Surgical site infection (SSI) is one of the most common complications following cesarean section, and has an incidence of 3%–15%. It places physical and emotional burdens on the mother herself and a significant financial burden on the health care system. Moreover, SSI is associated with a maternal mortality rate of up to 3%. With the global increase in cesarean section rate, it is expected that the occurrence of SSI will increase in parallel, hence its clinical significance. Given its substantial implications, recognizing the consequences and developing strategies to diagnose, prevent, and treat SSI are essential for reducing postcesarean morbidity and mortality. Optimization of maternal comorbidities, appropriate antibiotic prophylaxis, and evidence-based surgical techniques are some of the practices proven to be effective in reducing the incidence of SSI. In this review, we describe the biological mechanism of SSI and risk factors for its occurrence and summarize recent key clinical trials investigating preoperative, intraoperative, and postoperative practices to reduce SSI incidence. It is prudent that the surgical team who perform cesarean sections be familiar with these practices and apply them as needed to minimize maternal morbidity and mortality related to SSI.

Both the single-balloon and double-balloon catheters are equally efficacious for inducing labor. The double-balloon catheter may be associated with more operative deliveries.

OBJECTIVETo compare the efficacy and safety of glyburide versus metformin and their combination for the treatment of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODSIn this prospective randomized controlled study, we randomly assigned patients with GDM at 13-33 weeks gestation and whose blood glucose was poorly controlled by diet to receive either glyburide or metformin. If optimal glycemic control was not achieved, the other drug was added. If adverse effects occurred, the drug was replaced. If both failed, insulin was given. The primary outcomes were the rate of treatment failure and glycemic control after the first-line medication according to mean daily glucose charts. RESULTSGlyburide was started in 53 patients and metformin in 51. In the glyburide group, the drug failed in 18 (34%) patients due to adverse effects (hypoglycemia) in 6 (11%) and lack of glycemic control in 12 (23%). In the metformin group, the drug failed in 15 (29%) patients, due to adverse effects (gastrointestinal) in 1 (2%) and lack of glycemic control in 14 (28%). Treatment success after second-line therapy was higher in the metformin group than in the glyburide group (13 of 15 [87%] vs. 9 of 18 [50%], respectively; P = 0.03). In the glyburide group, nine (17%) patients were eventually treated with insulin compared with two (4%) in the metformin group (P = 0.03). The combination of the drugs reduced the need for insulin from 33 (32%) to 11 (11%) patients (P = 0.0002). Mean daily blood glucose and other obstetrical and neonatal outcomes were comparable between groups, including macrosomia, neonatal hypoglycemia, and electrolyte imbalance. CONCLUSIONSGlyburide and metformin are comparable oral treatments for GDM regarding glucose control and adverse effects. Their combination demonstrates a high efficacy rate with a significantly reduced need for insulin, with a possible advantage for metformin over glyburide as first-line therapy.

No abstract

The findings suggest that very few factors contributing to brachial plexus injury are modifiable. For that reason, it remains an unpredictable and probably an unavoidable event.

ClinicalTrials.gov, http://www.clinicaltrials.gov , NCT01242293.

Time from catheter insertion to delivery and delivery mode were comparable between the two types of catheter.

The purpose of this study was to examine factors influencing women's compliance with medical therapy for osteoporosis in Israel. The study population consisted of women diagnosed with osteoporosis using a DEXA examination in the year 2000. Medication purchases for a period of 13 months after the exam were analyzed. Data were gathered from the computerized data base of Clalit Health Care Services and phone interviews. Treatment was divided into specific drugs and food additives (preparation of calcium plus vitamin D). Full, intermediate, low and no compliance were defined as >80, 50-80, 25-50 and <25% of treatment days, respectively. In the study, 857 women with a mean age of 73.6 years were enrolled; 581 (67.8%) were interviewed by telephone. Most of women were undereducated and unemployed. Twenty percent did not purchase any specific drug; 4.5% did not purchase any drug or food additive for osteoporosis; 60% were fully or intermittently compliant (by purchasing) with drug therapy. The most frequent single specific drugs purchased were bisphosphanates and SERM: 62.3 and 76.3% purchased bisphosphanates and/or food additives, respectively. Multi-variant analysis showed that predictors of compliance were healthy women, compliant with calcium plus vitamin D preparations, and/or spending more on drugs. Reasons for low or non-compliance were inconsistent recommendations by various physicians and the side effects of specific drugs. The relatively high compliance rate of osteoporosis treatment may be attributed to the increase in awareness of its benefits. The effect of physicians on compliance needs further investigation.