ABSTRACT
The intrauterine contraceptive device (IUCD) is the most frequently used method of reversible contraception with high efficacy. Despite these benefits, rare complications, such as spontaneous migration of the device into adjacent organs, particularly the bladder, are possible. Minimally invasive surgery is a safe and effective procedure with few complications for the management of migrated IUCDs. We presented a 36-year-old multiparous woman referred by her gynecologist who had an IUCD inserted 4 years prior. She had been experiencing dysuria and lower abdomen pain for 3 months. Ultrasonography of the abdomen revealed a hyperechoic lesion on the bladder wall's left anterior-superior portion. An MRI revealed that the device was embedded in the bladder's anterior left wall. Under general anesthesia, a cystoscopy and laparoscopy exploration were subsequently scheduled. Cystoscopy was performed, but the long limb of the IUCD was embedded in the mucosal and muscular layers, preventing its removal from the bladder wall. Laparoscopic retrieval of the IUCD was performed without complications. The patient was discharged 2 days after surgery with a Foley catheter inserted in the bladder for 10 days. When the urethral catheter was removed, a cystoscopy was performed to confirm bladder wall healing. In the postoperative follow-up 1 month after IUCD removal, no abnormalities were observed. Patients with a suspected IUCD migration must undergo a comprehensive evaluation, regardless of whether they are symptomatic or asymptomatic. Before surgical retrieval, imaging such as ultrasonography and MRI were utilized to locate the migrated IUCD and consider therapeutic options. Even though cystoscopy is considered as an effective and safe minimally invasive procedure for managing a migrated IUCD to the bladder, laparoscopic removal could serve as an option once cystoscopy retrieval is failed.
ABSTRACT
Background: The unpredictability of the progression of coronavirus disease 2019 (COVID-19) may be attributed to the low precision of the tools used to predict the prognosis of this disease. Objective: To identify the predictors associated with poor clinical outcomes in patients with COVID-19. Methods: Relevant articles from PubMed, Embase, Cochrane, and Web of Science were searched as of April 5, 2020. The quality of the included papers was appraised using the Newcastle-Ottawa scale (NOS). Data of interest were collected and evaluated for their compatibility for the meta-analysis. Cumulative calculations to determine the correlation and effect estimates were performed using the Z test. Results: In total, 19 papers recording 1,934 mild and 1,644 severe cases of COVID-19 were included. Based on the initial evaluation, 62 potential risk factors were identified for the meta-analysis. Several comorbidities, including chronic respiratory disease, cardiovascular disease, diabetes mellitus, and hypertension were observed more frequent among patients with severe COVID-19 than with the mild ones. Compared to the mild form, severe COVID-19 was associated with symptoms such as dyspnea, anorexia, fatigue, increased respiratory rate, and high systolic blood pressure. Lower levels of lymphocytes and hemoglobin; elevated levels of leukocytes, aspartate aminotransferase, alanine aminotransferase, blood creatinine, blood urea nitrogen, high-sensitivity troponin, creatine kinase, high-sensitivity C-reactive protein, interleukin 6, D-dimer, ferritin, lactate dehydrogenase, and procalcitonin; and a high erythrocyte sedimentation rate were also associated with severe COVID-19. Conclusion: More than 30 risk factors are associated with a higher risk of severe COVID-19. These may serve as useful baseline parameters in the development of prediction tools for COVID-19 prognosis.
