ABSTRACT
BACKGROUND: Despite no observed increase in obstetrical complication rates, cesarean delivery rates are increasing worldwide. A significant proportion of planned cesarean deliveries are performed for patients with 1 previous cesarean delivery who opt for an elective repeat cesarean delivery rather than a trial of labor after cesarean delivery. The facilitation of informed decision-making by healthcare professionals may influence patient choices and could affect the trial of labor after cesarean delivery uptake rates. OBJECTIVE: This study aimed to assess how obstetricians in the Middle Eastern region approach counseling of patients with a previous cesarean delivery concerning birth choices in the current pregnancy. STUDY DESIGN: This was a prospective survey-based study. An online survey of obstetricians in the 2 largest state maternity hospitals in Doha, Qatar, was conducted with participation offered voluntarily. The survey gathered background demographic data and investigated the obstetrician's awareness of factors that could influence the success of the trial of labor after cesarean delivery and the obstetrician's approach to counseling women. The data collected were transferred to SPSS (version 23.0; IBM Corp, Armonk, NY) for analysis. Descriptive statistics were performed, and nonparametric analysis of continuous variables and chi-squared analysis of discrete variables were cross-referenced with gender, length of time of specialist qualification, and personal family experience of cesarean delivery. RESULTS: Most respondents had training in the Middle East and generally practiced obstetrics in this region, and >80% of the respondents had more than 5 years of experience in the specialty. The obstetrician's gender or length of experience did not significantly influence the attitude to the assessment of risks and benefits. Furthermore, there was little consensus among the group about factors that were the most and the least important for the success of the trial of labor after cesarean delivery. The group emphasized the importance of the patient's wishes in choosing the mode of birth. If a relative contraindication to the trial of labor after cesarean delivery was present, half of the obstetricians would emphasize the various negatives of the approach to the patient during counseling. Most participants favored a dedicated trial of labor after cesarean delivery clinic to reduce cesarean delivery rates. The participants did not feel that supporting the trial of labor after cesarean delivery would be improved with legal department support. CONCLUSION: Obstetricians had different approaches in the counseling for trial of labor after cesarean delivery, and this can influence the patients' acceptance of the trial of labor after cesarean delivery, thereby affecting cesarean delivery rates.
ABSTRACT
Perforated peptic ulcer (PPU) treatment guidelines are still up for discussion. Due to the morbidity and mortality linked to each, the use of both operative and non-operative management, including conservative and endoscopic treatment, is still debatable. A standardized protocol has been used to write a best evidence topic. The discussion focused on whether operative management for PPU is preferable to non-operational management or vice versa. MEDLINE, the Cochrane Library, Scopus, and the Web of Science were the databases used to conduct an electronic search of the pertinent literature. We found 56 articles, out of these only 5 studies were found to be appropriate to answer the question. The outcome assessed was failure of management. The best evidence showed that both operative and non-operative management can be used with similar outcomes depending on the patient selection for each category.
ABSTRACT
Five simple, rapid, accurate, and precise spectrophotometric methods are developed for the determination of Silodosin (SLD) in the presence of its acid induced and oxidative induced degradation products. Method A is based on dual wavelength (DW) method; two wavelengths are selected at which the absorbance of the oxidative induced degradation product is the same, so wavelengths 352 and 377â¯nm are used to determine SLD in the presence of its oxidative induced degradation product. Method B depends on induced dual wavelength theory (IDW), which is based on selecting two wavelengths on the zero-order spectrum of SLD where the difference in absorbance between them for the spectrum of acid induced degradation products is not equal to zero so through multiplying by the equality factor, the absorption difference is made to be zero for the acid induced degradation product while it is still significant for SLD. Method C is first derivative (1D) spectrophotometry of SLD and its degradation products. Peak amplitudes are measured at 317 and 357â¯nm. Method D is ratio difference spectrophotometry (RD) where the drug is determined by the difference in amplitude between two selected wavelengths, at 350 and 277â¯nm for the ratio spectrum of SLD and its acid induced degradation products while for the ratio spectrum of SLD and its oxidative induced degradation products the difference in amplitude is measured at 345 and 292â¯nm. Method E depends on measuring peak amplitudes of the first derivative of the ratio (1DD) where peak amplitudes are measured at 330â¯nm in the presence of the acid induced degradation product and measured by peak to peak technique at 326 and 369â¯nm in the presence of the oxidative induced degradation product. The proposed methods are validated according to ICH recommendations. The calibration curves for all the proposed methods are linear over a concentration range of 5-70⯵g/mL. The selectivity of the proposed methods was tested using different laboratory prepared mixtures of SLD with either its acid induced or oxidative induced degradation products showing specificity of SLD with accepted recovery values. The proposed methods have been successfully applied to the analysis of SLD in pharmaceutical dosage forms without interference from additives.
