Dexketoprofen versus Tenoxicam in Acute Severe Pain Due to Primary Dysmenorrhea.

OBJECTIVE: To evaluate the analgaesic efficacy of tenoxicam and dexketoprofen in patients admitted to the Emergency Medicine (EM) Clinic with severe acute pain due to primary dysmenorrhea (PD). STUDY DESIGN: Randomised-controlled trial. Place and Duration of the Study: Emergency Medicine Clinic, Health Sciences University, Adana City Training and Research Hospital, Adana, Turkiye, from January to December 2022. METHODOLOGY: Patients presenting with PD, were divided into two groups of 60 each, administered 50 mg dexketoprofen and 20 mg tenoxicam intravenously. Visual analogue scale (VAS) scores were recorded at the 15th, 30th, 60th, and 120th minutes. VAS scores and ΔVAS scores were compared with the effectiveness of drugs, the need for rescue drugs and its side-effects. RESULTS: Intravenous (IV) dexketoprofen was administered to 60 of the patients and IV tenoxicam was administered to another 60. At the time of admission, mean VAS scores of the patients were 8.8 ± 0.9 for the dexketoprofen group and 8.6 ± 0.8 for the tenoxicam group. The VAS scores of the dexketoprofen group were found to be statistically significantly lower after 30 minutes with lower need for rescue analgaesics. ΔVAS scores of the dexketoprofen group were statistically significantly higher from the 30th minute. CONCLUSION: According to the VAS scoring, IV dexketoprofen was a more effective drug than IV tenoxicam in patients who were admitted to the EM clinic with severe pain due to PD. KEY WORDS: Dexketoprofen, Primary dysmenorrhea, VAS score.

Comparison of patients undergoing vaginal hysterectomy with sacrospinous ligament fixation, laparoscopic hysterectomy with sacrocolpopexy and abdominal hysterectomy with sacrocolpopexy in terms of postoperative quality of life and sexual function.

AIM: To investigate whether there is a significant difference among the patients who underwent vaginal hysterectomy with sacrospinous ligament fixation (VH + SSLF), laparoscopic hysterectomy with sacrocolpopexy (LH + SCP) and abdominal hysterectomy with sacrocolpopexy (AH + SCP) in terms of sexual function and quality of life. MATERIAL AND METHOD: Sixty-five patients undergoing vaginal hysterectomy with sacrospinous ligament fixation (VH + SSLF), laparoscopic hysterectomy with sacrocolpopexy (LH + SCP) or abdominal hysterectomy with sacrocolpopexy (AH + SCP) participated in the study. The Quality of Life Scale and Sexual Function Scale Index (PISQ-12) were used to see whether there is a significant difference among the three groups (VH + SSLF, LH + SCP, AH + SCP) at least 1 year after surgery. The Pelvic Floor Distress Inventory-20 (PFDI-20) Scale consisting of Pelvic Organ Prolapse Distress Inventory (POPDI-6), Urinary Distress Inventory (UDI-6), and Colorectal-Anal Distress Inventory (CRADI-8) was used to evaluate the functional outcomes. RESULTS: The participants had a mean age of 60 ± 8.79 years. The mean PFDI-20 score in the VH + SSLF groups is higher than that in the AH + SCP group (p = 0.047). There is no significant difference among three VH + SSLF, LH + SCP and AH + SCP groups regarding scores of POPDI-6, UDI-6, CRADI-8, and PISQ-12. CONCLUSION: In the present study, it was concluded that AH + SCP group had a higher quality of life than the VH + SSLF group did while the sexual function was not affected significantly by the vaginal or abdominal surgical procedures. The pelvic surgeon should skillfully choose different prolapse surgical techniques to tailor the surgical treatment to the patient's needs.

Which imaging method is better for the differentiation of adenomyosis and uterine fibroids?

OBJECTIVE: The paper compares shear wave elastography (SWE), strain elastography (SE) and magnetic resonance imaging apparent diffusion coefficient (MRI ADC) values, to evaluate their efficacy for differentiating between adenomyosis (AM) and uterine fibroids (UF). METHODS: Patients who were scheduled for hysterectomy for AM or UFs, with a preliminary diagnosis, were additionally evaluated before surgery by transabdominal and transvaginal ultrasound elastography. SE of patients were evaluated by transvaginal ultrasound, and SWE of patients and control subjects were evaluated by transabdominal ultrasound. Then, the patients with a definitive histopathological diagnosis as AM or UFs were evaluated retrospectively and compared to the control group without myometrial pathology. In addition, MRI images of patients with UFs and AM were examined for ADC values. RESULTS: The results of 98 patients in the UF group, 37 patients in the AM group, and 40 volunteers with a healthy myometrium in the control group were compared. There were no statistically significant differences in age and body mass index between the groups (P > 0.05). Uterine size was significantly higher in the UF and AM group than the control group (P < 0.001). A statistically significant difference was found between strain ratio (mean), strain ratio (max), and ADC values between the UF and AM groups (P < 0.001 for all three). There was a statistically significant difference in elastography scores distribution between the groups (P < 0.001). There was a statistically significant difference between the UF and control (P < 0.001) and between the UF and AM (P < 0.001) groups in terms of SWE (kilopascal (kPa)) averages (P < 0.001). We found that none of these discrimination methods were statistically superior to each other in differentiating the UFs from the AM. CONCLUSION: In the differentiation of myometrial pathologies in gynecological imaging, both SE and SWE are cheaper, provide faster results, are non-invasive and easy to apply, and hence are as promising as the more expensive MRI ADC. Our study is the first to use both modalities of elastography and MRI ADC values together, compare these methods with each other and confirm the results pathologically.

Optical coherence tomography angiography findings in preeclampsia.

OBJECTIVES: To investigate vascular density analysis in the superficial (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ), peripapillary vascular density analysis (PPCVD), and peripapillary retinal nerve fiber thickness analysis (PPRNFL) using optical coherence tomography angiography (OCTA) in pregnant women with preeclampsia and to compare the obtained values with healthy pregnant and nonpregnant healthy individuals. METHODS: A total of 98 pregnant women (55 had preeclampsia, 43 were healthy pregnant women) and 38 healthy nonpregnant women of reproductive age were included in the study. The patients were divided into three groups. Group 1 consisted of pregnant women with preeclampsia, group 2 comprised healthy pregnant women without preeclampsia, and group 3 consisted of healthy women who were not pregnant. All participants underwent a comprehensive ophthalmologic examination including OCTA. RESULTS: Superficial foveal density (SFD) and deep foveal density (DFD) were lower in group 1 than in group 3 (p = 0.033, p = 0.041, respectively). Deep parafoveal density (DPD), deep temporal density (DTD), and deep superior density (DSD) values were lower in group 1 than in group 2 and group 3 (p = 0.001). PPRNFL superior and mean values were higher in group 1 and group 2 than in group 3 (p = 0.022, p = 0.029, respectively). The mean superior and inferior RPCVD values were significantly higher in group 1 than in group 2 and group 3 (p = 0.001, p = 0.043, and p = 0.001, respectively). CONCLUSIONS: In preeclampsia, OCTA shows changes in the microvascular structure of the retina, even without retinopathy findings on biomicroscopy examination.