Ovarian follicular maturation in women. I. Intermittent versus daily administration of human menopausal gonadotropin

This study was designed to compare the efficiency of daily intramuscular human menopausal gonadotropin (hMG) therapy to an intermittent subcutaneous regimen in women with ovulatory dysfunction. Ovarian follicular development was assessed with the use of serial ultrasound scans and serum 17 beta-estradiol (E2) levels. Ovulation was based on pregnancy and/or elevated luteal progesterone values. There were no significant differences between the two treatment regimens, based on E2 levels, follicular size, and/or number of follicles greater than 1.0 cm. Pregnancy and ovulation occurred more frequently after intramuscular hMG therapy. These results indicate that daily hMG is preferred over intermittent subcutaneous administration because of convenience.     

Mallory-Weiss syndrome. A changing clinical picture.

A retrospective study of 18 episodes of upper gastrointestinal (UGI) bleeding secondary to Mallory-Weiss syndrome occuring in 16 patients is presented. Reported cases published since 1969 have been summarized and compared with earlier collected series. It is evident that the clinical spectrum, prognosis, and opinion regarding etiology and treatment of the syndrome have changed in the last decade. Increased awareness of gastroesophageal lacerations secondary to emesis as well as other causes of significantly increased intraesophagogastric pressures, and widespread utilization of fiberoptic endoscopy have resulted in identification of Mallory-Weiss syndrome with increasing frequency. Less severe lacerations which are healing with medical therapy are being recognized. It is recommended that endoscopy by performed in all cases of UGI hemorrhage and that patients with Mallory-Weiss syndrome be managed medically unless hemorrhage is massive or persistent since nearly three of four patients can be successfully treated without operation.     

A multicenter point prevalence survey of antibiotic use in Punjab,Pakistan: findings and implications

Objectives: In line with the recent global action plan for antimicrobial resistance, this is the first time such a comprehensive antimicrobial point prevalence survey has been undertaken in Pakistan, the sixth most populous country.

Methods: This point prevalence survey (PPS) was conducted in 13 hospitals among 7 different cities of Pakistan. The survey included all inpatients receiving an antibiotic on the day of PPS. A web-based application was used for data entry, validation, and reporting as designed by the University of Antwerp (www.global-pps.com).

Results: Out of 1954 patients, 1516 (77.6%) were treated with antibiotics. The top three most reported indications for antibiotic use were prophylaxis for obstetrics or gynaecological indications (16.5%), gastrointestinal indications (12.6%) and lower respiratory tract infections (12.0%). The top three most commonly prescribed antibiotics were ceftriaxone (35.0%), metronidazole (16.0%) and ciprofloxacin (6.0%). Out of the total indications, 34.2% of antibiotics were prescribed for community-acquired infections (CAI), 5.9% for healthcare-associated infections (HAI), and 57.4% for either surgical or medical prophylaxis. Of the total use for surgical prophylaxis, 97.4% of antibiotics were given for more than one day.

Conclusions: Unnecessary prophylactic antibiotic use is extremely high, and broad-spectrum prescribing is common among hospitals in Pakistan. There is an urgent need to work on the national action plan of Pakistan on antibiotic resistance to address this.     

MRI of patients with cardiac pacemakers: a review of the medical literature

OBJECTIVE: Numerous studies testing the use of pacemakers with MRI have been published. Our aim was to analyze these trials to determine the safety of MRI for patients with cardiac pacemakers. We performed a systematic search of peer-reviewed databases. A total of 31 articles were reviewed. CONCLUSION: The data are heterogeneous with regard to MRI being considered for patients with pacemakers, and the benefits of the imaging should outweigh the risks.