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Body friendly, safe and effective regimen of MgSO4 for eclampsia  [PDF]
Gautam S. Aher, Urmila Gavali
International Journal of Medical Research and Health Sciences , 2013,
Abstract: Pre-eclampsia and eclampsia are major health problems in developing countries. MgSO4 is the standard drug in the control of convulsions in eclampsia. Our study carried out at PDVVPF’s hospital is based on the low dose regimen than Pritchard, which is suitable for Indian women who are of smaller built thanwomen in western world. This prospective study included 50 eclampsia patients receiving low dose MgSO4 therapy. The loading dose of MgSO4 was 9gm. Following this 2.5 gm was given intramuscularly every 6 hourly for 24 hours after administration of the loading dose. Patients were monitored hourly by observing their respiratory rate, knee jerk and urine output. Out of 50, two patients required Pritchard regimen, rest completely recovered from eclampsia. The maternal and perinatal morbidity and mortality were comparable to those of the standard Pritchard regime. The study did not find a single case of magnesium related toxicity with low dose MgSO4 regime. Low dose magnesium sulphate regime was found to be safe and effective in eclampsia
Randomised Controlled Trial Of Two Doses Of Heparin In Cerebral Venous Thrombosis
Sarma G.K,Nagaraja D
Annals of Indian Academy of Neurology , 2005,
Abstract: Cerebral venous thrombosis accounts for 10-20% of strokes in the young in India. Over the past decade, heparin has become the mainstay of treatment of cerebral venous thrombosis. The conventional doses of heparin require strict monitoring of activated partial thromboplastin time. Efficacy of low doses of heparin in cerebral venous thrombosis has already been studied. Objective: The present study compared the low dose heparin to medium dose of heparin in cerebral venous thrombosis. Methods: A prospective, randomized controlled study including consecutive patients was conducted in the department of Neurology, a tertiary referral center in India from 1996 to 1998. Patients with cerebral venous thrombosis confirmed clinically and by neuroimaging were randomized to receive low dose (2500 units TID) or medium dose (5000 units TID) heparin. All patients were assessed periodically until discharge or death. Outcome was assessed using modified Rankin scale (good outcome <3, poor outcome 3 3). Patients who deteriorated without increase of hemorrhage or developed deep venous thrombosis were given higher doses of heparin. Results: Twenty-nine patients were randomized into each group. There was no increase or additional hemorrhage in either group. Five patients in the low dose group required increase in heparin dose (to 5000 units TID) due to deterioration. Good outcome was seen in 89% on medium dose and 44.8% on low dose heparin (p<0.05). Conclusions: the randomized controlled trial from an Indian center demonstrated that medium dose regimen of heparin is better than low dose regimen and also safe in the treatment of cerebral venous thrombosis.
A simple and safe technique for reconstruction of the acromioclavicular joint  [cached]
Rushton Paul,Gray James,Cresswell Tim
International Journal of Shoulder Surgery , 2010,
Abstract: Surgical reconstruction of the dislocated acromioclavicular joint often requires exposure and instrumentation of the coracoid. This carries risks to the surrounding neurovascular structures. We present a safe and simple technique of primary fixation of the acromioclavicular joint, relying on mechanical principles and biological repair, without the need for metalwork. By avoiding the coracoid we hope this approach will appeal to the general orthopedic surgeon. We have found that this technique is suited to both acute and chronic acromioclavicular joint dislocation.
Raltegravir-based post-exposure prophylaxis (PEP): a safe, well-tolerated alternative regimen
D Annandale,C Richardson,M Fisher,D Richardson
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.6.18165
Abstract: Three-drug regimens are routinely recommended in the UK for PEP after possible high-risk exposure to HIV. The current Department of Health and British Association for Sexual Health and HIV first-line regimen is lopinavir/ritonavir, tenofovir and emtricitabine (Truvada). Raltegravir-based regimens may be used as an alternative. This is a review of the use of raltegravir-containing PEP to identify why and when this is initiated and its tolerability and safety compared to first-line PEP. From February 2010 to April 2012, 509 courses of PEP were prescribed; 33 (6.5%) raltegravir-containing PEP. Pharmacy records identified eligible patients; these were compared to 33 courses of first-line PEP in the same time period. 18/33 (54%) of raltegravir-containing PEP were initiated due to potential drug-drug interactions with ritonavir, 3/33 (10%) due to the resistance profile of the contact and 12/33 (36%) due to intolerance of first-line regimen. All switches to raltegravir-based PEP occurred by day 3 of the course with 83% identified on day 1. All switches to raltegravir-containing PEP due to the resistance profile of the contact took place by day 3 of the course. Patients switching due to drug intolerance was largely due to gastrointestinal side effects between days 1 to 16; 2 cases were due to ALT changes. 19 courses of raltegravir-containing PEP were commenced on day one. Reported side effects in the raltegravir-containing PEP were lower than courses of first-line PEP: 10/19 (53%) patients reported no side effects by day 28 treatment compared to 5/33 (15%) patients on first-line PEP. 12/14 (79%) patients on first-line PEP who were switched to raltegravir-containing PEP reported improvement in their side effects. There were no significant liver or renal toxicities in the raltegravir group; 3 patients on first-line PEP had a significant ALT rise. One patient who started first-line PEP was found to be HIV-positive at baseline. An MSM who received raltegravir-containing PEP seroconverted 4.5 months after the course of PEP. He reported 3 episodes of unsafe sexual behaviour since PEP. Raltegravir-based regimens are safe and as well tolerated when compared to first-line regimen. Switching to raltegravir-based regimen is associated with a decrease in reported side effects. Self-reported adherence is better if patients are started on raltegravir. This study suggests that raltegravir-based PEP may be a preferred first-choice regimen.
HEPARIN THERAPY IN PATIENT WITH NON-Q WAVE MYOCARDIAL INFARCTION AND UNSTABLE ANGINA  [cached]
M.H EMAMI,M HEKMAT
Journal of Research in Medical Sciences , 2000,
Abstract: Introduction. This study was conducted to find that, is there any advantage from (5000 IU/6h) in patient with non-Q wave MI and unastable angina. Methods. In a randomized clinical trial two group of patients with non-Q wave MI and unstable angina were compared about their prognosis and management outcomes. In interventional group (n= 145), heparin (5000 IU/6h) was administered and in another group (n= 133) no treatment with heparin was used. Duration of chest pain, recurrent angina, intrahospital mortality were indices for patients outcome study. Findings. Anticoagulant complication was not report in any patient in interventional group. There is no significant difference between two groups about prognosis factors. Conclusion. Heparin administration (5000 IU/6h) may have not any role in improving management outcome in patient with non-Q wave MI and unastable angina at least in acute phase. So, it is recommended that heparin have been administered to these patients in continuous regimen (1000-1500 U/hour continuously effusion).
Update on the clinical use of the low-molecular-weight heparin, parnaparin  [cached]
Giuseppe Camporese,Enrico Bernardi,Franco Noventa
Vascular Health and Risk Management , 2009,
Abstract: Giuseppe Camporese1, Enrico Bernardi2, Franco Noventa31Unit of Angiology and 3Department of Clinical and Experimental Medicine, Clinical Epidemiology Group, University Hospital of Padua, Italy; 2Department of Emergency and Accident Medicine, Hospital of Conegliano Veneto, ItalyAbstract: Parnaparin is a low-molecular-weight heparin that has widely shown its efficacy and safety in prevention of venous thromboembolism, in the treatment of chronic venous disorders, and in the treatment of venous and arterial (stable and unstable angina, acute ST-segment elevation myocardial infarction) thrombosis. Parnaparin at the respective dosages of 3200, 4250, 6400, or 12800 IUaXa for a period ranging from 3 to 5 days to 6 months, is usually administered subcutaneously by means of once-daily regimen and is better tolerated than unfractionated heparin at the injection site. In the variety of commercially available low-molecular-weight heparins, parnaparin represents a useful therapeutic option, even though little evidence is available comparing the superiority or the equivalent efficacy and safety of parnaparin to that of the unfractionated heparin or placebo. This review summarizes the available literature on the use of parnaparin in different settings of cardiovascular diseases, including papers published during the past year and ongoing studies.Keywords: low-molecular-weight heparin, heparin, parnaparin, acute coronary syndromes, venous thromboembolism
Identification of Chemically Sulfated/desulfated Glycosaminoglycans in Contaminated Heparins and Development of a Simple Assay for the Detection of Most Contaminants in Heparin
Jing Pan, Yi Qian, Xiaodong Zhou, Andrew Pazandak, Sarah B. Frazier, Peter Weiser, Hong Lu and Lijuan Zhang
Glycobiology Insights , 2012, DOI: 10.4137/GBI.S4237
Abstract: Contaminated heparin was linked to at least 149 deaths and hundreds of adverse reactions. Published report indicates that heparin contaminants were a natural impurity, dermatan sulfate, and a contaminant, oversulfated chondroitin sulfate (OSCS). OSCS was assumed to derive from animal cartilage. By analyzing 26 contaminated heparin lots from different sources, our data indicate that the heparin contaminants were chemically sulfated or chemically sulfated/desulfated glycosaminoglycans (GAGs) consisting of heparan sulfate, chondroitin sulfate, and dermatan sulfate based on monosaccharide quantification, CE, heparin lyase digestion, and liquid chromatography/mass spectrometry analysis. Since currently recommended heparin quality control assays had failed to detect certain heparin contaminants, a simple method that detects most contaminants in heparin was developed. This assay detects specific heparin structures that most contaminants cannot mimic and can be performed in any laboratory equipped with an UV spectrometer.
Histopathologic changes during mesenteric ischaemia and reperfusion
JK Lapido, SA Seidel, LA Bradshaw, S Halter, JP Wikswo Jr, WO Richards
West African Journal of Medicine , 2003,
Abstract: The basic electrical rhythm (BER) of the intestine is known to decrease during mesenteric ischaemia. Some studies have reported the relationship between the BER and the pathologic changes that occur in the bowel during vascular injury. However, these changes have not been completely elucidated. This study describes the histopathologic pattern when the rabbit small intestine was subjected to ischaemia of varying time lengths (30 – 150 minutes) and subsequent reperfusion for six hours. Intestinal biopsies were taken at baseline, at the end of ischaemia, and at hourly intervals during reperfusion. Microscopic examination of the biopsies revealed evidence of progressive infarction of the mucosa during ischaemia. There was an acute worsening of the pathology during reperfusion, the severity being greater when reperfusion was preceded by longer periods of ischaemia. These changes were statistically significant. The observed pattern in this study shows clearly that reperfusion injury is reflected in the histopathologic response and that this is worse in severity than the response to ischaemia. Studies of longer duration should further clarify the picture during recovery in ischaemia/reperfusion injuries of the bowel.
Targeting out-of-hospital cardiac arrest: the effect of heparin administered during cardiopulmonary resuscitation (T-ARREST)  [cached]
JIRí KNOR,MILANA POKORNá,ROMAN ?KULEC,JIRí MáLEK
Signa Vitae , 2011,
Abstract: Introduction. Heparin administration during cardiopulmonary resuscitation (CPR) may prevent activation of coagulation after successful resuscitation for out-of-hospital cardiac arrest (OHCA). We hypothesize that such an approach is not associated with an increased rate of bleeding, but it has not been evaluated. We performed a pilot randomized clinical study assessing the safety of intra-arrest heparin administration in OHCA patients with suspected acute myocardial infarction (AMI) and its impact on their prognosis. Materials and Methods. OHCA patients were randomized during CPR to 10 000 units of intra-arrest intravenous heparin (Group H) or to treatment without heparin (Group C). The occurrence of major bleeding and the presence of a favourable neurological result 3 months after OHCA, were analyzed. Results. Out of 88 randomized patients, AMI was subsequently confirmed in 63 of them (71.6 %). There were 30 patients in group H and 33 in group C. No major bleeding event was observed in either group. Return of spontaneous circulation (ROSC, Group H: 40.0%, Group C: 45.4%, p=0.662) and a good neurological result 3 months after OHCA (Group H: 6.7 %, Group C: 9.1 %, p=0.921) did not differ between groups. Conclusions. Intravenous administration of 10 000 units of heparin during CPR for OHCA in patients with supposed AMI was safe. We did not find any improvement in prognosis for our sample of limited size. Though the procedure proved safe, we recommend postponing the administration of heparin until ROSC, assessment of clinical state and recording of a twelve-lead ECG.
Update on the clinical use of the low-molecular-weight heparin, parnaparin
Giuseppe Camporese, Enrico Bernardi, Franco Noventa
Vascular Health and Risk Management , 2009, DOI: http://dx.doi.org/10.2147/VHRM.S3430
Abstract: ate on the clinical use of the low-molecular-weight heparin, parnaparin Review (3452) Total Article Views Authors: Giuseppe Camporese, Enrico Bernardi, Franco Noventa Published Date September 2009 Volume 2009:5 Pages 819 - 831 DOI: http://dx.doi.org/10.2147/VHRM.S3430 Giuseppe Camporese1, Enrico Bernardi2, Franco Noventa3 1Unit of Angiology and 3Department of Clinical and Experimental Medicine, Clinical Epidemiology Group, University Hospital of Padua, Italy; 2Department of Emergency and Accident Medicine, Hospital of Conegliano Veneto, Italy Abstract: Parnaparin is a low-molecular-weight heparin that has widely shown its efficacy and safety in prevention of venous thromboembolism, in the treatment of chronic venous disorders, and in the treatment of venous and arterial (stable and unstable angina, acute ST-segment elevation myocardial infarction) thrombosis. Parnaparin at the respective dosages of 3200, 4250, 6400, or 12800 IUaXa for a period ranging from 3 to 5 days to 6 months, is usually administered subcutaneously by means of once-daily regimen and is better tolerated than unfractionated heparin at the injection site. In the variety of commercially available low-molecular-weight heparins, parnaparin represents a useful therapeutic option, even though little evidence is available comparing the superiority or the equivalent efficacy and safety of parnaparin to that of the unfractionated heparin or placebo. This review summarizes the available literature on the use of parnaparin in different settings of cardiovascular diseases, including papers published during the past year and ongoing studies.
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