Povidone-iodine versus normal saline solution in preoperative vaginal cleansing before office hysteroscopy: a randomized controlled trial

Background: Hysteroscopy is well-thought-out the gold standard for assessing the uterine cavity, and now can be done as an office process due to enhanced endoscopic advances with no need to in-patient admission. Objective of the present study was to compare the difference in the rate of postoperative vaginal irritation symptoms and postoperative infections after using povidone iodine (PI) and normal saline (NS) solution in vaginal cleaning before outpatient office hysteroscopy (OH).Methods: Women attended to the hospital for diagnostic OH were included for present study. Eligible women were randomly allocated in a 1:1 ratio to two groups. Group I "PI group" women exposed to PI for vaginal cleansing before hysteroscopy, and group II "NS group” women exposed to the NS solution for vaginal cleansing. The primary outcome of the study was to compare the difference in the rate of postoperative vaginal irritation symptoms and postoperative infections in both groups.Results: The mean age of the study participants was 34.26±4.14 years for NS group compared to 35.22±4.01 years for PI group (p=0.652). The PI group reported higher rate of vaginal irritation than NS group with no statistically significant difference between the two groups (p=0.179). Both groups were similar in postoperative fever, urinary tract infection and vaginitis (p>0.05).Conclusions: This study concluded that preoperative vaginal disinfection at the time of OH with a NS solution is less frequently causing postoperative vaginal irritation symptoms. Additionally, it is as effective as the usual agent (PI) in preventing postoperative infections

Acute Fatty Liver of Pregnancy; 10 Years’ Experience in a Large Tertiary Center in Egypt

Objective:To provide a description for the demographics, clinical presentation, maternal and perinatal outcome in patients with acute fatty liver of pregnancy (AFLP) admitted in Assiut Woman’s Health Center, Egypt.Materials and Methods:This was a retrospective study over a period of 10 years included all women who were admitted in Assiut Woman’s Health Center with the diagnosis of AFLP. Data were collected from the records of patients; their symptoms, laboratory findings, clinical course, maternal and perinatal outcome were reviewed.Results:Thirty-two women with AFLP were identified. Twenty-nine of them were diagnosed in the antepartum period, and three cases were diagnosed after delivery. There were 27 cases of maternal deaths (84.7%). Persistent nausea and vomiting was the most common initial presentation (68.8%). Moderate rise of liver transaminases was the only constant laboratory finding in all cases. Conclusions:AFLP is a medical and obstetrical emergency. In Egypt, the disease still has a high mortality rate. Lack of awareness of many health care providers about the nature of this mysterious disease is a contributing factor. Early recognition and treatment can improve both maternal and fetal survival

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Prognostic value of serum soluble FMS-like tyrosine kinase (sFlt-1) levels in pre-eclampsia and eclampsia; a prospective cohort study

Objective: To evaluate the levels of circulating sFlt-1 in pre-eclampsia (PE) and eclampsia patients and to assess its prognostic value in detection of PE complications. Methods: The present study was a prospective cohort study conducted in tertiary hospital between January and December 2016. Included patients were divided into two groups; (Group I) severe PE group and (Group II) eclampsia group. Age-, parity-, and gestational age-matched women had approached to participate in the study as a control group (Group III). Serum sFlt-1 levels were measured at inclusion and 2 days later with all basic investigations. Patients were followed up until delivery to record any complications. Correlation analysis was performed between the serum sFlt-1 levels and clinical, laboratory investigations. Receiver operating characteristic analysis was constructed for the evaluation of the area under curve (AUC) as well as the sensitivity and specificity regarding the cutoff point of sFlt-1 level that predict occurrence of complications. Results: The study included 84 women. Women with complicated severe PE showed higher sFlt-1 levels than in non-complicated cases (120.2 ± 19.6 versus 72.2 ± 19.6, p < 0.001). Similarly, the mean serum level of sFlt-1 in complicated eclampsia was higher than in non-complicated cases (298.3 ± 75.2 versus 128.1 ± 36.5, p < 0.001) (OR = 1.119, 95% CI: 10.057–1.184, p < 0.001). SFlt-1 levels were strongly correlated with systolic blood pressure (r = 0.641) and diastolic blood pressure (r = 0.540) (p < 0.001 and p < 0.001, respectively). At cutoff point 102.60 ng/ml of sFlt-1 levels, the sensitivity was 90% and specificity was 80% with AUC = 0.923, 95% CI: 0.871–0.975. Conclusions: Serum sFlt-1 can be used as a prognostic marker to predict the occurrence of complications of preeclampsia

Prognostic value of serum soluble FMS-like tyrosine kinase (sFlt-1) levels in pre-eclampsia and eclampsia; a prospective cohort study

Objective: To evaluate the levels of circulating sFlt-1 in pre-eclampsia (PE) and eclampsia patients and to assess its prognostic value in detection of PE complications. Methods: The present study was a prospective cohort study conducted in tertiary hospital between January and December 2016. Included patients were divided into two groups; (Group I) severe PE group and (Group II) eclampsia group. Age-, parity-, and gestational age-matched women had approached to participate in the study as a control group (Group III). Serum sFlt-1 levels were measured at inclusion and 2 days later with all basic investigations. Patients were followed up until delivery to record any complications. Correlation analysis was performed between the serum sFlt-1 levels and clinical, laboratory investigations. Receiver operating characteristic analysis was constructed for the evaluation of the area under curve (AUC) as well as the sensitivity and specificity regarding the cutoff point of sFlt-1 level that predict occurrence of complications. Results: The study included 84 women. Women with complicated severe PE showed higher sFlt-1 levels than in non-complicated cases (120.2 ± 19.6 versus 72.2 ± 19.6, p < 0.001). Similarly, the mean serum level of sFlt-1 in complicated eclampsia was higher than in non-complicated cases (298.3 ± 75.2 versus 128.1 ± 36.5, p < 0.001) (OR = 1.119, 95% CI: 10.057–1.184, p < 0.001). SFlt-1 levels were strongly correlated with systolic blood pressure (r = 0.641) and diastolic blood pressure (r = 0.540) (p < 0.001 and p < 0.001, respectively). At cutoff point 102.60 ng/ml of sFlt-1 levels, the sensitivity was 90% and specificity was 80% with AUC = 0.923, 95% CI: 0.871–0.975. Conclusions: Serum sFlt-1 can be used as a prognostic marker to predict the occurrence of complications of preeclampsia