Combined low dose aspirin and 17 alpha hydroxyl progesterone versus 17 alpha hydroxyl progesterone alone study in pregnancy: a randomized clinical trial for prevention of spontaneous preterm birth

Background: Preterm birth: defined as any live birth occurring through the end of the last day of the 37th week [259th day] following the onset of the last menstrual period. Low-dose aspirin [LDA] has been noted to reduce the preterm birth [PTB] rate in multiple meta-analyses of the preeclampsia [PreE] prevention trials. It is unclear if this effect of LDA is entirely due to a reduction in indicated PTB versus reductions in preterm premature rupture of membranes [PPROM] or spontaneous PTB. In the Maternal-Fetal Medicine Unit [MFMU] high-risk aspirin [HRA] study, a near significant decrease in PTB was found despite no effect on preeclampsia. The objective of this study was to assess the impact of LDA on indicated PTB, spontaneous PTB, and PPROM PTB in the MFMU HRA study population

Aim of the work: This study aim to assess the efficacy of 17 alpha hydroxyl progesterone and low dose aspirin in reducing the rate of preterm birth in pregnant women at this risk

Patients and Methods: Study type: A double blinded randomized placebo controlled clinical trial

Study settings: This study conducted at outpatient clinic of Ain Shams University Maternity Hospital

Time of the study: The study was held from August 2016 to November 2017

Results: Data was analyzed according to the intention-to-treat principle. In a total 400 women whom recruited in the study, 160 were excluded. So we ended in to 240 women whom randomized and allocated in to 2 groups to intervention. Primary outcome measure was preterm birth. The most important secondary outcome is a composite of poor neonatal outcome [including bronchopulmonary dysplasia [BPD], periventricular leucomalacia, intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity [ROP], sepsis and perinatal death].There was no statistically significant difference between both groups as regarding to age, gravidity, parity, body mass index, mean cervical length, and number of previous preterm labor. There was no significant difference between two groups as regard preterm premature rupture of membranes [P.PROM].There was no significant difference between two groups as regard time of delivery there was no significant difference between both groups in Need for NICU admission, neonatal birth weight, APGAR score, fetal complications [RDS, jaundice, BPD, HIE, NEC, bleeding, sepsis or even neonatal death].Long term neurodevelopmental complications was not conducted at this study as it needs more time.In maternal complications there was no significant difference between both groups

Conclusion: Further randomized controlled trials with larger sample size should be done to demonstrate the efficacy of low dose Aspirin in prevention of preterm labor and its complications

Results of senning operation modified with wide-based pericardial graft [an echocardiographic evaluation]

Despite the fact that the arterial switch operation is the treatment of choice for complete transposition of the great arteries, patients with unbalanced ventricles still needs the Senning operation. Known surgical complications like baffle obstruction may result in early deterioration of ventricular function and impaired exercise performance. It is not clear wether these complications are inevitable or predisposing factors at surgery or during follow up may identify patients at high risk Baffle obstruction after Senning operation may result in early deterioration of RV function and impaired exercise performance. The Objective was to assess the effect of surgical modification in avoiding surgical complications with its deleterious effects on early as well as late follow up. Echocardiography was used to assess postoperative outcome. This prospective study included 30 cases who were candidates for Senning operation for simple transposition of great arteries in the cardiothoracic department of Aboul-Reesh Pediatic hospital Cairo University where an in-situ wide-based pericardial patch was used for the outer baffle, modified right atriotomy and suture lines were modified in all patients. Left atrial appendage augmentation was used in 8, Eustachian valve in 6 cases. Postoperatively patients were subjected to clinical evaluation using Ross scoring for heart failure, ECG and echocardio graphic evaluation to assess RV size, degree of TR, baffle patency, LVOT dynamic obstruction, and global RV systolic and diastolic functions using the myocardial performance index [MPI]. We had early 2 mortalities [6.66%] out of low cardiac output, accelerated nodal rhythm was experienced in other 2 patients [6.66%], internal baffle pressure was 6.1 +/- 2.64cc H20. Data higher than 12cc H[2]O was found in 3 patients [10%], none of them had augmentation with the left appendage. Outer baffle pressure was 9.2+ 1.08 cc H20. No baffle leakage was detected. Clinical examination postoperatively revealed that only one patient had four points on Ross score of HF and the rest of patients had a zero score. Nodal arrhythmias were found in three patients, marked RV dilatation was found in one case and the other 27 cases had mild dilatation, moderate TR was present in 4% of cases, mild TR in 72% of cases. There was no baffle obstruction or LVOT obstruction in our patients. Patients who had Senning operation after the first year of life [40%] had RV MPI more than 0.4 while those under the first year [60%] had MPI less than 0.4. Baffle Augmentation with the wide based pericardial patch offered less chance for baffle obstruction, Left atrial appendage could be used in addition to offer an additional tool to avoid higher internal baffle pressures. Patients subjected to Senning operation earlier in the first year of life and patients have higher oxygen saturation at the time of the operation have better global RV functions

Comparison of pharmacokinetics and pharmacodynamics of rocuronium infusion in adults and children

This study compared the pharmacokinetics and pharmacokinetic-dynamic relationship of rocuronium in children and adults, we studied 10 children [4-8 years] and 10 adults [20-40 years] ASA I and II underwent surgical operation in Kasr-El-Aini hospital. After induction with thiopentone [2-6 mg/kg], fentanyl 5-10 Hg/kg, infusion of rocuronium 0.09 mg/kg/min. in children group and 0.1 mg/kg/min. in the adults group. The infusion was given over +/- 5 minutes. The patients were monitored with the EMG of the adductor pollicis muscle. When neuromuscular block reached 85% endotracheal intubation, and then mechanical ventilation was started Maintenance of anesthesia with isoflurane 0.5- 1%, O[2]/NO[2] 50% in both groups. Arterial sample were obtained over 240 min./ Plasma concentrations were measured by HpLc. pharmacokinetic-dynamic variables were calculated using sheiner model, and the Hill equation. Statistical analysis was performed using the Mann-Whitney U test [p < 0.05]. The mean administered dose of rocuronium infusion was 0.65 +/- 0.09 mg/kg/hour in adults group and 0.35 +/- 0.1 mg/kg/hour in children group. Children differed from adults in plasma clearance 5.2 +/- 0.043 versus 7.65 +/- 1.05 ml/min./kg in adults group, distribution volume at steady state 220 +/- 20 ml/kg in children group and 168+50 ml/kg in adults group, mean residence time 50.5 +/- 9.0 [min.] in children group and 26 +/- 9.0 [min.] in adults group, concentration in effect compartment at 50% block 1.19 +/- 0.4 mg/liter in children group and 1.3 +/- 0.3 mg/liter in adults group, calculated mean ED[90] values were 0.345 +/- 0.077 in adults group, 0.25 +/- 0.067 in children group. The time course of neuromuscular block did not differ. The study concluded that infusion of rocuronium has different pharmacokinetic-dynamic in both adults and children, but it can be safely used in children especially when the infused dose adjusted by using the EMG