randomized controlled trial of psychosocial counselling for first-time IVF couples

Of this study was to evaluate pre-IVF counselling using self report questionnaire on couples. The acceptability of counselling, perception of help and effects on anxiety and depression were considered. The study included 423 consecutive childless Arabic couples preparing for their first IVF. Randomization was carried out through sealed envelopes attributing participants to counselled and non-counselled groups and was accepted by 300 couples. Another 42 couples refused randomization because they wanted counselling and 81 couples because they did not. Questionnaires including the State-Trait Anxiety Inventory, the Beck Depression Inventory and assessments of help were answered by couples before IVF and counselling, and after the IVF outcome result. Counselling was accepted by 81% [342/423] of couples. There was no significant effect of counselling on anxiety and depression scores which were within normal ranges at both times. Counselling provided help for 86% [225/261] of initially non-demanding subjects and 96% [81/84] of those initially requesting a session. Help was noted in areas of psychological assistance, technical explanations and discussing relationships. This model of routine counselling provides an acceptable form of psychological assistance for pre-IVF couples

Coronary artery bypass graft in elderly patients with and without cardiopulmonary bypass: early and mid-term clinical

To assess the influence of off-pump coronary artery surgery on early and midterm clinical results in elderly patients. Coronary artery bypass grafting [CABG] in elderly patients is associated with perioperative mortality and morbidity rates higher than those observed in young aged patients. The avoidance of cardiopulmonary by pass [CPB] in this population is potentially beneficial. This a retrospective study consisted of 1007 CABG patients. Of these 583 patients underwent CABG without CPB [group A] and 424 patients underwent CABG with CPB [group B]. Patients that converted from off-pump to CPB ere included in group A. Most of the preoperative variables ere comparable between the two groups. Group A patients had more preoperative cerebrovascular accident [p=0.044], carotid artery disease [p=0.025] and renal impairment [p=0.03]. Group B had more female patients [p=0.045], more patients with low EF [p=0.007] and more patients with multivessel disease [P=0.031]. 33[5.7%] patients were converted to CPB. Early mortality was 3.7% [group A, 2.6%, Group B, 5.2%; p=0.045, acute myocardial infarction incidence was 2.38% [group A, 1.5%; group B, 35%; p=0.041], cerebrovascular accident incidence was 0.99% [group A, 0.34%; group B, 1.88%; p=0.0.34], and early major events incidence was 9.9% [group A, 7.9%; group B, 13.2%; p=0.006]. Group A had a short ICU and hospital stay than group B, Stepwise logistic regression analysis showed that CPB was an independent risk factor for higher mortality [Odds Ratio "OR", 2.2; p=0.021 7], higher incidence of acute myocardial infarction [Odds Ratio, 2.5; p=0.0185], and higher incidence of early major events [Odd Ratio, 1.8, p=0.0034]. Mid-term mortality or cardiac-related events were similar in the two groups. In elderly patients, off-pump CABG is safe-procedure that facilitates early recovery and reduces the incidence of postoperative mortality and morbidity. At mid-term follow up, the incidence of mortality and cardiac-related events were low in both group supporting a more aggressive policy of coronary revascularization in elderly patients

Effects of oxytocin and dextrose 5% infusion during labor on neonatal serum sodium, glucose and bilirubin levels

Maternal serum sodium and glucose levels were measured in three groups of laboring women before and after labor. Cord serum samples were also analyzed for the same parameters as well as for bilirubin, and after 72 hours of labor, a neonatal serum sample was analyzed again for bilirubin. The study groups included cases who had full term vaginal delivery and who had no medical or obstetric complication The first group [group A] had neither fluid, nor oxytocin administration during labor. The second group [group B] received 5% glucose in water during labor. The third group [group C] received Oxytocin in 5% glucose infusion [1 unit in 100 ml]. All groups were comparable as regards maternal age, parity and gestational age. Newborns were comparable as regards birth weight and Apgar score, and weight of placenta. Maternal serum sodium [Na] and glucose did not show any significant correlation with cord serum values. Cord serum Na and glucose did not show significant correlation with the 72 hours neonatal serum bilirubin values. A significant increase in neonatal serum bilirubin was found in both groups B and C after 72 hours of birth. On the other hand, mean serum bilirubin [72 hours level] was higher in oxytocin group than in the control group and in the glucose only group. We concluded that the dose range used in this study [less than one litre - IV aqueous glucose solution given during labor] does not induce significant changes in either maternal or cord serum values of Na and glucose. Also oxytocin could be considered responsible of neonatal hyper bilirubinemia without inducing neonatal hyponatremia