AIMS AND OBJECTIVESTo study and compare medical (Methotrexate) versus surgical (Laparoscopic salpingostomy) conservative management for unruptured ectopic pregnancy. MATERIALS AND METHODSThis is a prospective study conducted at CKM Government Maternity Hospital, Warangal, Telangana. The recruitment period was from July 2012 to June 2013 and these patients were followed for 2 years from July 2013 to June 2015. An institutional ethical clearance was obtained and an informed consent was taken from the patients who were selected for the study. Of the 63 unruptured ectopic pregnancy cases, 31 patients were given multiple dose methotrexate and 32 underwent conservative surgical management (Laparoscopic salpingostomy) according to the inclusion and exclusion criteria. The distribution of patients was studied according to the age, parity, literacy status, presence of risk factors and followed up with serum β HCG levels. The success and failure with both the treatments were defined and the patients were followed up till 2 years for fertility outcome. RESULTSMost of the patients were nulliparous (71.4%), illiterates (77.7%) and belong to age group 21-25 years (53.9%). Half of them had prior risk factors (55.5%) for ectopic pregnancy. Mean β HCG levels came down to normal from day 4 after salpingostomy, but there was a consistent fall till day 28 after methotrexate treatment. Complications were seen with both the treatments. The rate of success was comparatively more for salpingostomy patients (84.3%), but the difference is not statistically significant. The successful patients were followed up for tubal patencies, ectopic pregnancies and recurrent ectopic pregnancies and the differences were not statistically significant with both medical and conservative surgical treatments. CONCLUSIONConservative surgical treatment and medical treatment are both almost equally effective to preserve the subsequent fertility of the women. According to our study, the difference in success and failure for both the treatments (Medical and surgical) and the difference in fertility outcome in 2 years -pregnancy rate and recurrent ectopic with both medical and conservative surgical is not statistically significant. However, for firm conclusion to be drawn randomized multicentric trials have to be done.
AIMTo evaluate the importance of Urodynamic assessment in postmenopausal women for confirmation of the type of Incontinence, which is valuable in guiding the management by conservative or surgical measures. MATERIAL AND METHODSThis is a multicentric prospective study conducted from Nov 2010 -May 2012 on 88 postmenopausal women who presented with complaints of Urinary Incontinence at Outpatient dept. of Tertiary Teaching Hospital, Govt. Maternity Hospital, Petlaburz, Hyderabad and at Hyderabad Nursing Home, Basheerbagh, Hyderabad. Out of 88 patients who were recruited and evaluated, 26 patients responded to initial management and the remaining 62 patients were enrolled for Urodynamic study but 3 patients deferred and lost for follow up. UDS was conducted in these 59 patients, cystoscopy was optional and essential in 5 cases and hence it was performed in these cases.Methods and units of multichannel conventional UDS used in this study maintained the standards recommended by the international continence society. Filling, voiding cystometry and uroflowmetry was done. RESULTSThe distribution of the patients in our study according to age, parity, BMI, Literacy and mode of delivery were analysed. The presence of precipitating factors (1 or more), associative with cystocele and history of prior surgeries were also recorded. In our study out of 59 patients, Detrusor underactivity (37.28%) were seen in maximum number of patients followed by mixed incontinence (25.42%) and OAB (18.64%). Clinical experience and the literature suggests that older women have decreased detrusor contractility, increase in OAB and mixed incontinence and decrease in pure stress symptoms. Our results support this statement. In our study UDS has completely changed the course of management in many cases and guided us to specific and appropriate treatment. Established voiding and continent centres have advised that these patients should thoroughly evaluated with UDS and their treatment should be individualized according to their symptoms with team approach. CONCLUSIONUrodynamic study is gold standards in evaluation of urinary incontinence which guide us for specific management with better results. UDS provide enough information for treatment decision and prognosis in cases of UI. Research is critically needed to provide data that will allow better understanding of the unique nature of this urologic disease in these older postmenopausal women. KEYWORDSUrinary Incontinence (UI), Urodynamic Study (UDS), Quality of Life (QOL), Overactive Bladder (OAB, Body Mass Index (BMI). HOW TO CITE THIS ARTICLE:
AIM OF THE STUDYTo evaluate the effectiveness and safety of reduced dose of Ormeloxifene in the management of Dysfunctional Uterine Bleeding (DUB). Long term medical management for DUB, which is ideal and cost-effective is not yet available. Once it is available, it can revolutionise the management of DUB in developing countries. If Ormeloxifene is proved to be effective long-term at lower doses with minimal side effects, it can prevent the major number of blood transfusions and hysterectomies, which are common especially in the lower socioeconomic group of patients who cannot afford costly conservative measures. MATERIAL AND METHODSOut of 240 eligible patients with DUB, recruited from Gynaec OPD of CKM Hospital, Warangal, only 160 women consented to participate, out of which half of the patients were given the standard dose of Ormeloxifene that is 60mg twice a week for 3 months and once a week for 3 months (Group A). Half of the patients were given reduced dose of Ormeloxifene that is 30mg twice a week for all 6 months (Group B); 54 women from each group who completed the 6 months treatment and came regularly for followup were included in the present study. Both groups were matched for age and parity.Pre-treatment PBAC (Pictorial Blood Loss Assessment Chart) scores were done for all cases and mean PBAC scores were calculated. Same was done at follow-up visits at 1 month, 3 months and 6 months. Side effects were looked for and TVS was done for Endometrial Thickness (ET)/Ovarian cysts. Haemoglobin estimation was done at the end of the study. Effectiveness was taken as reduction of mean PBAC score at the end of 6 months. CONCLUSIONMean PBAC scores at the end of 6 months, in each group showed a reduction of 86.64% of blood loss in group A (standard dose of Ormeloxifene) and 87.69% of blood loss in group B (reduced dose of Ormeloxifene). The reduction in both groups was similar. When the reduction in group A and group B was compared, the difference was not statistically significant [P = 0.33]. Hence, the lower dose schedule followed in group B can be recommended for management of DUB. This could make long term usage of Ormeloxifene more feasible when proved safe by larger randomised double blind studies.
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