Comparison of Varying Bolus Doses of Oxytocin in Patients Undergoing Caesarean Spinal Delivery

2020 ◽  
Vol 10 (4) ◽  
pp. 261-265
Author(s):  
Muhammad Maqbool ◽  
Huda Shafqat
Keyword(s):  
Side Effects ◽  
Bolus Dose ◽  
Uterine Contraction ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Epigastric Discomfort ◽  
Hemodynamic Variables ◽  
Before And After ◽  
Oxytocin Infusion ◽  
Elective Cesarean

Objective: To determine the lowest effective bolus dose of oxytocin to produce adequate uterine tone during elective caesarean delivery avoiding side effects. Study design and setting: A study was conducted at Rawal General and Dental Hospital, from 10th Oct, 2018 to 27th May, 2019. Methodology: Patients undergoing elective cesarean spinal delivery were randomly divided by computer generated numbers(n=155) into 5 groups A, B, C, D and E receiving 0.5, 1, 3, 5 and 10 units of injection oxytocin as bolus respectively after delivery of baby. Uterine contraction was assessed by gynecologist by manual palpation of uterus on a linear scale. Value of 8 was considered adequate and 8 inadequate uterine tone respectively. Heart rate, non-invasive blood pressure and oxygen saturation were noted before and after oxytocin bolus. All patients received oxytocin infusion. The primary outcome measure was the assessment of uterine tone at 2 minute of oxytocin bolus. The secondary outcome variables included shortness of breath, chest discomfort, top-up bolus administered, hemodynamic variables, epigastric discomfort and oxytocin related effects (tachycardia, epigastric discomfort and hypotension). Results: The use of 5 units oxytocin (group-D) showed most optimal uterine contractions, 61.3% in comparison to commonly used 10 units bolus dose (group-E) 48.4% with minimal side effects like, less tachycardia(12.9% versus 72.9%) and hypotension (12.9% versus 32.3%), no top-up bolus dose was required in 54.8% cases and no complain of epigastric discomfort was observed. Conclusion: Low doses of oxytocin are effective in terms of uterine contraction with minimal side effects

Comparison of the Mean Minimum Dose of Bolus Oxytocin for Proper Uterine Contraction during Cesarean Section

2019 ◽  
Vol 14 (3) ◽  
pp. 208-213 ◽  
Author(s):  
Siavash Beiranvand ◽  
Arash Karimi ◽  
Sepideh Vahabi ◽  
Arash Amin-Bidokhti
Keyword(s):  
Heart Rate ◽  
Side Effects ◽  
Cesarean Section ◽  
Uterine Contraction ◽  
Elective Cesarean Section ◽  
Minimum Dose ◽  
Oxytocin Infusion ◽  
Elective Cesarean ◽  
Elective Group ◽  
The Mean

Background: Cesarean section is the most common midwifery operation. The aim of this study is to determine the mean minimum dose of bolus oxytocin for proper uterine contraction during cesarean section. Method: Patients were divided into two groups: elective cesarean section (n=41) and cesarean section due to difficulty in labor (n=42 patients). Patients underwent spinal anesthesia and oxytocin infusion was begun at 30 drops per minute (20 units of oxytocin per 1000 cc serum), and was also administered as a half-dose in cc to achieve effective contraction of the uterus. Meanwhile, the information of patients including systolic and diastolic blood pressure (SBP and DBP), heart rate and amount of bleeding during the operation was recorded in a questionnaire. Results: In the elective cesarean section group, the average SBP was about 117.10mmHg, average DBP 70.50 mmHg, the amount of bleeding during surgery was 623.63mL, and heart rate was 88.88bpm. In the cesarean section group due to difficulty in labor progress, SBP was 113.5 mmHg, DBP 62.69 mmHg, and bleeding was 573.81mL. In addition, 9 patients in the elective group and 3 patients in the lack of progress group, did not require bolus oxytocin. In the lack of a progress group, 8 patients needed more than 5 doses of oxytocin. In addition, about 10 (12%) of all patients had no side effects, and hypotension. Conclusion: Given that, the minimum effective dose of oxytocin in the elective cesarean section was 1IU, and in those in labor progress was 1-1.5IU, less oxytocin administration represents lesser side effects. It is recommended that patients who are candidates of cesarean section should be administered 1.5IU of oxytocin in the form of bolus.

scholarly journals Use of connected digital products in clinical research following the COVID-19 pandemic: a comprehensive analysis of clinical trials

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047341
Author(s):  
Caroline Marra ◽  
William J Gordon ◽  
Ariel Dora Stern
Keyword(s):  
Clinical Trials ◽  
Clinical Research ◽  
Outcome Measures ◽  
Remote Monitoring ◽  
Search Algorithm ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Digital Products ◽  
Clinical Trial Registry ◽  
Before And After

ObjectivesIn an effort to mitigate COVID-19 related challenges for clinical research, the US Food and Drug Administration (FDA) issued new guidance for the conduct of ‘virtual’ clinical trials in late March 2020. This study documents trends in the use of connected digital products (CDPs), tools that enable remote patient monitoring and telehealth consultation, in clinical trials both before and after the onset of the pandemic.DesignWe applied a comprehensive text search algorithm to clinical trial registry data to identify trials that use CDPs for remote monitoring or telehealth. We compared CDP use in the months before and after the issuance of FDA guidance facilitating virtual clinical trials.SettingAll trials registered on ClinicalTrials.gov with start dates from May 2019 through February 2021.Outcome measuresThe primary outcome measure was the overall percentage of CDP use in clinical trials started in the 10 months prior to the pandemic onset (May 2019–February 2020) compared with the 10 months following (May 2020–February 2021). Secondary outcome measures included CDP usage by trial type (interventional, observational), funder type (industry, non-industry) and diagnoses (COVID-19 or non-COVID-19 participants).ResultsCDP usage in clinical trials increased by only 1.65 percentage points, from 14.19% (n=23 473) of all trials initiated in the 10 months prior to the pandemic onset to 15.84% (n=26 009) of those started in the 10 months following (p<0.01). The increase occurred primarily in observational studies and non-industry funded trials and was driven entirely by CDP usage in trials for COVID-19.ConclusionsThese findings suggest that in the short-term, new options created by regulatory guidance to stimulate telehealth and remote monitoring were not widely incorporated into clinical research. In the months immediately following the pandemic onset, CDP adoption increased primarily in observational and non-industry funded studies where virtual protocols are likely medically necessary due to the participants’ COVID-19 diagnosis.

Abatacept in the Treatment of Severe, Longstanding, and Refractory Uveitis Associated with Juvenile Idiopathic Arthritis

2015 ◽  
Vol 42 (4) ◽  
pp. 706-711 ◽  
Author(s):  
Christoph Tappeiner ◽  
Elisabetta Miserocchi ◽  
Bahram Bodaghi ◽  
Kaisu Kotaniemi ◽  
Friederike Mackensen ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Immunosuppressive Treatment ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Ocular Complications ◽  
Systemic Corticosteroids ◽  
Before And After ◽  
Active Arthritis ◽  
Factor Α ◽  
Antigen Presenting

Objective.Abatacept (ABA), a selective T cell costimulation modulator that binds to CD80 and CD86 on antigen-presenting cells, was investigated for its antiinflammatory effect in treating severe chronic uveitis associated with juvenile idiopathic arthritis (JIA).Methods.Our retrospective study was conducted by members of the Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC). Patients with JIA who are receiving ABA treatment for active uveitis were included. In all patients, uveitis had been refractory to previous topical and systemic corticosteroids, immunosuppressives, and at least 1 tumor necrosis factor–α inhibitor. A standardized protocol was used to document uveitis (MIWGUC) and arthritis. Baseline visit and visits at 3, 6, 9, and 12 months before and after ABA start were evaluated. Primary outcome measure was defined as achievement of uveitis inactivity; secondary outcome measures were tapering of corticosteroid and/or immunosuppressive treatment, and occurrence of complications.Results.In all, 21 patients (16 female) with active uveitis (n = 21) and arthritis (n = 18) were included (mean age 11.8 ± 3.6 yrs). In 7 of 18 patients with active arthritis at baseline, inactivity was achieved following ABA treatment. Uveitis inactivity was achieved in 11 patients, but recurred later in 8 of them, and remained active in another 10 cases. Systemic corticosteroids or immunosuppression were tapered in 3 patients, but uveitis recurred in all of them during further followup. Ocular complications secondary to uveitis were present in 17 patients at baseline, while 3 patients developed new ocular complications during followup.Conclusion.A sustained response to ABA was uncommon in patients with severe and refractory uveitis.

scholarly journals The ED50 and ED95 of oxytocin infusion rate for maintaining uterine tone during elective caesarean delivery: a dose-finding study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Xiao Wei Qian ◽  
Dan M. Drzymalski ◽  
Chang Cheng Lv ◽  
Fei He Guo ◽  
Lu Yang Wang ◽  
...  
Keyword(s):  
Side Effects ◽  
Effective Dose ◽  
Infusion Rate ◽  
Caesarean Delivery ◽  
Dose Finding ◽  
Bolus Administration ◽  
Estimated Blood Loss ◽  
Oxytocin Infusion ◽  
Elective Cesarean ◽  
Elective Caesarean Delivery

Abstract Background The 90% effective dose (ED90) of oxytocin infusion has been previously estimated to be 16.2 IU h− 1. However, bolus administration of oxytocin prior to the infusion may decrease the infusion dose required. The aim of this study was to estimate the ED95 for oxytocin infusion after a bolus at elective caesarean delivery (CD) in nonlaboring parturients. Methods We performed a randomized, triple blinded study in 150 healthy termparturients scheduled for elective CD under epidural anaesthesia. After delivery of the infant and i.v. administration of 1 IU oxytocin as a bolus, Participants were randomized to receive oxytocin infusion at a rate of 0, 1, 2, 3, 5, or 8 IU h− 1, to be given for a total of 1 h. Uterine tone assessed by the blinded obstetrician as either adequate or inadequate. Secondary outcomes included estimated blood loss (EBL), requirement for supplemental uterotonic agents, and development of side effects. Results The 95% effective dose (ED95) of oxytocin infusion was estimated to be 7.72 IU h− 1 (95% confidence interval 5.80–12.67 IU h− 1). With increasing oxytocin infusion rate, the proportion of parturients who needed rescue oxytocin bolus or secondary uterotonic agents decreased. No significant among-group differences in the EBL and oxytocin-related side effects were observed. Conclusions In parturients who receive a 1 IU bolus of oxytocin during elective cesarean delivery, an infusion rate of oxytocin at 7.72 IU h− 1 will produce adequate uterine tone in 95% of parturients. These results suggest that the total dose of oxytocin administered in the postpartum period can be decreased when administered as an infusion after oxytocin bolus.

scholarly journals Oral Nifidepine versus IV labetalol in severe preeclampsia: A randomized control trial

2020 ◽  
Vol 36 (6) ◽  
Author(s):  
Tayyiba Wasim ◽  
Shazia Agha ◽  
Kanwal Saeed ◽  
Anam Riaz
Keyword(s):  
Side Effects ◽  
Apgar Score ◽  
Randomized Control Trial ◽  
Primary Outcome Measure ◽  
Severe Preeclampsia ◽  
Secondary Outcome ◽  
Creative Commons ◽  
Randomized Control ◽  
Nicu Admission ◽  
Gestational Age At Birth

Objective: To compare oral Nifidepine and IV labetalol in terms of rapidity of BP control in severe preeclampsia. Methods: All patients coming to Services Hospital from March 2017 to February 2019 with diagnosis of severe preeclampsia ≥ 24 weeks gestation were randomized to either receive Nifidepine or Labetalol. Primary outcome measure was time taken to control BP and number of doses required. Secondary outcome measures were side effects of drugs, APGAR score, NICU admission and perinatal mortality. Results: Two hundred four patients were included in trial with 102 patients in each group. Labetalol took 22.6± 13.5minutes and Nifidepine took 22.09± 11.7 minutes to achieve target BP (p>0.05). Labetalol required 2.3± 1.58 doses and Nifidepine 2.2± 1.58 doses to control BP ( p>0.05). No maternal side effects were seen in 86 (84.31%) and 92(90.19%) patients in both groups (p>0.05). Mean gestational age at birth was 34.8 ±2.73weeks in Labetalol and 35.2±2.48 weeks in Nifidepine group (p>0.05). In labetalol group, 43 (42.15%) babies had APGAR Score < 7/10 and 23(22.54%) babies required admission to NICU while in Nifidepine group 42 (41.17%) babies had Apgar score < 7/10 & 30(29.4%) babies were admitted to NICU(p>0.05). There were 21(20.5%) perinatal deaths in labetalol Group-And 19(18.6%) in Nifidepine group (p>0.05) Conclusion: Oral Nifidepine and IV labetalol are equally efficacious in controlling BP in patients with severe pre eclampsia without any significant side effects. doi: https://doi.org/10.12669/pjms.36.6.2591 How to cite this:Wasim T, Agha S, Saeed K, Riaz A. Oral Nifidepine versus IV labetalol in severe preeclampsia: A randomized control trial. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2591 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals M245. AN RCT PROTOCOL OF HYBRID-ECT FOR SCHIZOPHRENIA

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S229-S229
Author(s):  
Han Rong
Keyword(s):  
Side Effects ◽  
Rating Scale ◽  
Remission Rate ◽  
Auditory Hallucination ◽  
Pilot Trial ◽  
Primary Outcome Measure ◽  
Seizure Threshold ◽  
Secondary Outcome ◽  
Control Group ◽  
Initial Sessions

Abstract Background Electroconvulsive therapy (ECT) is an rapid and effective treatment for schizophrenia patients, ECT may achieve significant antipsychotic effects in the several initial sessions, but significant side effects limit its use. However, our low-charge electrotherapy (LCE) pilot trial demonstrated antipsychotic effects with significantly fewer side effects. The aim of this trial is to propose a novel two-step charge set strategy for ECT treatment, referred to as Hybrid-ECT, try to decrease side effects by using a lower charge while preserving treatment efficacy. Methods A randomized, double-blinded, standard-controlled, parallel-group design will be used. We plan to enroll 62 inpatients diagnosed with acute schizophrenia and randomly assign them to routine ECT (control group) or to Hybrid-ECT (treatment group, 3 ECT sessions followed by LCE sessions (approximately half of seizure threshold per session)). The primary outcome measure is the change in total PANSS score after the last ECT/LCE session. The secondary outcome measures include the response rate, remission rate, CGI, auditory hallucination rating scale, and everyday memory questionnaire (EMQ) scales. Neuropsychological metrics include the repeatable battery for the assessments of neuropsychological status (RBANS) and the stroop test, and detailed side effects will be evaluated. Structure and functional magnetic resonance imaging (MRI) assessments during treatment will be performed to explore brain changes between ECT and hybrid-ECT groups. The follow-up phase is set at the one-month after the last ECT/LCE session Results No results. Discussion This research will propose a simple but completely novel ECT strategy that aims to rapidly relieve psychosis symptoms and minimize side effects. If Hybrid-ECT is found to have the potentiality mentioned above, this could have important implications for future ECT strategies in treating schizophrenia patients in the acute phase. In addition, by using the detailed neuropsychological assessments and MRI scanning, this study may improve the knowledge of ECT-related antipsychotic mechanisms.

Analysis of the paramedic administration of fentanyl

2018 ◽  
Vol 7 (3) ◽  
pp. 229-234
Author(s):  
Jocelyn Freeman Garrick, MD, FACEP ◽  
Senai Kidane, MD, EMS Fellow ◽  
James E. Pointer, MD ◽  
William Sugiyama, MA, RN, NREMT-P ◽  
Christopher Van Luen, EMT-P ◽  
...  
Keyword(s):  
Side Effects ◽  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Adverse Outcomes ◽  
Secondary Outcome ◽  
Onset Of Action ◽  
Time Period ◽  
Subjective Pain ◽  
Reduction Of Pain ◽  
Fentanyl Administration

Introduction: Pain is a common complaint among emergency medical services patients. When compared with the most commonly used morphine, fentanyl has a shorter onset of action, shorter duration, and far fewer side effects making it an appealing candidate for prehospital pain management. This study’s intent is to prospectively assess the feasibility and safety of fentanyl for pain in prehospital patients in comparison with morphine.Methods: Observational trial to evaluate select characteristics of fentanyl administration. The primary outcome measure was the reduction of pain from time of initial patient assessment to transfer of care (TOC) to emergency department (ED) staff. Secondary outcome measures included the development of adverse outcomes and side effects related to fentanyl administration. Additionally, data obtained were compared with morphine retrospectively from an identical prior time period, ie, 1 year earlier.Results: About 16.6 percent of the patients who received fentanyl reported subjective pain relief in less than 1 minute, 47 percent in 1-2 minutes, 19.9 percent in 2-3 minutes, and 16.6 percent at greater than 3 minutes. The reduction of pain after fentanyl administration, on a scale of 1-10, was 3.82 points in TOC at the ED. No significant adverse clinical outcomes or incidents of diversion were reported during the trial period.Conclusions: Fentanyl can be used safely and effectively for pain control in the prehospital setting.

Local Treatment of Recent Arterial Thromboembolic Occlusions with Brinase

1975 ◽  
Vol 34 (02) ◽  
pp. 498-503 ◽  
Author(s):  
D Nyman ◽  
M. A da Silva ◽  
L. K Widmer ◽  
F Duckert
Keyword(s):  
Side Effects ◽  
Local Treatment ◽  
Before And After ◽  
Local Side

SummaryBrinase was administered intra-arterially in 16 patients with thrombotic or embolic arterial occlusions. Angiography could be performed before and after treatment in 13 patients. Thrombolysis was obtained in 3 of 9 patients with thrombotic and in 3 of 4 patients with embolic occlusions. In 3 patients severe local side effects occurred.

EVALUATION OF THE EFECTS OF ELECTRONIC ACUPUNCTURE COMBINED WITH “TAM TY THANG” REMEDY IN THE TREATMENT OF RHEUMATOID ARTHRITIS BY WIND-COLD-DAMP

2017 ◽  
pp. 122-127
Author(s):  
Thi Luu Nguyen ◽  
Thi Tan Nguyen
Keyword(s):  
Rheumatoid Arthritis ◽  
Side Effects ◽  
Prospective Study ◽  
Key Words Rheumatoid Arthritis ◽  
Good Effect ◽  
Good Level ◽  
Relieve Pain ◽  
Level Of Activity ◽  
Before And After ◽  
The Moment

Objectives: To assess the effect of electronic acupuncture combined with “Tam ty thang” remedy in the treatment of rheumatoid arthritis by wind-cold-damp. Materials and methods: prospective study, comparing before and after treatment, including 43 patients who were diagnosed with rheumatoid arthritis by wind-cold-damp according to traditional medicine. Results: good level occupied 69,8%, and fair good level occupied 30,2%.The improved motor function accounted for 95.3%, to relieve pain up to 95,3%, reducing inflammation of VSS in 1 hour at the moment No 31,65, N28 17,88. The improvement in the level of activity of the hand reached 48,8% for good level. Conclusions: The method of electronic acupuncture combined with “Tam ty thang” remedy have a good effect in the treatment of rheumatoid arthritis by wind-cold-damp and it didn’t cause significantly side effects in clinic. Key words: rheumatoid arthritis, electronic acupuncture, “Tam ty thang” remedy

EDUKASI TERHADAP REMAJA DALAM PENINGKATAN PENGETAHUAN TENTANG PENGGUNAAN GAME DENGAN BIJAK

2020 ◽  
Vol 2 (1) ◽  
pp. 11
Author(s):  
Ikhsan Fuady ◽  
Rangga Saptya MP
Keyword(s):  
Side Effects ◽  
Violent Behavior ◽  
Daily Lives ◽  
Before And After ◽  
Improper Use ◽  
Effective Role ◽  
Education And Outreach ◽  
The Right ◽  
Dedicated Team ◽  
User Ratings

<p align="center"><strong>Abstrak</strong></p><p><em>Pemanfaatan game dikalangan remaja memiliki peran yang efektif sebagai wadah untuk hiburan. Tetapi pemanfaatan game tidak tepat memiliki efek samping game terhadap kehidupan sehari hari remaja, mulai dari kurang bersosialIsasi hingga perilaku kekerasan dikalangan remaja. Penyuluhan terhadap remaja bertujuan untuk memberikan pemahaman kepada remaja tentang variasi game berdasarkan rating pengguna, maupun cerdas dalam manajemen penggunaan game dalam kehidupan remaja sehari hari. Pengetahuan remaja tentang varian/ragam game berdasarkan rating relatif rendah sebagaian besar pemengetahuannya tersebar pada kategori sangat rendah dan rendah yaitu sebesar 65 persen. Metode edukasi dan sosialisasi ini adalah dengan beberapa tahapan. Tahap pertaman tim pengabdian memberikan edukasi dan diskusi tentang beragam bentuk game, karakteristik, serta karakteristik pengguna game yang tepat. Selanjutnya beberapa permainan dan kuis untuk meingkatkan literasi remaja tentang pemanfaatan game secara bijak. Kegiatan penyuluhan ini mampu meningkatkan pemahaman para remaja dalam mengenali game yang baik digunakan, hal ini dapat dilihat dari peningkatan pengetahuan remaja relatif signifikan sebelum dan sesudah penyuluhan.</em></p><p><strong>Kata kunci<em>:</em></strong><strong><em> </em></strong><strong><em>Edukasi, Game, Penyuluhan </em></strong></p><p align="center"><em> </em></p><p align="center"><strong>Abstract</strong> </p><p><em>The use of games among teenagers has an effective role as a forum for entertainment. But the improper use of games has the side effects of games on the daily lives of adolescents, ranging from lack of socialization to violent behavior in adolescents. Counseling against adolescents aims to provide understanding to adolescents about the variety/variance of games based on user ratings, as well as being smart in managing game use in daily teenage life. Teenagers' knowledge about game variants/based on the rating is relatively low, most of the knowledge is spread in the very low and low categories, which is 65 percent. The method of education and outreach is by several stages. The first stage of the dedicated team provided education and discussion about various forms of games, characteristics, and characteristics of the right game user. Furthermore, some games and quizzes to improve teen literacy about game use wisely. This counseling activity can increase the understanding of teenagers in recognizing games that are well used, this can be seen from the relatively significant increase in adolescent knowledge before and after counseling.</em></p><p><strong>Keywords<em>:</em></strong><em> <strong>Education, Games, Counseling</strong></em></p>

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