Urine Pregnancy Test Research Articles

Could routine pregnancy self-testing facilitate earlier recognition of unintended pregnancy? A feasibility study among South African women

IntroductionWe explored whether routine pregnancy self-testing is feasible and acceptable to women at risk of late recognition of pregnancy as a strategy to facilitate early entry into either antenatal or...

2020 STD Prevention Conference: Disrupting Epidemics and Dismantling Disparities in the Time of COVID-19.

2020 STD Prevention Conference: Disrupting Epidemics and Dismantling Disparities in the Time of COVID-19.

Adult Onset Isolated Hypogonadotropic Hypogonadism- a Cause of Secondary Amenorrhea

A 23-year-old African American female was referred for secondary amenorrhea evaluation. She attained menarche at 12 years and had regular menses. At 18 years, she used OCPs for few months, and used plan B, after which her menses stopped. She had hot flashes and sweating. She was placed on progesterone, but never had withdrawal bleeding. Review of systems was positive for intentional weight loss after her menses stopped, hair loss and nipple discharge. She denied any loss of sensation of smell. She has a PMH of asthma, anxiety and OSA. Family history was not significant for any fertility issues. She smoked cannabis after menses stopped. On physical examination, vitals were stable, BMI of 35 kg/meter2, well-developed secondary sexual characteristics, no thyromegaly, acne or hirsutism. Upon work up, CBC, CMP were normal, Urine pregnancy test was negative, gonadotropins were undetectable (FSH- <0.7mIU/ml, LH- <0.2mIU/ml), anti-mullerian hormone was 3.82ng/ml (WNL), Estradiol was also absent (<15pg/ml), with a low Total testosterone (11ng/dl), TSH was 1.17uIU/ml, Free T4 was 1.1ng/dl, ACTH was 9.58pg/ml, Cortisol was 14.8mcg/dl, and Prolactin was 1.5ng/ml. MRI brain was normal with normal pituitary gland, no focal lesion visualized. Pelvic ultrasound showed ovaries 5.9mL and 4.6mL with multiple follicles present bilaterally. Diagnosis of adult-onset isolated hypogonadotropic hypogonadism (IHH) was made. Patient was started on estradiol patches and progesterone. IHH is a genetic disorder of defective production or action of GnRH. IHH when associated with anosmia is called Kallmann syndrome. It was first described by German American geneticist Joseph Kallmann in 1944. GnRH is a decapeptide, produced in arcuate nucleus and pre-optic nucleus of hypothalamus. GnRH stimulates anterior pituitary to secrete FSH and LH. IHH is caused due to impaired migration of GnRH neurons to brain during embryogenesis. It is inherited as autosomal or X-linked dominant or recessive. Gene mutations associated are ANOS-1, FGFR, PROK-2. It is rare in females. IHH has a broad spectrum of clinical presentation from complete absence of sexual development to partial completion of puberty. It presents with microphallus, cryptorchidism, cleft lip/palate, syndactyly, renal aplasia. In childhood presents with anosmia, hearing deficits, dental agenesis, mirror movements, short stature. During puberty, absent pubertal growth spurt, amenorrhea, lack of virilization, no secondary sexual characteristics, infertility. In partial forms, known as Adult onset or acquired form of IHH, patients have slight testicular growth, thelarche, menarche. Goals of treatment are- pubertal induction, maintenance of sexual maturation and restoration of fertility. In females, pre-puberty only estrogen is given, after puberty both estrogen and progesterone are used, for fertility, pulsatile gonadotropins or GnRH analogues are used.

A Challenging Diagnosis of Primary Hyperparathyroidism in an Adolescent Female

Background: Hypercalcemia secondary to primary hyperparathyroidism (PHPT) is less common in children than adults. Single parathyroid adenoma is commonly the cause of primary hyperparathyroidism in children. Clinical Case: We present a 15-year-old female with one-week history of abdominal pain despite taking over the counter antacids. Her initial work up by her primary care provider revealed serum calcium of 11.8 mg/dL (9.0–11.5) and creatinine of 0.8 mg/dL (0.4–1.2). A week later, she presented to the emergency department with same complaint. In ED, she was found to have hypercalcemia (12.8 mg/dl) with elevated parathyroid hormone (PTH) at 78.5 pg/mL (15–65). Her random urine calcium creatinine ratio was high at 2.1. Her 25OHD was 25 ng/mL (30–100). She had negative urine pregnancy test but had trace ketones, leukocyte esterase, blood and bacteria. CBC and CMP were otherwise unremarkable. She continued to complain abdominal pain with nausea, decrease appetite, fatigue, and general muscle weakness. There was no known family history of calcium or metabolic bone disorders. Her vital signs and physical exam were normal. Subsequent labs showed mild improvement of calcium between (11–12.3 mg/dL), PTH between 54.5 and 77 pg/mL, normal thyroid function. Ionized calcium was mildly elevated 6.0 mg/dL (4.5–5.3) but her repeat 25OHD was low at18 ng/mL. Serum phosphorus levels were relatively normal with lowest level of 2.5 mg/dL (2.7–4.5). Gliadin Deamidated IgA was detectable 15 U/mL (< 15.0 U/). Ultrasound of abdomen was significant for nonspecific mild hepatomegaly; kidneys were normal in size and appearance. Ultrasound of thyroid was significant for probably intrathyroid parathyroid, measuring 6 x 8 x 8 mm. Tc-Sestamibi scan did not confirm a parathyroid adenoma. Genetic testing for MEN-1 was negative. FHH- related genes (i.e. CASR) was positive for p.R990G variant resulting in a mild gain of function of the calcium-sensing receptor. Although previous Tc-Sestamibi scan was unremarkable, an over read of it raised a concern for questionable uptake in the left superior lobe. SPEC-CT demonstrated possible abnormal parathyroid tissue in the upper pole of the left thyroid. FNA of the left thyroid nodule confirmed likely intrathyroidal parathyroid adenoma. Subsequent follow up and treatment, including parathyroidectomy, was done by another institution. She underwent a left parathyroidectomy with normalization of serum calcium and PTH levels post operatively (10.1 mg/dl and 8 pg/mL, respectively) and has complete resolution of her previous abdominal and gastrointestinal symptoms. Conclusion: PHPT is uncommon in children and adolescents and is typically associated with a single parathyroid adenoma. High index of suspicion is key for early diagnosis of PHPT despite a negative Tc-Sestamibi initially.

False negative point-of-care urine pregnancy tests in an urban academic emergency department: a retrospective cohort study.

Study objectiveTo determine the prevalence of false negative point‐of‐care (POC) urine pregnancy tests among emergency department (ED) patients and among those with abdominal pain or vaginal bleeding.MethodsWe identified all female patients, ages 14–50 years without prior hysterectomy who had a negative POC urine pregnancy test (beta subunit of human chorionic gonadotropin [β‐hCG]) performed by trained clinical staff in the ED between September 1, 2017 and December 31, 2018, as well as a subgroup we defined a priori as “high risk” for early pregnancy complications based on a triage chief complaint (text) of abdominal pain or vaginal bleeding. We identified those with a positive urine β‐hCG, serum β‐hCG >5 mIU/mL, or a diagnosis of pregnancy within 3 months of the initial ED visit (index visit). We used structured chart review with American College of Obstetrics and Gynecology guidelines to determine pregnancy diagnosis and outcomes (ectopic, intrauterine, abnormal including spontaneous abortion, and unknown), the date of conception, and whether the pregnancy was present at the index visit.ResultsOf 10,924 visits with a negative urine pregnancy test result that were screened for a pregnancy outcome, 171 (1.6%, 95% confidence interval [CI] = 1.4, 1.8) had a pregnancy present at the index visit. Diagnoses were ectopic (n = 12, 7.0%), intrauterine (n = 71, 41.5%), abnormal (n = 77, 45.0%), and unknown (n = 11, 6.4%). Of the 2732 patients with high‐risk complaints, 97 (3.6%, 95% CI = 2.9, 4.3) had a pregnancy present at the index visit (relative risk of a pregnancy diagnosis 3.9, 95% CI = 2.9,5.3), including 10/12 ectopic (83%), 58/77 abnormal (75%), and 25/71 intrauterine pregnancies (35%). Serum β‐hCG ranged from 2 mIU/mL to above assay (median = 119.5, interquartile range = 957.5).ConclusionAlthough false negative urine pregnancy tests were uncommon, multiple pregnancy diagnoses were missed, including ectopic pregnancies. False negatives were more common among patients with abdominal pain or vaginal bleeding. Concurrent serum β‐hCG levels demonstrated a broad distribution.

Situation analysis of medical laboratories in primary health centres

Background: This study was conducted with the objective to assess the medical laboratories attached with primary health centres (PHCs) focusing on the current needs, gaps and to understand the utilization pattern of the laboratory services. There are hardly any relevant studies that are known to have investigated the functioning of laboratories attached with PHCs based on quality of service they are providing.Methods: This study was a cross sectional study based on observations and assessment made at 33 randomly selected medical laboratories attached with PHCs in Ahmedabad district, Gujarat. Checklist adapted from National Quality Assurance Standards (NQAS) and Indian Public Health Standards (IPHS) were used as a tool for data collection.Results: Though all the laboratories have been found to be functioning effectively based on the indicators in this study, some of the laboratories were not performing basic important tests like rapid plasma reagin (RPR) (18%) and hepatitis B surface antigen (HbSAg) (21%). None of the laboratories attached to the PHCs under study performed Widal test. There was very low utilization of urinary pregnancy test (UPT) (1.81%) in the first quarter of the year.Conclusions: Although most of the indicators reflect satisfactory performance of the laboratories, there exists certain gaps and needs that are essential in provision of quality laboratory services in the primary level of health care. The laboratory information management system (LIMS) was the major issue in the laboratories.

Expansion of a direct-to-patient telemedicine abortion service in the United States and experience during the COVID-19 pandemic

ObjectiveTo present updated evidence on the safety, efficacy and acceptability of a direct-to-patient telemedicine abortion service and describe how the service functioned during the COVID-19 pandemic. Study DesignWe offered the study at 10 sites that provided the service in 13 states and Washington DC. Interested individuals obtained any needed preabortion tests locally and had a videoconference with a study clinician. Sites sent study packages containing mifepristone and misoprostol by mail and had remote follow-up consultations within one month by telephone (or by online survey, if the participant could not be reached) to evaluate abortion completeness. The analysis was descriptive. ResultsWe mailed 1390 packages between May 2016 and September 2020. Of the 83% (1157/1390) of abortions for which we obtained outcome information, 95% (1103/1157) were completed without a procedure. Participants made 70 unplanned visits to emergency rooms or urgent care centers for reasons related to the abortion (6%), and 10 serious adverse events occurred, including 5 transfusions (0.4%). Enrollment increased substantially with the onset of COVID-19. Although a screening ultrasound was required, sites determined in 52% (346/669) of abortions that occurred during COVID that those participants should not get the test to protect their health. Use of urine pregnancy test to confirm abortion completion increased from 67% (144/214) in the 6 months prior to COVID to 90% (602/669) in the 6 months during COVID. Nearly all satisfaction questionnaires (99%, 1013/1022) recorded that participants were satisfied with the service. ConclusionsThis direct-to-patient telemedicine service was safe, effective, and acceptable, and supports the claim that there is no medical reason for mifepristone to be dispensed in clinics as required by the Food and Drug Administration. In some cases, participants did not need to visit any facilities to obtain the service, which was critical to protecting patient safety during the COVID-19 pandemic. ImplicationsMedical abortion using telemedicine and mail is effective and can be safely provided without a pretreatment ultrasound. This method of service delivery has the potential to greatly improve access to abortion care in the United States.

AYURVEDIC MANAGEMENT OF INFERTILITY DUE TO TUBAL BLOCKAGE- A CASE STUDY

Infertility is defined as failure to conceive within one or more years of regular unprotected coitus. Tubal blockage is one of the most common causative factors for female infertility. The prevalence of fallopian tubal obstruction was 19.1% in the fertility age group. In this case study patient suffered from infertility since 3yrs and diagnosed as primary infertility due to right tubal blockage after allopathic consultation. IUI has done thrice which went unsuccessful and was advised for IVF. But she was reluctant to do the same. So she approached OPD of GAVCH for W&amp;C, Poojappura, Kerala for Ayurvedic management. Patient was managed with Ayurvedic treatment protocol including internal medications and purification therapies. The line of treatment was to normalize the Vata-kapha dosha and removes the Sroto avarodha in the fallopian tube. Uttaravasti delivers medicines close to Garbhashaya &amp; Yoni especially in fallopian tubes. Taila can help to clear the Sroto rodha due to its Vyavayi, Vikashi and Sookshma property. Just after one cycle of treatment patient came with positive urine pregnancy test after one week of missed period. Then she took regular antenatal care from an allopathic hospital and delivered a healthy male baby of 2.8 kg.

“False positive” urine pregnancy test results after successful medication abortion

ObjectiveTo examine the proportion of high-sensitivity urine pregnancy test (HSPT) results that were positive by time after successful medication abortion. Study designWe used data from an ongoing study that provides mifepristone and misoprostol for medication abortion by direct-to-patient telemedicine and mail. Providers evaluated abortion outcomes by patient interview and clinical tests per clinical judgment and participant preference. We identified all participants enrolled July 2016 to September, 2020 who had an HSPT result and no indication of viable pregnancy after treatment. We used logistic regression to examine the association between the timing of the initial post-treatment HSPT, gestational age, and the proportion of HSPTs that gave a positive result. ResultsOf the 472 participants in our analysis, 88 (19%) had positive initial HSPTs. The proportions that were positive at ≤20 days, 21 to 27 days, 28 to 34 days, and ≥35 days after mifepristone ingestion was 14 of 29 (48%), 15 of 58 (26%), 49 of 258 (19%), and 10 of 127 (8%), respectively (p < 0.001). Gestational age at mifepristone ingestion was not significantly related to positive HSPT results (p = 0.28). Multivariable logistic regression confirmed both findings and did not identify a statistically significant interaction between these variables. In the 67 participants who relied solely on further HSPTs to confirm abortion outcome, the median interval between the initial positive test and first negative test was 14 days. ConclusionsThe proportion of participants with positive HSPTs declined with time after successful medication abortion. However, nearly one-fifth of participants with complete abortion had positive tests 4 weeks after treatment. ImplicationsHSPTs provide an inexpensive, convenient option for confirming success of medication abortion at home. However, a substantial minority of patients without ongoing pregnancy have positive HSPT results. Development of a symptom-based strategy for medication abortion outcome assessment without any confirmatory tests should be a priority.

Levonorgestrel vs. Copper Intrauterine Devices for Emergency Contraception

BackgroundIn the United States, more intrauterine device (IUD) users select levonorgestrel IUDs than copper IUDs for long-term contraception. Currently, clinicians offer only copper IUDs for emergency contraception because data are lacking on the efficacy of the levonorgestrel IUD for this purpose.MethodsThis randomized noninferiority trial, in which participants were unaware of the group assignments, was conducted at six clinics in Utah and included women who sought emergency contraception after at least one episode of unprotected intercourse within 5 days before presentation and agreed to placement of an IUD. We randomly assigned participants in a 1:1 ratio to receive a levonorgestrel 52-mg IUD or a copper T380A IUD. The primary outcome was a positive urine pregnancy test 1 month after IUD insertion. When a 1-month urine pregnancy test was unavailable, we used survey and health record data to determine pregnancy status. The prespecified noninferiority margin was 2.5 percentage points.ResultsAmong the 355 participants randomly assigned to receive levonorgestrel IUDs and 356 assigned to receive copper IUDs, 317 and 321, respectively, received the interventions and provided 1-month outcome data. Of these, 290 in the levonorgestrel group and 300 in the copper IUD group had a 1-month urine pregnancy test. In the modified intention-to-treat and per-protocol analyses, pregnancy rates were 1 in 317 (0.3%; 95% confidence interval [CI], 0.01 to 1.7) in the levonorgestrel group and 0 in 321 (0%; 95% CI, 0 to 1.1) in the copper IUD group; the between-group absolute difference in both analyses was 0.3 percentage points (95% CI, −0.9 to 1.8), consistent with the noninferiority of the levonorgestrel IUD to the copper IUD. Adverse events resulting in participants seeking medical care in the first month after IUD placement occurred in 5.2% of participants in the levonorgestrel IUD group and 4.9% of those in the copper IUD group.ConclusionsThe levonorgestrel IUD was noninferior to the copper IUD for emergency contraception. (Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and others; ClinicalTrials.gov number, NCT02175030.)

Artava Kshaya with Hypothyroidism: A case study

Artava Kshaya is the condition in which the menstruation does not occur in its appropriate time, which can be correlated with oligomenorrhoea with Scanty Menstrual flow. Hypothyroidism is one of the causative factors of oligomenorrhoea, i.e. Artava Kshaya. The prevalence of hypothyroidism in the reproductive age group ranges from 2% to 4%. It affects female fertility in the form of menstrual irregularities, infertility and spontaneous first trimester miscarriages. In modern science, thyroxine is used for the management of hypothyroidism which is useful but with specific side effects. A 27 years old married female with the complaints of delayed and scanty menstrual flow for four years with an obstetric history of G1P1L1 &amp; on 12.5 thyroxine tablet, visited the OPD. A urine pregnancy test was negative. Thyroid profile showed high TSH level, i.e. 9.23 uIU/ml and USG report showed small-sized Uterus with thin endometrium and very small-sized both ovaries without detectable follicles. Based on the symptoms and investigations, the patient was diagnosed as a case of Artava Kshaya with hypothyroidism. The principle of treatment was focused on Agnideepana, Strotoshodhana, Artava Pravartana and Vata Kapha Shamana. A treatment scenario was selected for the management, and follow up was done after every month.

Review Article The evolution of rapid antigen detection systems and their application for COVID-19 and other serious respiratory infectious diseases

Making the correct diagnosis of a patient seeking medical attention is the ultimate goal of a practicing physician, irrespective of whether the cause of the patient's condition is infectious or non-infectious. Antigen detection tests can be used to aid in the diagnosis of various infectious-related disorders including COVID-19 where it has become especially important due to the serious nature of this disease and its worldwide prevalence. These tests closely mimic one of the earliest prototypes -the urine pregnancy test -and as a result they have gained wide acceptance based on their overall simplicity, low cost and relative accuracy. In some situations, especially as a screening test, they can be used instead of the more technically demanding and complex molecular and serologic assays that are still useful and helpful under many different circumstances. Antigen detection systems are based on finding a particular immunogenic component, typically a protein or polysaccharide molecule, that is both unique and an integral part of the pathogen or other biological entity. Because these tests generally provide only qualitative results, they often need to be supplemented with other and sometimes more sophisticated laboratory-based diagnostic procedures to corroborate the initial test result. In this review, we first describe general background information on antigen-detection methods, including any unique aspects of their overall design, and then follow with an extensive description on the merits and limitations of these tests for detecting COVID-19 and, to a lesser extent, for other serious respiratory diseases caused by three common bacterial pathogens -Streptococcus pyogenes, Streptococcus pneumoniae and Legionella pneumophila.

Sexual assault cases at a tertiary referral hospital in urban Ethiopia: One-year retrospective review.

Sexual assault is an important health and social problem affecting young girls. The aim of the study is therefore to do a one-year retrospective review of documents of alleged sexual assaults managed at Saint Paulo's Hospital Millennium Medical College (SPHMMC) to determine survivors' characteristics, circumstances of the assault, and treatment offered. This is a hospital-based one-year retrospective review of alleged sexual assault cases. The case records of survivors were retrieved, reviewed and information extracted analyzed using SPSS version 17. Characteristics of victims of the sexual assault, clinical presentation, and management provided were described by frequency and percentage distribution. A total of 170 cases of alleged sexual assault who received care during the study period were identified. Around 96% of the survivors were female while there were 6 male cases. The mean age of the victims was 13 yrs. with a range from 2 to 25 yrs. About 23.6% of the victims were less than 10 years. Half of the victims were assaulted by neighbors (45%) followed by strangers (36.5%). The interval between the incident and presentation to the hospital ranged from 2 hours to 93 days (2224 hours) with an average of 98 hours. Most (93.0%) had one or more physical examination findings at presentation. Serology tests for HIV, Hepatitis B, and Syphilis were done in 97.3%, 88.7%, and 84.5% cases respectively. Urine pregnancy tests were done in 62.5% of the cases. Prophylaxis against HIV and STI prophylaxis was provided to 42% and 45% respectively. Social support/counseling was provided to 61% of the victims and legal evidence (certificate) was provided to 45.5% of the cases. Although it is largely not reported by the victims, sexual assault is a grievous offense still happening constantly. Children and young girls remain the most vulnerable. There is inadequate forensic evidence collection, legal and medical care. There is also a delay in presentation to hospital by victims. Therefore, there is a need to have standardized protocols for comprehensive evaluation and care of the survivors. It is also imperative that a multidisciplinary approach like a one-stop clinic should be utilized to provide effective and efficient medical, social, psychological, and legal services. Finally, it is very necessary to increase public awareness and preventive interventions are required particularly to protect the vulnerable age group to enhance their safety.

Long-term Effects of an Evidence-based Guideline for Emergency Management of Pediatric Syncope.

We included healthy patients aged 8-22 years, presenting to the pediatric emergency department with syncope between 2009 and 2017. Interrupted time series analysis compared testing rates and length of stay among the pre-EBG, short-term follow-up, and long-term follow-up periods. The study included 1,294 subjects. From the pre-EBG period to the long-term follow-up period, recommended electrocardiogram and urine pregnancy test rose significantly [level change odds ratio (95% confidence interval) 5.56 (1.73-17.91) and 3.15 (1.07-9.32), respectively]. Testing and management not recommended by the EBG decreased significantly, including complete blood count, electrolytes, point-of-care glucose, chest radiograph, and intravenous fluids [level change odds ratio (95% confidence interval) 0.19 (0.09-0.40), 0.15 (0.07-0.32), 0.38 (0.18-0.81), 0.17 (0.06-0.49), and 0.18 (0.08-0.39), respectively]. Length of stay declined significantly. No delayed diagnoses occurred. Sustained improvements in syncope management persisted during long-term follow-up of the EBG despite minimal resources. The EBG was associated with increased focused evaluation and decreased low yield testing. EBGs may be useful tools to influence sustained clinical practices to promote safe, cost-effective, and high-quality care.

Ectopic Twin Pregnancy : About A Case

Unilateral tubal twin pregnancies occur in approximately 1 in 125,000 spontaneous pregnancies. Due to the lack of data, there are few recommendations on the appropriate management of a twin tubal ectopic pregnancy. We report a CLINICAL CASE of A 28-year-old woman, with type 1 diabetes on insulin and with no significant surgical or gynaecological history, the patient presented to the emergency room for metrorragia evolving for two days in a context of 6sa-2j amenorrhea. Clinical examination finds a hemodynamically stable patient, a depressible flexible abdomen with sensitivity to the right iliac pit and a slightly painful reversed uterus has mobilization with a moderate bleeding abundance of endo uterine origin. The emergency room urine pregnancy test was positive. Beta Hcg serum was 3,966 mUI/ml. Transvaginal ultrasound showed a reversed empty uterus, a fine and homogeneous endometrium of 7.8 mm with the presence at the right tubal level of two gestational bags measuring (7.2mm5.8mm) and (7mm-5.6 mm) with two embryos of 3.8mm and 3.6mm respectively, both had positive cardiac activity. at the douglas bag cul level, the presence of an effusion blade. the diagnosis of bi-amniotic bi-horoial bi-chorial ectopic pregnancy was made.a laparoscopy was performed with a right salpingectomy. postoperative evolution was favourable. Health care providers should have a high index of clinical suspicion for ectopic pregnancies. Unilateral tubal twin ectopic pregnancies, although rare, can be correctly diagnosed by transvaginal ultrasound. Laparoscopic salpingectomy provides an effective treatment for unilateral tubal twin gestation with a short recovery time. Due to the lack of data in the literature, there are few recommendations on the appropriate management of an ectuous ectopic twin pregnancy.

Troublesome bleeding following early medical abortion

### Key messages Early medical abortion (EMA) (ie, using combination mifepristone and misoprostol to terminate pregnancies of less than 10 weeks’ gestation) is the the most common method of induced...

Observational Study of Patients Presenting with Bleeding in First Trimester

Objective: First trimester is an important period during which there is risk of bleeding and may lead tospontaneous abortion. More than 80% spontaneous abortions occur in first trimester. The aim of this studywas to determine the causes of first trimester bleeding.Method: This was a cross sectional descriptive study conducted at Shalinitai Meghe hospital and Researchcentre Hingana, Nagpur during January 2020 to June 2020. The patients presenting to OPD with history ofbleeding or spotting per vaginum, positive urine pregnancy test and less than 12 weeks of gestation wereincluded in this study. Clinical examination and ultrasonography was done.Result: Most of the patients presented with moderate bleeding and associated pain. The duration of bleedingwas 2 to 5 days. Majority of cases were between 4-8 weeks (69.5%). History of prior miscarriage was presentin 23.7%. 61% of cases were anemic. Threatened abortion was most common in patients presenting withbleeding per vaginum (in 47.5%). 18.6% patients were with incomplete abortion and 11.8% had completeabortion. There were 2 cases of unruptured ectopic pregnancy and 1 case of ruptured ectopic pregnancy.Salpingectomy was done in all the 3. Dilatation and evacuation was done in 12 cases. Gestational sac waspresent in 52 cases and the appearance was normal in 53.8% cases. Yolk sac was present in 65.4% cases.Fetal pole and cardiac activity was seen in 57.7%cases.Conclusion: Bleeding in first trimester of pregnancy is the common complaint with which the pregnantwomen presents to the health care worker. The commonest cause is the threatened abortion. Other causesare incomplete, complete and missed abortions. Bleeding in early pregnancy may be early presentation of aserious situation like ectopic pregnancy. Ultrasonography, especially the Trans Vaginal is very important inconcluding the causes of bleeding. Pregnant women should be educated in the first visit to antenatal OPDitself for the symptoms like bleeding per vaginum and to seek help from health care worker as soon aspossible.

S1409 A Rare Case of Symptomatic Multiseptate Gallbladder in a Young Female

INTRODUCTION: Multiseptate gallbladder is a rare congenital anomaly. Usually, these cases are incidentally found during surgery or imaging. We present the case of a young female patient who had intermittent epigastric pain and was found to have a septated gallbladder for which she ultimately required cholecystectomy to get symptomatic relief. CASE DESCRIPTION/METHODS: A 19 year old female with no prior medical history, presented with intermittent postprandial epigastric abdominal pain for 6 months. The pain would begin soon after meal intake, would be moderately severe and continue for the next 2–3 hours. No specific foods patterns were noted as a trigger. She tried to treat the pain with calcium based antacid tablets to attempt to alleviate her pain, but these did not offer any relief. Her pain was also associated with nausea but no other gastrointestinal symptoms were present. Family history was significant for symptomatic cholelithiasis in the patient’s sister requiring cholecystectomy. Social history was positive for active cigarette use. There was mild right upper quadrant tenderness on palpation during physical exam. Labs revealed a mildly elevated total bilirubin of 1.57 mg/dL while other LFTs, electrolytes, renal function and CBC were within normal limits. Urine pregnancy test was negative. An abdominal ultrasound revealed a gallbladder with multiple septations (Image 1) and hepatic steatosis. She underwent esophagogastroduodenoscopy which was normal and biopsies of her stomach and small bowel were also normal. The pain continued despite conservative management and so subsequently she had laparoscopic cholecystectomy which resulted in cessation of her pain during follow up clinic visit a few weeks after her surgery. The gallbladder tissue was sent for pathological evaluation, which showed mild chronic cholecystitis (Image 2). DISCUSSION: To our knowledge, multiseptate gallbladder has been rarely reported in the literature and chronic cholecystitis is not a common etiology. Symptoms usually occur due to transient impaired emptying of bile from the gallbladder. Some patients have had co-existing pancreatic and biliary duct abnormalities as well as gallbladder or bile duct cancer. Most of the cases were symptomatic and required therapy. Treatment options include conservative measures such as intake of a modified diet or treatment with ursodeoxycholic acid which have limited benefit and patients usually ultimately require cholecystectomy as definitive treatment.Figure 1.: US abdomen showing multiple septations in the gallbladder. No thickening of gallbladder wall or pericholecystolic fluid seen.Figure 2.: & E stain (10X) showing mild chronic cholecystitis with lymphocytic inflammation within the lamina propria (red arrows) and muscularis (blue arrows). Fibrosis and metaplastic changes are absent.

The Potential Teratogenicity Alert for Women Conceiving on Dolutegravir-Based Regimens: An Assessment of Risk Communication by an Urban HIV Clinic in Uganda and Choices made by Women.

A clinic response plan was developed in the first week following the alert and clinic staff were trained on safety guidance. All women aged < 55years taking dolutegravir were identified from the clinic database and contacted by phone for earlier appointments. Non-menopausal and non-surgically sterilized women were referred for urine pregnancy testing and evaluation of pregnancy intentions in the following 12months and effective family planning was offered. We describe the coverage of women who received the communication as well as the fidelity to the outlined plan from 21 May to 12 September, 2018. We used modified a Poisson regression analysis to determine factors associated with switching off dolutegravir. Of all active patients in the clinic, 9% (690/7963) were identified as female aged < 55years taking dolutegravir. Ninety-five percent (656/690) were reviewed by September 2018 and informed of the safety alert, implying a high level of uptake. Fidelity to standard operating procedures was also high at 72%. Twenty-two percent (146/656) of patients were menopausal or surgically sterilized. Five hundred and ten women were of reproductive potential with a median age (interquartile range) of 37years (30-42years). Five percent (23/510) were human chorionic gonadotrophin positive and all initial ultrasound reports revealed no deformities. Twenty-one percent (108/510) had intentions to conceive and opted to stop taking dolutegravir with 90% (97/108) switching to efavirenz. Seventy-nine percent (402/510) opted to remain taking dolutegravir. However, only 40% (160/402) chose effective contraceptive methods and 60% (242/402) opted for condoms only/no contraceptive method. A rapid well-coordinated response ensured prompt communication of the dolutegravir safety warning. The process developed by the clinic can act as a model for response during drug safety alerts. Women made informed decisions with most opting to remain taking dolutegravir; however, effective contraception uptake was low.

Efficacy and safety of fire needle therapy for blood stasis syndrome of plaque psoriasis: protocol for a randomized, single-blind, multicenter clinical trial

BackgroundFire needle therapy is a characteristic treatment in traditional Chinese medicine (TCM). An increasing number of studies have indicated that fire needle treatment for psoriasis provides satisfactory results with few side effects and a low recurrence rate. We herein describe the protocol for a multicenter, randomized, single-blind, placebo-controlled trial that will provide high-quality evidence on the efficacy and safety of fire needle therapy for plaque psoriasis.MethodsNinety-two patients with blood stasis syndrome (BSS) of plaque psoriasis will be enrolled and randomly assigned to receive fire needle therapy (intervention group) or fire needle control therapy (control group) once a week for 4 weeks. The Psoriasis Area and Severity Index (PASI) score will serve as the major efficacy index, while the body surface area (BSA), Physician Global Assessment (PGA) score, Dermatology Life Quality Index (DLQI) score, patient-reported quality of life (PRQoL), visual analog scale (VAS) score for itching, TCM symptom score, and relapse rate will be assessed as secondary outcomes. The PASI score, BSA, PGA score, and VAS score for itching will be evaluated at baseline and during the 4-week treatment and follow-up periods. DLQI score, PRQoL, and TCM symptom score will be assessed at baseline and during the treatment period. Recurrence will be evaluated during the follow-up period. Safety assessments include vital sign monitoring, routine blood tests, blood biochemistry, routine urine tests, pregnancy tests, physical examinations, and adverse-event recording. SAS software will be used for data analysis. The data network platform will be designed by the data management center of Nanjing Ningqi Medical Technology Co., Ltd.DiscussionIt is believed that fire needle therapy can activate the meridians, promote blood circulation, and regulate skin immunity. BSS of plaque psoriasis is related to not only immune dysfunction but also poor or stagnant blood flow. We anticipate that the results of the trial described in this protocol will provide strong evidence for the safety and efficacy of fire needle therapy for BSS of plaque psoriasis.Trial registrationClinicaltrials.govNCT03953885. Registered on May 15, 2019. Name: Fire Needle Therapy on Plaque Psoriasis with Blood Stasis Syndrome