Contraceptive implant migration to the ulnar nerve: A case report with literature review.

Key Clinical Message: Contraceptive implant migration is a rare complication associated with contraceptive implants: migration to the ulnar nerve, emphasizing the importance of accurate diagnosis, imaging, and a multidisciplinary approach to mitigate neurovascular risks during insertion and removal procedures. The case report demonstrates the necessity for careful removal techniques and thorough patient follow-up to ensure positive outcomes and prevent long-term nerve damage.There are some potential risks and complications associated with contraceptive implants, including neurovascular injury. The aim of this case report is to report a rare complication associated with contraceptive implants. A 32-year-old female, right-hand dominant, presented to the orthopedic clinic for the extraction of a contraceptive implant (Implanon) from her left arm. She reported intermittent numbness in the ring and little fingers. Upon examination, the Implanon was not palpable. Both Phalen's test and Tinel signs were negative. An x-ray of the arm revealed the implant's position. Under local anesthesia through a longitudinal incision, the Implanon was found within the perineurium of the ulnar nerve. Two weeks after the operation, the patient returned to the clinic. Upon examination, there were no indications of ulnar nerve neuropathy. If a patient undergoes subdermal implant-associated pain or is at risk of neurovascular damage during removal, it is advisable to refer the patient to a family planning specialist experienced in handling challenging implant removals, and subsequently to a peripheral nerve surgeon, to optimize outcomes. The migration of a contraceptive implant to the ulnar nerve is an exceedingly rare but possible complication.

Sodium citrate buffer improves pazopanib solubility and absorption in gastric acid-suppressed rat model.

Pazopanib exhibits pH-dependent solubility and its absorption depends primarily on the stomach pH. Significant decrease of pazopanib absorption by coadministration with proton pump inhibitors in clinical situation need to be overcome. Thus, the purpose of this study is firstly to investigate the effect of acidic beverages and sodium citrate buffer on the solubility of pazopanib and secondly to examine the effect of sodium citrate buffer on pazopanib absorption in a rat model with esomeprazole-mediated gastric acid suppression. Pazopanib solubility decreased with increasing pH of sodium citrate buffer in vitro. Interestingly, its solubility in some acidic beverages was significantly lower than that in sodium citrate buffer of the same pH. The AUC0-24h of pazopanib administered in tap water to rats treated with esomeprazole (ESP rats) was 66 % lower than that in the control rats treated with saline. However, AUC0-24h was 4.8 times higher in ESP rats that received pazopanib with sodium citrate buffer (pH 2.3) compared to ESP rats that received pazopanib with tap water. Our results indicate that the drug-drug interactions between pazopanib and proton pump inhibitors can be overcome, at least in part, by suspending pazopanib in sodium citrate buffer.

Critical Appraisal of Content Quality of YouTube Videos on the Whipple Pancreaticoduodenectomy.

INTRODUCTION: The coronavirus pandemic has demonstrated profound issues with using the Internet to research health information. For patients recommended a complex operation, such as the Whipple pancreaticoduodenectomy, the quality of health information online has not been appraised. The objective of this study was to define the readability and content quality of YouTube search results for the Whipple pancreaticoduodenectomy. METHODS: The first 100 search results for "whipple procedure" less than 10 min long in English with audio and or text were transcribed. The Flesch-Kincaid Grade defined the reading grade level. High content quality videos were accredited by YouTube in accordance with principles specified by the National Academy of Medicine or mentioned the standard components for a surgical consent. The Anderson-Lau score is a composite of these consent criteria out of a maximum of 8/8. The simplicity of videos for patient education was defined by the DISCERN tool. RESULTS: The reading level of 23% of the top 100 search results met the American average (8th grade). Accreditation was present for 45% and associated with an earlier median search ranking (36 versus 68, P = 0.002) and more 5th-8th grade level material (70% versus 38%, P = 0.014). The median Anderson-Lau score was 3/8 (range = 0/8-7/8) with only 5% achieving 7/8. Only 4% were high quality per DISCERN. CONCLUSIONS: Although accredited videos were more readable, most videos, especially those targeting patients, were beyond the comprehension of the average American. Simpler and higher quality educational materials are needed to inform patients on Whipple pancreaticoduodenectomy beyond their date of clinical diagnosis or surgical consenting.

Efficacy of sexual intercosurse in the spontaneous passage of distal or intramural ureteral stones: a randomsized controlled trial.

Background: The role of sexual intercourse as an alternative treatment approach for ureteral stones (UTSs) is a recent area of investigation with only small sample-sized studies. This study aims to evaluate the role of sexual intercourse in the spontaneous passage of distal or intramural UTSs via a larger sample size. Materials and methods: The study population included cases that had either a distal ureteric or an intramural radiopaque stone. The patients were divided into two groups; group A was instructed to engage in sexual intercourse two to three times per week while also receiving symptomatic treatment for 4 weeks. Group B received symptomatic treatment alone and was instructed to abstain from sexual intercourse or masturbation for the same period. Results: A total of 160 male patients were enrolled in this study. The ages of the patients ranged from 21 to 58 years. The rate of stone expulsion after 2 weeks was 68.18% in group A and 53% in group B (P=0.053). The expulsion rate after 4 weeks was 80% in group A and 68.4% in group B (P=0.072). The mean expulsion time was 13.9±5.4 days for the experimental group and 15.2±6.7 days for the control group (P=0.179). The experimental group required fewer analgesic injections in comparison to the control group (P<0.05). Conclusion: While the role of sexual intercourse in facilitating the passage of distal or intramural UTSs cannot be fully established, it may aid to some extent. However, it should not be relied upon as a standalone treatment modality.

Optimization, cellular uptake, and in vivo evaluation of Eudragit S100-coated bile salt-containing liposomes for oral colonic delivery of 5-aminosalicylic acid.

Eudragit S100-coated bile salt-containing liposomes were prepared and optimized by experimenting with different variables, including bile salt type and concentration, and the method of incorporation into liposomes using a model hydrophilic compound, 5-aminosalicylic acid (5-ASA). After optimizing the formulation, cellular uptake, and animal pharmacokinetic experiments were performed. The inclusion of sodium glycocholate (SG) into liposomes decreased liposome particle size and entrapment efficiency significantly but had no effect on zeta potential. The method of incorporating SG into the lipid or aqueous phase of the liposome did not notably impact the characteristics of the liposomes but the hydration media had a substantial effect on the entrapment efficiency of 5-ASA. In vitro drug release in different fluids simulating distinct gastrointestinal tract sections, indicated pH-dependent disintegration of the coating layer of coated SG-containing liposomes. The majority of the drug was retained when subjected to simulated gastric fluid (SGF) and fed-state simulated intestinal fluid (FeSSIF) (≈ 37% release after 2 h in SGF pH 1.2, followed by 3 h in FeSSIF pH 5). The remaining drug was subsequently released in phosphate-buffered saline pH 7.4 (≈ 85% release within 24 h). Increasing SG concentration in the liposomes decreased the amount of drug released in FeSSIF. Similar results were observed when SG was replaced with sodium taurocholate. Cellular uptake studies in Caco-2 cells demonstrated that all liposomal formulations (conventional liposomes, bile salt-containing liposomes, and coated bile salt-containing liposomes) have shown to be equally effective at increasing the cellular uptake compared to free fluorescein solution. In the pharmacokinetic study, coated bile salt-containing liposomes showed a lower Cmax and prolonged residence in the gastrointestinal tract in comparison to conventional liposomes. Taken together, these findings suggest that the polymer-coated bile salt-containing liposomes have the potential to serve as a drug delivery system targeted at the colon.

Association Between High-Deductible Health Plans and Hernia Acuity.

IMPORTANCE: About half of people younger than 65 years with private insurance are enrolled in a high-deductible health plan (HDHP). While these plans entail substantially higher out-of-pocket costs for patients with chronic medical conditions who require ongoing care, their effect on patients undergoing surgery who require acute care is poorly understood. It is plausible that higher out-of-pocket costs may lead to delays in care and more complex surgical conditions. OBJECTIVE: To determine the association between enrollment in HDHPs and presentation with incarcerated or strangulated hernia. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort analysis included privately insured patients aged 18 to 63 years from a large commercial insurance claims database who underwent a ventral or groin hernia operation from January 2016 through June 2019 and classified their coverage as either a traditional health plan or an HDHP per the Internal Revenue Service's definition. Multivariable regression, adjusting for demographic and clinical covariates, was used to examine the association between enrollment in an HDHP and the primary outcome of presentation with an incarcerated or strangulated hernia. EXPOSURES: Traditional health plan vs HDHP. MAIN OUTCOMES AND MEASURES: Presence of an incarcerated or strangulated hernia per International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes. RESULTS: Among 83 281 patients (71.9% men and 28.1% women; mean [SD] age, 48.7 [10.9] years) who underwent hernia surgery, 27 477 (33.0%) were enrolled in an HDHP and 21 876 (26.2%) had a hernia that was coded as incarcerated or strangulated. The mean annual deductible was considerably higher for those in the HDHP group than their traditional health plan counterparts (unadjusted mean [SD], $3635 [$2094] vs $705 [$737]; adjusted, -$2931; P < .001). Patients in the HDHP group were more likely to present with an incarcerated or strangulated hernia (adjusted odds ratio, 1.07; 95% CI, 1.03-1.11; P < .001). CONCLUSIONS AND RELEVANCE: In this cohort study, enrollment in an HDHP was associated with higher odds of presenting with an incarcerated or strangulated hernia, which is more likely to require emergency surgery that precludes medical optimization. These data suggest that, among patients with groin and ventral hernias, enrollment in an HDHP may be associated with delays in surgical care that result in complex disease presentation.

The effects of hepatitis B virus infection on natural and IVF pregnancy: A meta-analysis study.

BACKGROUND: Hepatitis B virus (HBV) has been considered a significant cause of human reproductive failure in different studies; however, there is a considerable disagreement on the true impacts of HBV on female reproduction. This study has evaluated the impact of HBV infection on pregnancy complications in natural pregnancy and also on pregnancy outcomes in women undergoing in vitro fertilization (IVF) treatment. METHOD: We searched Embase, Web of Science, PubMed and Google Scholar databases to identify the potentially relevant studies. Summary odds ratio (OR) or standardized mean difference (SMD) with 95% confidence interval (CI) was applied to assess the relationship. Heterogeneity testing, sensitivity analysis and publication bias testing were also performed. RESULTS: A total of 42 studies concerning the effect of HBV infection on the natural and IVF pregnancy were included in this study. Our meta-analysis results revealed that HBV infection had a positive correlation to gestational diabetes mellitus (GDM) [OR = 1.32 (1.17-1.48) (p < 0.01)] and preterm birth [OR = 1.26 (1.14-1.40) (p < 0.01)] in natural pregnancy; however, HBV infection was not significantly associated with decreased fertility rates among the patients who underwent IVF. CONCLUSION: This study revealed a strong association of GDM and preterm birth with higher rates of HBV infection in pregnant women. Also, our results suggested that HBV infection in patients undergoing IVF may not negatively influence the pregnancy outcome. It may be rational to conclude that IVF might be rather a safe and effective method for HBV+ females who desire to have children.