Mg For Prevention Research Articles

Comparing aspirin 75–81 mg vs 150–162 mg for prevention of preterm preeclampsia: systematic review and meta-analysis

Comparing aspirin 75–81 mg vs 150–162 mg for prevention of preterm preeclampsia: systematic review and meta-analysis

Evaluation of denosumab in adult oncology patients for the prevention of skeletal related events across a large academic health system.

Denosumab (Xgeva®) and zoledronic acid (Zometa®) are widely utilized for prevention of skeletal related events (SREs) in oncology patients. Drug costs, renal function, ease and logistics of administration, and adverse effect profile are factors frequently considered by patients and/or providers when selecting an optimal agent. Given the significantly higher drug cost of denosumab compared to zoledronic acid, an evaluation of our institution's denosumab use and investigation into opportunities to shift denosumab administrations to zoledronic acid and/or to lower cost sites-of-care was warranted. A single-center, multi-site, retrospective, observational analysis of the electronic medical record (EMR) was conducted for adult oncology patients who received denosumab 120 mg for prevention of SREs from October 1st, 2018 to September 30th, 2019 at three institutions within our health system. Additional information was collected to characterize the patient population based on cancer diagnosis, renal function, and concomitant calcium and vitamin D supplementation. Our primary objective was to evaluate if the use of denosumab met current formulary restrictions of the health system. In total, 304 adult oncology patients received 1411 doses of denosumab for the prevention of SREs. The majority of reviewed patients had a primary oncology diagnosis of breast (35%) or lung (24%) cancer. Of the patients who received denosumab, 278 (93%) met the health system's current formulary restrictions. The majority of patients who did not meet formulary restrictions were those with multiple myeloma (MM) (20/22; 91%). Of the 304 patients reviewed, 70 had the appropriate parameters in the EMR to calculate creatinine clearance (CrCl) using Cockcroft-Gault Equation. Of those 70 patients, 59 (84%) would have been eligible to receive zoledronic acid instead of denosumab given that their CrCl >30 mL/min with no documented intolerance to bisphosphonates. Concurrent use of calcium and vitamin D is recommended when using denosumab. Based on the most recent prior to admission (PTA) medication list obtained from the 304 patients evaluated, 222 (73%) had both calcium and vitamin D listed as "taking". Within our health system, denosumab is restricted to those who meet formulary restrictions. Additional education is recommended to help limit the use of denosumab, specifically in MM, to reduce drug costs when zoledronic acid is also an appropriate first-line agent.

A randomized controlled trial of two-doses of vaginal progesterone 400 vs. 200mg for prevention of preterm labor in twin gestations.

To compare between the effectiveness and safety of two different daily doses of vaginal progesterone (400 vs. 200mg) in the prevention of preterm labor in twin pregnancy. This is a prospective single-blinded randomized controlled trial conducted on 100 primi-gravida who had twin pregnancy and attended the antenatal clinic of a University hospital. They were equally and randomly allocated into two arms each containing 50 patients. Arm 1 received 400mg and arm 2 received 200mg vaginal progesterone daily at bed time starting from 14weeks of pregnancy to 36weeks. Transvaginal ultrasound was performed for assessment of the length of cervix at 14 and 22weeks. Both arms of the current study were comparable regarding the cervical length at 14 and 22weeks, mean gestational age at delivery, incidence of pre-term delivery, birth weight of the first twin. Second twin in addition to the average weight of both twins. No statistical significance differences between two arms regarding incidence of early neonatal death. NICU, mechanical ventilation, length of admission in NICU for the first twin. Second twin as well as both twins. Vaginal progesterone treatment with different doses was tolerable, but wasn't effective in the prevention of preterm labor in twin pregnancy.

Prophylactic ondansetron eight milligrams versus four milligrams against post spinal anaesthesia shivering

Background: Shivering is one of the commonly encountered adverse affect after spinal anaesthesia. Shivering can be very discomforting to the patient and hampers operative maneuvering. Pharmacological therapies have been studied for control and management of shivering. One such drug is ondansetron, a 5-HT3 antagonist. Aim of current study is to evaluate the efficacy of prophylactic administration of ondansetron 8 mg vs. 4 mg for prevention of shivering.Methods: A prospective, randomized, and double blind study was conducted on 100 patients, from either gender, aged 20-60 years, of the American society of anesthesiologists grade I or II, scheduled for various surgeries under spinal anesthesia. The patients were randomly divided into two groups of 50 each to receive either ondansetron 8 mg (group E) or ondansetron 4 mg, (group F) as slow intravenous infusion prior to spinal anesthesia. The primary end point were intraoperative shivering and secondary outcomes included hypotension, adverse reaction, cardiac dysrhythmia’s.Results: A total of 10 patients in group E (20%) and 20 (40%) patients in group F experienced shivering (p=0.029). Incidence of nausea was similar in both groups, total of 8 (16%) patients in group E and 5 (10%) in group B had hypotension (p=0.27). 1 (2%) patient in group E experienced bradycardia.Conclusions: Prophylactic administration of ondansetron 8 mg has better efficacy in prevention of spinal anaesthesia induced shivering with minimal side effects as compared to 4 mg dosage.

A Study Comparing Efficacy of Morning Dosage versus Evening Dosage of Oral Micronised Progesterone Sustained Release SR 300mg in Prevention of Preterm Labour

Objectives: To assess the efficacy of oral micronized progesterone SR 300 in preventing preterm labour after arresting it, with changes in dosage timing. The main purpose of this study is to find out whether there is a clinico pharmacological correlation if same drug is given at different timings Materials and Methods: Prospective randomized study was done at our institution. Total sample size of 130 women who came in preterm labour and process of preterm labour was arrested with Tocolytics were included in the study group. Sample was divided into 2 groups of 65 womens in each group in view of prevention of preterm labour. One group was given MNP SR 300 at 9am and 2nd group was given MNP SR 300 at 9pm by oral route. They were studied for the difference in maternal outcomes like prolongation of gestational age at delivery and neonatal outcome like birth weight, maturity, morbidity and mortality. Results: Both the group were comparable with respect to age and parity. Our study showed that there was no statistically significant difference with respect to maternal and fetal outcome with changes in timings to two groups who were given MNP SR 300 orally at 9am and 9pm. Conclusion: More studies on big samples are recommended to further analyse our results, since this the only study till date.

CLO20-059: Comparison of a Single Dose Immediate Instillation of Mitomycin C 20mg Versus 40mg in Prevention of Tumour Recurrence After Resection of Non Muscle Invasive Bladder Cancer

CLO20-059: Comparison of a Single Dose Immediate Instillation of Mitomycin C 20mg Versus 40mg in Prevention of Tumour Recurrence After Resection of Non Muscle Invasive Bladder Cancer

Comparison of Ondansetron with Gabapentin for prevention of intrathecal morphine induced pruritus

Background: Ondansetron has been used successfully for prophylaxis and treatment of intrathecal morphine induced pruritus. Gabapentin has anxiolytic, antiemetic, antipruritic effects and has also been shown to potentiate the analgesic effect of intrathecally or epidurally administered opioids.
 Materials and method: We compared the effectiveness of oral gabapentin with intravenous ondansetron to prevent incidence of intrathecal morphine induced pruritus. In a prospective, double-blind study, sixty patients aged 18-65 years with ASA physical status I and II undergoing surgery under subarachnoid block were randomized to receive placebo tablets (ondansetron group) or gabapentin 1200 mg (gabapentin group) 2 hours before surgery. Patients receiving placebo tablets received 8 mg of intravenous ondansetron and those receiving gabapentin received 4 ml of intravenous normal saline just prior to subarachnoid block with 3 ml of 0.5% hyperbaric bupivacaine plus 0.2 mg morphine. The incidence, onset, severity, location of pruritus and incidence of side effects were studied for next 24 hours.
 Results: The overall incidence of pruritus was 48.3%. The incidence, severity, location of pruritus was comparable between the two groups. There was significant difference between the onset of pruritus between groups (p=0.009). The incidence and grade of nausea vomiting, requirement of intraoperative sedation was comparable between groups. The incidence of urinary retention was significantly high in gabapentin group (p=0.020). Respiratory depression was observed in one patient.
 Conclusion: A single dose of 1200 mg oral gabapentin 2 hours before, is as effective as prophylactic intravenous ondansetron 8 mg for prevention of intrathecal morphine induced pruritus.

Efficacy of Single Dose Rasburicase (1.5mg) for Prophylaxis and Management of Laboratory Tumor Lysis Syndrome.

Rasburicase is a recombinant urate oxidase enzyme approved for use in tumor lysis syndrome (TLS) and it acts by reducing serum uric acid levels. Using rasburicase at the recommended dose of 0.2mg/kg/day for 5days is expensive and it is not known whether this extended schedule is clinically beneficial compared to a single fixed dose of 1.5mg. The aim of the present study was to evaluate the efficacy of single dose rasburicase 1.5mg in prevention and management of TLS. Rasburicase is available as single use 1.5mg vial. At our institution a single dose of rasburicase 1.5mg irrespective of bodyweight has been used in adults and in children a dose of 0.15mg/kg (maximum 1.5mg) has been used since 2012 for prevention and management of TLS and subsequent doses are given based on biochemical response and clinical condition. We retrospectively analysed the case records of patients who had received rasburicase from January 2012 to January 2017. The study included 186 patients with hematological malignancies who received rasburicase. Children accounted for 56.4% (n = 105) patients and males comprised 73% (n = 135). Rasburicase was used prophylactically in 59 (31.7%) patients, for laboratory TLS in 76 patients (40.8%) and for clinical TLS in 51 (27.4%) patients. Single fixed dose rasburicase prevented laboratory/clinical TLS in 87% of the prophylactic group and prevented clinical TLS in 72% of the laboratory TLS group. None of the patients in prophylactic and laboratory TLS group developed clinical TLS. However, majority of the patients with clinical TLS required more than one dose rasburicase. Single dose of 1.5mg (1 vial) rasburicase is efficient in preventing and managing laboratory TLS and is economically viable in resource constrained settings.

Palonosetron A Promising New Prophylactic for PONV

Aim and Objective- The aim of the study was to evaluate the efficacy of palonosetron 0.075 mg for prevention of postoperative nausea and vomiting (PONV) in patients undergoing middle ear surgeries in comparison with ondansetron. Methods - In this prospective observational study, 70 healthy patients who were undergoing elective middle ear surgeries were divided into 2 groups: Group P (palonosetron 0.075 mg i.v., n = 35) and group C (ondansetron 8 mg i.v., n = 35). The drugs were given 5 minutes before induction of anaesthesia. The incidence of nausea, vomiting, retching, severity of nausea, use of recue antiemetic and incidence of complete response were evaluated. Results - The incidence of nausea, vomiting and severity of nausea was lower in palonosetron group as compared to ondansetron group but this difference was not statistically different. The incidence of use of rescue antiemetic (5.71% vs 23.53%) was significantly lower in palonosetron group. The incidence of complete response was higher in palonosetron group (88.87% vs 68.57%) but the difference was not statistically significant. Conclusion- The prophylactic intravenous administration of single dose of palonosetron 0.075 mg is not more effective in controlling postoperative nausea and vomiting as compared to ondansetron 8 mg in middle ear surgery.

The efficacy of febuxostat 10 mg for the prevention of hyperuricemia associated with tumor lysis syndrome (TLS) in Japanese patients with non-Hodgkin's lymphoma .

Tumor lysis syndrome (TLS) is a life-threatening oncologic emergency. The control of serum uric acid level (UA) is important for prevention of TLS. Febuxostat has demonstrated its superiority over allopurinol in decreasing UA level. We retrospectively evaluated the efficacy of febuxostat 10mg in prevention of hyperuricemia associated with TLS (HU-TLS) in 12 patients with non-Hodgkin's lymphoma (NHL). Mean UA levels were found to significantly decrease (p=0.003). HU-TLS was prevented in all patients. Thus, febuxostat 10 mg is effective in prevention of HU-TLS. Future study is need to determine whether the incidence of HU-TLS change with dosage of febuxostat. .

Rilonacept for Gout Flare Prevention in Patients Receiving Uric Acid-lowering Therapy: Results of RESURGE, a Phase III, International Safety Study

To evaluate the safety and efficacy of once-weekly subcutaneous rilonacept 160 mg for prevention of gout flares in patients initiating or continuing urate-lowering therapy (ULT). This phase III study was conducted in the United States, South Africa, Europe, and Asia. Adults (n = 1315, 18-80 yrs) with gout, who were initiating or continuing ULT, were randomized to treatment with weekly subcutaneous injections of rilonacept 160 mg or placebo for 16 weeks followed by a 4-week safety followup. The primary endpoint was safety, assessed by adverse events (AE) and laboratory values. Efficacy was a secondary endpoint. Demographic and clinical characteristics were similar between treatments; predominantly male (87.8%), mean age 52.7 ± 11.3 years. Patients with ≥ 1 AE were 66.6% with rilonacept versus 59.1% placebo, with slightly more AE-related withdrawals with rilonacept (4.7% vs 3.0%) because of the greater incidence of injection site reactions (15.2% rilonacept, 3.3% placebo). Serious AE were similar in both groups, as were serious infections (0.9% placebo, 0.5% rilonacept); no tuberculosis or opportunistic infections occurred. Most common AE were headache, arthralgia, injection site erythema, accidental overdose, and pain in extremity. Of the 6 deaths, only 1 in the placebo group was considered treatment-related. At Week 16, rilonacept resulted in 70.3% fewer gout flares per patient (p < 0.0001), fewer patients with ≥ 1 and ≥ 2 gout flares (p < 0.0001), and 64.9% fewer gout flare days (p < 0.0001) relative to placebo. Weekly subcutaneous administration of rilonacept 160 mg showed no new safety signals. The safety profile was consistent with previous studies. Rilonacept also significantly reduced the risk of gout flares. Clinicaltrials.gov identifier NCT00856206; EudraCT No. 2008-007784-16.

463: Chorioamnionitis, neonatal sepsis and cerebral palsy or death in PROM

Expectant management (EM) of PPROM increases the risk of chorioamnionitis (CA) and adverse fetal/ neonatal outcomes and cerebral palsy (CP). Prior studies reported increased risk of CP in association with CA and/or neonatal sepsis (NS). Risks were reported prior to universal use of steroids (CS), latency antibiotics (LA) and magnesium sulfate (MG). Our objectives are 1) determine the rate of CA, fetal/neonatal death (FND), NS and CP or death by gestational age (GA) at rupture, and 2) evaluate whether the presence of CA or NS is associated with CP or death in the era of universal use of CS, LA and MG. Secondary analysis from a multicenter trial of MG for prevention of CP. Women with singleton PROM < 32 wk (n = 1760) receiving universal CS and LA were studied. Rates and clinical risk factors for CA, FND, NS and CP or death at rupture were evaluated. CA was diagnosed in 221 (13%), FND in 135 (8%), NS in 276 (16%) and CP or death in 166 (10%). NS was significantly higher in CA as compared to control (22% vs 15%, P < 0.001). Table describes the outcomes by GA at rupture. The rate of serious complications was inversely related to GA at rupture. Multivariate analysis revealed that GA at PROM (aOR 0.67: 95 CI, 0.62-0.73) and latency period (aOR 0.97: 95 CI, 0.96-0.98) were associated with CP death. Neither CA (aOR 1.21: 95 CI, 0.74-1.98) nor NS (aOR 1.34: 95 CI, 0.91-1.99) were associated with CP or death. There was no association between CA and any CP (aOR 1.1: 95 CI, 0.57-2.3). In the era of universal use of steroids, latency antibiotics, magnesium sulfate, and expectant management of PROM < 32 wks, the rate of clinical chorioamnionitis was 13% and inversely associated with GA at rupture. Our findings do not support the prior literature regarding the association of clinical chorioamnionitis with CP in preterm births. We speculate this may be due to differences in current treatment regimens for preterm PROM compared to prior studies.Tabled 1Serious perinatal and long term infant outcomes*Clinical Chorioamnionitis; **Culture-proven neonatal sepsis; ***Moderate or severe cerebral palsy at or beyond 2 years of corrected age. Infant death at 1 year of corrected age. Open table in a new tab

Oral olanzapine versus oral ondansetron for prevention of post-operative nausea and vomiting. A randomized, controlled study

BackgroundThis study was designed to mainly evaluate the efficacy and safety of olanzapine compared with placebo and ondansetron for prevention of postoperative nausea and vomiting in patients undergoing breast surgeries.MethodsEighty two female patients scheduled for breast surgeries were randomly assigned to four test groups received placebo or single oral dose of olanzapine 5 mg (OL5) or 10 mg (OL10) or ondansetron 16 mg (ON16) before induction of anesthesia by 4 h for olanzapine and 1 h for ondansetron. All patients were monitored for 24 h. Emetic episodes and nausea occurrence were the primary outcome in this study. Secondary endpoint was the complete response (CR) (without nausea and vomiting, no rescue therapy) for the acute (0–2 h) and late (2–24 h) periods.ResultsNeed for rescue antiemetics showed significant reduction (P < 0.05) for all groups in comparison with placebo. Number needed to be treated (NNT) improved on increasing dose of olanzapine from 5 mg to 10 mg for prevention of both nausea (48%) and vomiting (36%) in comparison to placebo.In the 0–2 h postoperative time interval, complete response (CR) rates were insignificant (P = 0.48, P = 0.11) for olanzapine 5 mg and 10 mg when compared to placebo; and significant for ondansetron 16 mg (P = 0.04). For the 2–24 h interval after surgery, CR rates were significant for OL5, OL10, and ON16 (P = 0.02, P = 0.005, P = 0.007) when compared to placebo. On comparing both olanzapine doses with ondansetron 16 mg during 0–2 h and 2–24 h study periods, there were no significant differences.ConclusionOlanzapine can be used safely and effectively for prophylaxis against PONV especially for late postoperative periods.

Magnesium exerts both preventive and ameliorating effects in an in vitro rat Parkinson disease model involving 1-methyl-4-phenylpyridinium (MPP +) toxicity in dopaminergic neurons

A study was conducted to clarify the effects of magnesium (Mg) administration in a rat Parkinson disease (PD) model involving culture of ventral mesencephalic–striatal cells with 1-methyl-4-phenylpyridinium (MPP +), based on recent evidence for significant loss of dopaminergic neurons exclusively in the substantia nigra of 1-year-old rats after exposure to low Mg intake over generations [Oyanagi, K., Kawakami, E., Kikuchi-Horie, K., Ohara, K., Ogata, K., Takahama, S., Wada, M., Kihira, T., Yasui, M., 2006. Magnesium deficiency over generations in rats with special references to the pathogenesis of the parkinsonism–dementia complex and amyotrophic lateral sclerosis of Guam. Neuropathology 26, 115–128.]. The results indicated that Mg might protect dopaminergic neurons in the substantia nigra from degeneration. The concentration of Mg in the culture medium varied from 0.8 mM, corresponding to the control condition, to 4.0 mM. Effects were estimated by counting the number of surviving dopaminergic neurons immunopositive for tyrosine hydroxylase and measuring the length of dopaminergic neurites. An increase in the concentration of Mg to 1.2 mM significantly inhibited the toxicity of MPP +, and a concentration of 4.0 mM completely prevented any decrease in the number of dopaminergic neurons. The length of dopaminergic neurites was significantly preserved in the presence of Mg at 1.2 and 4.0 mM. An increase in the concentration of Mg to 1.2 and 4.0 mM led to a significant amelioration in the length of dopaminergic neurites after MPP + toxicity. This is the first report to document a significant and striking effect of Mg for prevention of neurite and neuron pathology, and also amelioration of neurite pathology in a PD model.

A Meta-analysis of the Efficacy of Granisetron 0.1 mg for Postoperative Nausea and Vomiting (PONV)

This meta-analysis of published randomized clinical trials (RCTs) compared the efficacy of granisetron 0.1 mg versus ≥ 1.0 mg for prevention of postoperative nausea and vomiting (PONV). Efficacy data (proportion of patients without PONV or requiring rescue medication) were extracted and stratified by the postoperative period (i.e., early, late, and overall). Meta-analytic techniques were used to integrate findings and estimate pooled efficacy. Ten RCTs met inclusion criteria, but only 2 directly compared granisetron 0.1 mg versus 1.0 mg, which was insufficient for meta-analysis, necessitating indirect comparisons between pairwise sets of granisetron 0.1 mg and granisetron 1.0 mg with common comparators: placebo and granisetron dose levels > 1.0 mg. Granisetron 0.1 mg appears to be at least as effective as granisetron 1.0 mg during the early and overall postoperative periods. There were insufficient data for meta-analysis of any outcomes during the late postoperative period. CONFLICT OF INTEREST DISCLOSURE The author received in the past financial support (Independent Investigator Grant) from Roche Pharmaceuticals (maker of Kytril-granisetron).

Pain during Injection of Propofol: The Effect of Prior Administration of Ephedrine

Propofol causes pain on intravenous injection in 28 to 90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. In a randomized, double-blind, placebo-controlled trial, we compared the efficacy of ephedrine 30 microg/kg pretreatment to lignocaine 40 mg for prevention of propofol-induced pain. Ninety-three adult patients, ASA 1 and 2, undergoing elective laparoscopic cholecystectomy were randomly assigned to three groups of 31 each. Group 1 received normal saline, group 2 received lignocaine 2% (40 mg) and group 3 received 30 microg/kg ephedrine. All pretreatment drugs were made up to 2 ml. Pain at the time of propofol injection was assessed on a four-point scale: 0=no pain, 1 =mild pain, 2=moderate pain, and 3=severe pain. Twenty-seven patients (87%) of ephedrine pretreatment patients had pain during intravenous injection of propofol as compared to 24 (77%) in the normal saline group. In the lignocaine group, propofol-induced pain was observed in only 13 (42%) when compared with other study groups (P<0.05). Pretreatment with ephedrine 30 microg/kg did not attenuate pain associated with intravenous injection of propofol, nor did it improve haemodynamic stability during induction. However, pretreatment with 2% lignocaine (40 mg) was effective in attenuating propofol-associated pain.

Single-dose non-prescription ranitidine 75mg is superior to single-dose omeprazole 20mg for prevention of postprandial and nighttime heartburn following a provocative meal

Single-dose non-prescription ranitidine 75mg is superior to single-dose omeprazole 20mg for prevention of postprandial and nighttime heartburn following a provocative meal

H. pylori status influences the efficacy of omeprazole 20mg but not ranitidine 75mg for prevention of nighttime heartburn following a provocative meal

Purpose: Acid inhibition appears less effective in H. pylori negative individuals (Hp neg) than in H. pylori positive ones (Hp pos) with proton pump inhibitors but not with H2-antagonists and may result in insufficient control of heartburn (HB) in many subjects. We evaluated a bedtime provocative meal and response to treatment in healthy subjects (18–75 yrs) who tested Hp neg (429) or pos (61) with a history of nighttime HB (2 episodes/wk) rated as moderate to very severe.

Safety and clinical efficacy of pantoprazole 40 mg in prevention of relapse of reflux esophagitis. Spanish multicenter study

Safety and clinical efficacy of pantoprazole 40 mg in prevention of relapse of reflux esophagitis. Spanish multicenter study

Pantoprazole 20 MG is as effective as pantoprazole 40 MG in prevention of relapse of reflux esophagitis

Pantoprazole 20 MG is as effective as pantoprazole 40 MG in prevention of relapse of reflux esophagitis