American Journal of Clinical Medicine Research

The differentiation of therapies for nocturnal enuresis responds to peculiarities of children and their families. In this study three modalities of approach to enuretic symptom were evaluated: the sole behavioral approach, the alarm treatment and the use of desmopressin; we have envisaged the response to treatment for 90 children. In particular, the effectiveness of desmopressin suggests that the cause of monosymptomatic nocturnal enuresis often lies in the structure of the sleep.

American Journal of Clinical Medicine Research. 2014, 2(2), 51-52. DOI: 10.12691/ajcmr-2-2-3
Pub. Date: April 22, 2014

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Maternal Outcome of Hypothyroidism in Pregnancy- a South Indian Perspect

by Nirmala C, Jayakumari C, Rajasekharan C and Nandini VR

Original Research

Background: Hypothyroidism in pregnancy is increasing and is a major cause for concern because of its association with adverse maternal outcome if untreated. The literature related to the burden of adverse pregnancy outcomes associated with hypothyroid pregnant women on thyroxine replacement therapy is limited. Hence, this study was designed. Objective: The primary objective was to study the maternal outcome of hypothyroidism in pregnancy. Methodology: This study was conducted in the Department of Obstetrics & Gynecology in Govt. Medical College Trivandrum. This was a mixed method study that included retrospective patient data collection and a prospective matched case control study. Seventy-eight pregnant women were recruited as cases based on diagnosis of hypothyroidism prior to pregnancy from the medical department records. They were compared with 78 euthyroid pregnant women, approximately age matched. History and pregnancy outcome were assessed. Data was analyzed using SPSS statistical package. Results: Hypothyroidism was associated with 3.6 times higher risk of developing threatened abortion and 3.8 times higher risk of developing gestational hypertension (P=0.001). Rate of caesarian section (51.3%) and postpartum hemorrhage (12.8%) were higher among cases. Conclusions: Based on our study we conclude that hypothyroid mothers, in spite of thyroid replacement therapy, are at significantly higher risk of obstetric complications. A multidisciplinary team approach, where the services of an endocrinologist and an obstetrician experienced in high risk pregnancy care are used, and a tertiary level institution with good facilities for ante partum and intrapartum care, is essential to improve the outcomes.

American Journal of Clinical Medicine Research. 2014, 2(2), 47-50. DOI: 10.12691/ajcmr-2-2-2
Pub. Date: March 17, 2014

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Diclofenac vs. Placebo in a Randomized Double Blind Controlled Trial, in Post ERCP Pancreatitis

by Yasser Abu-Safieh, Raed Altiti and Mohammad Lobadeh

Original Research

Background and Study Aim: In several studies non-steroidal anti inflammatory drugs (NSAIDs) showed reduction of post (ERCP) pancreatitis incidence and severity. Our aim is to study the effect of NSAIDs in reducing post ERCP pancreatitis (PEP). Patients and Methods: A double blind placebo controlled study was conducted, patients who underwent ERCP in Specialized Arab Hospital (SAH), collected over one year, from June 2012 to June 2013 . Patients were randomized by an endoscopy nurse to receive IM Diclofenac 75 mg, or IM isotonic saline 3 ml as placebo. 12 hours after completing the procedure all patients were evaluated for abdominal pain and serum amylase. Results: The total number of patients was 199 patients, 17 patients were excluded, 182 patients completed the study, diclofenac group (89), placebo (93), the two groups were comparable for the following: age, sex, ERCP finding, pancreatic duct cannulation, failure of common bile duct (CBD) cannulation, number of pancreatic duct cannulation, ERCP time, sphincterotomy, and stenting. The overall incidence of pancreatitis was (18/182) 10%, (6/89) 6.9% for the diclofenac group and (12/93) 12.9% for the placebo group. There was no significant difference in the incidence of pancreatitis between the two groups; the P value was 0.164. In all the cases in which pancreatitis occurs, it was mild or moderate; there was no severe pancreatitis among the two groups. But in subgroup analysis the frequency of pancreatitis in patients with multiple pancreatic duct cannulation was significantly lower in the diclofenac group than in control group with p value = 0.021. Conclusion: Intramuscular diclofenac does not lower PEP rate or severity. But it significantly decreased PEP in patients with multiple pancreatic duct cannulations.

American Journal of Clinical Medicine Research. 2014, 2(2), 43-46. DOI: 10.12691/ajcmr-2-2-1
Pub. Date: March 09, 2014

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