RESUMEN
OBJECTIVE: To critically appraise current best available management of pain and subfertility ascribable to endometriosis. METHODS: Medline and specialist computer databases were searched along with reference lists of known reviews and primary articles to identify cited articles not captured by electronic searches. We included all studies pertaining to treatment of pain and subfertility ascribable to endometriosis. DISCUSSION: Medical and surgical management options for pain and subfertility are presented as Evidence-based inquiries for critically appraised topics. Each problem is presented as an answerable question followed by assessment of literature search for level of evidence. This is followed by critical appraisal of results. In the end, take-home answer to individual problem is presented in view of best available evidence. CONCLUSION: Evidence-based management of endometriosis provides realistic therapeutic goals and expectations for the clinicians and women experiencing pain and subfertility due to this disease. It also promotes efficient and effective use of medical and surgical options when required.
Asunto(s)
Endometriosis/diagnóstico , Endometriosis/terapia , Infertilidad Femenina/terapia , Dolor Pélvico/terapia , Adulto , Analgésicos/uso terapéutico , Anticonceptivos Orales/administración & dosificación , Países en Desarrollo , Endometriosis/complicaciones , Femenino , Humanos , Infertilidad Femenina/etiología , Infertilidad Femenina/fisiopatología , Laparoscopía/métodos , Persona de Mediana Edad , Dimensión del Dolor , Pakistán , Dolor Pélvico/etiología , Dolor Pélvico/fisiopatología , Pronóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVES: To identify risk factors for uterine atony following assisted or unassisted vaginal delivery. DESIGN: This hospital based case control study was done at The Aga Khan University Karachi, Pakistan. Cases were defined as all women with uterine atony within 24 hours of an assisted or unassisted vaginal delivery. Controls were based on women with normal assisted or unassisted vaginal delivery without uterine atony. Data abstracted form the medical records; adjusted odds ratios were estimated by multiple logistic regression. RESULTS: Factors having a significant association with uterine atony were gestational diabetes mellitus (odds ratio 7.6, 95% CI 6.9-9.0, p = 0.003) and a prolonged second stage of labour in multiparas (odds ratio 4.0, 95% CI 3.1-5.0, p = 0.002). No associations were found with high parity, age, preeclampsia, augmentation of labour, antenatal anemia and a history of poor maternal or perinatal outcomes. CONCLUSIONS: Among previously documented risk factors for uterine atony, only a prolonged second stage of labour in multiparas was found to be significant in this study. Gestational diabetes mellitus, a previously undocumented factor, has also been identified as an independent risk factor. Multiparity and age were not found to be significant risk factors. The study underlines the importance of confirming these findings for better prevention and management of uterine atony.
Asunto(s)
Parto Obstétrico/efectos adversos , Mortalidad Materna , Hemorragia Posparto/epidemiología , Contracción Uterina/fisiología , Adulto , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Femenino , Humanos , Modelos Logísticos , Pakistán , Hemorragia Posparto/etiología , Embarazo , Probabilidad , Medición de Riesgo , Factores de Riesgo , Útero/inervaciónRESUMEN
OBJECTIVE: Nutritional status of women has been considered an important prognostic indicator of birth outcome. The study aims to show the effect of various prepregnancy Body Mass Index (BMI) categories and corresponding gestational weight gain on newborn birth weight. METHODS: Two hundred women were included in the study. These women had regular antenatal visits and later delivered at The Aga Khan University Hospital (AKUH) between the period January 1, 1996 to December 31, 1997. RESULTS: For women with prepregnancy BMI < 19., mean birth weight of newborns was lower for those gaining < 12.5 kg than those gaining > 12.5 kg (P < 0.001). Women who started their pregnancy with BMI 19.8-26 and gained weight above expected range gave birth to high birth weight babies (P = 0.009). Gestational weight gain did not have a significant association with birth weight for women having prepregnancy BMI > 26. CONCLUSION: Efforts should be made to attain adequate prepregnancy weight to reduce the likelihood of low birth weight babies. Hence, special attention should be paid to women with low prepregnancy BMI.
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Peso al Nacer/fisiología , Índice de Masa Corporal , Embarazo/fisiología , Aumento de Peso/fisiología , Adulto , Femenino , Edad Gestacional , Humanos , Recién Nacido , Resultado del Embarazo , Estudios RetrospectivosRESUMEN
BACKGROUND: The relationship of Haemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) syndrome with maternal and perinatal health and its presentation in Pakistani population is not known. PURPOSE: To determine the mode of presentation along with maternal and perinatal outcome of patients with HELLP syndrome. METHODS: Case records of patients with severe hypertension in pregnancy who delivered between January 1, 1989 and December 31, 1994 at The Aga Khan University Hospital, Karachi. Out of 120 cases of severe pre-eclampsia/eclampsia, there were 36 cases of HELLP syndrome (Group-A). These were then compared with cases without HELLP syndrome (Group B) for their mode of presentation along with maternal and perinatal morbidity and mortality. RESULTS: The overall incidence of HELLP syndrome was 0.4%. In the antepartum factors; unbooked status (66% vs 30%; p < 0.05), diastolic B.P. > 120 mmHg (61% vs 16%; p < 0.05) DIC (13% vs 2%; p = 0.03), seizures (40% vs 16%, p = 0.01) and ARF (11% vs 1%, p = 0.07) were significantly raised. In the intrapartum factors there were no significant differences between the two groups in mode of delivery and complications of delivery. Neonatal outcomes did not differ significantly in the two groups. CONCLUSIONS: Women with severe hypertension in pregnancy manifesting with HELLP syndrome show a significantly greater frequency of developing DIC, seizures and acute renal failure. Therefore, their care necessitates intensive monitoring to preclude development of these complications.
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Eclampsia/epidemiología , Resultado del Embarazo/epidemiología , Adulto , Recolección de Datos , Eclampsia/complicaciones , Femenino , Síndrome HELLP/complicaciones , Síndrome HELLP/epidemiología , Humanos , Incidencia , Mortalidad Infantil , Recién Nacido , Mortalidad Materna , Pakistán/epidemiología , Preeclampsia/complicaciones , Preeclampsia/epidemiología , Embarazo , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
In order to determine which patients with congestive heart failure (CHF) develop Cheyne-Stokes respiration (CSR) during sleep, we compared the cardiorespiratory profiles of CHF patients with CSR to those of CHF patients without CSR. Overnight polysomnography and continuous transcutaneous PCO2 (tc PCO2) monitoring, estimation of left ventricular ejection fraction (LVEF), pulmonary function tests, and chest radiograph were performed on 16 consecutive patients with chronic, stable CHF. The tc PCO2 monitor (Kontron 7640) was calibrated so that measurements reflected arterial PCO2 values. A mean value was calculated for wakefulness (W) and total sleep time (TST). Circulation time (CT) from the lung to the carotid body was estimated from the end of an apnea or voluntary breath-hold to the nadir of oxygen desaturation recorded on an ear oximeter. The duration of CSR was expressed as a percent of TST. Nine patients developed CSR during sleep (52.5 +/- 31.6 percent TST) (group 1) and 7 did not (group 2). All patients were male and both groups were a similar age (64 +/- 8 vs 63 +/- 4 years) and weight (body mass index, 28.1 +/- 3.5 vs 25.4 +/- 3.4 kg/m2). There were no significant intergroup differences between LVEF (22 +/- 5.2 vs 24.1 +/- 5.2 percent), CT (19.1 +/- 3.6 vs 15.9 +/- 6.7 s), SaO2 (W) (94 +/- 1.2 vs 92.4 +/- 2.1 percent), and SaO2 (TST) (90.8 +/- 2.7 vs 92.4 +/- 2.1 percent). The tc PCO2 (W) was lower in group 1 (34.4 +/- 3.5 vs 38.1 +/- 1.9 mm Hg), increased during sleep by a similar amount in both groups (1.6 +/- 1.5 vs 2.1 +/- 2.2 mm Hg), and was significantly lower during sleep in group 1 (36.1 +/- 3.4 vs 40.2 +/- 2.2 mm Hg). We conclude that CHF patients with CSR hyperventilate during sleep and wakefulness and that CHF patients with awake hypocapnia are more likely to develop CSR during sleep. These findings indicate that arterial PCO2 is important in determining which CHF patients develop CSR.
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Dióxido de Carbono/sangre , Respiración de Cheyne-Stokes/etiología , Insuficiencia Cardíaca/complicaciones , Hiperventilación/complicaciones , Monitoreo de Gas Sanguíneo Transcutáneo , Femenino , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Contracción Miocárdica/fisiología , Polisomnografía , Pruebas de Función Respiratoria , Sueño/fisiología , Volumen Sistólico/fisiologíaRESUMEN
It was hypothesized that obstructive sleep apnea may precipitate myocardial ischemia, reflected by ST-segment depression, in some patients during sleep. Overnight sleep studies and simultaneous 3-channel Holter monitoring were performed on 23 consecutive patients with obstructive sleep apnea without a history of coronary artery disease. Each patient was randomly assigned to nasal continuous positive airway pressure for the first half of the night. An episode of significant ST depression was defined as > 1 mm from baseline for > 1 minute. The total duration (minutes) of ST depression was indexed to the total sleep time (minutes per hour of sleep). Seven patients (30%) had ST depression during sleep. In all 7 patients the duration of ST depression decreased during nasal continuous positive airway pressure (30 +/- 18 vs 11 +/- 13 minutes per hour of sleep) in association with a reduction in the apnea-hypopnea index (65 +/- 35 vs 7 +/- 6/hour), arousal index (49 +/- 14 vs 6 +/- 4/hour) and the duration that oxygen saturation was < 90% (44 +/- 27 vs 12 +/- 23% total sleep time). When patients were not on nasal continuous positive airway pressure, the apnea-hypopnea and arousal indexes were higher during periods of ST depression than when ST segments were isoelectric, whereas oxygen saturation was not different. These 7 patients underwent exercise testing, which was positive for inducible myocardial ischemia in 1 patient. It is concluded that ST depression is relatively common in patients with obstructive apnea during sleep and that the duration of ST depression is significantly reduced by nasal continuous positive airway pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Electrocardiografía Ambulatoria , Síndromes de la Apnea del Sueño/fisiopatología , Sueño/fisiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiología , Polisomnografía , Respiración con Presión Positiva , Síndromes de la Apnea del Sueño/complicaciones , Síndromes de la Apnea del Sueño/terapiaRESUMEN
We report the association between periodic leg movements (PLM) during sleep and congestive heart failure (CHF) in a patient who had a successful heart transplant. Pretransplant, the patient had chronic insomnia and CHF. Overnight polysomnography revealed severe PLM disorder and sleep disruption. Three months following transplantation his insomnia had resolved associated with a dramatic reduction in PLM.
Asunto(s)
Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/fisiología , Infarto del Miocardio/cirugía , Polisomnografía , Complicaciones Posoperatorias/fisiopatología , Síndrome de las Piernas Inquietas/fisiopatología , Trastornos del Inicio y del Mantenimiento del Sueño/fisiopatología , Dióxido de Carbono/sangre , Corteza Cerebral/fisiopatología , Estudios de Seguimiento , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/fisiopatología , Oxígeno/sangre , Tiempo de Reacción/fisiología , Síndromes de la Apnea del Sueño/fisiopatología , Fases del Sueño/fisiologíaRESUMEN
We hypothesized that intermittent hypoxemia and increased ventricular afterload due to obstructive apnea during sleep (OSA) would cause chronic left ventricular dysfunction. Overnight polysomnography, M-mode and two-dimensional echo-Doppler studies while awake were performed on 51 consecutive snorers, 30 with OSA and 21 without apnea. Patients with previous myocardial infarction, awake hypoxemia or hypercapnia, or other causes of nocturnal hypoxemia were excluded. Echo-Doppler measurements included end-diastolic right and left ventricular dimensions and wall thickness, indices of left ventricular systolic performance (fractional shortening, ejection fraction and ejection time and diastolic performance, (isovolumic relaxation time, ratio of peak early [E] to late [A] diastolic transmitral flow and mitral pressure half-time). Both OSA patients and nonapneic snorers were of similar age. Although OSA patients were heavier, had a greater apnea-hypopnea index, and significant nocturnal hypoxemia, their echo-Doppler measurements were within normal limits and were not significantly different from nonapneic snorers. It is concluded that isolated obstructive sleep apnea does not cause chronic left ventricular dysfunction.