The use of CAM by women suffering from nausea and vomiting during pregnancy

Background  

Nausea and vomiting during pregnancy (NVP) affects two-thirds of pregnant women to varying degrees and over the years many modalities have been used to try to alleviate this often debilitating condition. There is a paucity of information in the literature about the use or efficacy of complementary and alternative medicine (CAM) for the treatment of this condition that affects so many women. Our primary objective was to examine the prevalence of CAM usage by women suffering from NVP. Our secondary objective was to ascertain if women had any supervision in the use of these treatments.     

Mirtazapine: treatment of depression, anxiety, and hyperemesis gravidarum in the pregnant patient. A report of 7 cases

Summary Objective: Though selective serotonin re-uptake inhibitors have been studied in pregnancy (Gupta, 1998), there is little information on the efficacy and safety of mirtazapine (Remeron^?), a central alpha-2 blocker for treatment of depression and anxiety in pregnancy. Since mirtazapine blocks the 5HT-3 receptor postsynaptically, like ondansetron (Zofran^?) but unlike any other antidepressant, there is reason to believe that mirtazapine may be of great use in treating not only depression and anxiety in pregnancy but also nausea and the more severe condition, hyperemesis gravidarum. Method: Seven cases are reviewed in which mirtazapine was given in pregnancy for hyperemesis and depression. Five patients were treated as outpatients. Two patients were begun on mirtazapine as inpatients already on transparenteral nutrition, one having had a negative reaction to ondansetron and metoclopramide. Results: All patients demonstrated improvement of depressed mood, and reduced nausea and vomiting. All seven babies were born at term, each with APGAR scores of 7 or 8 at one minute, 9 at five minutes. Conclusions: Mirtazapine may prove a valuable treatment in pregnancy for depression, anxiety and/or hyperemesis, based on its dual action (serotonin and norepinephrine), efficacy in treating depression, and antagonism of 5HT-3. Further studies of its potential therapeutic use in pregnancy are warranted.     

Incidence of postoperative nausea and vomiting (PONV) after general pre-anaesthetic prophylaxis with antihistamines

Inflammation Research -     

In-vitro fertilization: the experience of treatment, pregnancy and delivery

The present study compares the experience of pregnancy and deliveryamong in-vitro fertilization (IVF) parents (45 couples), otherformerly infertile parents (35 couples) and fertile parents(35 couples). All deliveries concerned primaparous women andsingleton births. In addition, the burden of fertility treatmentswas investigated. Results show that the psychological burdenof the treatments exceeds the physical burden. Fertility treatmentswere judged very worthwhile. Complications during pregnancywere more frequently reported by IVF mothers and other initiallyinfertile mothers than by fertile mothers. However, controllingfor the older age in both formerly infertile groups (IVF andnon-IVF), no significant difference was found. No differencesappeared regarding the evaluation of the development of thedelivery. IVF parents and other infertile parents evaluatedthe pregnancy as more stressful than fertile parents. However,mothers experienced their delivery as more exceptional, andfathers experienced the pregnancy as more exceptional. In addition,IVF fathers enjoyed the pregnancy more than fathers from theother groups.     

Analysis of the polymorphism of the tumour necrosis factor (TNF) gene and promoter and of circulating TNF-alpha levels in heart-transplant patients suffering or not suffering from severe rejection

Plasma TNF-α levels are generally higher in heart-graft patients who experience a rejection episode than in those who do not. Because the TNF gene and its promoter are polymorphic, we studied the relationships between genetic variability at the TNF locus, the occurrence of graft rejection and TNF-α plasma levels in 62 heart-transplant patients in order to investigate inter-individual differences in plasma TNF-α levels after allogeneic stimulation. TNF-α was immunoenzymatically measured in blood specimens collected on the same day as endomyocardial biopsy. After PCR amplification of DNA, NcoI and AspHI polymorphisms were characterized by their restriction profiles, TNFa microsatellites by electrophoretic separation on acrylamide and the promoter region by sequencing. Plasma levels and molecular genetic results were compared to the grade of heart graft rejection established according to pathological criteria. In our study, allograft rejection was associated neither with NcoI or AspHI polymorphism nor with nucleotide changes in the TNF-Α promoter. We observed low TNF-α levels in n1/n1 homozygous patients and in subjects with G→A at position – 308 of the promoter sequence. Concerning the polymorphism of the TNFa microsatellite, our results might suggest an association with graft rejection but we have to be very careful in drawing conclusions because of the small size of the sample.     

Granulocyte migration abnormality in patients suffering from seasonal allergic rhinitis: failure of treatment with cimetidine

Granulocyte locomotory responses in 5 patients with symptomatic seasonal allergic rhinitis were lower compared with similar responses from 27 normal nonallergic controls. In a subsequent controlled, double-blind crossover study, neither cimetidine (histamine H2-receptor blocker) nor placebo improved these responses. In our in vitro study, histamine did not inhibit granulocyte responses to chemotactic attractant. These results indicate that defective granulocyte response in patients with seasonal allergic rhinitis may be due to factors other than or in addition to histamine.     

Treatment of nausea and vomiting associated with cerebellar infarction using the traditional herbal medicines banhabaekchulcheonma-tang and oryeong-san: Two case reports (CARE-complaint)

RationaleMetoclopramide is commonly used to treat nausea and vomiting. However, long-term administration of metoclopramide is associated with various adverse effects, and its therapeutic effects are short-lasting. Hence, traditional East Asian medicine has received increasing attention as a short-term strategy for treating these symptoms.Patient concernsThe present report discusses the cases of a 71-year-old man and an 80-year-old woman diagnosed with cerebellar infarction. Both patients reported nausea and vomiting, which appeared during hospitalization following cerebellar infarction.DiagnosesOne patient was diagnosed with a left cerebellar infarction and hemorrhagic transformation, while the other was diagnosed with a bilateral cerebellar infarction.InterventionsBoth patients took Banhabaekchulcheonma-tang (BT) and Oryeong-san (OS) extracts.OutcomesThe patient in Case 1 experienced a rapid decrease in nausea from day 5 of BT and OS administration, and metoclopramide was discontinued on day 7. The patient in Case 2 experienced a clear decrease in the number of vomiting episodes from day 6 of BT and OS administration and did not take metoclopramide thereafter.LessonsOther than drugs used to mitigate symptoms, there are no suitable treatments available for nausea and vomiting caused by cerebellar infarction. In the present cases, nausea and vomiting remained unresolved even after 3 weeks of treatment with conventional therapies; however, these symptoms significantly improved after administration of the traditional East Asian herbal medicines BT and OS, and there were no recurrences. These cases demonstrate that traditional herbal medicine can reduce the side effects associated with long-term administration of metoclopramide and help patients resume their daily lifestyle. In addition, BT and OS treatment can facilitate administration of other drugs, highlighting its potential to aid in the treatment of stroke. Further research including relevant clinical trials is required to obtain more conclusive evidence.     

Analysis of the polymorphism of the tumour necrosis factor (TNF) gene and promoter and of circulating TNF-alpha levels in heart-transplant patients suffering or not suffering from severe rejection.

Plasma TNF-alpha levels are generally higher in heart-graft patients who experience a rejection episode than in those who do not. Because the TNF gene and its promoter are polymorphic, we studied the relationships between genetic variability at the TNF locus, the occurrence of graft rejection and TNF-alpha plasma levels in 62 heart-transplant patients in order to investigate inter-individual differences in plasma TNF-alpha levels after allogeneic stimulation. TNF-alpha was immunoenzymatically measured in blood specimens collected on the same day as endomyocardial biopsy. After PCR amplification of DNA, NcoI and AspHI polymorphisms were characterized by their restriction profiles, TNFa microsatellites by electrophoretic separation on acrylamide and the promoter region by sequencing. Plasma levels and molecular genetic results were compared to the grade of heart graft rejection established according to pathological criteria. In our study, allograft rejection was associated neither with NcoI or AspHI polymorphism nor with nucleotide changes in the TNF-A promote. We observed low TNF-alpha levels in n1/n1 homozygous patients and in subjects with G-->A at position--308 of the promoter sequence. Concerning the polymorphism of the TNFa microsatellite, our results might suggest an association with graft rejection but we have to be very careful in drawing conclusions because of the small size of the sample.     

Variations in fluconazole susceptibility and DNA subtyping of multiple Candida albicans colonies from patients with AIDS and oral candidiasis suffering one or more episodes of infection.

Five Candida albicans colonies from each infection in AIDS patients receiving fluconazole therapy for oropharyngeal candidiasis over a 2-year period were evaluated by antifungal susceptibility testing and DNA subtyping, and the results were correlated with clinical response to determine the occurrence of clinically significant selection of more-resistant C. albicans over multiple infections. A total of 534 C. albicans isolates were obtained from 38 patients who exhibited 84 episodes of infection. Antifungal susceptibility testing revealed that the MICs for 93% of the isolates were < or = 8.0 microg/ml and the MICs for 7% of the isolates were > or = 64 microg/ml. DNA subtyping revealed 70 different subtypes, with 78% of patients with one infection exhibiting one DNA subtype and 80% of patients with more than one infection exhibiting multiple DNA subtypes. Also, patients who had multiple infections had lower CD4 counts than those with single infections. Differences between the single-infection group and the multiple-infection group regarding the number of DNA subtypes and CD4 counts were both statistically significant. Of the 74 evaluable infections all were successfully treated with regular-dose (100-mg/day) fluconazole, except for three patients who ultimately responded to higher-dose fluconazole. Only one patient may have shown clinically significant selection of a more-resistant C. albicans strain over multiple courses of treatment. Interestingly, MICs reached only 8.0 microg/ml, even though doses of 400 mg of fluconazole were necessary for clinical cure.     

Use of exchange blood transfusion in the management of severe COVID-19 infection in pregnancy: experience from Lagos,Nigeria

Coronavirus disease 2019 (COVID-19) presents with symptoms that may be mild or severe. The individual with the severe form of the disease usually presents with a constellation of respiratory symptoms typical of acute respiratory distress syndrome. In this report, we present our experience of the successful management of an oxygen-dependent pregnant woman with severe COVID-19 infection who had 2 sessions of partial exchange blood transfusion. We discussed the principles that informed this intervention and the need to adopt this novel approach in the care of severe COVID-19 infection.     

Granulomatosis with polyangiitis (Wegener): Clinical aspects and treatment

Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis, which affects small- and medium-sized blood vessels and is often associated with cytoplasmic ANCA. GPA occurs in patients between 45 and 60 years old of both genders, and is rarely observed in blacks. The prevalence of GPA increases along a south–north gradient in Europe (20 to 150/million). The main clinical characteristics involve the upper and/or lower respiratory tract and kidneys. Ear, nose and throat manifestations with recurrent sinusitis and crusting rhinorrhea are usually severe. Lung nodules are frequently seen, sometimes excavated. Renal involvement is characterized by rapidly progressive necrotizing glomerulonephritis with extracapillary crescents. Limited forms of GPA predominantly affect the upper respiratory tract, whereas generalized forms of GPA include renal manifestations and/or alveolar hemorrhage and/or vital organ involvement with an altered general condition. The combination of immunosuppressant drugs and corticosteroids has converted this typically fatal illness into one in which 80% of patients achieve remission. However, despite considerable therapeutic progress over the last decades, relapses remain frequent (50% at 5 years), and maintenance treatment is now the main therapeutic challenge.     

Subpopulations of T and B lymphocytes in peripheral blood and lymphocytes reactivity to non-specific mitogens (PHA, Con A, PWM) in in vitro cultures in patients suffering from in vitro cultures in patients suffering from glomerulonephritis.

Studies were performed on 79 subjects, out of which 32 belonged to the control group and 47 suffered from glomerulonephritis. The number of T and B lymphocytes in peripheral blood was determined using the technique of E, EA and EAC-rosette tests. Also, the lymphocyte blast response to non-specific mitogens (PHA, Con A, PWM) was established in vitro. Patients suffering from acute proliferative glomerulonephritis, as compared to the control group, displayed a statistically significant increase of lymphocytes with the receptor for complement (EAC-rosettes). Their reactivity to all three mitogens did not differ from the values obtained in the control group. In patients suffering from chronic glomerulonephritis (proliferative, membranous-proliferative, membranous), shiftings in the contents of the peripheral blood lymphocytes pools were of opposite directions, i.e., statistically significant in comparison with the control group. Also an increase in the absolute number of T lymphocytes (E-rosettes) was observed. Generally speaking, the values of blast transformations after mitogen stimulations were smaller in patients suffering from chronic than in those suffering from acute glomerulonephritis. In 1/3 of them, the decrease of blast response to one of the three mitogens was detected. The decrease exceeded the lower limit of values of healthy subjects, and most often, it was connected with Con A stimulation.