“Comparative study of medical abortion by mifepristone with vaginal misoprostol in women < 49 days versus 50–63 days of amenorrhoea”

Objectives

To compare the outcome with Mifepristone and vaginal Misoprostol combination in women having amenorrhea <-49 days (group-A) verses 50–63 days. (Group-B)

Methods

We administered 200 mg of mifepristone to 200 women willing for medical abortion within 63 days of amenorrhea. After 48 hours they were assigned to receive 400 microgram of misoprostol vaginally. At the end of 4 hours, if required, reinstillation of 400 microgram misoprostol vaginally was done.

Results

Complete abortion rate in women with amenorrhea <-49 days verses 50–63 days were 99.16% and 98.75% respectively. Average duration of bleeding was 6.26 (S, D. 2.43 days ) and 6.98 days (2.26 days)respectively and the difference is statistically significant (p<0.05). The proportion of women with induction abortion interval <-4 hours in the two groups as 83.33% and 72.25% respectively. This difference is statistically not significant (Chi-square=3.47, P>0.05). The success rate at the end of 14 days in group A and B was 99.16% and 98.75% respectively and this difference is statistically not significant. (Chi-square = 0.19, P>0.05)

Conclusions

The combination of oral mifepristone and vaginal misoprostol is currently approved for medical abortion in women with amenorrhoea up to 49 days (7 weeks gestation ). Our study has demonstrated that the use of this combination can be effectively and safely extended for inducing abortions in women with amenorrhoea up to 63 days (9 weeks gestation).     

Implementation of amplitude-integrated electroencephalography in tertiary Canadian Neonatal Intensive Care Units—a longitudinal study

AimTo investigate the implementation of amplitude-integrated electroencephalography (aEEG) as bedside monitoring tool of cerebral function in tertiary Canadian Neonatal Intensive Care Units (NICU) over the past decade.MethodsLongitudinal study consisting of online surveys of neonatologists on the use of aEEG in 2009 and 2018.ResultsThe response rate to the survey was 72 of 149 (49%) in 2009 and 18 of 30 (60%) in 2018, respectively. aEEG has been implemented in almost all (2009: 62.5%; 2018: 94%) tertiary Canadian NICUs. Two-thirds (2009: 67%; 2018: 71%) of the respondents considered information from aEEG tracing helpful in clinical practice. The main indications for aEEG were term neonates with hypoxic ischemic encephalopathy (2009 and 2018: 76%) and seizure detection/surveillance (2009: 88%; 2018: 94%). Teaching on aEEG has been implemented for neonatologists (2018: 100%) and health care providers (2018: 50%) in tertiary Canadian NICUs but there is a lack of standardization of training. Use of aEEG in preterm neonates (2009: 37%, 2018: 33%) and application of aEEG in research (18% reported occasional use) is less common.ConclusionaEEG is well established in tertiary Canadian NICUs to monitor cerebral function and detect seizure activity. There is a need to develop formalized aEEG training programs and methods to assess competence. Further implementation of aEEG in preterm neonates and research is desirable.     

Genetic and immunological comparison of anti-botulinum type A antibodies from immune and non-immune human phage libraries

Understanding the antibody response in botulinum intoxication is important for vaccine design and passive prophylaxis. To investigate this activity, we have studied the immune response to BoNT/A (botulinum neurotoxin serotype A) binding domain (HC) at the molecular level using phage display. The scFv antibodies were isolated from V-gene repertoires prepared from (a) human volunteer immunized with pentavalent botulinum toxoid and (b) non-immune human peripheral blood lymphocytes and spleenocytes. A large panel of serotype specific phage expressing botulinum binding scFv could be selected from both libraries. Epitope mapping of immune scFv binders towards BoNT/A HC revealed surprisingly a limited number of scFv recognizing conformational epitopes that corresponded to two distinct groups, clusters I and II. Only scFv from cluster I exhibited neutralizing activity in the mouse hemidiaphragm assay. Anti- BoNT/A HC clones derived from a non-immune library could be conveniently grouped into clusters III-XI and appeared to share no overlapping epitopes with cluster I or II. In addition they showed no neutralization of toxin at biologically significant concentrations. We therefore suggest that a vaccine based on the pentavalent botulinum toxoid directs the humoral immune response to a limited number of immunodominant epitopes exposed on the binding domain HC.     

Gestational age assessment with clinical criteria and amniotic fluid study using point scoring system

A comparative study on gestational age assessment of 155 newborn infants was undertaken using a scoring system with the clinical criteria: (1) criteria of Dubowitz et al, (2) external criteria alone, and (3) primitive reflexes in relation to the amniotic fluid study. The effect of certain prenatal and perinatal abnormal states on the results of these methods was evaluated. The criteria of Dubowitz et al, external criteria and amniotic fluid studv showed greater accuracy than the primitive reflexes for the assessment of gestational age of normal infants, especially the preterm group. In asphyxiated babies and in babies of diabetic mothers, the neurological score, being poor, under-estimated the gestational age. The amniotic fluid score and the external criteria were more helpful than the neurological score for the assessment of gestational age in these states. Smoking and toxemia did not influence the score by any of the methods in normal infants. In dysmaturity, the amniotic fluid score and score by primitive reflexes were more reliable than the external criteria alone and the criteria of Dubowitz et al. In general, the amniotic fluid score was not influenced by abnormal states compared to scores by other methods.     

Serum mucoprotein tyrosine in rheumatism

Summary and Conclusions 75 cases of rheumatism in children with clinical manifestations such as arthritis, chorea, carditis and arthritis with carditis were studied for serum mucoprotein values. The values were raised consistently in all the cases. Even cases of rheumatic chorea showed a significant rise in mucoproteins while other tests for judging rheumatic activity may be non-contributory. From the Department of Pediatrics, M. G. Medical College, Indore.     

Hepatitis C drug discovery: in vitro and in vivo systems and drugs in the pipeline

The combination therapy of ribavirin and pegylated interferon-alpha for hepatitis C has significant side effects, is often poorly tolerated and is ineffective in many patients, despite causing impressive improvement in the sustained virological response. Discovery and development of more effective and well-tolerated antihepatitis C virus drugs are clearly in great demand. During the past few years, remarkable advances have been made in the establishment of in vitro and in vivo systems. Armed with these systems, a wave of specific antihepatitis C virus compounds have been discovered and are moving into the clinical phase. More effective combination therapies with specific antivirals are predicted to emerge in the near future for the treatment of hepatitis C.