Single IUI timed post-ovulation gives a better CPR when compared with single pre-ovulation IUI for non-male infertility, whereas for male factors, pre-ovulation, double IUI gives a better CPR when compared with single IUI.
This study aimed at evaluating the role of laparoscopy in the management of unexplained infertility in a prospective randomised controlled trial. The study comprised of 255 patients as a study group and 257 patients as a control group. All women had unexplained infertility. Patients in the study group had laparoscopy followed by ovarian stimulation and timed intercourse for six cycles, while patients in the control group were treated directly with ovarian stimulation and timed intercourse for six cycles. Severe adhesions were found in one in each of the two groups, respectively. They were referred directly to the IVF/ICSI programme. Moderate pelvic endometriosis was demonstrated in three cases in the two groups. Again, severe endometriosis was found in two cases in the study groups and they were referred to the IVF/ICSI programme. After 6 months of follow-up, clinical pregnancy occurred in 114/255 (44.7%) in the study group and 107/257 (41.7%) in the control group and the difference was not statistically significant (p > 0.05). The miscarriage rate was similar in the two groups. We concluded that laparoscopy could be postponed when proceeding in the management of unexplained infertility, until ovarian stimulation and timed intercourse had been found to be unsuccessful in achieving pregnancy.
Methods: Sixty-six severe TBI patients who required emergency craniotomy or craniectomy and were planned for post-operative ventilation were randomised into NS (n = 33) and BF therapy groups (n = 33). The calculation of maintenance fluid given was based on the Holliday-Segar method. The electrolytes and acid-base parameters were assessed at an 8 h interval for 24 h. The data were analysed using repeated measures ANOVA.Results: The NS group showed a significant lower base excess (-3.20 versus -1.35, P = 0.049), lower bicarbonate level (22.03 versus 23.48 mmol/L, P = 0.031), and more hyperchloremia (115.12 versus 111.74 mmol/L, P < 0.001) and hypokalemia (3.36 versus 3.70 mmol/L, P < 0.001) than the BF group at 24 h of therapy. The BF group showed a significantly higher level of calcium (1.97 versus 1.79 mmol/L, P = 0.003) and magnesium (0.94 versus 0.80 mmol/L, P < 0.001) than the NS group at 24 h of fluid therapy. No significant differences were found in pH, pCO 2 , lactate, and sodium level.Conclusion: BF therapy showed better effects in maintaining higher electrolyte parameters and reducing the trend toward hyperchloremic metabolic acidosis than the NS therapy during prolonged fluid therapy for postoperative TBI patients.
Introduction: The intensive care unit (ICU) is one of the most stressful environments among various clinical settings. ICU patients are not only compromised by the illness, but they also faced with a wide range of stressors such as pain, unfamiliar environment and loss of interaction with family and friends. Stress and anxiety will increase the sympathetic tone (sympathet ic nervous system) and stimulate the hypothalamus-pituitary-adrenal (HPA) axis response. Stressful circumstances as well as chronic diseases may alter the normal cortisol mechanisms resulting in marked increases in plasma levels. Thus, high stress response will lead to delayed healing and prolong stays in ICU. Recitation of Quran by the sick person or for the sick person has shown to have direct healing effect on the sick person. Holy Quran Listening is the most suitable way for the patients in reduces stress responses during ICU stay.Objectives: To examine the effectiveness of Holy Quran Listening (HQL) in reducing stress response among ICU patients.Methods: A randomized controlled clinical trial was conducted in the Intensive Care Unit. Total 94 subjects were recruited and randomly assigned to either Control (n=49) or Holy Quran Listening (n=45) group respectively. The HQL given via headphone for 7 hours while control group given no music. Primary measures include mean blood pressure, heart rate, systolic blood pressure, diastolic blood pressure, serum cortisol level and serum blood sugar. Secondary outcomes include duration of stay in intensive care unit, total usage of insulin and sedation.Results: The HQL group show clinically significant in reducing HR and SBP over time. Serum cortisol level is stable in HQL group. However, there are no significantt reduction in duration of stay, total usage of sedation and insulin.Conclusion: HQL is one of the adjunct methods that can be used to reduce stress response among ICU patients.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 36
A combination of scalp block and monitored anesthesia care (MAC) is one of the options among anesthetic techniques that can be used during an awake craniotomy for epilepsy surgery. Even though a scalp block is useful as locoregional analgesia during the surgery, it also has the potential to cause some complications. Trigeminocardiac reflex and transient facial nerve palsies have previously been reported following scalp block. The toxicity of local anesthetic agents and nerve injuries present other potential complications. However, complete unilateral ptosis is a rare complication after scalp block. We report a case of unilateral complete mechanical ptosis after a scalp block using ropivacaine 0.75% for an awake craniotomy for epilepsy surgery.
IntroductionBronchoscopy is a commonly used procedure in the context of aspiration in the Intensive Care Unit setting. Despite its ability to remove mucus plug and undigested gastric contents, aspiration of gastric content into the trachea is one of the most feared complications among anesthesiologist.DiscussionThe scenario is made worst if the aspiration causes acute hypoxemic respiratory failure immediately post intubation. However, in the event of desaturation, the quick decision to proceed with bronchoscopy is a challenging task to the anesthesiologist without knowing the causes.Case presentationWe present a case of a 12-year-old boy who had a difficult-to-ventilate scenario post transferring and immediately connected to ventilator in operation theatre (OT) from portable ventilator from the emergency department. She was successfully managed by bronchoscopy.ConclusionSpecial attention should be given to the difficult-to-ventilate scenario post intubation of traumatic brain injury patient prior to operation. Prompt diagnosis and bronchoscope-assisted removal of foreign body was found to be a successful to reduce morbidity and mortality.
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