Tubal patency after Laparoscopic salpingostomy versus Methotrexate therapy in undisturbed tubal pregnancy

Future fertility after ectopic pregnancy is dependent on several factors, including age, history of infertility, history of previous EP, tubal rupture, and contralateral tubal lesion. Thus, it seems reasonable to assess tubal patency following a treatment of an ectopic pregnancy in those women who are willing to have future pregnancy. Aimed to: Compare between tubal patency after methotrexate & laparoscopic salpingostomy. The study included 72 patients equally divided in number into 2 main groups. First group: (36cases) Tubal ectopic pregnancy treated by MXT therapy single or multiple doses. Single dose regimen (MTX 1.0 mg/kg or 50 mg/m2 i.m or multiple dose regimen (MTX 1.0 mg/kg i.m days (0,2,4,6). Second group: - (36 cases) Tubal ectopic pregnancy treated by laparoscopic salpingostomy. After 3 months, we used laparoscopy with administration of methylene blue (MB) as a marker to detect the tubal patency. As regard to tubal patency, of 31 cases (86.1%) from 36 cases that treated by MTX were patent and 5 cases (13.9 %) were blocked. On the other side 21 cases (58.3 %) from 36 cases that treated by laparoscopic salpingostomy were patent and 15 cases (41.7 %) were blocked). Conclusions:Methotrexate is better than laparoscopic salpingostomy in treating undisturbed tubal pregnancy.

Effects of Different Drug Combinations in Immunodeficient Mice Infected with an Influenza A/H3N2 Virus

The prolonged treatment of immunosuppressed (IS) individuals with anti-influenza monotherapies may lead to the emergence of drug-resistant variants. Herein, we evaluated oseltamivir and polymerase inhibitors combinations against influenza A/H3N2 infections in an IS mouse model. Mice were IS with cyclophosphamide and infected with 3 × 103 PFU of a mouse-adapted A/Switzerland/9715293/2013 (H3N2) virus. Forty-eight hours post-infection, the animals started oseltamivir, favipiravir or baloxavir marboxil (BXM) as single or combined therapies for 10 days. Weight losses, survival rates and lung viral titers (LVTs) were determined. The neuraminidase (NA) and polymerase genes from lung viral samples were sequenced. All untreated animals died. Oseltamivir and favipiravir monotherapies only delayed mortality (the mean day to death (MDD) of 21.4 and 24 compared to 11.4 days for those untreated) while a synergistic improvement in survival (80%) and LVT reduction was observed in the oseltamivir/favipiravir group compared to the oseltamivir group. BXM alone or in double/triple combination provided a complete protection and significantly reduced LVTs. Oseltamivir and BXM monotherapies induced the E119V (NA) and I38T (PA) substitutions, respectively, while no resistance mutation was detected with combinations. We found that the multiple dose regimen of BXM alone provided superior benefits compared to oseltamivir and favipiravir monotherapies. Moreover, we suggest the potential for drug combinations to reduce the incidence of resistance.

Efficacy of a Single Dose versus a Multiple Dose Regimen of Mebendazole against Hookworm Infections among School Children: a Randomized Open-label Trial

Background: Despite the existence of a population-based control program using single dose albendazole or mebendazole as a preventive chemotherapy, hookworm transmission remains high. It causes a negative impact on the growth and school performance of children. In connection to this preventive chemotherapy, different studies produced conflicting results. This study aimed at evaluating the efficacy of single (500mg) versus multiple doses (100mg twice a day during three consecutive days) of mebendazole against hookworm infections among school-aged children. Methods: This randomized open-label clinical trial took place among school-aged children (6-14 years old) in Burie and Debre Elias towns, Northwest Ethiopia. Using simple randomization, eligible hookworm-positive children were allocated (1:1) to either a single or multiple dose treatment arms. Stool samples were collected and processed using McMaster method at baseline and follow-up period (14-21 days after treatment). Only laboratory technicians were blinded. The cure and egg reduction rates which were assessed after 14-21 days of treatment were the primary and secondary therapeutic outcome measures against hookworm infections, respectively. An independent t-test was used to compare group means, and logistic regression was used to calculate odds ratio (OR). P-value < 0.05 at 95% CI was considered statistically significant. Result: 108 children, 54 in each treatment arm had completed baseline data and received allocated treatment. 103 children had completed follow-up data records and included for the final efficacy analysis. Cure rate against hookworm was significantly higher in the multiple dose (96.1%) than in the single dose (30.8%) with OR=55.125; 95% CI: 11.92-254.9; P < 0.001. The egg reduction rate in the multiple dose treatment arm (99.5%) was also significantly higher than in the single dose arm (68.9%) with difference t (101) =5.38; 95% CI 230.95-505.36; P < 0.001. Conclusion: The single dose regimen of mebendazole for the treatment of hookworm infections showed poor cure and egg reduction rates, while the multiple dose revealed satisfactory. Although multiple dose regimen administration is a bit more complex than the single dose, we strongly encourage replacing it with multiple dose regimen during deworming programs in hookworm endemic areas. Trial registration: This trial is registered in www.pactr.org, # PACTR201911466695052.

Efficacy of a Single dose versus a Multiple Dose Regimen of Mebendazole against Hookworm Infections among School Children: A Randomized Single-Blinded Trial

Background : Despite the existence of population-based control program using single dose albendazole or mebendazole as a preventive chemotherapy, Hookworm disease transmissions remains high. It causes a negative impact on the growth and school performance of children. In connection to this preventive chemotherapy, different studies produced conflicting results. This study evaluated the efficacy of single (500mg) versus multiple doses (100mg twice a day during three consecutive days) of mebendazole against Hookworm infections among school aged children. Methods : This randomized single-blinded clinical trial took place among school-aged children (6-14 years old) in Burie and Debre Elias towns, Northwest Ethiopia. Using simple randomization, eligible Hookworm positive children were allocated (1:1) to either a single or multiple doses treatment arm. Stool samples were collected and processed using McMaster method at baseline and follow-up period (14-21 days after treatment). Main outcome measures : The cure rate against Hookworm and egg reduction rate for determining the changes in infection intensity were the main outcome measures after 14-21 days following dosing. An independent t-test was used to compare group means, and logistic regression was used to calculate odds ratio (OR). P-value < 0.05 at 95% CI was considered statistically significant. Result: 109 children were participated in both treatment arms. Cure rate against Hookworm was significantly higher in the multiple dose (96.1%) than in the single dose (30.8%) with (OR=55.125; 95% CI: 11.92-254.9; P < 0.001). The egg reduction rate in the multiple dose treatment arm (99.5%) was also significantly higher than in the single dose arm (68.9%) with difference (t (101) =5.38; 95% CI 230.95-505.36; P < 0.001). Conclusion : The single dose regimen of mebendazole for the treatment of Hookworm infection showed poor efficacy, while the multiple dose revealed satisfactory efficacy. Moreover, infection intensity reduction was not achieved following single dosing. Therefore, we strongly recommend replacing the single dose mebendazole regimen with multiple dose regimen during deworming program in hookworm endemic areas. Trial registration : This trial is registered in www.pactr.org , # PACTR201911466695052

A Comprehensive Insights of the Multiple Dose Regimen

A multiple dose regimen is a concept that is used for certain diseases as arthritis, heart diseases etc. It is used to increase the therapeutic activity and clinical efficacy of the drugs. Drugs are usually used in single doses to produce acute effect but in cases where chronic affect is required multiple dosage regimen is required. Designing the dosage regimen and maintaining the drug concentration in blood plasma after administration are the primary goals to achieve safety and efficacy. That is to maintain drug concentration in therapeutic window. Moreover, the IV infusion and continuous IV diffusion is reviewed.

Single Versus Multiple Dose Regimen of Prophylactic Antibiotic in Cesarean Section

Aims: The purpose of this study was to compare the efficacy of single combined dose of Cefotaxime and Metronidazole against conventional regimen of Ampicllin and Metronidazole for five days for the prevention of infectious morbidities in cesarean deliveries. Methods: This study was carried out at Paropakar Maternity and Women’s Hospital, Kathmandu from April to August 2011. Hundred patients, who had cesarean deliveries for various indications, were divided into two groups with fifty on each arm. Patients in group I were treated with intravenous single dose of Cefotaxime and Metronidazole after cord clamping, whereas those patients in group II were treated with Ampicillin and Metronidazole for five days. Efficacy of the treatment was compared in terms of postoperative infectious morbidities, duration of hospital stay and cost of antibiotics. Results: Overall ten cases (10%) had post-operative complications in which eight (8%) had infectious and two (2%) had thrombophlebitis. The infectious morbidities were febrile morbidities in four cases (4%) followed by urinary tract infection in three cases (3%) and wound infection in one case (1%). There was no statistically significant difference among distribution of these morbidities and in the mean duration hospital stay. The cost of single dose regimen was one-eighth of the multiple dose regimens which was statistically significant (p=0.000). Conclusions: Single dose of Cefotaxime and Metronidazole was equally effective as multiple doses of Ampicllin and Metronidazole for five days in prevention of infectious morbidities with benefit of cost.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 50-53 DOI: http://dx.doi.org/10.3126/njog.v8i2.9771