Human papillomavirus (HPV) infection is linked to development of cancer of cervix, vagina, vulva, penis, ano-genital and non-genital oro-pharyngeal sites. HPV being a sexually transmitted virus infects both genders equally but with higher chances of pathological outcome in women. In the absence of organized screening programs, women report HPV-infected lesions at relatively advanced stages where they are subjected to standard treatments that are not HPV-specific. HPV infection-driven lesions usually take 10–20 years for malignant progression and are preceded by well-characterized pre-cancer stages. Despite availability of window for pharmacological intervention, therapeutic that could eradicate HPV from infected lesions is currently lacking. A variety of experimental approaches have been made to address this lacuna and there has been significant progress in a number of lead molecules which are in different stages of clinical and pre-clinical development. Present review provides a brief overview of the magnitude of the problem and current status of research on promising lead molecules, formulations and therapeutic strategies that showed potential to translate to clinically-viable HPV therapeutics to counteract this reproductive health challenge
Introduction: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn,
research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1
rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl.
Aim: To predict the probability of stone free status calculated by CROES nomogram and to test the accuracy of our fi tted regression model to predict outcomes of PCNL. Methods: From July 2018 to May 2019, data of 100 patients underwent PCNL procedure for renal stones at Urology department at Menoufi a University was collected and postoperative results were compared to the preoperative predicted stone free status. The CROES nomogram was applied to the data of all cases using its scale to calculate the total score and corresponding percent of stone free status after the procedure. We used binary logistic regression to test whether the six factors in the study can predict the PCNL outcome. We compared the calculated probabilities of stone free by our fitted regression model to the traditional method using the whole 6 parameters on the scale of nomogram.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This article discusses the use of magnesium sulfate (MgSO4) for treating severe preeclampsia and eclampsia. It summarizes evidence from the Magpie Trial showing MgSO4 significantly reduces the risk of eclampsia recurrence and maternal mortality compared to other anticonvulsants. The article reviews MgSO4 regimens, monitoring for toxicity, and the need for training health workers in developing countries on its proper use. It concludes increased availability and training on MgSO4 could help reduce eclampsia's contribution to maternal mortality.
EFFECTIVENESS OF INTERMITTENT PREVENTIVE TREATMENT IN PREGNANCY WITH SULPHADO...oyepata
EFFECTIVENESS OF INTERMITTENT PREVENTIVE TREATMENT IN PREGNANCY WITH
SULPHADOXINE-PYRIMETHAMINE AGAINST MALARIA IN NORTHERN NIGERIA
Builder MI*1, Anzaku SA2 and Joseph SO1
Oral antihypertensive therapy for severe hypertension in pregnancy and postp...Ant Guzman
Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review
This systematic review identified 15 randomized controlled trials involving 914 pregnant women and one postpartum trial with 38 women evaluating oral antihypertensive agents for treating severe hypertension. Most trials compared oral/sublingual nifedipine capsules to parenteral hydralazine or labetalol. Nifedipine achieved similar treatment success rates as hydralazine or labetalol with fewer side effects. Target blood pressure was achieved about 50% of the time with oral labetalol or methyldopa with no differences in maternal or fetal outcomes between these agents. The review concluded that oral nifedip
Albumin versus fresh frozen plasma in managing diuretic resistant edema in ch...iosrphr_editor
This study was carried out to compare the efficacy, cost effectiveness and outcome of albumin with fresh frozen plasma (FFP) in the treatment of diuretic resistant edema in childhood idiopathic nephrotic syndrome.Methods: Fifty four patients with idiopathic NS were enrolled in this prospective analytic study. Patients with moderate to severe edema with serum albumin <15 gm/L were given albumin and FFP dividing into two groups. Group-A, received intravenous albumin- 1 gm/kg/day and Group-B intravenous FFP 15ml/kg/day. Total number of albumin and FFP infusion were determined by edema reduction. Cost effectiveness was also calculated. Results: Diagnosis of NS and biochemical parameters were same in both groups. Dry weight was achieved in Group-A in 6.66± 3.710 days and in Group-B 6.66± 3.038 days. In Group-A the number of albumin infusion required was 1.44±0.697 and Group-B FFP infusion required was 3.11± 1.5 (p=0.0001). Group A needed 4608.00 ($57.6) taka for albumin whereas Group B needed only 2177.00($ 27.2) taka for FFP (p=0.0001). No significant complications were observed in both the groups.Conclusion: FFP costs half than albumin and same duration required reducing edema but the cost-effectiveness may place FFP as a better choice especially in developing countries of the world.
Introduction: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn,
research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1
rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl.
Aim: To predict the probability of stone free status calculated by CROES nomogram and to test the accuracy of our fi tted regression model to predict outcomes of PCNL. Methods: From July 2018 to May 2019, data of 100 patients underwent PCNL procedure for renal stones at Urology department at Menoufi a University was collected and postoperative results were compared to the preoperative predicted stone free status. The CROES nomogram was applied to the data of all cases using its scale to calculate the total score and corresponding percent of stone free status after the procedure. We used binary logistic regression to test whether the six factors in the study can predict the PCNL outcome. We compared the calculated probabilities of stone free by our fitted regression model to the traditional method using the whole 6 parameters on the scale of nomogram.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
This article discusses the use of magnesium sulfate (MgSO4) for treating severe preeclampsia and eclampsia. It summarizes evidence from the Magpie Trial showing MgSO4 significantly reduces the risk of eclampsia recurrence and maternal mortality compared to other anticonvulsants. The article reviews MgSO4 regimens, monitoring for toxicity, and the need for training health workers in developing countries on its proper use. It concludes increased availability and training on MgSO4 could help reduce eclampsia's contribution to maternal mortality.
EFFECTIVENESS OF INTERMITTENT PREVENTIVE TREATMENT IN PREGNANCY WITH SULPHADO...oyepata
EFFECTIVENESS OF INTERMITTENT PREVENTIVE TREATMENT IN PREGNANCY WITH
SULPHADOXINE-PYRIMETHAMINE AGAINST MALARIA IN NORTHERN NIGERIA
Builder MI*1, Anzaku SA2 and Joseph SO1
Oral antihypertensive therapy for severe hypertension in pregnancy and postp...Ant Guzman
Oral antihypertensive therapy for severe hypertension in pregnancy and postpartum: a systematic review
This systematic review identified 15 randomized controlled trials involving 914 pregnant women and one postpartum trial with 38 women evaluating oral antihypertensive agents for treating severe hypertension. Most trials compared oral/sublingual nifedipine capsules to parenteral hydralazine or labetalol. Nifedipine achieved similar treatment success rates as hydralazine or labetalol with fewer side effects. Target blood pressure was achieved about 50% of the time with oral labetalol or methyldopa with no differences in maternal or fetal outcomes between these agents. The review concluded that oral nifedip
Albumin versus fresh frozen plasma in managing diuretic resistant edema in ch...iosrphr_editor
This study was carried out to compare the efficacy, cost effectiveness and outcome of albumin with fresh frozen plasma (FFP) in the treatment of diuretic resistant edema in childhood idiopathic nephrotic syndrome.Methods: Fifty four patients with idiopathic NS were enrolled in this prospective analytic study. Patients with moderate to severe edema with serum albumin <15 gm/L were given albumin and FFP dividing into two groups. Group-A, received intravenous albumin- 1 gm/kg/day and Group-B intravenous FFP 15ml/kg/day. Total number of albumin and FFP infusion were determined by edema reduction. Cost effectiveness was also calculated. Results: Diagnosis of NS and biochemical parameters were same in both groups. Dry weight was achieved in Group-A in 6.66± 3.710 days and in Group-B 6.66± 3.038 days. In Group-A the number of albumin infusion required was 1.44±0.697 and Group-B FFP infusion required was 3.11± 1.5 (p=0.0001). Group A needed 4608.00 ($57.6) taka for albumin whereas Group B needed only 2177.00($ 27.2) taka for FFP (p=0.0001). No significant complications were observed in both the groups.Conclusion: FFP costs half than albumin and same duration required reducing edema but the cost-effectiveness may place FFP as a better choice especially in developing countries of the world.
1. The document provides information on the emergency contraceptive ulipristal acetate (UPA), including its mechanism of action, pharmacokinetics, clinical evaluations in randomized studies, contraindications, precautions, adverse reactions and drug interactions.
2. Key points include that UPA prevents pregnancy by inhibiting or delaying ovulation and altering the endometrium; clinical trials found it to be over 99% effective in preventing pregnancy when taken as directed within 120 hours of intercourse.
3. Common adverse reactions included headache, nausea and menstrual irregularities. UPA should not be used by women with current or history of certain cancers, liver disease or high risk of arterial or venous thrombotic diseases.
1. The document discusses extended cycle oral contraceptives that provide contraception for 84 days by suppressing ovulation through a combination of ethinyl estradiol and levonorgestrel, followed by 7 days of placebo or low-dose estrogen pills.
2. Clinical trials showed that extended cycle pills were as effective at preventing pregnancy as conventional 28-day pills, with similar safety profiles. Adverse effects were mild and consistent with other combined oral contraceptives.
3. The extended cycle regimen was found to be over 99% effective at preventing pregnancy when taken correctly, and resulted in less frequent bleeding and spotting compared to a 28-day regimen.
This guideline from the European Society of Anaesthesiology and Intensive Care provides evidence-based recommendations for pre-operative fasting in children. A literature review was conducted covering studies comparing liberal versus conservative fasting regimens, the impact of food/fluid composition and comorbidities, the use of gastric ultrasound, and early postoperative feeding. The main recommendations based on GRADE 1C or 1B evidence were to reduce clear fluid fasting to 1 hour, reduce breast milk fasting to 3 hours, and allow early postoperative feeding. Gastric ultrasound may be useful for clinical decision making, and a light breakfast with controlled intake may be well tolerated. More research is still needed in several areas.
This study assessed the acceptability and feasibility of menstrual regulation with medication (MRM) among early pregnant women in Bangladesh. 294 women underwent MRM using mifepristone followed by misoprostol. 91% had successful termination, with most complaining of moderate bleeding and pain. 87% found the side effects acceptable. 90% were satisfied with MRM and said they would recommend it. The study concluded MRM is a safe, effective and acceptable method for early termination in Bangladesh that could help reduce unsafe abortions.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This randomized controlled trial tested the effects of antibiotics (erythromycin and co-amoxiclav) on neonatal outcomes in women with preterm prelabor rupture of membranes (pPROM). 4826 women with pPROM were assigned to receive erythromycin, co-amoxiclav, both antibiotics, or placebo for 10 days or until delivery. Erythromycin was associated with reductions in the composite outcome of neonatal death, chronic lung disease or major brain abnormality compared to placebo, as well as prolongation of pregnancy and reductions in other neonatal complications. Co-amoxiclav provided no benefits and was associated with an increased risk of necrotizing enterocolitis. Eryth
This randomized controlled trial tested the effects of antibiotics (erythromycin and co-amoxiclav) on neonatal outcomes in women with preterm prelabor rupture of membranes (pPROM). 4826 women with pPROM were assigned to receive erythromycin, co-amoxiclav, both antibiotics, or placebo for 10 days or until delivery. Erythromycin was associated with reductions in the composite outcome of neonatal death, chronic lung disease or major brain abnormality compared to placebo, as well as prolongation of pregnancy and reductions in other neonatal complications. Co-amoxiclav was associated with prolongation of pregnancy but also an increased risk of necrotizing enterocolitis and did
Bain et al-2014-bjog__an_international_journal_of_obstetrics_&_gynaecologyJaime Zapata Salazar
1) The study evaluated different loading infusion rates (60 minutes vs 20 minutes) of magnesium sulfate given to women before 30 weeks gestation for preterm fetal neuroprotection.
2) Overall, 71% of women experienced adverse effects during the first hour of infusion, with no significant difference between the 60-minute (60%) and 20-minute (81%) groups.
3) Women in the 60-minute group experienced significantly less warmth and flushing at 20 minutes into the infusion compared to the 20-minute group, but there were no other significant differences in adverse effects between the groups.
Program Strategies to Reduce Post-Partum Hemorrhage and Pre-Eclampsia_John Va...CORE Group
This document summarizes research on strategies to reduce postpartum hemorrhage (PPH) and pre-eclampsia/eclampsia (PE/E) through the use of misoprostol and magnesium sulfate (MgSO4). It finds that:
1) Community-based distribution of misoprostol for home births achieved higher coverage rates than programs that only distributed in antenatal care or health facilities. Distribution by community health workers during home visits late in pregnancy resulted in the highest coverage.
2) Studies found very low rates of adverse outcomes from misoprostol use, including few instances of mistimed administration. No maternal deaths were attributed to misoprostol.
3)
Safety and efficacy of aflibercept in combination with fluorouracil, leucovor...Mary Ondinee Manalo Igot
This study evaluated the safety and efficacy of combining aflibercept with FOLFIRI chemotherapy (fluorouracil, leucovorin, irinotecan) in Asian patients with metastatic colorectal cancer who had progressed after prior oxaliplatin-based therapy. Nineteen patients received treatment with aflibercept and FOLFIRI. The combination showed a median progression-free survival of 4.1 months and median overall survival of 11.6 months. The majority of adverse events were grade 1-2 and included neutropenia, anemia, fatigue, and liver enzyme elevation. Grade 3 toxicities included neutropenia and neutropenic complications. All adverse events were managed with supportive care and
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Management of epilepsy and sodium valproateNoor Giasuddin
- Epilepsy is one of the most common neurological conditions characterized by recurrent seizures.
- Sodium valproate is recommended as a first-line treatment for many seizure types and epilepsy syndromes according to guidelines due to its broad spectrum of effectiveness shown in clinical studies.
- Multiple randomized controlled trials have found sodium valproate to be an effective and well-tolerated treatment for both children and adults with newly diagnosed focal epilepsy. However, women must be warned about the risks of fetal exposure during pregnancy.
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The document summarizes 3 journal articles on the treatment of severe hypertension during pregnancy. The first article recommends intravenous labetalol and hydralazine as first-line therapies. It also recommends oral nifedipine and close monitoring of maternal and fetal status. The second article finds that low-dose aspirin initiated before 16 weeks of gestation reduces the risk of severe preeclampsia but not mild preeclampsia. The third article finds that oral nifedipine is as effective as intravenous antihypertensives for treating severe hypertension during pregnancy and postpartum, with similar safety profiles.
Prophylactic Aminophylline for Prevention of Apnea at Higher-Risk Preterm Neo...amir mohammad Armanian
1. The study assessed the prophylactic effects of aminophylline on apnea in preterm neonates with a gestational age less than 32 weeks and/or birth weight less than 1200g.
2. 52 neonates were randomly assigned to receive either aminophylline (group A) or no aminophylline (group C) for the first 10 days.
3. Primary outcomes like apnea, bradycardia and cyanosis were significantly lower in the aminophylline group compared to the control group. Secondary outcomes like need for CPAP and length of hospital stay were also lower in the aminophylline group.
1) Magnesium sulfate has been shown to provide neuroprotective effects for extremely premature infants by reducing cerebral injury and cell death.
2) While some studies found magnesium sulfate to be neuroprotective, others did not find sustainable effects, so more randomized studies were conducted.
3) A Cochrane review of 5 randomized trials found magnesium sulfate significantly reduced the risk of cerebral palsy in premature infants without increasing mortality risks for mother or infant.
A COMPARATIVE ANALYSIS OF HEMATOLOGICAL INDICES IN PREGNANT WOMEN AND NON PR...FidelityP
Red blood cell (RBC) indices are individual components of a routine blood test called the complete blood count (CBC). The CBC is used to measure the quantity and physical characteristics of different types of cells found in your blood. Blood consists of RBCs, white blood cells (WBCs), and platelets that are suspended in your plasma. Platelets are cells that enable clot formation. RBCs contain hemoglobin, which carries oxygen throughout your body to all of your tissues and organs. An RBC is pale red and gets its color from hemoglobin. It’s shaped like a doughnut, but it has a thinner area in the middle instead of a hole. Your RBCs are normally all the same color, size, and shape. However, certain conditions can cause variations that impair their ability to function properly. The RBC indices measure the size, shape, and physical characteristics of the RBCs. Your doctor can use RBC indices to help diagnose the cause of anemia. Anemia is a common blood disorder in which you have too few, misshapen, or poorly functional RBCs123
Intensive glycemic control aimed at maintaining blood glucose between 80-110 mg/dl in adult ICU patients does not reduce mortality and significantly increases the risk of hypoglycemia compared to conventional control between 140-180 mg/dl. Multiple large randomized controlled trials found no benefit to intensive control and post-hoc analyses determined hypoglycemia independently increases mortality. Current guidelines recommend insulin therapy only for blood glucose over 180 mg/dl and targeting 140-180 mg/dl range to minimize hypoglycemia risk while avoiding hyperglycemia's harmful effects.
Abdominal & vaginal hysterectomy, approaches to preventing complicatios.pptxAdeniyiAkiseku
This document discusses approaches to preventing complications from abdominal and vaginal hysterectomy. It notes that hysterectomy is a common procedure that can have risks depending on the surgical technique and route. The main complications discussed are infection, bleeding, injury to nearby organs like the ureters or bowels, and blood clots. It provides details on risk factors and effective strategies to prevent these complications, such as proper technique, use of prophylactic antibiotics and blood thinners, and approaches like ligating blood vessels close to the uterus.
This document summarizes a study estimating the incidence of induced abortion in Nigeria in 2012. The study used an indirect methodology relying on surveys of 772 health facilities and 194 health professionals. The surveys found that an estimated 1.25 million induced abortions occurred in Nigeria in 2012, equivalent to a rate of 33 abortions per 1,000 women aged 15-49. An estimated 212,000 women received treatment for complications from unsafe abortion. The high levels of unintended pregnancy and unsafe abortion indicate a need for improved access to contraception and safe abortion services in Nigeria.
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1. The document provides information on the emergency contraceptive ulipristal acetate (UPA), including its mechanism of action, pharmacokinetics, clinical evaluations in randomized studies, contraindications, precautions, adverse reactions and drug interactions.
2. Key points include that UPA prevents pregnancy by inhibiting or delaying ovulation and altering the endometrium; clinical trials found it to be over 99% effective in preventing pregnancy when taken as directed within 120 hours of intercourse.
3. Common adverse reactions included headache, nausea and menstrual irregularities. UPA should not be used by women with current or history of certain cancers, liver disease or high risk of arterial or venous thrombotic diseases.
1. The document discusses extended cycle oral contraceptives that provide contraception for 84 days by suppressing ovulation through a combination of ethinyl estradiol and levonorgestrel, followed by 7 days of placebo or low-dose estrogen pills.
2. Clinical trials showed that extended cycle pills were as effective at preventing pregnancy as conventional 28-day pills, with similar safety profiles. Adverse effects were mild and consistent with other combined oral contraceptives.
3. The extended cycle regimen was found to be over 99% effective at preventing pregnancy when taken correctly, and resulted in less frequent bleeding and spotting compared to a 28-day regimen.
This guideline from the European Society of Anaesthesiology and Intensive Care provides evidence-based recommendations for pre-operative fasting in children. A literature review was conducted covering studies comparing liberal versus conservative fasting regimens, the impact of food/fluid composition and comorbidities, the use of gastric ultrasound, and early postoperative feeding. The main recommendations based on GRADE 1C or 1B evidence were to reduce clear fluid fasting to 1 hour, reduce breast milk fasting to 3 hours, and allow early postoperative feeding. Gastric ultrasound may be useful for clinical decision making, and a light breakfast with controlled intake may be well tolerated. More research is still needed in several areas.
This study assessed the acceptability and feasibility of menstrual regulation with medication (MRM) among early pregnant women in Bangladesh. 294 women underwent MRM using mifepristone followed by misoprostol. 91% had successful termination, with most complaining of moderate bleeding and pain. 87% found the side effects acceptable. 90% were satisfied with MRM and said they would recommend it. The study concluded MRM is a safe, effective and acceptable method for early termination in Bangladesh that could help reduce unsafe abortions.
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This randomized controlled trial tested the effects of antibiotics (erythromycin and co-amoxiclav) on neonatal outcomes in women with preterm prelabor rupture of membranes (pPROM). 4826 women with pPROM were assigned to receive erythromycin, co-amoxiclav, both antibiotics, or placebo for 10 days or until delivery. Erythromycin was associated with reductions in the composite outcome of neonatal death, chronic lung disease or major brain abnormality compared to placebo, as well as prolongation of pregnancy and reductions in other neonatal complications. Co-amoxiclav provided no benefits and was associated with an increased risk of necrotizing enterocolitis. Eryth
This randomized controlled trial tested the effects of antibiotics (erythromycin and co-amoxiclav) on neonatal outcomes in women with preterm prelabor rupture of membranes (pPROM). 4826 women with pPROM were assigned to receive erythromycin, co-amoxiclav, both antibiotics, or placebo for 10 days or until delivery. Erythromycin was associated with reductions in the composite outcome of neonatal death, chronic lung disease or major brain abnormality compared to placebo, as well as prolongation of pregnancy and reductions in other neonatal complications. Co-amoxiclav was associated with prolongation of pregnancy but also an increased risk of necrotizing enterocolitis and did
Bain et al-2014-bjog__an_international_journal_of_obstetrics_&_gynaecologyJaime Zapata Salazar
1) The study evaluated different loading infusion rates (60 minutes vs 20 minutes) of magnesium sulfate given to women before 30 weeks gestation for preterm fetal neuroprotection.
2) Overall, 71% of women experienced adverse effects during the first hour of infusion, with no significant difference between the 60-minute (60%) and 20-minute (81%) groups.
3) Women in the 60-minute group experienced significantly less warmth and flushing at 20 minutes into the infusion compared to the 20-minute group, but there were no other significant differences in adverse effects between the groups.
Program Strategies to Reduce Post-Partum Hemorrhage and Pre-Eclampsia_John Va...CORE Group
This document summarizes research on strategies to reduce postpartum hemorrhage (PPH) and pre-eclampsia/eclampsia (PE/E) through the use of misoprostol and magnesium sulfate (MgSO4). It finds that:
1) Community-based distribution of misoprostol for home births achieved higher coverage rates than programs that only distributed in antenatal care or health facilities. Distribution by community health workers during home visits late in pregnancy resulted in the highest coverage.
2) Studies found very low rates of adverse outcomes from misoprostol use, including few instances of mistimed administration. No maternal deaths were attributed to misoprostol.
3)
Safety and efficacy of aflibercept in combination with fluorouracil, leucovor...Mary Ondinee Manalo Igot
This study evaluated the safety and efficacy of combining aflibercept with FOLFIRI chemotherapy (fluorouracil, leucovorin, irinotecan) in Asian patients with metastatic colorectal cancer who had progressed after prior oxaliplatin-based therapy. Nineteen patients received treatment with aflibercept and FOLFIRI. The combination showed a median progression-free survival of 4.1 months and median overall survival of 11.6 months. The majority of adverse events were grade 1-2 and included neutropenia, anemia, fatigue, and liver enzyme elevation. Grade 3 toxicities included neutropenia and neutropenic complications. All adverse events were managed with supportive care and
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
All manuscripts are subject to rapid peer review. Those of high quality (not previously published and not under consideration for publication in another journal) will be published without delay.
Management of epilepsy and sodium valproateNoor Giasuddin
- Epilepsy is one of the most common neurological conditions characterized by recurrent seizures.
- Sodium valproate is recommended as a first-line treatment for many seizure types and epilepsy syndromes according to guidelines due to its broad spectrum of effectiveness shown in clinical studies.
- Multiple randomized controlled trials have found sodium valproate to be an effective and well-tolerated treatment for both children and adults with newly diagnosed focal epilepsy. However, women must be warned about the risks of fetal exposure during pregnancy.
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The document summarizes 3 journal articles on the treatment of severe hypertension during pregnancy. The first article recommends intravenous labetalol and hydralazine as first-line therapies. It also recommends oral nifedipine and close monitoring of maternal and fetal status. The second article finds that low-dose aspirin initiated before 16 weeks of gestation reduces the risk of severe preeclampsia but not mild preeclampsia. The third article finds that oral nifedipine is as effective as intravenous antihypertensives for treating severe hypertension during pregnancy and postpartum, with similar safety profiles.
Prophylactic Aminophylline for Prevention of Apnea at Higher-Risk Preterm Neo...amir mohammad Armanian
1. The study assessed the prophylactic effects of aminophylline on apnea in preterm neonates with a gestational age less than 32 weeks and/or birth weight less than 1200g.
2. 52 neonates were randomly assigned to receive either aminophylline (group A) or no aminophylline (group C) for the first 10 days.
3. Primary outcomes like apnea, bradycardia and cyanosis were significantly lower in the aminophylline group compared to the control group. Secondary outcomes like need for CPAP and length of hospital stay were also lower in the aminophylline group.
1) Magnesium sulfate has been shown to provide neuroprotective effects for extremely premature infants by reducing cerebral injury and cell death.
2) While some studies found magnesium sulfate to be neuroprotective, others did not find sustainable effects, so more randomized studies were conducted.
3) A Cochrane review of 5 randomized trials found magnesium sulfate significantly reduced the risk of cerebral palsy in premature infants without increasing mortality risks for mother or infant.
A COMPARATIVE ANALYSIS OF HEMATOLOGICAL INDICES IN PREGNANT WOMEN AND NON PR...FidelityP
Red blood cell (RBC) indices are individual components of a routine blood test called the complete blood count (CBC). The CBC is used to measure the quantity and physical characteristics of different types of cells found in your blood. Blood consists of RBCs, white blood cells (WBCs), and platelets that are suspended in your plasma. Platelets are cells that enable clot formation. RBCs contain hemoglobin, which carries oxygen throughout your body to all of your tissues and organs. An RBC is pale red and gets its color from hemoglobin. It’s shaped like a doughnut, but it has a thinner area in the middle instead of a hole. Your RBCs are normally all the same color, size, and shape. However, certain conditions can cause variations that impair their ability to function properly. The RBC indices measure the size, shape, and physical characteristics of the RBCs. Your doctor can use RBC indices to help diagnose the cause of anemia. Anemia is a common blood disorder in which you have too few, misshapen, or poorly functional RBCs123
Intensive glycemic control aimed at maintaining blood glucose between 80-110 mg/dl in adult ICU patients does not reduce mortality and significantly increases the risk of hypoglycemia compared to conventional control between 140-180 mg/dl. Multiple large randomized controlled trials found no benefit to intensive control and post-hoc analyses determined hypoglycemia independently increases mortality. Current guidelines recommend insulin therapy only for blood glucose over 180 mg/dl and targeting 140-180 mg/dl range to minimize hypoglycemia risk while avoiding hyperglycemia's harmful effects.
Similar to Therapeutic startegies for human papillomavirus infection and associated cancers (20)
Abdominal & vaginal hysterectomy, approaches to preventing complicatios.pptxAdeniyiAkiseku
This document discusses approaches to preventing complications from abdominal and vaginal hysterectomy. It notes that hysterectomy is a common procedure that can have risks depending on the surgical technique and route. The main complications discussed are infection, bleeding, injury to nearby organs like the ureters or bowels, and blood clots. It provides details on risk factors and effective strategies to prevent these complications, such as proper technique, use of prophylactic antibiotics and blood thinners, and approaches like ligating blood vessels close to the uterus.
This document summarizes a study estimating the incidence of induced abortion in Nigeria in 2012. The study used an indirect methodology relying on surveys of 772 health facilities and 194 health professionals. The surveys found that an estimated 1.25 million induced abortions occurred in Nigeria in 2012, equivalent to a rate of 33 abortions per 1,000 women aged 15-49. An estimated 212,000 women received treatment for complications from unsafe abortion. The high levels of unintended pregnancy and unsafe abortion indicate a need for improved access to contraception and safe abortion services in Nigeria.
HYPERTENSION IN PREGNANCY SOGON FINAL ONE.pptAdeniyiAkiseku
Hypertensive disorders are the most common medical complication of pregnancy
It complicates up to 10% of pregnancies
It is a leading cause of maternal and perinatal morbidity and mortality worldwide
Rates are rising because of the older, more obese obstetric population with medical issues
This is an acute terrifying emergency following delivery in which patient suddenly develops dyspnoea, apnoea, cyanosis with or without seizure and shock among other features. It usually occurs secondary to several catastrophic events and may be a tragic experience to the patient and the physician
This document provides an outline on infertility, including definitions, incidence, classifications, factors responsible for fertility, etiology, investigation, and management. It notes that infertility affects 10-15% of couples in developed countries and 25-30% in Nigeria. Causes are classified as male factors (40%), female factors (40%), combined (10%), or unexplained (5-10%). Investigations include semen analysis, ovulation confirmation, and tubal patency tests. Management includes treating any etiological factors, ovulation induction drugs, surgery, and artificial reproductive techniques like IVF and ICSI.
MANAGEMENT OF EARLY STAGE OVARIAN MALIGNANCY.pptAdeniyiAkiseku
This document discusses the management of early stage ovarian malignancy. It covers the epidemiology, risk factors, clinical presentation, staging, and treatment options for early stage ovarian cancer. Standard treatment involves total abdominal hysterectomy, bilateral salpingo-oophorectomy, and infracolic omentectomy. For young women who wish to preserve fertility, fertility-sparing surgery may be an option for stage 1A disease less than 35 years old with certain criteria met. Chemotherapy is also sometimes recommended post-surgery to improve survival outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
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8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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Therapeutic startegies for human papillomavirus infection and associated cancers
1. See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/369173342
Pregnancy Hypertension: An International Journal of Women's
Cardiovascular Health
Article · January 2023
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3. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 32 (2023) 22–27
23
the commonest being Zuspan and Pritchard regimens [13]. The Zuspan
regimen involves a loading intravenous dose of 4 g given over 10 –
15mins followed by an intravenous infusion of 1 g per hour for 24 h
[14]. In a study by Oguntunde et al. [15], the challenges with the use of
MgSO4 were facility-oriented (most facilities assessed had no MgSO4 in
store), provider oriented (there was inadequate staffing and less than
half of the providers had ever been trained on the correct use of MgSO4
and community/patient-oriented (misconception of the disease entity
thus preventing prompt presentation for care was identified).
Imaralu et al in their study on clinical correlates of MgSO4 revealed
that using the Pritchard regimen, MgSO4 levels peak at 8 h and there
after decline with recorded seizures occurring within 4 h before the
onset of maintenance dose [16]. The effect of reduction in the mainte
nance dose of the Zuspan regimen to 12 h in Eclampsia and severe
preeclampsia by Anjum et al and Unwaha et al respectively revealed its
efficacy and safety in the prevention of convulsions [17,18]. However,
while Anjum and colleagues did not assess maternal adverse effects and
perinatal outcomes, Unwaha et al did not assess the effect as regards
postpartum haemorrhage [17,18].
This study thus aimed to compare the Zuspan regimen with its 12-
hour modification in the treatment of severe pre-eclampsia and
eclampsia (SPE/EC) at Federal Medical Centre and Sacred Heart Hos
pital, Abeokuta, Ogun state, Nigeria. The outcomes of interest include
the occurrence of seizures, maternal signs of MgSO4 toxicity including
loss of deep tendon reflex, respiratory depression and pulmonary
oedema, blood loss at delivery, Apgar scores, incidence of neonatal
admissions and perinatal/neonatal deaths following treatment with the
short course of MgSO4 regimen as against the Zuspan Regimen in pa
tients with SPE/EC.
2. Methods
This was a randomised double-blind placebo-controlled trial con
ducted at the departments of Obstetrics and Gynaecology, Federal
Medical Centre and Sacred Heart Hospital, Abeokuta. The study
involved two groups; Group A – intervention (4 g loading dose and
maintenance dose for 12 h) and Group B– control (4 g loading dose and
maintenance dose being standard for Zuspan Regimen).
Participants in this study included parturients with either severe
preeclampsia or eclampsia at gestational ages of ≥34 weeks or in their
puerperium but excluded those with urinary output less than 30mls/hr.,
those who had had previous administration of MgSO4 or any form of
anticonvulsants from the referral center, background history of seizures,
metabolic disorders or other neurologic disorders, presence of other
complications of SPE/EC including pulmonary edema and those with
contraindication/ allergy to MgSO4 (such as myasthenia gravis).
The sample size was calculated using the formula [19]:
N = 2 x
[
z1− α + z1− β
δ0
]2
x p(1 − p)
p = 5.7% (rate of occurrence of convulsion (primary outcome variable)
following treatment with MgSO4 in the Collaborative Eclampsia trial)
[20]; δ = 10%; α = 0.05 thus z1− ∝ = 1.645;β = 0.20 thus z1− β = 0.845.
A total of 148 participants with 74 in each group were studied (using
an attrition rate of 10%).
One hundred and forty-eight pre-packed study drugs which consisted
of 74 packs of intervention drugs and 74 packs of control were provided.
Using computer-generated ‘74′
random numbers between 1 and 148, the
number label for the intervention group (Group A) was determined and
the remaining numbers were assigned to the control group (Group B).
The 7 ampoules in the control packs contained 10mls of 50% w/v of
MgSO4 while the first four (I-IV) ampoules of the intervention packs
comprised 10mls of 50% w/v of MgSO4 and the last 3 ampoules were
placebo (10mls of sterile water).
Patients were recruited into the study based on standard definitions
of SPE/EC [8,9]. Randomization of the participants was based on the
number labelled on the pack at the time of recruitment. Following
randomization, 8mls was taken from vial I in a 20mls syringe mixed
with 12mls of sterile water and this was administered as bolus intrave
nously over 15 mins. The remaining 2mls within the vial were discarded.
Then, 8mls of contents of vial II–VII taken serially were then given as a
continuous infusion in 500mls of 0.9% normal Saline alternating 5%
Dextrose saline 4hourly.
Patients with recurrence of seizures had 2 g (4mls) MgSO4 given to
abort seizures if these occurred >30mins from the time of loading dose
(Vial I). MgSO4 for this purpose was of the same brand and batch but
packed separately from the interventional medicinal products.
Information obtained from the participants through the proforma
was coded and analyzed using the Statistical Package for Social Sciences
(SPSS) version 25.
Ethical permission to carry out the study was obtained from both
Hospitals’ Health Research Ethics Committee (HREC). Protocol number
was FMCA/243/HREC/03/2016/10; SHH/EC/EA/03/03/19. Written
informed consent was obtained from each parturient before random
isation and those who declined to participate were managed according
to the departmental protocol for such conditions without prejudice.
3. Results
All women recruited had allocated regimen and completed follow-
up. The recruitment flow diagram is as shown in Fig. 1. Data analysis
was done by intention to treat. Intervention group had 15 (20.3%) pa
tients with eclampsia (EC) and 59 (79.7%) patients with severe pre
eclampsia (SPE) (with five (6.8%) post-partum EC and three (4.1%)
post-partum SPE) while control group had 17 (23.0%) patients with
EC and 57 (77.0%) with SPE (with three (4.1%) post-partum EC and
seven (9.5%) post-partum SPE). Although fewer patients with EC were
in the intervention than the control group, this difference was not sta
tistically significant (ᵡ2
= 0.160; p = 0.690).
Table 1 shows the Socio-demographic characteristics of the patients
in each group. The modal parity for both groups was nulliparity. There
was no statistical difference in both groups as per socio-demographics.
The modal urinalysis for Group A was 3+ of proteinuria while that
for Group B was 2+ of proteinuria. No statistically significant difference
occurred in the clinico-biochemical parameters between both groups as
stated in Table 2.
Concerning patients with SPE, there was no statistical difference in
the incidence of eclampsia and post-partum haemorrhage (PPH) be
tween the two groups. The blood loss at delivery was significantly less in
the intervention group than the control group (400mls (188) vs 500mls
(200); U = 1128.5; p = 0.044).
There were no signs of MgSO4 toxicity observed in both groups of
parturient with SPE.
There were 56 (75.7%) participants with ante/intrapartum SPE in
the intervention group and 50 (67.6%) with ante/intrapartum SPE in the
control group. Of these, 40 (71.4%) participants in the intervention
group and 37 (74%) participants in the control group had caesarean
section but this difference was not statistically significant (ᵡ2
= 0.088; p
= 0.829).
There was no statistical difference in the recurrence of seizures be
tween both groups of parturient with EC. There was no record of post-
partum haemorrhage in both groups. The blood loss at delivery was
significantly more in the intervention group than the control group
(400mls (300) vs 200mls (150); U = 32.00; p = 0.008). There were 10
(13.5%) participants with ante/intrapartum EC in the intervention
group and 14 (18.9%) with ante/intrapartum EC in the control group.
There was a statistically significant increase in the caesarean section rate
in participants in the intervention group (80.0% vs 28.6%; ᵡ2
= 6.171; p
= 0.036).
There was no statistically significant difference in other maternal
outcomes of both groups as illustrated in Table 3.
E.O. Grillo et al.
4. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 32 (2023) 22–27
24
There were no signs of MgSO4 toxicity in both groups of parturient
with EC.
The perinatal outcomes for the parturient with severe preeclampsia
and eclampsia are illustrated in Table 4.
4. Discussion
This study was to compare maternal and perinatal outcomes between
the intervention group – had 12 h maintenance dose of Zuspan Regimen
and the control group – had 24 h maintenance dose of Zuspan Regimen
in parturient with SPE and EC. It revealed no statistical difference in the
occurrence and recurrence of seizures in both groups for those with both
pre-eclampsia and eclampsia respectively. No participants in this study
had signs of MgSO4 toxicity vis a vis loss of deep tendon reflex, pul
monary oedema and respiratory depression. The blood loss at delivery
was less in the intervention group in those with SPE while in those with
EC, it was more in the intervention group but these differences were
statistically significant. The perinatal outcomes were similar in both
groups for both SPE and EC except for a significant increase in the
number of days on admission in the control group of those neonates
delivered to mothers with eclampsia.
Similar to the findings in the intervention arm of this study, studies
by Unwaha et al, Abd EL Khalifa et al. and Anjum et al. [18,21,22] there
was no incidence of eclampsia in the reduction of maintenance dose of
MgSO4. The findings in the control arm of this study (incidence of
eclampsia of 1.4%) was similar to the study by Abd EL Khalifa et al. [21]
in which the incidence of eclampsia was 1.3% (observed in the 24-hour
group only), though this difference was not statistically significant.
This study revealed no incidence of PPH in the intervention group
with SPE but 0.04% in the control group (both participants in the control
group had abruptio placentae complicating the severe preeclampsia),
similar to the study by Vigil-De Gracia et al. [23] in which a reduced
incidence was found in the reduced maintenance group but in both
studies this was not statistically significant. Though the blood loss in the
intervention group with SPE was less than that of the control group, this
was not statistically significant. The increase in the blood loss in the
control group was affected by the blood loss in the patients with
abruptio placentae. This result reveals that MgSO4 though a smooth
muscle relaxant may not increase the incidence of PPH when used in the
management of ante/intrapartum severe preeclampsia which is also
similar to the findings of the systematic review by Héman et al. [24] that
there was no significant increase in the risk of PPH with use of MgSO4. A
reduction in caesarean section rate in the intervention group with SPE
though not statistically significant was similar to the study by Abd EL
Khalifa et al. [21]. The high rate of caesarean section in both groups may
be attributed to unfavourability of the cervix at presentation and the fact
Fig. 1. CONSORT 2010 flow diagram.
E.O. Grillo et al.
5. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 32 (2023) 22–27
25
that early and safe delivery may improve perinatal and maternal
morbidity and mortality.
Similar to the study by Anjum et al., El-Khayat et al. and Ekele et al.
[22,25,26] (who also attempted a reduction in Pritchard regimen), there
were no signs of MgSO4 toxicity in the mothers with SPE. This was in
contrast to the study by Unwaha et al. [18] in which maternal side effects
like pulmonary oedema (6.3%), hyporeflexia (48.8%) were observed.
This could be explained by the relatively lower concentration of the
MgSO4 infusion used for the maintenance regimen in this study, though
the serum MgSO4 levels were not measured in this study.
The non-significant increase in the recurrence of seizures in the
intervention group among participants with eclampsia was in contrast to
the study by Anjum et al. [17] who recorded recurrence of seizures only
in the 24hr group (13.1%). Recurrent seizures in this study occurred
within the first 12 h of maintenance dose and responded to a repeat
loading dose of 2 g MgSO4 but treatment failure was observed in 4
(5.26%) of the patients in the study by Anjum et al. [17]. The significant
increase in the blood loss for eclamptics in the intervention group
compared with the control group may be explained by the higher rate of
caesarean section in the intervention group. The statistically significant
increase in the caesarean section rate in the intervention group than the
control group (80.0% vs 28.6%) might have been influenced by the less
IUFD in the intervention group than control group (18.2% vs 66.7%) as
caesarean section might be more apt to deliver a live baby and inap
propriate for IUFD. There were no signs of MgSO4 toxicity in this study
as regards patients with eclampsia and this was similar to the study by
Anjum et al. [17].
The higher perinatal mortality in the control groups with both SPE
and EC was cofounded with the higher IUFD (as the IUFD occurred
before enrolment into the study) in the control groups as a sub-analysis
using the neonatal death revealed no significant difference. This was in
contrast to findings by Unwaha et al. [18] which revealed a lower
perinatal mortality (12.5% vs 17.5%) in the 24-hr group in participants
with SPE (though not statistically significant). There was no statistical
difference in the mean Apgar scores at 1 and 5 min between babies in the
intervention and control groups for both severe preeclampsia and
eclampsia however the mean Apgar scores at 1 and 5 min for the neo
nates of eclamptic mothers were lower than that of those with severe
preeclampsia in both groups. This may be explained by the period of
apnoea during the convulsive episodes of eclampsia resulting in respi
ratory and or lactic acidosis from hypoxia thus translating to a reduced
oxygen supply to the foetus causing foetal hypoxia and acidosis.
There was no statistical difference in neonatal unit admission of
these neonates between the intervention and control groups both severe
preeclampsia and eclampsia. This was consistent with the findings in a
similar study by Abd EL Khalifa et al. [21] on women with severe pre
eclampsia in terms of the loading dose regimen, 12-hour maintenance
and 24 h maintenance. In neonates whose mothers had severe pre
eclampsia, the most common indication for NNU admission for both
groups was low birth weight and this is a function of hypertensive dis
orders of pregnancy being a risk factor for intrauterine growth restric
tion and the risk of preterm delivery of these neonates [9]. Similar to the
finding of Unwaha et al. [18], only the intervention group had neonates
admitted for perinatal asphyxia though this was not statistically signif
icant. The number of days on admission in intervention group was less
than that in the control group in neonates whose mothers had SPE
(though not significant) being in contrast to the study by Unwaha et al.
[18] in which the 24-hr group had lesser mean stay on admission. This
may be explained by a lower mean birth weight in the control group in
this study as opposed to a lower mean birthweight in the 12 hr group in
the study by Unwaha et al. [18]. Indications for admission were not
studied in the study by Abd EL Khalifa et al. [21]. In neonates of mothers
with eclampsia, the intervention group had 2 babies (18.2%) admitted
apiece on account of low birth weight and perinatal asphyxia but all the
3 neonates admitted in NNU in the control group were admitted on
account of low birth weight. No baby was admitted for respiratory
distress in both groups. The number of days on admission being statis
tically significantly lower for those in the intervention group of neonates
Table 1
Socio-Demographic characteristics of participants within treatment groups.
Characteristics Group A
(N = 74)N
(%)
Group B
N = 74)N
(%)
P-value
Age (years)
≤19 2 (2.7) 0 (0.0)
20–34 58 (78.4) 55 (74.3)
>34 14 (18.9) 19 (25.7) 0.242**
Parity
0 35 (47.3) 34(45.9)
1 19 (25.7) 11 (14.7)
2 11 (14.7) 11 (14.7)
3 3 (4.1) 6 (8.2)
4 4 (5.4) 8 (10.8)
>4 2 (2.7) 4 (5.4) 0.484**
Educational status
No formal 3 (4.1) 2 (2.7)
Formal 71 (95.9) 72 (97.3) 0.649**
Marital status
Not currently married 2 (2.7) 4 (5.4)
Currently married 72 (97.3) 70 (94.6) 0.405**
Occupation
Unemployed 15 (20.3) 12 (16.2)
Unskilled 22 (29.7) 32 (43.2)
Semi-skilled 15 (20.3) 17 (23.0)
Skilled 22 (29.7) 13 (17.6) 0.201
Gestational age (weeks) (N = 66) (N = 64)
34–36 22 (33.3) 35 (54.6)
37–42 44 (66.7) 29(45.4) 0.323
**Fisher’s exact test.
Table 2
Clinico-biochemical parameters of participants within treatment groups.
Clinico-biochemical
parameter
Group A
Median
(IQR)
Group B
Median
(IQR)
U p-
value
Age (years) 29.0 (8) 30.0 (10) 2604.00 0.607
Gestational age (weeks) 38.0 (3) 37.0 (5) 2080.00 0.458
Systolic B.P (mmHg) 170.0 (30) 170.0 (23) 2605.50 0.603
Diastolic B.P (mmHg) 110.0 (20) 110.0 (30) 2384.50 0.165
Clotting time (seconds) 200 (118) 240.0 (75) 681.50 0.073
SGOT (IU/l) 32.0 (24) 33.0 (20) 452.00 0.919
SGPT (IU/l) 24.0 (17) 24.0 (18) 447.50 0.867
Uric acid 7.0 (0.7) 6.5 (1.8) 417.00 0.413
Table 3
Maternal outcomes in those with SPE and EC.
SPE EC
GROUP A
N = 59 n
(%)
GROUP B
N = 57 n
(%)
ᵡ2
p-value GROUP A
N = 15 n
(%)
GROUP B
N = 17 n
(%)
ᵡ2
p-value
Occurrence of seizures 0(0.00) 1 (0.02) 2.106 0.239** 2 (13.3) 2 (11.8) 0.018 1.000**
PPH 0(0.00) 2 (0.04) 2.277 0.221** 0(0.00) 0(0.00) – –
HDU Stay > 48hrs 0(0.00) 0(0.00) – – 1 (6.7) 2 (11.8) 0.244 1.000**
E.O. Grillo et al.
6. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 32 (2023) 22–27
26
delivered to mothers with eclampsia than the control group may be
explained by the lower mean birthweight in the control group (2.79
(0.98) vs 1.8 (0)).
5. Conclusion and recommendations
From this study:
• The reduction in maintenance dose of Zuspan regimen to 12 h
resulted in no increase in the incidence of eclampsia in patients with
severe preeclampsia or recurrence of convulsions in patients with
eclampsia.
• There was no difference in the toxic/side effect profile of MgSO4 as
regards the Zuspan regimen and its 12 h modification
• The perinatal outcomes in both groups were similar.
Thus, the use of 12 h modification of the maintenance dose of Zuspan
regimen could be recommended for use in the management of severe
pre-eclampsia and eclampsia however further studies considering the
long term effects of a reduced maintenance dose of MgSO4 on the neo
nates is required.
Ongoing from this study is a need for a IPD meta-analysis on the effect
and efficacy of abridged regimen of MgSO4 to help solve the problem of
scarce resources in LMICs.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influence
the work reported in this paper.
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Table 4
Perinatal Outcomes of those with antepartum SPE and antepartum EC.
SPE EC
GROUP A
N = 57n (%)/
median
(IQR)
GROUP B
N = 51n (%)/
median
(IQR)
ᵡ2
/U p-value GROUP A
N = 11n (%)/
median
(IQR)
GROUP B
N = 15n (%)/
median
(IQR)
ᵡ2
/U p-value
Alive 56 (98.2) 42 (82.4) 8(72.7) 3 (20.0)
Perinatal death 1 (1.8) 9 (17.6) 0.005 3 (27.3) 12 (80.0) 0.015
IUFD 0 (0.0) 6 (11.7) 2 (18.2) 10 (66.7)
Neonatal death 1 (1.8) 3 (5.9) 1.611 0.207 1 (9.1) 2 (13.3) 0.209
Median Apgar at 1 min 7.0 (1.0) 8.0 (1.0) 1061.5 0.120 5.0 (1.0) 4.0 (0.0) 1061.5 0.120
Median Apgar at 5 mins 9.0 (1.0) 9.0 (2.0) 1139.5 0.299 8.0 (2.0) 8.0 (0.0) 1139.5 0.299
Median birth weight (Kg) 1.90 (0.45) 1.95 (0.85) 1283.0 0.293 2.79 (0.98) 1.8 (0.0) 1283.0 0.293
Admission into NNU 20 (35.1) 19 (37.3) 0.446 0.504 4(36.4) 3(20.0) 2.357 0.236**
Indication for admission
Low birth weight 13 (23.2) 12 (23.5) 0.014 0.905 2 (18.2) 3 (20.0) 2.100 0.429**
Respiratory distress 4 (7.0) 7 (13.7) 1.365 0.301** – – – –
Perinatal asphyxia 3 (5.3) 0 (0.0) 3.088 0.231** 2 (18.2) 0 (0.0) 2.100 0.429**
Median Number of days on
Admission
9.0 (6.0) 10.0 (9.0) 129.0 0.084 3.5 (1) 10.0 (0) 0.000 0.025
**Fisher’s exact test.
E.O. Grillo et al.
7. Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 32 (2023) 22–27
27
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E.O. Grillo et al.
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