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Title: The logistics handbook: A practical guide for supply chain managers in family planning and health programs.
Author: John Snow [JSI]. DELIVER
Source: Arlington, Virginia, JSI, DELIVER, 2009 Jul. 182 p. (USAID Contract No. GPO-I-01-06-00007-00) Oringinally published in 2004.
Abstract: The Logistics Handbook includes the major aspects of logistics management with an emphasis on contraceptive supplies. The text should be helpful to managers who work with supplies every day as well as managers who assess and design logistics systems for entire programs. Policymakers may find the text useful in exploring the inputs needed to create an effective logistics system. Key terms and concepts are clearly defined and explained, and the design and implementation of management information systems and inventory control are discussed in detail. Storage and quality control practices are also discussed, and overviews of forecasting and procurement processes are included.
Language: English
Keywords:
DEVELOPING COUNTRIES | MANUAL | USAID | FAMILY PLANNING PROGRAMS | LOGISTICS | CONTRACEPTIVE METHODS | DRUGS | INFORMATION RETRIEVAL SYSTEMS | RECORDS | QUALITY CONTROL | MONITORING | STORAGE AND WAREHOUSES | IMPLEMENTATION | PLANNING | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Family Planning | Management | Organization and Administration | Contraception | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Data Storage and Retrieval | Information Processing | Information | Evaluation | Programs
Document Number: 331681

Title: mHealth for development: The opportunity of mobile technology for healthcare in the developing world.
Author: Vital Wave Consulting
Source: Washington, D.C., United Nations Foundation, 2009. 66 p.
Abstract: Mounting interest in the field of mHealth -- the provision of health-related services via mobile communications -- can be traced to the evolution of several interrelated trends. In many parts of the world, epidemics and a shortage of healthcare workers continue to present grave challenges for governments and health providers. Yet in these same places, the explosive growth of mobile communications over the past decade offers a new hope for the promotion of quality healthcare. Among those who had previously been left behind by the 'digital divide,' billions now have access to reliable technology. There is a growing body of evidence that demonstrates the potential of mobile communications to radically improve healthcare services -- even in some of the most remote and resource-poor environments. This report examines issues at the heart of the rapidly evolving intersection of mobile phones and healthcare. It helps the reader to understand mHealth's scope and implementation across developing regions, the health needs to which mHealth can be applied, and the mHealth applications that promise the greatest impact on heath care initiatives. It also examines building blocks required to make mHealth more widely available through sustainable implementations. Finally, it calls for concerted action to help realize mHealth's full potential. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | PUBLIC HEALTH | TELECOMMUNICATIONS | INFORMATION DISTRIBUTION | EDUCATION | AWARENESS | DATA COLLECTION | PRIMARY HEALTH CARE | TRAINING ACTIVITIES | HEALTH PERSONNEL | DISEASE PREVENTION | TECHNOLOGY | TREATMENT | ADMINISTRATION AND DOSAGE | DRUGS | HIV TESTING | HIV PREVENTION | Health | Broadcast Media | Mass Media | Communication | Knowledge | Sociocultural Factors | Research Methodology | Health Services | Delivery of Health Care | Training Programs | Prevention and Control | Diseases | Economic Factors | Medical Procedures | Medicine | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | HIV Infections | Viral Diseases
Document Number: 331450

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Title: Interventions for pain with intrauterine device insertion.
Author: Allen RH; Bartz D; Grimes DA; Hubacher D; O'Brien P
Source: Cochrane Database of Systematic Reviews. 2009;(3):CD007373.
Abstract: BACKGROUND: Fear of pain during intrauterine device (IUD) insertion is a barrier to use of this contraceptive method. Interventions for pain during IUD insertion include non-steroidal anti-inflammatory drugs (NSAIDs), local cervical anesthetics, and cervical ripening agents such as misoprostol. OBJECTIVES: To review all randomized controlled trials that have evaluated a treatment for IUD insertion-related pain. SEARCH STRATEGY: We searched the computerized databases MEDLINE, POPLINE, CENTRAL, and EMBASE for relevant trials. We also examined reference lists of pertinent articles and wrote to known investigators for information about other published or unpublished trials. SELECTION CRITERIA: We included all randomized controlled trials in any language that evaluated a treatment for IUD insertion-related pain. The intervention could be compared to a placebo or another active intervention. DATA COLLECTION AND ANALYSIS: Two authors independently abstracted data from relevant trials and data were entered into RevMan 5.0 for analysis. For dichotomous variables, the Peto odds ratios with 95% confidence intervals was calculated. For continuous variables, the mean differences with 95% confidence interval was computed. MAIN RESULTS: Four trials met the inclusion criteria; the total number of participants was 2204. Nonsteroidal anti-inflammatory drugs of varying types and doses were not effective for reducing pain during IUD insertion. Misoprostol for cervical ripening did not reduce pain with IUD insertion in nulliparous women. Two trials evaluated pain that occurs after IUD insertion using nonsteroidal anti-inflammatory drugs. In one trial, naproxen taken prior to IUD insertion was effective in reducing pain compared with placebo in the first two hours after IUD insertion in mostly nulliparous women. However, this trial utilized the Dalkon Shield, an IUD with a wider diameter than modern IUDs. In another trial, ibuprofen 600 mg taken before IUD insertion did not show evidence of an effect on pain four to six hours after IUD insertion. AUTHORS' CONCLUSIONS: No interventions that have been properly evaluated reduce pain during or after IUD insertion. One poorly controlled trial suggested that topical lidocaine gel may reduce insertion-related pain and warrants further investigation.
Language: English
Keywords:
UNITED STATES OF AMERICA | CHILE | DENMARK | SWEDEN | LITERATURE REVIEW | CLINICAL TRIALS | IUD | INSERTION | PAIN | DRUGS | ADMINISTRATION AND DOSAGE | MISOPROSTOL | Developed Countries | North America | Americas | Developing Countries | South America, Southern | South America | Latin America | Europe, Northern | Europe | Clinical Research | Research Methodology | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology
Document Number: 342475

Title: Nitric oxide-dependent human acrosomal loss induced by PPCM (SAMMA) and by nitric oxide donors occurs by independent pathways: basis for synthesis of an improved contraceptive microbicide.
Author: Anderson RA; Feathergill KA; Chany CJ 2nd; Jain S; Krunic A
Source: Journal of Andrology. 2009 Mar-Apr;30(2):168-82.
Abstract: PPCM (previously designated sulfuric acid-modified mandelic acid [SAMMA]) is a contraceptive microbicide in preclinical development. Its contraceptive activity is attributable in part to its ability to promote premature acrosomal loss. Prior studies showed that PPCM-induced human acrosomal loss (PAL) is Ca(2+)-dependent. This study was carried out to determine transduction elements downstream from Ca(2+) entry. PAL is inhibited by inhibitors selective for endothelial-type nitric oxide synthase. PAL is completely inhibited by 0.1 microM ODQ (soluble guanylate cyclase inhibitor). PAL is inhibited by protein kinase G inhibitors with selectivity for the type II isotype. Several inhibitors of the nitric oxide/cyclic guanosine monophosphate (cGMP)/protein kinase G pathway induce Ca(2+)-dependent acrosomal loss when added alone. These responses are inhibited by nifedipine, a blocker of Ca(v1.x) voltage-dependent channels. Acrosomal loss induced by the nitric oxide donor SNAP (SNAL) does not require added Ca(2+). Sperm production of nitric oxide is increased by PPCM, an effect inhibited by nitro-L-arginine (nitric oxide synthase inhibitor). Although inhibited by ODQ, SNAL and acrosomal loss induced by other nitric oxide donors are unaffected by KT5823 (protein kinase G inhibitor). Unlike PAL, SNAL is partially inhibited by KT5720 (protein kinase A inhibitor) and genistein (protein tyrosine kinase inhibitor). Acrosomal loss response to PPCM and SNAP added in combination suggests that these agents act by independent mechanisms. A PPCM derivative was synthesized, in which a nitric oxide donor was esterified to PPCM (NOSPPA-23). NOSPPA-23 induces acrosomal loss with or without added Ca(2+). The ED(50) of NOSPPA-23 (4.8 nM) in the presence of Ca(2+) is 35-fold less than that of PPCM. These findings suggest the following: 1) elements responsible for PAL include endothelial nitric oxide synthase, soluble guanylate cyclase, and type II protein kinase G; 2) the resting state of the nitric oxide/cGMP/protein kinase G pathway is a determinant of acrosomal status; 3) PPCM and nitric oxide donors induce acrosomal loss via nitric oxide, but through independent pathways; and 4) covalent attachment of a nitric oxide donor to PPCM provides synergistic efficacy as a stimulus of acrosomal loss. Further studies with this novel prototype as an improved contraceptive microbicide are warranted.
Language: English
Keywords:
UNITED STATES OF AMERICA | ILLINOIS | RESEARCH REPORT | MICROBICIDES | DRUGS | CONTRACEPTION RESEARCH | Developed Countries | North America | Americas | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraception | Family Planning
Document Number: 331202

Title: RISUG: a potential candidate for the entry inhibitor group of antiretroviral drugs.
Author: Banerjee S; Guha SK
Source: Medical Hypotheses. 2009 Aug;73(2):150-2.
Abstract: Entry inhibitors are a group of antiretroviral drug which prevents HIV from entering human immune cells. They include both fusion and attachment inhibitors. A hypothesis is put forward in which a new male contraceptive drug with proven antimicrobial property is proposed as a possible candidate for the entry inhibitor group of antiretroviral drugs. The proposed mechanism of action involves (i) interaction with gp120 and thereby preventing binding to CD4 and (ii) competitive binding with the viral glycoprotein and inhibit the glycoprotein - cell surface glyocosaminoglycan Heparan Sulfate (HS) interaction. A new drug RISUG (Reversible Inhibition of Sperm Under Guidance) presently undergoing Phase III clinical trials throughout India for its contraceptive effect in male has also antimicrobial actions. RISUG is a chemical complex of styrene maleic anhydride (SMA(AN)) and dimethyl sulfoxide. On injection into the vas deferens, it reacts with the components of intravas fluid, the spermatic fluid and gets converted to styrene maleic acid (SMA(AC)) and breakdown products like mandelic acid. An anti HIV activity of RISUG is likely due to its electrical charge and mandelic acid generation. For experimental validation HIV in vitro assays can be performed which will involve infectivity assays, luciferase assay and soluble gp120 assays. A positive result from the studies will validate the hypothesis.
Language: English
Keywords:
INDIA | RESEARCH PROPOSAL | DRUGS | CONTRACEPTIVE AGENTS, MALE | MICROBICIDES | ANTIRETROVIRAL DRUGS | HIV INFECTIONS | IMMUNE SYSTEM | ANTIGEN-ANTIBODY REACTIONS | Asia, Southern | Asia | Developing Countries | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Agents | Contraception | Family Planning | Viral Diseases | Diseases | Physiology | Biology | Antibodies | Immunologic Factors | Immunity
Document Number: 342410

Peer Reviewed

Title: Medication abortion.
Author: Bartz D; Goldberg A
Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):140-50.
Abstract: Medical methods for pregnancy termination in early gestation offer women an alternative to surgical evacuation and have the potential to improve access globally to safe abortion. Several drug regimens are used with varying efficacy including mifepristone plus misoprostol, misoprostol alone, and methotrexate plus misoprostol. Where available, a mifepristone plus misoprostol regimen is most frequently used and is highly effective for early abortion. We review these drug regimens along with clinical practice recommendations including patient counseling and selection, regimen administration location, expected side effects, and follow-up procedures. Overall, women who choose medical abortion report high levels of satisfaction.
Language: English
Keywords:
UNITED STATES OF AMERICA | MASSACHUSETTS | RESEARCH REPORT | ABORTION | MISOPROSTOL | RU-486 | DRUGS | COUNSELING | Developed Countries | North America | Americas | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Hormone Antagonists | Hormones | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | Program Activities | Programs | Organization and Administration
Document Number: 342250 Notification

8.
Title: Primary and secondary tuberculosis preventive treatment in HIV clinics: simulating alternative strategies.
Author: Basu S; Maru D; Poolman E; Galvani A
Source: International Journal of Tuberculosis and Lung Disease. 2009 May;13(5):652-8.
Abstract: BACKGROUND: Isoniazid preventive treatment (IPT) has been recommended for human immunodeficiency virus (HIV) infected individuals. OBJECTIVE/DESIGN: We used a mathematical model to simulate the benefits and risks of preventive treatment delivered through antiretroviral (ARV) clinics using clinical data from Botswana. RESULTS: Preventive treatment was found to reduce the incidence of tuberculosis (TB) by at least 12 cases per 100000 population per year versus the scenario without such treatment over a 50-year simulation. Isoniazid (INH) resistant TB was observed to increase by <1% per year, even when using pessimistic assumptions about resistance emergence. The use of tuberculin skin testing had little impact as a screening procedure, while secondary treatment was observed to nearly double the impact of a preventive treatment program. Regardless of whether or not preventive treatment was implemented, INH-resistant TB rose in the context of increasing HIV prevalence, but was minimally amplified by preventive treatment itself. CONCLUSIONS: IPT programs implemented through ARV clinics may be effective at reducing TB incidence. The resistance contribution of IPT appears unlikely to supersede its overall incidence and mortality benefits.
Language: English
Keywords:
BOTSWANA | RESEARCH REPORT | MATHEMATICAL MODEL | PERSONS LIVING WITH HIV/AIDS | CLIENTS | TUBERCULOSIS | DRUGS | TESTING | ANTIRETROVIRAL DRUGS | DRUG RESISTANCE | INCIDENCE | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Theoretical Models | Research Methodology | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Infections | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement
Document Number: 341945

Peer Reviewed

Title: Independent association between rate of clearance of infection and clinical outcome of HIV-associated cryptococcal meningitis: analysis of a combined cohort of 262 patients.
Author: Bicanic T; Muzoora C; Brouwer AE; Meintjes G; Longley N; Taseera K; Rebe K; Loyse A; Jarvis J; Bekker LG; Wood R; Limmathurotsakul D; Chierakul W; Stepniewska K; White NJ; Jaffar S; Harrison TS
Source: Clinical Infectious Diseases. 2009 Sep 1;49(5):702-9.
Abstract: BACKGROUND: Progress in therapy for cryptococcal meningitis has been slow because of the lack of a suitable marker of treatment response. Previously, we demonstrated the statistical power of a novel endpoint, the rate of clearance of infection, based on serial quantitative cultures of cerebrospinal fluid, to differentiate the fungicidal activity of alternative antifungal drug regimens. We hypothesized that the rate of clearance of infection should also be a clinically meaningful endpoint. METHODS: We combined data from cohorts of patients with human immunodeficiency virus-associated cryptococcal meningitis from Thailand, South Africa, and Uganda, for whom the rate of clearance of infection was determined, and clinical and laboratory data prospectively collected, and explored the association between the rate of clearance of infection and mortality by Cox survival analyses. RESULTS: The combined cohort comprised 262 subjects. Altered mental status at presentation, a high baseline organism load, and a slow rate of clearance of infection were independently associated with increased mortality at 2 and 10 weeks. Rate of clearance of infection was associated with antifungal drug regimen and baseline cerebrospinal fluid interferon-gamma levels. CONCLUSIONS: The results support the use of the rate of clearance of infection or early fungicidal activity as a means to explore antifungal drug dosages and combinations in phase II studies. An increased understanding of how the factors determining outcome interrelate may help clarify opportunities for intervention.
Language: English
Keywords:
SOUTH AFRICA | THAILAND | UGANDA | RESEARCH REPORT | CLIENTS | MENINGITIS | HIV INFECTIONS | DRUGS | INTERVENTIONS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Asia, Southeastern | Asia | Africa, Eastern | Program Activities | Programs | Organization and Administration | Central Nervous System Effects | Central Nervous System | Physiology | Biology | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342967

10.

Title: The association of serotonin transporter genotypes and selective serotonin reuptake inhibitor (SSRI)-associated sexual side effects: possible relationship to oral contraceptives.
Author: Bishop JR; Ellingrod VL; Akroush M; Moline J
Source: Human Psychopharmacology. 2009 Apr;24(3):207-15.
Abstract: OBJECTIVE: To study the relationship between functional variants in the serotonin transporter gene (SLC6A4) and selective serotonin reuptake inhibitor (SSRI)-associated sexual dysfunction. METHODS: One hundred fifteen subjects aged 18-40 years and currently being treated with an SSRI for depression were assessed for clinical variables known to affect sexual well-being. SSRI-associated sexual difficulties were assessed with the Changes in Sexual Functioning Questionnaire (CSFQ). Subjects were subsequently genotyped for the SLC6A4 promoter region (5HTTLPR) insertion/deletion variant and a variable number of tandem repeats (VNTR) in the second intron. RESULTS: The 5HTTLPR insertion/deletion variant was associated with sexual dysfunction in this study sample [odds ratio (OR) = 2.7; 95% confidence interval (CI) 1.2, 6.4; p = 0.02]. The relationship between promoter genotypes and sexual well-being differed in males and females and was related to whether females were taking an oral contraceptive (OC) medication. Females with the ll genotype were nearly eight times more likely to be categorized as having sexual dysfunction if they were taking OCs, while no relationship was observed in those not taking OCs. CONCLUSIONS: These results suggest that a functional variant in the serotonin transporter gene is associated with sexual difficulties in persons taking an SSRI for depression. This relationship may differ by sex and be dependent on OC status in females.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | SAMPLING STUDIES | CLIENTS | DEPRESSION | DRUGS | ADMINISTRATION AND DOSAGE | SEROTONIN | SIDE EFFECTS | DECREASED LIBIDO | ORAL CONTRACEPTIVES | GENETICS | Developed Countries | North America | Americas | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Mental Disorders | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology | Sex Behavior | Behavior | Contraceptive Methods | Contraception | Family Planning
Document Number: 341959

11.
Title: Contraception for women with epilepsy.
Author: Burakgazi E; Harden C; Kelly JJ
Source: Reviews in Neurological Diseases. 2009 Spring;6(2):E62-7.
Abstract: The choice of a contraceptive drug can be challenging for women with epilepsy due to possible interactions between antiepileptic drugs (AEDs) and hormonal contraception. Enzyme-inducing AEDs can cause hormonal contraception to fail and can increase the risk of teratogenicity. Higher doses of oral contraceptives can overcome pharmacologic failure but may create additional risks. The effects of reproductive hormones on individual AEDs have recently been clarified, providing helpful guidelines for physicians and patients. Studies show that lamotrigine has a significantly increased clearance (> 50%) when used with combined oral contraceptives, which results in an increased seizure frequency in most patients. Useful alternatives to oral contraceptives include depot injections and intrauterine devices. Subdermal implants may increase the risk of pregnancy in women with epilepsy on enzyme-inducing AEDs. Depot medroxyprogesterone acetate is effective but can increase side effects. Intrauterine devices arean alternative to pharmacologic approaches because they lack drug-drug interactions and side effects.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | ORAL CONTRACEPTIVES | IUD | INJECTABLES | NEUROLOGIC EFFECTS | DRUGS | DRUG INTERACTIONS | TREATMENT | SIDE EFFECTS | Developed Countries | North America | Americas | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341913

12.
Title: Causes of death in HIV-infected persons who have tuberculosis, Thailand.
Author: Cain KP; Anekthananon T; Burapat C; Akksilp S; Mankhatitham W; Srinak C; Nateniyom S; Sattayawuthipong W; Tasaneeyapan T; Varma JK
Source: Emerging Infectious Diseases. 2009 Feb;15(2):258-64.
Abstract: Up to 50% of persons with HIV and a diagnosis of tuberculosis (TB) in Thailand die during TB treatment. In a prospective observational study, a team of physicians ascribed the cause of death after reviewing verbal autopsies (interviews of family members about events preceding death), laboratory data, and medical records. Of 849 HIV-infected TB patients enrolled, 142 (17%) died. The cause of death was TB for 38 (27%), including 6 with multidrug-resistant TB and 20 with disseminated TB; an HIV-associated condition other than TB for 50 (35%); and a condition unrelated to TB or HIV for 22 (15%). Twenty-three patients (16%) were judged not to have had TB at all. Death from all causes except those unrelated to TB or HIV was less common in persons receiving antiretroviral therapy (ART). In addition to increasing the use of ART, death rates may be reduced through expanded use of modern TB diagnostic techniques.
Language: English
Keywords:
THAILAND | RESEARCH REPORT | PROSPECTIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | CAUSES OF DEATH | AUTOPSY | ANTIRETROVIRAL THERAPY | DRUGS | PNEUMONIA | EXAMINATIONS AND DIAGNOSES | Developing Countries | Asia, Southeastern | Asia | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Infections | Mortality | Population Dynamics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Treatment | Pulmonary Effects | Physiology | Biology
Document Number: 341840

13.

14.

Title: Women's health and gender-based clinical trials on etoricoxib: methodological gender bias.
Author: Chilet-Rosell E; Ruiz-Cantero MT; Horga JF
Source: Journal of Public Health. 2009 Sep;31(3):434-45.
Abstract: BACKGROUND: The aim of this study was to determine compliance with published good practice guidelines for gender and clinical trials using etoricoxib. The rationale for choosing etoricoxib was that it is widely used by women and there is evidence of potential interaction with contraceptives and hormone replacement therapy as highlighted in the product characteristics. METHODS: The study reviewed 58 etoricoxib published trials (54 papers) to determine if they met the gender recommendations of the Guidelines of Food and Drug Administration (1993) and the Sex, Gender and Pain Special Interest Group Consensus Working Group Report (2007). RESULTS: Women formed 70% of a total of 49 835 subjects included in the etoricoxib trials, but only 31% of the subjects were in Phase I. About 85.7% of trials did not show sex-stratified data. About 90.6 and 93.3% did not provide efficacy and adverse effects data by sex, respectively. There is scarce information about the influence of issues that specifically affect women. Discussion Women are under-represented in the published etoricoxib trials, specifically, in Phase I. Sex-stratified data on efficacy and adverse effects are scarce in etoricoxib trials. Together with the lack of data on women-specific issues, this suggests that etoricoxib may pose the same potential problems for women as other cyclooxygenase-2 inhibitors.
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | CLINICAL TRIALS | DRUGS | ADMINISTRATION AND DOSAGE | DRUG INTERACTIONS | CONTRACEPTIVE AGENTS, FEMALE | HORMONE REPLACEMENT THERAPY | SIDE EFFECTS | THROMBOSIS | SEX FACTORS | PREGNANCY | VALIDITY | Clinical Research | Research Methodology | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Agents | Contraception | Family Planning | Thromboembolism | Embolism | Vascular Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Reproduction | Measurement
Document Number: 342950

15.

Title: Comparison of intramuscular magnesium sulfate with low dose intravenous magnesium sulfate regimen for treatment of eclampsia.
Author: Chowdhury JR; Chaudhuri S; Bhattacharyya N; Biswas PK; Panpalia M
Source: Journal of Obstetrics and Gynaecology Research. 2009 Feb;35(1):119-125.
Abstract: Objectives: Our objective was to compare intramuscular (i.m.) magnesium sulfate with a low dose intravenous (i.v.) magnesium sulfate regimen in prevention of convulsion recurrence and maternal deaths in women with eclampsia. Methods: This prospective trial was conducted in Nilratan Sircar Medical College, India from January 2001 to December 2005. All women with a clinical diagnosis of eclampsia were included in the trial. Magnesium sulfate (4 gm) was given as an i.v. loading dose, followed by either i.m. injections as recommended by Pritchard or low dose i.v. infusions (0.6 gm/h). Primary measures of outcome were recurrence of convulsions and maternal death. Secondary measures of outcome were potentially life threatening events, events related to labor and delivery as well as perinatal mortality and morbidity. Results: Of the 630 women participating in the trial, 480 women received i.m. magnesium sulphate according to the Pritchard regimen and 150 women were subjected to a low dose i.v. regimen ofmagnesium sulphate. There was no significant difference in recurrence of convulsion (3.3% in the i.m. and 2% in the i.v. groups P = 0.586). Maternal deaths were not significantly lower in the i.v. group than the i.m. group (5% in the i.m. and 3.3% in the i.v. groups, P = 0.506) There were no significant differences in other measures of serious maternal morbidity, in perinatal morbidity or mortality. Conclusion: Low dose i.v. magnesium sulfate regimen is equally effective in prevention of convulsion recurrence and maternal deaths in eclamptic women when compared with an i.m. magnesium sulfate regimen.
Language: English
Keywords:
INDIA | RESEARCH REPORT | COMPARATIVE STUDIES | PREECLAMPSIA | PREGNANCY COMPLICATIONS | DRUGS | TREATMENT | CONTRACEPTIVE USE-EFFECTIVENESS | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Effectiveness | Contraception | Family Planning
Document Number: 340214

16.

Peer Reviewed

Title: Is phosphodiesterase type 5 inhibitor use associated with condom breakage?
Author: Crosby R; Yarber WL; Sanders SA; Graham CA
Source: Sexually Transmitted Infections. 2009 Sep;85(5):404-5.
Abstract: We tested the hypothesis that phosphodiesterase type 5 inhibitor (PDE5i) use would be associated with increased likelihood of condom breakage using an event-specific analysis. A convenience sample of 440 men completed an internet-based questionnaire that assessed variables pertaining to the last time they used condoms for penile-vaginal intercourse (PVI). A bivariate (screening) analysis was performed to identify covariates for a multivariate analysis using logistic regression. Altogether, 5.9% of the men reported breakage and 9.5% reported PDE5i use during the last time a condom was used for PVI. Among men who had used PDE5i during the last condom-protected occasion of PVI, 11.9% reported breakage compared with 5.3% of those not reporting PDE5i use. Adjusting for men's age, ethnic minority status, marital status, reported duration of PVI and alcohol use at last PVI, those using PDE5i were about four times more likely to also report condom breakage (AOR 4.02; 95% CI 1.20 to 13.48; p = 0.04). Of note, duration of PVI was independently associated with breakage (AOR 1.36; CI 1.02 to 1.83; p = 0.04). Findings suggest that PDE5i use may potentially be associated with increased odds of condom breakage among some men.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | SAMPLING STUDIES | STATISTICAL REGRESSION | MEN | CONDOM FAILURE | RISK FACTORS | DRUGS | GENITAL EFFECTS, MALE | ALCOHOL USE AND ABUSE | MARITAL STATUS | Developed Countries | North America | Americas | Studies | Research Methodology | Data Analysis | Demographic Factors | Population | Condoms | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Health | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology | Behavior | Nuptiality
Document Number: 342845

17.

Peer Reviewed

Title: Use of contraceptive methods by women with current venous thrombosis on anticoagulant therapy: a systematic review.
Author: Culwell KR; Curtis KM
Source: Contraception. 2009 Oct;80(4):337-45.
Abstract: BACKGROUND: As nearly all women with venous thromboembolism (VTE) will be treated with anticoagulant therapy, it is important to consider how anticoagulation affects the safety of contraceptive use. STUDY DESIGN: We conducted a systematic review of the literature regarding use of contraceptive methods in women with current VTE on anticoagulant therapy. Due to the limited direct evidence that was identified, we expanded our search to include women on anticoagulant therapy for indications other than VTE and women with bleeding disorders. RESULTS: Six articles met our inclusion criteria. Three observational studies found the levonorgestrel-releasing IUD (LNG-IUD) was an effective treatment for menorrhagia for women on anticoagulation therapy or with bleeding disorders. Prevention of recurrent hemorrhagic ovarian cysts was seen in women on chronic anticoagulation treated with depot-medroxyprogesterone acetate (DMPA) in one small observational study. Among women with bleeding disorders, no complications were seen in 16 women with placement of the LNG-IUD. One pharmacokinetic study found no statistically significant interaction between combined oral contraceptives and warfarin. Other than one case report, no evidence was found regarding the risk of recurrent thrombosis in women on anticoagulation therapy using a contraceptive method. CONCLUSION: The majority of studies in this review examined treatment effects of the LNG-IUD or DMPA on complications of anticoagulation and found overall beneficial effects of their use in these circumstances. Minimal evidence in women with inherited bleeding disorders suggests that insertion of the LNG-IUD does not pose major bleeding risks in these women with appropriate management.
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | THROMBOSIS | COMPLICATIONS | DRUGS | IUD, HORMONE RELEASING | IUD SIDE EFFECTS | INSERTION | DEPO-PROVERA | BLOOD COAGULATION EFFECTS | HEREDITARY DISEASES | MENSTRUATION DISORDERS | CONTRACEPTIVE SAFETY | Thromboembolism | Embolism | Vascular Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | IUD | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Hematological Effects | Hemic System | Physiology | Biology | Safety | Public Health
Document Number: 342773

18.
Title: [An uncommon localization of pyoderma gangrenosum on the penis of an HIV infected patient in the Ivory Coast] L'atteinte du penis, une localisation rare du pyoderma gangrenosum: a propos d'un
Author: Ecra E; Ahogo KC; Sangare A; Kaloga M; Kassi K; Kouame K; Kacou DE; Gbery IP; Yoboue YP; Kanga JM
Source: Bulletin De La Societe De Pathologie Exotique. 2009 May;102(2):85-7.
Abstract: Pyoderma gangrenosum is an uncommon chronic ulcerative dermatosis with unknown aetiology and with a pathology which is still obscure. In 15-45% of cases, it is related to intestinal chronic inflammatory disease (MICI), to a systemic disease that it can sometimes reveals or to an immunodeficiency This disease starts whether with a pustule, a bubble or a nodule which leads during its evolvement to a superficial ulceration with clear edges. Its diagnosis is easy and is mainly clinical. It is a disease which is localized preferably in lower limbs. Treatment is mainly based on oral route corticotherapy. We report a case of gangrenosum pyoderma localized on the penis in a 43-year-old HIV infected patient. It is an uncommon localization, misleading and delicate. We have treated successfully this patient by oral corticotherapy combined with local antiseptic treatments for 6 months.
Language: French
Keywords:
COTE D'IVOIRE | RESEARCH REPORT | MEN | PERSONS LIVING WITH HIV/AIDS | GENITAL EFFECTS, MALE | UROGENITAL EFFECTS | GASTROINTESTINAL EFFECTS | TREATMENT | DRUGS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Genitalia, Male | Genitalia | Urogenital System | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342812

19.
Title: Rates of spontaneous and therapeutic abortions following use of antidepressants in pregnancy: results from a large prospective database.
Author: Einarson A; Choi J; Einarson TR; Koren G
Source: Journal of Obstetrics and Gynaecology Canada. 2009 May;31(5):452-6.
Abstract: OBJECTIVE: The use of antidepressants during pregnancy remains a controversial issue, and there is little information on the risk of spontaneous abortions following antidepressant exposure in early pregnancy. We sought to examine whether use of antidepressants increases the rates of spontaneous abortion (SA) and therapeutic abortion (TA) in women exposed in early pregnancy. METHODS: In a cohort of women who contacted the Motherisk program during pregnancy, we compared two groups of women, one exposed and the other not exposed to antidepressants during pregnancy, and calculated the associated rates of SA and TA. RESULTS: Among 937 women exposed to antidepressants prior to and during early pregnancy, there were 122 SAs (13.0%) including three ectopic pregnancies, and in the comparison group there were 75 SAs (8.0%) and no ectopic pregnancies. The relative risk was 1.63 (95% CI 1.24-2.14). Three-fold more women reported a TA in the exposed group, 26 (2.4%) compared to 8 (0.7%) in the non-exposed group (RR 3.25; 95% CI 1.48-7.14). A sub-analysis revealed that in both groups, of 338 women with a prior SA, 58 (17.2%) reported having a SA in the current pregnancy, compared with 61/652 (9.4%) with no prior SA (chi square = 12.09, P lt; 0.001). In the antidepressant group, the incidence was 20.7%, and in the non-exposed group, it was 13.3%. Logistic regression confirmed that only antidepressant exposure and prior SA were significantly associated with current SA. CONCLUSION: Exposure to antidepressants in the first trimester of pregnancy appears to be associated with a small but statistically significant increased risk of SA and decision to terminate a pregnancy. The risk for SA is further elevated with a history of previous SA. However, any underlying depression must be taken into consideration when evaluating these results.
Language: English
Keywords:
CANADA | RESEARCH REPORT | PROSPECTIVE STUDIES | PREGNANT WOMEN | ABORTION, SPONTANEOUS | ABORTION | RISK FACTORS | DEPRESSION | DRUGS | PREGNANCY, FIRST TRIMESTER | INCIDENCE | INTERVIEWS | Developed Countries | North America, Northern | Americas | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy Complications | Diseases | Fertility Control, Postconception | Family Planning | Health | Mental Disorders | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Pregnancy | Reproduction | Measurement | Data Collection
Document Number: 342785 Notification

20.
Title: Providing HIV care for co-infected tuberculosis patients: a perspective from sub-Saharan Africa.
Author: Harries AD; Zachariah R; Lawn SD
Source: International Journal of Tuberculosis and Lung Disease. 2009 Jan;13(1):6-16.
Abstract: Human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) and tuberculosis (TB) are overlapping epidemics that cause an immense burden of disease in sub-Saharan Africa. This region is home to the majority of the world's co-infected patents, who have higher TB case fatality and recurrence rates than patients with TB alone. A World Health Organization interim policy has been developed to reduce the joint burden of TB-HIV disease, an important component of which is provision of HIV care to co-infected patients. This review focuses on HIV testing of TB patients and, for those who are HIV-positive, the administration of adjunctive cotrimoxazole preventive treatment (CPT) and antiretroviral treatment (ART). HIV testing has moved from a voluntary, client-initiated intervention to one that is provider-initiated and a routine part of the diagnostic work-up. The efficacy and safety of CPT in HIV-infected patients is now well established, and this is an essential part of the package of HIV care. ART scale-up in Africa can substantially improve outcomes in co-infected patients. However, the clinical and programmatic challenges of combining ART with anti-tuberculosis treatment need to be resolved to realise the full potential of this benefit. These include the optimal time to start ART, how best to combine rifampicin-containing regimens with first-line and second-line ART regimens, management of immune reconstitution disease, the role of isoniazid preventive treatment with ART after TB treatment completion, and where and how to provide combined treatment to best suit the patient. Clinical and operational studies in the next few years should help to resolve some of these issues.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | TUBERCULOSIS | ANTIRETROVIRAL THERAPY | HIV TESTING | DRUGS | ADMINISTRATION AND DOSAGE | TREATMENT | Africa | Developing Countries | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Infections | HIV | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 330579

21.

Title: Valproate and lamotrigine level variation with menstrual cycle phase and oral contraceptive use.
Author: Herzog AG; Blum AS; Farina EL; Maestri XE; Newman J; Garcia E; Krishnamurthy KB; Hoch DB; Replansky S; Fowler KM; Smithson SD; Dworetzky BA; Bromfield EB
Source: Neurology. 2009 Mar 10;72(10):911-4.
Abstract: OBJECTIVE: To determine whether 1) combined oral contraceptive (COC) use affects serum levels of valproate (VPA) as well as lamotrigine (LTG) and 2) the naturally occurring high (mid-luteal) and low (early-mid follicular) reproductive steroid level phases of the menstrual cycle might affect antiepileptic drug levels as well. METHODS: This investigation compared serum antiepileptic drug levels at two timepoints during a single menstrual cycle in four groups of women with epilepsy: 12 on VPA, 12 on VPA plus COC (VPA-COC), 12 on LTG, and 12 on LTG plus COC (LTG-COC). RESULTS: Both VPA and LTG levels were lower (p < 0.01) on active COC than on inactive pill with median declines of 23.4% for the VPA-COC group and 32.6% for the LTG-COC group. Serum LTG levels showed a notable but not significant 31.3% median decline during the mid-luteal phase compared to the early-mid follicular phase in the non-COC group. The non-COC valproate group showed the least change of any group between the two measured timepoints with a decline of 8.3% (p = NS). CONCLUSIONS: The findings suggest that valproate (VPA), like lamotrigine (LTG), has substantially and significantly lower serum levels while women take active combined oral contraceptives as compared to inactive pills. Larger sample sizes will be required to determine whether LTG levels may drop significantly also during the luteal (high steroid) phase of natural menstrual cycles and whether VPA levels may show greater stability in levels across the phases of the menstrual cycle.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | NEUROLOGIC EFFECTS | ORAL CONTRACEPTIVES, COMBINED | DRUGS | DRUG INTERACTIONS | MENSTRUATION | Developed Countries | North America | Americas | Demographic Factors | Population | Physiology | Biology | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction
Document Number: 330553

22.

Title: Breast cancer in young women and its impact on reproductive function.
Author: Hickey M; Peate M; Saunders CM; Friedlander M
Source: Human Reproduction Update. 2009 May-Jun;15(3):323-39.
Abstract: BACKGROUND: Breast cancer is the most common cancer in women in developed countries, and 12% of breast cancer occurs in women 20-34 years. Survival from breast cancer has significantly improved, and the potential late effects of treatment and the impact on quality of life have become increasingly important. Young women constitute a minority of breast cancer patients, but commonly have distinct concerns and issues compared with older women, including queries regarding fertility, contraception and pregnancy. Further, they are more likely than older women to have questions regarding potential side effects of therapy and risk of relapse or a new primary. In addition, many will have symptoms associated with treatment and they present a management challenge. Reproductive medicine specialists and gynaecologists commonly see these women either shortly after initial diagnosis or following adjuvant therapy and should be aware of current management of breast cancer, the options for women at increased genetic risk, the prognosis of patients with early stage breast cancer and how adjuvant systemic treatments may impact reproductive function. METHODS: No systematic literature search was done. The review focuses on the current management of breast cancer in young women and the impact of treatment on reproductive function and subsequent management. With reference to key studies and meta-analyses, we highlight controversies and current unanswered questions regarding patient management. RESULTS: Chemotherapy for breast cancer is likely to negatively impact on reproductive function. A number of interventions are available which may increase the likelihood of future successful pregnancy, but the relative safety of these interventions is not well established. For those who do conceive following breast cancer, there is no good evidence that pregnancy is detrimental to survival. We review current treatment; effects on reproductive function; preservation of fertility; contraception; pregnancy; breastfeeding and management of menopausal symptoms following breast cancer. CONCLUSION: This paper provides an update on the management of breast cancer in young women and is targeted at reproductive medicine specialists and gynaecologists.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | BREAST CANCER | SURGERY | DRUGS | GENETICS | FERTILITY | CONTRACEPTION | PREGNANCY | BREASTFEEDING | MENOPAUSE | AGE FACTORS | TAMOXIFEN | Oceania | Developed Countries | Cancer | Neoplasms | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Biology | Population Dynamics | Demographic Factors | Population | Family Planning | Reproduction | Infant Nutrition | Nutrition | Population Characteristics | Fertility Agents | Reproductive Control Agents
Document Number: 341960

23.
Title: Smart RISUG: a potential new contraceptive and its magnetic field-mediated sperm interaction.
Author: Jha RK; Jha PK; Guha SK
Source: International Journal of Nanomedicine. 2009;4(1):55-64.
Abstract: The rationale and technique underlying a novel concept of noninvasive fertility control by a new Cuproferrogel contraceptive drug, iron oxide-copper-styrene maleic anhydride-dimethyl sulphoxide (Fe3O4-Cu-SMA-DMSO) composite named 'Smart RISUG' (smart reversible inhibition of sperm under guidance) in presence of pulsed magnetic field (PMF; 1 mT to 800 mT) is explained. It was synthesized by dispersing iron oxide particles and copper particles into SMA-DMSO (male contraceptive RISUG) and characterized for particle distribution, particle size measurement and transmittance peaks, etc. Interaction of the RISUG particles as well as Smart RISUG particles with Albino rat sperm cell was studied in presence as well as absence of PMF. To find an explanation to increased reaching of the Smart RISUG drug into sperm under influence of magnetic field, the transport properties were characterized by high resolution transmission electron microscopy and atomic force microscopy. Smart RISUG could be mobilized into sperm cell membrane at the PMF, 760 mT in about 50 seconds. Adoption of novel drug Smart RISUG involving new technique may open the pathway for non surgical control of drug distribution, detection and restoration of the normal fertility after removal of the contraceptive from the male/female reproductive tube in presence of electromagnetic field.
Language: English
Keywords:
INDIA | RESEARCH REPORT | LABORATORY PROCEDURES | REPRODUCTIVE TECHNOLOGIES | FERTILITY CONTROL, POSTCONCEPTION | SPERM TRANSPORT | DRUGS | Asia, Southern | Asia | Developing Countries | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproduction | Family Planning | Treatment
Document Number: 341052

24.

25.

26.

Peer Reviewed

Title: Oral contraceptives alone and with spironolactone increase sCD40 ligand in PCOS patients.
Author: Kebapcilar L; Bilgir O; Taner CE; Kebapcilar AG; Kozaci DL; Alacacioglu A; Yildiz Y; Yuksel A; Sari I
Source: Archives of Gynecology and Obstetrics. 2009 Aug 5;
Abstract: BACKGROUND: The present study was designed to determine the effect of oral contraceptives (OCP) and OCP plus spironolactone (Sp) on plasma soluble CD40L levels in polycystic ovary syndrome (PCOS) patients. METHODS: Fifty-six women with PCOS were randomized into two treatment protocols: ethinylestradiol + cyproterone acetate (2 mg, EE/CA; n = 28), and EE/CA with spironolactone (Sp; n = 28). Plasma sCD40L levels were measured before and after a 3-month treatment. RESULTS: Before the initiation of treatment, the sCD40L levels were not significantly different between the groups [EE/CA (1.33 ng/mL) vs. EE/CA + Sp (1.23 ng/mL); P > 0.05]. In the post-treatment period, sCD40L concentrations were increased compared with pre-treatment values in the EE/CA and EE/CA + Sp groups (1.33 vs. 2.70 ng/mL, P = 0.011; and 1.23 vs. 2.41 ng/mL, P = 0.017; respectively). CONCLUSION: Increased plasma concentrations of sCD40L are associated with OCP and OCP + Sp treatment regimens in PCOS patients.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | CLINICAL RESEARCH | CLIENTS | OVARIAN CYSTS | TREATMENT | ORAL CONTRACEPTIVES | DRUGS | IMMUNOLOGICAL EFFECTS | BLOOD COAGULATION EFFECTS | LIPID METABOLIC EFFECTS | Europe, Southeastern | Europe | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraceptive Methods | Contraception | Family Planning | Immunity | Immune System | Physiology | Biology | Hematological Effects | Hemic System | Lipids
Document Number: 342417

27.

Peer Reviewed

Title: The effect of levonorgestrel-releasing intrauterine device on menorrhagia in women taking anticoagulant medication after cardiac valve replacement.
Author: Kilic S; Yuksel B; Doganay M; Bardakci H; Akinsu F; Uzunlar O; Mollamahutoglu L
Source: Contraception. 2009 Aug;80(2):152-7.
Abstract: BACKGROUND: This study was conducted to evaluate the effect of levonorgestrel-releasing intrauterine devices (LNG-IUDs) on menorrhagia in patients receiving anticoagulant therapy after cardiac valve replacement. STUDY DESIGN: Forty women with menorrhagia who underwent cardiac valve replacement and were taking anticoagulant medication were enrolled in the study. The women were randomly divided into two groups: LNG-IUDs were inserted into 20 women in Group 1 over the first 3 days of menstrual bleeding, while the women in Group 2 were followed without any intervention. The activated partial thromboplastin time, prothrombin time, international normalized ratio, hematocrit level, hemoglobin level, ferritin level and pictorial bleeding assessments for the quantity of menstrual bleeding were recorded. RESULTS: Three months after insertion of LNG-IUDs, the women in Group 1 had a significant decrease in blood loss and higher hemoglobin, hematocrit and ferritin values. No difference was detected for these parameters in the control group at the third and sixth months of the study. Coagulation parameters did not differ between the two groups. CONCLUSION: LNG-IUDs can be considered as an effective non-surgical treatment for menorrhagia in women receiving anticoagulant therapy after cardiac valve replacement.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | IUD, HORMONE RELEASING | LEVONORGESTREL | MENORRHAGIA | CARDIOVASCULAR EFFECTS | POSTOPERATIVE PROCEDURES | DRUGS | BLOOD COAGULATION EFFECTS | Europe, Southeastern | Europe | Developing Countries | Research Methodology | Program Activities | Programs | Organization and Administration | IUD | Contraceptive Methods | Contraception | Family Planning | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Menstruation Disorders | Diseases | Physiology | Biology | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Hematological Effects | Hemic System
Document Number: 342392

28.

Title: Persistence of nevirapine in breast milk and plasma of mothers and their children after single-dose administration.
Author: Kunz A; Frank M; Mugenyi K; Kabasinguzi R; Weidenhammer A; Kurowski M; Kloft C; Harms G
Source: Journal of Antimicrobial Chemotherapy. 2009 Jan;63(1):170-7.
Abstract: OBJECTIVES: Nevirapine is widely used in the developing world for the prevention of mother-to-child transmission (PMTCT) of HIV. A single mutation in the HIV genome is sufficient to lead to significant nevirapine resistance. Persistence of low-level drug concentrations in body compartments can foster resistance formation. In this study, concentration-time courses of nevirapine after single-dose administration were analysed over an extended post-partum period. PATIENTS AND METHODS: Breast milk and plasma samples of 62 HIV-positive Ugandan mother-child pairs who had received single-dose nevirapine were collected at delivery and 1, 2 and 6 weeks post-partum. Nevirapine concentrations were quantified by LC/tandem-mass-spectrometry using a quantification limit of 15 ng/mL, and a population pharmacokinetic (PK) analysis was performed. RESULTS: Concentration-time profiles in breast milk, maternal plasma and child plasma showed similar shapes. At week 1, median nevirapine concentrations were 164 ng/mL in maternal plasma, 114 ng/mL in breast milk and 183 ng/mL in child plasma. The population PK model predicted nevirapine concentrations>10 ng/mL (IC50 for nevirapine) for 13 days in breast milk, 14 days in maternal plasma and 18 days in child plasma in 80% of the samples. CONCLUSIONS: Nevirapine concentrations were present for 2-3 weeks in the three compartments. The concentrations are probably sufficiently high to protect most breastfed children from HIV transmission during the first 2 weeks. The long presence of slowly decreasing levels of nevirapine is likely to induce resistance formation. Post-natal addition of antiretrovirals for 1 week only, as recommended in the current PMTCT guidelines, will not suffice to avoid nevirapine resistance formation.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | MOTHERS | INFANT | POSTPARTUM | PERSONS LIVING WITH HIV/AIDS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | DRUGS | BREASTFEEDING | HUMAN MILK | ADMINISTRATION AND DOSAGE | TREATMENT | Europe, Central | Europe | Developed Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Puerperium | Reproduction | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infant Nutrition | Nutrition | Lactation | Maternal Physiology | Physiology | Biology
Document Number: 329752

29.

Title: Female issues in epilepsy: a critical review.
Author: Luef G
Source: Epilepsy and Behavior. 2009 May;15(1):78-82.
Abstract: The focus on gender-related issues for women with epilepsy has heightened in recent years. The emphasis, however, has been on the childbearing years. Epilepsy and antiepileptic drug treatment affect sexual development, the menstrual cycle, and aspects of contraception, fertility, and reproduction. Female patients with epilepsy at a reproductive age face a unique set of reproductive issues, ranging from descriptions of disorders of reproduction in epilepsy and its causes, to contraception, pregnancy, sexuality, menopause, and osteoporosis. Conditions and diseases that specifically affect women are discussed. The role of hormones across the life cycle--endogenous and exogenous hormones and their effects on drug interactions, drug metabolism, and therapeutic outcomes--is described. Contraception and pregnancy issues for women with epilepsy have received the appropriate attention.
Language: English
Keywords:
GLOBAL | CRITIQUE | WOMEN | CHRONIC DISEASES | NEUROLOGIC EFFECTS | DRUGS | ENDOCRINE EFFECTS | DRUG INTERACTIONS | HORMONES | ORAL CONTRACEPTIVES, COMBINED | BIRTH DEFECTS | DECREASED LIBIDO | MENOPAUSE | Demographic Factors | Population | Diseases | Physiology | Biology | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Endocrine System | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Neonatal Diseases and Abnormalities | Sex Behavior | Behavior | Reproduction
Document Number: 342324

30.

Peer Reviewed

Title: Adverse events to antituberculosis therapy: influence of HIV and antiretroviral drugs.
Author: Marks DJ; Dheda K; Dawson R; Ainslie G; Miller RF
Source: International Journal of STD and AIDS. 2009 May;20(5):339-45.
Abstract: This study investigated whether serious adverse events (SAEs) during antituberculosis therapy occur more frequently in HIV co-infected patients in a South African population. A retrospective analysis examined incidences of hepatotoxicity, peripheral neuropathy, severe arthralgia, persistent vomiting and severe rash in 400 patients treated for tuberculosis in a community clinic. A total of 141 patients were co-infected with HIV, among whom only 16.3% were receiving antiretrovirals. Details of SAEs were ascertainable in 331/400 patients, and occurred in 26.7% of HIV-infected and 13.3% of HIV-uninfected individuals (P = 0.003). The excess was attributable to increased peripheral neuropathy (8.3% and 1.9%, respectively, P = 0.009) and persistent vomiting (13.3% and 3.3%, P = 0.001). SAE occurrence was not related to antiretroviral use, although median CD4 counts were lower in those experiencing side-effects (130 and 259 cells/microL, P = 0.008). The treatment completion did not differ significantly between the two groups (76.6% and 84.2%, P = 0.08).
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | DRUGS | ADMINISTRATION AND DOSAGE | ANTIRETROVIRAL DRUGS | SIDE EFFECTS | NEUROLOGIC EFFECTS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Infections | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology
Document Number: 341815


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