Use Of Prophylactic Drugs Research Articles

Impact of an emergency department nurse training intervention on the adequacy of thromboprophylaxis for venous thromboembolism: the PROTESU III study.

Objectives. To assess the impact of training for emergency department (ED) nurses on adequate thromboprophylaxis for patients admitted to hospital from the ED for medical conditions. Methods. Multicenter quasiexperimental pre-post study of an ED nurse training intervention in 8 hospitals. Patients were recruited from January 2022 through May 2023 in 3 phases: before nurse training, in the first month after training, and in the sixth month after training. Included were patients attended in the ED for medical conditions. Adequate thromboprophylaxis was defined as 1) use of prophylactic drugs in patients at high risk for venousthromboembolism according to the Padua Prediction Score (PPS), and 2) nonuse in patients at low risk. We compared the percentage of adequate prophylaxis in the first phase to the percentages in the second and third phases. Results. A total of 928 patients were included (326 in phase 1, 295 in phase 2, and 307 in phase 3). PPS scores indicated that 238 (73%) of the patients were at high risk in phase 1 vs 189 (64.1%, P = .016) in phase 2 and 207 (67.4%, P = .125) in phase 3. A total of 187 patients (57.4%, 95% CI, 51.8%-62.8%) were adequatelythromboprophylaxed in phase 1 vs 178 (60.%, 95% CI, 54.5%-66%) in phase 2 (absolute difference in proportions, 3.0% (95% CI, -4.8% to 10.6%; P = .462)]. In phase 3, 166 patients (54.1%, 95% CI, 48.3%-59.7%) received adequate prophylaxis (difference, -3.3% (95% CI, -11.0% to 4.4%; P = .405). Conclusions. A training intervention for ED nurses, implemented as an isolated strategy, had no impact on the adequacy of thromboprophylaxis in patients admitted from the ED for medical conditions.

Prospective clinical study of the efficacy and safety of different doses of PEG recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) for preventing leukopenia/neutropenia caused by concurrent chemoradiotherapy for cervical cancer

ObjectiveThe efficacy and safety of different doses of PEG recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) in the prevention of leukopenia/neutropenia during concurrent chemoradiotherapy for cervical cancer were investigated.MethodsThe patients who received concurrent radiotherapy and chemotherapy for cervical cancer from June 2020 to January 2023 were selected to evaluate the difference in efficacy, adverse reactions, and treatment cost of PEG-rhG-CSF in the prevention of leukopenia/neutropenia between the test group and the control group.ResultsThe minimum value of leukopenia/neutropenia in the test group was significantly higher than that in the control group (P < 0.05). The incidence of grade ≥ 3 leukopenia/neutropenia was significantly lower than that of the control group (P < 0.05). The number of interrupted days of radiotherapy was less than that of the control group (P < 0.05). PEG-rhG-CSF of different prophylactic doses (100 μg/kg dose or 50 μg/kg dose) had similar prophylactic effects in the test group, OR=1.192 (0.761, 1.868), P=0.443.ConclusionProphylactic application of PEG-rhG-CSF could reduce the incidence of leukopenia/neutropenia in cervical cancer during concurrent chemoradiotherapy. There was no significant difference in efficacy and safety with prophylactic use of drug at doses of 100 μg/kg and 50 μg/kg.

Investigation of Prophylactic Drug Use Adherence in Patients with Migraine

Investigation of Prophylactic Drug Use Adherence in Patients with Migraine

Biotechnology of regulation of reproductive functions of Bos primigenius taurus

Since cattle are biologically capable of giving birth to only one calf per year, they are considered a single-fruited animal species. One of the cardinal methods of solving the problem of accelerated reproduction of livestock is biotechnological regulation of reproductive function in cows and synchronisation of their sexual activity. The aim of the study is to investigate the peculiarities of the reproductive function of Red Steppe cows under the influence of various methods of its regulation using modern hormonal agents. To evaluate the reproductive function of cows, generally accepted zootechnical methods were used, methods of variation statistics were used to calculate data, and biotechnological methods were used to regulate sexual activity in cows. Based on the analysis of the state of reproduction of the cattle herd, it was established that 164-187 cows and 85-96 heifers are artificially inseminated annually, which ensures the yield of calves per 100 cows of 89-91 heads and the annual introduction of 36 to 40 first-born calves per 100 cows. The shortened service period contributes to both a higher calf yield and an increase in milk yield, which is a desirable production effect. However, calving to conception interval, necessary to prepare the cow’s body for a new insemination, can be reduced to at least 30 days. Insemination of heifers with artificial insemination devices should be started when they reach a live weight of 314±6.5 kg, which will allow to obtain fertility from the first insemination at the level of 73.7-77.8% and thereby prevent obesity of heifers, which mainly reduces the percentage of fertility from the first insemination. It is necessary to establish obstetric and gynaecological examinations and treatment of problematic replacement heifers and cows, and it is advisable to use prostaglandin F2α analogues in combination with vitamins or biologically active drugs to stimulate the sexual function of cows and heifers. The use of prophylactic drugs will help to synchronise the heifers' sexual desire and increase their fertility during insemination. And the organisation of cattle reproduction and the proposed biotechnological ways to improve artificial insemination of the red steppe breed breeding stock will significantly improve their reproductive status, which will increase the overall economic efficiency of the industry

Use of Prophylactic Drugs according to Risk Classification for TLS in Patients with Hematological Malignancies

Use of Prophylactic Drugs according to Risk Classification for TLS in Patients with Hematological Malignancies

Long-Term Effects of COVID-19 Pandemic on Migraine in Adolescents. A Retrospective Analysis of the Population Attending the Headache Center in Different Phases of the Pandemic.

Literature data report that the first COVID-19 pandemic had an impact on the progression of migraine both in adults and children. The present study aimed to verify how the migraine course and psychological aspects varied in adolescent patients in relation to some of the different phases of the COVID-19 pandemic and compared with the months before COVID-19. In addition, the relationship between the characteristics of headache episodes and psychological and school-related aspects were analyzed. The study included 418 adolescents. Based on the timing of the evaluation, they were categorized into patients observed before the COVID-19 pandemic (pre COVID) or during the first (COVID 1) or second (COVID 2) wave of the pandemic. Subjects were also categorized into three further groups: those who had high or low frequency of migraine attacks during the month, those who had mild or severe pain during the attack, and those who were taking prophylactic drugs. The Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scales were utilized to assess depression and anxiety. We observed a significant increase in the frequency of attacks and the use of prophylactic drugs during the COVID 2 period compared to the COVID 1 and pre-COVID periods (p < 0.05). Patients showed higher levels of anxiety and depression during each of the two COVID periods compared with the pre-COVID months (p < 0.05), especially during the COVID 2 period (p < 0.05). Our results show long-term negative impacts of the COVID-19 pandemic on clinical parameters and psychological symptoms in adolescents with migraine.

Brain volumetry by voxel-based-morphometry in migraineurs: comparison between groups and clinical correlations

Background&#x0D; Migraine was previously interpreted as “benign” disease since the major part of patients were asymptomatic between attacks and brain lesions are absent in primary headaches. Advances in structural neuroimaging have changed this point of view. Voxel-based-morphometry is an accurate technique to evaluate objectively structural brain damage. Our hypothesis was that some clinical features of migraine, as aura and attack frequencies, are more related to volumetric changes in migraineurs brains. &#x0D; &#x0D; Objectives&#x0D; To compare brain lobes volumetry between migraine patients (episodic migraine, with and without aura, chronic migraine) and healthy controls. To evaluate the correlations of brain volumetric variables with clinical variables.&#x0D; &#x0D; Methods&#x0D; This is a cross-sectional study performed with 60 female volunteers, aged between 18 and 55 years old, equally allocated into four groups: episodic migraine without aura, episodic migraine with aura, chronic migraine and controls. The sample was clinically characterized by the following variables: age, number of days with headache in the last month, number of days with aura in the last month, average pain intensity in the last month, disease duration calculated in number of years from the migraine diagnosis to the MRI performance, and the use of prophylactic drugs for migraine. Volunteers underwent brain MRI, and Free Surfer software was used to perform volumetric studies. Statistical analyses included Mann-Whitney test, Kruskal-Wallis test, Dunn test and Spearmann correlations.&#x0D; &#x0D; Results&#x0D; No statistically relevant differences were found in cerebral lobe volumes and supratentorial white matter in the comparison between groups. Regarding to clinical correlations, age influenced the brain lobes volumetric reduction, as expected, except for the parietal lobe, for which the correlation was not important. The disease duration was correlated with the reduction of the frontal (p&lt;0.001 / r=-0.531), temporal (p=0.003/r=-0.433), parietal (p=0.004/r=-0.431) lobes; when adjusted by age...&#x0D; &#x0D; (To see the complet abstract, please, check out the PDF.)

The practice patterns of migraine management among neurologists in the Philippines - A cross-sectional survey

Objectives: We aimed to describe the current preferences of Filipino neurologists in the diagnosis and management of migraine. Methods: This is an observational descriptive study using a web-based survey done from November 2019 to June 2020 among certified locally practicing neurologists belonging to the Philippine Neurological Association. Results: A total of 259 (56.67%) from the 2018 roster of 457 neurologists participated in the survey. The prevalence of migraine in the respondents was 49.81% with a F:M ratio of 3.3:1. The majority (78%) based their diagnosis on established international criteria for migraine. Many (77%) would request neuroimaging for their patients with a history of more than 3 years of recurrent severe migraine. The most preferred class of drugs for acute migraine was NSAIDs (48.26%). One-third of respondents would give anti-nausea medications for moderate to severe attacks of migraine. About half would not consider using triptans for their patients with moderate to severe episodic migraine attacks. The top three drugs used for migraine prophylaxis were topiramate (80.69%) followed by flunarizine (73.36%) and propranolol (49.03%). Among patients with two or more headaches per week, 74.13% would prescribe prophylactic drugs. The use of a headache diary and the Migraine Disability Assessment Scale (MIDAS) was advised by 62.16% and 14.67% of respondents respectively, while cautioning about medication overuse headache was done by 68.34%. Conclusions: We have described the preferred practice of Filipino neurologists in diagnosing and treating migraine patients with locally available resources. The use of measurement tools (specifically MIDAS scoring to assess migraine disability), triptans, and anti-nausea drugs are not popular practices among Filipino neurologists The survey shows the need to promote the use of prophylactic drugs, counselling for medication overuse and more teaching about primary headaches in medical school.

Does COVID-19 infection increase the risk of pulmonary embolism in ambulatory patients with deep vein thrombosis.

Coronavirus disease 2019 (COVID-19) can lead to systemic coagulation activation and thrombotic complications including venous thromboembolism. This study compares the development of pulmonary embolism, post-thrombotic syndrome, and clinical outcomes of COVID-19 and non-COVID-19 patients with deep vein thrombosis (DVT). One hundred and eight patients diagnosed with acute deep vein thrombosis (DVT) between June 2020 and February 2021 in our institution were included in this retrospective study. Thirty-nine patients had been previously diagnosed with COVID-19 and specified as the COVID-19 group. Sixty-nine patients did not have COVID-19 and specified as the non-COVID-19 group. Mean ages of both groups were 64.3 ± 15.8 and 60.1 ± 19.7 years, respectively (p = .37). The median duration from the onset of the COVID-19 to diagnosis of DVT was 22 (2-120)days in the COVID-19 group. The patients of two groups were mostly treated outpatient at rates of 94.9% vs 94.2%, respectively (p = .88). Pulmonary embolism was seen in six patients (15.4%) in the COVID-19 group and in three patients (4.3%) in the non-COVID-19 group (p = .04). Kaplan-Meir curves showed that patients with COVİD-19 had significantly higher pulmonary embolism than those without COVID-19 (p = .015). The recurrence rate of DVT was 2.6% in the COVID-19 group (n = 1), and 4.3% in the non-COVID-19 group (n = 3), indicating no statistically significant difference (p = .63). Mortality was seen in six patients (15.4%) in the COVİD-19 group, and in seven patients (10.1%) in the non-COVID-19 group. According to the Kaplan-Meir method, 10months survival rates were 73.9 ± 10% in the COVID-19 group, and 66.3 ± 12.8% in the non-COVID-19 group with no statistical significance (p = .218). Our data draw attention to the fact that deep vein thrombosis should not be considered a safe and self-limited condition. Efficient preventive measures such as mobilization and prophylactic drug use should be considered to prevent DVT during the management of COVID-19.

Descrição do serviço de gestão da condição da saúde voltado a crianças recém-diagnosticadas com doença falciforme

Objective: To assess the results of the health condition management service provided for children with sickle cell disease (SCD). Methods: a cross-sectional study of the health condition management service offered to newly diagnosed children with SCD treated between January 2016 and December 2019 at the Blood Center in Belo Horizonte, Brazil. The service was provided by a clinical pharmacist and an academic from the pharmacy course, with data from the initial consultation (start of drug use) performed in a pharmacist’s office and telephone contact carried out eight days later. All children seen at the service were evaluated, and their demographic characteristics, compliance with the beginning of the use of prophylactic drugs for sickle cell disease (phenoxymethylpenicillin and folic acid) according to the protocol of the Ministry of Health (within 90 days after birth), and documented reason in case of non-compliance. The doubts regarding the medications and the standardized interventions of the service to the children´s guardians were also described. The difference in the distribution of variables in the adequacy and non-adequacy group to the MS protocol was assessed using Pearson’s chi-square test (categorical) and Mann-Whitney (numerical). Results: In the SCD condition management service, all children together with their guardians (N = 298) had their first consultation with the pharmacist (initial dispensation day), however, only 185 (62.1%) participated in the pharmaceutical service by telephone (eight days after the initial dispensing). Approximately 88.3% of children started using drugs for sickle cell disease according to the protocol of the Ministry of Health; the most frequent reason for non-compliance was the late diagnosis in the complementary health system (22.9%). The guardians pointed out 63 doubts about the medications, highlighting their non-acceptance by the child (28.6%), and for all doubts standard pharmaceutical guidelines were provided in the service. Conclusion: It was identified that the health condition management service provided is relevant, since most of those responsible for the children with SCD had doubts about their medication after the administration of medications began. The pharmacist contributes positively to the pharmacotherapeutic management of SCD, promoting empowerment about the correct use of medicines.

Reduction of faecal shedding of parasites in West African dwarf bucks fed yeast and Lactobacillus acidophilus

Ruminants serve as reservoirs of pathogenic microorganisms and their faecal shedding forms the vehicle of entry into human food chain which in turn causes food borne diseases. Usually drugs and live vaccines are the main control measures; however, due to increasing concerns of resistance and residues in meat with prophylactic drug use and the high cost of vaccines, alternative control methods are needed. The aim of this study was to determine if administration of probiotics could influence the shedding of faecal pathogenic bacteria and parasites/helminthes from WAD goats. In a completely randomised design, thirty goats were allotted to six dietary treatments which were formulated using concentrate as: control (D1); antibiotic (D2); 2.5g bakers yeast (D3); 5.0g bakers yeast (D4); 2.5g yeast plus Lactobacilli (D5) and 5.0g yeast plus Lactobacilli (D6), where D5 and D6 were fortified with Lactobacillus acidophilus at 1.00x1012cfu/g each. Faecal samples (3g) were collected from bucks for faecal egg count reduction test (FECRT, %). Data obtained were subjected to descriptive statistics and ANOVA α0.05. The results showed that the FECRT (%) for the pathogenic bacteria revealed a significant (p&lt;0.05) reduction in load at two weeks by 99.99 % in D6 while the least was seen in D2 with 98.98 %. The salmonella as at day 14 recorded significant percentage reduction which was high in D5 (90 %) and lowest in D6 (19.23 %). The parasitic shedding of coccidia at day 14 showed that the goats on D1 shed 400 egg per gram (epg) while those on D3 recorded 150 epg. The animals on D2, D4, D5 and D6 recorded no trace of coccidia eggs in their faeces while animals on D5 and D6 showed reductions of 5.60 and 50.00 % respectively in Ascaris. Tapeworm was identified only in faecal sample of D1. The result revealed that yeast combined with Lactobacillus acidophilus at 5g/day could serve as a potential alternative to anti-bacteria and anti-helminthes.

Pharmacoprophylactic equivalence of rifapentine compared with isoniazid

Background Tuberculosis is an important infection and is still the most important problem worldwide. The prevention of infection is an important consideration. Focusing on the risk group, HIV-infected patient group is an important risk population for getting tuberculosis. The use of pharmacoprophylaxis has become a new concept in preventive medicine against tuberculosis for HIV-infected population. The classical regimen is the isoniazid regimen. However, the new introduction of combined rifapentine and isoniazid has become a new alterative preventive measure that can help prevent tuberculosis among HIV-infected cases. The alternative is reported for its efficacy and also mentioned for the shorter period of drug use. Materials and methods In the present report, the authors performed a clinical mathematical modeling study to determine the pharmacoprophylactic equivalence of rifapentine compared with isoniazid, with special referencing to the HIV-infected population. First, the comparison of required dosage, period of treatment, as well as prophylactic end point is primarily performed and then appraisal on pharmacoprophylactic equivalence of rifapentine compared with isoniazid is done based on mathematical adjustment for required dosage, period of treatment, and prophylaxis end point. Results Based on the appraisal, the final pharmacoprophylaxis equivalence is 1 rifapentine dosage is equal to 4.002748–8.005496 isoniazid dosage or 1 mg rifapentine is equal to 0.00143 week of drug use. Conclusion Based on the derived pharmacoprophylactic equivalence, rifapentine can help lower required isoniazid dosage and period of prophylactic drug use in prevention of tuberculosis for HIV-infected case.

Increased deep vein thrombosis cases during the COVID-19 quarantine.

The aim of this study was to compare the number of deep vein thrombosis (DVT) cases during the quarantine period for COVID-19 to that of the last year. This study was conducted as a single-center and retrospective study. All hospital admissions during April 2020 and May 2020 were screened from the hospital records, and DVT cases were recorded. Likewise, all hospital admissions during April 2019 and May 2019 were screened, and DVT cases were noted. DVT cases of both years were compared. Among 480931 patients admitted to our hospital in April 2019 and May 2019, DVT was detected in 82 patients (0.017%) (47 males, 35 females) with a mean age of 56.99 ± 9.1 years (ranges 39 to 79 years). Besides, among 145101 patients admitted to our hospital in April 2020 and May 2020, DVT was detected in 123 patients (0.084%) (51 males, 72 females) with a mean age of 58.64 ± 8.9 years (ranges 40 to 83 years). Despite the decrease in the total number of patients admitted to the hospital, there was a significant increase in the number of DVT patients. Interestingly, there were only two symptomatic pulmonary-embolism cases in the 2019 period, whereas there were seven symptomatic pulmonary embolisms secondary to DVT in the 2020 period. Unfortunately, one patient died due to pulmonary embolism secondary to DVT in 2020. The previous history of DVT was remarkable in patients admitted during the COVID-19 confinement. In conclusion, COVID-19 confinement seems to be associated with increased rates of DVT. Strict preventive measures such as exercise training or prophylactic drug use should be considered to prevent immobility-related DVT during the COVID-19 quarantine.

Evaluation of Patients’ Behavior with Bleeding Disorder in Preferring Primary Health Care Centre for Follow-Up and Treatment

Aim: The aim of this study is to examine the behaviors of patients who are members of the hemophilia association due to bleeding disorder, and due to health problems related to their diseases preferring primary health care institutions first, and to determine the reasons if they do not. Methods: The study was a descriptive cross-sectional study. The universe of the study was composed of hemophilia patients who are members of the hemophilia association living in Tekirdağ province (n=48). In the study face to face questionnaire was applied. People were asked about their first medical institutions in their complaints about their illness. The patients were asked about their age, gender, working status, educational status, types of bleeding disorders, severity and history of diseases. Results: Nobody preferred the primary health care institution for his complaints about bleeding disorder. Of the participants, 42.9% (n=18) stated that family physicians do not have sufficient information about this disease as the reason for not choosing primary health care institution. Conclusion: The trust of patients with bleeding disorders to family physicians is not sufficient. Regardless of the severity, type and prophylactic drug use of their disease, they do not prefer primary health care institution for their follow-up and treatment. Keywords: hemophilia, bleeding, family practice

MANAGEMENT OF PATENT DUCTUS ARTERIOSUS IN VERY PRETERM NEWBORNS: CURRENT CONTROVERSIES AND RECOMMENDATIONS

According to numerous studies, the persistence of patent ductus arteriosus (PDA) in very preterm infants is associated with increased morbidity and mortality. The prophylactic use of drugs that prevent or reduce the hemodynamic significance of PDA in preterm infants has several short-term benefits, including reduction in the incidence of symptomatic PDA, severe intraventricular hemorrhages (IVH) and the need for additional medical or surgical treatment. At the same time, this approach does not affect the long-term outcomes of such patients. Pre-symptomatic treatment with cyclooxygenase inhibitors before the time of appearance of symptoms caused by PDA generally does not affect mortality, but significantly reduces the incidence of symptomatic PDA and the need for pharmacological and surgical treatment. Pre-symptomatic treatment of PDA may be of value in extremely preterm infants born within 23-25 wk of gestation taking into account the high incidence of hemodynamically significant PDA (hsPDA) requiring further treatment in such newborns. Treatment of clinically obvious PDA may minimize the risk of exposing preterm infants to the treatment with undesirable side effects. At the same time, the disadvantages of late intervention are lower success rate and an increased risk of complications associated with hsPDA. Expectant management of PDA in preterm newborns is gaining increasing interest because in a substantial proportion of preterm infants, the PDA will close spontaneously and there is a lack of proven benefit of medical treatment. This approach is not associated with a higher risk of death, necrotizing enterocolitis (NEC), or IVH than any other treatment approaches. A conservative approach aimed to close PDA (fluid restriction, diuretics, etc.) can contribute to avoidance of medical and surgical intervention and their potential side effects only in some preterm infants with gestation &gt; 26 wk, without affecting mortality and quality of survival. However, such a therapy is associated with a high risk of dehydration, development of hyponatremia, and an increase in serum creatinine, that is why it isn’t routinely recommend.

Prophylactic lactoferrin for preventing late-onset sepsis and necrotizing enterocolitis in preterm infants: A PRISMA-compliant systematic review and meta-analysis.

Background:Currently, prophylactic use of drugs to promote a healthy gut microbiota and immune system in preterm infants is hot debated, among which lactoferrin is a promising supplementation. However, the effect and safety of lactoferrin to prevent late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) in preterm infants remains controversial.[1]Methods:Databases including Medline, Ovid-Embase, The Cochrane Library, CBM, CNKI, and VIP database of Chinese Journal were searched to collect randomized controlled trials (RCTs) about lactoferrin for preventing LOS and NEC in preterm infants. Languages of included RCTs were restricted to English and Chinese. Meta-analysis was conducted by Rev Man 5.3 software. The Mantel–Haenszel method with random-effects model was used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs).Results:A total of 9 RCTs, involving 1834 patients, were included. Pooled analysis showed that prophylactic lactoferrin could significantly reduce the incidence all culture-proven LOS (41/629 [6.5%] vs 96/659 [15.3%]; RR 0.47; 95% CI 0.33–0.67; P < .01) and NEC (stage II or more) (9/448 [2.0%] vs 26/462 [5.6%]; RR 0.40; 95% CI 0.18–0.86; P < .01). Lactoferrin was also associated with a significantly decreased hospital-acquired infection (16/139 [11.5%] vs 35/140 [25%]; RR 0.47; 95% CI 0.27–0.80; P < .01); and infection-related mortality (4/474 [0.8%] vs 25/505 [4.9%]; RR 0.24; 95% CI 0.04–1.32; P < .01, I = 53%). Lactoferrin could shorten time to reach full enteral feeding (weighted mean difference [WMD] = −2.11, 95% CI −3.12 to −1.10; P < .01) and showed a decreasing trend of duration of hospitalization (WMD = −1.69, 95% CI −6.87 to 3.50; P < .01; I = 95%). Lactoferrin did not have a significant effect on all-cause mortality (22/625 [3.5%] vs 35/647 [5.4%]; RR 0.70; 95% CI 0.38–1.30; P = .16; I = 13%). None of the included trials reported any confirmed adverse effects caused by the supplemented lactoferrin or probiotics.Conclusion:Current evidence indicates that lactoferrin could significantly reduce the incidence of NEC and LOS, and decrease the risk of hospital-acquired infection and infection-related mortality in premature infants without obvious adverse effects.

Carbetocin versus Oxytocin for the Prevention of Postpartum Haemorrhage

Postpartum haemorrhage is the leading cause of maternal mortality worldwide. Total 67-80% of cases are caused by uterine atony. Preventive measures include prophylactic drug use to aid uterine contraction after delivery, thus avoiding severe blood loss and reducing maternal morbidity and mortality. Carbetocin is a synthetic analogue of oxytocin with a long half-life which ensure more effective contraction and less adverse effects. It can be administered as a single dose injection either intravenously or intramuscularly rather than as an infusion over several hours as is the case with oxytocin. Carbetocin is currently indicated for prevention of uterine atony after delivery by caesarean section in spinal or epidural anaesthesia. A reduced need for additional uterotonics was observed with carbetocin vs. oxytocin in high-risk women and carbetocin was at least as effective as syntometrine in low-risk women. Carbetocin is effective treatment for the prevention of postpartum haemorrhage not only following caesarean delivery but also after vaginal delivery in high-risk women and those who suffer from hypertensive disorders in pregnancy. Further research is required to assess whether prophylactic carbetocin is superior to conventional uterotonic agents following vaginal delivery in low-risk women.Faridpur Med. Coll. J. Jul 2015;10(2): 76-83

Analysis of risk factors of intra-abdominal infection after surgery for colorectal cancer

To investigate the risk factors of intra-abdominal infection(IAI) after colorectal cancer surgery. Clinical and follow-up data of 773 colorectal cancer patients undergoing operation in our hospital from October 2011 to December 2014 were retrospectively analyzed. Patients were divided into intra-abdominal cavity infection group (110 cases, IAI group) and non intra-abdominal infection group(663 cases, non-IAI group). All the patients administered prophylactic antibiotics 30 minutes to 2 hours before operation. Univariate and multivariate analysis were performed to evaluate the risk factors of IAI. Preoperative factors associated with postoperative IAI included hepatic cirrhosis, kidney diseases, diabetes or other basic diseases, prophylactic use of drugs, hypoalbuminemia, anemia, intestinal obstruction, and American Society of Anesthesiologists (ASA) anesthetic grading score (all P<0.05). Postoperative factors associated with postoperative IAI included use of laparoscopy or stapler, united exenteration, existence of anastomotic fistula, time of drainage tube placement, operation time and tumor staging (all P<0.05). Multivariate logistic regression analysis showed that preoperative diabetes(OR=2.36, 95% CI:1.45 to 4.76, P<0.01), combined exenteration (OR=2.02, 95% CI:1.02 to 4.00, P<0.01), anastomotic leak (OR=4.41, 95% CI:1.77 to 10.99, P=0.001), operation time≥140 minutes (OR=2.88, 95% CI:1.78 to 4.67, P<0.01) and period of postoperative drainage≥10 days(OR=4.57, 95% CI:2.78 to 7.52, P<0.01) were independent risk factors of postoperative IAI, while the use of stapler was protective factor (OR=0.37, 95% CI: 0.23 to 0.60, P<0.01). Compared with prophylactic use of cephamycins plus metronidazole, cefuroxime plus metronidazole had a higher rate of IAI(OR=2.10, 95% CI:1.23 to 3.58, P=0.007). Prevention of postoperative IAI is required for colorectal cancer patients, particularly in those with preoperative diabetes, combined exenteration, anastomotic leak, operation time longer than 140 minutes and postoperative drainage period longer than 10 days. Preoperative use of cephamycins plus metronidazole has better efficacy in prevention of postoperative IAI.

Predictors for initiation of pharmacological prophylaxis in patients with newly diagnosed bipolar disorder—A nationwide cohort study

BackgroundTreatment guidelines state that all patients with bipolar disorder should use pharmacological prophylaxis; however the actual use of prophylactic drugs after bipolar disorder diagnosis is unknown. Our aim was to assess the use of, and predictors for, pharmacoprophylaxis in newly diagnosed bipolar disorder patients. MethodsData from three Swedish nationwide registers were obtained. We identified patients aged 18–75 with a first time diagnosis of bipolar disorder between 2006 and 2012 (n=31,770) and reviewed subsequent mood-stabilizer and antipsychotic prescription fills. In multivariable Cox regression models, we studied demographic and illness related factors as predictors of prescription fills after diagnosis. ResultsIn total, 72.2% (95% confidence interval [CI] 71.7–72.7%) of the patients filled a prescription of a prophylactic drug within 3 months after diagnosis. Pharmacological prophylaxis was mainly associated with a longer duration of hospitalization at bipolar disorder diagnosis (adjusted hazard ratio [AHR] 2.18; CI 2.02–2.35 for a hospitalization of ≥28 days compared to <7 days) and previous use of any mood-stabilizer or antipsychotic (inpatients: AHR 1.24; CI 1.17–1.31 and outpatients: AHR 1.78; CI 1.73–1.84). LimitationsWe had no information on drug prescriptions that were never filled. ConclusionsThe proportion of newly diagnosed bipolar disorder patients without pharmacological prophylaxis is substantial. Patients who are naïve to mood-stabilizers and antipsychotics and are hospitalized for a brief period at diagnosis are the ones least likely to initiate pharmacoprophylaxis, suggesting that this group deserves attention in order to improve the long term prognosis.

WITHDRAWN: Drugs for preventing migraine headaches in children.

Background It has been estimated that about 10 per cent of children between 6 and 20 years of age suffer from migraine, and that children with migraine lose one and a half weeks more schooling per year than their peers. Prophylactic drugs can be prescribed when children suffer from frequent or disabling headaches. Objectives To describe and assess the evidence from controlled trials on the efficacy and tolerability of pharmacological agents taken on a regular basis to prevent the occurrence of migraine attacks and/or reduce the intensity of such attacks in children with migraine. Search methods The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE were searched from 1966 through 2002. Additional strategies for identifying trials included searching the reference lists of review articles and included studies and searching books related to headache. Selection criteria Prospective randomised controlled trials (RCTs) of self‐ or parent‐administered drug treatments in children (under 18 years of age) who had received a diagnosis of migraine were included. Data collection and analysis Two investigators extracted, assessed, and coded separately all data for each study, using a form that was designed specifically for the review. Any disagreement was resolved by discussion. Headache frequency standardised over 28 days was used as the primary outcome measure. Headache intensity, headache duration, amount of symptomatic treatment used, and headache indices were used as secondary outcome measures. Data were extracted from both parallel‐group and crossover trials. Continuous and dichotomous data were used to calculate standardised mean differences (SMDs) and odds ratios (ORs), respectively. Numbers‐needed‐to‐treat (NNTs) and numbers‐needed‐to‐harm (NNHs) were also calculated. Main results Thirty‐eight studies were selected. Eighteen were excluded. Eleven preventive drugs were compared with placebo in a total of 15 studies. Drug‐drug comparisons were made in just six studies. For only four drugs (L‐5‐hydroxytryptophan [L‐5HTP], flunarizine, clonidine, and propranolol) were two or more studies selected. For only six drugs (trazodone, L‐5HTP, propranolol, flunarizine, papaverine, and nimodipine) were data reported for effect on frequency. For no individual drug were comparable data reported in more than one study, thus meta‐analysis was not possible. Two placebo‐controlled studies showed a beneficial effect on the primary outcome measure, headache frequency. They were for the drugs propranolol and flunarizine. The propranolol study reported a dichotomous outcome (proportion of children responding), and it was possible to calculate a number‐needed‐to‐treat to produce a two‐thirds reduction in headache frequency (NNT = 1.5, 95%CI 1.15 to 2.1). The flunarizine study produced a SMD of 1.51 (95% confidence interval, ‐2.21 to ‐0.82), which was statistically significant in favour of flunarizine (p Authors' conclusions Only one study each for propranolol and flunarizine were identified showing efficacy of these drugs as prophylactics of paediatric migraine. Nimodipine, timolol, papaverine, pizotifen, trazodone, L‐5HTP, clonidine, metoclopramide, and domperidone showed no efficacy in reduction of frequency of attacks. Available studies on other commonly used drugs failed to meet our inclusion criteria. The quality of evidence available for the use of drug prophylaxis in paediatric migraine was poor. Studies were generally small, with no planning of sample size, so that for many drugs, despite the negative findings of this review, we do not have conclusive evidence of 'no effect'. There is a clear and urgent need for methodologically sound RCTs for the use of prophylactic drugs in paediatric migraine, starting with propranolol. These studies need to be adequately powered to investigate meaningful reductions in pain and suffering from a patient's perspective.