Long-term outcomes of endoscopic submucosal dissection for undifferentiated type early gastric cancer over 2 cm with R0 resection

BACKGROUND Endoscopic submucosal dissection(ESD)for over 2 cm in size undifferentiated type(UD type)early gastric cancer(EGC)confined to the mucosa is not only challenging,but also long-term outcomes are not well known.AIM To evaluate the long-term outcomes of ESD done for UD type EGCs confined to the mucosa over 2 cm in size and compare the results with those where the lesions were less than 2 cm.METHODS 143 patients with UD type EGC confirmed on histology after ESD at a tertiary hospital were reviewed.Cases with synchronous and metachronous lesions and a case with emergency surgery after ESD were excluded.A total of 137 cases were enrolled.79 cases who underwent R0 resection were divided into 2 cm or less(group A)and over 2 cm(group B)in size.RESULTS Among 79 patients who underwent R0 resection,the number in group A and B were 51 and 28,respectively.The mean follow-up period(SD)was 79.71±45.42 months.There was a local recurrence in group A(1/51,2%)and group B(1/28,3.6%)respectively.This patient in group A underwent surgery while the patient in group B underwent repeated ESD with no further recurrences in both patients.There was no regional lymph node metastasis,distant metastasis,and deaths in both groups.With R0 resection strategy for ESD on lesions over 2 cm,20.4%(28/137)of patients were able to avoid surgery compared with expanded indication.CONCLUSION If R0 resection is achieved by ESD,UD type EGCs over 2 cm also showed good and similar clinical outcomes as compared to lesions less than 2 cm when followed for over 5 years.With R0 resection strategy,several patients can avoid surgery.

Short-Term and Long-Term Outcomes among COVID-19 Survivors: A Multi-Center Prospective Observational Study

Background: Since the outbreak of the COVID-19 pandemic caused massive case fatalities across the world, people have been left with significant physical and mental disabilities, which has had an adverse impact on their quality of life. The objective of this study is to measure the short-term and long-term outcomes among COVID-19 survivors. Methods: This is a six-month-long multicentre prospective observational study, carried out in four specialized hospitals in the capital city Dhaka, where six hundred participants were enrolled by non-probability convenience sampling. Data were collected through three structured interviews, and follow-ups were done during discharge, at 1st month, and 6th month. An analytical study was done on demographic variables, socio-economic conditions, physical findings and outcomes. Data were analysed using Statistical Package for Social Sciences (SPSS). Results: A total of 600 participants were enrolled. The mean age was 49.83. Many participants belong to the age range of 31 to 40 years. More than two-thirds (72.7%) of participants were male, whereas 27.30% were female. Most patients admitted had mild and moderate COVID-19 symptoms (40% and 58%, respectively). Among short-term COVID complications, it was found that 43.3% of the participants complained of fatigue, 32.6% of depression, 24.7% of sleep disturbance, 19% of anxiety and, 5% memory loss. In long-term COVID complications the number reduced significantly: 5% of the participants complained of fatigue, 10% of depression, 2.7% of sleep disturbance, 7.3% of anxiety and, 2.7% memory loss. The severity of lung parenchymal disease also reduced in long term COVID symptoms. The study found a statistically significant relationship between age groups and CT severity index (χ2 = 9.458, p = 0.032). Most patients (29.2%) in the under-30 age group had a CT Severity Index score of 2 & 3 (29.2%). The important CT Severity Index scores for individuals aged 30 to 60 years were 3 and 4, accounting for 37.7% and 33.3%, respectively. In the over-60 age group, 40.8% of patients showed a CT Severity Index score of 4, showing a range of 51% - 75%. Conclusion: This study found that fatigue, depression, and sleep disturbances are prevalent among COVID-19 survivors;however, these symptoms generally reduce over time. Lung problems improved;however, some patients suffered from persistent effects. Older patients, especially those with pre-existing conditions, suffer from more severe outcomes. These findings underscore the need for ongoing care for COVID-19 survivors.

Long-term outcomes after laparoscopic colectomy

AIM:To evaluate long-term outcomes in a large series of patients who randomly received laparoscopic or open colorectal resection.METHODS:From February 2000 to December 2004,six hundred sixty-two patients with colorectal disease were randomly assigned to laparoscopic(LPS,n = 330) or open(n = 332) colorectal resection.All patients were analyzed on an intention-to-treat basis.Long-term follow-up was carried out every 6 mo by office visits.In 526 cancer patients five-year overall and disease-free survival were evaluated.Median oncologic follow-up was 96 mo.RESULTS:Eight(4.2%) LPS group patients needed conversion to open surgery.Overall long-term morbidity rate was 7.6%(25/330) in the LPS vs 11.1%(37/332) in the open group(P = 0.17).In cancer patients,fiveyear overall survival was 68.6% in the LPS group and 64.0% in the Open group(P = 0.27).Excluding stage Ⅳ patients,five-year local and distant recurrence rates were 32.5% in the LPS group and 36.8% in the Open group(P = 0.36).Further,no difference in recurrence rate was found when patients were stratified according to cancer stage.CONCLUSION:LPS colorectal resection was associated with a slightly lower incidence of long-term complications than open surgery.No difference between groups was found in overall and disease-free survival rates.

Short-and long-term outcomes of endoscopically treated superficial non-ampullary duodenal epithelial tumors

BACKGROUND It is widely recognized that endoscopic resection(ER) of superficial nonampullary duodenal epithelial tumors(SNADETs) is technically challenging and may carry high risks of intraoperative and delayed bleeding and perforation.These adverse events could be more critical than those occurring in other levels of the gastrointestinal tract. Because of the low prevalence of the disease and the high risks of severe adverse events, the curability including short-and long-term outcomes have not been standardized yet.AIM To investigate the curability including short-and long-term outcomes of ER for SNADETs in a large case series.METHODS This retrospective study included cases that underwent ER for SNADETs at our university hospital between March 2004 and July 2017. Short-term outcomes of ER were measured based on en bloc and R0 resection rates as well as adverse events. Long-term outcomes included local recurrence detected on endoscopic surveillance and disease-specific mortality in patients followed up for ≥ 12 mo after ER.RESULTS In the study, 131 patients with 147 SNADETs were analyzed. The 147 ERs consisted of 136 endoscopic mucosal resections(EMRs)(93%) and 11 endoscopic submucosal dissections(ESDs)(7%). The median tumor diameter was 10 mm.The pathology diagnosis was adenocarcinoma(56/147, 38%), high-grade intraepithelial neoplasia(44/147, 30%), or low-grade intraepithelial neoplasia(47/147, 32%). The R0 resection rate was 68%(93/136) in the EMR group and73%(8/11) in the ESD group, respectively. Cap-assisted EMR(known as EMR-C)showed a higher rate of R0 resection compared to the conventional method of EMR using a snare(78% vs 62%, P = 0.06). No adverse event was observed in the EMR group, whereas delayed bleeding, intraoperative perforation, and delayed perforation in 3, 3, and 5 patients occurred in the ESD group, respectively. One patient with perforation required emergency surgery. In the 43 mo median follow-up period, local recurrence was found in four EMR cases and all cases were treated endoscopically. No patient died due to tumor recurrence.CONCLUSION Our findings suggest that ER provides good long-term outcomes in the patients with SNADETs. EMR is likely to become the safe and reliable treatment for small SNADETs.

D-dimer level and long-term outcome in patients with end-stage heart failure secondary to idiopathic dilated cardiomyopathy

Background Previous studies had demonstrated hemostatic abnormalities in patients with heart failure (HF) and several studies have shown that abnormal coagulation indices, represented by elevated D-dimer, had prognostic significance in patients with compatible or acute decompensated HF. However, the impact of D-dimer on the outcome in patients with end-stage HF remains unclear. Methods A total of 244 consecutive patients with end-stage HF due to idiopathic dilated cardiomyopathy (DCM) were prospectively enrolled from February 2011 to September 2014. D-dimer levels were measured and its prognostic value was assessed. Primary endpoint was all-cause mortality during the follow-up period. Secondary endpoints were stroke, bleeding, occurrence of sustained ventricular tachycardia or ventricular fibrillation, and major adverse cardiovascular events (MACE). Results D-dimer was significantly elevated in the non-survivors (median: 0.8 vs. 1.1 mg/L, P < 0.001). Traditional markers including B-type natriuretic peptide, troponin I, left ventricular ejection fraction, and left ventricular end-diastolic dimension provided limited prognostic value;but the addition of D-dimer refined the risk stratification. The optimal cut-off value of D-dimer to predict all-cause mortality was 0.84 mg/L by receiver operator characteristic analysis. Elevated D-dimer level was independently associated with increased risk of long-term all-cause mortality (HR = 2.315, 95% CI: 1.570–3.414, P < 0.001) and MACE (HR = 1.256, 95% CI: 1.058–1.490, P = 0.009), and the predictive value was independent of age, sex, atrial fibrillation and anticoagulation status. Conclusions Elevated D-dimer level was independently associated with poor long-term outcome in patients with end-stage HF secondary to idiopathic DCM, and the predictive value was superior to that of traditional prognostic markers.

Quality of life following laparoscopic Nissen fundoplication: Assessing short-term and long-term outcomes

AIM: To investigate the quality of life following lapa-roscopic Nissen fundoplication by assessing short-term and long-term outcomes. METHODS: From 1992 to 2005, 249 patients under-went laparoscopic Nissen fundoplication. Short-term outcome data including symptom response, side effects of surgery, endoscopy, and patient's perception of over-all success were collected prospectively. Long-term out-comes were investigated retrospectively in patients witha median follow-up of 10 years by assessment of reflux symptoms, side effects of surgery, durability of antire-flux surgery, need for additional treatment, patient's perception of success, and quality of life. Antireflux sur-gery was considered a failure based on the following criteria: moderate to severe heartburn or regurgitation; moderate to severe dysphagia reported in combination with heartburn or regurgitation; regular proton pump inhibitor medication use; endoscopic evidence of erosive esophagitis Savary-Miller grade 1-4; pathological 24-h pH monitoring; or necessity to undergo an additional surgery. The main outcome measures were short-and long-term cure rates and quality of life, with patient sat-isfaction as a secondary outcome measure. RESULTS: Conversion from laparoscopy to open sur-gery was necessary in 2.4% of patients. Mortality was zero and the 30-d morbidity was 7.6% (95%CI: 4.7%-11.7%). The median postoperative hospital stay was 2 d [interquartile range (IQR) 2-3 d]. Two hundred and forty-seven patients were interviewed for short-term analysis following endoscopy. Gastro-esophageal reflux disease was cured in 98.4% (95%CI: 95.9%-99.6%) of patients three months after surgery. New-onset dysphagia was encountered postoperatively in 13 patients (6.7%); 95% reported that the outcome was better after antireflux surgery than with preopera-tive medical treatment. One hundred and thirty-nine patients with a median follow-up of 10.2 years (IQR 7.2-11.6 years) were available for a long-term evalu-ation. Cumulative long-term cure rates were 87.7% (81.0%-92.2%) at 5 years and 72.9% (64.0%-79.9%) at 10 years. Gastrointestinal symptom rating scores and RAND-36 quality of life scores of patients with treatment success were similar to those of the general population but significantly lower in those with failed antireflux surgery. Of the patients available for long-term follow-up, 83% rated their operation a success. CONCLUSION: For the long-term, our results indicate decreasing effectiveness of laparoscopic antirefluxsurgery, although most of the patients seem to have an overall quality of life similar to that of the general population.

Long-term outcomes of endoscopic resection for small(≤4.0cm) gastric gastrointestinal stromal tumors originating from the muscularis propria layer

AIM To evaluate the long-term efficacy of endoscopic resection(ER) for small(≤ 4.0 cm) gastric gastrointestinal stromal tumors(GISTs) originating from the muscularis propria layer.METHODS Between June 2005 and February 2015, we retrospectively analyzed 229 consecutive patients with gastric MP-GISTs who underwent ER with a follow-up at least 36 mo. The main outcome measurements included complete resection rate, complications, and long-term follow-up outcomes.RESULTS ER included endoscopic muscularis excavation in 179 cases, endoscopic full-thickness resection in 32 cases, and submucosal tunneling endoscopic resection in 18 cases. The median size of GISTs was 1.90 cm. Of the 229 GISTs, 147 were very low risk, 72 were low risk, 8 were intermediate risk, and 2 were high risk. Shortterm outcomes showed the complete resection rate was 96.5%, and 8 patients(3.5%) had complications. Of the 8 patients with complications, only one patient required surgical intervention. Long-term outcomes showed 225 patients were actively followed-up until composition of this manuscript. The remaining 4 patients were lost because of unrelated death. During the follow-up period(median, 57 mo), no residual, recurrent lesions, or distant metastasis were detected in any patients. Binary logistic regression analysis showed tumor size was a risk factor associated with a high mitotic index(≥ 5/50 HPF) of GISTs(P = 0.002).CONCLUSION ER seems to be an effective and safe method for gastric MP-GISTs ≤ 4.0 cm, and, for some intermediate or high risk GISTs, adjuvant therapy and/or additional surgery might be required to reduce the risk of recurrence or metastasis.

Long-term outcomes of staged recanalization for concurrent chronic total occlusion in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.

Treatment of central precocious puberty by GnRH analogs： long-term outcome in men

In boys, central precocious puberty （CPP） is the appearance of secondary sex characteristics driven by pituitary gonadotropin secretion before the age of 9 years. In the last years, relevant improvements in the treatment of CPP have been achieved. Because CPP is rare in boys, the majority of papers on this issue focus on girls and do not address specific features of male patients regarding end results and safety. In the present paper, recent advances of CPP management with GnRH analogs in men are summarized. End results in untreated and treated patients are also reviewed by an analysis of the recently published literature on treatment of CPP in men. The available data indicate that therapy with GnRH analogs can improve final height into the range of target height without significant adverse short-term and long-term effects, but longer follow-up of larger series of patients is still required to draw definitive conclusions.

Long-Term Patient-Aspect Outcomes of the Single-Port Laparoscopic Cholecystectomy

Background: Single port laparoscopic cholecystectomy (SPLC) is a widely performed advanced technique in laparoscopic surgery which has many benefits compare to conventional three port laparoscopic cholecystectomy (TPLC). The purpose of this study was to compare the patients’ satisfaction of SPLC and TPLC after one year of operation by using questionnaire which not only objective factors such as results of operation and hospital days but also subjective factor such as social and cosmetic quality of life. Materials and Methods: This study analyzed the data of 74 patients (SPLC = 42, TPLC = 32) who underwent the laparoscopic cholecystectomy between March and July 2013. The patients were asked to complete a patient-assessment questionnaire measuring the postoperative social and cosmetic quality-of-life values at the 12-month mark. Results: Statistically significant differences in the age, sex distribution, and body mass index are absent between the two groups. All the average scores of the different parameters of the social-activity aspect—satisfaction with physical condition, limitation of nutrition, stamina, postoperative pain level, returning to social life, impairment of social life, degree of complications, and cost-effectiveness of the surgery—are not statistically significant in both groups. Alternatively, all the results of the cosmetic aspect—scar influence on charms (p p = 0.015), and patient’s score of scars (p < 0.001)—show statistically significant differences. Conclusion: The SPLC is a safe and an attractive approach regarding the patients of this study. It offers a more effective cosmetic result that may be conveyed by a greater patient satisfaction.

Original Article: Prognostic Factors of Long-Term Outcome and Functional Status Following Spontaneous Cerebellar Hemorrhage

Cerebellar hemorrhage (CH) has a higher early mortality rate compared with other types of intracranial hemorrhage and the survivors often suffer from momentous disability. Hence, the prognostic factors of long-term outcome beyond 6 months after CH are clinically valuable, however only three studies were reported in the literature. Sixty-one patients with CH were retrospectively analyzed at least 6 months after hemorrhage. The long-term outcome of all patients and long-term functional status of survivors beyond 6 months (the patients who died within 6 months after hemorrhage were excluded) were assessed using the modified Rankin Scale (mRS): favorable outcome (mRS 0 - 2) and unfavorable outcome (mRS 3 - 6). All of the prognostic factors were analyzed by univariate and multivariate Cox proportional hazards regression models. There were 16 (26.2%) patients in the favorable outcome group and 45 (73.8%) in the unfavorable outcome group with respect of long-term outcome in all patients. The radiological brainstem compression (HR = 3;p = 0.015) was shown to be an independent predictor. On the other hand, 46 out of 61 (75.4%) patients survived beyond 6 months. In total, 16 (34.7%) patients had a favorable functional status, and 65.3% (30/46) had a persistent unfavorable functional status. Moreover, only age 365 years (HR = 3;p = 0.019) was an independent predictor. Radiological brainstem compression and age 365 were respectively shown to be a strong prognostic factor for long-term outcome and functional status among survivors beyond 6 months after hemorrhage in patients with CH.

Improvement of type 2 diabetes mellitus after gastric cancer surgery:Short-term outcome analysis after gastrectomy

AIM:To evaluate the effect of gastrectomy on diabetes control in patients with type 2 diabetes mellitus and early gastric cancer.METHODS:Data from 64 patients with early gastric cancer and type 2 diabetes mellitus were prospectively collected.All patients underwent curative gastrectomy(36 subtotal gastrectomy with gastroduodenostomy,16subtotal gastrectomy with gastrojejunostomy,12 total gastrectomy)and their physical and laboratory data were evaluated before and 3,6 and 12 mo after surgery.RESULTS:Fasting blood glucose(FBS),HbA1c,insulin,C-peptide,and homeostasis model assessment-estimated insulin resistance were significantly improved 3mo after surgery,regardless of operation type,and the significant improvement in all measured values,except HbA1c,was sustained up to 12 mo postoperatively.Approximately 3.1%of patients stopped diabetes medication and had HbA1c<6.0%and FBS<126 mg/dL.54.7%of patients decreased their medication,and had reduced FBS or HbA1c.In multivariate analysis,good diabetic control was not associated with operation type,but was associated with diabetes duration.CONCLUSION:Diabetes improved in more than 50%of patients during the first year after gastric cancer surgery.The degree of diabetes control was related to diabetes duration.

Long term oncological outcome of laparoscopic techniques in pancreatic cancer

The laparoscopic technique in distal pancreatic resection(LDP) has been widely accepted, and outcome data support the hypothesis that survival is improved,partly due to improved postoperative safety and recovery, thus optimizing treatment with adjuvant chemotherapy. But laparoscopic pancreaticoduodenectomy(LPD or Whipple-procedures) has spread more slowly, due to the complexity of the procedure. Surgical safety has been a problem in hospitals with low patient volume, resulting in raised postoperative mortality, requiring careful monitoring of outcome during the surgical learning curve. Robotic assistance is expected to improve surgical safety, but data on long term oncological outcome of laparoscopic Whipple procedures with or without robotic assistance is scarce. Future research should still focus surgical safety, but most importantly long term outcome, recorded as recurrence at maximal follow up or-at best-overall long term survival(OS). Available data show median survival above 2.5 years, five year OS more than 30% after LDP even in series with suboptimal adjuvant chemotherapy. Also after LPD, long term survival is reported equal to or longer than open resection. However, surgical safety during the learning curve of LPD is a problem, which hopefully can be facilitated by robotic assistance. Patient reported outcome should also be an endpoint in future trials, including patients with pancreatic ductal adenocarcinoma.

Pattern, Precipitants and Short Term Outcome of Heart Failure Patients Managed at Federal Medical Centre Nguru, a Tertiary Health Centre in Yobe State Northeastern Nigeria

Heart Failure (HF) is a syndrome characterized by typical symptoms (e.g. breathlessness, ankle swelling and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles and peripheral oedema) caused by a structural and/or functional cardiac abnormality, resulting in a reduced cardiac output and/or elevated intracardiac pressures at rest or during stress. Clinical studies investigating the aetiological patterns of heart failure in Sub-Saharan Africa (SSA) revealed that hypertension, cardiomyopathy and rheumatic heart disease account for more than two-thirds of cardiac disease cases. The objective of this study therefore is to assess the pattern, precipitating factors and short term outcome of heart failure among patients admitted into our hospital. Method: The study was a prospective cross-sectional type conducted among in patients with heart failure in the medical ward of the hospital. Results: A total of three and fifty four (354) subjects were recruited into the study, comprising one hundred and twenty nine males (36.4%) and two hundred and twenty five (63.4%) females. Majority of the patients were admitted in NYHA functional class IV. This however improved to class II at discharge though few were discharged in NYHA class III. Heart failure secondary to progressive hypertensive heart disease was the most common (39.0%) followed by peripartum cardiomyopathy (22.6%) while idiopathic dilated cardiomyopathy (11.0%) and rheumatic heart disease (7.3%) were the third and fourth causes of heart failure respectively. The most common precipitating factor for heart failure in this study was chest infection (44.9%). In conclusion, the study revealed that progressive hypertensive heart disease was the leading cause of heart failure, followed by peripartum cardiomyopathy while idiopathic dilated cardiomyopathy and rheumatic heart disease were ranked third and fourth causes of heart failure respectively. Though myocardial infarction is on the increase, it was found to be the fifth cause of heart failure. The study also identified the following precipitants of heart failure in decreasing order of occurrence: chest infection, non-adherence to prescription, and urinary tract infection.

Prevalence, Aetiology, Maternal and Neonatal Outcome of Term Mothers with Anaemia, Presenting to a Tertiary Care Unit for Confinement in Sri Lanka

Objective: To describe the proportion of women presenting with undiagnosed anaemia at confinement and to explore associations between anaemia and socio economic factors, dietary pattern and compare maternal and neonatal outcome among term mothers with anaemia compared to non-anaemic pregnant women at a tertiary care centre in Sri Lanka. Method: A comparative cross-sectional study was performed by recruiting anaemic and non-anaemic term mothers who delivered at the Teaching Hospital Peradeniya during the period March 2018-March 2019. Pregnant mothers whose haemoglobin level was less than 10.5 g/dl were considered as anaemic and compared with the mothers whose haemoglobin level was above this level. With written consent, demographic data, etiological factors, maternal and neonatal outcomes of term mothers were evaluated by an interview and blood samples were withdrawn to carry out anaemia related investigations. Results: Among 2854 pregnancies, a total of 234 (8.19%) term pregnant mothers were anaemic and they were and compared with 199 non-anaemic mothers. Out of the anaemic mothers (Hb < 105 g/l), 133 (56.76%) had moderate anaemia, 100 (42.79%) had mild anaemia and 1 mother (0.45%) had severe anaemia. Low monthly family income was significantly associated with the incidence of anaemia. Anaemia was also associated with low weekly consumption of red meat (OR 8.994;95% CI, 5.74 - 14.09, p < 0.05) and high weekly tea intake (OR 0.217;95% CI 0.144 - 0.327, p < 0.05). Among anaemic mothers, 215 (67.44%) had low serum ferritin (<30 ng/mL) while most of them were diagnosed with iron deficiency anaemia (58.24%) (n = 113) based on haemoglobin. Most anaemic mothers had undergone elective caesarean section (46.26%) while vaginal deliveries (33.33%) were common among non-anamic group. Conclusions: A moderate prevalence of anaemia among term pregnant women in Peradeniya, Sri Lanka was observed and was associated with low socio economic status, low consumption of tea and poor nutrition lacking in red meat.

Predictive Value of Amniotic Fluid Index in Term Small for Gestational Age with Normal Doppler Studies for Perinatal Outcomes

Background and Aim: Delivery of a fetus with SGA is associated with increased risk of perinatal morbidity and mortality. Evidence is limited for the accuracy of Oligohydramnios to predict substantive perinatal morbidity and mortality in non–anomalous SGA fetuses monitored with normal Doppler studies. The aim of this study is to determine the association between amniotic fluid index and adverse perinatal outcomes in term SGA fetuses with normal Doppler studies. Method: This is a prospective observational study carried out by 340 pregnant women who were admitted to obstetrics unit, Sri Jayewardenepura from January 2019 to January 2023. Singleton pregnancies at term who were diagnosed with SGA (EFW 10th centile or AC 10th centile) with normal umbilical artery and middle cerebral artery Doppler studies were included. AFI was assessed predelivery and data were collected according to demographic details, mode of delivery, time of delivery, intrapartum events, and neonatal outcomes. Results: A total of 340 term pregnant women were studied. Out of them, 44% were in AFI more than 10 groups and 37% and 19% were in AFI 5 - 10 and less than 5 groups respectively. More obstetrics interventions were reported in AFI 5 groupa in terms of induction of labor (P 0.04) and emergency caesarean sections (P 0.003). No significant deference in immediate neonatal outcome was detected between each group. (Meconium-stained liquor (P 0.634), 1 minute APGAR (P 0.575) and 5-minute APGAR P 0.165)). Neonatal unit admission (P 0.001) and long-term neonatal complications were

Six-year outcomes in neovascular age-related macular degeneration with ranibizumab

AIM： To evaluate the outcomes of （6y ranibizumab therapy in neovascular age-related macular degeneration （AMD）.METHODS： HELIX was a retrospective, observational effectiveness study using medical records of patients treated in three clinics in Belgium. Patients had neovascular AMD and were initially treated with intravitreal ranibizumab （0.5 mg） between November 1, 2007 and October 31, 2008, had （6y of data available, and were treated on an ongoing, as-needed basis. Outcomes included best-corrected visual acuity （BCVA） and central retinal thickness （CRT）.RESULTS： The sample consisted of 88 eyes from 69 patients. Mean age was 76.4±6.5y, most patients were female （62.3%）. Most eyes （62.5%） were treatment-naive, 33 previously treated eyes had received predominantly other anti-vascular endothelial growth factor agents and verteporfin. Mean baseline BCVA was 57.4±12.7 ETDRS letters and CRT was 291.5±86.1 （m. On average, patients received 20.6±11.9 ranibizumab injections over the （6y. Intervals between injections were on average 12.7±16.1wk. Mean change in BCVA from baseline to last observation for the sample was less than one letter （-0.9±17.3 letters）, with an average loss of -3.2±15.6 letters in previously treated eyes versus a gain of 0.6±18.4 letters in treatment-na？ve eyes. When considering a loss of 〈15 letters over 6y as stabilization of disease, 75.9% of all eyes showed a positive （improvement or stabilization） outcome. Mean change in CRT from baseline to last observation for the sample was -26.9±148.4 （m with the greatest reduction observed in treatment-naive eyes.CONCLUSION： This retrospective study of 69 neovascular AMD patients treated for （6y with ranibizumab demonstrates long-term visual stabilization. In light of the natural evolution of the disease, these data confirm that ranibizumab is effective long-term under real-world conditions of heterogeneity of patients, clinicians, and centers.

Effect of Early Cumulus Cell Removal on the Fertilization and Clinical Outcome in Human <i>in Vitro</i>Fertilization

The short-term insemination technique has been widely applied, although it is not clear whether the mechanical desorption of cumulus cells can affect normal fertilization and birth outcomes. Therefore, the present study aimed to evaluate whether early cumulus cell removal could affect in vitro fertilization outcomes. Based on a history of infertility and semen analysis, 61 patients were identified, and the cumulus cells were mechanically removed at either6 h post-insemination (Group A, 387 mature oocytes) or 18 - 20 h post-insemination as traditional in vitro fertilization (Group B, 424 mature oocytes). There were no significant differences in the rates of fertilization, available embryos, high quality embryos, birth, premature birth, pregnancy, or implantation when we compared the two groups. However, Group A exhibited a significantly higher polyspermy rate, and significantly lower rates of blastocyst formation and high-quality blastocyst formation, compared with Group B. Therefore, the results of present study indicate that early cumulus cell removal (at 6 h post-insemination) may negatively affect the rates of polyspermy, blastocyst formation, and high-quality blastocyst formation.

Perinatal outcomes associated with meconium-stained amniotic fluid in Japanese singleton pregnancies

Introduction: We examined the perinatal outcomes in Japanese singleton pregnancies associated with meconium-stained amniotic fluid (MSAF) in relation to gestational age at delivery. Methods: We reviewed the obstetric records of all Japanese singleton deliveries after 22 weeks’ gestation managed at Japanese Red Cross Katsushika Maternity Hospital between 2002 and 2008 (n = 11,249). Results: The incidence of MSAF in the whole singleton pregnancies was 13%. The incidence of MSAF at preterm, term and post-term were 9.1%, 13% and 48%, respectively. The incidence of intrauterine fetal death, low Apgar score and low umbilical artery pH at delivery in cases with MSAF were significantly higher than those without MSAF in various gestational ages at delivery. Conclusion: Obstetric management should be affected by meconium in the amniotic fluid.

Effects of two different protocols of oxytocin infusion for labor induction on obstetric outcomes: A cohort study

Objective: Concerns remain about the safety and efficacy of high dose and low dose protocols of oxytocin for labor induction. We have compared 2 regimens of oxytocin induction (low-dose vs high dose) on perinatal outcomes over a 1-year period. Study Design: Included were all women undergoing induction of labor at term with live singleton gestations. Cesarean delivery (CD) and a composite adverse neonatal outcome (5-min Apgar score < 7, umbilical artery pH < 7.10, or need for admission to NICU) were assessed using logistic regression analysis. Admission-to-delivery intervals was compared between the two groups by log-rank test. Results: A total of 544 women fulfilled the study criteria. The two groups were comparable for demographic and obstetric variables. There was no significant association between oxytocin regimen and rates of CD (P = 0.77) or adverse neonatal outcome (P = 0.99) even after controlling for confounders. The admission-to-delivery interval was significantly shorter for the high-dose group than for the low-dose group (median interval = 11.7 vs 14.3 hours, respectively, P = 0.026). Conclusion: Use of a high-dose protocol of oxytocin administration for induction of labor at term is associated with similar rates of cesarean section and adverse neonatal outcome as a low-dose protocol, but with an average of 2.5 hours shorter duration of labor.