Evaluation of insulin-like growth factor binding protein-1 in cervico-vaginal secretions as an indicator of premature rupture of membranes: a comparison with nitrazine test and amniotic fluid index

Objective: To evaluate the diagnostic potential of insulin-like growth factor binding protein-1 [IGFBP-1] in cervicovaginal secretions as an indicator of premature rupture of membranes [PROM] in comparison with the nitrazine test and amniotic fluid index [AFI]. The predictivity of these tests on the latency of pregnancy in patients with PROM was also studied

Design: Prospective controlled study

Setting: Department of Obstetrics and Gynaecology, Faculty of Medicine, Alexandria University

Subjects: 50 pregnant females [20 continued PROM, 20 suspected PROM and 10 with intact membranes acting as controls]

Interventions: Patients were subjected to sterile speculum examination, the nitrazine test, measurement of IGFBP-1 in cervicovaginal fluid by a rapid dipstick method [PROM test] and ultrasonographic assessment of AFI by the four quadrant method. All patients were followed up for one week to determine who went into spontaneous labour

Results: The mean gestational age did not differ significantly between groups. The sensitivity. Specificity, positive and negative predictive values of the nitrazine test, AF] and the PROM test in diagnosing PROM were 68.75%, 30%, 64.7%, 37.50% and 75%, 89%, 92.31%, 66.67% and 96.90%, 100%, 100%, 94.70%, respectively. Only a positive PROM test was associated with delivery within 1 week

Conclusion: The dipstick immunochromatographic method of detecting IGFBP-l in cervicovaginal fluid [PROM test] is a. rapid, reliable and non-invasive method in diagnosing PROM. It is the most accurate predictor of the latency of pregnancy in patients with suspected PROM

Double-blind randomized comparison of epidural co-analgesics on the postoperative analgesic consumption

Pain mediators are responsible for the peripheral and central sensitization. Preempetive treatment will prevent the establishment of hypersensitivity by blocking the sensory input that induces the central sensitization. This prospective double blind study was carried out on 45 adult patients who underwent upper abdominal operations. All patients were assigned into 3 groups according to the drug injected epidurally. [Plain bupivacaine [group I], Ketamine + plain bupivacaine [group II]. and clonidine + plain bupivacaine [group III]],. 15 minutes before the general anesthesia. The purpose of this study was to evaluate and compare the effects of epidural ketamine and clonidine as co-analgesics on postoperative analgesic consumption for upper abdominal surgery Measurements for efficacy of preemptive analgesia evaluated by visual analogue scale [VAS] and Prince Henry score [PHS]. sedation score, mood state, cumulative postoperative analgesic consumption and the time of the first need of fentanyl Monitoring of vital signs and recording of possible side effects were performed on the postanesthesia care unit VAS was significantly less in group III at most times of measurements until 2 hr postoperatively. PHS showed less significant reading in groups I and III compared to group II at 15 min and 6 hr postoperatively. Sedation score was significantly higher in group III compared to group II, I and II at 15, 30 min. respectively. Mood score was significantly high in group II and III. No significant side effects and respiratory rate, oxygen saturation, and ECG were within normal range in the three groups. The total amount of fentanyl requirements in the first 24 hrs postoperatively was significantly less in group III compared to group I and II. The time of first need of fentanyl was't changed significantly between the three groups. In conclusion the preemptive analgesic effect of epidural clonidine combined with plain bupivacaine with lack of vcnak ventilatory effects makes clonidine a potenlially useful drug for the reduction of postoperative narcotic consumption or in other words for the postoperative pain management

Duration of action of mivacurium chloride in patients with hepatosplenic schistosomiasis

Mivacurium is a new, non-depolarizing short acting muscle relaxant. It is largely metabolized by hydrolysis by pseudocholinesterase which is known to be under genetic control and to have low activity in a variety of disease conditions. In patients with hepatosplenic schistosomiasis, the synthetic ability of the liver is decreased and cholinesterase activity is lowered. It was, therefore, of interest to study the duration of muscular relaxation by mivacurium in these patients in relation to their plasma cholinesterase activity. The duration of action of mivacurium was found to have a strong negative correlation with the activity of pseudocholinesterase [r = 0.9067]. This correlation indicated a good statistical significance [P <0.01]. The data obtained in the present study suggested that the neuromuscular blocking pattern of mivacurium nearly fits criteria suggested for a short acting non-depolarizing neuromuscular blockers and the anesthetist should be aware of the fact that conditions that lower cholinesterase activity will result in prolonged duration of neuromuscular blockade

Response of cortisol and cytokines to lower abdominal surgery a comparative study between general anaesthesia and epidural analgesia

Thirty patients were allocated randomly to one of two groups according to the types of anesthesia, group I received general anesthesia and group II received epidural analgesia. Venous blood samples were collected from each patient before induction of anesthesia and 20 minutes after the start of surgery for the determination of serum interleukin-1, interleukin-6, tumor necrosis factor, ceruloplasmin, C-reactive protein and cortisol levels. Lower abdominal surgical maneuvers resulted in increase in the level of the parameters tested, the only exception was cortisol which was refractory to change under epidural. All increases in the epidural group were significantly less than that in general anesthesia group. The results of this study showed that the complete afferent neuronal blockade achieved by regional analgesia for surgery of lower abdomen leads to suppression of the cortisol response to surgery and this many influence the value of cytokines studied

Attenuation of the agonistic effects of succinylcholine on the nicotinic receptors by the pretreatment with d-tubocurarine and tracrium

The present study was designed to evaluate the effects of pretreatment with d-tubocurarine and tracrium on succinylcholine induced increases in plasma catecholamines concentration, plasma K+ level, mean blood pressure, heart rate and fasciculation in patients anesthetized with halothane. Eighteen patients were randomly divided into three groups: Saline, d-tubocurarine and tracrium groups. The mean plasma catecholamines concentration, mean plasma K+ level, mean blood pressure and mean heart rate were significantly increase in the saline group after 4 and 10 minutes from i.v. succinylcholine injection. Also, the fasciculation was peaked. In d-tubocurarine group, there were no significant changes in the above measurements. In tracrium group, there were significant increases in catecholamines and K+ levels. D-tubocurarine attenuated the cardiovascular effects and the induced increases in plasma catecholamines and K+ levels following succinylcholine injection. Tracrium attenuated the cardiovascular effects, but to a lesser extent and did not attenuate the increases in plasma catecholamines following succinylcholine injection. The results obtained in the present study showed that the nicotinic receptors on the sympathetic ganglia are not the only sites of interaction, suggest the possibility that the presynaptic nicotinic receptors on the postganglionic sympathetic terminals might be involved in the interaction between these drugs

Interleukin-1 production by monocytes from patients anaesthetized with halothane and isoflurane

Twenty female patients formed the population of this study. They were divided into two groups according to the anesthetic agent used for the maintenance of anesthesia. Group I was the halothane group and group II was the Isoflurane group. The aim of this study was to compare the effect of both anesthetics on the liberation of IL-1 from monocytes. The results showed that there were insignificant changes between the two groups in the spontaneous release of IL-1 either immediately or 24 hours postoperatively. But there was a significant difference between the two groups both after activation of monocytes and spontaneous index in the immediate postoperative period. After 24 hours, there was insignificant difference after activation and the stimulation index