Validation of the Modena bleeding score in endoscopic sinus surgery

IntroductionThe Modena bleeding score is a categorical rating scale that allows the assessment of the surgical field in relation to bleeding during endoscopic surgery. It has recently been presented and validated in the field of endoscopic ear surgery by the present authors. The Modena bleeding score provides five grades for rating the surgical field during endoscopic procedures (from grade 1 ? no bleeding to grade 5 ? bleeding that prevents every surgical procedure except those dedicated to bleeding control).ObjectiveThe aim of this study was to validate the Modena bleeding score in the setting of endoscopic sinus surgery.MethodsFifteen three-minute videos of endoscopic sinus surgery procedures (each containing three bleeding situations) were evaluated by 15 specialists, using the Modena bleeding score. Intra and inter-rater reliability were assessed, and the clinical validity of the Modena bleeding score was calculated using a referent standard.ResultsThe data analysis showed an intra-rater reliability ranging from 0.6336 to 0.861. The inter-rater reliability ranged from 0.676 to 0.844. The clinical validity was α = 0.70; confidence limits: 0.64 ? 0.75, corresponding to substantial agreement.ConclusionThe Modena bleeding score is an effective method to score bleeding during endoscopic sinus surgery. Its application in future research could facilitate the performance and efficacy assessment of surgical techniques, materials or devices aimed to bleeding control during endoscopic sinus surgery.     

Prevalence of periodontitis based on retrospective radiographic evaluation at dental hospital in Eastern Province of Saudi Arabia: A retrospective study

ObjectivesThe contemporary information on the prevalence of periodontitis and associated risk factors is deficient in the Kingdom of Saudi Arabia. Our aim was to measure the prevalence of periodontitis and associated risk factors among the Saudi population in the Eastern Province of Saudi Arabia who visited the University Dental Hospital.MethodsIn this retrospective study, the demographic data and medical and dental records of 700 subjects were examined. Bitewing radiographs were analyzed to measure the alveolar bone loss in posterior teeth by measuring the distance between the cementoenamel junction and the crest of the alveolar bone. A chi-square test was performed to compare the severity of periodontitis. A comparison of multivariate mean bone loss was performed using a t-test. Logistic regression analysis was used to evaluate the predictors of periodontitis. A P-value equal to or under 0.05 reflected statistical significance.ResultsAmong 700 cases, the patients’ mean age was 35.6 ± 12.1; 52.6 % were male and 47.4 % were female. Overall periodontitis prevalence was 52.1 %. The distribution of mild, moderate, and severe periodontitis prevalence was 36.1 %, 14.1 %, and 1.8 %, respectively. The severity of periodontitis was statistically similar between males and females (p = 0.148); however, significantly more Saudi than non-Saudi patients had moderate periodontitis. Higher proportions of severe periodontitis were seen in the age group of over 50-years-old (p < 0.001) and in patients with poor oral hygiene (p < 0.001), diabetes mellitus (p < 0.005), and hypertension (p < 0.002). Six total predictors of periodontitis were depicted, i.e., age > 50 years (OR = 3.73), poor OH status (OR = 2.24), BOP (OR = 3.35), presence of plaque (OR = 2.61), diabetes mellitus (OR = 3.19), and hypertension (OR = 3.62).ConclusionThe primary factors associated with the prevalence of periodontitis were age, nationality, diabetes, hypertension, BOP, plaque, and OH status. However, no association was observed between gender or cardiovascular disease and the prevalence of periodontitis in the studied population.     

卡贝缩宫素和缩宫素治疗剖宫产高危产妇的效果比较

目的:比较卡贝缩宫素和缩宫素治疗剖宫产高危产妇的效果。方法:选取122例剖宫产高危产妇为研究对象,按照随机数字表法分为观察组与对照组各61例。两组均行剖宫产手术,胎儿娩出后,对照组给予缩宫素治疗,观察组给予卡贝缩宫素治疗,比较两组术中、产后2、24 h出血量,产后加用前列素氨丁三醇率,凝血功能指标[纤维蛋白原(FIB)、D-二聚体(D-D)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)]水平,心率,血压,血红蛋白水平和不良反应发生率。结果:观察组术中、产后2、24 h出血量均低于对照组,差异有统计学意义(P<0.05);观察组加用卡前列素氨丁三醇率为4.92%(3/61),明显低于对照组的16.39%(10/61),差异有统计学意义(P<0.05);术后,两组FIB、D-D水平均高于术前,且观察组高于对照组,两组PT、APTT均短于术前,且观察组短于对照组,差异有统计学意义(P<0.05);术后,两组血红蛋白水平均低于术前,但观察组高于对照组,差异有统计学意义(P<0.05);手术前后,两组心率、血压和不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:卡贝缩宫素治疗剖宫产高危产妇可减少出血量和加用卡前列素氨丁三醇率,提高其术后血红蛋白水平,以及改善凝血功能指标,效果优于缩宫素。     

结扎速血管闭合切割系统在巨大神经纤维瘤手术中的应用效果

目的：探讨结扎速血管闭合切割系统(LigaSure vessel sealing system, LVSS)在巨大神经纤维瘤手术中的应用效果。方法：选取2013年10月至2020年5月行巨大神经纤维瘤手术的患者22例纳入本研究。传统手术组12例采用常规缝扎电凝止血手术方式,LigaSure组10例采用LigaSure血管闭合切割的手术方式,对比两组患者切除瘤体大小、手术时间、术中出血量、术后引流量、术后拔管时间及术后并发症情况。结果：两组间患者的一般资料具有可比性。LigaSure组术中出血量、术后引流量、术后拔管时间均较传统手术组显著降低(P＜0.05)。两组间切除瘤体大小、手术时间及术前术后血红蛋白差值无统计学差异。传统手术组出现1例术后皮下积液,予再次引流后伤口愈合良好。结论：LigaSure在手术治疗巨大神经纤维瘤方面的应用安全有效,能显著地减少出血量,简化手术操作,缩短术后恢复时间,值得在临床上进一步推广。     

A pilot study of levonorgestrel concentrations and bleeding patterns in women with epilepsy using a levonorgestrel IUD and treated with antiepileptic drugs

Objectives

We explored levonorgestrel (LNG) concentrations, bleeding patterns and endometrial thickness in women with epilepsy (WWE) initiating an LNG-intrauterine device (IUD) co-administered with antiepileptic drugs (AEDs).

Bleeding during pregnancy is associated with familial preterm birth

Purpose: the purpose of this study is to identify risk factors for familial, likely genetically-determined, preterm birth.

Materials and methods: We performed a case–control study, enrolling 211 patients (103 cases and 108 controls). Cases delivered between 20 and 35 weeks gestation, with a prior preterm birth or first-degree relative born prematurely. Controls delivered between 37–42 weeks. Groups were compared using a comprehensive questionnaire validated by medical record. Multivariate logistic regression assessed risk factor associations.

Results: Of cases, 30% reported bleeding during pregnancy compared with 5% of controls, adjusted odds ratio (adjOR) 9.0, 95%CI 3.31–24.47. Of cases that delivered at 20–28 weeks, 44.8% reported bleeding during pregnancy compared with 24.6% at 29–35 weeks, p?=?.04. Other associations were prior first-trimester miscarriage adjOR 2.55 (CI 1.21–5.35) or second-trimester miscarriage, adjOR 6.3 (CI 1.76–22.56).

Conclusions: Bleeding during pregnancy and prior miscarriage were significantly associated with familial preterm birth. The magnitude of effect for bleeding in pregnancy was higher with earlier preterm births. These associations warrant further investigation.