To estimate the minimum effective dose of oxytocin required to produce adequate uterine tone in women undergoing elective caesarean delivery

To estimate the minimum effective dose of oxytocin required to produce adequate uterine tone in women undergoing elective caesarean delivery under spinal anaesthesia.BackgroundPatients undergoing caesarean delivery are at increased risk of obstetric haemorrhage. Uterine atony has been shown to be most common aetiology (30%) for PPH in patients undergoing caesarean delivery. Use of uterotonic agents decreases the incidence of PPH by approximately 40% when compared with placebo. Oxytocin is the most frequently used uterotonic agent because of less side-effects compared with all other available agents. We did the study to find out the minimal dose of oxytocin required to produce adequate uterine tone (UT) in primigravida women undergoing elective caesarean delivery.MethodsThis randomized double blind study was conducted in ninety full term primigravidas undergoing elective caesarean delivery under spinal anaesthesia. All patients received intravenous bolus of either 0.5, 1, or 2 unit oxytocin followed by infusion of 10 unit/h. UT was assessed by a blinded obstetrician as either adequate or inadequate, and using a five point scale, where 1 = atonic, 2 = partial but inadequate contraction, 3 = adequate contraction, 4 = well contracted and 5 = very well contracted at 2, 3, 6, and 9 min after oxytocin administration. Minimum effective doses of oxytocin were analysed. Oxytocin related side-effects (including hypotension) were recorded.ResultsThere were no significant differences in the prevalence of adequate UT among the study groups at 2 min (86%, 90% and 93% for, 0.5, 1 and 2 unit oxytocin, respectively). The prevalence of nausea and vomiting was significantly higher after 2 unit oxytocin vs 0.5 unit at 1 min (13% vs 3%).ConclusionSmall bolus dosages of oxytocin (0.5–2 unit) result in adequate uterine tone in primigravida women undergoing elective caesarean delivery with minimal effects on haemodynamic parameters and less incidence of nausea and vomiting.     

Effect of training on VO2max, thigh strength, and muscle morphology in septuagenarian women

The purpose of this study was to determine the effects of a long-term (50 wk) combined aerobic-resistance training program on maximal oxygen consumption (VO2max, thigh strength, and vastus lateralis fiber morphology in healthy septuagenarian women (mean age = 72 +/- 6 yr). Subjects volunteered to be in either an exercise (Ex; N = 17) or control (Con; N = 10) group. Con subjects were 34% less active in winter than in summer, Ex subjects maintained their summer activity level on exercise days in winter. Initial, intermediate (20 wk), and final (50 wk) measurements were made for isokinetic knee extension/flexion strength; VO2max and morphological measurements from a muscle biopsy were made at the initial and final times only. Both groups gained in leg strength (Ex = +6.5%; Con = +7.8%; P less than or equal to 0.05) during the summer; in the winter the Ex group maintained leg strength and the Con group declined 12.2% (P less than or equal to 0.05). The fast-twitch muscle fiber area (Type IIb) increased 29% (P less than or equal to 0.001) in the Ex group and declined 26% (P = 0.014) in the Con group. VO2max increased only in the Ex group (16%; P less than 0.001). We conclude that healthy septuagenarian women can increase aerobic capacity, leg strength, and Type IIb muscle fiber area with a long-duration, combined aerobic-resistance exercise program.     

Patterns of eating and abstinence in women treated for bulimia nervosa

OBJECTIVE: The current study sought to determine whether there is an optimal pattern of eating leading to cessation of binge eating and purging in bulimic women. METHOD: Data on the number of meals and snacks consumed were obtained from the Eating Disorders Examination (EDE) pretreatment and posttreatment, for individuals participating in a randomized controlled study comparing cognitive-behavioral therapy and interpersonal therapy. Records were available for 158 participants. RESULTS: The numbers of meals and snacks eaten from pretreatment to posttreatment increased significantly. A pattern of eating with at least 80 meals combined with at least 21 afternoon snacks within a 28-day period was associated with an abstinence rate of 70%. In contrast, for subjects having 72-80 meals, those having greater than 11 evening snacks have an abstinence rate of 4%. CONCLUSION: The critical elements of the pattern of eating related to abstinence appear to be the total number of meals consumed and the timing of snacks.     

Diaryl dihydropyrazole-3-carboxamides with significant in vivo antiobesity activity related to CB1 receptor antagonism: synthesis, biological evaluation, and molecular modeling in the homology model

A number of analogues of diaryl dihydropyrazole-3-carboxamides have been synthesized. Their activities were evaluated for appetite suppression and body weight reduction in animal models. Depending on the chemical modification of the selected dihydropyrazole scaffold, the lead compounds--the bisulfate salt of (+/-)-5-(4-chlorophenyl)-1-(2,4-dichlorophenyl)-4,5-dihydro-1H-pyrazole-3-carboxylic acid morpholin-4-ylamide 26 and the bisulfate salt of (-)-5-(4-chlorophenyl)-1-(2,4-dichlorophenyl)-4,5-dihydro-1H-pyrazole-3-carboxylic acid morpholin-4-ylamide 30--showed significant body weight reduction in vivo, which is attributed to their CB1 antagonistic activity and exhibited a favorable pharmacokinetic profile. The molecular modeling studies also showed interactions of two isomers of (+/-)-5-(4-chlorophenyl)-1-(2,4-dichlorophenyl)-4,5-dihydro-1H-pyrazole-3-carboxylic acid morpholin-4-ylamide 9 with CB1 receptor in the homology model similar to those of N-piperidino-5-(4-chlorophenyl)-1-(2,4-dichlorophenyl)-4-methyl-3-pyrazole-carboxamide (rimonabant) 1 and 4S-(-)-3-(4-chlorophenyl)-N-methyl-N'-[(4-chlorophenyl)-sulfonyl]-4-phenyl-4,5-dihydro-1H-pyrazole-1-carboxamidine (SLV-319) 2.     

Radiation Oncology: a Primer for Medical Students

Radiation oncology requires a complex understanding of cancer biology, radiation physics, and clinical care. This paper equips the medical student to understand the fundamentals of radiation oncology, first with an introduction to cancer treatment and the use of radiation therapy. Considerations during radiation oncology consultations are discussed extensively with an emphasis on how to formulate an assessment and plan including which treatment modality to use. The treatment planning aspects of radiation oncology are then discussed with a brief introduction to how radiation works, followed by a detailed explanation of the nuances of simulation, including different imaging modalities, immobilization, and accounting for motion. The medical student is then instructed on how to participate in contouring, plan generation and evaluation, and the delivery of radiation on the machine. Lastly, potential adverse effects of radiation are discussed with a particular focus on the on-treatment patient.