scholarly journals Oxytocin Versus Misoprostol Plus Oxytocin in the Prevention of Postpartum Hemorrhage at a Semi-Urban Hospital in sub-Saharan Africa: A Retrospective Cohort Study

2020 ◽  
Vol 9 (3) ◽  
pp. 287-296
Author(s):  
Emmanuel Numfor ◽  
Nkengafac Nyiawung Fobellah ◽  
Joel Noutakdie Tochie ◽  
Tsi Njim ◽  
Sylvester Atanga Ndesso
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Sub Saharan Africa ◽  
Urban Hospital ◽  
Before And After ◽  
Misoprostol Group ◽  
Group A ◽  
Sub Saharan ◽  
Group B

Background: Post-partum hemorrhage (PPH) is a leading cause of maternal mortality. Its first-line of prevention often entails uterotonic drugs like oxytocin and misoprostol which constitute a core point of management in low-resource settings of sub-Saharan Africa. This study aimed to assess the effectiveness of oxytocin alone compared with oxytocin plus misoprostol in two different eras (before and after the advert of misoprostol) of a semi-urban Cameroonian hospital. Methods: This was a retrospective cohort study carried out between January 2015 to April 2015 and between January 2016 to April 2016 on a group of parturients (group A) who received only oxytocin and another administered oxytocin and misoprostol (group B), respectively. All participants delivered at the Bamenda Regional Hospital, Cameroon. The two different periods represent the era before and after the implementation of misoprostol in the prevention of PPH in this semi-urban hospital. Socio-demographic data, clinical characteristics and details of delivery as well as risk factors for PPH were studied from obstetric records. Results: We studied the obstetric records of 1778 parturients were studied; 857 in group A and 879 in group B. Their mean age was 26.3 ±5.2 years. Both groups were comparable in several baseline sociodemographic and clinical characteristics. The prevalence of PPH was 2.7% (3.4% vs 2.2%; p = 0.0744). The risk of PPH in the oxytocin only group was about 1.5 times higher than in the oxytocin plus misoprostol group. The estimated blood loss between the two groups was statistically significant (1100 ± 150 vs 800 ± 100 ml, p< 0.0001). The active management of the third stage of labor without misoprostol was the only risk factor for PPH. Conclusion and Global Health Implications: The implementation of misoprostol plus oxytocin in the prevention of PPH in this low-resource setting improved the obstetrical outcome by reducing the risk and the amount of blood loss during delivery. Keywords: • Misoprostol • Oxytocin • Postpartum Hemorrhage • Cameroon   Copyright © 2020 Numfor et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

scholarly journals Effectiveness of a Gelatin–Thrombin Matrix Sealant (Floseal®) for Reducing Blood Loss During Microendoscopic Decompression Surgery for Lumbar Spinal Canal Stenosis: A Retrospective Cohort Study

2021 ◽  
pp. 219256822110088
Author(s):  
Kazunori Nomura ◽  
Munehito Yoshida ◽  
Motohiro Okada ◽  
Yosuke Nakamura ◽  
Kenichi Yawatari ◽  
...  
Keyword(s):  
Cohort Study ◽  
Blood Loss ◽  
Retrospective Cohort ◽  
Spinal Canal Stenosis ◽  
Lumbar Spinal Canal Stenosis ◽  
Canal Stenosis ◽  
Postoperative Drainage ◽  
Group A ◽  
Group B ◽  
Lumbar Spinal

Study Design: Retrospective cohort study. Objectives: To investigate the effectiveness and safety of a gelatin–thrombin matrix sealant (GTMS) during microendoscopic laminectomy (MEL) for lumbar spinal canal stenosis (LSCS). Methods: This study included 158 LSCS cases on hemostasis-affecting medication who underwent MEL by a single surgeon between September 2016 and August 2020. Patients were divided into 2 groups depending on whether GTMS was used (37 cases, Group A) or not (121 cases, Group B). Perioperative data related to bleeding or postoperative spinal epidural hematoma (PSEH) was investigated. Clinical outcomes were evaluated using the Japanese Orthopedic Association (JOA) score for low back pain. Results: The mean intraoperative blood loss per level was greater in Group A (26.0 ± 20.3 g) than in Group B (13.6 ± 9.0 g), whereas the postoperative drainage volume was smaller in Group A (79.1 ± 42.5 g) than in Group B (97.3 ± 55.6 g). No revision surgeries for PSEH were required in Group A, while 2 (1.7%) revisions were required in Group B ( P = .957). The median JOA score improved significantly from the preoperative period to 1-year postoperatively in both Group A and B (total score, 16.0-23.5 and 17.0-25.0 points, respectively). Conclusions: The use of GTMS during MEL for LSCS may be associated with a reduction in postoperative drainage volume. The revision rate for PSEH was not affected significantly by the use of GTMS. Clinical outcomes (represented by the JOA score) were significantly improved after the surgery, regardless of GTMS use during MEL.

scholarly journals Potential of Spirulina Platensis as a Nutritional Supplement in Malnourished HIV-Infected Adults in Sub-Saharan Africa: A Randomised, Single-Blind Study

2011 ◽  
Vol 4 ◽  
pp. NMI.S5862 ◽  
Author(s):  
M. Azabji-Kenfack ◽  
S. Edie Dikosso ◽  
E.G. Loni ◽  
E.A. Onana ◽  
E. Sobngwi ◽  
...  
Keyword(s):  
Body Composition ◽  
Viral Load ◽  
Serum Albumin ◽  
Spirulina Platensis ◽  
Sub Saharan Africa ◽  
Nutritional Rehabilitation ◽  
Group A ◽  
The Mean ◽  
Sub Saharan ◽  
Group B

Background Malnutrition is a major global public health issue and its impact on communities and individuals is more dramatic in Sub-Saharan Africa, where it is compounded by widespread poverty and generalized high prevalence of human immunodeficiency virus (HIV). Therefore, malnutrition should be addressed through a multisectorial approach, and malnourished individuals should have access to nutritional rehabilitation molecules that are affordable, accessible, rich in nutrient and efficient. We thus assessed the efficacy of two affordable and accessible nutritional supplements, spirulina platensis versus soya beans among malnourished HIV-infected adults. Methods Undernourished patients, naïve of, but eligible to antiretroviral treatment (ART), aged 18 to 35 years were enrolled and randomly assigned to two groups. The first group received spirulina (Group A) as food supplement and the second received soya beans (Group B). Patients were initiated ART simultaneously with supplements. Food supplements were auto-administered daily, the quantity being calculated according to weight to provide 1.5 g/kg body weight of proteins with 25% from supplements (spirulina and soya beans). Patients were monitored at baseline and followed-up during twelve weeks for anthropometric parameters, body composition, haemoglobin and serum albumin, CD4 count and viral load. Results Fifty-two patients were enrolled (Group A: 26 and Group B: 26). The mean age was 26.4 ± 4.9 years (Group A) and 28.7 ± 4.8 (Group B) with no significant difference between groups ( P = 0.10). After 12 weeks, weight and BMI significantly improved in both groups ( P < 0.001 within each group). The mean gain in weight and BMI in Group A and B were 4.8 vs. 6.5 kg, ( P = 0.68) and 1.3 vs. 1.90 Kg/m2, ( P = 0.82) respectively. In terms of body composition, fat free mass (FFM) did not significantly increase within each group (40.5 vs. 42.2 Kg, P = 0.56 for Group A; 39.2 vs. 39.0 Kg, P = 0.22 for Group B). But when compared between the two groups at the end of the trial, FFM was significantly higher in the spirulina group (42.2 vs. 39.0 Kg, P = 0.01). The haemoglobin level rose significantly within groups ( P < 0.001 for each group) with no difference between groups ( P = 0.77). Serum albumin level did not increase significantly within groups ( P < 0.90 vs. P < 0.82) with no difference between groups ( P = 0.39). The increase in CD4 cell count within groups was significant ( P < 0.01 in both groups), with a significantly higher CD4 count in the spirulina group compared to subjects on soya beans at the end of the study ( P = 0.02). Within each group, HIV viral load significantly reduced at the end of the study ( P < 0.001 and P = 0.04 for spirulina and soya beans groups respectively). Between the groups, the viral load was similar at baseline but significantly reduced in the spirulina group at the end of the study ( P = 0.02). Conclusion We therefore conclude in this preliminary study, firstly, that both spirulina and soja improve on nutritional status of malnourished HIV-infected patients but in terms of quality of nutritional improvement, subjects on spirulina were better off than subjects on soya beans. Secondly, nutritional rehabilitation improves on immune status with a consequent drop in viral load but further investigations on the antiviral effects of this alga and its clinical implications are strongly needed.

scholarly journals Palliative Sedation for Children at End of Life: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Yang Chen ◽  
Jianjun Jiang ◽  
Wei Peng ◽  
Chuan Zhang
Keyword(s):  
Cohort Study ◽  
Survival Time ◽  
End Of Life ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Palliative Sedation ◽  
Hospitalization Time ◽  
Group A ◽  
Group B ◽  
Sedation Group

Abstract Background: Palliative sedation is consciously reducing the patient's consciousness to alleviate the refractory symptoms. However, studies on palliative sedation for children are scarce. We aimed to survey the symptom control and risks for children with sedative therapy in end of life.Method: This study was a single center retrospective cohort study. Children who died in the Department of Palliative Medicine were divided into palliative sedation (Group A) and non-palliative sedation group (Group B). The symptoms relief, survival time, and last hospitalization time were compared between two groups. Results: From January 2012 to November 2019, 41 children died in department of palliative care. 24 children were sedated (Group A), meanwhile 17 children were not (Group B). The symptoms in Group A were more complex than Group B (p =0.013). Overall symptom relief in Group A was higher than that in Group B (24/24, 10/15 p =0.041). Pain relief rates（7/7, 20/21 p =0.714）, maximum/pre-death opioid dose [30(20, 77.5), 18(9, 45) p =0.175, 30(20, 60), 18(9, 45) p =0.208]and pain intensity difference [5(4,6.5), 4(2,6) p =0.315] were not statistically significant difference in both group. After diagnosis, the survival time of the Group A was longer than the Group B (p =0.047). However, the length of hospitalization before death was similar in two groups (p =0.385).Conclusion: Palliative sedation controls complicated, painful symptoms at the end of life and does not shorten the hospitalization time in children.

scholarly journals Commencement of systemic corticosteroids in emergency Department versus in ward in management of acute adult asthma requiring hospitalization: a retrospective cohort study

2016 ◽  
Vol 15 (4) ◽  
pp. 608-614
Author(s):  
Suen Pao Yim
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Acute Asthma ◽  
Length Of Hospital Stay ◽  
Adult Asthma ◽  
Systemic Corticosteroids ◽  
Group A ◽  
The Difference ◽  
Group B

Introduction: Systemic corticosteroids are commonly used in management of acute asthma, sometimes started before admission in emergency department, sometimes in ward after admission. This study is to determine whether commencing systemic corticosteroids in emergency department compared to in ward for managing acute adult asthma requiring hospitalization can improve the outcome: shorter length of hospital stay.Methods: A retrospective cohort study was conducted in an emergency department in Hong Kong. Adults aged 18 to 65 years-old who presented to the emergency department with acute asthma and subsequently hospitalized with use of systemic corticosteroids were recruited and divided into two groups: a group with commencement of systemic corticosteroids in emergency department (Group A, n=139) and the other group with commencement of systemic corticosteroids in ward (Group B, n=209). The outcome measurement was length of hospital stay.Results: A total of 348 subjects were recruited in final analyses. We used Mann-Whitney U test to test the difference in ranking of length of hospital stay (days) between these two groups. The mean rank of length of hospital stay in Group A was 159, and that in Group B was 185 (p=0.014). The difference was statistically significant with commencement of systemic corticosteroids in emergency department resulting in higher ranking-shorter length of hospital stay.Conclusion: It may be possible to result in earlier discharge in acute adult asthma requiring hospitalization when systemic corticosteroids is started before admission in emergency department, instead of in ward after admission.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.608-614

scholarly journals Liposomal Doxorubicin in Aggressive B Cell Lymphoma Has Similar Efficacy to the Conventional Formulation: Results from a Retrospective Cohort Study

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5106-5106 ◽  
Author(s):  
Evelyn Acuña Cruz ◽  
Jimena Cannata Ortiz ◽  
Ana García-Noblejas ◽  
Adrian Alegre ◽  
Reyes Arranz Sáez
Keyword(s):  
Cohort Study ◽  
Board Of Directors ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Liposomal Doxorubicin ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Advisory Committees ◽  
Group A ◽  
Group B

Abstract Introduction: Anthracyclines plays a key role in the treatment of Diffuse Large B cell Lymphoma (DLBCL). There is a great concern about its cardiotoxicity, especially among elderly patients with raising age and related morbidities. Liposomal doxorubicin (LD) has proven to be efficacious and less cardiotoxic in combinations of neo-adjuvant chemotherapy regimes through phase II and III studies in breast cancer. There are some phase II studies in DLBCL but to our knowledge, controlled randomized studies are pending. Aim: To analyze the efficacy and toxicity of LD (Myocet¨) in DLBCL patients with cardiovascular/cardiopathy risk, in comparison with a control population who received the standard therapy during the same period of time. Methods: We conducted a retrospective cohort study in patients with de novo DLBCL treated with standard immunochemotherapy, comparing conventional Doxorubicin vs LD. Selection of a 3.3 vs 1 ratio was used to increase statistic power. Criteria to indicate LD therapy were any of the following: left heart ejection fraction < 50%, cardiovascular risk factors or prior history of cardiopathy. Overall response (OR), complete/uncertain response (CR/CRu), progression free survival (PFS) and overall survivall (OS) were analyzed. Toxicity was evaluated with CTCAE v.4.0. and the used statistical package was SPSS v18.0. Results: 78 patients (pts) treated between March 2006 and June 2012 were selected: 60 pts in the control group (group A) and 18 in the study arm (group B). Their characteristics are shown in table 1. Homogeneity was observed, except in LVEF < 50%, older age and hypertension in group B. Efficacy: 69 pts were evaluable for response, with similar OR rate and CR+CRu in both groups (see table 2). Response was consolidated in 17 pts: 22% in group A and 40% in group B. With a median follow up of 4.3 years for surviving pts (0.74 yrs - 8 yrs), actuarial OS and PFS for the whole series were 64% ±SD 13% and 55% ±SD 7%, respectively, without significant differences between both arms (OS: 64% vs 77%; p=0,7 and 56% vs 55%; p=0,9). Toxicity: Hematological toxicity was 43% vs 11%, grade 3 neutropenia 43% vs 6% and febrile neutropenia 37% vs 11%, all significantly different and favoring group B. These differences were probably due to the systematical use of Peg- GSF in group B. Four (5%) cardiac events were observed in group B: 1 heart failure and 3 arrhythmias. Currently, 16 (21%) pts have died, 11 due to lymphoma, 4 due to infection grade 5 during induction treatment and 1 suicide. Conclusion: In this study, the association of LD to immunochemotherapy showed the same efficacy as conventional Doxorubicin in fragile patients, without increased toxicity. Acknowledgment: We are grateful to TEVA for their contribution with the CRO for the statistical analysis. Disclosures Alegre: Celgene Corporation: Membership on an entity's Board of Directors or advisory committees; Janssen: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees.

scholarly journals Analysis of discordance between AMH and AFC in IVF patients: a retrospective cohort study

2021 ◽  
Author(s):  
Yannan Chen ◽  
Xiaoling Gu ◽  
Xi Guan ◽  
Minyan Yu ◽  
Shuping Zhong ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Entire Study ◽  
Therapeutic Regime ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background Both anti-Mullerian hormone (AMH) and antral follicle count (AFC) predict ovarian reserve independently and have been shown to correlate well. However, it is quite common to encounter discordance between the two clinical indices. This objective of this study is to speculate which condition is favorable to patients and to decide what best to be done in cases of such discordance. Methods This retrospective cohort study analyzed the medical records of 714 women undergoing the first IVF cycle at the Center for Reproductive Medicine, the Affiliated Hospital of Nantong University, Nantong, Jiangsu between January 2017 and December 2020. All patients had their essential characteristics, baseline FSH, Estradiol, PRL, LH, Testosterone, CA125, AMH, and AFC recorded. Patients were classified into three groups according to whether their AMH and AFC values were in the lower quartile, upper quartile, or in between, namely Group A (Concordance, concordant in AMH and AFC), Group B (HTP, AMH concentration higher than predicted according to AFC) and Group C (LTP, AMH concentration lower than predicted according to AFC). SPSS 25.0 software package (SPSS, Inc., Chicago, IL, USA) was used for statistical analysis. Results The entire study population has a good concordance between AMH and AFC. 240 women (33.61%) had discordant AMH and AFC values, and the proportion in Group B(HTP) and Group C(LTP) seemed similar (16.67% VS 16.94%). The three cohorts had similar age, infertile duration, FSH, Estradiol, PRL, LH, Testosterone, and CA125 levels. BMI progressively increased from Group B to Group A and to Group C. The ratio of patients, who had completely mature oocytes (COM), rapidly decreased from Group C to Group A and to Group B. Although no significant difference in CMO rate was observed among Group A, B, and C when stratified according to BMI, CMO rate was the highest (72.31%) when BMI < 18.5 kg/m2 in all BMI categories. Conclusions Our analysis demonstrated a high frequency of clinical discordance between AMH and AFC in women undergoing IVF therapeutic regime. Patients’ BMI and completely mature oocytes ratio are significantly different among distinct grouping based on their AMH and AFC partition.

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