Practice of self-medication of mifepristone-misoprostol drug combination for medical abortion.

Most medical abortion protocols require women to take mifepristone in the hospital setting. The rate of complete abortion up to 63 days’ gestation with mifepristone and misoprostol was reported to be 92-95% using the Food and Drug Administration-approved regimen.1,2 In a recent study, the completion rates of 96-97% was reported in early pregnancy, including pregnancies up to 63 days’ gestation.3 Women choosing medical abortion must consent to undergo vacuum aspiration or dilatation and curettage in cases of incomplete abortion. Medical methods for first trimester abortion have been demonstrated to be both safe and effective. Regimens that combine mifepristone with a prostaglandin analogue such as misoprostol are more efficacious than a prostaglandin alone. Mifepristone, (RU 486, a substitute 19- norethisterone derivative)by blocking the progesterone receptors causes estrogen dominance and results in intrauterine fetal death. Simultaneously, it sensitizes the uterus to the activity of the prostaglandin. Thus, a combination of these two drugs is significantly more efficacious for termination of early pregnancy when compared to mifepristone given alone. A regimen that includes mifepristone in a dosage of 200 mg administered orally, followed by misoprostol in a dosage of 800 µg vaginally administered 48 hrs after mifepristone, and is highly effective for medical abortion up to 63 days gestation. This regimen is reported to be the best in most of the studies and moreover mifepristone serum levels do not increase proportionally with increasing oral doses.4 In a study conducted by Schaff et al., it was observed that the success rate was seen in 96-97% of women who were prescribed a combination of mifepristone and misoprostol by authorized personnel at the hospital.3 Women are commonly advised to return for one or more follow-up visits, after 10-14 days because in cases of incomplete abortion she can be managed either expectantly, with an additional dose of misoprostol, or with an aspiration procedure. Women may be given the option of home administration of misoprostol after the initial clinic visit.5 However, the use of mifepristone – misoprostol combination for medical abortion used as self-medication, is rising due to changing socio-cultural practices and increased awareness among women for the termination of early pregnancy up to 63 days. It is observed that many women indulge in the practice of self-medication for termination of pregnancy. They take medicines either from local pharmacists, nurses, on advice of relatives, friends, husband, neighbors, newspaper articles, radio, television, magazines or any other such unauthorized sources for termination of pregnancy which mostly leads to incomplete abortion or many complications. It is observed that only few number of women have complete abortion with self-medication from an unauthorized source and moreover they suffer from pain and heavy bleeding when compared to normal menstrual flow. It is noticed that now-a-days, these drugs are used irrationally and nonjudiciously. Women are thus advised to take proper regimen of mifepristone and misoprostol under the guidance of an authorized practitioner and if they still fail to abort, then they have to undergo surgical evacuation that is, vaccum aspiration for termination of pregnancy.

Lornoxicam versus diclofenac sodium in acute renal colic: a prospective randomized trial.

Background: Acute renal colic is excruciatingly painful event, opioid analgesics and nonsteroidal anti-inflammatory drugs remain the mainstay of treatment for acute renal colic. This study compares diclofenac and lornoxicam in their efficacy to relieve pain of renal origin. Methods: Prospective, randomized, double blind clinical study including eighty patients with renal pain admitted in emergency department of a tertiary care teaching hospital. Parameters were observed at baseline and after 15, 30, 60, 180 minutes and 5hrs of drug treatment. The efficacy of the drug was measured by observing: Pain score, onset & duration of action, rescue drug use, global patient and physician impression. Results: Both drugs are effective in relieving pain of renal origin (p<0.05) and maintaining it over time as well. When decrease in value of pain score compared between two groups at various interval there was statistically significant (p<0.05) decrease in pain score only at 15 minutes in lornoxicam group showing this slightly more effective in early phase compared to diclofenac. In either group there is no statistically significant difference regarding onset of action, duration of action and side effect profile. Conclusions: Both the drugs are equally effective and safe in renal colicky pain with added advantage of lornoxicam being more effective in early period.

Use of polycarbonate plastic products and human health.

As plastic and plastic products are being used in day to day at the cost of environment pollution, the human and wild life health and has become a global concern. Researchers found link between abnormal liver enzymes in the people and Bisphenol-A (BPA). Changes in insulin resistance, reproduction system, cardiovascular and brain function are also reported. BPA is used in the production of epoxy resins, polycarbonate resins, and polyester resins. BPA can leach out of certain plastic products including variety of modern goods, reusable food storage containers, eyeglass lenses, white dental fillings, sealants, medical equipments etc. In the body, BPA behaves as an estrogen receptor agonist and mimics estrogen hormone. Bisphenol-A (BPA) is a widespread endocrine-disrupting chemical (EDC) used as the base compound in the manufacture of polycarbonate plastics. Children and unborn and new born babies are at high risk of unwanted effects of BPA. Children suffer from chronic exposure to bisphenol A with manifestation of gastrointestinal problems, adrenal stress, immune dysfunction, toxic over load and neurological disorders. Some study in Japan has observed that more BPA can leach from polycarbonate products that have been scratched or is more than 4 years old or used bottles that have been subjected to bottle brushing or dishwashing and sterilization. People exposed to higher levels of BPA due to use of plastic food and beverages containers are more likely to develop cardiovascular diseases, diabetes and metabolic disorder. Recent studies have suggested that BPA exposure may have a role in the development of weight gain, insulin resistance, pancreatic endocrine dysfunction, thyroid hormone disruption, and several other mechanisms involved in the development of diabetes. Urinary BPA levels are found to be associated with diabetes mellitus independent of traditional diabetes risk factors. There is a concern of exposure of BPA to pregnant women that can affect the development of offspring in the womb. It is considered that women may be placing their fetuses at the risk by having dental sealants applied during pregnancy. Public should be educated about the use of plastic and plastic products which can prove to be hazardous and risk factor to many health problems of human and wild life.