Objective The objective of this study was to determine the optimal dose of intravenous oxytocin administered during cesarean delivery (CD) to decrease the amount of blood loss. Methods Out of a total of 226 women presenting for CD, 189... more
Objective The objective of this study was to determine the optimal dose of intravenous oxytocin administered during cesarean delivery (CD) to decrease the amount of blood loss. Methods Out of a total of 226 women presenting for CD, 189 patients were randomized into three groups by a computer-generated random number sequence table. Low-risk women with singleton term pregnancies undergoing scheduled CD were assigned to receive 20, 30, or 40 units (U) of oxytocin diluted in 500 mL of lactated Ringer solution intraoperatively. The primary outcome was the change in hemoglobin from pre-CD to post-CD. Results Overall, 63 women were assigned to each group. The primary outcome which was the drop in hemoglobin (1.4 ± 1.1 g/dL, 1.1 ± 0.8 g/dL, 1.0 ± 1.1 g/dL; p = 0.097) and the total calculated blood loss (798.6 ± 298.3 mL, 794.4 ± 313.5 mL, 820.2 ± 316.2 mL; p = 0.893) were not significantly different among the study groups. The incidence of intraoperative hypotension, postoperative systolic, and diastolic blood pressure changes was similar across the groups. Conclusion The amount of blood loss during CD was not significantly different among the three groups, thus the lowest dose of oxytocin infusion (20 U in 500 mL of lactated Ringer solution) seems to be an appropriate regimen.
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We report an unusual case of teflonoma which appeared three years after teflon injection and presented as cystourethrocele. The pathology confirmed the presence of a giant cell reaction compatible with a teflonoma.
A unilateral twin tubal pregnancy occurring in a solitary fallopian tube is presented. The gynecological history was notable for a previous extrauterine pregnancy in the contralateral fallopian tube and reconstructive surgery to the... more
A unilateral twin tubal pregnancy occurring in a solitary fallopian tube is presented. The gynecological history was notable for a previous extrauterine pregnancy in the contralateral fallopian tube and reconstructive surgery to the ipsilateral one. Radical total salpingectomy was performed. The rationale for this management is discussed and different therapeutic alternatives presented.
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Women with Kartagener's syndrome (KS) are at a risk for infertility because of the dyskinetic ciliary activity in the fallopian tubes. In vitro fertilization - embryo transfer (IVF-ET) is considered the treatment of choice for... more
Women with Kartagener's syndrome (KS) are at a risk for infertility because of the dyskinetic ciliary activity in the fallopian tubes. In vitro fertilization - embryo transfer (IVF-ET) is considered the treatment of choice for patients with tubal factor infertility. In the literature only 2 patients with KS were treated with IVF-ET, with only one pregnancy achieved. We report 2 patients with KS and infertility treated successfully with IVF-ET.
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To determine whether 17 alpha-hydroxyprogesterone caproate (17OHPC) prolongs gestation beyond 37 weeks of gestation (primary outcome) and reduces neonatal morbidity (secondary outcome) in twin pregnancy. Randomised controlled double-blind... more
To determine whether 17 alpha-hydroxyprogesterone caproate (17OHPC) prolongs gestation beyond 37 weeks of gestation (primary outcome) and reduces neonatal morbidity (secondary outcome) in twin pregnancy. Randomised controlled double-blind clinical trial. Tertiary-care university medical centre. Unselected women with twin pregnancies. Participants received weekly injections of 250 mg 17OHPC (n = 194) or placebo (n = 94), from 16-20 to 36 weeks of gestation. Randomisation was performed using the permuted-block randomisation method. Data were analysed on an intention-to-treat basis. Preterm birth (PTB) rate before 37 weeks of gestation. There were no significant differences in the average gestational age at delivery, or in the rates of PTB before 37, 32, and 28 weeks of gestation, between the two groups. The proportion of very-low-birthweight neonates (<1500 g) was significantly lower in the 17OHPC group (7.6%) compared with placebo (14.3%) (relative risk, RR 0.5; 95% confidence interval, 95% CI 0.3-0.9; P = 0.01). Progestogen-treated neonates had a significantly lower composite neonatal morbidity (19.1%) compared with placebo (30.9%) (odds ratio, OR 0.53; 95% CI 0.31-0.90; P = 0.02), with significantly lower odds for respiratory distress syndrome (14.4 versus 23.4%; OR 0.55; 95% CI 0.31-0.98; P = 0.04), retinopathy of prematurity (1.1 versus 4.6%; OR 0.21; 95% CI 0.05-0.96; P = 0.04), and culture-confirmed sepsis (3.4 versus 12.8%; OR 0.24; 95% CI 0.10-0.57; P = 0.00). Intramuscular 17OHPC therapy did not reduce PTB before 37 weeks of gestation in unselected twin pregnancies. Nonetheless, 17OHPC significantly reduced neonatal morbidity parameters and increased birthweight.
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Transient osteoporosis of the hip (TOH) is a rare clinical disorder of unknown etiology characterized by hip pain and functional disability that resolve spontaneously in 6-24 months. To report 2 patients with TOH during pregnancy who had... more
Transient osteoporosis of the hip (TOH) is a rare clinical disorder of unknown etiology characterized by hip pain and functional disability that resolve spontaneously in 6-24 months. To report 2 patients with TOH during pregnancy who had rapid resolution of their illness with the use of calcitonin. To review the literature on TOH with special emphasis on its treatment. A MEDLINE search of studies published from 1966 to 2002 was performed to review treatment options for TOH and their effect on the natural history of the disease. Our 2 patients developed hip pain during pregnancy with classical changes of TOH on MRI. Both patients received calcitonin, 1 during pregnancy and 1 postpartum with resolution of their symptoms within 6 to 9 weeks. Previous reports in the literature of treatment of TOH showed that antiresorptive agents (bisphosphonates and calcitonin) had shortened the duration of the illness compared with the natural history of the disease. TOH is an under-recognized entity associated with pain and disability. The use of antiresorptive agents may be of help in reducing the duration of the disease. To increase the recognition of TOH and to consider therapeutic interventions to shorten the duration of the disease.
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Uterine rupture is a serious and often tragic complication that is life threatening to both mother and child. It occurs at a frequency of around 1% in patients with a previously scarred uterus. Rupture of an unscarred uterus is an... more
Uterine rupture is a serious and often tragic complication that is life threatening to both mother and child. It occurs at a frequency of around 1% in patients with a previously scarred uterus. Rupture of an unscarred uterus is an unexpected and devastating complication of pregnancy. With the increased use of misoprostol as a labor-inducing agent, cases of rupture of an unscarred uterus following its use have been published in the literature. We report a case of uterine rupture in a multigravid woman with an intrauterine fetal death at 29 weeks' gestation whose labor was induced with misoprostol. A review of all cases of uterine rupture with misoprostol induction is also included. Excessive doses of misoprostol should be used with extreme caution in multiparous women and in patients with a previously scarred uterus even in the context of intrauterine fetal death or termination of pregnancy.
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Pyloric atresia occurs in one in a million births and usually occurs sporadically. We report a family with nine affected members and review the literature for all reported familial cases. The article stresses the possibility of recurrence... more
Pyloric atresia occurs in one in a million births and usually occurs sporadically. We report a family with nine affected members and review the literature for all reported familial cases. The article stresses the possibility of recurrence of pyloric atresia in the progeny of consanguinous parents, with an emphasis on prenatal diagnosis and counseling, diagnosis of the entity in neonates, associated conditions, and prognosis in sporadic and familial cases. A high index of suspicion in affected families contributes to the early diagnosis and treatment with a great impact on outcome.
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We report a 39-year-old primigravida, a case of systemic lupus erythematosus (SLE) and secondary anti-phospholipid syndrome (APS) with a smooth antenatal course who delivered by caesarean for non-reassuring foetal heart rate. On day 2... more
We report a 39-year-old primigravida, a case of systemic lupus erythematosus (SLE) and secondary anti-phospholipid syndrome (APS) with a smooth antenatal course who delivered by caesarean for non-reassuring foetal heart rate. On day 2 postoperatively, she developed a sudden severe colicky upper abdominal pain with tachypnoea, dyspnoea, and tachycardia, and blood pressure (BP) reaching 150/95 mmHg. Computed tomography of the abdomen revealed lesions consistent with liver infarction. She developed haemolytic anaemia, elevated liver enzymes, and low platelets (HELLP syndrome); heparin and methylprednisolone were started. On day 3, BP normalized, respiratory symptoms improved but abdominal symptoms persisted. Methylprednisolone was increased to 80 mg/day on day 8 when she had significant clinical response and was discharged on day 16. This case emphasizes that a morbid clinical course including liver infarction should be anticipated in patients with SLE and APS complicated with HELLP syndrome.
Research Interests: Medicine, Platelet, Pregnancy, Humans, Systemic Lupus Erythematosus, and 12 moreLiver, Female, Anti-inflammatory agents, HELLP Syndrome, Primary Antiphospholipid Syndrome, Clinical Sciences, Adult, Abdominal Pain, Methylprednisolone, Antiphospholipid Syndrome, Infarction, and Pregnancy complications
Factors that influence a pregnant... more
Factors that influence a pregnant woman's decision to accept or decline genetic tests are largely undefined. The objective of this study was to determine the acceptance rate of prenatal diagnostic testing in Lebanon according to religion. Prenatal charts were reviewed to obtain information about prenatal genetic testing. Women were divided according to their religion and were compared regarding the acceptance of triple screen test (TST) or amniocentesis (AMN) and reasons for declining such tests. Differences between groups were examined using the student's t-test, chi(2)-test and multivariate analysis (age >or= 35 years, religion, education and class). The religious distribution was 73.8% Moslems, 14.0% Christians and 11.2% Druze. Utilization of TST, AMN, and either (TST/AMN) was 61.2%, 7.6% and 67.0%, respectively. Uptake of TST/AMN was highest in Christians and lowest in Moslems and that of AMN higher in Christians >or= 35 years compared with Moslems. On multivariate analysis, none of the factors studied significantly affected the utilization of TST or TST/AMN except for age >or= 35 years which was associated with a borderline decrease in the utilization of TST Odds Ratio (OR) 0.485 (95% CI 0.21-1.12). The utilization of AMN significantly increased with age >or= 35 years OR 7.19 (95% CI 2.65-19.56) and lower education. Religion does not seem to affect utilization of prenatal diagnostic tests in Lebanon.
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A hospital-based case-control study was conducted to examine the relationship between hyaline membrane disease (HMD) and caesarean route of delivery, in light of sociodemographic, obstetric and perinatal confounders and risk modifying... more
A hospital-based case-control study was conducted to examine the relationship between hyaline membrane disease (HMD) and caesarean route of delivery, in light of sociodemographic, obstetric and perinatal confounders and risk modifying factors. The study population consisted of 78 HMD cases and a control group of 803 infants delivered at 25-36 weeks' gestation and admitted over a 16-month period to nine hospitals in Greater Beirut, Lebanon. The likelihood of delivery by caesarean section was nearly twice as high among newborn infants diagnosed with HMD as compared with the non-HMD control group (OR = 2.02, [95% CI 1.04, 3.92], after adjusting for fetal growth ratio, one-minute Apgar score, maternal age, antenatal steroid administration and pregnancy-related complications. The impact of caesarean section on HMD was considerably more important in infants delivered < or = 32 weeks' gestation (OR = 2.10, [95% CI 0.79, 5.52]) as compared with those delivered afterwards (OR = 1.13, [95% CI 0.40, 3.21]).
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To evaluate the impact of an amnioinfusion (AI) policy for thick or moderate meconium-stained amniotic fluid (AF) on neonatal outcome, specifically meconium-aspiration syndrome and its complications. We reviewed maternal and neonatal... more
To evaluate the impact of an amnioinfusion (AI) policy for thick or moderate meconium-stained amniotic fluid (AF) on neonatal outcome, specifically meconium-aspiration syndrome and its complications. We reviewed maternal and neonatal charts of 937 vertex, singleton pregnancies complicated by moderate or thick meconium-stained AF during a 3-year period. The patients were divided into groups according to whether AI was performed. Demographic characteristics, risk factors, mode of delivery, pregnancy outcome, and neonatal complications, including meconium-aspiration syndrome, were analyzed. Four hundred forty patients (47%) received AI (AI group); 497 (53%) did not, for the following reasons: imminent delivery (310 patients), occult meconium (141), or emergency cesarean delivery (46) (no-AI group). Our study did not show any reduction in the incidence of 5-minute Apgar scores of 7 or less (8 versus 7%), meconium below the vocal cords (28 versus 29%), meconium aspiration syndrome (4.5 versus 3.8%), ventilation requirement (4.3 versus 2.4%), or neonatal death (0.7 versus 0.2%) in the AI and no-AI groups, respectively. The AI group had a higher incidence of fetal heart rate abnormalities in labor (48 versus 31%, P < .05), instrumental delivery (15 versus 8%, P < .05), cesarean delivery (28 versus 17%, P < .001), and endometritis (21 versus 13%, P = .004). With the policy of routine AI for moderate or thick meconium-stained AF, AI was not clinically feasible in 53% of the cases. We were unable to demonstrate any improvement in neonatal outcome in those who received AI for moderate or thick meconium.
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Granulomas of the female genital tract are rare and usually occur after operative procedures. A patient with rheumatoid arthritis presented with vaginal discharge and bleeding with ulcerative, red, friable lesions of the cervix, which... more
Granulomas of the female genital tract are rare and usually occur after operative procedures. A patient with rheumatoid arthritis presented with vaginal discharge and bleeding with ulcerative, red, friable lesions of the cervix, which extended to the bladder floor and the right upper vaginal wall. Cervical biopsy was highly suggestive of rheumatoid nodules. This prompted revision of the diagnosis of tuberculosis, which was suspected several months earlier when pulmonary and renal lesions were noted. The cervico-vaginal lesions did not respond to local steroid treatment and improved when the systemic steroid dose was increased; however, they recurred on tapering the dose. Rheumatoid nodules can occur in the genital tract, which poses diagnostic and treatment challenges.
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To estimate the rate of peripartum hysterectomy over the last 8 years in Calgary, the primary indication for peripartum hysterectomy (defined as any hysterectomy performed within 24 hours of a delivery), and whether there was an increase... more
To estimate the rate of peripartum hysterectomy over the last 8 years in Calgary, the primary indication for peripartum hysterectomy (defined as any hysterectomy performed within 24 hours of a delivery), and whether there was an increase in the rate of peripartum hysterectomy during that time. Detailed chart review of all cases of peripartum hysterectomy, 1999-2006, including previous obstetric history, details of the index pregnancy, indications for peripartum hysterectomy, outcome of the hysterectomy, and infant morbidity. The overall rate of peripartum hysterectomy was 87 of 108,154 or 0.8 per 1,000 deliveries. The primary indications for hysterectomy were uterine atony (32 of 87, 37%) and suspected placenta accreta (29 of 87, 33%). After hysterectomy, 46 (53%) women were admitted to the intensive care unit. Women were discharged home after a mean 6-day length of stay. The rate of peripartum hysterectomy did not appear to increase over time. Our population-based study found that abnormal placentation is the main indication for peripartum hysterectomy. The most important step in prevention of major postpartum hemorrhage is recognizing and assessing women's risk, although even perfect management of hemorrhage cannot always prevent surgery.
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To study the effect of a short period of war on the menstrual cycles of exposed women. Six months after a 16-day war, women in exposed villages aged 15-45 years were asked to complete a questionnaire relating to their menstrual history at... more
To study the effect of a short period of war on the menstrual cycles of exposed women. Six months after a 16-day war, women in exposed villages aged 15-45 years were asked to complete a questionnaire relating to their menstrual history at the beginning, 3 months after, and 6 months after the war. A control group, not exposed to war, was also interviewed. The data collected were analyzed to estimate the effect of war on three groups of women: those who stayed in the war zone for 3-16 days (Group A), those who were displaced within 2 days to safer areas (Group B), and women not exposed to war or displacement (Group C-control). More than 35% of women in Group A and 10.5% in Group B had menstrual aberrations 3 months after the cessation of the war. These percentages were significantly different from each other and from that in Group C (2.6%). Six months after the war most women regained their regular menstrual cycles with the exception of 18.6% in Group A. We found a short period of war, acting like an acute stressful condition, resulted in menstrual abnormalities in 10-35% of women and is probably related to the duration of exposure to war. This might last beyond the war time and for more than one or two cycles. In most women the irregular cycles reversed without any medical intervention. II.
Research Interests: Obstetrics, Research Methodology, Behavior, Reproduction, Lebanon, and 15 moreDeveloping Countries, Economic Development, Adolescent, Medicine, Humans, Female, Obstetrics Gynecology, Incidence, Menstrual Cycle, Middle Aged, Gynecology, Adult, Health surveys, Case Control Studies, and Paediatrics and reproductive medicine
Research Interests: Computer Science, Obstetrics, Research Design, Treatment, Treatment Outcome, and 14 moreComparative Study, Medicine, Pregnancy, Humans, Magnesium, Female, Obstetrics Gynecology, Adult, Randomized Controlled Trial, Bias (Epidemiology), Nifedipine, Magnesium Sulfate, Preterm Labor, and Paediatrics and reproductive medicine
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Research Interests: Twins, Birth Weight, Pregnancy, Humans, Female, and 15 moreMale, Amniotic Fluid, Birth Order, Clinical Sciences, Newborn Infant, Infant Mortality, Perinatology, Mechanical Ventilation, Twin Study, Perinatal mortality, Perinatal Outcome, Pregnancy Outcome, Mode of Delivery, Respiratory distress syndrome, and Paediatrics and reproductive medicine
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Research Interests: Child Development, Medicine, Probability, Birth Weight, Pregnancy, and 15 moreHumans, Female, Birth Order, Clinical Sciences, Newborn Infant, Adult, Perinatology, Retrospective Studies, Group, Study design, Gestational Age, Perinatal Outcome, Pregnancy Outcome, Cohort Studies, and Paediatrics and reproductive medicine
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Research Interests: Obstetrics, Treatment, Pregnancy, Humans, Female, and 12 moreOvulation Induction, Gynecology and Obstetrics, Newborn Infant, Congenital Anomalies, Gynecology, Adult, Methotrexate, Teratogenesis, Congenital abnormalities, Ectopic Pregnancy, Paediatrics and reproductive medicine, and Diagnostic errors
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Research Interests: Lebanon, Medicine, Pregnancy, Humans, IVF, and 15 moreFemale, Attitude, Amniocentesis, Logistic Regression Analysis, Human reproduction, Adult, Odds ratio, Prenatal Diagnosis, Fertilization in Vitro, Diagnostic Test, Gestation, Confidence Interval, Case Control Studies, attitude to health, and Medical and Health Sciences
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Research Interests: Obstetrics, Randomization, Evolution, Pregnancy, Humans, and 15 moreFemale, In Vitro Fertilization, Randomized Trial, Embryo Transfer, Clinical Sciences, Middle Aged, Gynecology, Adult, Fertilization in Vitro, Uterus, Gestation, Progestins, Pregnancy Rate, Pregnancy Outcome, and Paediatrics and reproductive medicine
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Drews Krzystof, 2002, Ginekol Pol, V73, P337; Hill LM, 1998, AM J OBSTET GYNECOL, V179, P703, DOI 10.1016-S0002-9378(98)70068-7; Schmeler KM, 2005, OBSTET GYNECOL, V105, P1098, DOI 10.1097-01.AOG.0000157465.996339.e5; Usui R, 2000, J... more
Drews Krzystof, 2002, Ginekol Pol, V73, P337; Hill LM, 1998, AM J OBSTET GYNECOL, V179, P703, DOI 10.1016-S0002-9378(98)70068-7; Schmeler KM, 2005, OBSTET GYNECOL, V105, P1098, DOI 10.1097-01.AOG.0000157465.996339.e5; Usui R, 2000, J Obstet Gynaecol Res, V26, P89
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OBJECTIVE: To study the perinatal outcome of vaginally delivered twins when twin B is more than 250 g larger than twin A. STUDY DESIGN: Maternal and neonatal charts of live-born, nonanomalous twins,> 25 weeks' gestation and... more
OBJECTIVE: To study the perinatal outcome of vaginally delivered twins when twin B is more than 250 g larger than twin A. STUDY DESIGN: Maternal and neonatal charts of live-born, nonanomalous twins,> 25 weeks' gestation and vaginally delivered over a period of ...
Research Interests: Child Development, Medicine, Probability, Birth Weight, Pregnancy, and 15 moreHumans, Female, Birth Order, Clinical Sciences, Newborn Infant, Adult, Perinatology, Retrospective Studies, Group, Study design, Gestational Age, Perinatal Outcome, Pregnancy Outcome, Cohort Studies, and Paediatrics and reproductive medicine
OBJECTIVE: To compare the perinatal outcome of the presenting twin to its co-twin. STUDY DESIGN: All live nonanomalous twin gestations delivered at> 25 weeks' gestation between 1984 and 1994 (N= 461) were identified. Twin A was... more
OBJECTIVE: To compare the perinatal outcome of the presenting twin to its co-twin. STUDY DESIGN: All live nonanomalous twin gestations delivered at> 25 weeks' gestation between 1984 and 1994 (N= 461) were identified. Twin A was compared to twin B regarding the ...
Research Interests: Twins, Birth Weight, Pregnancy, Humans, Female, and 15 moreMale, Amniotic Fluid, Birth Order, Clinical Sciences, Newborn Infant, Infant Mortality, Perinatology, Mechanical Ventilation, Twin Study, Perinatal mortality, Perinatal Outcome, Pregnancy Outcome, Mode of Delivery, Respiratory distress syndrome, and Paediatrics and reproductive medicine
To determine the effect of fasting during the month of Ramadan on the rate of preterm delivery (PTD). A prospective cohort study of women with singleton pregnancies who elected to fast and matched controls. Four medical centres in Beirut,... more
To determine the effect of fasting during the month of Ramadan on the rate of preterm delivery (PTD). A prospective cohort study of women with singleton pregnancies who elected to fast and matched controls. Four medical centres in Beirut, Lebanon. Women presenting for prenatal care (20-34 weeks of gestation) during the month of Ramadan, September 2008. Data were collected prospectively. The frequency of PTD was evaluated in relation to the duration of fasting and the stage of gestation at the time of fasting. The primary endpoint was the percentage of pregnant women who had PTD, defined as delivery before 37 completed weeks of gestation. A total of 468 women were approached, of whom 402 were included in the study. There were no differences in smoking history and employment. There was no difference in the proportion of women who had PTD at <37 weeks (10.4% versus 10.4%) or PTD at <32 weeks (1.5% versus 0.5%) in the Ramadan-fasted group and the controls, respectively. The PTD rate was also similar in those who fasted before or during the third trimester. The mean birthweight was lower (3094 ± 467 g versus 3202 ± 473 g, P = 0.024) and the rate of ketosis and ketonuria was higher in the Ramadan-fasted women. On multivariate stepwise logistic regression analysis, fasting was not associated with an increased risk of PTD (odds ratio 0.72; 95% confidence interval 0.34-1.54; P = 0.397). The only factor that had a significant effect on the PTD rate was body mass index (odds ratio 0.43; 95% confidence interval 0.20-0.93; P = 0.033). Fasting during the month of Ramadan does not seem to increase the baseline risk of preterm delivery in pregnant women regardless of the gestational age during which this practice is observed.
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Sir, In reference to the study byAwwad et al. published in the October issue of BJOG, I would like to raise a few pertinent issues concerning the methodology. The authors state that the design was that of a prospective cohort study. It is... more
Sir, In reference to the study byAwwad et al. published in the October issue of BJOG, I would like to raise a few pertinent issues concerning the methodology. The authors state that the design was that of a prospective cohort study. It is also stated that the participant recruitment involved ‘a rigid process of patient matching by recruiting the controls who matched study women at every level of known confounding variables including age, period of gestation, parity and BMI’ and the controls were recruited within the same or on the following day. However, data on the leftover cohort —those not matched with the study participants—are not accounted for. Therefore, to be precise, the design does not fulfil the characteristics of a conventional prospective cohort. However, the sequence here was from cause (fasting) to effect (preterm delivery) unlike that of a conventional ‘case–control study’ or nested case–control design (retrospective) with a portion of underlying cohort data missing. The current study presumably employed, a prospectively ‘matched’ case–cohort design with the exposure identified before outcome though, conceptually, controls are to be selected randomly in this design. However, the main reason for concern in this study is the statistical method employed by the authors, which ignores the matched-controls design. Matching is employed in observational studies to reduce or eliminate the effects of confounding factors, i.e. to control variation due to extraneous variables at sampling stage; pairing reduces bias and increases precision of the statistical inference, especially when the sample size is small. There are two methods of matching: individual matching and frequency matching. When controls are matched to cases on one or more attributes like age, BMI, parity, etc. it amounts to individual matching. Whenever two groups are closely matched on potential confounders, the two samples are considered dependent (‘independent’ when they are not matched) because they are paired by design. To analyse the results, a procedure that accounts for the sample match is therefore required. Odds ratio is estimated as the ratio of case-positive to case-negative matched pairs. To test the statistical significance of the difference between paired means, a matched-pairs t-test is applied. McNemar’s test is used as a normal approximation to the binomial test with correction for discontinuity. Whereas in the current study Student’s t-test, Wilcoxon rank-sum test and a multivariate logistic regression were applied, thereby ignoring the matched design of the study; this may result in odds ratios biased toward conservation. The ‘confusion’ in the biomedical literature about case–control study nomenclature has been previously highlighted. Niven et al., in a structured review, analysed 37 matched case–control studies published in peer-reviewed journals and found that statistical methods were inappropriate in more than half of the studies they reviewed. Though one cannot be sure that use of proper statistics would change the conclusions reached by the studies that employed improper statisticalmethods, the observationmade by the authors remains cogent. To conclude, appropriateness of statistical procedures for the study design needs to be validated by stringent statistical methodology reviews by the authors, reviewers and editors. In this context, it is noteworthy that a recent article suggested an association of the strength of study design and use of recommended analytic techniques with the journal’s impact factor.&
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... 5 Badr El-Din MK. A familial convulsive disorder with an unusual onset during intrauterine life: a case report. ... 16 Mitra AG, Salvino AR, Spence JE. Prenatal diagnosis of fatal infantile olivopontocerebellar hypoplasia syndrome. ...
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To assess whether application of cocoa butter lotion reduces the development of striae gravidarum (SG). Multicentre, double-blind, randomised and placebo-controlled trial. Beirut and Tripoli, Lebanon. Nulliparous women presenting for... more
To assess whether application of cocoa butter lotion reduces the development of striae gravidarum (SG). Multicentre, double-blind, randomised and placebo-controlled trial. Beirut and Tripoli, Lebanon. Nulliparous women presenting for prenatal care. Nulliparous women presenting in the first trimester were randomly assigned to receive a lotion containing cocoa butter or a placebo lotion. Women were instructed to apply the assigned lotion daily until delivery. The development of striae over the abdomen, breasts and thighs postpartum. Of 210 women enrolled, 175 (83%) completed the study. Ninety-one women received the study lotion and 84 received the placebo. There was no difference in the development of SG (45.1% versus 48.8%; P = 0.730) or the severity of SG between cases and controls. The results did not change when presence of stretch marks at enrolment or compliance with the regimen were taken into account. Topical application of a lotion containing cocoa butter does not appear to reduce the likelihood of developing striae gravidarum.