Success Of Medical Treatment Research Articles

EFFECT OF EMPLOYEE LABOR EXPENSES ON THE RESPONSE TIME IN EMERGENCY DEPARTMENT OF SAMPANG HOSPITAL, INDONESIA

Background: The Emergency Department (ED) has the main purpose of receiving, triageing, stabilizing, and providing acute health services to patients, including those who require resuscitation and emergency patients to some degree. An indicator of the success of medical treatment of emergency patients is the speed of providing adequate assistance both in daily routine situations or during disasters. Factors that influence nurses’ motivation to work, especially implementing triage at the Emergency Department include the characteristics of nurses such as age, sex, education, length of work and training. Objective: To analyze the effect of workload of the medical staff of the Emergency Department on the response time in the Emergency Department of Sampang Hospital, Indonesia. Materials and Methods: Observational analytic research with cross-sectional design. Sampling was performed with total sampling method to 24 people who met the criteria. Data collection was done by questionnaire and observation. Data were analyzed using the Chi-square correlation test and Fisher’s exact test. Results: There was a significant influence between workload and response time of triage P1 of Emergency Department staff at Sampang Hospital, Indonesia (p=0.015), whereas in triage P2 and P3 there was no effect of workload of staff on response time (p>0.05). Conclusion: In Emergency Department of Sampang Hospital, Indonesia, the response time in all categories of emergency (P1/red, P2/yellow, and P3/green) is fast. Workload correlates significantly with response time in P1/red category, while in P2/yellow and P3/green categories the workload has no effect on the response time.

Outcomes of cesarean scar pregnancy treatment: Do we have options?

Objective:To investigate the success and complications of medical and surgical modalities used in the treatment of cesarean scar pregnancies.Materials and Methods:Medical and surgical approaches that have been used to treat cesarean scar pregnancies were evaluated retrospectively, Local, systemic, and combined methotrexate treatments were grouped as the medical approach, and dilatation and evacuation, hysteroscopic resection, laparoscopic and laparotomic approaches were grouped as the surgical approach. Fifty-three patients were diagnosed as having cesarean scar pregnancy during the study period, 48 of whom were included in the final analysis. Eighteen patients were treated with medical interventions and 30 patients were treated surgically.Results:The success rate of surgical modalities was 96.6% and the medical treatment success was 33% (p<0.001). The complication rate was higher with medical approaches compared with surgical methods (66% vs 3.3%, respectively; p<0.001).Conclusion:Surgical intervention seems safer and more successful than medical treatment.

Are the immature granulocyte count and percentage important in continue medical treatment in acute appendicitis? A prospective, randomized, and controlled study.

Although appendectomy is still a curative therapy for acute appendicitis, medical treatment has come to the fore in uncomplicated cases. This study aimed to determine the importance of immature granulocyte (IG) count and percentage for the role of medical treatment success in uncomplicated acute appendicitis. Acute appendicitis cases were prospectively registered between July 2019 and April 2020. Using ball drawing, patients were divided into two groups as medical treatment (Group M) and undergo appendectomy (Group A). Group M was divided into two subgroups as those who responded to medical treatment medically responded (MR) and failed medical treatment (MF) within 24 h of follow-up. Changes in IG count and percentage, C-reactive protein levels, neutrophil-lymphocyte ratio, and white blood cell count between initial administration and 24th h of follow-up were examined. Sixty-four patients who met the inclusion criteria were followed as 31 patients in Group A and 33 in Group M. At Sub-group MF 11 patients and Subgroup MR 22 patients were followed up. At the 24th h of the follow-up, the IG count and percentage were higher in the Group MF (for IG count: Between Group A and MF, p=0.002; between Group A and Group MR, p=0.111; and between Group MR and MF, p<0.001) (for IG percentage: Between Group A and MF, p=0.001; between Group A and MR, p=0.809; and between Group MF and MR, p=0.001). This decrease in the IG count and percentage suggests that the response to medical treatment was effective [for IG count: F (148.862) = 61, p≤0.001, η2=0.707] [for IG percentage: F (10.157) = 0.252, p≤0.001, η2=0.504]. IG count and percentage are effective for evaluating the success of medical treatment of uncomplicated acute ap-pendicitis and they guide in the decision to continue medical treatment of uncomplicated acute appendicitis.

COMMUNICATIVE COMPETENCE IS AN INTEGRAL PART OF THE QUALITY PROFESSIONAL ACTIVITY OF ANESTHESIOLOGIST

Preamble. Last years there were noticeable increase of interest to communicative capability which is meaningful component of physician’s professional activity seeing its considerable influence on quality of process of medical treatment and patient satisfaction.Capable physician behavior towards patient and his/her family members increase success of medical treatment and patient trust in physician.Problems in communication of anesthesiologist with patient are discussed in this article considering continuous increase of intensity of work and society requirements to medical professionals. Significance of highly developed communication experience in prevention of complaints and judicial claims is underlined.The aim of this article is to summarize separate information about communicative capability, peculiarities of communication of anesthesiologist with patient and show practical doctors’ way how they can improve communication.Materials and methods. Given in this article evidence are based on information that was derived from PubMed database, on recommendations of American Society of Anesthesiologists and data from «The Complete Guide to Communication Skills in Clinical Practice», materials published in foreign and domestic issues, experience.Results. The review of modern data highlighted in the article reflects the difficulties and peculiarities of communication between an anesthesiologist and patients and their relatives, based on the specifics of his work in the perioperative period at different stages of anesthesiologic support of surgical interventions and in the conditions of medical care provided to patients in the intensive care unit (ICU).Attention is focused on the high tension in the work of medical personnel, the high severity of the patient’s condition, which is accompanied by a decrease in the possible time for communication with the patient and his relatives.The recommendations given in the article will help the anesthesiologist to improve the existing communication skills and increase his desire to further improve them.

The effect of intrauterine device presence and other factors in medical treatment success of tuboovarian abscess

BackgroundTo identify the epidemiologic and clinical risk factors associated with failed response to medical treatment in tuboovarian abscess (TOA) patients and whether there is a relationship between the presence of intrauterine device (IUD), duration of use and medical treatment success or not. MethodsFor this study, the medical records of patients diagnosed with TOA and hospitalized in an 8-year period were analyzed retrospectively. The presence of TOA and IUD was confirmed ultrasonographically in all patients. Parenteral antibiotic treatment was initiated as the first step. Patients who did not improve with this medical treatment underwent surgery. Patients who recovered with medical treatment were defined as the successful group, while those who underwent surgery after medical treatment failure were recorded as the failed group. ResultsThere were 37 patients in successful group and 87 patients in failed group. The mean age, parity, white blood count, TOA size, duration of IUD use, rate of multigravida and multiparity were higher in the failed group. Logistic regression analysis revealed that presence of multiparity, TOA size and the duration of IUD use were significant independent factors in predicting medical treatment success of TOA. The best cut-off value for TOA size was 4.5 cm and for duration of IUD use was 5.5 years in the Receiver Operating Characteristic curve analysis. ConclusionThe presence of long-term IUD use, increased TOA size, and multiparity were found to be risk factors related to the failure of medical treatment in TOA cases.

Medical treatment for an isolated renal multilocular hydatid cyst in an elderly: a case report

BackgroundAlmost all cases of renal hydatid cysts need surgical intervention for treatment. We report a case of isolated renal hydatid cyst treated successfully only with medical therapy.Case presentationThis case is a 79-year-old veterinarian presented with right flank pain, hydatiduria and positive echinococcus granulosus serology. A 70*50 mm cyst with daughter cysts in mid-portion of right kidney on presentation was changed into a 60*40 mm cyst without daughter cysts at last follow-up. Due to patient’s refusal of surgery, our patient received medical treatment including praziquantel and albendazole. After completion of first round of treatment, recurrence occurred and the same treatment was repeated. At last, the cyst became inactive and calcified with negative serology and no clinical symptoms under medical treatment.ConclusionThe treatment of choice in renal hydatid cyst is surgery; although there are some reports about the efficacy of medical treatments for hydatid cysts but lower rates of recurrence and higher efficacy put surgery in a superior position compared to medical approaches. Our case showed relative success of medical treatment, despite the presence of a large multilocular renal involvement. Thus, medical therapy without surgery can be considered in very particular cases with isolated renal hydatid cysts.

STANDARDIZATION OF LAPAROSCOPIC TREATMENT PATIENTS WITH DEEP INFILTRATIVE ENDOMETRIOSIS

Despite the success of medical treatment of endometriosis, in cases of deep infiltrative endometriosis (DIE) accompanied by resistant pelvic pain and (or) infertility surgical treatment remains the method of choice.The aim of the study: standardization of methods and techniques of laparoscopic treatment of GIE using different surgical energies.Material and research methods. We conducted a retrospective analysis of cases of laparoscopic treatment of 126 patients with deep infiltrative endometriosis (DIE).The results and discussion: Standardized laparoscopic surgery for DIE included: laparoscopic revision of the pelvic and abdominal cavities; visceroadhesiolysis, DIE verification, identefication of ureteral; surgical treatment of endometriomas; lateral and (or) central resection of the peritoneum, resection of noduls of endometriosis, and, if necessary, sigmoid resection with the anastomosis. The use of the modern surgical energies in the standardized treatment of DIE helped to reduce the incidence of postoperative hyperthermia, intestinal paresis, prolonged drainage of the abdominal cavity, the length of stay in the hospital.Conclusions. Standardization of laparoscopic treatment of D IE using the latest surgical energies helps to improve the postoperative period, reduce the frequency of postoperative complications, length of hospital stay, which indicates the clinical and cost effectiveness of this surgical approach in the treatment of deep infiltrative endometriosis.

Stereolithography (SLA) 3D printing of ascorbic acid loaded hydrogels: A controlled release study.

Patients' genetic characteristics, age, gender, diet, and lifestyle affect the success of medical treatment. The treatment's effectiveness can be increased by using personalized medication; however, using conventional large-scale drug production methods can restrict tablet geometry and drug dosage combinations. To create these personalized drugs, 3D printing has been studied as an alternative production method. In this study, stereolithography 3D printing is used to create custom tablet geometries using a novel biocompatible photochemistry consisting of ascorbic acid (AA) encapsulated in a poly(ethylene glycol) dimethacrylate (PEGDMA)-based polymer network and polymerized using riboflavin as a photoinitiator. The printing process is customized for the chemistry and different geometries (small and large tablet, coaxial annulus, 4-circle pattern and honeycomb pattern) with surface area to volume ratios ranging from 0.6 to 1.83 are fabricated. The tablets' microstructures are examined and the cumulative release rates in gastrointestinal conditions are analyzed periodically for 6h. After 1h of release, honeycomb and coaxial annulus tablet gels exhibit higher release rates at approximately 80%. The experimental data is fitted to empirical release kinetic models and the Higuchi model is shown to yield the best fitting results. Overall, by using a novel biocompatible photochemistry and 3D printing we have shown that it is possible to successfully load and release ascorbic acid as a model agent, opening up a new class of manufacturing protocols to encapsulate ascorbic acid and other water-soluble vitamins as well as many different drugs for drug delivery applications.

Marfan syndrome revisited: From genetics to clinical practice

Abstract Marfan syndrome is an autosomal dominant connective tissue disease with an estimated incidence of 1 in 5000 individuals. In 90% of cases it is caused by mutations in the gene for fibrillin-1, the main constituent of extracellular microfibrils. Studies on animal models of Marfan syndrome have revealed that fibrillin-1 mutations interfere with local TGF-β signaling, in addition to impairing tissue integrity. The cardinal features involve the cardiovascular, ocular and skeletal systems. The diagnosis of Marfan syndrome is made according to the revised Ghent nosology. Early identification and appropriate management are critical for patients with Marfan syndrome, who are prone to the life-threatening cardiovascular complications of aortic aneurysms and aortic dissection. The standard treatment includes prophylactic beta-blockers in order to slow down dilation of the ascending aorta, and prophylactic aortic surgery. The success of current medical and surgical treatment of aortic disease in Marfan syndrome has substantially improved mean life expectancy, extending it above 72 years. This review aims to provide an overview of this hereditary disorder.

Abstract P561: Fall in the Proportion of Atherothrombotic Stroke in the Last Decade. Success of Current Medical Treatment?

Background and Purpose: Etiologic subtypes of ischemic strokes are influenced by the vascular risk factors profile of patients. Strict management of hypertension and dyslipidemia may have an impact on the prevalence of atherosclerosis. We evaluated changes in the proportion of different ischemic stroke etiologies during the last 22 years. Methods: We studied patients with acute ischemic strokes admitted to a single institution between 1997 and 2018. Demographics, VRF, treatments prior to admission and TOAST subtypes of ischemic strokes were assessed. These variables were compared between 2 periods: 1997-2007 (P1) and 2008-2018 (P2). Results: There were 2747 patients (64% men, aged 66.6 ±14.9 years), 920 subjects in P1 and 1827 in P2. Age and gender distribution did not change over time. Proportion of large artery atherothrombotic strokes decreased from 29% in P1 to 14% in P2 (p &lt;0.0001) and small vessel strokes from 15% in P1 to 11% in P2 (p &lt;0.05). Cardioembolic and undetermined strokes increased from 17 to 25% (p &lt;0.0001) and from 30% to 41% (p &lt;0.0001), respectively. Detection of atrial fibrillation increased from 10% to 19% (p&lt;0.00001). Use of medication prior to stroke increased for aspirin from 27% in P1 to 45% in P2 (p &lt;0.0001), for antihypertensive drugs from 26% to 62% (p &lt;0.0001), for statins from 14% to 42% (p &lt;0.0001) and for anticoagulants from 4% to 9% (p&lt;0.0001). Conclusion: The proportion of strokes associated to large and small vessel atherosclerosis is declining with a substantial increase in the proportion of cardioembolic and undetermined strokes. Higher rates of use of preventive medications and higher prevalence and/or better screening for atrial fibrillation could explain, at least in part, these findings.

The effect of ultrasonography in predicting medical treatment success in ectopic pregnancy

Ectopic pregnancy(EP) treatment success in a single dose methotrexate(MTX) regimen is decided by more than 15% β chorionic gonadotropin reduction in the 4th and 7th days after administration of 50mg/m² of medication. In our study , it was aimed whether the EP mass size less than 40mm detected by ultrasonography and the adnexal side on which it was located had an effect on the success of medical treatment.&#x0D; 82 patients who treated with MTX included in the study were divided into two groups as those with a single dose of methotrexate success and those without (n:67 vs n:15). The groups were compared in terms of age, parity, size of adnexal mass detected on ultrasonography, and the side of ectopic pregnancy.&#x0D; The parity rates and the age of patients were similar in both groups(p = 0.615, p = 0.742). Although the average adnexal mass size was found to be higher in the patient group those single dose MTX treatment was not successful, there was no statistically significant difference(p = 0.098). Ectopic pregnancy was frequently observed on the right side in the group in which the medical treatment was successful(66 % vs 33%).&#x0D; The effect of ectopic pregnancy mass size on medical treatment prediction was investigated in cases with mass size less than 40mm. Ectopic pregnancy mass size, even if it is below 40 mm, may not indicate the medical treatment success.

1260 Medical Treatment Success of Recurrent Ectopic Pregnancy vs. Primary Ectopic Pregnancy: A Case Control Study

Study Objective We aim in our study to evaluate whether there is a significant difference between women presenting with primary tubal ectopic pregnancy (EP) or recurrent ectopic pregnancy (REP) that are treated medically with methotrexate (MTX). Design A retrospective cohort study. Setting A tertiary medical center during 2010-2018. Patients or Participants All patients diagnosed with an EP and treated by intention of single-dose regimen of intramuscular MTX. Interventions Cases (REP) and controls (first-time only EP) were compared. Measurements and Main Results 262 patients had primary EPs and 32 had a REP. Women with REP had significantly higher gravidity order and higher incidence of previous abortions (5 vs. 3, median, p Conclusion Our study suggests that while women with REP may not represent a unique sub-group of women with EP, medical treatment success with a single-dose regimen of MTX is lower than expected and hence different regimens should be considered.

1225 Early Prediction of Methotrexate Treatment Success by 24‐Hour Pretreatment HCG Increment and Day 1-4 HCG Ratio

Study Objective Several studies have tried to identify early markers for treatment outcome after methotrexate (MTX) treatment for an ectopic pregnancy (EP) including pretreatment and day 4 hCG levels and corresponding ratio, and hCG increment during the initial 24 hours following treatment, with conflicting results. We aim to re‐evaluate the role the aforementioned markers in the earlier identification of treatment success in a large cohort of women. Design A retrospective cohort study. Setting A tertiary medical center during 2010-2018. Patients or Participants All women diagnosed with an EP and treated by intention of single-dose regimen of intramuscular MTX. Interventions A comparison of maternal and gestation characteristics was performed between treatment success and failure groups. Measurements and Main Results 292 women treated with single-dose intramuscular MTX for EP during were included in this study. Treatment success rate with a single dose of MTX of the overall cohort was 62.7% (183/292). Only two independent determinants were significantly associated with the treatment success: initial 24 hours hCG percentage of increment (adjusted odds ratio [OR]: 1.82; 95% confidence intervals [CI]: 1.26, 2.63; p Conclusion A low rise in hCG levels 24 hours prior to treatment with MTX, alongside a decline in hCG levels from day 1 to day 4 may predict success of medical treatment of EP.

1261 Risk Factors for Recurrent Ectopic Pregnancy Following Single-Dose Methotrexate Treatment

Study Objective We aimed to investigate the predisposing factors for recurrent ectopic pregnancy (REP) following single-dose methotrexate (MTX) treatment. Design A retrospective cohort study. Setting A tertiary medical center. Patients or Participants All patients diagnosed with a first EP and treated by intention of single-dose regimen of intramuscular MTX. Interventions Cases (REP) and controls (first-time only EP) were compared in order to identify risk factors for REP. Forward stepwise multivariate logistic regression analyses were subsequently carried out. Measurements and Main Results 272 women were included in the cohort of the study. Of those 22 (8.1%) had a REP. Women in the REP group had higher proportion of history of abortions (45.4% vs. 23.6%, p=0.02), higher rates of previous pelvic surgery and a history of both pelvic and uterine surgery (45.4% vs. 6.4%, 4.5% vs. 1.6%, respectively, p Conclusion Among women with EP, attention should be paid to women with previous pelvic surgery. Efforts should be made in order to achieve medical treatment success to prevent REP.

Evaluation of risk factors predicting surgical treatment in tuboovarian abscess cases

Objective: The main outcome measure of the present study was to find out the predictive factors affecting the need for surgery in patients diagnosed with tuboovarian abscess (TOA). We also examined the success of different medical treatment regimens in those patients.&#x0D; Material and Methods: This was a retrospective clinical study performed on 96 TOA patients who were treated in the current hospital between August 2015 and August 2019. All patients underwent physical examination and ultrasonographic imaging with some laboratory tests to investigate the presence of TOA. Two different medical treatment regimens were administered as recommended by the international guidelines after the initial diagnoses. Patients with worsening clinical and/or laboratory findings and/or who did not respond to medical treatment were taken to surgery. Predictive factors for surgical intervention and success rates of medical treatment regimens were evaluated.&#x0D; Results: White blood cell (WBC) levels≥ 16000 and abscess size≥ 7 cm was strongly correlated with the requirement for surgery. The 94 patients received the Regimen 1. Six patients underwent surgery urgently when they were under medical treatment. Regimen 1 failed in 21 (22.34 %) patients out of 94, Regimen 2 was shifted to. Six patients (28.5%) out of 21 underwent surgery because of treatment failure with Regimen 2. Recovery was achieved in the remaining 15 (71.4%) patients.&#x0D; Conclusion: The success of medical TOA treatment was found to be high. Therefore, medical treatment can be applied first, except in case of acute abdomen. It was found that WBC and abscess diameter in patients with TOA in admission were the most important factors affecting the need for surgery. The factors affecting the duration of medical treatment were found to be age, WBC count, CRP (C-Reactive Protein), ESR (Erythrocyte Sedimentation Rate) and NLR (Neutrophil/Lymphocyte Ratio) levels.

The management of suspected or confirmed laryngopharyngeal reflux patients with recalcitrant symptoms: A contemporary review.

To summarise current knowledge about the prevalence, aetiology and management of recalcitrant laryngopharyngeal reflux (LPR) patients-those who do not respond to anti-reflux medical treatment. A literature search was conducted following the PRISMA guidelines to identify studies that reported success of anti-reflux medical treatment with emphasis on studies that attempted to be rigorous in defining a population of LPR patients and which subsequently explored the characteristics of non-responder patients (ie aetiology of resistance; differential diagnoses; management and treatment). Three investigators screened publications for eligibility from PubMED, Cochrane Library and Scopus and excluded studies based on predetermined criteria. Design, diagnostic method, exclusion criteria, treatment characteristics, follow-up and quality of outcome assessment were evaluated. Of the 139 articles screened, 45 met the inclusion criteria. The definition of non-responder patients varied substantially from one study to another and often did not include laryngopharyngeal signs. The reported success rate of conventional therapeutic trials ranged from 17% to 87% and depended on diagnostic criteria, treatment scheme, definition of treatment failure and treatment outcomes that varied substantially between studies. The management of non-responders differed between studies with a few differential diagnoses reported. No study considered the profile of reflux (acidic, weakly acid, non-acid or mixed) or addressed personalised treatment with the addition of alginate or magaldrate, low acid diet, or other interventions that have emerging evidence of efficacy. To date, there is no standardised management of LPR patients who do not respond to traditional treatment approached. A diagnostic and therapeutic algorithm is proposed to improve the management of these patients. Future studies will be necessary to confirm the efficacy of this algorithm through large cohort studies of non-responder LPR patients. 2a.

Place de l’antibiothérapie en première intention en cas de bartholinite aiguë : à propos d’une série de 33 cas

ObjectivesAcute Bartholinitis is a common pathology affecting nearly 2% of women in their lifetime. Many treatments are used, although their effectiveness is not demonstrated in the literature. The main objective was to evaluate the success rate of first-line antibiotic therapy. The secondary objective was to identify factors associated with successful treatment. MethodsWe conducted a retrospective unicentric study between January 2014 and June 2018 at the University Hospital Center of Nancy. Inclusion criteria were the presence of acute bartholinitis treated with first-line antibiotic therapy. Exclusion criteria were patients lost to follow-up after initiation of treatment. The primary endpoint was the absence of surgical treatment within 30 days of initiation of antibiotic therapy. Factors associated with successful medical treatment were sought. ResultsThirty-three patients were included. The success rate of medical treatment was 48.5% at 30 days. In the case of symptoms that had been evolving for less than 3 days, the success of medical treatment was more frequent (75% vs. 35.3%, P=0.02). Medical treatment was more effective in lesions of less than 2cm (68.7% vs. 23.5%, P=0.01). After adjustment, the only factor associated with successful medical treatment was lesion size≤2cm [ORa=5.31 (1.05–26.81)]. ConclusionFirst-line antibiotic therapy for acute bartholinitis seems effective but should be targeted according to certain eligibility criteria.

Success rate of methotrexate treatment for recurrent vs. primary ectopic pregnancy: a case-control study

The aim of this study was to compare the success rate of methotrexate (MTX) treatment in patients with recurrent ectopic pregnancy (REP) and primary EP (PEP). A retrospective cohort study. The study cohort comprised all patients diagnosed with an EP and treated by intention with single-dose regimen of intramuscular MTX in a tertiary medical centre during 2010–2018. Cases (REP) and controls (PEP) were compared.262 patients had PEP and 32 had a REP. Women with REP had significantly higher gravidity order and higher incidence of previous abortions (5 vs. 3, median, p < .001, 59.3% vs. 32.8%, p < .001, respectively). Women with REP had a higher proportion of a history of previous surgery in general, and specifically pelvic surgery (46.8% vs. 20.6%, p < .001, 24.4% vs. 7.2%, p < .001, respectively). Treatment success was lower in the REP group (40.6% vs. 66.4%, p = .006, Odds ratio 0.34, 95% confidence interval 0.16, 0.73). In a logistic regression analysis, the only factor found to be independently associated with treatment failure was REP (adjusted odds ratio 0.30, 95% confidence interval 0.12, 0.77, p = .01). Our study suggests that medical treatment success with a single-dose regimen of MTX is lower than expected among REP cases, suggesting that different treatment approach should be considered in this setting.Impact statementWhat is already known on this subject ? There is paucity of data regarding success rate of methotrexate treatment for a recurrent ectopic pregnancy (REP).What do the results of this study add? Medical treatment success with a single-dose regimen of MTX in patients with a REP is lower than expectedWhat are the implications of these findings for future clinical practice and/or further research? As medical treatment success with a single-dose regimen of MTX for women with a REP is lower than expected, different treatment approach should be considered. Further and prospective studies with a larger sample size are needed to confirm our findings.

Risk factors for recurrent ectopic pregnancy following single-dose methotrexate treatment

Objective: Our study aimed to investigate the predisposing factors for recurrence of an ectopic pregnancy (EP) following single-dose methotrexate (MTX) treatment for a primary EP.Methods: This was a retrospective cohort study performed in a tertiary care medical centre including all patients diagnosed with primary EP and treated with a single-dose regimen of intramuscular MTX. EPs with future recurrence were compared with first time only EPs, to identify risk factors for recurrent EP. Forward stepwise multivariate logistic regression analyses were subsequently carried out.Results: The study included 272 women. Of those, 22 (8.1%) had a recurrent EP. Women in the recurrent EP group had a higher rate of abortions (45.5% vs 32.7%; p = 0.02), previous pelvic surgery (45.5% vs 6.5%; p < 0.001) and both pelvic and uterine surgery (4.5% vs 1.6%; p < 0.001). Conception by assisted reproductive technology (ART) was more common among the non-recurrent EP group (23.0% vs 4.5%; p = 0.04). Success of single-dose MTX treatment was lower in the recurrent EP group compared with the non-recurrent EP group (36.4% vs 65.7%; p = 0.006). A history of pelvic surgery was independently associated with recurrent EP (adjusted odds ratio [OR] 17.6; 95% confidence interval [CI] 4.9, 63.2; p = 0.001). Treatment success of single-dose MTX was independently protective for recurrent EP (adjusted OR 0.25; 95% CI 0.08, 0.76; p = 0.02).Conclusions: Among women with an EP, attention should be paid to those with previous pelvic surgery. Efforts should be made to achieve medical treatment success to prevent recurrent EP.

Early prediction of the success of methotrexate treatment success by 24-hour pretreatment increment in HCG and day 1-4 change in HCG.

Several studies have tried to identify early markers of treatment outcome after methotrexate (MTX) treatment for ectopic pregnancy, including pretreatment and day 4 human chorionic gonadotrophin (HCG) concentrations and their corresponding changes, and the increment in HCG during the initial 24 h after treatment. There have, however, been conflicting results. This study aimed to re-evaluate the role of these markers in the earlier identification of treatment success in a large cohort of women. This was a retrospective cohort study including women diagnosed with an ectopic pregnancy and treated with a regimen of a single dose of MTX. A comparison of maternal and gestation characteristics was made between groups in whom treatment was successful or failed. A total of 292 women treated with single-dose intramuscular MTX for ectopic pregnancy were included in this study. In the overall cohort, the treatment success rate with a single dose of MTX was 62.7% (183/292). Only two independent determinants were significantly associated with treatment success: the initial 24-h percentage increase in HCG (adjusted odds ratio [OR] 1.82, 95% confidence interval [CI] 1.26-2.63; P<0.001) and the percentage change in HCG from day 1 to day 4 (adjusted OR 1.12, 95% CI 1.04-1.21; P<0.001). The optimal cut-off points for prediction of treatment success were an increment of less than 17% in the 24 h before treatment and a decrease of more than 22% between the day 1 and day 4 HCG concentrations. A small increase in HCG concentration 24 h before treatment with MTX, alongside a decline in HCG concentration from day 1 to day 4, may predict the success of medical treatment for an ectopic pregnancy.