Maternal complications after Caesarean section in HIV-infected pregnant women

A study of maternal complications after elective Caesarean section in HIV-infected women was carried out from January 1999 to April 2001. The control group consisted of all the seronegative pregnant women who underwent the elective Caesarean section during the study period. The study group was divided into two subgroups. Subgroup 1 patients were given 600 mg zidovudine (ZDV) orally and 300 mg lamivudine (3TC) daily from 34 to 38 weeks' gestation. Subgroup 2 patients were given 600 mg ZDV orally daily from 34 to 38 weeks' gestation and 150 mg nevirapine orally on the morning of the Caesarean section day. In both groups, the elective Caesarean section was carried out at 38 weeks' gestation and ZDV syrup (2 mg/kg) was given orally to the newborn immediately in the operating theatre and then every 6 h for 4 weeks. No statistically significant differences in maternal complications were found between the HIV-infected and non HIV-infected women.     

Autologous Blood Donation for Elective Gynaecological Surgery

The utilization and effectiveness of a hospital autologous blood donation programme for elective gynaecological surgery at Ramathibodi Hospital during April 1, 1988-March 31, 1991 were analyzed. A total of 438 patients or 98% of eligible patients were enrolled into the programme. Each patient gave 1 unit of blood within 14 days of undergoing gynaecological surgery. The untoward effects observed in the programme were higher than those found in the regular donors. However, these were very mild. Nearly 90% of the participants used no homologous blood during their hospitalization, 8% used only their autologous blood, while 2% used additional homologous transfusion. The released autologous components were subsequently administered to other recipients. The patients' acceptance was excellent. Autologous blood donation is a safe, inexpensive and feasible procedure for transfusion treatment in elective gynaecological surgery especially in developing countries.     

Urinary Calcium/Creatinine Ratio in the Prediction of Preeclampsia

Summary: The prediction of preeclampsia by the urinary calcium/creatinine ratio during the early third trimester was assessed in 190 primigravidas, aged less than 35 years and between 28 and 32 weeks' gestation without pregnancy complications. Preeclampsia developed in 6.8% of the patients. The mean maternal age, gestational age at entry into the study and at delivery, and the average mean arterial blood pressure at entry into the study did not differ significantly between the 13 patients with subsequent preeclampsia and the 177 normotensive patients. The patients with preeclampsia did not have significantly less excretion of calcium than the normotensives.     

Elective cesarean delivery plus short-course lamivudine and zidovudine for the prevention of mother-to-child transmission of human immunodeficiency virus type 1

OBJECTIVE: The purpose of this study was to evaluate the effect of elective cesarean delivery plus a lamivudine-zidovudine prophylaxis regimen on non-breastfeeding mothers with human immunodeficiency virus type 1 and their infants. STUDY DESIGN: Forty-six antiretroviral-na?ve, pregnant women with human immunodeficiency virus type 1 were included. The prophylactic regimen was a lamivudine-zidovudine tablet (150 mg/300 mg) twice daily from week 34 of pregnancy until cesarean delivery at week 38 of gestation, preoperative intravenous zidovudine, and neonatal zidovudine syrup for 4 weeks. RESULTS: At weeks 34 and 38 of gestation, the median maternal viral loads were, respectively, 3.65 log(10) copies/mL (range, 2.34-4.70 log(10) copies/mL) and 2.51 log(10) copies/mL (range, 2.04-3.66 log(10) copies/mL; P<.001), respectively; the viral reduction was 1.12 log(10) copies/mL (range, -0.16-2.60 log(10) copies/mL), and the CD4(+) cell counts increased from 335 cells/mm(3) (range, 57-974 cells/mm(3)) to 420 cells/mm(3) (range, 84-1,083 cells/mm(3); P=.002). No mother or infant had a serious adverse event. Two infants were infected (4.3%; 95% CI, 0.5%-15.7%); 1 infant had intrapartum infection. CONCLUSION: Elective cesarean delivery plus short-course lamivudine-zidovudine is safe but does not eliminate mother-to-child transmission of human immunodeficiency virus type 1.     

Criteria for high-risk medication use in Thai older patients

Many older patients have multiple diseases that require high-risk drug use, which may cause serious adverse effects. Criteria for the use of these drugs in older people are vital to the prevention of adverse events. This study aimed to develop explicit criteria for determining high-risk medication use in Thai older patients. It was conducted using a Delphi technique with the three-round survey of 16 geriatric medicine (GM) experts. A structured questionnaire with 56, 93, and 95 statements were devised for Rounds 1, 2, and 3, respectively. In each statement, the panelists were requested to confirm a high-risk drug in Round 1, and to rate on a 5-point Likert scale and classify the high-risk medication use in Rounds 2 and 3. The results showed that 77 practice statements (81.1%) that embraced the use of high-risk medications with potential adverse reactions, drug-disease interactions, and drug-drug interactions were agreed by the expert panel. A total of 23 statements (29.9%) were categorized as Groups 1-3 and the rest remained unclassified. Most high-risk medications were utilized in the central nervous system, musculoskeletal system, and cardiovascular system. Further studies are warranted to evaluate the criteria in terms of prescribing and monitoring medication use in older patients.     

Topical Application of Honey in Treatment of Abdominal Wound Disruption

The usefulness of honey application as an alternative method of managing abdominal wound disruption was assessed. Fifteen patients whose wound disrupted after Caesarean section were treated with honey application and wound approximation by micropore tape instead of the traditional method of wound dressing with subsequent resuturing. We achieved excellent results in all the cases with complete healing within 2 weeks. Honey application is inexpensive, effective and avoids the need to resuture which also requires general anaesthesia.