Changing trends of prevalence and presentation of ectopic pregnancy cases admitted in DMCH

Background: An ectopic pregnancy occurs outside the uterus and is a relatively common condition among women of childbearing age. Most ectopic pregnancies occur in the Fallopian tube (so-called tubal pregnancies), but implantation can also occur in the cervix, ovaries, and abdomen. An ectopic pregnancy is a potential medical emergency, and, if not treated properly, can lead to death. The aim of the study was to evaluate the changing trends of prevalence and presentation of ectopic pregnancy cases admitted in DMCH. Methods: This study was undertaken among the patients admitted in the Department of Obstetrics and Gynecology, Dhaka Medical College Hospital during the period from October 2012 to March 2013. Clinical evaluation of cases of ectopic pregnancy in terms of sociodemographic factors, presentations, risk factors, examination findings, per operative findings and management offered to the patients. The period from Data was entered in MS Excel and Statistical analysis was done using SPSS-24. Results: Most of the patients were 20-30 years age group and mean age was 28.08±4.24 years. The frequency of ectopic pregnancy was 7.60%.  High incidence was found among 0-1 parity (48%) and from a lower socioeconomic status. Commonest presentation was lower abdominal pain (94%), amenorrhoea (100%), P/V bleeding (38%) and syncopal attack (48%). Most of the cases was without contraceptic coverage (60%). Previous history of abortion/MR (50%), history of pelvic infection (30%) and history of D&C (16%) constitute the main bulk of risk factors. Most of the patients managed by laparotomy followed by salpingectomy which is still the standard treatment in many cases. Conclusions: Study has found that previous abortions are major etiological factor for ectopic pregnancy than previous pelvic infection. Most of the patients were managed by laparotomy. The general public should be made aware the sign and symptoms of ectopic pregnancy. Proper and modern diagnostic tools and training program for these should be made available in all tertiary level hospital

The Prominence of Artificial Intelligence in COVID-19

In December 2019, a novel virus called COVID-19 had caused an enormous number of causalities to date. The battle with the novel Coronavirus is baffling and horrifying after the Spanish Flu 2019. While the front-line doctors and medical researchers have made significant progress in controlling the spread of the highly contiguous virus, technology has also proved its significance in the battle. Moreover, Artificial Intelligence has been adopted in many medical applications to diagnose many diseases, even baffling experienced doctors. Therefore, this survey paper explores the methodologies proposed that can aid doctors and researchers in early and inexpensive methods of diagnosis of the disease. Most developing countries have difficulties carrying out tests using the conventional manner, but a significant way can be adopted with Machine and Deep Learning. On the other hand, the access to different types of medical images has motivated the researchers. As a result, a mammoth number of techniques are proposed. This paper first details the background knowledge of the conventional methods in the Artificial Intelligence domain. Following that, we gather the commonly used datasets and their use cases to date. In addition, we also show the percentage of researchers adopting Machine Learning over Deep Learning. Thus we provide a thorough analysis of this scenario. Lastly, in the research challenges, we elaborate on the problems faced in COVID-19 research, and we address the issues with our understanding to build a bright and healthy environment.Comment: 63 pages, 3 tables, 17 figure

A BRAZILIAN CASE OF TREATMENT-RESISTANT GENERALIZED ANXIETY DISORDER SUCCESSFULLY TREATED WITH MONOAMINE OXIDASE INHIBITOR (MAOI)

In this brief report we present the case of a 53 year old man with a very debilitating Generalized Anxiety Disorder successfully treated with tranylcypromine. After several failed treatment attempts following international guidelines recommendations over the course of one year and a half, tranylcypromine was prescribed which led to effective and sustained remission of anxiety symptoms for this patient. We also briefly explore treatment options for resistant cases of generalized anxiety disorder, given the major negative impacts of untreated GAD in a person\u27s daily functioning and quality of life

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362