Office hysteroscopy prior to ART cycle-analysis and outcome at a private IVF clinic setup in Surat, Gujarat, India

Background: Hysteroscopy is a gold standard test for assessing the uterine cavity. The presence of uterine pathology may negatively affect the chance of implantation .This study investigated the use of routine office hysteroscopy and correction of any intrauterine pathologies prior to starting IVF cycle on treatment outcome in women seeking IVF treatment for primary infertility and recurrent implantation failure.Methods: This was a retrospective study of 100 women who attended our infertility clinic from July 2016 to December 2016 and who were willing for office hysteroscopy. The main outcomes measured were clinical pregnancy rates achieved in the index IVF cycle, multiple pregnancy rate, ectopic pregnancy rate, miscarriage rate and failure rate.Results: Of the 100 patients who participated in the study, 75 patients conceived, 25 patients failed to conceive. 80.64% patients with normal findings on diagnostic hysteroscopy conceived after the procedure, 58.33% patients conceived after polypectomy, 68.42% conceived after septal resection, 71.42% conceived after adhesiolysis, 50% conceived after lateral metroplasty and 73.07% of recurrent implantation failure conceived after local endometrial injury was done on hysteroscopy.Conclusions: Hysteroscopy in infertile women prior to their IVF cycle when performed atleast 3 months in advance could improve treatment outcome

A comparative study between agonist and antagonist protocol for ovarian stimulation in art cycles at a rural set up in South Gujarat

Background: Modern infertility practice provides us with several protocols for controlled ovarian hyperstimulation for the ART (Assisted Reproductive Techniques) cycles. The review summarises the clinical characteristics of the protocols using Gonadotrophin Releasing Hormone (GnRH) agonists and antagonists emphasising on the major clinical and laboratory outcomes with each protocol.Methods: A total of 322 cases undergoing ovarian stimulation with agonist and antagonist protocols in ART cycles at a rural set up at Killa Pardi in the year 2014 were studied and their laboratory and clinical outcomes were evaluated.Results: Antagonist group had the maximum number of oocytes retrieved and the mature M2 oocytes, maximum No. of follicles >16 mm on day of HCG, maximum No. of positive pregnancy rates. Agonist group had also a good pregnancy rate with maximum Grade I embryos.Conclusions: Taking all data together, it may be concluded that antagonists and minimal ovarian stimulation with antagonist protocols offer a new treatment regimen in ovarian stimulation that is short, safe, cost effective, well tolerated, optimizing convenience for the patient

A comparative study of pregnancy outcome of sequential versus day 3 versus only blastocyst (day 6) transfer at a single IVF center over one year

Background: The recent introduction of sequential media has refocused attention upon the role of human blastocyst in IVF.  For optimisation of extended cycles, one needs to give importance to all the aspects of treatment cycle like the stimulation regimens, medium composition, endometrial quality and uterine receptivity. This study was done to know the pregnancy outcomes of Day 3 transfer vs Day3/Day 6 transfer vs only Day 6 transfer.Methods: It was a retrospective study in which 342 patients undergoing ICSI were included. 199 women underwent Day 3/Day 6 sequential transfers, 112 underwent only Day 3 transfer and only 30 women were given only Blastocyst i.e. day 6 transfer. Pregnancy outcomes of all the three groups were studied.Results: Sequential transfer was found to give maximum pregnancy rate and highest implantation rate. But it was also associated with highest number of multiple pregnancies.Conclusions: Sequential transfer is a very good efficacious approach in ART cycles if extended media are available as it gave maximum pregnancy rate and implantation rate. However it is associated with multiple pregnancies. Thus the ultimate goal is to have a single blastocyst transfer with better outcomes and lower multiple pregnancy rates

Development of a Web-based Resident Profiling Tool to Support Training in Practice-based Learning and Improvement

Multiple factors are driving residency programs to explicitly address practice-based learning and improvement (PBLI), yet few information systems exist to facilitate such training. We developed, implemented, and evaluated a Web-based tool that provides Internal Medicine residents at the University of Virginia Health System with population-based reports about their ambulatory clinical experiences. Residents use Systems and Practice Analysis for Resident Competencies (SPARC) to identify potential areas for practice improvement. Thirty-three (65%) of 51 residents completed a survey assessing SPARC’s usefulness, with 94% agreeing that it was a useful educational tool. Twenty-six residents (51%) completed a before–after study indicating increased agreement (5-point Likert scale, with 5=strongly agree) with statements regarding confidence in ability to access population-based data about chronic disease management (mean [SD] 2.5 [1.2] vs. 4.5 [0.5], p < .001, sign test) and information comparing their practice style to that of their peers (2.2 [1.2] vs. 4.6 [0.5], p < .001)

Antihistaminic effect of Bauhinia racemosa leaves

Bauhinia racemosa Lam. (Caesalpiniaceae) leaves have been used in the treatment of asthma traditionally and we therefore undertook this study to scientifically validate its benefit in asthma using suitable animal models. Antihistaminic principles are known to be useful in the treatment of asthma; hence, in the present work, the antihistaminic activity of an ethanol extract of B. racemosa (at a dose of 50 mg/kg, i.p.) was assessed using clonidine-induced catalepsy and haloperidol-induced catalepsy in Swiss albino mice. The results showed that the ethanol extract inhibits clonidine-induced catalepsy but there is no effect on haloperidol-induced catalepsy. This suggests that the inhibition is through an antihistaminic action and that there is no role of dopamine. Hence, we concluded that the ethanol extract has significant antihistaminic activity. The polar constituents in the ethanol extract of leaves of B. racemosa may be responsible for the antihistaminic activity and B. racemosa may therefore have a role in the treatment of asthma

Improving Smoking Cessation Counseling Using a Point-of-Care Health Intervention Tool (IT): From the Virginia Practice Support and Research Network (VaPSRN)

Purpose: Primary care practices are an ideal setting for reducing national smoking rates because >70% of smokers visit their physician annually, yet smoking cessation counseling is inconsistently delivered to patients. We designed and created a novel software program for handheld computers and hypothesized that it would improve clinicians' ability to provide patient-tailored smoking cessation counseling at the point of care. Methods: A handheld computer software program was created based on smoking cessation guidelines and an adaptation of widely accepted behavioral change theories. The tool was evaluated using a validated before/after survey to measure physician smoking cessation counseling behaviors, knowledge, and comfort/self-efficacy. Results: Participants included 17 physicians (mean age, 41 years; 71% male; 5 resident physicians) from a practice-based research network. After 4 months of use in direct patient care, physicians were more likely to advise patients to stop smoking (P = .049) and reported an increase in use of the “5 As” (P = .03). Improved self-efficacy in counseling patients regarding smoking cessation (P = .006) was seen, as was increased comfort in providing follow-up to patients (P = .04). Conclusions: Use of a handheld computer software tool improved smoking cessation counseling among physicians and shows promise for translating evidence about smoking cessation counseling into practice and educational settings.This is the publisher’s final pdf. The published article can be found at: http://www.jabfm.org/Keywords: Practice-based Research, Health Information Technology, Smoking Cessation, Behavioral Counselin

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially