By reporting a case series from a referral hospital we aimed to determine the treatment options and outcomes of one of the serious complications of the labour uterine atony refractory to the medical treatment. In this study, a total of 58 postpartum uterine atony cases refractory to uterotonic treatment and managed with intrauterine balloon tamponade, B-Lynch suture, internal iliac artery ligation or hysterectomy was a retrospectively analyzed. Initially, thirty two cases managed with intrauterine Bakri balloon tamponade and six B-Lynch compression sutures alone, in eight cases both procedures were done together. Eight cases managed with internal iliac artery ligation and four hysterectomies. Our success rate with intrauterine Bakri balloon tamponade, B-Lynch compression suture and internal iliac artery ligation were 84.4%, 83.3%, 75% respectively in stopping postpartum haemorrhage regarding uterine atony and the most successfull rate was obtained with the Bakri balloon tamponade in the combination with B-Lynch compression suture 87.5%. The median estimated blood loss was 2018ml, intraoperative median hemoglobin was 5.8 mg/dl and the median amount of blood transfused was five units, the median volume infused into balloon was 285ml; balloon was in place for a median duration of 36 hours. In 6 cases Bakri balloon tamponade with or without B-Lynch compression sutures failed to stop haemorrhage and hysterectomy required. In two patients Asherman’s syndrome and infertility, in two patients’ amenore were developed and uterine prolapse was observed in 2 patients, one of which was uterine necrosis. No maternal mortality was observed.
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Equines as Tools Vs Partners: A Critical Look at the Uses and Beliefs Surrounding Horses in Equine Therapies and Argument for Mechanical Horses
Horses have their own unique status as therapy animals due to their function in both physical and psychotherapies. Current models of Equine Assisted Activities and Therapies (EAAT) utilize horses for a range of physical, psychological and learning therapies to benefit humans, often referring to horses as therapeutic “partners”. To fulfill certification requirements for existing models of EAAT, practitioners are required to study equine behavior through the belief systems currently modeled in the natural horsemanship community. Despite requiring knowledge in horse behavior, studies and anecdotal evidence suggests that horses used in EAAT commonly display confusion or escape behaviors, “burn out” and/or display signs of depression. These behaviors could be a result of contradictions in the interpretation of equine behavior within the natural horsemanship practices or a lack of understanding and utilization of equine learning theory within the context of EAAT.
The unidentified, decomposed dead bodies and skeletal remains are very often reported for investigation by the police.
Development and Optimization of an LC-MS/MS Method for Dosage Form of Ergocalciferol (Vitamin D2 ) in Human Plasma
Accurate measurement of ergocalciferol in biological samples has become easier using high-end mass spectra. Currently, various LCMS/MS methods have been developed to quantify ergocalciferol. Use of LC-MS/MS has accomplished to develop an accurate method that could quantify ergocalciferol in a large number of samples where it should be analyzed in the blood immediately after dosage. The objective of this study is to optimize chromatographic conditions and evaluate the LC-MS/MS method for accurate quantification of the dosage form of ergocalciferol in human plasma. Extraction and separation of ergocalciferol in human plasma was achieved using methanol liquid-liquid extraction and by a reverse phase C8 column, respectively