Tranexamic Acid: A Potential Adjunct to Resectoscopic Endometrial Ablation

Abnormal uterine bleeding (AUB) is a substantial cause of ill health in women worldwide. In this study, our aim was to evaluate the effectiveness of endometrial ablation using a modified urologic resectoscope along with tranexamic acid in AUB. Sixty patients were enrolled in this study. All patients underwent resectoscopic surgery. Patients were randomly divided into two groups. Group 1 (n = 30) received 500 mg of tranexamic acid. Group 2 (n = 30) served as the control group and underwent surgery without the administration of tranexamic acid. Total pictorial blood loss assessment chart (PBAC) scores were significantly lower postoperatively (152.14 +/- 9.65 versus 6.6 +/- 0.90; P 15 was lower in the tranexamic group (11 versus 17), but the differences were not statistically significant (P > 0.05). AUB is a complex disease that may need repeated treatments. In expert hands, the treatment rate of resectoscopic surgery seems acceptable. However, some patients may require additional interventions, like repeated surgery, hysterectomy, or a drug therapy in the long run. Introduction of tranexamic acid as a potential adjunct to rollerball endometrial ablation may present an interesting option that requires additional well-designed studies before firm conclusions can be made

Assessment of impaired glucose tolerance prevalence with hemoglobin A(1c) and oral glucose tolerance test in 252 Turkish women with polycystic ovary syndrome: a prospective, controlled study

What is the prevalence of abnormalities in glucose metabolism in patients with polycystic ovary syndrome (PCOS) and controls in a Turkish population? The total prevalence of glucose abnormalities in PCOS patients was 16.3 [impaired glucose tolerance (IGT) 14.3; type 2 diabetes mellitus (T2DM) 2] and was higher than in healthy subjects (IGT 8.5; T2DM 0, respectively). One of the most common markers of chronic glycemia is hemoglobin Alc (HbA(1c)). However, little is known about whether the use of HbA(1c) results in diagnosis of more cases of glucose intolerance in the PCOS population than the oral glucose tolerance test (OGTT) alone. This was a prospective study, including 252 women with PCOS and 117 control women without PCOS. The study was carried out in the gynecological outpatient department of Namik Kemal University Hospital, Turkey, between 2010 and 2012. Women with PCOS (n 252) were diagnosed according to Rotterdam criteria. The control group included 117 women (aged 1745 years) who were selected randomly. BMI of participants ranged between 15.6 and 47.9 kg/m(2). Patients with PCOS were comparable to controls in terms of age (24.8 versus 25.9 years, respectively) and had higher BMI (26.1 versus 24.9 kg/m(2), respectively). Of 252 patients with PCOS, 41 had glucose intolerance (IGT 14.3; T2DM 2) when compared with 10 of the 117 control patients (IGT 8.5; T2DM 0; odds ratios 2.08; P 0.045) during the OGTT. When an HbA(1c) value 5.6 was used to divide the total population, the prevalence of abnormal glucose metabolism was 7.9 in the patients with PCOS, below the value detected in the control patients (8.5), which showed that 20 of 41 patients with abnormal glucose tolerance would not have been diagnosed, if the HbA(1c) alone had been used. When compared with the OGTT results, HbA(1c) provided 52.4 sensitivity, 74.4 specificity, 67.1 positive and 60.9 negative predictive values with a threshold value of 5.6 in abnormal glucose tolerance. The receiver operating characteristic analysis suggested a threshold value of 5.35 in HbA(1c) (75.6 sensitivity and 52.6 specificity) for the prediction of abnormal glucose tolerance. This study did not involve weight-matched healthy subjects, which may cause a difference in prevalence of abnormal glucose metabolism between the groups, and the results are limited to an unselected population of patients who have the full PCOS phenotype. In addition, the incidence of T2DM among the first-degree relatives and 2-h insulin levels could not be reported in full. Further investigation of the efficacy of HbA(1c) for the prediction of abnormal glucose tolerance should be undertaken in long-term prospective studies and in different geographic populations. At present, the only way to reliably detect abnormal glucose metabolism in Turkish women with PCOS appears to be using the OGTT. No financial support. The authors have no competing interests to declare. Not applicable

Cervical Priming Before Diagnostic Operative Hysteroscopy in Infertile Women: A Randomized, Double-Blind, Controlled Comparison of 2 Vaginal Misoprostol Doses

The aim of this study was to evaluate the efficacy of vaginal misoprostol for cervical priming at doses of 200 mcg and 400 mcg, 12 to 15 hours before diagnostic office hysteroscopy (OH) without anesthesia in patients with infertility. Sixty infertile patients requiring a diagnostic office hysteroscopy for investigation of infertility were included in the study. The patients were randomly allocated into 3 vaginally administered misoprostol groups: (1) control group, (2) 200-mcg dose group, and (3) 400-mcg dose group. Misoprostol significantly facilitated the procedure of OH: cervical entry was easier; procedural time was shorter; baseline cervical width was larger; and pain scoring was lower in the misoprostol groups compared with the control group. Increasing the dose of misoprostol from 200 mcg to 400 mcg did not improve the effect on cervical dilation. Misoprostol is a promising analog to use for cervical priming before OH. Since doses of 200 mcg and 400 mcg vaginal misoprostol 12 hours before the OH both have proven to be effective regimens, 200 mcg may be preferred. However, before routine clinical usage, further research is needed through large, randomized, controlled trials powered to detect a difference in complications to determine whether misoprostol reduces complications in OH.Scientific Research Projects Coordination Unit of Istanbul UniversityIstanbul University [26324]An earlier version of this research was presented at the 42nd Annual Meeting of American Society of Reproductive Medicine in San Diego, 2012. This was made possible by funding from the Scientific Research Projects Coordination Unit of Istanbul University (grant 26324)

Evaluation de la qualité de la prise en charge de la dyspnée par les médecins généralistes à Parakou en 2013

Introduction: La dyspnée est un symptôme qui peut être l'expression de pathologies potentiellement grave et urgentes. Notre objectif était d'évaluer la qualité de la prise en charge de la dyspnée en milieu hospitalier à Parakou.Méthodes: Il s'agissait d'étude rétrospective portant sur tous les patients admis dans les centres hospitaliers de Parakou pour dyspnée non traumatique entre le 1er Février 2012 et le 31 Mai 2013. Les recommandations tunisiennes sur la prise en charge de la dyspnée aux urgences ont été utilisées comme référentiel d'évaluation. Chaque étape de la démarche médicale a été notée et la prise en charge était bonne lorsque la note obtenue au score était entre 51 et 100. Les autres variables utilisées étaient la qualification du soignant principal, les antécédents du patient et les données cliniques et paracliniques.Résultats: Sur les 11101 patients reçus aux urgences on a dénombré 328 cas de dyspnée (2,9%). La PEC était assuré principalement par les cardiologues (55,9%) et les médecins généralistes (29,2%). La qualité de la prise en charge par les généralistes était bonne chez 73,2%. Les facteurs associés à la bonne qualité de PEC étaient: la recherche des antécédents médicaux (84,4% vs 15,6%; p<10-4), la description des caractéristiques cliniques de la dyspnée (94,1% vs 5,9%; p<10-4) et la réalisation de l'examen physique complet (86,8% vs 13,2%; p<10-4).Conclusion: A Parakou en 2013 près d'un généraliste sur trois gère mal la dyspnée. Cette mauvaise gestion est liée à une mauvaise démarche médicale.Keywords: Dyspnée, prise en charge, Afriqu

Oral medications including clomiphene citrate or aromatase inhibitors with gonadotropins for controlled ovarian stimulation in women undergoing in vitro fertilisation

We thank:• Richard Kirubakaran, Cochrane South Asia, Prof. BV Moses Centre for Evidence-Informed Health Care and Health Policy, Christian Medical College, Vellore, India;• Marian Showell, Information Specialist for the Cochrane Gynaecology and Fertility Group;• Editorial team of the Cochrane Gynaecology and Fertility Group for their support and assistancePeer reviewedPublisher PD

Relaxin-like peptides in male reproduction: a human perspective

The relaxin family of peptide hormones and their cognate GPCRs are becoming physiologically well-characterized in the cardiovascular system and particularly in female reproductive processes. Much less is known about the physiology and pharmacology of these peptides in male reproduction, particularly as regards humans. H2-relaxin is involved in prostate function and growth, while insulin-like peptide 3 (INSL3) is a major product of the testicular Leydig cells and, in the adult, appears to modulate steroidogenesis and germ cell survival. In the fetus, INSL3 is a key hormone expressed shortly after sex determination and is responsible for the first transabdominal phase of testicular descent. Importantly, INSL3 is becoming a very useful constitutive biomarker reflecting both fetal and post-natal development. Nothing is known about roles for INSL4 in male reproduction and only very little about relaxin-3, which is mostly considered as a brain peptide, or INSL5. The former is expressed at very low levels in the testes, but has no known physiology there, whereas the INSL5 knockout mouse does exhibit a testicular phenotype with mild effects on spermatogenesis,probably due to a disruption of glucose homeostasis. INSL6 is a major product of male germ cells, although it is relatively unexplored with regard to its physiology or pharmacology, except that in mice disruption of the INSL6 gene leads to a disruption of spermatogenesis. Clinically, relaxin analogues may be useful in the control of prostate cancer, and both relaxin and INSL3 have been considered as sperm adjuvants for in vitro fertilization

Hubungan Antara Work Engagement Dan Burnout Pada Karyawan PT. Redline Production Surabaya Dengan Mengontrol Intrapsychic-Coping

Penelitian ini bertujuan untuk mengetahui apakah terdapat hubungan antara engagement dan burnout pada karyawan PT. Redline Production dengan mengontrol intrapsychic-coping. Engagement pemenuhan pikiran terkait dengan pekerjaan yang memiliki karakteristik vigor (kekuatan mental dan fisik), dedication (pengabdian), dan absorption (kesungguhan). Engagement yang rendah akan menimbulkan stres yang jika dihadapi menggunakan intrapsychiccoping akan memunculkan burnout. Intrapsychic-coping atau palliation atau yang biasa disebut dengan emotion-focused coping adalah pengurangan derita emosi (emotional distress) dari stres yang mencakup usaha untuk mengatur konsekuensi-konsekuensi emosi dari situasi stres melalui modifikasi persepsi, sikap, dan goals. Intrapsychic-coping yang digunakan untuk menyikapi stres dapat mengakibatkan burnout. Burnout adalah respon berkepanjangan dari stressor interpersonal dan emosional kronis yang didefinisikan melalui tiga dimensinya yaitu emotional exhaution (kelelahan fisik dan emosi), depersonalization (depersonalisasi atau sinisme), dan reduced personal accomplishment (inefikasi). Penelitian dilakukan di sebuah perusahaan event organizer PT. Redline Production. Subjek dalam penelitian ini adalah seluruh karyawan PT. Redline. Alat pengumpul data berupa skala UWES yang diadaptasi dari skala asli milik Schaufeli et al. untuk mengukur engagement, skala MBI-HSS untuk mengukur burnout yang diadaptasi dari skala asli milik Maslach et al. yang dimodifikasi berdasar penelitian Schaufeli pada 2002, dan WCQ-37 (e-f) untuk mengukur intrapsychic-coping yang diadaptasi dari skala asli milik Lazarus. Analisis data dilakukan dengan menggunakan teknik statistik korelasi parsial 3 variabel dengan bantuan program SPSS 16.0 for windows. Dari hasil analisis data penelitian diperoleh nilai korelasi antara engagement dan burnout dengan intrapsychic-coping yang dikontrol sebesar -0,625 dengan p ≤ 0,05. Hal ini menunjukkan bahwa terdapat korelasi negatif antara engagement dengan burnout karyawan PT. Redline Production Surabaya jika intrapsychic-coping dikontrol

Ovarian stem cells and aging

Objective To review successes to date in the field of ovarian stem cell research and discuss the evidence supporting their potential to rejuvenate the follicular pool during adult life; to present factors that may contribute to their competence; and to address the question of why menopause is an inevitable outcome of advanced age if ovarian stem cells exist

Nature of Light: Spectroscopic Techniques in Obstetrics and Gynecology Applications

In recent years, advances in spectroscopic techniques led to an increase in their medical applications. In medical sciences, emphasis is increasingly placed on instrumental techniques and accurate, quantitative measurements. It is especially apparent in diagnosis, where imaging techniques and laboratory results have became invaluable and compulsory. Breakthroughs in biochemistry made it possible to characterize physiological processes and living organisms at the molecular level. This led to a proliferation of new methods such as DNA tests and the use of biomarkers in daily clinical practice. Characterization of molecular structure and determination of the composition of a mixture are the fields of analytical chemistry and analytical biochemistry