Yrs In Group Research Articles

A comparison between direct true lumen versus conventional cannulation for management of acute type- aortic dissection patients.

Objective: To compare the postoperative outcomes while using direct true lumen approach versus conventional cannulation approach in management of acute type-A aortic dissection patients. Study Design: Randomized Clinical Trial. Setting: Department of Vascular Surgery, Combined Military Hospital, Rawalpindi. Period: 1st June 2022 to 31st December 2022. Methods: A total of 22 patients age more than 18 years who presented in CMH Emergency Department with acute type A aortic dissection were included in this study. In group A (11 patients) were managed with direct true lumen cannulation while in group B (11 patients) were managed with conventional (axillary/femoral) cannulation. In both groups intra-operative parameters like procedure time, mean time of cardiopulmonary bypass, cross clamp and circulatory arrest time were measured. In both groups, outcome was measured in terms of occurrence of multi-organ failure, acute kidney injury, arrhythmias on ECG and in-hospital mortality. Data was analyzed using SPSS 26. Results: Mean age of our patients were 43.36±2.16yrs in group A while 43.36±2.94yrs in group B. Male gender predominates in both groups (gp A- 81.8% & gp B-90.9%). We found no difference of statistical significance between two groups in terms of various intra-operative parameters like mean duration of procedure in group A was 428.15min and in group B was 427.36 min. Similarly mean circulatory arrest time was 31 min in group A and 29.09 min in group B. Patients in “direct true lumen cannulation” group had significantly shorter duration of intubation. In terms of post-operative outcomes, multi-organ failure occurred in 1 (9.09%) patient in group A while it occurred in 3(27.27%) patients in group B. In hospital mortality occurred in 2(18%) patients in group A as compared to 4(36%) in group B. So better results were observed in “direct true lumen cannulation” group as compared to “conventional (axillary/femoral) cannulation” group. Conclusion: In our study, acute type-A aortic dissection patients who had undergone direct true lumen cannulation during operative management showed better post-operative outcomes.

Effects of Age-Dependent Hormonal Changes and Estrogen Supplementation on Voice in Girls with Anorexia Nervosa—Preliminary Report

IntroductionHuman development includes lots of physical and emotional changes. The human voice depends on age. Voice production is a complex physiological and acoustic phenomenon that depends on many factors such as structure, hormone level, degree of fatigue or nutrition and hydration of the body, systemic diseases and emotional state. All these factors can be present in anorexia nervosa (AN), such as excessive weight loss, generated hydro-electrolytic changes, nutritional deficiencies, hormonal disturbances in the function of the hypothalamic-pituitary-adrenal axis, the hypothalamic-pituitary-thyroid axis, the hypothalamic-pituitary-ovarian axis, and emotional distress. The prevalence of AN ranges between 0.3 and 3%, and it is the third most common chronic disease affecting adolescent girls. However, voice changes related to AN have not been fully investigated. ObjectiveThe purpose of this study was to evaluate the impact of AN on age-related changes in the voice of adolescent women – before and after puberty, particularly through acoustic analysis. An additional objective was to evaluate estrogen substitution in female patients with AN in order to investigate their effect on voice condition. Materials and methods126 girls diagnosed with AN (15.32± 2.12yrs, range 12-19, BMI=14.38 ± 1.67), were assessed for the condition of the voice such as perceptual voice evaluation on the GRBAS scale, maximal phonation time (MPT), laryngoscopy, with special attention to voice acoustic analysis - Multi-Dimensional Voice Program (MDVP). The control group (B) included 93 girls without eating disturbances (aged 12-19, mean age 15.52 ± 2.40, BMI= 21.50 ± 1.54). Perceptual voice assessment, aerodynamic test MPT, and acoustic parameters were analyzed in age groups (≤16 yrs. and >16 yrs). The human vocal tract is sensitive to sex hormones, so the analysis was carried out in the group up to the age of 16 and above 16 to check possible effects. ResultsGRBAS scale was higher in girls with AN compared to the control group for breathiness (B) (p=0.0002) and asthenia (A) (p<0.05). The median GRBAS scale for the older group of anorexic women was the highest (2.0). The mean MPT for group A was significantly lower (15.40±3.51s). Comparing age subgroups there was a prolongation of MPT in the healthy group (in group ≤16 yrs. and >16 yrs. respectively 21.13s vs 25.40s) and a shortening in the anorectic group (≤16 yrs. vs >16 yrs.: 17.06s vs 14.17s). There was no difference between groups A and C up to 16 years of age, but above 16 years of age appeared (14.17s vs 25.40s). Acoustic analysis revealed lower F0 values in group A and C in older subgroups (215,85Hz vs 236,01Hz - statistically significant), as well as between subgroups both groups (A: 251,38Hz vs 215,85Hz; C: 248,20Hz vs 236,01Hz). A narrowing of the vocal range in girls over 16 yrs in group A was observed. There were no statistically significant differences in F0 between subgroups ≤16 years in groups A and C (251.38Hz vs 248.20Hz). The ENT study found that more than half of the girls (54.55%) over the age of 16 who took hormone supplementation manifested laryngeal structure that was normal for their age, there was no effect of hormone supplementation on any of the MDVP parameters between the drug-taking and non-drug-taking groups. ConclusionsThe acoustic results of the voice in MDVP measurements in adolescent women with AN are not within the normal range and do not mimic the normal developmental changes of the voice. The most important acoustic characteristics of the voice are changes in the fundamental frequency F0 and the range of the voice tended to be more severe in anorectic women >16 years of age and to increase with age, indicating a possible cumulative effect of malnutrition-related disorders as well as hormonal dysfunctions. MDVP can be considered a simple, non-invasive method of assessing the voice organ in AN. MPT differentiated the study groups well: statistically significant differences were noted both between the groups, as well as between age groups. There was no significant effect of oral hormone supplementation on any parameters of the voice. In conclusion, body mass and fat volume in AN may be related to voice production/physiology, affecting voice quality, voice acoustic parameters, voice aerodynamics, and phonatory range in an age-dependent manner. Future studies are needed to assess the long‐term efficacy of estrogen treatment in AN.

Ablative Fractional CO2 Laser with or without Low Dose Isotretinoin in Treatment of Acne Scars: A Comparative Study

Abstract Background Acne scarring is one of the most common sequelae of acne vulgaris. The severity of acne scars correlates with acne duration, severity and delay in treatment of acne as well as positive family history. Patients who have acne scars frequently seek treatment options to improve appearance and quality of life. Aim of the Study The aim of this study was to assess the safety of combining low-dose isotretinoin with ablative fractional CO2 laser in patients with acne scars. Patients and Methods This study included 40 patients with different types of acne scars. There were 27 females and 13 males. The patients have divided into two groups; Group A received low-dose isotretinoin with full face AF Co2 laser session, while Group B was treated with full face AF Co2 laser session. The age of patients ranged from 18 to 45 years old, with the mean age was 27.2± 6.9 yrs in group A and was 27.5± 6.06 yrs in group B. Results Duration of wound healing, PIH and pain were parallel in both groups with no significant difference between them. No other complications were reported as keloid formation, secondary infection, edema, milia or acneform eruption in study groups. Satisfactory results were reported in most of the patients. Conclusion Our study concluded that using low-dose isotretinoin with AF Co2 laser session safe procedure with normal wound healing and no keloid or hypertrophic scars formation.

A Study to Evaluate the Effect of Opportunistic Salpingectomy on Ovarian Reserve and Function.

There are conflicting reports on status of ovarian function after hysterectomy and opportunistic salpingectomy in premenopausal women. The present study was undertaken to understand the effect of salpingectomy done at the time of hysterectomy on ovarian reserve and function as measured by serum AMH and FSH levels before and after the surgery. This was a prospective study conducted on 60 women who underwent hysterectomy at our tertiary care centre, Shri Guru Ram Rai Institute of medical and health sciences, Dehradun, from January 2020 to September 2021. Serum AMH and FSH levels were monitored preoperatively and 3months postoperatively in patients undergoing hysterectomy with bilateral salpingectomy and hysterectomy without salpingectomy. The mean age of the patients was 41.83 yrs in group 1 and 43.73 yrs in group 2 [p value = 0.078]. Most common indication of hysterectomy was AUB-L in both the groups (86% and 80%, respectively). Mean operative time was 115.50min in group 1 and 114.40min in group 2 [p value = 0.823]. Mean intra-operative blood loss was 214ml in group 1 and 199.33ml in group 2 [p value = 0.087]. Serum AMH and FSH were insignificantly decreased in both the groups post-operatively after 3months, and the difference between both groups was also not statistically significant. Salpingectomy done at the time of hysterectomy for benign indications with preservation of ovaries did not have any short-term adverse effects on ovarian reserve and function.

Polyclonality Strongly Correlates with Biological Outcomes and Is Significantly Increased Following Improvements to the Phase 1/2 HGB-206 Protocol and Manufacturing of LentiGlobin for Sickle Cell Disease (SCD; bb1111) Gene Therapy (GT)

Polyclonality Strongly Correlates with Biological Outcomes and Is Significantly Increased Following Improvements to the Phase 1/2 HGB-206 Protocol and Manufacturing of LentiGlobin for Sickle Cell Disease (SCD; bb1111) Gene Therapy (GT)

Myocardial injury in COVID-19 patients is associated with the thickness of epicardial adipose tissue.

Aim High sensitive troponin (hs-TnI) levels may increase secondary to Coronavirus disease-2019 (COVID-19), and this increase is associated with cardiovascular mortality in COVID-19 patients. Epicardial adipose tissue (EAT) is associated with myocardial injury directly as a reservoir tissue for coronavirus, and indirectly through mediators it secretes as an apocrine gland. We aimed to evaluate the relationship between myocardial injury secondary to COVID-19 infection and EAT thickness.Material and methods Thoracic computed tomography (CT) was performed in 73 consecutive patients diagnosed with COVID-19. EAT thickness and volume were calculated by two radiologists blind to the study data. We formed two groups according to hs-TnI concentrations, patients with myocardial damage (hs-TnI ≥11.6 ng / l) and without myocardial damage (hs-TnI&lt;11.6 ng / dl).Results A total of 46 patients were women (63.0 %). The mean age was 66.4±12.3 yrs in the myocardial injury group and 55.9±9.7 yrs in the group without myocardial injury (p&lt;0.001). There were 20 hypertensive patients (68.9 %) in the injury group, while there were 12 hypertensive patients (27.3 %) in the group without injury (p=0.001). Glucose, C-reactive protein, D-dimer, white blood cell count, neutrophil, and neutrophil / lymphocyte ratio were higher in the injury group (p&lt;0.05, for all variables). The mean EAT thickness was 5.6±1.6 mm in the injury group, whereas it was 4.8±1.8 mm in the group without injury (p=0.031). EAT thickness of 4.85 mm and above was associated with the myocardial injury with 65 % sensitivity and 39 % specificity (AUC=0.65, 95 % CI: 0.52-078, p=0.031).Conclusion In patients with COVID-19 infection, higher rates of myocardial injury were observed as the EAT thickness increased. Epicardial adipose tissue, contributes to cytokine-mediated myocardial injury either directly or indirectly by acting as a reservoir for coronavirus. Increased EAT thickness is associated with myocardial injury in COVID-19 patients.

Exaggerated Premature Adrenarche in Boys: Comparative Study of a Therapeutic Intervention With the Aromatase Inhibitor Anastrozole Versus Morning Low Dose Hydrocortisone

Abstract Background: In boys, idiopathic premature adrenarche (IPA) is defined as the appearance of pubic or axillary hair/odor before the age of 9 yrs, not due to pathology of the adrenal glands. Exaggerated Adrenarche (EXAD), occurring in 10-15% of children with IPA, is characterized by an elevated &amp;gt;10 DHEA/Δ4 ratio (theoretically indicating reduced 3-β-HSD activity) and accelerated bone age (BA) maturation, continuously increasing the projecting distance from the target height (TH) curve, beyond the one observed in the pattern of Constitutional Advancement of Growth (CAG), eventually leading to short stature (SS). It is traditionally successfully treated with a morning (6-8 am) low dose of hydrocortisone (8 mg/m2) in order to reduce the androgens produced and delay BA progression, similarly to the standard treatment of non-classical (late-onset) CAH. Third generation aromatase inhibitors (AI) have been shown to delay BA by inhibiting the peripheral aromatization of androgens and are being widely used off-label to treat short SS in boys. Aims: To evaluate the effectiveness of the AI anastrozole in delaying BA in boys with EXAD. Methods: 39 boys with advanced BA and a predicted adult height (PAH) &amp;lt;170cm and &amp;gt; -1SDS from TH) were included. Group-A (n=28) received anastrozole 1mg x 1 p.o. and group-B (n=11) low dose (8 mg/m2) hydrocortisone at 6-8 am for at least 3 yrs. All measurements were made on the same height meter by the same examiner. The two groups did not differ in terms of age at intervention onset: 8.6 in group A vs 8.74 yrs in group B, TH: 175.7 vs 175.7 cm, PAH: 168.4 vs 167.8 cm and BA advancement: +2.3 yrs in group A vs +2.4 yrs in group B. A 6-month follow-up included clinical examination, BA assessment, and laboratory tests (general blood, lipid chart, LH, FSH, TESTO, E2, E1, and complete calcium metabolism). Lumbar spine DEXA scan and X-Ray was performed on an annual basis. Results: Both groups had a statistically significant gain in PAH after 3yrs of treatment: Group A +10.3 cm (1.53 SD), p&amp;lt;0.001, and group B +7.1 cm (1.06 SD), p=0.007. Thus, group A exceeded their TH by +3cm (0.45 SDS) and group B reached -0.8cm (-0.11 SDS) from their TH, p=0.03. The reduction of BA advancement was statistically significant in both groups (p&amp;lt;0.05), with superiority of the anastrozole-treated group: at 3yrs in group A BA advancement was +0.48 yrs, and at group B +1.24 yrs (p&amp;lt;0.001). No clinical adverse events or abnormal tests were noted in any of the groups. Bone density and vertebral morphology was not affected within or between groups. Conclusions: Aromatase Inhibitors may have a place in managing exaggerated adrenarche in boys, showing superiority to traditional low-dose hydrocortisone in improving predicted adult height and delaying bone age maturation, but notably by overcoming quality of life and compliance issues associated with hydrocortisone therapy (mandatory 6-8 am).

Anastrozole Improves Near Adult Height in Boys With Compromised Height Potential, as Monotherapy or in Combination With a GnRH Analogue

Background: Bone maturation depends mainly on locally produced estrogens by aromatization. Third generation aromatase inhibitors (AIs) are being widely used off-label to improve predicted adult height (PAH) in boys as well as in girls, either as monotherapy or in combination with growth hormone and/or puberty inhibition. They induce reverse binding inhibiting the activity of aromatase (a cytochrome P450 enzyme), which catalyzes the conversion of androstenedione and testosterone to estrone and estradiol, respectively. While numerous studies have shown that AIs delay bone maturation and improve PAH, data on near-adult height (NAH) of children treated with AIs are lacking. Aims: To compare results on NAH of boys treated with anastrozole either as monotherapy or in combination with pubertal inhibition (for at least 1yr at onset). Methods: 159 boys with advanced bone age (BA) and PAH <170 cm that received anastrozole 1 mg/day p.o. either as monotherapy (n=76, group A) or as co-therapy with a GnRH analogue for at least 1yr and then as monotherapy (n=83, group B) until bone age of 15-16 yrs were included. Data on boys that reached NAH (BA at least 16 yrs with height velocity <2 cm/yr) were analyzed: group A, n=16 with PAH 167.3 and TH 170.9 and group B, n=10 with PAH 165.5 and TH 171.7 cm. Measurements were made on the same height meter by the same examiner. The choice of therapeutic intervention was made randomly. Groups A and B did not differ in terms of age at intervention onset, TH or PAH. During treatment, they underwent a 6-month follow-up that included clinical examination, BA, and laboratory tests at 8:00 hrs (general blood count, lipid chart, LH, FSH, testosterone, estradiol, estrone, and complete calcium metabolism), with lumbar spine DEXA (Dual Energy X-ray Absorptiometry) and X-ray performed annually. Results: The duration of anastrozole treatment was 3.9 yrs in group A, and 4.6 yrs in group B (where the GnRHa was administered for at least 1 yr) and the median age at intervention onset was 11.04 and 11.8 yrs, respectively. Both groups had a statistically significant gain in NAH with no difference between them: for group A 3.6 cm (+0.53 SD, p=0.002) and for group B 4.8 cm (+0.71 SD, p=0.0007). Thus, distance from TH was finally 0 cm for group A and -1.5 cm (0.19 SD) for group B. According to the definition of NAH, the adult height of the two groups is expected to be about 2% higher. Follow-up showed no side effects on their biochemical or lipid profile, bone density and vertebral architecture. Conclusions: Anastrozole therapy is safe and effective in improving adult height in boys with advanced puberty and poor height prediction, either as monotherapy or in combination with pubertal inhibition.

Association of low Serum Magnesium level with occurrence of Ventricular Arrhythmia in patients with Acute Myocardial Infarction

Background: Acute Myocardial Infarction is the leading cause of morbidity and mortality throughout the world. Its prevalence among developing countries has increased significantly over the past two decades. Acute myocardial infarction is associated with electrolyte imbalance most commonly hypomagnesemia and hypokalaemia. Both are associated with ventricular arrhythmia which can lead to increase hospital mortality and morbidity.&#x0D; Objectives: To find out association of hypomagnesemia with ventricular arrhythmia in patients with acute myocardial infarction. Methods: Patients with acute myocardial infarction admitted in the department of Cardiology, DMCH, within the study period and who fulfilled the inclusion and exclusion criteria were taken as study sample. Informed consent was taken from all patients and then the patients were evaluated by detailed history, clinical examination and relevant investigations. Serum magnesium level was measured after admission. The sample population was Grouped into Group A(Acute myocardial infarction with normal serum magnesium) and Group B(Acute myocardial infarction with hypomagnesemia). Patients were followed up regularly till discharge or death for evidence of ventricular arrhythmia. Then the obtained data was analysed with SPSS 22.0.&#x0D; Results: Among 110 patients of Acute MI, 44 patients were in Group A who had plasma magnesium level e”0.7 mmol/ l and 66 patients were in Group B who had plasma magnesium level &lt;0.7 mmol/l. Incidence of hypoagnesemia was 60% and more common in male. Male vs female percentage of hypomagnesemia were 61% vs 39%. Mean age was 54.16±11.72 yrs vs 57.52±10.59 yrs in group A vs group B. On admission serum magnesium level was 0.9218 vs 0.523 mmol/L( group A vs group B). The study showed that group B patients were more haemodynamically unstable and mean SBP and DBP were found 89.39±19.93 and 60.67±11.56 mm-Hg respectively. Troponin I was markedly increased in group B than A (i.e 4.7±1.79 vs 14.6±4.3 vs ng/ml). Adverse cardiac events such as cardiogenic shock (group A vs group B = 11.36% vs 28.27%) and ventricular arrhythmias(group A vs group B = 34% vs 72.73%) were also higher in group B than group A. Mean hospital stay for group B patient was higher than group A(6.78±0.85 vs 5.31±0.35 days). The study result showed that ventricular arrhythmia is negatively correlated with serum magnesium and the correlation coefficient was - 0.541. It also showed that serum Magnesium is positively correlated with Potassium(r= 0.831, p&lt;0.01) and Calcium(r= 0.902, p&lt;0.001). Multiple logistic regression analysis showed that hypomagnesemia is an independent risk factor for ventricular arrhythmia.&#x0D; Conclusions: This study showed that in patients with acute myocardial infarction, hypomagnesemia is common and it is significantly associated with ventricular arrhythmia. So the presence of hypomagnesemia should alert the physicians to adopt corrective measures as it increases both mortality and morbidity.&#x0D; Bangladesh Heart Journal 2020; 35(1) : 39-46

Abstract P6-10-13: Associated ductal carcinoma in situ in primary operated TNBC is associated with a longer time to distant event

Abstract Purpose We studied presence of accompanying ductal adenoma in situ (accom-DCIS) in a consecutive series of primary operated TNBC for distant time-to-event outcome. Methods A retrospective cohort study (diagnosis 1/1/2000 - 31/12/2017) of prospectively registered primary operated TNBC patients in UZ Leuven. Only TNBC of no special type were included. We compared patient (age, BMI, symptomatic/screening-detected) and tumor related factors (Nottingham Prognostic Index (NPI), Lymphovascular Involvement (LVI)) for accom-DCIS and analyzed the effect of accom-DCIS on distant time to event outcome using the Cox proportional hazards model. Multivariate models were used to correct for possible confounders. Results We included 524 patients. Median follow-up was 102 months. Mean age of patient was 57.3 [26-90] years and 361 had accom-DCIS (68,9 %); demographics, clinical-pathological characteristics and postoperative chemo- and radiotherapy were similar in patients with and without accom-DCIS; only LVI was significantly more likely to be present in accom-DCIS cases (p=&amp;lt;0.001). There were no differences in distant relapse rate (16.6% in accom-DCIS group vs 12.9% in no DCIS group [HR = 1.350, 95% CI (0.817;2.248) p=0.239]. Time to distant event was later if accom-DCIS was present: Mean time to distant event was 2.72yrs in the accom-DCIS group and 1.61yrs in the group with absent DCIS. In accom-DCIS 20/63 (31.8%) distant relapses occurred after 3 years while only 1/21 distant relapse (4.8%) occurred after 3 years in the non-DCIS group [HR =6.667, 95% CI (0.952-46.705) p=0,029]. Conclusion In our series of TNBCs, patients with and without accom-DCIS had similar distant relapse rates. Significantly more distant relapse occurred after 3 years in patients with accom-DCIS compared to patients without accom-DCIS. Citation Format: Jan Ardui, Hans Wildiers, Giuseppe Floris, Hava Izci, Kevin Punie, Tatjana Geukens, Els Van Nieuwenhuysen, Sileny Han, Patrick Berteloot, Annouschka Laenen, Hilde Janssens, Ann Smeets, Caroline Weltens, Ignace Vergote, Patrick Neven. Associated ductal carcinoma in situ in primary operated TNBC is associated with a longer time to distant event [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-10-13.

Comparison of standard and low-pressure pneumoperitoneum; reduction in frequency and intensity of post-operative shoulder pain

Laparoscopic cholecystectomy is now gold standard and depends on good exposure of the peritoneal cavity. It is achieved by insufflation of the abdominal cavity with CO2. Operating at lower intraabdominal pressure (&lt;12 -15mmHg) has been associated with fewer pulmonary and hemodynamic complications and lesser postoperative pain.&#x0D; Objective: To ascertain the advantages of low pressure pneumoperitoneum over standard pressure pneumoperitoneum&#x0D; Methods: Our study was quasi experimental study conducted at KRL Hospital, Islamabad over period of 3years from 2013 to 2016. SPSS version 20 was used to calculate p value. &#x0D; Results: A total of 456 patients of gallstones were equally divided in two groups assigned to undergo low pressure (7-8mm of Hg) pneumoperitoneum or standard pressure (12-14mm of Hg) pneumoperitoneum laparoscopic cholecystectomy The average age of patients was 46.2+/-13.6yrs in group A compared to 43.5 +/- 12.9 in group B. There were 60 (26.3%) male and 168 (73.7%) female patients in group A compared to 53 (23.2% and 175 (76.85) in group B respectively. It was found that group A 14 (6.1%) had no pain, 26 (11.4%) had VAS between 1 – 7 and 188 (82.5%) had VAS of 8 – 10 where as in group B 164 (72.6%) patients reported no shoulder tip pain postoperatively, 42 (18.6%) had VAS of 1 – 7 and 20 (8.8%) had VAS OF 8 – 10. The difference was statistically significant (p-value = &lt;0.001).&#x0D; Conclusions: reduced pressure of pneumoperitoneum to 7 – 8 mm of Hg produce lower incidence of postoperative shoulder tip pain.

Comparative study on maternal and fetal outcome in pregnant women with rheumatic heart disease and severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy

IntroductionMitral stenosis due to rheumatic heart disease is a common problem in India causing significant morbidity and mortality. We have compared the maternal and fetal outcome of women with severe mitral stenosis undergoing percutaneous balloon mitral valvotomy before or during pregnancy. MethodsA total of 24 women of severe rheumatic mitral stenosis who underwent balloon mitral valvotomy before pregnancy (14 women, group 1) or during pregnancy (10 women, group 2) were included in the retrospective descriptive analysis. ResultsThe mean age was 25.5±3.6 yrs in group 1 and 25.7±3.5 yrs in group 2. There was no difference in characteristics –primigravidas, time since diagnosis from pregnancy, NYHA (New York Heart Association) class and associated medical problems in the two groups. There was significant difference in cardiac events during pregnancy in the two groups. New York Heart Association class deterioration was observed in only 3(21.4% women in group 1) as compared to all (10; 100% women) in group 2(p<0.001). The incidence of arrhythmias and atrial fibrillation was not different in two groups. Obstetric events were similar in the two groups. Mode of delivery and caesarean section rate was also similar in the two groups. There was no significant difference in mean birth weights (2399.75±601.8gm vs. 2641.70±580.6gm),rate of fetal growth restriction, still birth and congenital malformation rates in the two groups. ConclusionPercutaneous mitral valvotomy for patients with severe mitral stenosis can be safely performed during pregnancy and has equivalent maternal and fetal outcomes as that performed before pregnancy.

Dietary supplementation with coenzyme Q10 in poor responder patients undergoing IVF-ICSI Treatment

Ovarian aging and age-related reduction in live birth rate reflects a decline in response to ovarian stimulation, reduced embryo quality and pregnancy rate (PR), and an increased incidence of miscarriages and fetal aneuploidy. This is attributed to a high rate of aneuploidy and follicle depletion, probably due to energy-dependent mechanism as mitocondrial mutations in follicular cells increase with age and oxidative phosphorylation an ATP production in the follicle is also impaired in older women. Coenzyme Q10 (CoQ10) is a crucial substrate in the electron transport chain of mitochondria., and has been shown to decrease in several tissues with aging. The aim of this study was to asses if dietary supplementation of mitochondrial nutrients such as C0Q10 may improve mitochondrial energy production for the maturing oocyte and developing embryo, thereby improving ovarian response and reproductive outcome in poor responders. Prospective randomized controlled study. Seventy eight poor responders (36-40 years of age) in a previous IVF cycle according to Bologna criteria were randomized to Group 1 : 600 mg Co Q10 twice a day for 12 weeks and Group 2: no treatment for 12 weeks. Mean age was 37.8 yrs. in Group 1 and 37.2 yrs in group 2. Anti-Mullerian hormone (AMH) (0.67 +- 0.26vs 0.7 +-0.28) and FSH values (12 +- 2.11 vs 11.6 +- 1.89) were comparable. The primary outcomes were number of oocytes retrieved, number of good quality embryos obtained, pregnancy rate and live birth. Both groups were comparable in terms of age, BMI, ovarian reserve (AMH and FSH) and length of treatment. There were no significant differences in the number of MII oocytes retrieved (1.82 ± 0.82 vs. 1.87 ± 0.76; p=0.77), implantation rate (26.2% vs. 21.4%; p=0.75) and clinical pregnancy rate (fetal heartbeat at 7 weeks) (15.4% vs. 12.8%; p=0.64) No significant differences in outcome were detected between the CoQ10 and no treatment groups. However, the sample size of this study may be underpowered to detect a significant difference.

MP22-11 SAFETY AND SURGICAL OUTCOMES OF PERCUTANEOUS NEPHROLITOTOMY IN PATIENTS WITH POOR RENAL FUNCTION.

You have accessJournal of UrologyStone Disease: Surgical Therapy I1 Apr 2016MP22-11 SAFETY AND SURGICAL OUTCOMES OF PERCUTANEOUS NEPHROLITOTOMY IN PATIENTS WITH POOR RENAL FUNCTION. Alexander Heinze, Miguel Villalobos, Eduardo Cruz-Nuricumbo, Lizzette Gomez de Regil, Rodrigo Suarez-Ibarrola, Carlos Otilio García-Jiménez, María Teresa del Carmen Moreno y Suarez, Eddie Noj-Moreno, Maria Dolores Alsina, Joey Piccolo, and Kassandra Oliva Alexander HeinzeAlexander Heinze More articles by this author , Miguel VillalobosMiguel Villalobos More articles by this author , Eduardo Cruz-NuricumboEduardo Cruz-Nuricumbo More articles by this author , Lizzette Gomez de RegilLizzette Gomez de Regil More articles by this author , Rodrigo Suarez-IbarrolaRodrigo Suarez-Ibarrola More articles by this author , Carlos Otilio García-JiménezCarlos Otilio García-Jiménez More articles by this author , María Teresa del Carmen Moreno y SuarezMaría Teresa del Carmen Moreno y Suarez More articles by this author , Eddie Noj-MorenoEddie Noj-Moreno More articles by this author , Maria Dolores AlsinaMaria Dolores Alsina More articles by this author , Joey PiccoloJoey Piccolo More articles by this author , and Kassandra OlivaKassandra Oliva More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.699AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolitotomy (PCNL) is today's standard of care for patients with kidney stones >20mm. Recently studies have been focused on preventing complications and predicting surgical outcomes. Urolithiasis is frequently associated to chronic kidney disease due to its obstructive and infectious implications. The glomerular function rate (GFR) can be calculated from various formulas and is used to evaluate renal function and be staged accordingly (KDIGO, Kidney Disease Improving Global Outcomes). We investigated surgical outcomes of percutaneous nephrolitotomy (PCNL) in patients with poor renal function (GFR <60 mL/min/1.73m2) in a reference center with a high proportion of staghorn stones and large stone burden (mean stone diameter 39.8, range 5-89mm). METHODS We systematically reviewed all patients who underwent PCNL in our center from June 2009 to May 2015. We assed patients renal function using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. Then classified them into their KDIGO stage. Posteriorly we subdivided them in two different groups, group 1 (KDIGO 1 and 2) and group 2 (KDIGO 3, 4 and 5). We analyze both groups and compared them according to sociodemographic, biochemical, surgical, and clinical outcomes. RESULTS A total of 257 patients were reviewed in the present study. 181 patients in group 1 and 76 into group 2. When classified according to KDIGO, 110, 56, 42, 13 and 14 were in stage 1 to 5, respectively. Group 2 had significantly higher mean patient age (49.2 vs 42.4 yrs in group 1), higher proportion of single kidney (26% vs 0.6% in group 1, p<0.001), lower levels of preoperative hemoglobin (11.9 vs 12.77mg/dl in group 1, p=0.001), larger stone diameter (43.6 vs 38.2 mm in group 1, p=0.001), nephroscopy time (113 min compared to 87 min in group 1, p=0.003), higher incidence of incidental purulent urine (35.53% vs 17.67% in group 1, p=0.002) and lower stone-free rate (27.1 vs 47.0% in group 2, p=0.005). No statistical difference was found in estimated blood loss, need for blood transfusion, nor surgical complications as evaluated by Clavien-Dindo classification. CONCLUSIONS PCNL in patients with poor renal function are usually older, have lower hemoglobin levels although this does not translate into higher transfusion rate. Their stones are larger and have a higher incidence of purulent urine. Importantly, PCNL can be performed safely in this subgroup of patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e257 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Alexander Heinze More articles by this author Miguel Villalobos More articles by this author Eduardo Cruz-Nuricumbo More articles by this author Lizzette Gomez de Regil More articles by this author Rodrigo Suarez-Ibarrola More articles by this author Carlos Otilio García-Jiménez More articles by this author María Teresa del Carmen Moreno y Suarez More articles by this author Eddie Noj-Moreno More articles by this author Maria Dolores Alsina More articles by this author Joey Piccolo More articles by this author Kassandra Oliva More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A PROSPECTIVE RANDOMIZED COMPARATIVE EVALUATION OF FLUPIRTINE AND DICLOFENAC SODIUM IN POST INGUINAL HERNIA SURGERY PAIN

Introduction: Effective postoperative pain control is an essential component of care of surgical patients. Nonsteroidal anti-inflammatory drugs are mainstay to treat pain and inflammation. Flupirtine is a novel, non-opiate, non-NSAID, centrally acting analgesic without side effects associated with NSAIDs. Aim and Objectives: Prospective, randomized, double blind comparative study to evaluate and compare analgesic efficacy of flupirtine with diclofenac sodium in inguinal hernia surgery. Methods: The study was conducted in tertiary care teaching hospital on 50 patients aged 15-65 yrs of either sex who underwent inguinal hernia surgery between March 2014 and January 2016. Patients with liver and renal failure, hypersensitivity to flupirtine or diclofenac, pregnant/lactating women, bronchospastic disease, inability to understand pain score, prior history of peptic ulcer were excluded from study. The patients were randomly allocated into two groups consisting of 25 patients each: group-A (tab flupirtine 100mg),group-B (tab diclofenac sodium 50mg). Pain was evaluated in detail using simple and sensitive visual analog scale. Results: The mean age of the participants was 37.57±12.02 yrs in group A and 37.82±13.43 yrs in group B(p>0.05 ) with male-to-female ratio 3:1. The mean weight of the participants was 66.72±12.90 vs 64±13.10 kg (p>0.05). The mean VAS values observed were 1.36±1.77 at baseline, 1.24±2.18 at 6 hours, 0.60±1.65 at 12 hours, 0.40±1.19 at 18 hours, 0.16±0.62 at 24 hours, 0.08±0.4 at 30 hours & 36 hours, at 42 and 48 hours were 0 for group A. For group B values calculated were 2.20±2.58 at baseline, 1.40±1.55 at 6 hours, 1.28±1.72 at 12 hours, 0.76±1.56 at 18 hours, 0.28±0.61 at 24 hours and at 30, 36, 42 and 48 hours were 0. The intergroup comparison between group A and group B by independent t-test at various intervals revealed no statistically significant difference between two groups in mean VAS (p>.05) that means both the drugs are equally efficacious in relieving post-operative pain. Only 1 patient (4%) in group A experienced nausea. A total of 4 patients in group B had side effects, all 4 patients (16%) had heart burn, 2 out these 4 also complains of pain abdomen and 1 patient (4%) had vomiting. Conclusion: Flupirtine could be a better alternative to opioids and NSAIDs in postoperative pain relief

Moderate Intensive Chemotherapy Including CNS-Prophylaxis with Liposomal Cytarabine Is Feasible and effective in Older Patients with Ph-Negative Acute Lymphoblastic Leukemia (ALL): Results of a Prospective Trial From the German Multicenter Study Group for Adult ALL (GMALL)

Abstract 1493 Few older ALL pts are entered into prospective trials and data on characteristics and outcome are scarce. The GMALL started a prospective trial in older ALL (>55 yrs) in 2003. In Ph-neg ALL a prephase (Dexa, Cyclo, MTX i.th.) was followed by induction I (Dexa, VCR, Idarubicin), induction II (Cyclo, AraC), alternating consolidation with IDMTX (d 1,15) ×3, VM26/AraC ×2, reinduction (VCR, Ida, Cyclo, AraC) and maintenance (MP, MTX) up to 2 yrs. In CD20+ ALL Rituximab ×8 was added. CNS-prophylaxis consisted of i.th. triple combination (MTX, AraC, Dexa) ×4 during induction, ×8 during consolidation/maintenance. The original protocol (group 1) was amended to optimize CNS prophylaxis and consolidation (group 2). I.th. therapy was then performed with liposomal cytarabine, 3x during induction, 3x during consolidation. IDMTX dose was increased from 500 to 1000 mg/m 2 and native E.coli ASP (10.000 U/m 2 ) was added on d2 and d16 of IDMTX. VM26/AraC was replaced by IDAraC (1000 mg/m 2 d1,3,5). In a further amendment the original i.th. prophylaxis was reinserted until final analysis of liposomal AraC became available. Furthermore, after induction, one cycle with pegylated ASP (500 U/m 2 ) (PEG-ASP) was scheduled to evaluate feasibility in older pts (group 3). Results of induction were compared for groups 1–3; outcome analysis was restricted to 1–2 due to still short follow-up for group 3. 268 pts with a median age of 67 (55–85) yrs treated in 94 hospitals were evaluable (180, 43 and 45 pts in groups 1, 2 and 3 resp.). 39% were aged 55–65 yrs, 51% 66–75 yrs and 10% above 75 yrs. 67% had c/pre-B-ALL, 18% pro-B-ALL and 15% T-ALL. WBC was >30/nL in 27%. Poor ECOG status (≥2) before (ECOGb) or after (ECOGa) onset of ALL was described in 7% or 38% resp. 78% had any comorbidity and 9% had a Charlson score (ChS) ≥3. No significant differences were detected between groups 1–3. Overall 76% (N=203) achieved CR after induction, 14% experienced early death (ED) and 10% did not achieve CR. In groups 1–3 CR rates were 72%, 86% and 82% resp. and ED rates 18%, 0% and 11% resp. (p=.03). CR rates were 84%, 74% and 52% in three age groups (p=.002) with ED rates of 7%, 14% and 37% resp. (p=.0004). Immunophenotype and WBC ( 30.000) correlated with CR but not ED rate. ECOGb 0–1 vs ≥2 correlated with CR (82% vs 33%;p Overall survival (OS) at 5 yrs was 23%; 33% at 2 yrs for group 1 and 52% for group 2 resp. (p=.01). Mortality in CR was 6% and 15% of the pts were withdrawn in CR. Probability of continuous complete remission (CCR) was 32% at 5 yrs, 42% and 43% at 2 yrs for group 1 and group 2 resp. (p=>.05). Age (42% vs 37% vs 8%;p=.0007), WBC (43% vs 15%;p With this age adapted regimen a favorable CR rate was achieved in a large patient group with a median age of 67 yrs. CR was increased (86%) and mortality was decreased (0%) significantly with liposomal cytarabine compared to triple i.th. prophylaxis during induction, since the latter probably induced more bone marrow toxicity. Reduced ED contributed considerably to improved OS. Moderate intensive consolidation was feasible and ASP, including PEG-ASP, was well tolerated. Age was correlated with outcome and 75 yrs appears to be the upper limit for this regimen. General condition was an additional highly relevant prognostic factor whereas comorbidity, measured by Charlson score was associated with ED but not with OS. These results encourage further treatment optimisation in older ALL pts, including those with comorbidities, based on comprehensive diagnostics, geriatric assessment, MRD evaluation, intensified consolidation, use of ASP, dose-reduced stem cell transplantation and integration of new, targeted drugs. Disclosures: Goekbuget: Medac: Consultancy, Research Funding, Speakers Bureau; Novartis: Research Funding; BMS: Research Funding; Genzyme: Research Funding; Mundipharma: Research Funding, Speakers Bureau; Glaxo: Research Funding, Speakers Bureau; Micromet/AMGEN: Consultancy; Sigma Tau: Consultancy. Off Label Use: Liposomal cytarabine in prophylaxsis of CNS relapse in ALL.

Comparison of Transumbilical and Conventional (Pfannenstiel) Laparoscopic Donor Nephrectomy

Forty-eight healthy voluntary renal donors between 18 and 60 years of age with BMI less than 30 who were planned for laparoscopic left side donor nephrectomy were enrolled in the study. After randomization 25 donors (group A) underwent a conventional laparoscopic donor nephrectomy with a Pfannenstiel incision used for kidney extraction whereas in 23 donors (group B) the kidney was extracted via a midline extension of the transumbilical port. Both groups of recipients were comparable in terms of basic disease leading to end stage renal disease and were given triple drug immunosuppression comprising of calcineurin inhibitor, mycophenolate and steroid. Mean age of donors in group A was 41.72 yrs and 38.04 yrs in group B. Mean duration of surgery and warm ischemia time were comparable (227.12 min/ 263 seconds in group A versus 228.91 min/ 283 seconds in group B). Estimated blood loss was similar in both groups (165.6 ml in group A versus 151.3 ml in group B). There were no intraoperative or postoperative complications in both groups. Weight of the kidneys (128.2 gm in group A vs. 120.4 gm in group B), length of renal artery (2.37 cm in group A vs. 2.30 cm in group B) and length of renal vein (2.58 cm in group A vs. 2.67 cm in group B) were statistically similar in both groups. Length of ureter (8.7 cm in group A vs. 10.17 cm in group B) and length of extraction site incision (7.95 cm in group A vs. 10.17 cm in group B) showed statistically significant difference. Pain scores noted by numerical rating scale on day 1 (8 in group A vs. 6 in group B) and 3 (6 in group A vs. 3 in group B) after surgery and at time of discharge (5 in group A vs. 3 in group B) showed statistically significant difference. Both groups of donors rated pain at 0 at 1 month following surgery. Day of discharge was similar in both groups with median 3 days post operative stay. Serum creatinine of recipients on day 1 (2.57 vs. 2.99 mg/dl in groups A and B respectively) and 3 (1.74 vs. 2.15 mg/dl in groups A and B respectively) after surgery were comparable while mean serum creatinine on post operative day 7 (1.74 vs. 2.15 mg/dl in groups A and B respectively) was significantly higher in recipients of group B. Serum creatinine of recipients at 1 month post transplantation was similar in both groups (1.11 vs. 1.18 mg/dl in groups A and B respectively). The higher creatinine at day 7 may be explained by two patients in group B who had delayed graft function due to calcineurin inhibitor toxicity. In conclusion the lower pain scores and shorter incision length with similar outcomes suggests that a transumbilical route may be a better approach for kidney retrieval.

Comparative Study of Metformin Versus Clomiphine Citrate for Ovulation Induction in Polycystic Ovary Syndrome at Lady Willingdon Hospital Lahore

Background: Metformin has given quite encouraging results in a number of patients improving overall ova-rian health and inducing pregnancies. Objective: The Purpose of this study was t o compare the effectiveness of combined treatment regimen Met-formin and Clomiphene citrate with Clomiphene cit-rate alone for ovulation induction. Methodology: This randomized controlled trial was conducted over a period of 2 years from Jan. 2008 to Jan 2010. This study includes prospective analysis of PCOS subjects, who were treated in Gynaecological unit II of Lady Willingdon Hospital Lahore. Two hun-dred subjects were recruited and then divided rando-mly into two groups, A and B. Group A, included one hundred patients (50%) who were treated with clomi-phine citrate only while Group B, included one hun-dred patients who were treated with Metformin and clomiphine citrate both. The collected data was ente-red into SPSS version 17 and were analysed accordin-gly applying descriptive statistics e.g. mean, frequency and analytical e.g. t-test and Chi Square. Results: Mean age at presentation of group-A was 26.52 ± 0.23 which when compared with that of gro-up – B 26.17 ± 0.25 did not differ statistically (P-Value = 0.306 – in significant). Similarly age at mena-rche of group A (CC) 12.82 ± 0.08 did not show statis-tical difference when compared with that of group – B (CC + met) 13.04 ± 0.11 (P-Value = 0.123 – insignifi-cant) or > 0.05. As for as duration of infertility was concerned it was 5.28 ± 0.27 yrs for group – A and 4.99 ± 0.20 years, for group – B. Overall, 125 (62.5%) women ovulated, out of which 46 (36.8%) were from Group – A while 79 (63.2) were from Group – B). Conclusion: Metformin may be a therapeutic option for PCOS based on improvement in laboratory and clinical parameters. Our results also establish guide-lines for metformin treatment with special implication on non-obese patients. It should be recommended for being effective as well as ecnomical. Key words: Polycystic ovary, Metformin and Clomi-phene citrate.

Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in the Imatinib-Era: High Survival Rate Following Allogeneic HSCT after Imatinib Failure: Results of the German CML Study IV

Allogeneic HSCT remains an important option for patients with chronic myeloid leukemia (CML) who failed imatinib. Focus has been on second line tyrosine kinase inhibitors (TKI). Little is known on the outcome of HSCT for such patients. In July 2002, the German CML-Study Group activated a prospective randomized trial comparing different imatinib based strategies in chronic phase CML (CP). Elective early HSCT was considered for patients (pts) with EBMT score 0–1 for those with high disease risk, and after imatinib failure. By the end of July 2008, 1197 pts were randomized. In 80 (6,5 %) pts HSCT was documented. 52 pts were male (65%), 23 were high risk pts (28%) according to the Euro score. Median age at diagnosis was 37 years (yrs) (range 16–62), median time to HSCT was 12.6 months (mo, range 3.5–54 mo). EBMT score was 0–1 in 8 (10%), 2 in 10 (12%), 3–4 in 44 (55%) and 5 in 18 pts (23%). Median follow-up after HSCT was 19 mo (range 0–59). Cumulative response rates prior to HSCT were 68% for complete hematologic response, 23% for complete cytogenetic responses, and 9% for major molecular responses. Based on the indication for HSCT three groups were defined:early HSCT (n= 19, 23%; low EBMT score (n=9), high risk pts (n=7), patient request (n=3);HSCT after imatinib failure or intolerance in first CP (n=34, 43%) andHSCT in second CP or higher, accelerated phase or blast crisis (n=27, 34%).14 pts died, 10 deaths were transplantation related, 4 CML related. Two pts with a molecular relapse were successfully treated with donor lymphocyte infusion in combination with TKI. Overall survival rate at two yrs for group one was 87.8%, for group two 93.8%, and for group three 49.5%. By EBMT score, survival rates were 100% for risk score 0–2, 82.2% for risk score 3–4, and 43.5% for risk score 5. Data from this prospective controlled cohort study clearly show that HSCT remains an attractive and important rescue therapy for CML patients with imatinib failure or intolerance, particularly for those with a low EBMT risk score.HSCT in 1st CPearly HSCTHSCT for failure and intolerance in 1st CPTotalHSCT in advanced phasesN19345327Euro scorehigh68149intermediate312157low10142411% male63566078Median age (range)35 (16–56)38 (21–56)37 (16–56)37 (18–62)Median time to HSCT (Range) (months)8.5 (4.8–23.6)17,5 (5.0– 53.7)12.6 (4.8 53.7)12.0 (3.5–54.1)EBMT score0–15380254913–4926359>=501117Best responseCHR11/1828/3439/5214/26CCyR3/1710/3313/504/22MMR2/173/315/482/19Response at HSCTBC00024AP0003CP1934530HR1119300Ccyr2240MMR0000Transplant sourceSibling1010209Unrelated9243318Conditioning therapystandard14213517reduced3694other2796SourcePB13263922BM68145Dead22410TRM2246CML0004Probability of survival at 2 years after HSCT87.8%93.8%91.4%49.5%

Clinical Profile of Diabetes Mellitus in Children and Adolescents under Eighteen Years of Age

A total number of 125 patients with diabetes mellitus (DM) under eighteen years of age were admitted in the Paediartic department of BIRDEM hospital between January 2001 to October 2002. Eighty-eight patients (71%) were newly detected. Female to male ratio was 3:1. Out of the total admission 38 (30.4%) patients had type 1 DM (group 1), 37 (29.6%) patients had fibrocalculous pancreatic FCPD diabetes (group II), 48 (38.4%) patient had malnutrition modulated diabetes mellitus MMDM (group III) and 2 (1.6%) patients had type 2. Mean age of onset was 9±3.9 yrs in group I and 13±2.3 yrs in group II and group III. All groups had very high glucose and HbA1c value at presentation. The mean fasting glucose (mmol/l) was 19±7.14, 22.39±9 and 19.54±7.9 in group I, group II and group III respectively. The Mean HbA1c (%) value in the three groups was 14.4±2.7, 16.72±2.26 and 15.27±3.05 respectively. FCPD patients had poorest glycaemic status. Acute complications were more common in type 1 patients. Twelve (31.5%) patients had diabetic ketoatin DKA and two (5%) patients had hypoglycaemia in group I. Chronic complications were present in all three groups. MMDM patients had highest rate of complications. which was present in 2.6%, 21.6% and 33.3% patients in group I, group II and group III respectively. The rate of microalbuminuria was 5.3%. 10.8% and 18.8% in the three groups respectively. The rate of neuropathy was 2.6%, 16.2% and 20.8% in the three groups respectively. Among the associated problems skin infection, pulmonary tuberculosis and bilateral parotid swelling were common. Malnutrition was present in 66%, 86% and 100% in group I, group II and group III respectively. Majority (50% in group I, 91.6% in group II and 100% in group III) of our patients came from poor socio-economic background. Ibrahim Med. Coll. J. 2007; 1(1): 11-15 Key words: Diabetes mellitus doi: 10.3329/imcj.v1i1.2889