Background:Where laparoscopic ovarian surgery is to be recommended, there may be a small associated risk of lower ovarian reserve or loss of ovarian function. Based on its activities, Anti-Müllerian hormone (AMH) has been proposed to be involved in the pathophysiology of polycystic ovary syndrome (PCOS). AMH has become a useful clinical marker of ovarian reserve (OR) and reproductive disease in women. Its clinical utility has been expanding in scope for use in monitoring ovarian reserve, response to in vitro fertilization protocols, and diagnosis of ovarian diseases such as primary ovarian insufficiency and polycystic ovary syndrome (PCOS). Aim: Comparing AMH to other parameters of ovarian reserve (OR) in evaluating the effect of laparoscopic ovarian drilling (LOD) on OR in treatment of PCO. Patients and Methods: It is a prospective comparative clinical trial study. Serum AMH along with other parameters of OR measurement (LH/FSH ratio and Inhibin B) were done before and after LOD in forty eight PCO women. This study was conducted in Ain Shams University Maternity Hospital. The patients were recruited from the gynecologic outpatient clinic of Ain-Shams University Hospital from January 2014 to December 2017 (about four years). Results: Eight cases of our studied patients got pregnant within the first three months postoperative after LOD and six cases got pregnant after three months. The total number of cases that got pregnant was 14 out of 48 cases before excluding the 8 cases that got pregnant before 3 months (29.16⁒). The mean AMH level before the operation was 6.9 ± 1.4 ng/ml and 8.2 ± 1.4 ng/ml for the patients who got pregnant and those who did not get pregnant, respectively. While the mean AMH level after 3 months of the operation was 5.1 ± 1.1 ng/ml and 6.3 ± 1.4 ng/ml for the patients who got pregnant and those who did not get pregnant, respectively. The mean LH/FSH ratio before the operation was 2.04 ± 0.5 and 3.02 ± 0.6 for the patients who got pregnant and those who did not get pregnant, respectively. While the mean LH/FSH ratio after 3 months of the operation was 1.15 ± 0.2 and 1.93 ± 0.6 for the patients who got pregnant and those who did not get pregnant, respectively. The mean inhibin B level before the operation was 52.5 ± 2.2 pg/ml and 52.6 ± 3.9 pg/ml for the patients who got pregnant and those who did not get pregnant ,respectively. While the mean inhibin B level after 3 months of the operation was 48.3 ± 2.1 pg/ml and 49.1 ± 3.6 pg/ml for the patients who got pregnant and those who did not get pregnant, respectively. Lower preoperative AMH levels and LH/FSH ratio and after 3 months postoperatively were associated with increased pregnancy rates in patients who conceived compared to those who did not conceive (p=0.004) and (p=0.002) preoperative versus (p=0.003) and (p=0.004) postoperative, respectively. On the other hand, preoperative and 3 month's postoperative levels of Inhibin B had no effect on pregnancy rates (p=0.954) and (p=0.582). Conclusion:Pregnancy rates were significantly related to t...
Background: Dysfunctional uterine bleeding (DUB) is one of the commonest condition for which patient seeks out medical consultation. The prevalence increases with the increase of age peaking before menopause. Objective: The aim of this work is to evaluate the effect of this new form of levonorgestrel-releasing IUD on the treatment of patients with abnormal uterine bleeding. Subjects and methods: A prospective age-specific comparative analysis of 61 peri-menopausal women presented with dysfunctional uterine bleeding who constituted the study group. They underwent hysteroscopy and endometrial sampling during an 18 months period from June 2014 to January 2016 at Ain Shams University Materity Hospital. Prior to metraplant-E application, all the patients in this study were in the age of 25-58 years old. Results: The role of Metraplant-E in the treatment of abnormal uterine bleeding (AUB) was evaluated. Sixty-one women with failed attempt(s) of medical treatment unwilling or unfit for hysterectomy were treated with Metaplant-E. Menstrual blood loss was assessed by pictoral bleeding assessment chart (PBAC), bleeding index (B.I) and total bleeding score (T.B.S/month). The bleeding patterns in the form of the mean menstrual blood loss estimated by bleeding index and the mean menstrual loss estimated by the total bleeding score/month and PBAC decreased significantly (p = 0.001). The quality of life scale (Likert scale) improved significantly (p = 0.001). All 15 cases who had endometrial sampling demonstrated progestational effect on histo-pathological examination. Conclusion: Metraplant-E was found to be effective in managing dysfunctional menorrhagia on both clinical and histopathological levels. Keywords: Metraplant-E, LNG-IUS, Menorrhagia, Contraceptives INTRODUCTIONDysfunctional uterine bleeding (DUB) is one of the commonest condition for which patient seeks out medical consultation. The prevalence increases with the increase of age peaking before menopause. The peri-menopausal women who have anovulatory cycle resulting in DUB. The normal menstrual cycle is defined as having a mean interval of 28 ± 7 days with a men duration of 4 ± 3 days. The upper limit of normal menstruation is 80 ml per menstruation. Any deviation from the normal cycle and the amount of loss is regarded as abnormal uterine bleeding. Dysfunctional uterine bleeding (DUB) is one of the commonest causes of abnormal uterine bleeding. It is defined as heavy and/or irregular menstruation in the absence of detectable pelvic pathology, pregnancy or general bleeding disorder. It affects 20 to 30 % of women and accounts for 12 % of gynecological referrals. DUB can be ovulatory or anovulatory. Anovulatory DUB occurs at extreme reproductive age (adolescence and peri-menopausal age)
Background Hospitalization of the elderly patients carry greatest risk for complications and unfavorable outcomes, so better outcome requires a comprehensive geriatric assessment by multidisciplinary teams to detect the patients at higher risk for functional decline and institutionalization, such care and assessment have shown to reduce the hospital stay and functional decline, also increases the chances of living at home, one of this multi-dimentional management is the use of prognostic indices which predict the outcome of the admitted elderly patients, of which is MPI. The MPI showed good accuracy in estimating both short-and long-term mortality in hospitalized older patients with the most common conditions leading to death (Pilotto et al., 2012).
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