Success Rate Of Termination Research Articles

Subcutaneous Implantable Defibrillator programming: an analysis of Italian clinical practice and its evolution

Abstract Background The UNTOUCHED study (designed in 2017 and published in 2021) demonstrated high success rate for termination of ventricular arrhythmias, and very low inappropriate shock rate in subcutaneous implantable cardioverter-defibrillator (S-ICD) recipients. The prescribed device programming included a conditional zone between 200 and 250 beats per minute (bpm) with discrimination algorithms employed to avoid delivering inappropriate shocks in this range, and a shock zone based on the rate alone for arrhythmias >250 bpm. Whether these results influenced clinical practice is unknown. Methods We assessed the programming at implantation and changes in programmed parameters at follow-up (≥1 year) in a cohort of S-ICD recipients enrolled in the Rhythm Detect registry at 56 centers. Results From 2013 to 2021, 1521 consecutive patients (aged 49±15 years; 79% male, 52% dilated cardiomyopathy, 31% arrhythmic syndromes, 16% hypertrophic cardiomyopathy) were analyzed. At implantation, the programmed sensing vector was the Primary in 59% of patients, the Secondary in 35%, the Alternate in 6%. At follow-up, the sensed vector was changed in 13% of patients. The programmed conditional zone cutoff was set to 200 [200–220] bpm (median [25–75 percentile]), and the shock zone cutoff to 230 [210–250] bpm. At follow-up, the conditional zone cutoff was reprogrammed in 13% of patients, but the median value in the overall population did not change (200 [200–220] bpm; p>0.05). The shock zone cutoff was reprogrammed in 43% of cases, and the overall median value was 250 [230–250] bpm (p<0.001 versus implantation). Sorting patients by implantation date, we observed that in the first 764 patients (implanted ≤2017) the shock zone cutoff was set to 210 [210–230] bpm at implantation and to 240 [230–250] bpm at follow-up (reprogrammed in 66% of cases). While in patients implanted >2017, it was already set to 250 [230–250] bpm at implantation and to 250 [240–250] bpm at follow-up (reprogrammed in 20% of cases, p<0.001 versus ≤2017). Conclusions S-ICD programming parameters are rarely changed during follow-up (approximately 13% of patients). The only exception in clinical practice was the shock zone cutoff. Centers have begun to program high cutoffs in recent years. This happened at the time of implantation for new S-ICD recipients and at follow-up for pre-existing implants. This behavior is consistent with a substantial adoption of published trial findings and could contribute to reduce the incidence of inappropriate shocks in clinical practice. Funding Acknowledgement Type of funding sources: None.

Levetiracetam for treatment of status epilepticus - an update

Since 2004 several reports on the treatment of status epilepticus with levetiracetam have been published. In this review, the results of a PubMed-based search of publications December 12, 2011 - July 6, 2018 are summarized and compared to those of earlier publications. In total, 28 treatment episodes in case reports, each on one or two cases of treatment episodes, and 412 treatment episodes in case series and prospective studies were analyzed. Case series and prospective studies reported an average success rate for termination of status probably of 55,0 %-59,4 %. Since preclinical data suggest a delayed effect of levetiracetam, its use in the treatment of generalized convulsive status epilepticus appears still questionable. A loading dose of 30 mg / kg seems to be reasonable.

Misoprostol for Termination of Second Trimester Pregnancy

Introductions: The termination of second trimester pregnancy is challenging due unfavorable cervix. This study evaluate the efficacy and maternal side effects of intravaginal misoprostol for termination of second trimester pregnancy. Methods: During one year period from 15th June 2011 to 14th June 2012, Department of Obstetrics and Gynaecology of Patan Hospital, women admitted for second trimester termination of pregnancy for fetal congenital anomalies and intrauterine fetal demise were studied using the International Federation of Gynaecology and Obstetrics recommended doses of vaginal misoprostol. For congenital anomalies, 400 mcg 3 hourly to a maximum of 5 doses were used. For fetal demise, gestational age of 13-17 weeks received 200 mcg every 6 hourly to a maximum of 4 doses, and 18-26 weeks dose was adjusted to 100 mcg. Main outcome measures included success rate of abortion within 48 hours, induction to delivery interval and maternal side effects. Results: There were 40 patients during study period. Success rate for termination of 2nd trimester pregnancy within 48 hours was 88.8% for congenital anomalies. For fetal demise, success of termination was 90.9% at 13-17 weeks and 100% at 18-26 weeks. Median time from induction to delivery was 26.8 hours for congenital anomalies. For fetal demise, it was 18 hours for 13-17 weeks was and 24 hours at 18 to 26 weeks respectively. Abdominal pain was seen in all doses of misoprostol. Conclusions: Vaginal misoprostol is an effective method for termination of second trimester pregnancy. Plain Language Summary: The study was conducted to see the effectiveness of vaginal misoprostol for termination of second trimester pregnancy. The success rate of termination for congenital abnormality and fetal demise was high. Vaginal misoprostol was an effective method for termination of second trimester pregnancy. DOI: http://dx.doi.org/10.3126/jpahs.v1i1.13010 Journal of Patan Academy of Health Sciences. 2014 Jun;1(1):16-19

MID TRIMESTER TERMINATION;

Objective: The objective of study was to compare the efficacy of extra amniotic prostaglandin F2 alpha and vaginal misoprostol for termination of 2nd trimester pregnancy. Study design: It was quasi experimental study. Place and duration of study: The study was conducted at Gynae Unit II, DHQ Hospital affiliated with Punjab Medical College, Faisalabad for a period of one year from July 2012 to June 2013. Material and methods: This study included 100 patients who presented with congenitally anomalous foetus or IUD during 2nd trimester for termination of pregnancy. Outcome was evaluated by percentage of successful cases for TOP and induction to delivery interval. Result: As regards the efficacy of misoprostol, success rate for termination of pregnancy was 86% and mean induction to delivery interval was 13.16±1.987 hours. Regarding PGF2 alpha success rate for TOP was 88% and mean induction to delivery interval was 16.07±3.202 hours. Conclusions: Misoprostol is comparable in its efficacy to PGF2 alpha for mid trimester termination and can be used as a cheaper alternative.

Therapeutic termination of second trimester pregnancies with low dose misoprostol.

To determine the effectiveness of 50 microg misoprostol for midtrimester termination of pregnancies. Experimental, cross-sectional study. Department of Gynaecology and Obstetrics, Unit II, Jinnah Postgraduate Medical Centre, Karachi, a tertiary care centre, from 1st Jan 2003 to 30th June 2005. The study subjects were 54 pregnant women admitted during the 2nd trimester (14-26 weeks) of gestation, willing or requiring termination of pregnancy. Those patients were included in the study who were admitted with closed cervical os, either had intrauterine death, fetal anomaly, medical disorder (hypertension or diabetes) or history of previous ceasrean section. Cases of placenta previa, acute asthma, glaucoma, cardiac diseases and allergy to prostaglandins were excluded. Each patient received 50 microg misoprostol intravaginally. Maximum 4 doses were given at 4 hours interval and state of cervical os was assessed by vaginal examination before insertion of next dose or at the onset of uterine contractions. After 4 doses of misoprostol, patients were kept under observation and watched for uterine contractions to start or for expulsion of products. Syntocinon infusion was started to augment labour where products of conception failed to expel out inspite of open os. Outcome measures include success rate of termination within 12, 24, 36 and 48 hours, mean induction - abortion time interval and maternal side effects. The success rate of termination within 12, 24, 36 and 48 hours were 27.7%, 83.3%, 94.4% and 96.3% respectively. Mean induction to abortion time interval, in case of abortion within 48 hours, was found to be 18.9 +/- 11.58 (range 4 - 48 hours). Dead fetuses were aborted earlier than alive fetuses. The mean induction abortion time interval was 17.01 +/- 8.7 hours in dead and 23.4+/-15.9 hours in alive fetuses (t -value:1.9, p: 0.05). Two patients failed to deliver within 48 hours of induction. Two patients suffered from febrile illness. Vaginal administration of 50 microg misoprostol every 4 hourly is an effective and safe agent for ripening of cervix and convenient way of inducing abortion during 2nd trimester of pregnancy in a women either with alive or dead fetus. It is associated with a low frequency of side effect.

Termination of pathological pregnancy in second and early third trimesters with extraamniotic instillation of 16-phenoxy-ω-tetranor prostaglandin E 2 methylsulfonylamide

Objectives: To evaluate the efficacy, safety and influence on subsequent fertility of sulprostone, a prostaglandin E 2 analog, in terminating pathological pregnancies via the extraamniotic route. Methods: Forty pregnant women with intrauterine fetal death or major congenital anomalies were enrolled. Sulprostone was instilled into the extraamniotic space through a silicon Foley catheter. The instillation rate was 0.5–1 μg/min. Instillation was discontinued when the catheter was expelled or when rupture of the membranes occurred. The duration of instillation and the time interval to completion of abortion was recorded. Information about subsequent fertility was collected by telephone or at outpatient clinic visits. Results: The mean duration of instillation was 7.0 h and the mean dose of sulprostone was 314.8 μg. The mean induction-to-abortion interval (IAI) was 17.0 h. In two of the 40 patients, the cervix was not adequately ripened after 48 h and these pregnancies were ultimately terminated by alternative methods. The success rate of termination in 48 h was 92.5% ( 37 40 ). No severe side effects were encountered. Conclusion: To the best of our knowledge, this is the first report in the English literature of administration of sulprostone by extraamniotic instillation for termination of pathological pregnancies. The method is effective and safe and has an insignificant influence on subsequent fertility.