden death, 2 patients died in the perioperative setting of aortic surgery, and 2 patients died of an aortic rupture. In Group B, 3 patients died in the perioperative setting of aortic surgery and 1 of an intracranial hemorrhage. The proportions of aortic events during follow-up (death, distal redissection, proximal dissection, distal intervention or aortic root surgery) in both groups are described in Figure 2. Median survival free of reintervention or death (non-related to initial event) was 7.5 years in the overall cohort; 8.2 years in Group A and 2.2 years in Group B (log rank p=0.04) (Figure 2). Conclusions Patients with Marfan syndrome and aortic dissection involving the descending aorta have a poor clinical outcome, with high rates of reintervention, redissection or death. Although Group B required less often surgery during the acute phase, worst survival free of reintervention or death was observed during follow-up. Funding Acknowledgement Type of funding sources: None.

5-Methyltetrahydrofolate and Vitamin B12 Supplementation Is Associated with Clinical Pregnancy and Live Birth in Women Undergoing Assisted Reproductive Technology

The homocysteine pathway in the preconception period should be evaluated to highlight micronutrient deficiencies and warrants optimal multivitamin supplementation, before Assisted Reproduction, as preconception care. We conducted a retrospective study aimed at investigating the role of vitamin B complex (5-methyltetrahydrofolate, vitamin B12, vitamin B6) supplement use compared with the role of only folic acid supplement use, in relation to clinical pregnancy and live birth in infertile women undergoing homologous ART. We investigated 269 Caucasian women referred to the Centre for Assisted Reproductive Technology for homologous ART. In these women, 111 (Group A) were daily supplemented with vitamin B complex and 158 (Group B) with only folic acid. In group A the mean number of Metaphase II oocytes and the 2PN Fertilization Rate were higher in comparison to group A (p = 0.04; p = 0.05, respectively). A higher percentage of women in group A had a clinical pregnancy and live birth in comparison to group B (p = 0.01; p = 0.02, respectively). Vitamin B complex supplementation remained independently associated, after multivariable adjustment, with clinical pregnancy (OR 2.03, p = 0.008) and live birth (OR 1.83, p = 0.03). Women supplemented with 5-MTHF and vitamin B12, have a higher chance of clinical pregnancy and live birth in comparison to those supplemented with only folic acid.

LATERAL POSITION OF PLACENTA DETECTED ON ULTRA-SONOGRAM AT 18 TO 24 WEEKS OF PREGNANCY AS A PREDICTOR FOR DEVELOPMENT OF PREECLAMPSIA

The placenta is an important organ that connects the mother to the fetus. It is a well-known cause of pregnancy hypertension. The position of the placenta and the development of preeclampsia are linked in several studies. The purpose of this study was to determine whether the percentage delay as determined by ultrasound could be used as a predictor of the development of preeclampsia. A retrospective and prospective, and observational study was done in Choithram Hospital & Research Centre, Indore. The study was done on 130 pregnant women, out of which 62 females had laterally located placenta and 68 had centrally located placenta selected randomly from November 2015 to November 2017. Preeclampsia developed in 68.09 percent of women in the lateral placenta group. Only 31.91 percent of women in the group with the central placenta developed preeclampsia. As a result, females with a laterally positioned placenta had a 3.7 times higher risk of having PIH than those with a centrally situated placenta. With a laterally placed placenta, the overall chance of having PIH was 3.769. This study, laterally located placenta increased association of development of preeclampsia in patients than centrally located placenta which reduces the hospital burden, and long term consequences of the disease thereby reducing the huge cost of critical care for mother and newborn. Thus, making ultrasonography a cost effective, practical, painless, beneficial and reliable screening tool.

COVID-19 Pandemic Impacts Decision-Making and Psychosocial Behavior in Women Seeking Fertility Treatment in APAC—an ASPIRE Patient Experience Report

Background: ASPIRE (Asia-Pacific Initiative on Reproduction) aims to develop a “patient-centered” guide to provide fertility treatment based on patient preferences, needs, and concerns during and beyond the SARS-Cov-2 pandemic. Methods: Women, aged 20–45 years old, trying to conceive for more than 6 months and contemplating for pregnancy including IVF treatment. A country wise analysis of patient behavior, attitudes and concerns, reasons for disruption of treatment and availability of assistance from fertility clinics during SARS-Cov-2 pandemic was performed. Six problem statements addressing patient concerns were identified and corresponding solutions to improve patient experience were formulated. A two-tier recommendation was developed. Tier 1 comprises recommendations in which the rate of “absolutely agree” responses were [Formula: see text]60%, whereas tier 2 refers to recommendations in which the rate of “absolutely agree” plus “agree” together was >60%. Results: Women in countries that have better infection control and are living a new normal were less worried about the pandemic influencing their lifestyle and finances. The proportion of women choosing not to continue IVF/IUI treatment during COVID-19 was similar across countries. Sixty-five percent of women in Group A intend to continue treatment during COVID-19 pandemic. Nine out of 10 patients are expected to resume or start treatment once fertility clinics are accessible. A patient-centered guide focusing on management of patient safety concerns, reduction in difficulty of access to hospitals, prioritization of patients, provision of emotional support, and improvement in patient education and acceptance of remote health services was developed. Conclusion: This ASPIRE patient experience report highlights a patient-centered guide on provision of safe fertility treatment across the Asia-Pacific region, which can be adapted to suit country-specific requirements depending on the stage of the pandemic, local restrictions, and availability of resources.

Features of childbirth and the postpartum period in women who have undergone destructive treatments for cervical pathology

In the complex mechanism that controls the onset of labor, there are many factors, among which an important role belongs to the cervix, so to reduce the risk and development of obstetric and perinatal complications, the problems of timely diagnosis and adequate treatment of cervical diseases are still relevant today.The objective: еvaluate the features of childbirth and the postpartum period in women who have undergone destructive treatments for cervical pathology.Materials and methods. All examined women (n=201) after destructive methods of treatment of the cervix for dysplasia of I–III degree (electroconization, cryodestruction, laser vaporization or radiowave excision) were divided into 3 groups: 1 group (retrospective, n=114) – patients, in which features of childbirth and the postpartum period were studied anamnestically; 2 group (prospective, n=57) – women who were included in the study immediately after surgery; 3 group (control, n=30) – almost healthy women. Patients in the comparative groups were comparable in age (mean age 25,7±4.4 years) and the course of the pathological process in the cervix.Results. During the 5 years of the study, the peculiarities of the course of childbirth, the condition of newborns and the postpartum period in patients after surgery were studied. In the 1st group of subjects 114 pregnancies were registered, of which 97 ended in childbirth: naturally – in 66 women (57,9%), cesarean section – in 31 (27,2%). The main complications in childbirth were weakness of labor (44 patients – 45,4%), fetal hypoxia (41 patients – 42,3%), premature birth (36 patients – 37,1%).In the 2nd group of women 57 pregnancies were registered (50 births): naturally – in 7 patients (12,3%), cesarean section – in 43 women (75,4%). The most common complication in this group was placenta previa (6 cases – 12,0%).In the control group, 30 pregnancies (27 births) were registered: in 22 women (73,3%) by natural means, in 5 (16,7%) – by cesarean section. The most common complications of childbirth in this group were weakness of labor (4 cases – 14,8%), bleeding in the postpartum period (3 patients – 11,1%) and hypoxia of the fetus (3 cases – 11,1%).The high percentage of women in group 1 who were diagnosed with ruptures of the cervix of varying severity (the largest in patients after electroconization), in groups 2 and 3, isolated cases were noted.In all three groups, more than half of the newborns had normal body weight (3000 to 4000 g) and a high Apgar score (8 to 9 points).Conclusion. In the analysis of childbirth in women of the three study groups, it was found that compared with somatically healthy women (group 3) in patients after destructive treatment of cervical pathology (groups 1 and 2) there is a decrease in the proportion of births through natural routes (73,3%, 57,9% and 12,3%, respectively) and an increase in the proportion of births by cesarean section (16,7%, 27,2% and 75,4%). The highest percentage of surgical interventions was recorded in the first two groups in women after amputation and conization of the cervix, the lowest – in patients after laser vaporization and radiosurgical excision. Therefore, these methods of destruction of the cervix are the least traumatic, can cure the underlying disease and preserve reproductive function.

Effect of Electronic Video Education on Patient's Self-Assessed Knowledge About Obesity and Pelvic Floor Disorders: A Randomized Controlled Trial.

The objective of this study was to study the effect of electronic video education on patient's self-assessed perception of knowledge about pelvic floor disorders in relation to obesity in a prospective randomized controlled trial. From June to July 2015, women with a body mass index of 25 kg/m or higher seeking care at a single urogynecology center were recruited and randomized into either a standard visit with an 8-minute video (group A) or a standard visit control (group B). Randomization was performed with computer-generated number blocks of 4. Allocation sequence was concealed from the caregiver, in sequentially numbered, opaque, and sealed envelopes. Immediately after their visit, patients answered a series of 3 questionnaires, which were statistically analyzed using unpaired t tests, Wilcoxon rank sum and analysis of variance tests, presented as mean and standard deviation. Primary outcome was a difference in self-assessed perception of knowledge questionnaire scores. Secondary outcome was a difference in motivation to lose weight. Forty-eight women enrolled, and 40 completed all questionnaires, 20 in each group. Representation in both groups was demographically similar. The mean (SD) answers for the postvisit survey measuring participant's self-assessed perception of knowledge was 3.9 (0.8) for group A and 3.5 (1.1) for group B (P = 0.002). Ninety percent of women in group A reported motivation to lose weight, compared with 75% in group B (P = 0.4). Participants who received electronic video education scored significantly higher on self-assessed perception of knowledge questionnaire about pelvic floor disorders in relation to obesity. The video did not increase motivation to lose weight.

Small group gender ratios impact biology class performance and peer evaluations.

Women are underrepresented in science, technology, engineering, and mathematics (STEM) disciplines. Evidence suggests the microclimate of the classroom is an important factor influencing female course grades and interest, which encourages retention of women in STEM fields. Here, we test whether the gender composition of small (8–9 person) learning groups impacts course performance, sense of social belonging, and intragroup peer evaluations of intellectual contributions. Across two undergraduate active learning courses in introductory biology, we manipulated the classroom microclimate by varying the gender ratios of learning groups, ranging from 0% female to 100% female. We found that as the percent of women in groups increased, so did overall course performance for all students, regardless of gender. Additionally, women assigned higher peer- evaluations in groups with more women than groups with less women. Our work demonstrates an added benefit of the retention of women in STEM: increased performance for all, and positive peer perceptions for women.

A randomised trial to compare 200 mg micronised progesterone effervescent vaginal tablet daily with 250 mg intramuscular 17 alpha hydroxy progesterone caproate weekly for prevention of recurrent preterm birth

For prevention of a recurrent preterm birth (PTB), intramuscular 17-α-hydroxy progesterone caproate (IM 17 OHPC) weekly is recommended. Vaginal progesterone is preferred for women at risk for PTB due to a short cervical length, but may be useful in women with a prior PTB. However, there is no consensus about the optimal vaginal formulation or its efficacy as compared to 17 OHPC to prevent recurrent PTB. We randomised 100 women with a singleton pregnancy between 16 and 24 weeks of gestation and ≥ one prior spontaneous PTB, of a singleton (>16 to <37 weeks of gestation) to receive the 200 mg vaginal progesterone effervescent tablet daily (Group A) or IM 17-OHPC, 250 mg weekly (Group B) till 37 weeks of gestation or delivery. The spontaneous PTB rate of <37 weeks was similar (20% in Group A and 20.8% in Group B, p = .918). The PTB rate of <34 weeks or <28 weeks were also comparable. The mean birth weight and other neonatal outcomes were similar in the two groups. Two neonates in Group A and four neonates in Group B required NICU admission, one of whom (Group B) died due to prematurity. Twenty percent of women in Group A and 29.2% in Group B reported adverse effects from their respective study medications (p = .408, NS). Thus, there did not appear to be a difference between vaginal progesterone and 17-OHPC when used for the prevention of a recurrent PTB.Impact statementWhat is already known on this subject? Progesterone administration is useful for prevention of a recurrent preterm birth (PTB) and these women are prescribed the intramuscular 17-α-hydroxy progesterone caproate (IM 17 OHPC), 250 mg, weekly. Some studies found that vaginal progesterone (once daily) is also beneficial in these women, but there is no consensus regarding its efficacy when compared to 17 OHPC, or its optimal formulation and dose.What do the results of this study add? In the present study, 100 women with a singleton pregnancy between 16 and 24 weeks of gestation and ≥ one prior spontaneous singleton PTB or mid-trimester abortion were randomised to receive 200 mg of vaginal progesterone effervescent tablet daily (Group A) or 250 mg IM 17-OHPC weekly (Group B) till 37 weeks of gestation or delivery. The spontaneous PTB rate <37 weeks was similar in the two groups (20% in Group A and 20.8% in Group B, p = .918). The PTB rate <34 weeks or <28 weeks were also comparable. The mean birth weight and other neonatal outcomes were similar. Twenty percent of women in Group A and 29.2% of women in Group B reported adverse effects from their respective study medications (p = .408, NS). Thus, there did not appear to be a difference between the vaginal progesterone effervescent tablet and 17-OHPC when used for the prevention of a recurrent PTB.What are the implications of these findings for clinical practice and/or further research? The vaginal progesterone effervescent tablet may be a suitable alternative to IM 17 OHPC to prevent recurrent PTB. Future studies should identify the most appropriate route (IM or vaginal) and vaginal progesterone formulation for PTB prevention in women at risk for a recurrent PTB and in women with a short cervical length.

Cosmetic Vulvar Surgery and Perception of Vulvar Appearance

Cosmetic vulvar surgery has been popularized as more women who believe their vulvas to be abnormal seek ‘corrective’ surgery. Primary aim: to determine if women age 18 to 44 years (Group 1) are less likely to perceive their vulva as normal compared to women age 45 to 72 years (Group 2). Secondary aim: to determine if age impacts interest in cosmetic vulvar surgery. This IRB approved cross-sectional survey was conducted during July - September 2011. Women completed 24-items. Data was collected on demographics, perceptions of vulvas, grooming patterns, and sources of educational information. Participants were asked to identify which vulva appeared “normal” from 4 pairs of photographs. Washington Hospital Center, Georgetown University, and a community fair. Women ages 18 to 72. 516 women were approached; 121 declined, leaving 395 women, response rate 77%. Participants were grouped in two age categories: Group 1 (n = 207)and Group 2 (n = 147). A significantly larger percentage in Group 1 worked in health care (93% vs. 69%, p<0.01), were single (47% vs. 22%, p<.01), and sexually active (84% vs. 70%, p< 0.01). There was no difference in how often women looked at their vulva or in the perception that they had a normal vulva (Group 1: 91% vs. Group 2: 93%, p = 0.76). The two groups were similarly satisfied with the appearance of their vulva (81% vs. 82%, p = 0.71). A higher percentage of women in Group 2 would consider cosmetic surgery versus Group 1 (15% vs. 8%, p = 0.05). Women's age does not impact perception of a normal vulva. The majority of women, approximately 90%, perceived their vulva to be normal and were satisfied with their appearance. Despite this, older women are more interested in cosmetic vulvar surgery even though they are less sexually active.

Shoulder Dystocia: What is the Risk of Recurrence?

Shoulder dystocia is a unpreventable obstetric emergency complicating 0.19-3.3% of deliveries. Although a large number of potential risk factors for shoulder dystocia have been investigated, only in about one quarter of cases has at least one significant risk factor has been found, and the positive predictive value of antepartum factors individually and combined is low: <2% and <3%, respectively. There are few data on the risk of recurrence of shoulder dystocia in subsequent pregnancies and on the identification of women at risk of recurrence. Because the predisposing factors for the initial dystocia might be present in all subsequent pregnancies, it is assumed that previous shoulder dystocia is a risk factor for recurrence. This retrospective study evaluated the risk of recurrence of shoulder dystocia and investigated potential risk factors for recurrence in a population of Lebanese women. The investigators used medical records and charts to identify 193 women with shoulder dystocia (0.9%) among a population of 22,207 who had vaginal deliveries between 1990 and 2005. Of the 193 women with a first episode of shoulder dystocia, subsequent vaginal delivery occurred in 44 cases (index pregnancy). Recurrent shoulder dystocia was found in 11 cases (11/44, 25%). The investigators compared pregnancy characteristics among index pregnancies who developed recurrent shoulder dystocia (group I, n = 11) and those with no recurrence (group II, n = 33). No significant difference was found between the two groups for gestational age at delivery, parity, maternal age, duration of labor, gender, history of macrosomia, and obesity. The only significant differences between these groups were a larger mean birth weight for group I compared to group II (4019 ± 430 versus 3599 ± 398 gm, P ≤ 0.005); a higher percentage of women in group 1 with larger birth weight than in their prior pregnancy (72.7% versus 33.3%, P ≤.035); and a higher rate with macrosomia (≥4000) gm in group I (63.6% versus 15.2%, P ≤.004). Among these variables in multiple logistic regression analysis, the only independent risk factor associated with recurrence was larger birth weight in subsequent pregnancy (P ≤.008). The data show that the risk of recurrence of shoulder dystocia is about 25% in this study population, a rate higher than in previous studies. The investigators conclude that a lower birth weight than the previous pregnancy and absence of macrosomia (<4000 gm) may lower the risk.

Does urethral competence affect urodynamic voiding parameters in women with prolapse?

To (1) compare voiding parameters and (2) correlate symptoms and urodynamic findings in women with pelvic organ prolapse (POP) and varying degrees of urethral competence. We compared three groups of women with stages II-IV POP. Groups 1 and 2 were symptomatically stress continent women participating in the Colpopexy and Urinary Reduction Efforts (CARE) trial; during prolapse reduction before sacrocolpopexy, Group 1 (n = 67) did not have and Group 2 (n = 84) had urodynamic stress incontinence (USI) during prolapse reduction. Group 3 participants (n = 74), recruited specifically for this study, had stress urinary incontinence (SUI) symptoms and planned sacrocolpopexy. Participants completed standardized uroflowmetry, pressure voiding studies, and validated symptom questionnaires. Subjects' median age was 61 years, median parity 3 and 87% had stage III or IV POP. Fourteen percent of women in Group 3 demonstrated USI without, and 70% with, prolapse reduction. Women in Groups 2 and 3 had more detrusor overactivity (DO) than Group 1 (17 and 24% vs. 6%, P = 0.02) and detrusor overactivity incontinence (DOI) (15 and 8% vs. 0%, P = 0.004). Based on the Blaivis-Groutz nomogram, 60% of all women were obstructed. Post-void residual volume (PVR), peak flow rate, detrusor pressure at peak flow, voiding mechanisms, voiding patterns, obstruction and urinary retention did not differ among groups. Women in Group 3 had higher irritative and obstructive symptom scores than Group 1 or 2; neither score differed by presence of DO nor obstruction, respectively. Women with POP have significant rates of urodynamic obstruction and retention, independent of their continence status. Symptoms of obstruction and retention correlate poorly with urodynamic findings.

Reduced Expression of Interleukin-11 and Interleukin-6 in the Periimplantation Endometrium of Excessive Ovarian Responders during in Vitro Fertilization Treatment

Impaired implantation in assisted reproduction cycles with high serum estradiol (E2) concentrations may be related to abnormal endometrial functions. The in vivo expression of T helper type 2 (Th2) cytokines in the periimplantation endometrium of infertile patients was compared between natural and stimulated cycles. Uterine flushings and endometrial biopsies were collected 7 d after the LH surge in natural cycles or after human chorionic gonadotropin injection in stimulated cycles. Th2 cytokines were determined by immunolocalization and by ELISA. Natural cycles were in group A, whereas stimulated cycles with peak serum E2 of no more than 20,000 pmol/liter (moderate responders) and more than 20,000 pmol/liter (excessive responders) were classified as group B and group C, respectively. Higher E2 had a negative effect on IL-11 and IL-6 expression in the endometrium and IL-11 concentration in the uterine flushing. In endometrial biopsies, a significantly lower immunostaining of stromal IL-11 (P < 0.001) and glandular IL-6 (P < 0.05) was detected in group C compared with that of groups A and B. IL-11 concentration by ELISA was significantly lower in group C (P < 0.05). Endometrial leukemia inhibitory factor and IL-4 expression was similar in the three groups. In uterine flushings, a significantly higher percentage of women in group C had undetectable IL-11 and a lower IL-11 concentration (P < 0.01) compared with group A, whereas no difference in IL-6 concentration was noted in the three groups. Reduced expression of IL-11 and IL-6 in periimplantation endometrium may account for lower implantation in excessive responders.

Comparación de dos posiciones de electrodos en la cardioversión eléctrica de la fibrilación auricular

This study aims to compare effectiveness of electrical cardioversion (ECV) in patients with chronic atrial fibrillation (AF) according to the electrode positions: anteroapical (A-A) or anteroposterior (A-P). That which restores the sinus rhythm (SR) using the least energy is considered superior. Observational study comparing two consecutive series of patients. SCOPE. Intensive Care Unit (ICU) of second level hospital. Out-patients in AF referred to the ICU for biphasic ECV. The first series began with position A-A and the second one with A-P, administering up to 3 shocks (150-200-200J), changing to the alternative position if SR was not achieved and administering 2 more shocks of 200J. Age, gender, weight, baseline heart disease, ejection fraction, left atrial size, AF time, baseline vital signs, antiarrhythmic medication, reversion to SR, number of shocks, energy used and side effects were analyzed and compared between both series. RESULTS. A total of 50 patients were treated in each group. The baseline characteristics were similar except for a greater percentage of women in group A-A. The anteroapical electrode position achieved SR with significantly fewer numbers of shocks and less energy, more frequently achieving reversion on the first shock. We found greater effectiveness in the electrical cardioversion of the AF with the electrodes in the anteroapical position, that we recommend as first choice. If it is not effective, the A-P position should be attempted.

Elevated serum müllerian-inhibiting substance may be a marker for ovarian hyperstimulation syndrome in normal women undergoing in vitro fertilization

We identified patients who experienced ovarian hyperstimulation syndrome (OHSS) (n = 16) and compared their baseline pretreatment levels of müllerian-inhibiting substance (MIS) to age- and weight-matched patients with normal responses to gonadotropins (n = 14). Baseline serum MIS in patients with OHSS were sixfold higher than those seen in normal controls (3.62 +/- 0.87 vs. 0.63 +/- 0.09 ng/mL; P=.0036), indicating that MIS could potentially serve as a useful marker for identifying patients at risk for OHSS.

Incidental Parathyroidectomy during Thyroid Surgery: An Underappreciated Complication of Thyroidectomy

The aim of this study was to investigate the incidence, risk factors, and clinical relevance of incidental parathyroidectomy during thyroid surgery. Prospective analysis of data in patients following thyroidectomy, specifically regarding the presence of parathyroid parenchyma in the thyroidectomy specimens, the underlying thyroid pathology, and the presence of postoperative hypocalcemia (biochemical/clinical). The clinical records of 158 patients who underwent thyroid surgery during a 2-year period were reviewed. Pathology reports were carefully reviewed for the nature of the underlying thyroid disease, the presence, number, and size of incidentally resected parathyroid gland(s), their location, and possible parathyroid pathology. Serum calcium levels were measured preoperatively, on the day of surgery, and on postoperative days 1, 2, and 7 or even later as needed. Two groups of patients were studied: a group with incidental parathyroidectomy following thyroidectomy (group A) and a group without incidental parathyroidectomy after thyroidectomy (group B). Total/near-total thyroidectomy was the procedure of choice and was performed in 154 patients; total lobectomy and contralateral subtotal lobectomy was performed in the other 4 patients. Elective central neck lymph node dissection was performed in four patients with neck lymphadenopathy. Inadvertently removed parathyroid tissue was found in 28 cases (17.7 %); in 6 of these patients (21%) the parathyroid tissue was intrathyroidal. The percentage of women in group A was significantly higher than in group B (93% vs. 58.5%, P = 0.0002). There was no statistically significant difference between the two groups (A and B) regarding the preoperative (presumed) diagnosis, the histologic diagnosis of thyroid disease (benign versus malignant), the type/extent of surgery, or the presence of thyroiditis. Biochemical and clinical hypocalcemia was observed in 6 (21%) and 2 (7%) patients in group A, respectively, and in 30 (23%) and 8 (6%) patients of group B, respectively. There was no statistically significant difference regarding the occurrence of postoperative hypocalcemia (clinical/biochemical) between the two groups (P = 0.33). Incidental parathyroidectomy is not uncommon following thyroidectomy and in a significant percentage of cases it may be due to the intrathyroidal location of the parathyroid glands. Incidental parathyroidectomy was not found to be associated with postoperative hypocalcemia (biochemical/clinical). Incidental parathyroidectomy may be considered as a potentially preventable but clinically minor complication of thyroid surgery.

Vitamin D deficiency: a concern in premenopausal Bangladeshi women of two socio-economic groups in rural and urban region.

The study was designed to evaluate the vitamin D status in women of different physiological status of two socio-economic groups in Bangladesh. A cross-sectional study, using serum 25-hydroxyvitamin D (25-OHD), calcium, phosphorus and alkaline phosphatase activity. Two regions of Bangladesh. The Dhaka city area and west region of Nandail (Betagair Union), Mymensingh. Representative subjects of two groups (low socio-economic group=group L, n=99; and high socio-economic group=group H, n=90) of Bangladeshi women aged 16-40 y. About 87% of the subjects were housewives and the rest, 13%, were distributed among other different professions. Each group comprised of three sub-groups (non-pregnant non-lactating=1, pregnant=2, and lactating=3). The influence of socio-economic status and physiological status on serum 25-OHD concentration (P=0.038, P=0.015, respectively), serum calcium concentration (P<0.001, P<0.001, respectively) and alkaline phosphatase activity (P<0.001, P<0.001, respectively) were observed. The distribution of serum 25-OHD concentration in both groups was shifted overall toward the lower limit of the normal range. Seventeen percent of women in group L and 12% of women in group H had serum 25-OHD concentration <25 nmol/l. Hypovitaminosis D (serum 25-OHD concentration < or = 37.5 nmol/l) was observed in 50% of subjects in group L and 38% of subjects in group H, respectively. The prevalence of hypovitaminosis was higher in lactating subjects of the groups L and H (63 and 46%, respectively) than in the other sub-groups in the same group. The results of the study suggested that women in Bangladesh were at risk of hypovitaminosis D and lactation was an additional risk factor in low income groups. The situation may increase the risk of bone loss.

Changes in QUS and BMD Measurements with Antiresorptive Therapy: A Two-Year Longitudinal Study

There is lack of consensus on whether quantitative ultrasound (QUS) measurements can be used to monitor response to therapy. The aim of this 2-year longitudinal study was to assess whether calcaneal QUS measurement variables respond to antiresorptive therapy and whether these measurements display adequate long-term precision to be useful for monitoring purposes. The study population consisted of 195 postmenopausal women divided into three groups: Group 1: 39 women treated with antiresorptive therapy who commenced treatment at baseline; Group 2: 25 women treated with antiresorptive therapy who had been on treatment for at least 2 years at baseline; Group 3: 131 women who did not taken estrogen, bisphosphonates, or calcium during the 2-year study period. Subjects had baseline and 12 and 24 months follow-up BMD measurements at the lumbar spine (LS), femoral neck (FN), and total hip (THIP) and calcaneal QUS measurements of broadband ultrasound attenuation (BUA) and speed of sound (SOS). BUA and SOS were combined to provide an estimate of heel BMD (Est heel BMD). For women in Group 1, all BMD and QUS measurement variables increased significantly from baseline after 2 years of treatment. For women in Group 2, only THIP BMD and BUA increased significantly after 2 years and the changes were less than those observed in Group 1 women. The overall treatment effect for each measurement variable, defined as the difference in the mean absolute changes between Groups I and 3 after 2 years, was 0.08, 0.03, and 0.04 g/cm2 for LS, FN, and THIP BMD, and for BUA, SOS, and Est heel BMD it was 5.8 dB/MHz, 13.1 m/sec, and 0.05 g/cm2, respectively. When the overall treatment effect was expressed in T-score units, the effect was greatest for LS BMD (0.65 T-score units) and lowest for FN BMD (0.31 T-score units). QUS measurement variables yielded intermediate values of 0.43- 0.52 T-score units. The average least significant change (LSC) was 0.38 T-score units for BMD measurements, whereas the LSC for QUS measurements was three times greater at approximately 1.20 T-score units. Ninety-four percent of the women in Group 1 showed changes in LS BMD that exceeded the LSC after two years, while the percentage was lower for the other measurement variables ranging from approximately 6% for FN BMD, SOS and Est heel BMD to 50% for THIP BMD. A lower percentage of women in Groups 2 and 3 displayed changes that exceeded the LSC for both BMD and QUS measurement variables. Changes in all QUS variables were significantly correlated with changes in LS BMD, with correlation coefficients ranging from 0.26 to 0.40. In conclusion, calcaneal QUS measurement variables were found to show a highly significant response to antiresorptive therapy. However, the precision of QUS measurements was not good enough to allow QUS to be used for monitoring response to treatment. Future improvements in the precision of calcaneal QUS measurements are required to increase the utility of QUS for monitoring purposes.