scholarly journals Efficacy and safety of oral nifedipine with or without vaginal progesterone in the management of threatened preterm labor

Author(s):  
Bushra Ashraf MBBS

Background: Preterm labor (PTL) is a serious emergency wherein robust management is imperative for achieving improved outcome. Objective: To evaluate the efficacy and safety of nifedipine alone vs nifedipine with vaginal progesterone in managing threatened PTL. Materials and Methods: This comparative study was carried out at the Pakistan Institute of Medical Sciences, Islamabad over a 2-year’ period, from September, 2013 to August, 2015. The study included 276 patients with threatened PTL. Half of them were allocated to nifedipine alone group whereas the remainder half to the additional progesterone group. In nifedipine alone group (group A), all the patients were given 20mg of rapid release nifedipine orally. If uterine contraction continued, a 10mg dose was repeated every 20 min with a maximum of 40mg within the first hour. After completing the first hour, 20mg was given every 4–6 hr for 72 hr. In the additional vaginal progesterone group (group B), following successful tocolysis with nifedipine, additional - maintenance tocolysis was ensured with vaginal progesterone 200mg daily. Results: Successful acute tocolysis was achieved with nifedipine among 86.23% patients. Mean pregnancy prolongation was 11.13 ± 5.08 days in group A while 29.73 ± 3.10 days in group B. (p0.001). Conclusion: Acute tocolytic therapy with nifedipine was successful in the majority of our patients. The additional daily use of vaginal progesterone suppositories resulted in significant prolongation of pregnancy as well as reduction in the rate of low birth weight and neonatal ICU admissions. Key words: Preterm labor, Tocolytics, Nifedipine, Progesterone.

Author(s):  
MANJUSHREE N ◽  
ANANYA CHAKRABORTY ◽  
SHASHIDHAR V

Objectives: Chemotherapy-Induced Peripheral Neuropathy (CIPN) occurs as a common Adverse Drug Reaction (ADR) of anti-cancer drugs. The prevalence varies from 10% to 100%. To date, there is no standard effective treatment protocol for this condition. However, the neuro-modulators such as gabapentin and pregabalin are increasingly being used to treat CIPN. With this background this study was undertaken to compare the efficacy and safety of gabapentin and pregabalin in CIPN. Methods: This study was conducted in the department of medical oncology at Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. It was initiated after the approval from Institutional Ethics Committee. After obtaining written informed consent, the participants were randomized into two groups. Group A received gabapentin, 300 mg orally and Group B received pregabalin 75 mg orally; twice daily for 8 weeks. They were followed up at 2, 4, and 8 weeks. The intensity and quality of pain were assessed by visual analog scale (VAS) and pain quality assessment scale (PQAS). Safety was assessed by reported ADR. Data were analyzed using Student’s t-test and Mann–Whitney U-test. p=0.05 or less was considered as statistically significant. Results: Reduction in VAS and PQAS scores at 8 weeks was statistically significant in each group (p<0.0001). The ADR common to both the groups was drowsiness and sedation. The prevalence of ADR was more in the gabapentin group. Conclusion: Both gabapentin and pregabalin have similar clinical efficacy in the treatment of CIPN. The prevalence of ADR was higher in gabapentin group compared to pregabalin group.


2020 ◽  
Vol 33 (1) ◽  
pp. 41-47
Author(s):  
Mohsena Akhter ◽  
Ishrat Bhuiyan ◽  
Zulfiqer Hossain Khan ◽  
Mahfuza Akhter ◽  
Gulam Kazem Ali Ahmad ◽  
...  

Background: Scabies is one of the most common skin diseases in our country. It is caused by the mite Sarcoptes scabiei var hominis, which is an ecto-parasite infesting the epidermis. Scabies is highly contagious. Prevalence is high in congested or densely populated areas. Individuals with close contact with an affected person should be treated with scabicidal which is available in both oral and topical formulations. The only oral but highly effective scabicidal known to date is Ivermectin. Amongst topical preparations, Permethrin 5 % cream is the treatment of choice. Objective: To evaluate the efficacy & safety of oral Ivermectin compared to topical Permethrin in the treatment of scabies. Methodology: This prospective, non-randomized study was conducted at the out-patient department of Dermatology and Venereology of Shaheed Suhrawardy Medical College & Hospital over a period of 6 months, from August 2016 to January 2017. The study population consisted of one hundred patients having scabies, enrolled according to inclusion criteria. They were divided into two groups. group A was subjected to oral Ivermectin and the group B to Permethrin 5% cream. Patients were followed up on day 7 and 14 for assessment of efficacy and safety. Result: The mean scoring with SD in group A (Ivermectin) and group B (Permethrin) were 8.26 ± 2.22 and 7.59 ± 2.01 respectively at the time of observation. The difference between the mean score of the two group is not significant (p=0.117) the mean scoring with SD in group A and group B were 4.54 ± 2.05 and 1.64 ± 1.84 respectively at 7thdays. The difference between the mean score of the two group is significant (p<0.001). The mean scoring with SD in group A and group B were 2.68± 2.35 and .36± 1.10 respectively at 14th day difference between the mean score of the group is significant (p<0.001). Conclusion: Topical application of permethrin 5% cream is more effective and safer than oral Ivermectin in the treatment of scabies. TAJ 2020; 33(1): 41-47


2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11545-11545
Author(s):  
Daniel Pink ◽  
Dimosthenis Andreou ◽  
Anne Flörcken ◽  
Alexander Golf ◽  
Stephan Richter ◽  
...  

11545 Background: Single-agent PD-1 inhibitors have modest activity in the treatment of most STS. Potential strategies to increase efficacy include combination therapies targeting the tumor microenvironment. Considering that apart from direct growth inhibition and death of malignant cells, trabectedin (Tr) also induces macrophage depletion and/or different immunologic effects, suggesting a possible synergistic effect of combined Tr plus anti-PD-1 treatment. We therefore aimed to evaluate the efficacy and safety of combined Tr and nivolumab (Ni) as a second-line treatment in STS. Methods: The prospective, explorative, two group, non-randomized phase II NiTraSarc trial enrolled pretreated patients (pt) with advanced STS (Group A: lipo- or leiomyosarcomas, Group B: non-L-sarcomas). Pt were initially treated with 3 cycles of Tr 1.5 mg/m2, followed by the combination of Tr 1.5 mg/m2 + Ni 240 mg (“late combination cohort” (LCC)) for up to 16 cycles. After positive results of a preplanned interim analysis, pt received the combination therapy starting with cycle 2 (“early combination cohort” (ECC)). 92 pt were recruited to the trial (55 in Group A, 37 in Group B). Primary efficacy endpoint is progression-free survival rate after 6 months (PFSR6) according to RECIST v.1.1. This is a first analysis of the primary efficacy endpoint in Group B based on a modified intention-to-treat (mITT) population of evaluable 36 pt: 23 and 13 pt from the LCC and ECC, respectively. Results: The most common Group B subtypes comprised undifferentiated pleomorphic/not otherwise specified sarcoma (UPS/NOS, 13pt) and fibromyxoid sarcoma (FMS, 6pt). After a median follow-up of 5 months (m) PFSR6 was 13.9% for all pt, 8.7% in LCC and 23.1% in ECC. Median duration of disease stabilization (DoDS) was 4m in all pt, the LCC and the ECC. Two pt had a partial response (PR), 10 had disease stabilization (SD), while 13 pt progressed, and 11 had missing data. By subtype: PR- UPS/NOS=2 (DoDS 12.7m/12.5m). SD: UPS/NOS=3, epithelioid=2, synovial=2, FMS=1, fibrosarcoma=1, other=1. All 36 pt experienced at least one adverse event (AE) reaching a total of 579 AEs, 141 (24.4%) of which were considered to be grade ≥3 treatment-related AEs. The main grade ≥3 AEs were: leukopenia (47.2% of pt), neutropenia (41.7% of pt), thrombocytopenia (33.3% of pt), increased ALT (30.6% of pt), and anemia (27.8% of pt). Conclusions: Tr+Ni was well tolerated and showed activity in at least some patients with non-L-sarcomas (mostly UPS/NOS) especially in the ECC. Analyses of the collected data, including PD-L1 expression profile, with the goal to establish whether Tr+Ni should be further pursued in these patients, are ongoing. ClinicalTrials.gov Identifier: NCT03590210; EudraCT: 2017-001083-38. Clinical trial information: NCT03590210.


2019 ◽  
Author(s):  
Yanhui Cui ◽  
Peng Sun ◽  
Lixing Tang ◽  
Chengyue Zhang ◽  
Qian Wu ◽  
...  

Abstract Introduction This study was performed to compare the efficacy of marsupialization under nasal endoscopy versus Lacrimal probing in the treatment of congenital dacryocystocele. Methods Forty neonates (43 eyes) diagnosed with congenital dacryocystoceles were divided into Group A (nasal endoscopic marsupialization) and Group B (Lacrimal probing). The patients were followed up for 1 year after surgery. The efficacy, incidence of complications, and reoperation rate were compared between the two groups. Results The male:female ratio was 25:15 patients (27:16 eyes). In Group A, the success rate was 100%, the incidence of complications was 5%, and the reoperation rate was 0%. In Group B, the success rate was 90%, the incidence of complications was 20%, and the reoperation rate was 30%. Conclusion Compared with Lacrimal probing, marsupialization under nasal endoscopy provides greater efficacy and safety for congenital dacryocystoceles.


2020 ◽  
Author(s):  
Xiaoxia Gu ◽  
Jingjing Wang ◽  
Huihua Liao ◽  
Jian Mo ◽  
Weiming Huang ◽  
...  

Abstract Background: To compare the efficacy and safety of different compatibility schemes in the prevention of visceral pain after gynecological laparoscopic surgery. Methods: from April 2019 to April 2020, patients undergoing elective gynecological laparoscopic surgery in our hospital were randomly divided into four groups: group A: sufentanil 3 μ g / kg; group B: low-dose nalbuphine group: 0.1 mg / kg of nabufen + 3 μ g / kg of sufentanil; group C: medium dose of nabufen group: 1 mg / kg of nabufen + 2 μ g / kg of sufentanil; group D: high-dose nabufen 2 There were 30 cases in each group. The degree of pain and the number of adverse reactions at 2, 4, 8, 12, 24 and 48 hours after operation were observed and recorded. The number and dosage of morphine used as a remedial analgesic were recorded. The pain degree was assessed by visual analogue scale (VAS). The total amount of analgesic pump used, the total number of times of pressing and the effective times of pressing were recorded. The adverse reactions included respiratory depression, nausea and vomiting, drowsiness, restlessness and skin The skin itches. Results: the analgesic effect of group B was similar to that of group A, and there was no significant difference in the number of invalid pressing, total pressing times and rescue analgesia rate (P > 0.05), while the invalid pressing times, total pressing times and remedial analgesia rate of group C and group D were significantly lower than those of group A (P < 0.05). There was no significant difference between group C and group D in the number of invalid compressions, the total number of compressions and the rate of remedial analgesia (P > 0.05), suggesting that increasing the dose of nalbuphine could not significantly increase the analgesic effect. The incidence of postoperative nausea and vomiting, skin pruritus, lethargy and Ramsay Sedation score in group B and group C were significantly lower than those in group A (P < 0.05). Ramsay Sedation score and incidence of drowsiness were lower than those in group D, which indicated that the incidence of adverse reactions was higher in group D than group B and group C.Conclusion: the combination of 1 mg / kg nabufen and 2 μ g / kg sufentanil is a safe and effective combination scheme for the prevention of visceral pain after gynecological laparoscopic surgery with small adverse reactions.Trial registration: http://www.chictr.org.cn/showproj.aspx?proj=40635Registration number:ChiCTR1900025076 . Prospectively registered on 10 August 2019.


2016 ◽  
Vol 15 (1) ◽  
pp. 17-21
Author(s):  
Sakhawat Mahmud Khan ◽  
Md Matiar Rahaman Khan ◽  
Shahin Akhter ◽  
Md Mizanur Rahman

Background: Lower urinary tract symptoms suggestive of symptomatic Benign Prostatic Hyperplasia (BPH) are a very common disease in elderly men .The incidence of benign prostatic hyperplasia is age related.Objectives: To compare the efficacy and safety of Tamsulosin and Terazosin in the treatment of symptomatic Benign Prostatic Hyperplasia.Methods: This was a prospective study carried out in the Department of Urology, Chittagong Medial College Hospital, Chittagong, Bangladesh during the period of July to December 2014. Total 40 patients of 45-80 years of age were consequently selected according to inclusion criteria. After completion of baseline clinical evaluation and investigations, participants were divided into two groups, group A and group B. Group A (n=20) was given Terazosin 1mg daily for 3 days at bed time and then 2 mg daily at bed time for 2 months. Group B (n=20) was given Tamsulosin, 0.4 mg per day for 2 months. Efficacy was evaluated of each group after 2 month follow up and lastly a comparison was made between them. The parameters monitored were International Prostate Symptoms Score (IPSS) Maximum urine flow rate (Qmax) and Post Voidal Residual Volume (PVR). Tamsulosin 0.4 mg and Terazosin 2 mg once daily for 8 weeks both are effective in relieving symptoms of BPH but Tamsulosin is superior to Terazosin in improvement of total IPSS (p<0.001) and Qmax (p<0.01) PVR (p<0.01) at the end point.Results: Outcome of parameters at follow up after 2 months. Tamsulosin group showed significant improvement of IPSS (p<0.05) PVR (p<0.001) and Qmax (p<0.001) than Terazosin. The incidence of adverse events by administration of Tamsulosin was less than that by Terazosin.Conclusion: Tamsulosin appears to have more efficacy and safety than Terazosin in symptomatic BPH.Chatt  Shi Hosp Med Coll J; Vol.15 (1); Jan 2016; Page 17-21


Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5011-5011
Author(s):  
ZiYi Lim ◽  
Gordon Cook ◽  
Peter R. Johnson ◽  
Anne Parker ◽  
Mark Zuckerman ◽  
...  

Abstract The advent of reduced intensity conditioning(RIC) protocols for allogeneic haematopoietic stem cell transplantation(HSCT) has reduced the incidence of early transplantation related morbidity largely due to the attenuation of the conditioning intensity. Nevertheless, the incidence of CMV reactivation in these patients remains high. Herein we report the results of a multi-centre randomised prospective study to assess the bioavailability(auc0–12) of ganciclovir in the population of patients undergoing alemtuzumab-based RIC HSCT after oral administration of valganciclovir and secondly, the efficacy and safety of valganciclovir in the treatment of a CMV infection following allogeneic SCT. Recipients of allogeneic bone marrow or peripheral blood stem cell transplants with related or unrelated donors following reduced intensity conditioning, without proven graft versus host disease were eligible for this study. RIC protocols approved for the purposes of this study were FBC(fludarabine, busulphan, alemtuzumab) and FMC(fludarabine, melphalan,alemtuzumab). For inclusion into the study, patients had to have a detectable CMV DNA load in two consecutive blood specimens up to 120 days after transplant. Eligible patients were randomized to 1 of 2 treatment groups: group A received 900 mg oral valganciclovir(2 x 900 mg/d) for 14 days and group B received intravenous ganciclovir 5mg/kg/d twice daily for 14 days. All patients were monitored for 84 days(safety follow-up). pK profiles of ganciclovir were obtained after administration of the study drug in each study arm. pK assessments were scheduled at days 4 and 11. 27 patients were recruited into the study over a 24-month period from Jan 2005 to Dec 2006. The median age was 51 years(range:34–68). The median time to CMV reactivation was 43 days post-HSCT(range:20–114). 18 patients(67%) completed the allocated treatment resulting in CMV DNA load <10 copies/ml at a median of 14 days post-HSCT(range:7–28). In 9 cases, there were changes to the primary treatment regimen. In group A, treatment was modified in 5 cases; 3 due to rising CMV levels, 1 due to drug rash, 1 due to neutropenia. In group B, 4 patients had treatment modification; 3 patients due to rising CMV DNA levels, 1 had neutropenia. None of the patients in the study developed CMV invasive disease. The median value of the systemic clearance of ganciclovir was 11.8 l/h(95%CI: 8–15.6 l/h). The bioavailability of ganciclovir from valganciclovir(expressed as equivalents of ganciclovir) was 73%(95%CI, 34%–112%). The average exposure in the valganciclovir group(36.9 ± 14.9μg.h/ml) was significantly higher than in the ganciclovir cohort(27.9 ±7.5μg.h/ml). As a result, ganciclovir bioavailability in the subjects who received valganciclovir was 79%. In summary, when compared with intravenous ganciclovir, oral valganciclovir had high bioavailability with equivalent efficacy and safety in patients undergoing RIC HSCT. Use of valganciclovir can facilitate the out-patient treatment of patients with CMV reactivation post-HSCT with a potential reduction in hospitalization costs.


Author(s):  
Ali Firoozabadi ◽  
Mohammad M. Zarshenas ◽  
Alireza Salehi ◽  
Saye Jahanbin ◽  
Abdolali Mohagheghzadeh

Background. Depression is one the most common mental disorders that can be seen all over the world. In traditional Persian medicine, some medicinal herbs are recommended for depression treatment. This study aimed to evaluate the effects of Cuscuta planiflora Ten. and Nepeta menthoides Boiss. & Buhse in patients with major depression. Methodology. This study is a randomized triple-blind controlled clinical trial conducted in the year 2010 in Shiraz University of Medical Sciences on patients with major depression. Pharmaceutical capsules of Cuscuta planiflora (500 mg) and Nepeta menthoides (400 mg) were prepared by a pharmacist. Patients were randomly assigned to 3 groups: group A (treated with Nepeta menthoides capsules and conventional drugs), group B (treated with Cuscuta planiflora capsules and conventional drugs), and group C (treated only with conventional drugs). The study period was 8 weeks and depression was measured before and after the study by Beck Depression Inventory and Hamilton Depression Inventory. The data were analyzed by SPSS version 20 and the P < .05 was considered statistically significant. Results. A total of 43 subjects participated in this study, of whom 81.4% were females (n = 35) and 18.6% were males (n = 8). The mean ± standard deviation of age of the participants was 38 ± 10.9 years. The majority of patients (65.1%, n = 28) were married. There were 15 patients (34.9%) in group A, 13 (30.29%) in group B, and 15 (34.9%) in group C. There was a significant decrease in mean scores of Beck and Hamilton depression inventories in the 3 groups after treatment ( P < .01); moreover, there was more decrease in scores of the Beck and Hamilton depression inventories in groups A and B compared with group C after treatment ( P < .01). Conclusion. Despite the paucity of the population under study, the findings showed that Cuscuta planiflora and Nepeta menthoides capsules could be effective, affordable herbal medicines with improved cost–benefit in treatment of major depression and it is worth designing further and more extensive studies to get to a more accurate conclusion.


Author(s):  
Vinma H. Shetty ◽  
Saumya Goel ◽  
Amita Murali Babu ◽  
Hafsa Eram

<p class="abstract"><strong>Background:</strong> Psoriasis is a chronic, inflammatory systemic disease. Methotrexate acts by inhibiting dihydrofolic reductase enzyme. Apremilast is an oral PDE4 inhibitor approved by US Food and Drug Administration for treatment of psoriasis.</p><p class="abstract"><strong>Methods:</strong> This is hospital based comparative study conducted from February 2018 to August 2018. Seventy patients above 18 years of age with chronic plaque psoriasis were divided into 35 patients in each group and were treated with oral Apremilast (30 mg twice daily) and oral methotrexate (15 mg per week in three divided doses with a 12-hour interval between doses and tab folic acid on methotrexate free days) and were evaluated every 4 weeks for a period of 16 weeks and followed-up at 24th week. Outcome was assessed on basis of psoriasis area-and-severity index score (PASI), psoriasis disability index (PDI) and clinical photographs.<strong></strong></p><p class="abstract"><strong>Results:</strong> % of improvement in Group-A patients (76.8%) after 16 weeks of treatment was relatively more (p&lt;0.05) as compared to group B (71.5%). At the end of 16 weeks PASI score in methotrexate group was statistically significant (p&lt;0.05) as compared to group B, PDI became 17.90±3.87 in group A and was statistically significant (p&lt;0.05) as compared to group B which was 20.34±2.98. Side effects observed were comparatively less in group A patients.</p><p class="abstract"><strong>Conclusions:</strong> On comparing the two drugs, methotrexate was comparatively better tolerated and had better efficacy and safety. More studies are required to further prove the efficacy of Apremilast in treatment of psoriasis.</p>


2014 ◽  
Vol 5 (4) ◽  
pp. 21-24
Author(s):  
Mosin Mushtaq ◽  
Abid H Wani ◽  
Faud Sadiq ◽  
Mudasir Mushtaq ◽  
Sameena Tabassum ◽  
...  

Background and study aims: Hypertriglyceridemia can be a primary cause for acute pancreatitis or secondary to other factors prior to the increase of lipid levels, or both. The aim of our study was to assess the severity of acute pancreatitis with elevation in serum triglyceride levels and report the outcomes of our series. Patients and methods: One hundred twenty?six patients of acute pancreatitis were admitted within 72 hours of onset of symptoms, out of whom 26 patients were excluded during the course of study due to preexisting comorbidities. 100 patients in the study population were divided into group A having serum triglyceride levels ≥500 mg/dl (n = 30) and group B having <500 mg/dl (n = 70) at the time of admission. Results: The mean age of group A was similar to group B (50.2 ± 17.1 vs 49.26 ± 17.2 years; p = 0.860). Most common etiological factor of acute pancreatitis was found to be gall stones (56%) in both groups. Ranson's score at admission in group A was 2.93 ± 0.22 and in group B it was 1.34 ± 0.99. Mortality below two weeks was noted in (12/30, 40%) of group A and (6/70, 8%) of group B patients, which was statistically significant, (p = 0.015). Conclusions: The final conclusion of this study was that patients of acute pancreatitis with elevated triglyceride levels form a morbid group and these should be monitored aggressively for the development of any complications. DOI: http://dx.doi.org/10.3126/ajms.v5i4.9971 Asian Journal of Medical Sciences 2014 Vol.5(4); 21-24


Sign in / Sign up

Export Citation Format

Share Document