Randomized comparison of glycerol trinitrate and misoprostol for cervical ripening at term

The study was undertaken to assess efficacy and adverse effects of glycerol trinitrate compared with misoprostol for cervical ripening at term. The study was conducted on sixty term pregnant females with unfavorable cervices, Bishop score < 6, referred for induction of labor. They were randomly assigned, and divided into 2 groups: Group [A]: Includes thirty cases where Misoprostol [Cytotec] 200 micro g/tablets will be used vaginally, 50 micro g/6 hours maximally. Group [B] includes thirty cases where Nitroglycerine [Dinitra 5 mg] tablets/ 6 hours, vaginally, two doses maximally. Women were sent to the labor ward for amniotomy or oxytocin, if their Bishop scores improved more than 6 or their cervices were not ripe 24 hours after treatment, then the adverse effects, changes in Bishop scores, progress and outcome of labor were assessed. This study indicated that there was no significant difference as regards Bishop score in between both groups, but the median of Bishop scores 12 hours after PGE[1] analogue [Misoprostol] was higher than glycerol trinitrate. PGE[1] analogue [Misoprostol] group A had shorter mean duration from the start of medication till the start of pain than glycerol trinitrate [group B], the mean was 12.33, 12.12 hours respectively. Also, the time elapsed from induction till delivery was also significant in this group. P=0.001. There was highly significant tachysystole in group A, while headache, dizziness and palpitations were seen only in group B.10%, 10%, 13.3% of cases respectively, low Apgar score after 1 minute was significantly evident in group A compared to group B. Glycerol trinitrate is less effective than PGE[1] analogues [misoprostol] for ripening at term. It causes less tachysystole than misoprostol but headache, dizziness, palpitation are more in glycerol trinitrate group. Further study is needed to determine optimal dose and effectiveness of glycerol trinitrate for cervical ripening

Myocardial infarction. correlation with ventricular arrhythmia and left ventricular function

Great effort has been expended on attempts to predict ventricular arrhythmia and left ventricular function; a two major source of mortality in AMI. QT dispersion have been demonstrated to reflect regional inhomogenicity of ventricular repolarization, which is considered a fundamental factor for initiation of ventricular arrhythmia. Prospective study of 27 consecutive patients admitted to CCU with AMI indicated for streptokinase [SK] [21 M/ 6 F, mean age: 50ys] compared with control group of 15 consecutive patient contraindicated for SK [11 M/ 4F, mean age 50 ys] treated by nitroglycerin [NG]. Both groups were matched for age, and site of MI. For both study and control group 12 lead ECG was done on admission, post thrombolytic and at discharge. SAECG, Heart Rate Variability [HRV], 24 hour Holter monitoring and Doppler echocardiography were done only at discharge. QTc calculated as QT int [sec] square root [RR [sec]] QT dispersion [QTd] calculated from 12 lead ECG as difference between maximum QT interval minus minimum QT interval. QTc was not different in both groups on admission and on discharge [0.41 +/- 0.08 vs 0.39 +/- 0.04 in gpI; 0.47 +/- 0.05 vs 0.45 +/- 0.05 in gp. II]. QTd was high in all AMI patient on admission. However, only the thrombolytic therapy caused significant reduction of QTd which was maintained until discharge. SK: Admission: 103 +/- 26.7- Post therapy: 46.6 +/- 18.3- Before discharge 40 +/- 11- P value: 0.0001. NG Admission: 118 + 27.7- Post therapy: 0- Before discharge: 121 +/- 31.5- P value: 0.334. [There is significant difference in both groups as regard EDD in echocardiography where group II had more dilated end diastole than group I.] In 24 hour Holter monitoring, there was significant higher incidence of ischemic ST depression in NG gp than SK gp. [92.3% vs 3.7%, P value: 0.0001]. But there was no significant difference between the two group in SAECG and HRV indices. The SK group with improved QT dispersion showed significantly lower incidence of tachyarrhymia [none vs 66%] lower mortality [non vs 13%] and less LV dilatation [3.7% vs 33.3%]. QTd not QTc serve as a good discrimenant between complicated and non complicated MI. Persistent high QTd could predict more arrhythmia and left ventricular failure. SK therapy not NG is the treatment of choice in AMI for correction of QTd