Predictors of Successful Medical Management With Methotrexate in Unruptured Tubal Ectopic Pregnancy.

Introduction Medical treatment with methotrexate (MTX) is a safe and effective alternative to surgery in carefully selected cases of ectopic pregnancies diagnosed early prior to rupture. Aim To determine the optimal pre-treatment levels of beta human chorionic gonadotropin (𝛽-hCG) and its changing trends most likely to have a successful outcome with medical management. Material and methods A prospective observational study was conducted in a tertiary teaching hospital from December 2018 to May 2021. "Single-dose" MTX regime was used for medical management of ectopic pregnancy in patients fulfilling the selection criteria. The 𝛽-hCG levels were recorded at baseline and on day 4 and day 7 of MTX injection. Thereafter, at weekly intervals till complete resolution or surgical intervention due to failure of medical management. In addition, receiver operating characteristic (ROC) curve analysis for a pre-treatment 𝛽-hCG cut-off value and changing trends in post-treatment 𝛽- hCG levels most likely to have a successful outcome with MTX treatment were determined. Results Fifty patients fulfilling the inclusion criteria were included in the study, with successful medical management in 33 (66%). The mean pre-treatment 𝛽-hCG levels in women with successful medical management were 3270.97 (+/- 901) compared to 5249.17 (+/-808.02) for those with treatment failure (p=0.00001). The mean 𝛽-hCG level in the failed treatment group was significantly higher on day 4 than the pre-treatment levels (6742.56 +/- 572 vs. 5249.17+/- 808.02; p<0.05). Inadequate reduction of 𝛽-hCG level on day 7 (<15% of day 4 levels) requiring repeat dosage of MTX was more likely to have an unsuccessful outcome (p=0.00001). The area under curve (AUC) value of 0.905 (95% CI: 0.814-0.996) depicted that pre-treatment 𝛽-hCG level of 4000 mIU/ml taken as the cut-off value was able to predict levels ≤4000 mIU/ml had a greater likelihood of successful outcome with MTX, having a sensitivity of 84.5%, specificity of 83.3%, positive predictive value (PPV) of 90.3%, and negative predictive value (NPV) of 75% (p< 0.05). Demographic variables or previous clinical history, considered risk factors for ectopic pregnancy, did not affect the outcome of medical management in this study. Conclusion Medical management of ectopic pregnancy is a viable first-line treatment option in carefully selected patients. In this study, the most important predictors for the successful outcome of medical management were the pre-treatment ß-hCG levels and their fall on day 4 and day 7 after MTX therapy.

The oral health status of institutionalized children that is, Juvenile home and orphanage home run by Gujarat state Government, in Vadodara city with that of normal school children.

BACKGROUND: Dental Caries and Periodontal Diseases are widespread and virtually everybody suffers from them, and in global scenario dental caries are the most prevalent oral diseases among children. Observation home serve as temporary holding facilities of juvenile and orphans who are arrested by police or found to be living in neglected. AIM: The aim of the study was to evaluate oral health status (caries prevalence, dmft, DMF, OHI index) of the institutionalized children that is, juvenile home, orphanage home run by Gujarat Government in Vadodara city with that of normal school children. DESIGN: Cross-sectional study was conducted among the 166 children residing in juvenile and orphanage home with 384 school children. RESULTS: The prevalence of dental caries was higher among the school going children (62.12%) with juvenile group having (52.4%) but the oral hygiene was poor among the juvenile group children with respect to those of school going group. CONCLUSION: It is concluded from the present study that juvenile group children had lower caries prevalence but poor oral hygiene status in contrast to school going children.