Pay Rs 3 lakh as penalty for discontinuation of PG medical courses in Andhra this year

All the PG medical candidates getting admitted to Dr NTR University of Health Sciences will have to pay Rs 3 lakh as a discontinuation penalty if they do not complete their courses.

In this regard, the selected candidates will have to execute a bond at the time of admission. This rule applies to all the candidates getting admitted to either the competent authority quota or management quota seat for the academic year 2024-2025.
For more details, click the link below

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Study Finds Sleeve Gastrectomy Safe and Effective for Post-Liver Transplant Patients with Metabolic Dysfunction

Belgium: A recent nationwide study conducted in Belgium has highlighted the safety and feasibility of sleeve gastrectomy (SG) following liver transplantation. The research, which examined the outcomes of bariatric surgery in post-transplant patients, suggests that this procedure may play a crucial role in preventing metabolic dysfunction-associated steatotic liver disease (MASLD), a condition that can complicate the recovery of liver transplant recipients.

The findings were published online in the journal Liver Transplantation. 

Weight gain is an increasing concern following liver transplantation (LT), and metabolic dysfunction-associated steatotic liver disease can negatively affect graft health. The timing of bariatric surgery (BS) is critical for patients with liver disease or those who have undergone transplantation. While BS may be an option for addressing weight gain after LT, the available evidence is limited, and the long-term outcomes remain uncertain. To address this knowledge gap, Louis Onghena, Department for Human Structure and Repair, Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium, and colleagues set out to assess the effectiveness of sleeve gastrectomy as a weight-loss intervention in this specific population.

For this purpose, the researchers conducted a national retrospective analysis across five Belgian transplant centers, including 25 patients who underwent bariatric surgery following liver transplantation. In addition, 187 LT patients without bariatric procedures were included for comparative analysis. Clinical, biochemical, and outcome data were retrospectively gathered. In this nationwide cohort, the 25 patients who received BS did so at a median of 3.5 years post-transplant.

Based on the study, the researchers reported the following findings:

  • 84.0% underwent sleeve gastrectomy. The majority of these patients were male (72.0%) and had a lower age at the time of transplantation compared to the non-bariatric surgery population (54.5 years versus 60.6 years).
  • Significant and sustained weight loss was observed, with body mass index decreasing from 41.0 ± 4.5 before surgery to 32.6 ± 5.8 one to three years post-surgery, and further down to 31.1 ± 5.8 three to five years post-surgery.
  • Before surgery, three patients experienced recurrent and one patient developed de novo metabolic dysfunction-associated steatotic liver disease after liver transplantation, all of which resolved following bariatric surgery.
  • Significant reductions were noted in alanine transaminase levels, which decreased from 40.5 ± 28.5 U/L to 27.1 ± 25.1 U/L post-surgery, as well as in HbA1c levels, dropping from 6.9 ± 1.6 to 6.0 ± 1.4.
  • Throughout the study, three patients were re-transplanted, and eight patients passed away; of these, 20.0% of the patients died due to nonhepatic malignancies, while one succumbed to liver failure.

According to the authors, sleeve gastrectomy is the preferred bariatric surgery following liver transplantation and has demonstrated safety and feasibility in this context, along with positive metabolic outcomes. They suggest that SG is a valid treatment option for both de novo and recurrent metabolic dysfunction-associated steatotic liver disease in post-transplant patients.

“While this study represents the largest cohort examined to date, we emphasize the necessity for larger studies to further investigate the impact of bariatric surgery on patient and graft survival,” they concluded.

Reference:

Onghena, Louis1,2,3,4; Geerts, Anja3,4; Berrevoet, Frederik2; Pirenne, Jacques5; Verbeek, Jef6; Bonaccorsi-Riani, Eliano7,8; Dahlqvist, Geraldine9; Vonghia, Luisa10; Detry, Olivier11; Delwaide, Jean12; Lefere, Sander3,4; van Nieuwenhove, Yves1,2. Bariatric surgery post-liver transplantation: A Belgian nationwide study. Liver Transplantation 30(10):p 1050-1057, October 2024. | DOI: 10.1097/LVT.0000000000000372

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FDA approves flurpiridaz F-18 for diagnosing coronary artery disease

The U.S. Food and Drug Administration (FDA) has approved flurpiridaz F-18 (Flyrcado; GE Healthcare), a first-of-its-kind positron emission tomography (PET) imaging agent, for use in adult patients with known or suspected coronary artery disease (CAD). CAD, the leading cause of death in the U.S., is a condition where the coronary arteries are narrowed or blocked, reducing blood flow to the heart and leading to serious conditions like myocardial ischemia and heart attacks.

Flurpiridaz F-18 is a nuclear medicine tracer used in myocardial perfusion imaging (MPI), a test that evaluates blood flow to the heart muscle under both rest and stress conditions. The drug, administered intravenously, allows doctors to detect abnormalities in blood flow, offering improved diagnostic accuracy compared to the current standard of single-photon emission computed tomography (SPECT) MPI. The longer half-life of flurpiridaz F-18 (109 minutes) extends its availability, enabling broader distribution compared to other PET cardiac tracers.

The drug’s safety and efficacy were confirmed in two large clinical trials, where it demonstrated a sensitivity of 74-89% and specificity of 53-70% in detecting significant CAD. The studies showed the drug’s potential to improve diagnosis, especially in hard-to-image patients, such as those with high body mass index and women, for whom traditional imaging can be less accurate.

“The approval of flurpiridaz F-18 marks a notable advancement in cardiac imaging by offering improved diagnostic accuracy, particularly for patients who are more difficult to image, such as those with a higher body mass index and women,” said Cathy Cutler, PhD, president of SNMMI. “Its offsite manufacturing and ready-to-use dose format could potentially broaden access to PET-MPI, while enhancing image quality and efficiency.”

GE Healthcare will release flurpiridaz F-18 under brand name Flyrcado in U.S. markets in early 2025, with expanding availability thereafter.

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Higher hearing threshold associated with increased mortality in men, suggests study

A new study published in the journal of Otolaryngology-Head and Neck Surgery suggested that for men the hearing threshold is linked to both acute cardiovascular death and overall mortality, however, no similar relationship was observed for women.

In otolaryngology, dizziness, hearing loss, and imbalance are common symptoms that afflict people of all ages and account for around 10% of clinic visits. In addition to this, hearing loss is the third most common reason for years spent disabled throughout the globe. Research on both humans and animals found how important sex hormones are for hearing function. The female sex hormones may protect against noise, and in pre-menopausal women, the objective hearing levels vary over the menstrual cycle and then diminish after menopause. There is a knowledge gap on the relationship between hearing and long-term survival among younger women and men. Therefore, Jan Berge and team carried forward this study in order to examine the effects of postural balance on the relationship between hearing and sex-specific overall mortality as well as death from acute cardiovascular disease.

The patients received conventional clinical examinations as well as audiometric and stabilometric laboratory examinations. On the best hearing ear, a pure tone average of 0.5, 1, 2, and 3 kHz was determined. The Norwegian Cause of Death Registry provided the cause of death. This study was set out for a duration of 26.3 years and included a total of 1,036 patients, of whom 58.8% were women. A 10 dB rise in hearing threshold was linked to a 14% increase in mortality among males in Cox regression analysis for the overall mortality adjusted for age, prior medical history, and vestibular condition. But, no significant correlation was observed between hearing and death in women.

A 10 dB rise in hearing threshold was linked to a 57% increase in the hazard ratio in men, according to the same studies for acute cardiovascular mortality. However, there was no discernible influence of hearing on survival in women. The postural balance correction had no effect on the correlation between hearing loss and death. This study brings out the evidence to support that hearing is related to mortality in males, but not in women. It makes this clear that there is an increase in mortality overall as well as in deaths from ischemic stroke and acute myocardial infarction.

Reference:

Berge, J. E., Nilsen, G. A., Goplen, F. K., Kringeland, E., Nordahl, S. H. G., & Aarstad, H. J. (2024). Hearing, Balance, and Mortality: Sex‐Specific Patterns in a Longitudinal Study. In Otolaryngology-Head and Neck Surgery. Wiley. https://doi.org/10.1002/ohn.903

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New injectable may prevent and treat hypoglycemia, reveals research

People with diabetes take insulin to lower high blood sugar. However, if glucose levels plunge too low-from taking too much insulin or not eating enough sugar-people can experience hypoglycemia, which can lead to dizziness, cognitive impairment, seizures or comas. To prevent and treat this condition, researchers in ACS Central Science report encapsulating the hormone glucagon. In mouse trials, the nanocapsules activated when blood sugar levels dropped dangerously low and quickly restored glucose levels.

Glucagon is a hormone that signals the liver to release glucose into the bloodstream. It’s typically given by injection to counteract severe hypoglycemia in people who have diabetes. While an emergency glucagon injection can correct blood sugar levels in about 30 minutes, formulations can be unstable and insoluble in water. In some cases, the hormone quickly breaks down when mixed for injections and clumps together to form toxic fibrils. Additionally, many hypoglycemic episodes occur at night, when people with diabetes aren’t likely to test their blood sugar. To improve commercial glucagon stability and prevent hypoglycemia, Andrea Hevener and Heather Maynard looked to micelles: nanoscale, soap-like bubbles that can be customized to assemble or disassemble in different environments and are used for drug delivery. They developed a glucose-responsive micelle that encapsulates and protects glucagon in the bloodstream when sugar levels are normal but dissolves if levels drop dangerously low. To prevent hypoglycemia, the micelles could be injected ahead of time and circulate in the bloodstream until they are needed.

In lab experiments, the researchers observed that the micelles disassembled only in liquid environments that mimicked hypoglycemic conditions in both human and mice bodies: less than 60 milligrams of glucose per deciliter. Next, when mice experiencing insulin-induced hypoglycemia received an injection of the specialized micelles, they achieved normal blood sugar levels within 40 minutes. The team also determined that glucagon-packed micelles stayed intact in mice and didn’t release the hormone unless blood glucose levels fell below the clinical threshold for severe hypoglycemia. From additional toxicity and biosafety studies in mice, the researchers note that empty micelles didn’t trigger an immune response or induce organ damage.

While more studies are needed, the researchers say their proof-of-concept is a first step toward a new on-demand and effective method for preventing or mitigating extremely low blood sugar levels.

Reference:

Daniele VinciguerraRajalakshmi P SJane YangPanagiotis G. GeorgiouKatherine SnellThéo PesentiJeffrey CollinsMikayla TambolineShili XuR. Michael van DamKathryn M. M. MessinaAndrea L. Hevener Heather D. Maynard, A Glucose-Responsive Glucagon-Micelle for the Prevention of Hypoglycemia, ACS Central Science, DOI:10.1021/acscentsci.4c00937.

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Prolene suture gonioscopy-assisted transluminal trabeculotomy safe and effective treatment of glaucoma: Study

Researchers found that prolene suture gonioscopy-assisted transluminal trabeculotomy (GATT) is efficient in reducing intraocular pressure (IOP) and diminishing the long-term usage of glaucoma medication. A recent study was published in the Journal of Glaucoma conducted by Zhang and colleagues.

The objective of the study was to evaluate the long-term effectiveness of prolene suture GATT in reducing IOP, and in minimizing the use of glaucoma medications, while identifying the risk factors for surgical outcomes. This was a retrospective cohort study of adult patients undergoing prolene suture GATT by a single surgeon at a medical center. Data from 145 eyes of 124 patients were analyzed concerning changes in intraocular pressure, use of glaucoma medications, and rates of reoperation up to four years of follow-up.

  • The study showed a marked reduction of IOP from a preoperative level of 22.1±7.8 mm Hg to 15.1±3.2 mm Hg at three years and 15.1±3.5 mm Hg at four years after the surgery.

  • The number of medications for glaucoma was also reduced. It came down to 1.3 ± 1.4 at three years and 1.4 ± 1.5 at four years post surgery from the baseline of 3.2 ± 1.1 preoperatively. What was impressive was that 44% of the eyes were totally medication-free at year four.

  • Those who had GATT alone tended to have a higher revision rate of 31% compared with those who had GATT/CE combined.

  • Patients with prior trabeculoplasty had worse outcomes with a higher reoperation rate at 28.8% compared to those without trabeculoplasty, which stood at 16.1%.

  • Kaplan–Meier survival analysis of combined GATT/CE surgery not combined with trabeculoplasty achieved the best outcome, with a median time to failure of 48 months.

  • Contrastively, eyes that received GATT and previous trabeculoplasty exhibited a relatively short median time to failure of only 18 months. Eyes that had GATT alone, with or without prior trabeculoplasty, exhibited median times to failure of 9 and 12 months, respectively.

Prolene suture GATT effectively lowers intraocular pressure and reduces the use of medication for glaucoma during long-term follow-up, with many patients remaining medication-free years after surgery. These findings suggest that GATT is indeed a good option for the treatment of glaucoma.

Reference:

Zhang, X., Chow, A., & Chen, E. (2024). Surgery outcomes of prolene suture gonioscopy-assisted transluminal trabeculotomy (GATT): Up to 4 years follow-up and prognostic factors. Journal of Glaucoma, 33(9), 645–651. https://doi.org/10.1097/ijg.0000000000002417

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Bright Light Therapy Proves Effective for Nonseasonal Depressionan, Shows JAMA study

Researchers have found the use of bright light therapy (BLT) as an adjunctive treatment in patients with nonseasonal depressive disorders. A recent systematic review and meta-analysis claimed that BLT has shown significant improvements in terms of remission and response rates over standard treatments such as antidepressant monotherapy or dim red light therapy in these patients. This study was published in JAMA Psychiatry by Artur M. and colleagues..

Researchers conducted a broad search of the MEDLINE, Embase, and Cochrane databases on RCTs published between 2000 and March 2024. Information in eleven trials summarizing the data of 858 patients was included in the meta-analysis, of whom 649 were female (75.6%). The analysis compared the effects of BLT with dim red light therapy or antidepressant monotherapy. The Mantel-Haenszel method was used to compare the differences in treatment-related outcomes, and heterogeneity was quantified using I2 statistics.

  • Remission rates were more prominent among patients who had undergone BLT than those who did not undergo BLT (40.7% vs 23.5%; p<0.001).

  • The better response rates were also observed with BLT, wherein the overall response rates were 60.4% vs 38.6%, respectively for the non-BLT treatments (p<0.001).

  • Remission rates for patients followed up in under four weeks were 27.4% in the BLT group compared to those in the control group at 9.2% ( p<0.005).

  • The response rates for the same group were 55.6% in the BLT group compared to 27.4% in the control group (p < 0.001).

  • At over four weeks the benefits of BLT continued to exist with remission rates at 46.6% vs 29.1% (p = 0.01).

The researchers concluded that significant enhancement of remission and response rates was seen in the use of BLT over traditional treatments like antidepressants or dim red light therapy. Indeed, it appears that intervention is linked to a quicker time to response in symptoms, particularly within the first four weeks of treatment initiation. The findings also suggest that BLT could provide an effective though safe intervention that is deserved as an adjunct in the armamentarium for the treatment of nonseasonal depression.

Reference:

Menegaz de Almeida, A., Aquino de Moraes, F. C., Cavalcanti Souza, M. E., Cavalcanti Orestes Cardoso, J. H., Tamashiro, F., Miranda, C., Fernandes, L., Kreuz, M., & Alves Kelly, F. (2024). Bright light therapy for nonseasonal depressive disorders: A systematic review and meta-analysis. JAMA Psychiatry (Chicago, Ill.). https://doi.org/10.1001/jamapsychiatry.2024.2871

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AI driven models demonstrated outstanding performance in pulp space segmentation, States study

AI driven models demonstrated outstanding performance in pulp space segmentation, according to a study published in the Journal of Endodontics.

Automated segmentation of 3-dimensional pulp space on cone-beam computed tomography images presents a significant opportunity for enhancing diagnosis, treatment planning, and clinical education in endodontics. The aim of this systematic review was to investigate the performance of artificial intelligence-driven automated pulp space segmentation on cone-beam computed tomography images. A comprehensive electronic search was performed using PubMed, Web of Science, and Cochrane databases, up until February 2024. Two independent reviewers participated in the selection of studies, data extraction, and evaluation of the included studies. Any disagreements were resolved by a third reviewer. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to assess the risk of bias. Results: Thirteen studies that met the eligibility criteria were included. Most studies demonstrated high accuracy in their respective segmentation methods, although there was some variation across different structures (pulp chamber, root canal) and tooth types (single-rooted, multirooted). Automated segmentation showed slightly superior performance for segmenting the pulp chamber compared to the root canal and single-rooted teeth compared to multi-rooted ones. Furthermore, the second mesiobuccal (MB2) canalsegmentation also demonstrated high performance. In terms of time efficiency, the minimum time required for segmentation was 13 seconds. Artificial intelligence-driven models demonstrated outstanding performance in pulp space segmentation. Nevertheless, these findings warrant careful interpretation, and their generalizability is limited due to the potential risk and low evidence level arising from inadequately detailed methodologies and inconsistent assessment techniques. In addition, there is room for further improvement, specifically for root canal segmentation and testing of artificial intelligence performance in artifact-induced images.

Reference:

Alfadley A, Shujaat S, Jamleh A, Riaz M, Aboalela AA, Ma H, Orhan K. Progress of Artificial Intelligence-Driven Solutions for Automated Segmentation of Dental Pulp Space on Cone-Beam Computed Tomography Images. A Systematic Review. J Endod. 2024 May 29:S0099-2399(24)00336-4. doi: 10.1016/j.joen.2024.05.012. Epub ahead of print. PMID: 38821262.

Keywords:

AI driven, models, demonstrated, outstanding, performance, pulp, space, segmentation, States, study, 3-dimensional, artificial intelligence, cone-beam computed tomography, dental pulp space, Imaging, segmentation, Journal of Endodontics

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Preclinical studies suggest a drug-free nasal spray could ward off respiratory infections

Researchers from the Brigham detail how the spray they created may offer broad-spectrum protection from respiratory infections by COVID-19, influenza, everyday cold viruses, and pneumonia-causing bacteria.

A new study details how a nasal spray formulated by investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, may work to protect against viral and bacterial respiratory infections. Based on their preclinical studies, the researchers say the broad-spectrum nasal spray is long-lasting, safe, and, if validated in humans, could play a key role in reducing respiratory diseases and safeguarding public health against new threats. Their results are published in the journal Advanced Materials.

“The COVID pandemic showed us what respiratory pathogens can do to humanity in a very short time. That threat hasn’t gone away,” said co-senior author Jeffrey Karp, PhD, distinguished chair in Anesthesiology at Brigham and Women’s Hospital. “Not only do we have the flu to deal with seasonally, but we now have COVID, too.”

Influenza and COVID-19 infections cause thousands of deaths and hundreds of thousands of cases of severe disease every year. Milder infections cause significant discomfort, resulting in missed work or school.

Vaccines against these viruses can be beneficial, but they’re imperfect. Vaccinated people still get infected and spread the infection to others. Masks are also helpful but aren’t perfect, either-they can leak, and many people wear them improperly or choose not to wear them at all.

“We need new, additional ways to protect ourselves and reduce the transmission of the disease,” Karp said.

Most viruses enter our system through the nose. When we catch an airborne infection like the flu and COVID, we breathe out tiny droplets of fluids that contain the pathogen. Healthy people around us breathe in these pathogen-containing droplets, which attach inside their nose and infect the cells that line the nasal passageways. The pathogen replicates and can be released back into the air when an individual who is sick, whether they know it or not, sneezes, coughs, laughs, sings, or even just breathes.

The new study details the research team’s efforts to create a nasal spray to defend against airborne respiratory illness. “The spray, called Pathogen Capture and Neutralizing Spray (PCANS) in the paper, was developed using ingredients from the FDA’s Inactive Ingredient Database (IID), which have been previously used in approved nasal sprays, or from the Generally Recognized as Safe (GRAS) list of the FDA,” said co-senior author Nitin Joshi, PhD, an Assistant Professor of Anesthesiology at Brigham and Women’s Hospital. “We developed a drug-free formulation using these compounds to block germs in three ways — PCANS forms a gel-like matrix that traps respiratory droplets, immobilizes the germs, and effectively neutralizes them, preventing infection.”

The researchers did the experiments detailed in the study under laboratory settings. They have not studied PCANS directly in humans. The researchers developed the formulation and studied its ability to capture respiratory droplets in a 3D-printed replica of a human nose. They showed that when sprayed in the nasal cavity replica, PCANS captured twice as many droplets as mucus alone.

“PCANS forms a gel, increasing its mechanical strength by a hundred times, forming a solid barrier,” said primary author John Joseph, PhD, a former postdoctoral fellow at Brigham and Women’s Hospital. “It blocked and neutralized almost 100% of all viruses and bacteria we tested, including Influenza, SARS-CoV-2, RSV, adenovirus, K Pneumonia and more.”

Experiments in mice showed that a single dose of the PCANS nasal spray could effectively block infection from an influenza virus (PR8) at 25 times the lethal dose. Virus levels in the lungs were reduced by >99.99%, and the inflammatory cells and cytokines in the lungs of PCANS-treated animals were normal.

“The formulation’s ability to inactivate a broad spectrum of pathogens, including the deadly PR8 influenza virus, demonstrates its high effectiveness,” said co-senior author Yohannes Tesfaigzi, PhD, AstraZeneca Professor of Medicine in the Field of Respiratory and Inflammatory Diseases at Brigham and Women’s Hospital. “In a rigorous mouse model study, prophylactic treatment with PCANS demonstrated exceptional efficacy, with treated mice exhibiting complete protection, while the untreated group showed no such benefit.”

While the study’s limitations include the lack of human studies of PCANS, it provides a strong foundation for future research to explore the full potential of PCANS in a broader context. The researchers are exploring whether PCANS can also block allergens, opening a potential new avenue for allergy relief.

Reference:

John Joseph, Helna Mary Baby, Toward a Radically Simple Multi-Modal Nasal Spray for Preventing Respiratory Infections, Advanced Materials, https://doi.org/10.1002/adma.202406348.

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Maternal and neonatal outcomes following mechanical cervical dilatation similar to those without dilatation for first trimester pregnancy loss: Study

Maternal and neonatal outcomes following mechanical cervical dilatation are similar to those without dilatation for first trimester pregnancy loss suggests a study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology.

Earlier studies have indicated a potential link between dilatation and curettage (D&C) and subsequent preterm delivery, possibly attributed to cervical damage. This study examines outcomes in pregnancies subsequent to first-trimester curettage with and without cervical dilatation. A retrospective cohort study was conducted on women who conceived after undergoing curettage due to a first trimester pregnancy loss. Maternal and neonatal outcomes of the subsequent pregnancy were compared between two groups: women who underwent cervical dilatation before their curettage and those who had curettage without dilatation. The primary outcome assessed was the rate of preterm delivery at the subsequent pregnancy, and secondary outcomes included other adverse maternal and neonatal outcomes. Univariate analysis was performed, followed by multiple logistic regression models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS: Among the 1087 women meeting the inclusion criteria during the study period, 852 (78.4 %) underwent first-trimester curettage with cervical dilatation, while 235 (21.6 %) opted for curettage only. No significant maternal or neonatal different outcomes were noted between the study groups, including preterm delivery (5.5 % vs. 3.5 %, p = 0.16), fertility treatments, placental complications, and mode of delivery. However, deliveries following D&C were associated with higher rates of small for gestational age neonates (7.6 % vs. 3.8 %, p = 0.04). Multivariate analysis revealed that cervical dilation before curettage was not significantly linked to preterm delivery [adjusted odds ratio 0.64 (0.33-1.26), p = 0.20]. The use of cervical dilatation during a curettage procedure for first trimester pregnancy loss, does not confer additional risk of preterm delivery. Further studies are needed to reinforce and validate these results.

Reference:

Margaliot Kalifa, Tal, et al. “Impact of First-trimester Mechanical Cervical Dilatation During Curettage On Maternal and Neonatal Outcomes: a Retrospective Comparative Study.” European Journal of Obstetrics, Gynecology, and Reproductive Biology, vol. 300, 2024, pp. 1-5.

Keywords:

Maternal, neonatal, outcomes, following, mechanical, cervical, dilatation, similar, without dilatation, first trimester, pregnancy loss, study, European Journal of Obstetrics & Gynecology and Reproductive Biology, Margaliot Kalifa

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