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[PMID]: 29291730
[Au] Autor:Rashid MS; BOTA Collaborators
[Ad] Address:Botnar Research Centre, Windmill Road, Headington, Oxford, OX3 7LD, England. mustafa.rashid@ndorms.ox.ac.uk.
[Ti] Title:An audit of clinical training exposure amongst junior doctors working in Trauma & Orthopaedic Surgery in 101 hospitals in the United Kingdom.
[So] Source:BMC Med Educ;18(1):1, 2018 Jan 02.
[Is] ISSN:1472-6920
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: There are concerns regarding early years' training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom. Our primary objective was to audit the clinical activities undertaken by junior doctors working in Trauma & Orthopaedic (T&O) surgery in the National Health Service (NHS) in a typical workweek. A secondary objective was to audit the clinical exposure of junior surgeons in training to the Joint Committee on Surgical Training (JCST) standards for minimum weekly clinical exposure in T&O surgery. METHODS: We recruited collaborators in 101 T&O surgery departments in NHS hospitals to participate in this study. Clinical activity diaries from 935 doctors working in T&O surgery in the 101 participating NHS hospitals were involved. All junior doctors covering the junior on call tier were included. Collaborators collected clinical activity data from 08:00 18/01/2015 to 20:00 22/01/2015. Clinical activities recorded in sessions (morning, afternoon, evening) depending on what activity that doctor undertook for the majority of that session. Clinical activities were grouped into operating theatre/room, outpatient clinic, on call, "not in work" (i.e. leave, sickness), teaching, and ward cover sessions. The weekly clinical activity of Core Surgical Trainees (CSTs) were analyzed in accordance to two JCST standards for minimum weekly clinical exposure. RESULTS: Overall, junior doctors working in T&O surgery attended a theatre list session 8.5% of the time, an outpatient clinic 3.2%, were on call 14.8%, a teaching session 1.7%, providing ward cover 34.6%, and on a zero session 20.7% of the time. Only 5% of core surgical trainees (n = 200) met both the JCST standards for minimum weekly clinical exposure in the specialty. CONCLUSIONS: Junior surgeons in training, working in Trauma & Orthopaedic surgery in the United Kingdom are not meeting the minimum weekly clinical sessions laid out by the JCST. Further work to develop models allowing for enhanced training experiences and improved clinical exposure to operating lists and outpatient clinics would be beneficial.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Process
[do] DOI:10.1186/s12909-017-1038-5

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[PMID]: 29360138
[Au] Autor:Lawrie TA; Green JT; Beresford M; Wedlake L; Burden S; Davidson SE; Lal S; Henson CC; Andreyev HJN
[Ad] Address:Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group, 1st Floor Education Centre, Royal United Hospital, Combe Park, Bath, UK, BA1 3NG.
[Ti] Title:Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers.
[So] Source:Cochrane Database Syst Rev;1:CD012529, 2018 Jan 23.
[Is] ISSN:1469-493X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: An increasing number of people survive cancer but a significant proportion have gastrointestinal side effects as a result of radiotherapy (RT), which impairs their quality of life (QoL). OBJECTIVES: To determine which prophylactic interventions reduce the incidence, severity or both of adverse gastrointestinal effects among adults receiving radiotherapy to treat primary pelvic cancers. SEARCH METHODS: We conducted searches of CENTRAL, MEDLINE, and Embase in September 2016 and updated them on 2 November 2017. We also searched clinical trial registries. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of interventions to prevent adverse gastrointestinal effects of pelvic radiotherapy among adults receiving radiotherapy to treat primary pelvic cancers, including radiotherapy techniques, other aspects of radiotherapy delivery, pharmacological interventions and non-pharmacological interventions. Studies needed a sample size of 20 or more participants and needed to evaluate gastrointestinal toxicity outcomes. We excluded studies that evaluated dosimetric parameters only. We also excluded trials of interventions to treat acute gastrointestinal symptoms, trials of altered fractionation and dose escalation schedules, and trials of pre- versus postoperative radiotherapy regimens, to restrict the vast scope of the review. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. We used the random-effects statistical model for all meta-analyses, and the GRADE system to rate the certainty of the evidence. MAIN RESULTS: We included 92 RCTs involving more than 10,000 men and women undergoing pelvic radiotherapy. Trials involved 44 different interventions, including radiotherapy techniques (11 trials, 4 interventions/comparisons), other aspects of radiotherapy delivery (14 trials, 10 interventions), pharmacological interventions (38 trials, 16 interventions), and non-pharmacological interventions (29 trials, 13 interventions). Most studies (79/92) had design limitations. Thirteen studies had a low risk of bias, 50 studies had an unclear risk of bias and 29 studies had a high risk of bias. Main findings include the following:Radiotherapy techniques: Intensity-modulated radiotherapy (IMRT) versus 3D conformal RT (3DCRT) may reduce acute (risk ratio (RR) 0.48, 95% confidence interval (CI) 0.26 to 0.88; participants = 444; studies = 4; I = 77%; low-certainty evidence) and late gastrointestinal (GI) toxicity grade 2+ (RR 0.37, 95% CI 0.21 to 0.65; participants = 332; studies = 2; I = 0%; low-certainty evidence). Conformal RT (3DCRT or IMRT) versus conventional RT reduces acute GI toxicity grade 2+ (RR 0.57, 95% CI 0.40 to 0.82; participants = 307; studies = 2; I = 0%; high-certainty evidence) and probably leads to less late GI toxicity grade 2+ (RR 0.49, 95% CI 0.22 to 1.09; participants = 517; studies = 3; I = 44%; moderate-certainty evidence). When brachytherapy (BT) is used instead of external beam radiotherapy (EBRT) in early endometrial cancer, evidence indicates that it reduces acute GI toxicity (grade 2+) (RR 0.02, 95% CI 0.00 to 0.18; participants = 423; studies = 1; high-certainty evidence).Other aspects of radiotherapy delivery: There is probably little or no difference in acute GI toxicity grade 2+ with reduced radiation dose volume (RR 1.21, 95% CI 0.81 to 1.81; participants = 211; studies = 1; moderate-certainty evidence) and maybe no difference in late GI toxicity grade 2+ (RR 1.02, 95% CI 0.15 to 6.97; participants = 107; studies = 1; low-certainty evidence). Evening delivery of RT may reduce acute GI toxicity (diarrhoea) grade 2+ during RT compared with morning delivery of RT (RR 0.51, 95% CI 0.34 to 0.76; participants = 294; studies = 2; I = 0%; low-certainty evidence). There may be no difference in acute (RR 2.22, 95% CI 0.62 to 7.93, participants = 110; studies = 1) and late GI toxicity grade 2+ (RR 0.44, 95% CI 0.12 to 1.65; participants = 81; studies = 1) between a bladder volume preparation of 1080 mls and that of 540 mls (low-certainty evidence). Low-certainty evidence on balloon and hydrogel spacers suggests that these interventions for prostate cancer RT may make little or no difference to GI outcomes.Pharmacological interventions: Evidence for any beneficial effects of aminosalicylates, sucralfate, amifostine, corticosteroid enemas, bile acid sequestrants, famotidine and selenium is of a low or very low certainty. However, evidence on certain aminosalicylates (mesalazine, olsalazine), misoprostol suppositories, oral magnesium oxide and octreotide injections suggests that these agents may worsen GI symptoms, such as diarrhoea or rectal bleeding.Non-pharmacological interventions: Low-certainty evidence suggests that protein supplements (RR 0.23, 95% CI 0.07 to 0.74; participants = 74; studies = 1), dietary counselling (RR 0.04, 95% CI 0.00 to 0.60; participants = 74; studies = 1) and probiotics (RR 0.43, 95% CI 0.22 to 0.82; participants = 923; studies = 5; I = 91%) may reduce acute RT-related diarrhoea (grade 2+). Dietary counselling may also reduce diarrhoeal symptoms in the long term (at five years, RR 0.05, 95% CI 0.00 to 0.78; participants = 61; studies = 1). Low-certainty evidence from one study (108 participants) suggests that a high-fibre diet may have a beneficial effect on GI symptoms (mean difference (MD) 6.10, 95% CI 1.71 to 10.49) and quality of life (MD 20.50, 95% CI 9.97 to 31.03) at one year. High-certainty evidence indicates that glutamine supplements do not prevent RT-induced diarrhoea. Evidence on various other non-pharmacological interventions, such as green tea tablets, is lacking.Quality of life was rarely and inconsistently reported across included studies, and the available data were seldom adequate for meta-analysis. AUTHORS' CONCLUSIONS: Conformal radiotherapy techniques are an improvement on older radiotherapy techniques. IMRT may be better than 3DCRT in terms of GI toxicity, but the evidence to support this is uncertain. There is no high-quality evidence to support the use of any other prophylactic intervention evaluated. However, evidence on some potential interventions shows that they probably have no role to play in reducing RT-related GI toxicity. More RCTs are needed for interventions with limited evidence suggesting potential benefits.
[Mh] MeSH terms primary: Gastrointestinal Tract/radiation effects
Pelvic Neoplasms/radiotherapy
Radiation Injuries/prevention & control
Radiotherapy, Conformal/adverse effects
[Mh] MeSH terms secundary: Diarrhea/etiology
Diarrhea/prevention & control
Gastrointestinal Agents/therapeutic use
Gastrointestinal Tract/drug effects
Humans
Placebo Effect
Radiotherapy, Intensity-Modulated/adverse effects
Randomized Controlled Trials as Topic
[Pt] Publication type:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Name of substance:0 (Gastrointestinal Agents)
[Em] Entry month:1802
[Cu] Class update date: 180226
[Lr] Last revision date:180226
[Js] Journal subset:IM
[Da] Date of entry for processing:180124
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012529.pub2

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[PMID]: 29278627
[Au] Autor:Barisic T; Pecirep A; Milicevic R; Vasilj A; Tiric D
[Ad] Address:Department of Obstetrics and Gynecology, University Clinical Hospital Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina, tatjana.barisic@tel.net.ba, tbari711@gmail.com.
[Ti] Title:What do pregnant women know about harmful effects of medication and herbal remedies use during pregnancy?
[So] Source:Psychiatr Danub;29 Suppl 4(Suppl 4):804-811, 2017 Dec.
[Is] ISSN:0353-5053
[Cp] Country of publication:Croatia
[La] Language:eng
[Ab] Abstract:BACKGROUND: The objective of this study was assasment of women's knowledge and awareness on medication and herbal remedies use during pregnancy. SUBJECTS AND METHODS: Cross-sectional study was conducted in Department of Obstetrics and Gynaecology University Clinical Hospital Mostar. The study included 230 parturients (primipara) and 20 pharmacists who work in pharmacies of Mostar. Collected and analyzed data was based on a questionnaire of 25 questions. RESULTS: Out of total number of respondents (N =230), 159 of them (69.1%) used some vitamin or mineral product, 44.8% of respondents had problems with morning sickness and vomiting, but they did not use any medication in pregnancy. Higher educated respondents used folic acid more often (p=0.005), they knew the benefits of using folic acid (p<0.001) and magnesium during pregnancy (p=0.002) and they were familiar with harmful effect of alcohol and cigarettes consumption during pregnancy (p=0.005) so as with harmful effect of excessive quantity of vitamin A (p=0.037), they were more familiar with harmful effect of herbal remedies and at least one harmful herb compared to less educated respondents (p<0.001). CONCLUSION: There is lack of knowledge and unawareness on harmful effect of medication use and herbal remedies during pregnancy.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180222
[Lr] Last revision date:180222
[St] Status:In-Process

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[PMID]: 29310609
[Au] Autor:Marwa KJ; Njalika A; Ruganuza D; Katabalo D; Kamugisha E
[Ad] Address:Department of Pharmacology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania. carol_maro@yahoo.com.
[Ti] Title:Self-medication among pregnant women attending antenatal clinic at Makongoro health centre in Mwanza, Tanzania: a challenge to health systems.
[So] Source:BMC Pregnancy Childbirth;18(1):16, 2018 01 08.
[Is] ISSN:1471-2393
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Self-medication is a universal challenge that requires attention because of the potential threat not only to the pregnant women but also to unborn child. Data on self-medication practice and predictors among pregnant women is lacking in Tanzania. Information on the effects of this practice to the pregnant woman and the foetus globally is also scanty. METHODS: This was a cross sectional study which was conducted using face to face interview with 372 pregnant women at Makongoro health centre. Semi-structured questionnaires were used. Data were analysed using STATA 13 (Statistical Corporation, College Station, Texas, US). RESULTS: A total of 372 pregnant women participated in the study. The prevalence of self-medication among pregnant women was 172 (46.24%). There was a significant statistical association between self-medication and occupation (P value =0.01), gestation age (P < 0.01) and education (P < 0.01). Age, marital status and gravidity were not associated with self-medication (P = 0.809, P = 0.243 and P = 0.922) respectively. When bivariate logistic regression was performed, occupation and education were the only determining factors for self-medication. Pregnant women who were unemployed, doing business and house wife were most likely to practice self-medication than employed pregnant women (P = 0.03; OR = 2.33; 95% CI, 1.06-5.31, P = 0.01; OR = 2.31; CI 1.21-4.41, P = <0.01, OR = 2.73, 95% CI 0.52-2.43) respectively. Pregnant women with no formal education, incomplete primary education, primary education and secondary education were most likely to practice self-medication than pregnant women with college or university education (P < 0.01, OR = 6.37 95% CI 2.37-19.03, P < 0.01, OR = 6.58, 95% CI 2.36-18.25, P < 0.01, OR = 3.78, 95% CI 1.89-7.56, P < 0.01, OR = 2.59 95% CI = 1.30-5.17). The leading illness/symptoms which led to self-medication among pregnant women attending clinic were malaria 56 (32.56%, morning sickness 44 (25.55%) and headache 33(19.19%). Drugs commonly used in self-medication among pregnant women were ant malarial 42 (24.42%), antiemetics 59 (34.30%) and analgesics 33 (19.19%). CONCLUSION: Prevalence of self-medication among pregnant women is high in Tanzania. This is a threat to the safety of the developing foetus and the pregnant woman. Therefore there is a need of interventions to minimize the practice among pregnant women.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180212
[Lr] Last revision date:180212
[St] Status:In-Process
[do] DOI:10.1186/s12884-017-1642-8

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[PMID]: 29342163
[Au] Autor:Persaud N; Meaney C; El-Emam K; Moineddin R; Thorpe K
[Ad] Address:Department of Family and Community Medicine and Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.
[Ti] Title:Doxylamine-pyridoxine for nausea and vomiting of pregnancy randomized placebo controlled trial: Prespecified analyses and reanalysis.
[So] Source:PLoS One;13(1):e0189978, 2018.
[Is] ISSN:1932-6203
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Doxylamine-pyridoxine is recommended as a first line treatment for nausea and vomiting during pregnancy and it is commonly prescribed. We re-analysed the findings of a previously reported superiority trial of doxylamine-pyridoxine for the treatment of nausea and vomiting during pregnancy using the clinical study report obtained from Health Canada. METHODS AND FINDINGS: We re-analysed individual level data for a parallel arm randomized controlled trial that was conducted in six outpatient obstetrical practices in the United States. Pregnant women between 7 and 14 weeks of gestation with moderate nausea and vomiting of pregnancy symptoms. The active treatment was a tablet containing both doxylamine 10 mg and pyridoxine 10 mg taken between 2 and 4 times per day for 14 days depending on symptoms. The control was an identical placebo tablet taken using the same instructions. The primary outcome measure was improvement in nausea and vomiting of symptoms scores using the 13-point pregnancy unique quantification of emesis scale between baseline and 14 days using an ANCOVA. 140 participants were randomized into each group. Data for 131 active treatment participants and 125 control participants were analysed. On the final day of the trial, 101 active treatment participants and 86 control participants provided primary outcome measures. There was greater improvement in symptoms scores with doxylamine-pyridoxine compared with placebo (0.73 points; 95% CI 0.21 to 1.25) when last observation carried forward imputation was used for missing data but the difference is not statistically significant using other approaches to missing data (e.g. 0.38; 95% CI -0.08 to 0.84 using complete data). CONCLUSIONS: There is a trend towards efficacy for nausea and vomiting symptoms with doxylamine-pyridoxine compared with placebo but the statistical significance of the difference depends on the method of handling missing data and the magnitude of the difference suggests that there is no clinically important benefit employing the prespecified minimal clinically important difference or "expected difference" of 3 points. TRIAL REGISTRATION: Clinical Trial NCT00614445.
[Mh] MeSH terms primary: Doxylamine/administration & dosage
Morning Sickness/prevention & control
Pyridoxine/administration & dosage
[Mh] MeSH terms secundary: Drug Therapy, Combination
Female
Humans
Placebos
Pregnancy
[Pt] Publication type:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Name of substance:0 (Placebos); 95QB77JKPL (Doxylamine); KV2JZ1BI6Z (Pyridoxine)
[Em] Entry month:1801
[Cu] Class update date: 180207
[Lr] Last revision date:180207
[Js] Journal subset:IM
[Da] Date of entry for processing:180118
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189978

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[PMID]: 28745489
[Au] Autor:Wani TH; Chakrabarty A; Shibata N; Yamazaki H; Guengerich FP; Chowdhury G
[Ad] Address:Departments of Chemistry and Life Sciences, SONS, Shiv Nadar University , Greater Noida, Uttar Pradesh 201314, India.
[Ti] Title:The Dihydroxy Metabolite of the Teratogen Thalidomide Causes Oxidative DNA Damage.
[So] Source:Chem Res Toxicol;30(8):1622-1628, 2017 08 21.
[Is] ISSN:1520-5010
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Thalidomide [α-(N-phthalimido)glutarimide] (1) is a sedative and antiemetic drug originally introduced into the clinic in the 1950s for the treatment of morning sickness. Although marketed as entirely safe, more than 10 000 babies were born with severe birth defects. Thalidomide was banned and subsequently approved for the treatment of multiple myeloma and complications associated with leprosy. Although known for more than 5 decades, the mechanism of teratogenicity remains to be conclusively understood. Various theories have been proposed in the literature including DNA damage and ROS and inhibition of angiogenesis and cereblon. All of the theories have their merits and limitations. Although the recently proposed cereblon theory has gained wide acceptance, it fails to explain the metabolism and low-dose requirement reported by a number of groups. Recently, we have provided convincing structural evidence in support of the presence of arene oxide and the quinone-reactive intermediates. However, the ability of these reactive intermediates to impart toxicity/teratogenicity needs investigation. Herein we report that the oxidative metabolite of thalidomide, dihydroxythalidomide, is responsible for generating ROS and causing DNA damage. We show, using cell lines, the formation of comet (DNA damage) and ROS. Using DNA-cleavage assays, we also show that catalase, radical scavengers, and desferal are capable of inhibiting DNA damage. A mechanism of teratogenicity is proposed that not only explains the DNA-damaging property but also the metabolism, low concentration, and species-specificity requirements of thalidomide.
[Mh] MeSH terms primary: DNA Damage/drug effects
Thalidomide/toxicity
[Mh] MeSH terms secundary: Catalase/metabolism
DNA Cleavage
Free Radical Scavengers/chemistry
HEK293 Cells
Hep G2 Cells
Human Umbilical Vein Endothelial Cells
Humans
Microscopy, Fluorescence
Plasmids/metabolism
Poly(ADP-ribose) Polymerases/metabolism
Reactive Oxygen Species/analysis
Reactive Oxygen Species/metabolism
Teratogens/chemistry
Teratogens/metabolism
Teratogens/toxicity
Thalidomide/chemistry
Thalidomide/metabolism
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Name of substance:0 (Free Radical Scavengers); 0 (Reactive Oxygen Species); 0 (Teratogens); 4Z8R6ORS6L (Thalidomide); EC 1.11.1.6 (Catalase); EC 2.4.2.30 (Poly(ADP-ribose) Polymerases)
[Em] Entry month:1709
[Cu] Class update date: 180127
[Lr] Last revision date:180127
[Js] Journal subset:IM
[Da] Date of entry for processing:170727
[St] Status:MEDLINE
[do] DOI:10.1021/acs.chemrestox.7b00127

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[PMID]: 29266076
[Au] Autor:Committee on Practice Bulletins-Obstetrics
[Ti] Title:ACOG Practice Bulletin No. 189: Nausea And Vomiting Of Pregnancy.
[So] Source:Obstet Gynecol;131(1):e15-e30, 2018 01.
[Is] ISSN:1873-233X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Nausea and vomiting of pregnancy is a common condition that affects the health of a pregnant woman and her fetus. It can diminish a woman's quality of life and also significantly contributes to health care costs and time lost from work (1, 2). Because morning sickness is common in early pregnancy, the presence of nausea and vomiting of pregnancy may be minimized by obstetricians, other obstetric care providers, and pregnant women and, thus, undertreated (1). Furthermore, some women do not seek treatment because of concerns about the safety of medications (3). Once nausea and vomiting of pregnancy progresses, it can become more difficult to control symptoms. Treatment in the early stages may prevent more serious complications, including hospitalization (4). Safe and effective treatments are available for more severe cases, and mild cases of nausea and vomiting of pregnancy may be resolved with lifestyle and dietary changes. The woman's perception of the severity of her symptoms plays a critical role in the decision of whether, when, and how to treat nausea and vomiting of pregnancy. Nausea and vomiting of pregnancy should be distinguished from nausea and vomiting related to other causes. The purpose of this document is to review the best available evidence about the diagnosis and management of nausea and vomiting of pregnancy.
[Mh] MeSH terms primary: Antiemetics/administration & dosage
Maternal Health
Morning Sickness/prevention & control
Practice Guidelines as Topic
Pregnancy Trimester, First
[Mh] MeSH terms secundary: Advisory Committees/standards
Antiemetics/pharmacology
Evidence-Based Medicine
Female
Humans
Morning Sickness/drug therapy
Nausea/drug therapy
Nausea/physiopathology
Obstetrics/standards
Pregnancy
Pregnancy Outcome
Severity of Illness Index
United States
Vomiting/drug therapy
Vomiting/physiopathology
[Pt] Publication type:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Name of substance:0 (Antiemetics)
[Em] Entry month:1801
[Cu] Class update date: 180116
[Lr] Last revision date:180116
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:171222
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002456

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[PMID]: 29261669
[Au] Autor:Wai PP; Shewade HD; Kyaw NTT; Kyaw KWY; Thein S; Si Thu A; Oo MM; Htwe PS; Tun MMT; Win Maung HM; Soe KT; Aung ST
[Ad] Address:International Union against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar.
[Ti] Title:Patients with MDR-TB on domiciliary care in programmatic settings in Myanmar: Effect of a support package on preventing early deaths.
[So] Source:PLoS One;12(12):e0187223, 2017.
[Is] ISSN:1932-6203
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: The community-based MDR-TB care (CBMDR-TBC) project was implemented in 2015 by The Union in collaboration with national TB programme (NTP) in 33 townships of upper Myanmar to improve treatment outcomes among patients with MDR-TB registered under NTP. They received community-based support through the project staff, in addition to the routine domiciliary care provided by NTP staff. Each project township had a project nurse exclusively for MDR-TB and a community volunteer who provided evening directly observed therapy (in addition to morning directly observed therapy by NTP). OBJECTIVES: To determine the effect of CBMDR-TBC project on death and unfavourable outcomes during the intensive phase of MDR-TB treatment. METHODS: In this cohort study involving record review, all patients diagnosed with MDR-TB between January 2015 and June 2016 in project townships and initiated on treatment till 31 Dec 2016 were included. CBMDR-TBC status was categorized as "receiving support" if project initiation in patient's township was before treatment initiation, "receiving partial support" if project initiation was after treatment initiation, and "not receiving support" if project initiation was after intensive phase treatment outcome declaration. Time to event analysis (censored on 10 April 2017) and cox regression was done. RESULTS: Of 261 patients initiated on treatment, death and unfavourable outcomes were accounted for 13% and 21% among "receiving support (n = 163)", 3% and 24% among "receiving partial support (n = 75)" and 13% and 26% among "not receiving support (n = 23)" respectively. After adjusting for other potential confounders, the association between CBMDR-TBC and unfavourable outcomes was not statistically significant. However, when compared to "not receiving support", those "receiving support" and "receiving partial support" had 20% [aHR (0.95 CI: 0.8 (0.2-3.1)] and 90% lower hazard [aHR (0.95 CI: 0.1 (0.02-0.9)] of death, respectively. This was intriguing. Implementation of CBMDR-TBC coincided with implementation of decentralized MDR-TB centers at district level. Hence, patients that would have generally not accessed MDR-TB treatment before decentralization also started receiving treatment and were also included under CBMDR-TBC "received support" group. These patients could possibly be expected to sicker at treatment initiation than patients in other CBMDR-TBC groups. This could be the possible reason for nullifying the effect of CBMDR-TBC in "receiving support" group and therefore similar survival was found when compared to "not receiving support". CONCLUSION: CBMDR-TBC may prevent early deaths and has a scope for expansion to other townships of Myanmar and implications for NTPs globally. However, future studies should consider including data on extent of sickness at treatment initiation and patient level support received under CBMDR-TBC.
[Mh] MeSH terms primary: Antitubercular Agents/therapeutic use
Home Care Services
Tuberculosis, Multidrug-Resistant/drug therapy
[Mh] MeSH terms secundary: Adolescent
Adult
Directly Observed Therapy
Female
Humans
Male
Middle Aged
Myanmar
Retrospective Studies
Treatment Outcome
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (Antitubercular Agents)
[Em] Entry month:1801
[Cu] Class update date: 180116
[Lr] Last revision date:180116
[Js] Journal subset:IM
[Da] Date of entry for processing:171221
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0187223

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[PMID]: 29266070
[Ti] Title:ACOG Practice Bulletin No. 189 Summary: Nausea And Vomiting Of Pregnancy.
[So] Source:Obstet Gynecol;131(1):190-193, 2018 Jan.
[Is] ISSN:1873-233X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Nausea and vomiting of pregnancy is a common condition that affects the health of a pregnant woman and her fetus. It can diminish a woman's quality of life and also significantly contributes to health care costs and time lost from work (1, 2). Because morning sickness is common in early pregnancy, the presence of nausea and vomiting of pregnancy may be minimized by obstetricians, other obstetric care providers, and pregnant women and, thus, undertreated (1). Furthermore, some women do not seek treatment because of concerns about the safety of medications (3). Once nausea and vomiting of pregnancy progresses, it can become more difficult to control symptoms. Treatment in the early stages may prevent more serious complications, including hospitalization (4). Safe and effective treatments are available for more severe cases, and mild cases of nausea and vomiting of pregnancy may be resolved with lifestyle and dietary changes. The woman's perception of the severity of her symptoms plays a critical role in the decision of whether, when, and how to treat nausea and vomiting of pregnancy. Nausea and vomiting of pregnancy should be distinguished from nausea and vomiting related to other causes. The purpose of this document is to review the best available evidence about the diagnosis and management of nausea and vomiting of pregnancy.
[Mh] MeSH terms primary: Antiemetics/administration & dosage
Morning Sickness/diagnosis
Morning Sickness/drug therapy
Practice Guidelines as Topic
Pregnancy Outcome
[Mh] MeSH terms secundary: Advisory Committees
Evidence-Based Medicine
Female
Humans
Nausea/drug therapy
Nausea/physiopathology
Pregnancy
Pregnancy Trimester, First
Risk Assessment
Severity of Illness Index
United States
Vomiting/drug therapy
Vomiting/physiopathology
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Nm] Name of substance:0 (Antiemetics)
[Em] Entry month:1801
[Cu] Class update date: 180108
[Lr] Last revision date:180108
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:171222
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000002450

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[PMID]: 29212865
[Au] Autor:Lowry P; Woods R
[Ad] Address:School of Biological SciencesUniversity of Reading, Reading, UK p.j.lowry@reading.ac.uk.
[Ti] Title:The placenta controls the physiology of pregnancy by increasing the half-life in blood and receptor activity of its secreted peptide hormones.
[So] Source:J Mol Endocrinol;60(1):R23-R30, 2018 Jan.
[Is] ISSN:1479-6813
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:An efficient functioning placenta is essential for a healthy pregnancy and yet the way this is achieved has been the subject of much discussion and confusion, particularly with the occurrence of pathological conditions such as preeclampsia, morning sickness and hyperemesis/ptyalism gravidarum. We will attempt to explain the underlying physiology and the potential roles played by the placental tachykinins, neurokinin B and endokinin.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1712
[Cu] Class update date: 171220
[Lr] Last revision date:171220
[St] Status:In-Process
[do] DOI:10.1530/JME-17-0275


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