Effect of hyoscine butylbromide first stage of labour in multiparus women

Background

Prolonged labor is one of the most important risk factors for perinatal compromise and, if caused by obstructed labor, it carries the risk of uterine rupture, postpartum hemorrhage (PPH), puerperal sepsis, and maternal death.

Objective

To determine whether or not hyoscine butylbromide shortens the stages of labor, without an increase in maternal or neonatal complications.

Method

In single-blinded randomized clinical trial study, 188 multiparas women in active phase of labor who were admitted to Shahid Sadoughi Hospital from October 2006 to April 2007 in Yazd - Iran, were evaluated. They were divided hyoscine group (n = 94) received 20mg (1ml) of hyoscine and control group (n = 94) received 1 ml of normal saline was given as placebo, intravenously. The effects of hyoscine in shortening labor time; and neonatal Apgar score was compared.

Results

Duration of the first (mean± SD: 186.8 ± 125.6 minutes vs. 260.4 ± 120.9 minutes, p= 0.00 1) and second stage of labor (mean± SD: 20.0 ± 8.1minutes vs. 25.8 ± 9.4 minutes, p= 0.03) was shorter in hyoscine group.Frequency of cesarean section and mean of neonatal Apgar score at minutes of one and 5 were not different in both groups. No serious adverse events were seen in the two groups.

Conclusion

Injection of hyoscine in active phase of labor can be effective in shortening of labor without any adverse effect on mother and fetus.     

Increased Serum Concentration of Sphingosine-1-phosphate in Juvenile-onset Systemic Lupus Erythematosus

Purpose

Sphingosine-1-phosphate (S1P) is an active sphingolipid with chemotactic abilities and has been linked to inflammatory mediators and autoimmune disease. The aim of this study was to assess whether children with juvenile-onset systemic lupus erythematosus (JSLE) express increased systemic and/or urinary concentrations of S1P.

Methods

A subgroup of patients participating in the UK JSLE Cohort Study, were invited to participate. Cross sectional serum and urine samples were prospectively collected along with demographic and standard clinical data. Results were compared to a cohort of disease controls (Henoch Schonlein Purpura; HSP) and healthy controls (HC).

Results

The median age of JSLE patients (n?=?15) was 13.6?years (7.2–16.9?years). The serum concentrations of S1P in JSLE patients (7.4?uM, IQR 6.3–12.3?uM) were statistically significantly increased when compared to patients with HSP (n?=?10; 5.2?uM, IQR 4.0–7.9?uM; p?=?0.016) and HCs (n?=?10; 3.8?uM, IQR 2.1–5.8?uM; p?=?0.003). There was a trend towards increased serum S1P concentrations between patients with active lupus nephritis (n?=?8; 8.7?uM, IQR 6.2–15.3?uM) compared to lupus non-nephritis (n?=?7; 6.6?uM, IQR 6.3–10.6?uM; p?=?0.355). No relationship was found between disease activity markers and S1P. Urine S1P concentrations were no different between JSLE patients (56.0?nM, IQR 40.3–96.6?nM) and HCs (58.7?nM, IQR 0–241.9?nM; p?=?0.889).

Conclusions

We have demonstrated, for the first time, an increased serum concentration of S1P in a cohort of JSLE patients. These findings highlight a role of S1P in the pathophysiology of JSLE that warrants further investigation.     

Risk of stroke and oral anticoagulant use in atrial fibrillation: a cross-sectional survey

Background

Oral anticoagulants substantially reduce the risk of stroke in atrial fibrillation but are underutilised in current practice.

Aim

To measure the distribution of stroke risk in patients with atrial fibrillation (using the CHADS² and CHA₂DS₂-VASc scores) and changes in oral anticoagulant use during 2007–2010.

Design and setting

Longitudinal series of cross-sectional survey in 583 UK practices linked to the QResearch® database providing 99 351 anonymised electronic records from people with atrial fibrillation.

Method

The proportion of patients in each CHADS₂ and CHA₂DS₂-VASc risk band in 2010 was calculated; for each of the years 2007–2010, the proportions with risk scores ≥2 that were using anticoagulants or antiplatelet agents were estimated. The proportions identified at high risk were re-estimated using alternative definitions of hypertension based on coded data. Finally, the prevalence of comorbid conditions in treated and untreated high-risk (CHADS₂ ≥2) groups was derived.

Results

The proportion at high risk of stroke in 2010 was 56.9% according to the CHADS₂ ≥2 threshold, and 84.5% according to CHA₂DS₂-VASc ≥2 threshold. The proportions of these groups receiving anticoagulants were 53.0% and 50.7% respectively and increased during 2007–2010. The means of identifying the population of individuals with hypertension significantly influenced the estimated proportion at high risk. Comorbid conditions associated with avoidance of anticoagulants included history of falls, use of nonsteroidal anti-inflammatory drugs, and dementia.

Conclusion

Oral anticoagulant use in atrial fibrillation has increased in UK practice since 2007, but remains suboptimal. Improved coding of hypertension is required to support systematic identification of individuals at high risk of stroke and could be assisted by practice-based software.     

Public health and nursing practice: seizing the receptive moment

Both nursing and government policy indicate the crucial role that all nurses have in the public health arena and yet it would seem that the role of the nurse in general within public health is open to debate and criticism. The author has a responsibility for the development of public health across the undergraduate curriculum within a university. This paper presents a discussion of some of the issues raised from student nurses, nurse lecturers and nurse managers. These discussions are as a result of both a 5 year PhD study undertaken by the author and a revalidation the undergraduate nursing programme within the author's organisation. The aim of the paper being to consider what is needed to put public health at the core of all and every nurse's practice across the UK. It takes the approach of lessons learned as it discusses some of the changes made to the author's own organisations undergraduate nurse curriculum, and those changes which still need to happen in order for nursing to identify its public health capacity. Such changes it may be suggested are easily transferable across all UK nursing curricula.     

Crystallographic snapshots of the complete reaction cycle of nicotine degradation by an amine oxidase of the monoamine oxidase (MAO) family

FAD-linked oxidases constitute a class of enzymes which catalyze dehydrogenation as a fundamental biochemical reaction, followed by reoxidation of reduced flavin. Here, we present high-resolution crystal structures showing the flavoenzyme 6-hydroxy-l-nicotine oxidase in action. This enzyme was trapped during catalytic degradation of the native substrate in a sequence of discrete reaction states corresponding to the substrate-reduced enzyme, a complex of the enzyme with the intermediate enamine product and formation of the final aminoketone product. The inactive d-stereoisomer binds in mirror symmetry with respect to the catalytic axis, revealing absolute stereospecificity of hydrogen transfer to the flavin. The structural data suggest deprotonation of the substrate when bound at the active site, an overall binary complex mechanism and oxidation by direct hydride transfer. The amine nitrogen has a critical role in the dehydrogenation step and may activate carbocation formation at the α-carbon via delocalization from the lone pair to σ* C(α)-H. Enzymatically assisted hydrolysis of the intermediate product occurs at a remote (P?site) cavity. Substrate entry and product exit follow different paths. Structural and kinetic data suggest that substrate can also bind to the reduced enzyme, associated with slower reoxidation as compared to the rate of reoxidation of free enzyme. The results are of general relevance for the mechanisms of flavin amine oxidases.