MEDICAL TERMINATION OF INCOMPLETE ABORTION WITH MISOPROSTOL

 

ABSTRACT:

Objective:

To evaluate the efficacy and safety of misoprostol in the medical termination of incomplete abortion.

 

Materials and Methods:

This prospective experimental study was carried out in the Department of Obstetric & Gynaecology, DhakaMedicalCollegeHospital, Dhaka, during the period of July 2011 to December 2011. A total of 100 women that suffered from incomplete abortion admitted in department were enrolled in this study.

 

Results: More than one third (36.0%) of the patients age belonged to 21 – 25 years and mean age was 25.34±6.43 years with range from 16 to 45 years. Majority (58.0%) of them were housewife and most (60.0%) the patients came from low socio-economic status. Primi gravida was found 64.0% and 36.0% was multigravida. . The mean gestational age was found 10.2±1.97 wks with range from 6 to 12 wks. Closed OS was found 44.0% and UT was found 34.0% in 8 wks. The mean doses were found 2.34±1.15 with range from 1 to 4 doses. The mean induction expulsion interval was 10.83±5.45 hours. Most (50.0%) primi gravida received four doses, 37.5% received three doses, 37.5% double doses and 13.3% single dose. Majority (86.7%) of the multi gravida received single dose 66.7% double doses, 62.5% three doses and 50.0% receive four doses. According to gestational age, maximum (86.7%) single dose was found in 10-12 wks, double doses 73.4% in 10-12 wks, three doses 62.5% in 8-9 wks and four doses 58.3% in 6-7 wks. No side effect was found in 88.0% of the study patients and normal USG was observed in 88.0% cases. Nearly two third (65.0%) of the patients were strongly agree in ingestion of the drug was easy, Regarding the process more preferable than surgical procedure 55.0% strongly agree and 36.0% agree. About the recommendation of this process to other relatives 49.0% strongly agree and 42.0% agree.

 

Conclusions:

Misoprostol is as effective as manual vacuum aspiration (MVA) at treating incomplete abortion at uterine size of <12 weeks. This study was undertaken to evaluate the efficacy and safety of misoprostol in the medical termination of incomplete abortion. Treatment with misoprostol can reduce the demand for surgical evacuation in cases of incomplete abortion. The acceptability of misoprostol appears higher. There was a reduction in the incidence of diarrhea, nausea, vomiting and cramping with the use of oral misoprostol. Given the many practical advantages of misoprostol over manual vacuum aspiration (MVA) in low-resource settings, misoprostol should be more widely available for treatment of incomplete abortion in the developing world.

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Non-alcoholic fatty liver disease is associated with carotid artery wall thickness in diet-controlled type 2 diabetic patients.

fatty_liver_treatment1

Abstract

Non-alcoholic fatty liver disease (NAFLD) is closely associated with several metabolic syndrome (MetS) features. We assessed whether NAFLD is significantly associated with carotid artery intima-media thickness (IMT), as a marker of subclinical atherosclerosis, and whether such association is independent of classical cardiovascular risk factors and MetS features. We studied 100 diet-controlled Type 2 diabetic patients with ultrasonographically diagnosed NAFLD and 100 diabetic patients without NAFLD who were comparable for age and sex. Main outcome measures were carotid IMT (by ultrasonography), classical risk factors, insulin resistance [as estimated by homeostasis model assessment (HOMA)-IR] and MetS (as defined by the Adult Treatment Panel III criteria). NAFLD patients had a markedly greater carotid IMT (1.24 +/- 0.13 vs 0.95 +/- 0.11 mm; p < 0.001) than those without the condition. The MetS and all its clinical traits were more highly prevalent in those with NAFLD (p < 0.001). Adjustment for age, sex, smoking history, diabetes duration, glycosylated hemoglobin, LDL cholesterol, liver enzymes and microalbuminuria did not really affect the significant differences in carotid IMT that were observed between the groups. Further adjustment for the MetS also had little impact, but additional adjustment for HOMA-IR score consistently attenuated any statistical significance (p = 0.28). In multivariate regression analysis, HOMA-IR score along with age and MetS (principally raised blood pressure values) were independently related to carotid IMT, whereas NAFLD was not. In conclusion, these results suggest that among diet-controlled Type 2 diabetic individuals the significant increase of carotid IMT in the presence of NAFLD is largely explained by HOMA-estimated insulin resistance.

PMID:

16553034

[PubMed – indexed for MEDLINE]

Gastroparesis–diagnosis and treatment

Woman

Abstract

Gastroparesis is a disorder characterized by a delay in gastric emptying of a meal in the absence of a mechanical gastric outlet obstruction. Diagnosis of gastroparesis is based on the presence of symptoms ( nausea, vomiting, postprandial abdominal fullness), excluded mechanical obstruction (endoscopy) and on objectively determined delay in gastric emptying. Gastric emptying can be assessed by scintigraphy and stable isotope breath tests. The true prevalence of gastroparesis is unknown. The aetiology of gastroparesis is diverse. In approximately one third of cases, gastroparesis is related to the presence of diabetes mellitus; one third of case is of unknown cause (idiopathic). Mild disease will respond to dietary and life style measures and prokinetics (domperidone, metoclopramide, erytromicyne). Severe disease can benefit from intrapyloric botulinum toxin injection, gastric pacing or more radical surgical interventions (partial or total gastrectomy).

Diabetic Autonomic Neuropathy

Diabetic_Autonomic_Neuropathy-2

Abstract

Diabetic autonomic neuropathy (DAN) is a serious and common complication of diabetes. Despite its relationship to an increased risk of cardiovascular mortality and its association with multiple symptoms and impairments, the significance of DAN has not been fully appreciated. The reported prevalence of DAN varies widely depending on the cohort studied and the methods of assessment. In randomly selected cohorts of asymptomatic individuals with diabetes, ∼20% had abnormal cardiovascular autonomic function. DAN frequently coexists with other peripheral neuropathies and other diabetic complications, but DAN may be isolated, frequently preceding the detection of other complications. Major clinical manifestations of DAN include resting tachycardia, exercise intolerance, orthostatic hypotension, constipation, gastroparesis, erectile dysfunction, sudomotor dysfunction, impaired neurovascular function, “brittle diabetes,” and hypoglycemic autonomic failure. DAN may affect many organ systems throughout the body (e.g., gastrointestinal [GI], genitourinary, and cardiovascular). GI disturbances (e.g., esophageal enteropathy, gastroparesis, constipation, diarrhea, and fecal incontinence) are common, and any section of the GI tract may be affected. Gastroparesis should be suspected in individuals with erratic glucose control. Upper-GI symptoms should lead to consideration of all possible causes, including autonomic dysfunction. Whereas a radiographic gastric emptying study can definitively establish the diagnosis of gastroparesis, a reasonable approach is to exclude autonomic dysfunction and other known causes of these upper-GI symptoms. Constipation is the most common lower-GI symptom but can alternate with episodes of diarrhea. Diagnostic approaches should rule out autonomic dysfunction and the well-known causes such as neoplasia. Occasionally, anorectal manometry and other specialized tests typically performed by the gastroenterologist may be helpful. DAN is also associated with genitourinary tract disturbances including bladder and/or sexual dysfunction. Evaluation of bladder dysfunction should be performed for individuals with diabetes who have recurrent urinary tract infections, pyelonephritis, incontinence, or a palpable bladder. Specialized assessment of bladder dysfunction will typically be performed by a urologist. In men, DAN may cause loss of penile erection and/or retrograde ejaculation. A complete workup for erectile dysfunction in men should include history (medical and sexual); psychological evaluation; hormone levels; measurement of nocturnal penile tumescence; tests to assess penile, pelvic, and spinal nerve function; cardiovascular autonomic function tests; and measurement of penile and brachial blood pressure. Neurovascular dysfunction resulting from DAN contributes to a wide spectrum of clinical disorders including erectile dysfunction, loss of skin integrity, and abnormal vascular reflexes. Disruption of microvascular skin blood flow and sudomotor function may be among the earliest manifestations of DAN and lead to dry skin, loss of sweating, and the development of fissures and cracks that allow microorganisms to enter. These changes ultimately contribute to the development of ulcers, gangrene, and limb loss. Various aspects of neurovascular function can be evaluated with specialized tests, but generally these have not been well standardized and have limited clinical utility. Cardiovascular autonomic neuropathy (CAN) is the most studied and clinically important form of DAN. Meta-analyses of published data demonstrate that reduced cardiovascular autonomic function as measured by heart rate variability (HRV) is strongly (i.e., relative risk is doubled) associated with an increased risk of silent myocardial ischemia and mortality. The determination of the presence of CAN is usually based on a battery of autonomic function tests rather than just on one test. Proceedings from a consensus conference in 1992 recommended that three tests (R-R variation, Valsalva maneuver, and postural blood pressure testing) be used for longitudinal testing of the cardiovascular autonomic system. Other forms of autonomic neuropathy can be evaluated with specialized tests, but these are less standardized and less available than commonly used tests of cardiovascular autonomic function, which quantify loss of HRV. Interpretability of serial HRV testing requires accurate, precise, and reproducible procedures that use established physiological maneuvers. The battery of three recommended tests for assessing CAN is readily performed in the average clinic, hospital, or diagnostic center with the use of available technology. Measurement of HRV at the time of diagnosis of type 2 diabetes and within 5 years after diagnosis of type 1 diabetes (unless an individual has symptoms suggestive of autonomic dysfunction earlier) serves to establish a baseline, with which 1-year interval tests can be compared. Regular HRV testing provides early detection and thereby promotes timely diagnostic and therapeutic interventions. HRV testing may also facilitate differential diagnosis and the attribution of symptoms (e.g., erectile dysfunction, dyspepsia, and dizziness) to autonomic dysfunction. Finally, knowledge of early autonomic dysfunction can encourage patient and physician to improve metabolic control and to use therapies such as ACE inhibitors and β-blockers, proven to be effective for patients with CAN.

Sonographic assessment of gastric emptying. Reliability and validity

Sonographic assessment of gastric emptying. Reliability and validity of the antrum sagittal surface method for fluids.

 1-s2.0-S0301562910005363-gr1

Abstract

The reliability and validity of sonographic measurements of gastric emptying employing sagittal antral planimetry were investigated. The intraindividual reproducibility of this procedure was examined in 15 healthy volunteers, who ingested 400 ml of water on two separate study days. Simultaneous studies of gastric emptying by ultrasound and scintigraphy were performed on 17 of 20 patients with suspected gastroparesis (16 diabetics and one patient with disseminated encephalomyelitis), using a caloric liquid test meal (20 g Biloptin-fatty meal in 300 ml water at 37 degrees C, radiolabeled with 0.5 mCi 99mTc-colloid). The expansion of the antral area with increasing amounts of ingested fluid and the emptying times showed a good intraindividual reproducibility from day to day (r = 0.94 vs. r = 0.81). There was a significant correlation between the relative residual volumes calculated by scintigraphy and by ultrasound (r = 0.82). These results imply that the ultrasonic sagittal antral area method is reliable and valid in the assessment of gastric emptying rates in humans.

Gastric emptying disorders in diabetes mellitus AbstractOBJECTIVE:1. To find

Gastric emptying disorders in diabetes mellitus

 Image

Abstract

OBJECTIVE:

1. To find out the prevalence of gastroperesis and of accelerated gastric emptying in long-standing and recently diagnosed diabetic patients. 2. and to determine the relationship between the percentage of gastric retention of the test meal to the gastric symptoms, degree of metabolic control, cardiovascular autonomic neuropathy, and late diabetic complication.

RESEARCH DESIGN AND METHODS:

We studied the gastric emptying of technetium labeled digestible solid test meal in 81 diabetic patients (51 long-standing and 30 recently diagnosed diabetic patients) and in 44 healthy controls. Diabetic patients were divided roto 2 groups according to the type and duration of diabetes. All patients were evaluated for gastric symptoms, glycemic control, peripheral neuropathy, retinopathy and cardiovascular autonomic neuropathy.

RESULTS:

Delayed gastric emptying was found in 21 long-standing diabetic patients and in 3 recently diagnosed type 2 diabetic patients. Accelerated gastric emptying was found in 10 patients mainly recently diagnosed type 2 diabetic patients. The rate of gastric emptying was related to CANP but not gastric symptoms or actual glycemic control.

CONCLUSIONS:

1. Diabetics gastroparesis is a common disorder affecting both type 1 and type 2 long-standing diabetes mellitus in about 40% usually in the setting of late diabetic complications and can be manifested in recently diagnosed type 2 diabetes mellitus. 2. Accelerated gastric emptying is another gastrointestinal disorder manifested in about 20% of recently diagnosed diabetic patients (maimy type 2) but can be present in long-standing diabetic patients. 3. The rate of gastric emptying is related to cardiovascular autonomic neuropathy but not to gastric symptoms or actual metabolic control.

Diabetic autonomic neuropathy.AbstractDiabetic autonomic neuropathy (DAN) is a

Diabetic autonomic neuropathy.Image

Abstract

Diabetic autonomic neuropathy (DAN) is a serious and common complication of diabetes. Despite its relationship to an increased risk of cardiovascular mortality and its association with multiple symptoms and impairments, the significance of DAN has not been fully appreciated. The reported prevalence of DAN varies widely depending on the cohort studied and the methods of assessment. In randomly selected cohorts of asymptomatic individuals with diabetes, approximately 20% had abnormal cardiovascular autonomic function. DAN frequently coexists with other peripheral neuropathies and other diabetic complications, but DAN may be isolated, frequently preceding the detection of other complications. Major clinical manifestations of DAN include resting tachycardia, exercise intolerance, orthostatic hypotension, constipation, gastroparesis, erectile dysfunction, sudomotor dysfunction, impaired neurovascular function, “brittle diabetes,” and hypoglycemic autonomic failure. DAN may affect many organ systems throughout the body (e.g., gastrointestinal [GI], genitourinary, and cardiovascular). GI disturbances (e.g., esophageal enteropathy, gastroparesis, constipation, diarrhea, and fecal incontinence) are common, and any section of the GI tract may be affected. Gastroparesis should be suspected in individuals with erratic glucose control. Upper-GI symptoms should lead to consideration of all possible causes, including autonomic dysfunction. Whereas a radiographic gastric emptying study can definitively establish the diagnosis of gastroparesis, a reasonable approach is to exclude autonomic dysfunction and other known causes of these upper-GI symptoms. Constipation is the most common lower-GI symptom but can alternate with episodes of diarrhea. Diagnostic approaches should rule out autonomic dysfunction and the well-known causes such as neoplasia. Occasionally, anorectal manometry and other specialized tests typically performed by the gastroenterologist may be helpful. DAN is also associated with genitourinary tract disturbances including bladder and/or sexual dysfunction. Evaluation of bladder dysfunction should be performed for individuals with diabetes who have recurrent urinary tract infections, pyelonephritis, incontinence, or a palpable bladder. Specialized assessment of bladder dysfunction will typically be performed by a urologist. In men, DAN may cause loss of penile erection and/or retrograde ejaculation. A complete workup for erectile dysfunction in men should include history (medical and sexual); psychological evaluation; hormone levels; measurement of nocturnal penile tumescence; tests to assess penile, pelvic, and spinal nerve function; cardiovascular autonomic function tests; and measurement of penile and brachial blood pressure. Neurovascular dysfunction resulting from DAN contributes to a wide spectrum of clinical disorders including erectile dysfunction, loss of skin integrity, and abnormal vascular reflexes. Disruption of microvascular skin blood flow and sudomotor function may be among the earliest manifestations of DAN and lead to dry skin, loss of sweating, and the development of fissures and cracks that allow microorganisms to enter. These changes ultimately contribute to the development of ulcers, gangrene, and limb loss. Various aspects of neurovascular function can be evaluated with specialized tests, but generally these have not been well standardized and have limited clinical utility. Cardiovascular autonomic neuropathy (CAN) is the most studied and clinically important form of DAN. Meta-analyses of published data demonstrate that reduced cardiovascular autonomic function as measured by heart rate variability (HRV) is strongly (i.e., relative risk is doubled) associated with an increased risk of silent myocardial ischemia and mortality. The determination of the presence of CAN is usually based on a battery of autonomic function tests rather than just on one test. Proceedings from a consensus conference in 1992 recommended that three tests (R-R variation, Valsalva maneuver, and postural blood pressure testing)or longitudinal testing of the cardiovascular autonomic system. Other forms of autonomic neuropathy can be evaluated with specialized tests, but these are less standardized and less available than commonly used tests of cardiovascular autonomic function, which quantify loss of HRV. Interpretability of serial HRV testing requires accurate, precise, and reproducible procedures that use established physiological maneuvers. The battery of three recommended tests for assessing CAN is readily performed in the average clinic, hospital, or diagnostic center with the use of available technology. Measurement of HRV at the time of diagnosis of type 2 diabetes and within 5 years after diagnosis of type 1 diabetes (unless an individual has symptoms suggestive of autonomic dysfunction earlier) serves to establish a baseline, with which 1-year interval tests can be compared. Regular HRV testing provides early detection and thereby promotes timely diagnostic and therapeutic interventions. HRV testing may also facilitate differential diagnosis and the attribution of symptoms (e.g., erectile dysfunction, dyspepsia, and dizziness) to autonomic dysfunction. Finally, knowledge of early autonomic dysfunction can encourage patient and physician to improve metabolic control and to use therapies such as ACE inhibitors and beta-blockers, proven to be effective for patients with CAN.

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