Pentazocine versus tramadol-paracetamol combination as analgesia in labor: A randomized controlled trial

Objectives: Labor should be a satisfactory experience and effective pain management should be employed as recommended by the American Congress of Obstetricians and Gynaecologists. In developing countries, pain management in labor is still a big challenge and the search for the ultimate labor analgesia is still ongoing. The objectives of the study were to determine whether the synergistic analgesic effect of the combination of tramadol and paracetamol will produce analgesia comparable to pentazocine with a better side effect profile. Material and Methods: This was a randomized controlled, double-blinded trial of tramadol-paracetamol combination versus pentazocine as labor analgesia and was carried out at the University of Abuja Teaching Hospital, Abuja, between June 2018 and March 2019. A total of 218 eligible parturients recruited at term, were counseled on labor analgesia, its benefits, and the options made available to them and educated on the pain scoring system. Parturients were allocated into two groups using computer-generated numbers with the WINPEPI software. Group A was given tramadol-paracetamol combination, while Group B received pentazocine, both at standard doses. Hourly pain scores, APGAR scores, labor duration, patients' satisfaction, and side effects were collated. The level of significance was set at <0.05. Results: Tramadol-paracetamol was administered to 109 (50.9%) while pentazocine was administered to105 (49.1%) of the study participants. The mean age in the tramadol-paracetamol group was 29.6 ± 4.8 years, and in the pentazocine group, it was 28.8 ± 4.5 years. The difference in pain scores on the visual analog scale was statistically significant at the 3rd and 4th h (P = 0.02 and 0.004), but not significant in the 1st and 2nd h (P = 0.05 and 0.22) in the two groups. Overall, the average pain score in the tramadol-paracetamol group was significantly higher compared to the pentazocine group (5.27 ± 1.86 vs. 4.72 ± 1.54; P = 0.02). The 1st and 5th min APGAR scores (P = 0.44 and 0.67, respectively) of neonates in the tramadol-paracetamol and pentazocine groups were comparable. Nausea and drowsiness occurred more frequently in the pentazocine group at P-values of 0.047 and 0.0015, respectively. There was no statistically significant difference in the duration of labor between the tramadol-paracetamol and pentazocine groups. not statistically significant, a higher proportion of parturients in the pentazocine group was satisfied compared with the tramadol-paracetamol group (71.4% vs. 63.3%; P = 0.13).Conclusion: This study showed that intravenous pentazocine provides better pain relief in labor, but the tramadol-paracetamol combination has fewer side effects

A Randomized Clinical Trial Comparing Safety; Clinical and Parasitological Response to Artemether-Lumefantrine and Chlorproguanil-Dapsone in Treatment of Uncomplicated Malaria in Pregnancy in Mulago Hospital; Uganda

Background: Malaria infection during pregnancy is a major public health problem. Due to increasing resistance to Chloroquine and Sulphadoxine/Pyrimethamine; the Ugandan national policy on malaria treatment was changed in 2005 to Artemisinin-based combination therapy (ACT) as the first-line treatment for uncomplicated malaria. The policy recommends assessment of safety and efficacy of alternative drugs for treatment of uncomplicated malaria. We compared the efficacy and safety of Artemether- Lumefantrine (Coartemr) and Chlorproguanil-Dapsone (Lapdapr) in the management of uncomplicated malaria in pregnancy. Methodology: We enrolled 110 pregnant women in the second and third trimester of pregnancy who presented to Mulago hospital; Uganda; with uncomplicated malaria. The study design was an open-label randomized clinical trial. Partici- pants were randomized to receive either Artemether-Lumefantrine (Coartemr 20mg/120mg) orally or Chlorproguanil-Dapsone (Lapdapr) orally for 3 consecutive days. Primary endpoints were clinical and parasitological response assessed on days 0; 1; 2; 4; 7; 14 and 28. Adverse effects; clinical response (treatment failure) and parasitological response were compared. Analysis was by intention to treat. Results: Of the 100 women who completed the study; there was no statistically significant difference in clinical and parasitological response by Day 4. The mean fever clearance time 3.0 days with Lapdapr versus 2.5 days with Coartemr was comparable. Likewise; mean parasite clearance time of 2.4 and 2.2 days for Lapdapr and Coartemr respectively was comparable. The adverse effects were comparable between the two groups. Conclusion: Artemether- Lumefantrine and Chlorproguanil-Dapsone have high and comparable cure rates and similar safety profiles when used for treatment of uncomplicated malaria in pregnancy

Laparoscopic versus open retroperitoneal bilateral varix ligation for obese patients presenting with primary sub-fertility : a randomized comparative study

Objectives: To compare the outcome of laparoscopic versus open varicocelectomy in sub-fertile obese men presenting with bilateral testicular varicoceles. Materials and Methods Forty obese (body mass index 30) primary sub-fertile males with bilateral varicoceles have been selected for this study and randomized to either laparoscopic varicocelectomy (Goup I; n=20) patients or high retroperitoneal open ligation (Group II; n=20) patients. Semen analysis was performed preoperatively and three months or more postoperatively. Scrotal duplex was done for each case preoperatively and 6 months post-operatively. Results The average operative time in Group I and Group II was ~77.3 minutes and ~58 minutes; respectively (P 0.05). Analgesia requirements were significantly less in the laparoscopic group. Only one patient of Group I developed subcutaneous haematoma; while in Group II three developed wound infections and six patients developed wound seroma. The average hospital stay of the patients of Groups I and II was 8.4 hours and 52 hours; respectively (P 0.05). The patients of Group II returned to their usual daily activities after an average of 5.3 days; while the patients of Group II needed an average of 8.4 days (P 0.05). Hydrocele occurred in none of the patients of Group I and in 3 patients (15.7) of Group II (P0.05). Recurrence of the varicocele occurred in none of the patients of Group I; but in 3 patients (15.7) of Group II (P 0.05). The semen parameters improved after surgery in both groups. The mean improvement in sperm concentration was ~ 32.5 million sperm/ml in Group I and ~25 million sperm/ml in Group II (p0.05). The mean improvement in total sperm count was ~ 96 million sperms in Group I and ~92 million sperms in Group II (p0.05). The mean percentage of improvement in sperm motility was ~ 16.5in Group I and 14.1in Group II (p 0.05). The mean decrease in the percentage of abnormal forms was ~20in Group I and ~5.5in Group II (p 0.05). Moreover; the quality of motility (grades) improved significantly after laparoscopic varix ligation; to a higher extent than after open surgery. Conclusion: The laparoscopic approach is an excellent option for varix ligation in obese patients. Morbidity is less and convalescence is shorter compared to open surgery. A particular advantage of laparoscopy over conventional surgery is the possibility of treatment of bilateral varicoceles through the usual three laparoscopic ports. In this study improvement in some semen parameters was significantly better following laparoscopic varix ligation. This may be explained by the better view and magnification offered by laparoscopy

Randomized controlled trial of Mycobacterium vaccae immunotherapy in non-human immunodeficiency virus-infected Ugandan adults with newly diagnosed pulmonary tuberculosis. The Uganda-Case Western Reserve University Research Collaboration

Adjunctive immunotherapy with heat-killed Mycobacterium vaccae was studied in a randomized; placebo-controlled trial of 120 non-human immunodeficiency virus-infected adults with newly diagnosed pulmonary tuberculosis. Patients were randomised to a single dose of M.vaccae or placebo 1 week after beginning chemtherapy and were followed up for 1 year. M.vaccae was safe and well tolerated. the rate of sputum culture conversion after 1 month of tuberculosis treatment was 35in the M.vaccae group and only 14in the placebo group (P=01) but was comparable at 2 months and thereafter. Patients receiving M.vaccae had greater improvement on chest radiography at 6 months (91) vs. 77for placebo recipients; P=04) and 12 months (94vs. 80; P=04) after initiation of tuberculosis treatment. These data provide evidence of an early increase in sputum culture conversion and greater radiographic improvement among patients who received M.vaccae. Further studies are warranted

Randomized trial of sulfamethoxazole + trimethoprim versus procaine penicillin for the outpatient treatment of childhood pneumonia in Zimbabwe

Reported are the results of a randomized trial of sulfamethoxazole + trimethoprim versus procaine penicillin for the outpatient treatment of pneumonia in 614 children aged 3 months to 12 years at primary health care clinics in Chitungwiza, a large town near Harare, Zimbabwe. Diagnosis and treatment were carried out by nurses, without medical supervision. The presence of lower respiratory tract infection that required antibiotics was diagnosed on the basis of a recent history of a cough and the presence of a respiratory rate of greater than 50 per minute. Patients were followed up by a research nurse with minimal drop-out losses. Referred children were examined and assessed by a doctor at the Chitungwiza General Hospital. Of the study children, 65 (11%) were referred to hospital, but only 8 (1.3%) had pneumonia that required a change in the treatment (5 in the sulfamethoxazole + trimethoprim group and 3 in the procaine penicillin group). There were no significant differences in outcome between the two treatment groups. One child, who had evidence of infection with human immunodeficiency virus (HIV), died. Sulfamethoxazole + trimethoprim and procaine penicillin were highly and equally effective for the outpatient treatment of children who had been clinically diagnosed to have pneumonia by primary health care workers