Oral Versus Research Articles

Oral Versus Intragastric Inoculation: Similar Pathways of Trypanosoma cruzi Experimental Infection? From Target Tissues, Parasite Evasion, and Immune Response.

Currently, oral infection is the most frequent transmission mechanism of Chagas disease in Brazil and others Latin American countries. This transmission pathway presents increased mortality rate in the first 2 weeks, which is higher than the calculated mortality after the biting of infected insect vectors. Thus, the oral route of Trypanosoma cruzi infection, and the consequences in the host must be taken into account when thinking on the mechanisms underlying the natural history of the disease. Distinct routes of parasite entry may differentially affect immune circuits, stimulating regional immune responses that impact on the overall profile of the host protective immunity. Experimental studies related to oral infection usually comprise inoculation in the mouth (oral infection, OI) or gavage (gastrointestinal infection, GI), being often considered as similar routes of infection. Hence, establishing a relationship between the inoculation site (OI or GI) with disease progression and the mounting of T. cruzi-specific regional immune responses is an important issue to be considered. Here, we provide a discussion on studies performed in OI and GI in experimental models of acute infections, including T. cruzi infection.

Comparison of Oral Versus Normal and High-Dose Rectal Paracetamol in the Treatment of Fever in Children

Correction: On 13th June 2018 the author Yog Raj Sharma was changed to Yograj SharmaIntroduction: Paracetamol is the most commonly used drug in paediatrics with the standard dose (15 mg/kg) of oral and rectal paracetamol preparations interchangeably is used to treat fever in children, assuming they have equal antipyretic effect. We did a study to compare the effectiveness of two different rectal doses of paracetamol: 15 mg/kg and 30 mg/kg to that of a standard oral dose of 15 mg/kg.Material and Methods: This is a prospective, interventional, randomized controlled study done in Western Regional Hospital, Nepal in which 192 children with fever aged six months to six years. Study duration was August 2015 to October 2015. The sample included 63 in the oral normal dose group (15mg/kg), 59 in normal dose rectal group (15mg/kg) and 70 in high dose (30mg/kg) rectal paracetamol group. Temperature was recorded before and after the administration of paracetamol at an interval of 30, 60, 120, and 180 minutes by using a digital thermometer.Results: Total of 59 patients received 15 mg/kg rectal Paracetamol (group A), 70 received 30 mg/kg rectal Paracetamol (group B), and 63 received 15 mg/kg oral Paracetamol (group C). Mean temperature before giving medication in Group A, B and C respectively were 101.7° F, 101.9° F and 101.5° F. At 30 min temperature was 100.8° F, 100.8° F and 100.66° F, while at 60 minutes temperature was 99.9° F, 99.7° F, and 99.7° F respectively for Group A,B and C. But at 120 and 180 minutes temperature decreased significantly who got rectal 30 mg/kg of paracetamol.Conclusions: Rectal paracetamol in a dose of 30mg/kg is more effective than oral paracetamol in a dose of 15 mg/kg. However oral paracetamol given in a dose of 15 mg/ kg is more effective than rectal paracetamol in a same dose.

Randomized Double-Blinded Comparison of Titrated Oral Versus Vaginal Misoprostol for Labor Induction [24N

INTRODUCTION: For labor induction of an unfavorable cervix, we propose oral misoprostol, titrated to uterine response, to maximize safety and efficacy, based upon past studies. METHODS: Randomized double-blinded study. Identically appearing oral and vaginal study dosages were prepared containing either 25mcg misoprostol or placebo. The pharmacist randomized the study participants to receive either an “oral packet” (oral misoprostol, vaginal placebo) or a “vaginal packet” (opposite). Patients received both an oral protocol (quantity of capsules titrated to uterine contractions, every 2hrs) and vaginal protocol (25mcg/placebo every 4hrs) simultaneously. Providers and patients were blinded. RESULTS: Un-blinding revealed 28 oral and 22 vaginal participants, with four oral, and five vaginal participants removed (imperfect consent forms, missing data). Confounding variables had no statistical significance. Primary outcomes: 1) Time to Bishop Score > 7: Titrated oral route was 9.94 hours (Standard Deviation 5.149, 95%CI 6.82-13.05). Vaginal route was 6.59 hours (SD 1.826, 95%CI 5.06-8.11). 2) Time to NSVD: Titrated oral route was 15.52 hours (SD 5.862, 95%CI 11.98-19.06). Vaginal route was 12.74 hours (SD 4.790, 95%CI 8.74-16.74). 3) Change in Bishop score: Titrated oral route was 3.39; Vaginal route was 5.25. Several safety parameters and side effects were evaluated, showing a trend towards the oral route being safer. Approximately 25% of the oral route participants reached the maximum oral dose of 75 mcg, and none needed dosage reduction. Approximately 80% of all participants preferred oral administration because they disliked vaginal placement, while 20% preferred the vaginal administration because it “worked better” and they “dislike pills.” CONCLUSION: Results suggest our oral titrated protocol has less efficacy and side effects, although numbers didn’t reach statistical significance. Patients had strong preferences for the oral route. There is potential for future studies based upon our study. With a thorough review of recent studies, we can redesign our study in many ways, including a higher dose of oral misoprostol.

Oral Versus Intravenous Iron Supplementation for the Treatment of Iron Deficiency Anemia in Patients on Maintenance Hemodialysis—Effect on Fibroblast Growth Factor-23 Metabolism

Iron administration affects serum levels of intact (I-) fibroblast growth factor-23 (FGF23) and its cleavage product C-terminal (C-) FGF23 in iron-deficient patients on maintenance hemodialysis (MHD). The objective of this study was to compare the effect of oral or intravenous iron administration on serum levels of I-FGF23 and C-FGF23 in iron-deficient patients on MHD. A prospective randomized study. Participants on MHD with severe iron deficiency (n=61). Participants were randomized to receive oral iron (50mg of sodium ferrous citrate daily; oral group, n=29) or intravenous iron (40mg of saccharated ferric oxide weekly; IV group, n=32). Changes in I-FGF23 and C-FGF23 after 10 weeks of treatment. Iron supplementation significantly increased hemoglobin, mean corpuscular volume, ferritin, and transferrin saturation rate, and decreased erythropoiesis-stimulating agent dose and erythropoiesis-stimulating agent resistance index value. Serum phosphate, calcium, and intact parathyroid hormone levels did not change significantly during the study. I-FGF23 levels increased significantly in the IV group and did not change in the oral group, whereas C-FGF23 levels were significantly reduced in both groups. Serum interleukin-6 and tumor necrosis factor-α levels were increased in both groups. Multiple regression analysis indicated the relationship between iron or erythropoiesis and FGF23 metabolism. Iron administration to patients on MHD with severe iron deficiency decreased C-FGF23 levels, whereas intravenous iron increased I-FGF23 levels though oral iron did not. If the target of chronic kidney disease-mineral and bone disorder therapy is reducing I-FGF23 levels, we suggest the use of oral iron.

Assessing the Feasibility of a First‐Line Oral Versus Intravenous Iron Rct in Pregnancy

Assessing the Feasibility of a First‐Line Oral Versus Intravenous Iron Rct in Pregnancy

Healthcare Costs Associated With Oral Versus Intravenous Iron Therapy in IBD Patients With Anemia Or Non-anemic Iron Deficiency in Germany

Healthcare Costs Associated With Oral Versus Intravenous Iron Therapy in IBD Patients With Anemia Or Non-anemic Iron Deficiency in Germany

Oral Versus Intravenous Iron for Treatment of Iron Deficiency Anaemia in Pregnancy: A Randomized Controlled Trial

Oral Versus Intravenous Iron for Treatment of Iron Deficiency Anaemia in Pregnancy: A Randomized Controlled Trial

A Prospective Randomised Study of the Effects of Pregabalin Oral Versus Dexmedetomidine Infusion on Intra Operative Hemodynamic Stability in Patients Undergoing Laparoscopic Cholecystectomy

A Prospective Randomised Study of the Effects of Pregabalin Oral Versus Dexmedetomidine Infusion on Intra Operative Hemodynamic Stability in Patients Undergoing Laparoscopic Cholecystectomy

Prospective Comparative Study of Oral Versus Vaginal Misoprostol for Second-Trimester Termination of Pregnancy.

Various medical methods for second-trimester medical termination of pregnancy (MTP) exist. Misoprostol alone has been used with myriad variations in route and dosage. Comparison between oral and vaginal routes of misoprostol forms the basis of this study. This was a prospective comparative study of misoprostol for second-trimester (14-20weeks) MTP, comparing oral versus vaginal routes. Sixty patients were randomly allotted to two groups; 30 received oral misoprostol 400µg 4h up to a maximum of five doses (2000µg), and 30 received vaginal misoprostol in the same dose and duration. In both groups, oxytocin infusion was started if abortion did not occur. Efficacy of oral versus vaginal misoprostol, induction-abortion interval (AI) and need for surgical intervention were analyzed. Both groups were well matched in terms of age, parity, previous LSCS, mean gestational age and indication for MTP. Overall mean induction-abortion interval was 19.59h (21.66 vs. 18.57h, oral vs. vaginal, respectively), with vaginal group taking lesser time (p 0.09). Sixty percentage in oral group required five doses, while 70% in vaginal group required 3-4 doses of misoprostol (p 0.010). 23.7 versus 6.7% in oral versus vaginal group required check curettage (p 0.038). There were no major complications, and there was only one failure in oral group. Though both oral and vaginal misoprostol are safe, vaginal route appears to be more efficacious for second-trimester MTP.

A Clinical Perspective of Oral Versus Topical Diclofenac Sodium in The Treatment of Osteoarthritis

To review and discuss the current data with a clinical perspective regarding the utilization of oral versus topical Diclofenac sodium in the treatment of osteoarthritis to help clinicians in the decision making process in treating patients suffering from OA.

A Prospective Randomized Trial to Assess Oral Versus Intravenous Antibiotics for the Treatment of Postoperative Wound Infection After Extremity Fractures (POvIV Study): Erratum.

A Prospective Randomized Trial to Assess Oral Versus Intravenous Antibiotics for the Treatment of Postoperative Wound Infection After Extremity Fractures (POvIV Study): Erratum.

Comparison of Oral Versus Intravenous Fluorescein Widefield Angiography in Ambulatory Pediatric Patients

Purpose: To compare the image quality and clinical utility of oral versus intravenous (IV) dye administration for fluorescein widefield angiography in pediatric patients. Design: Retrospective observational case series. Methods: Retrospective chart review of pediatric patients who underwent noncontact widefield fluorescein angiography (FA; Optos plc) at a single tertiary referral center (UCHealth Eye Center, Aurora, Colorado) between January 1, 2014, and May 31, 2016. Fluorescein angiography images were de-identified, and FA timing was hidden. A masked retinal specialist graded FA image quality and clinical utility. Results: A total of 103 FAs (62 IV and 41 oral) in 82 patients were reviewed. Oral fluorescein administration was more common in young patients (mean age: 8.1 years) compared to IV administration (mean age: 14.5 years; P < .001). Multivariate analysis with adjustment for age showed no statistical difference between oral and IV FA image quality ( P = .59). There was a high incidence of excellent clinical utility in both oral and IV FAs, with no statistically significant difference between the 2 methods. Subgroup analysis of familial exudative vitreoretinopathy, Coats’ disease, choroidal neovascular membrane, and uveitis also showed no statistical difference in clinical utility between IV and oral FA. Conclusion: Oral widefield FA had excellent clinical utility and comparable image quality to IV fluorescein widefield angiography (with adjustment for age). For the evaluation of pediatric retinal disease, oral FA can be a clinically useful diagnostic tool in pediatric patients who are intolerant to IV access, which may avoid some need for FA under general anesthesia.

A Prospective Randomized Trial to Assess Oral Versus Intravenous Antibiotics for the Treatment of Postoperative Wound Infection After Extremity Fractures (POvIV Study).

Patients surgically treated for infection after extremity fractures are typically discharged with a 6- to 12-week antibiotic regimen. Intravenous (IV) antibiotics are associated with significant cost and potential complications of deep vein thrombosis, line clotting, and sepsis. Many of the pathogens that cause musculoskeletal infection have both oral (PO) and IV antibiotic options with adequate bioavailability and antibacterial effect, yet IV antibiotics remain the standard of care absent evidence that PO options are clinically as efficacious. The POvIV study is a prospective, multicenter, randomized trial to compare PO with IV antibiotic therapy in patients with postoperative wound infections after extremity fractures. Patients between the ages of 18 and 84 who have a culture-positive surgical site infection after internal fixation for fracture repair or arthrodesis are approached for this study, and if they provide consent, are randomly assigned to receive either PO or IV antibiotics. Antibiotic selection is based on culture and sensitivity results. Randomization determines the route of administration. Patients are followed for 1 year after study enrollment. This study will be the largest prospective randomized trial to evaluate the safety and effectiveness of PO antibiotic use for treatment of postoperative wound infections. Results will inform clinician decisions on antibiotic delivery in patients with postoperative wound infections.

Does Administration of Oral Versus Intravenous Antibiotics for Third Molar Removal Have an Effect on the Incidence of Alveolar Osteitis or Postoperative Surgical Site Infections?

To compare the incidence of postoperative alveolar osteitis (AO) and surgical site infections (SSIs) in 2 separate cohorts of patients undergoing elective third molar removal: those who received postoperative oral (PO) antibiotics and those who received perioperative intravenous (IV) antibiotics. A retrospective cohort study of all patients 14 to 30years old undergoing elective outpatient third molar removal under a single surgeon's service over a 12-year period was completed. Patients undergoing third molar removal during the first 72months received postoperative PO antibiotics alone. Patients undergoing third molar removal during the second 72months received perioperative IV antibiotics alone. The primary predictor variable for the study was the antibiotic regimen used at the time of third molar removal. The primary outcome variable was the postoperative development of AO or SSI. Covariates included age and gender. Univariable and multivariable regression models assessed for associations between the antibiotic regimen used and the presence of AO and SSI. The study sample consisted of 1,895 patients (1,020 patients receiving postoperative PO antibiotics and 875 patients receiving perioperative IV antibiotics). Of patients receiving postoperative PO antibiotics, 6.4% developed AO an average of 5.7days after the procedure and 2.6% developed an SSI an average of 23.2days after the procedure. Of patients receiving perioperative IV antibiotics, 5.5% developed AO an average of 6.2days after the procedure and 3.3% developed an SSI an average of 18.2days after the procedure. No statistically significant associations between the antibiotic regimen used and the presence of AO or SSI were identified in univariable (P = 0.42 for AO, P = 0.32 for SSI) or multivariable (P = 0.65 for AO, P = 0.26 for SSI) analyses. In the postoperative PO antibiotic cohort, older age (P<.001) and female gender (P<.001) were significantly associated with the development of AO, and female gender (P=.015) was significantly associated with the presence of an SSI. In the perioperative IV antibiotic cohort, female gender was significantly associated with the development of AO (P=.011), and younger age was significantly associated with the presence of an SSI (P=.011). The use of a postoperative PO versus a perioperative IV antibiotic regimen does not significantly alter the incidence of AO or SSI after elective third molar removal. If the surgeon chooses to use antibiotics in the setting of third molar surgery, then perioperative IV antibiotics are preferable over postoperative PO antibiotics because they obviate any issues with patient compliance and might be less costly.

Comparative Efficacy and Safety of Oral zinc Sulphate Versus Cryotherapy in the Treatment of Viral Warts

Viral warts are a common problem in dermatology. Viral warts have a considerable negative effect on a patient's quality of life; although the rate of spontaneous recovery is high, it usually takes a long time and some patients might not show this spontaneous healing. A clinical trial was carried out to evaluate and compare the efficacy of oral zinc sulphate and cryotherapy in patients with viral warts. The study was conducted in the Department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh for duration of July 2015 to December 2015. Total sixty patients were enrolled and divided into group A and group B. Thirty of group A patients was treated by cryotherapy and thirty of group B patients was treated by oral zinc sulphate. Improvement rate was highest for the lesions on the finger, which is 18 (34.6%) and lowest for scalp 03 (5.8%). Improvement rate for palm 17 (32.7%); for foot 10 (19.2%) and toe 04 (7.7%). Out of all respondents from Group-A, the mean size of the lesions were 8.17mm, 5.90 mm, 4.32 mm and 3.57 mm at before treatment and 1st visit, 2nd visit and 3rd visit after treatment respectively. In Group-B, the mean size of the lesions were 7.50 mm, 4.92 mm, 3.00 mm, and 4.75 mm at before treatment and 1st visit, 2nd visit and 3rd visit after treatment respectively. Among the respondents of group-A &amp; B, 27 (90%) and 25 (83.3%) were improved respectively. No statistical significant difference was observed between the two groups. Both cryotherapy and oral zinc sulphate when used individually were found to be equally effective in the treatment of viral warts but cryotherapy was found to be superior in efficacy.&#x0D; CBMJ 2017 January: Vol. 06 No. 01 P: 17-23

Comparative Study of Lipid Profile in Women Using Oral Contraceptive Pills Versus Non Oral Contraceptive Pills Users in Reproductive Age Group

Comparative Study of Lipid Profile in Women Using Oral Contraceptive Pills Versus Non Oral Contraceptive Pills Users in Reproductive Age Group

Assessing the Effect of Oral Versus Intravenous Fluids on Progress of Labor and Fetal Outcomes

Background: Childbirth is a natural physiological process, yet it is a life –changing events for many women. However, the care given to women during labor has the potential to affect them both physically and emotionally, likewise, short and long term labor and delivery management are the most common medical issues facing the health caregivers. The study aimed to evaluate effects of oral versus intravenous hydrations on progress of labor and fetal outcomes. A, quasi-experimental design was utilized. Purposive samples of 112 parturient women were randomly allocated into the study and the control groups. The study was conducted at obstetric and gynecologic department, Helwan General Hospital, Egypt. Data were collected through four main tools: structured interviewing questionnaire, delivery and maternal assessment, the Partograph, and neonatal assessment record. The study findings indicated that no significant differences were found between the two groups in their demographics, the mean duration of the first stage of labor in study group was significantly shorter than the control group. However, the duration of the second stage and the third stage of labor in the study group were significantly shorter than the control group. There were statistical significant difference among the study group and control group regarding the two Apgar scores in 1^st and 5^th minutes. The study and research hypothesis concluded that administration of intravenous infusion enhances labour and reduce the first stage of labour duration, consequently, the duration of labour. The study recommended the benefit of increased intravenous hydration in labor, as well as the role of supplemental oral hydration.

Comparision of Response of Oral Versus Injectible Vitamin D in Children Having Rickets

Malnutrition is one of the major issues around the world. According to one estimation, it is stated that one of three children daily die from malnutrition in all over the world. Rickets is one of the most prevalent metabolic bone diseases in children. Proper diet and treatment can help in prevention of rickets. Rickets is a bone disorder due to deficiency of vitamin D. The level of vitamin D tells the severity of nutritional rickets as vitamin D is the major factor of this disease. There were no undesirable side effects observed in either group of children and both oral and injectable forms of treatment were well-tolerated. Cost of oral and injectable vitamin-D was almost same.

PGI15 - Oral Versus Intravenous Iron Treatment in Patients with Inflammatory Bowel Disease and Iron Deficiency and/or Anemia in Germany

PGI15 - Oral Versus Intravenous Iron Treatment in Patients with Inflammatory Bowel Disease and Iron Deficiency and/or Anemia in Germany

Pharmacokinetic Interaction of Rifampicin with Oral Versus Intravenous Anticancer Drugs: Challenges, Dilemmas and Paradoxical Effects Due to Multiple Mechanisms.

Since many drugs are cytochrome P450 (CYP)-3A4 substrates, it has become common practice to assess drug–drug interaction (DDI) potential with a CYP3A4 inhibitor (ketoconazole) or inducer (rifampicin) in early drug development. Such an evaluation is relevant to anticancer drugs with metabolism governed by CYP3A4. DDIs with rifampicin are complex, involving other physiological mechanisms that may impact overall pharmacokinetics. Our objective was to study and delineate such mechanisms for oral versus intravenous anticancer drugs. We hypothesized that DDIs between anticancer drugs and rifampicin were primarily driven by CYP3A4 induction. This hypothesis was proven for the oral anticancer drugs; however, in some cases, other intrinsic mechanisms such as P-glycoprotein (Pgp)/UDP glucuronosyl transferase (UGT) induction and transporter inhibition may have played an important role alongside the induced CYP3A4 enzymes. The hypothesis that CYP3A4 induction would decrease drug exposure appeared paradoxical for intravenous romidepsin and—to a somewhat lesser extent—for cabazitaxel. In light of this dilemma in the interpretation of the pharmacokinetic data with rifampicin, several questions require further consideration. Given the complexity and paradoxical effects arising with DDIs with rifampicin, the continued preference for rifampicin as CYP3A4 inducer needs immediate re-appraisal.