Indução do estro em cutias (Dasyprocta leporina) utilizando-se protocolos à base de prostaglandina isolada ou em associação com análogo de GnRH / Estrus induction in agoutis (Dasyprocta leporina) using protocols based on prostaglandin isolated or in association to GnRH analogue

Comparou-se a eficiência de protocolos para indução de estro em cutias. Em cinco fêmeas, foram administradas duas doses de cloprostenol (5µg) com intervalo de nove dias, via intraperitoneal; em outras cinco, administraram-se 30µg de análogo do hormônio liberador de gonadotrofinas (GnRH), via intravulvar, seguidos de 5µg de cloprostenol, via intraperitoneal, após sete dias e, após mais dois dias, nova dose do análogo de GnRH. A cada três dias, a ciclicidade reprodutiva dos animais foi monitorada, por meio de coleta de sangue, para dosagem hormonal, ultrassonografia ovariana e citologia vaginal. Duas das fêmeas que receberam apenas prostaglandina, as quais estavam em fase luteal no início do tratamento, manifestaram o estro aos três e seis dias após a segunda administração da droga. Já nas fêmeas que receberam a prostaglandina associada ao análogo do GnRH, duas que originalmente estavam em fase luteal apresentaram estro aos quatro dias após o tratamento, e uma outra apenas após 10 dias. Não foram evidenciadas diferenças estatísticas quanto à eficiência dos tratamentos (P>0,05). Conclui-se que, de acordo com os protocolos utilizados, o uso da prostaglandina isolada ou em associação com análogo do GnRH para a indução do estro em cutias D. leporina apresenta eficiência limitada às fêmeas que estejam em fase luteal por ocasião do início do tratamento.(AU)

We compared the efficiency of protocols for estrus induction in agoutis. Five females received double intraperitoneal administration of cloprostenol (5µg) on a 2-days interval; other five females were treated with intravulvar administration of 30µg gonadotrophin release hormone analogue (GnRH associated to intraperitoneal administration of 5µg cloprostenol after seven days and a new administration of GnRH analogue after two days. Every 3 days, the agoutis' reproductive cycle was monitored by blood collection for hormonal analysis, ovarian ultrasound and vaginal cytology. Two females, originally in luteal phase, that received isolated prostaglandin presented estrous signs at 3 and 6 days after the second drug administration. From the females that received the association, two that were originally in luteal phase presented estrus at 4 days after treatment, and one other presented estrus only after 10 days. There was no significant statistical difference regarding the efficiency of treatments for estrus induction (P>0.05). We conclude that, according to the protocols tested in the study, the use of isolated prostaglandin or its association to GnRH analogue for estrus induction in D. leporine shows an efficiency limited to the females that were in luteal phase in the beginning of the treatment.(AU)

Estudo sobre os fatores relacionados a interrupção do tratamento do glaucoma / Study of the factors related to stop the treatment of glaucoma

OBJETIVO: Identificar causas relacionadas com a não aderência ao tratamento do glaucoma primário de ângulo aberto e sugerir meios para posteriormente minimizá-las. MÉTODOS: Foi aplicado um questionário a pacientes portadores de glaucoma primário de ângulo aberto no Hospital Universitário Gaffrée e Guinle, escolhidos aleatoriamente, para avaliação dos fatores relacionados com a interrupção do tratamento. Para isso, utilizou-se uma análise univariada, pelo teste exato de Fisher, e considerou estatisticamente significativo p<0,05. RESULTADOS: A partir do questionário, identificou-se dois subgrupos, um que já havia interrompido o tratamento e outro que nunca o havia interrompido, compostos por 25 e 11 pacientes respectivamente. Estes grupos foram comparados entre si e todos os parâmetros analisados. O custo dos medicamentos (p=0,001) e o fator esquecimento (p=0,007) foram estatisticamente relevantes para a interrupção do tratamento da doença. As demais variáveis testadas não obtiveram significância estatística. CONCLUSÃO: O custo dos medicamentos e o fator esquecimento foram os fatores mais importantes para interrupção do tratamento.

The objective was to identify causes related to noncompliance of primary open-angle glaucoma and suggest ways to minimize them later. A questionnaire was given to patients with primary open angle glaucoma in Hospital Gaffrée Guinle, chosen randomly, to assess factors related to discontinuation of treatment. For this we used a univariate analysis by Fisher's exact test and considered statistically significant p <0.05. From the questionnaire, we identified two sub-groups, who had stopped treatment and another who had never stopped for 25 compounds and 11 patients respectively. These groups were compared, and all parameters examined. The cost of drugs (p = 0.001) and forgetting factor (p = 0.007) were statistically significant for discontinuation of treatment of disease. The other variables tested did not achieve statistical significance. CONCLUSION: The cost of drugs and forgetting to take medication were the factors most important to withholding treatment.

Neuroprotection in glaucoma.

Glaucoma is a neurodegenerative disease characterized by loss of retinal ganglion cells and their axons. Recent evidence suggests that intraocular pressure (IOP) is only one of the many risk factors for this disease. Current treatment options for this disease have been limited to the reduction of IOP; however, it is clear now that the disease progression continues in many patients despite effective lowering of IOP. In the search for newer modalities in treating this disease, much data have emerged from experimental research the world over, suggesting various pathological processes involved in this disease and newer possible strategies to treat it. This review article looks into the current understanding of the pathophysiology of glaucoma, the importance of neuroprotection, the various possible pharmacological approaches for neuroprotection and evidence of current available medications.

Métodos farmacológicos de indução do trabalho de parto: qual o melhor? / Pharmacological methods for induction of labor: what's the best?

A indução do parto consiste em estimular artificialmente as contrações uterinas coordenadas e efetivas antes de seu início espontâneo, levando ao desencadeamento do trabalho de parto em mulheres que ultrapassaram a 22ª semana de gravidez. A antecipação do parto pode ser necessária em diversas situações obstétricas, como gestação prolongada, diabetes, ruptura prematura das membranas e pré-eclâmpsia. Estima-se que mais de 15% de todas as gestantes apresentem alguma indicação de indução do parto. Vários métodos de indução do parto são propostos, tanto naturais como artificiais e, dentre estes, os métodos farmacológicos merecem especial destaque. Realizou-se uma revisão da literatura baseada nos melhores níveis de evidências e considerando os graus de recomendação. De acordo com a literatura, a utilização de estrogênio, propranolol, relaxina, mefepristone e hialuronidade não deve ser estimulada por não existirem evidências suficientes para a sua recomendação. O seu uso, portanto, deve ser limitado a protocolos de pesquisas. Ocitocina é um método de indução efetivo que pode ser usado em pacientes com ruptura das membranas amnióticas. Prostaglandinas (PG) e misoprostol (um éster sintético da PGE1) são efetivos para a indução do parto independentemente da integridade das membranas. Prostaglandinas devem ser administradas preferencialmente por via vaginal. Habitualmente, o misoprostol é preferido devido a questões práticas, como o baixo custo e a facilidade de administração e estocagem. Doses baixas de misoprostol devem ser utilizadas e a atualmente recomendada é de 25 g a cada 4 ou 6 horas. Tanto a via oral como a via vaginal podem ser utilizadas.

Induction of labor consists of stimulation of effective and coordinated uterine contractions before their spontaneous onset for the purpose of bring on labor in women who have surpassed the 22nd week of pregnancy. In several obstetrical situations, such as prolonged pregnancy, diabetes, premature rupture of membranes and preeclampsia, anticipation of labor and delivery may be necessary. It is estimated that more than 15% of all pregnant women eventually present any indication for induction of labor. Several natural and artificial methods for induction are proposed. Among them, pharmacological methods are the most relevant. A literature review was carried out based on the highest levels of evidence and on the grade of recommendations. According to the literature, the use of estrogens, relaxin, mifepristone and hyaluronidade should not be stimulated because there are not enough evidences for their recommendation, so their utilization should be limited to research protocols. Oxytocin is an effective method for induction of labor that may be used in patients with ruptured membranes. On the other hand, prostaglandins and misoprostol (a prostaglandin E1 analog) are effective for induction of labor independently on the membrane integrity. Vaginal administration should be preferred for prostaglandins. Misoprostol is habitually preferred due to practical questions, such as low cost and facility for storage and administration. Low doses of misoprostol should be used, and the currently recommended dose is 25 g every four or six hours. Both vaginal and oral routes of administration can be used.

Eficácia da dose reduzida de gonadorelina e diferentes prostaglandinas no protocolo ovsynch em vacas holandesas / Efficacy of decreasing dose of gonadorelin and comparison between different prostaglandins on ovsynch protocol in lactating Holstein cows

Avaliou-se a eficácia da dose de 0,10 ou de 0,25mg de gonadorelina nas taxas de ovulação e de sincronização no protocolo Ovsynch e de 150mcg de D-cloprostenol ou 0,530mg de cloprostenol sódico na regressão do corpo lúteo (CL) de sete dias e de todos os CL. Foram utilizadas 136 vacas lactantes da raça Holandesa, com média de produção de leite de 23,75,8kg/dia, com 138,4±72,0 dias em lactação. As vacas foram distribuídas aleatoriamente em quatro grupos, de acordo com a dose de gonadorelina e o tipo da prostaglandina. As taxas de ovulação e de sincronização foram de 52,9 por cento e 80,9 por cento para 0,10mg de gonadorelina e de 57,4 por cento e 80,9 por cento para 0,25mg de gonadorelina, respectivamente. A taxa de regressão do CL de sete dias foi de 97,1 por cento para o D-cloprostenol e de 97,5 por cento para o cloprostenol sódico. A taxa de prenhez não foi influenciada pelos tratamentos, mas foi influenciada pela taxa de ovulação à primeira aplicação de gonadorelina, 16,0 por cento vs. 6,6 por cento para as vacas que ovularam e não ovularam, respectivamente. Conclui-se que 0,10mg de gonadorelina foi eficiente e ambas prostaglandinas podem ser usadas em protocolos de sincronização da ovulação.

The efficacy of 150mcg D-cloprostenol or 0.530mg cloprostenol sodium on the 7- day corpus luteum (CL) regression rate, and of two doses of gonadorelin, 0.10mg vs. 0.25mg, on the ovulation and synchronization rates during the Ovsynch protocol were evaluated. Lactating Holstein cows (n=136), producing 23.75.8kg milk/d and 138.4±72.0 days in milk were randomly assigned to four groups, according to dose of gonadorelin and prostaglandin type. No effect of the products and doses tested on conception rate were observed. The ovulation and synchronization rates using 0.10mg or 0.25mg of gonadorelin were 52.9 percent and 80.9 percent vs. 57.4 percent and 80.9 percent, respectively. The CL regression rates in cows ovulating after the first GnRH using D-cloprostenol or cloprostenol sodium were 97.1 percent and 97.5 percent, respectively. The pregnancy rate was not affected by treatment, but by ovulation rate after the first injection of GnRH. The pregnancy rates were 16.0 percent and 6.6 percent for ovulated and non ovulated cows, respectively. The results suggest that 0.10mg dose of gonadorelin was efficient and both prostaglandins can be used in synchronization of ovulation protocols.

Indicaciones de cesáreas en embarazadas asistidas en el Hospital Padre Justo Arias de Rubio: Estado Táchira enero 2004-abril 2005 / Indications of cesarean in pregnant attended in the Hospital Padre Justo Arias of Rubio: State Táchira january 2004-april 2005

El presente es un trabajo retrospectivo donde se analizaron 138 casos de cesáreas en el lapso comprendido enero 2004-abril 2005, en el Hospital Padre Justo Arias de Rubio, con el propósito de identificar las causas de las mismas, siendo la desproporción cefalo-pélvica (DCP), la cesárea anterior, la hipertención inducida por el embarazo, la inducción fallida del trabajo de parto seguida de la presentación viciosa, las mas importantes. Los resultados señalan que la edad predominante fue de 24,5 años, la mayor frecuencia de operación se presentó en primigestas, el 68,8 por ciento de las intervenciones se realizó de forma electiva, encontrándose que todos los casos se realizaron en gestaciones a término. Se concluye que los factores que proporcionan la indicación de cesárea deben ser objeto de revisión, para evitar una próxima interrupción del embarazo por vía alta.

Uso do hCG, GnRH ou 17beta-Estradiol e progesterona associados ao acetato de melengestrol e prostaglandina f2alfa em novilhas cruzadas (Bos taurus indicus x Bos taurus taurus) / Use of hCG, GnRH or 17beta-estradiol and progesterone associated with melengestrol acetate and prostaglandin F2alfa in cross-bred heifers (Bos taurus indicus x Bos taurus taurus)

O objetivo do presente experimento foi avaliar a performance reprodutiva e as características de estros em novilhas cruzadas de corte (Bos taurus indicus x Bos taurus taurus) tratadas com o protocolo MGA/Prostaglandina (PG) em associação a outros hormônios. No dia 0 (Dia 0 = início da ingestão do MGA) as novilhas foram distribuídas ao acaso para receber 2mL de solução salina (grupo Salina), 2500UI de hCG (grupo hCG), 20müg de acetato de buserelina (grupo GnRH) ou 5mg de 17beta-estradiol + 100mg de progesterona (grupo 17beta-E2 +P4. Amostras de sangue foram colhidas nos dias - 7, 0, 7 e 10 para a mensuração das concentrações plasmáticas de progesterona. Independentemente do tratamento, todas as novilhas receberam 0,5mg MGA/ animal/ dia durante 8 dias (Dia 0 ao 7) e PG (Dia 7). Os estros foram observados durante 120h, a partir da injeção de PG, pelo sistema Heat- Watch. As novilhas foram inseminadas 12 horas após o início dos estros ou 72h depois da injeção de PG. O diagnóstico de gestação foi realizado 35 dias após a última inseminação, por ultrasonografia. As respostas em estros foram de 50,0%, 22,2%, 59,5% e 71,8% para os grupos Salina, hCG, GnRH e 17beta-E2 +P4, respectivamente (P< ou =0,01). O intervalo médio da injeção de PG ao estro foi de 72,8 + ou - 22,2, 102,0 + ou - 22,7,84,6 + ou - 19,0 e 72,5 + ou - 24,4 horas (P< ou =0,01), sendo o grau de sincronização similar entre os grupos. As taxas de concepção foram de 57,9%, 37,5%, 40,9% e 39,3% e as taxas de prenhez de 29,0%, 11,1 %,27,0% e 28,2%, para os grupos Salina, hCG, GnRH e 17beta-E2 +P4, respectivamente. Não houve efeito do tratamento na duração dos estros (10,4 + ou - 5,7 horas), número de montas (23,0 + ou - 16,9) e duração das montas (2,7 + ou - 0,3 segundos), sendo os valores entre parênteses correspondentes às médias gerais e desvios padrão. Em conclusão, a performance reprodutiva não foi alterada pela adição do hCG, GnRH ou 17beta-E2 +P4 ao protocolo de sincronização MGA/PG.

comparison of oral misoprostol tablets and vaginal prostagl and in E2 pessary in induction of labour at term

To compare the cost-effectiveness, mode of delivery, fetal and maternal outcome of oral Misoprostol and vaginal prostagl and in E2 pessary in induction of labour at term. R and omized clinical trial. Hamdard University Hospital, Imam Clinic and General Hospital from February 2002 to January 2003. The trial was conducted over two groups of patient for labour induction such that Group A received 50 micro g oral Misoprostol 4 hourly to a maximum of four doses. Group B received prostagl and in Es vaginal pessary at 6 hourly intervals up to two doses. Labour induction, number of doses, need of augmentation, induction to delivery time interval, mode of delivery and neonatal outcome were the main outcomes. Test of proportions was used to compare the significance between both managements. Out of a total of 214 women, 106 received oral Misoprostol and 108 received PGE2 vaginal pessary. Ninety-three percent women in misoprostol group were successfully induced compared with 91% in PGE2 group. A significant response of labour induction with the minimal dose [58%, p = 0.001] and earlier induction to vaginal delivery [74%, p=0.01] was observed in Misoprostol group. Rate of operative delivery was also less [16%, p = 0.16] compared with PGE2 group [25%]. Oral Misoprostol administration was more efficient and cost-effective than PGE2 vaginal pessary for induction of labour due to earlier response with minimal dose and less number of operative deliveries

Intrarectal prostaglandin in the management of postpartum hemorrhage

To investigate the effectiveness of intrarectal prostaglandin in the management of atonic postpartum hemorrhage in patient who do not respond to conventional oxytocic agents. This study included patients, who had single term pregnancies with cephalic presentation and had normal vaginal deliveries in Gynae Unit-1 from 1st February 1999 to 30th November 1999. All patients had active management of third stage of labour and if uterine response was not adequate, then first uterine massage was done and oxytocic infusion was given. If patient continued to bleed PGE2 vaginal tablet was placed in the rectum. A total of 1200 normal vaginal deliveries occurred during the study period and 51 cases of atonic PPH were reported. Intrarectal PGE2 was used in 19 patients and was effective in 13 patients. In the rest six patients surgical intervention was done. Gynae Unit-1, Department of Obstetrics and Gynaecology Sandeman Provincial Hospital, Quetta. Results: During the study period 51 cases [4.25%] of atonic PPH were reported out of a total of 1200 normal vaginal deliveries. Twenty one [41.17%] patients were between 35 years and 45 years of age. Twenty two [43.1 3%] patients had a parity between P-5 and P-1 0. In 1 9 [37.25%] patients intrarectal PGE2 was used. It was effective in 13 [68.42%] patients and failed in six [31.57%] patients. Out of six patients, bilateral uterine artery ligation was done in four [66.66%] patients and hysterectomy done in two [33.33%] patients

Induction of labor as a planned program

Induction of labor near term in selected cases to procure a vaginal delivery of a selected time. The Aga Khan University Hospital, Karachi 1995 - 1996. Labor induced after ripening of the cervix with Folly's catheter, Prostine vaginal Pessary. Labor pains initiated with Prostaglandins, ARM syntocinon infusion or both. Vaginal/abdominal delivery with due safety to mother and child. Vaginal deliveries obtained in 89.2% cases, 10.8% cesarean section rate, no maternal or fetal mortality

Función el cuerpo lúteo formado a partir de la ovulación de un folículo dominante persistente, en vaquillas holstein tratadas con un dispositivo intravaginal de liberación de progesterona (CIDR-B), en ausencia de un cuerpo lúteo / Function of the corpus luteum developed from the ovulation of a persistent dominant follicle in Holstein heifers treated with a controlled internal drug release-bovine device (CIDR-B) in absence of a corpus luteum

Se evaluó la función del cuerpo lúteo (CL) formado a partir de la ovulación de un folículo dominante persistente, en vaquillas Holstein tratadas con un dispositivo intravaginal de liberación de progesterona (CIDR-B), en ausencia de un CL. Veinticuatro vaquillas recibieron 25 mg de prostaglandina F2Ó (PGF2Ó) im. Once días después a las vaquillas del grupo 1 (n=12) se les insertó un CIDR.B (CIDR-B con CL), a las vaquillas del grupo 2 (N=2) se les insertó sin estradiol y permaneció 12 días. Se evaluó el desarrollo folicular mediante ultrasonografía. En 2 vaquillas (16.6 por ciento) del grupo 1 y en 8 del grupo 2 (66.6 por ciento; P< 0.05) el folículo dominante observado el día de la inserción del CIDR-B persistió y ovuló después del tratamiento; en los animales restantes ovuló un folículo diferente. Se obtuvieron muestras sanguíneas para la determinación de progesterona diariamente, a partir del día del estro (día 1) hasta el día 16 del ciclo de 7 vaquillas del grupo 1, en las cuales ovuló el folículo diferente, y de 7 vaquillas del grupo 2, en las que ovuló un folículo dominante persistente. Las concentraciones de progesterona fueron similares en las vaquillas de ambos grupos (P > 0.05). En el presente trabajo no se encontró evidencia de que el cuerpo lúteo que se desarrolla a partir de la ovulación de un folículo dominante persistente en vaquillas tratadas con un CIDR-B en ausencia de un cuerpo lúteo, tenga afectada su función

Induction of labor by intracervical prostaglandin gel and oxytocin infusion in primigravid women with unfavorable cervix.

The rate of Cesarean Section for failed induction of labor and maternal and fetal compilations are high when labor is induced in a nulliparas women with an unripe cervix by amniotomy and oxytocin infusion. Prostaglandins (PG) in different forms have been used for ripening the cervix with an aim of reducing these problems. A prospective randomized trial was performed on one hundred primigravid women between 37 and 42 weeks of gestation with singleton pregnancy, cephalic presentation and unfavorable cervix (Modified Bishop Score < or = 5) in the department of Obstetrics & Gynaecology of Institute of Postgraduate Medicine & Research from 1st May 1996 to 30th April 1997. In this study the efficiency of prostaglandin E2 intracervical (PGE2 IC) gel in induction of labor in a group of primigravid women with unripe cervix was assessed and compared with another group with similar characteristics using oxytocin infusion and artificial rupture of membrane (ARM). The Modified Bishop Score (MBS), interval between IOL and onset of labor and the duration of labor after insertion of PGE2 gel was significantly different from those of oxytocin infusion group. But the Apgar Score at 1 & 5 min had shown no statistically significant difference. Any significant difference could also not be detected in the mode of delivery between the two induction group. The proportion of emergency Cesarean Section (CS) was high in the oxytocin infusion group than that of in the prostaglandin group. There was also no significant difference regarding the acceptability of both the induction methods.

Intracervical prostaglandin E2 gel for induction of labour in cases of unriped cervices

A clinical trial was carried out to study the effect of intracervical pg E2 gel used for induction of labor in cases of unriped cervices. 80 pregnant women, with medical indications for labor induction, were randomly divided into 2 groups. 40 were given 0.5 mg pg E2 gel intracervically, the other group was given oxytocin I.V. drip for induction of labor, [control group]. The prostaglandin E2 gel intracervically for induction of labor was followed by highly significant increase of Bishopscore after 6 hours [P <0.001], shorter induction-delivery period [P <0.005], shorter duration of oxytocin augmentation when it was needed [P <0.01] and lower rate of cesarean section [P <0.05]. No side effects were noticed during or after pg E2 gel. No maternal or fetal complications were recorded

RU-486=Preguntas y respuestas / RU-486 Question and answer

Los fármacos con antiprogestina constituyen un nuevo método prometedor para el control de la natalidad. El RU-486, también conocido con el nombre de mifepristone, es el primer fármaco con antiprogestina disponible en el mercado. Hasta ahora se ha aprobado en Francia y China como alternativa no quirúrgica para terminar los embarazos en su etapa inicial. Siguen investigándose las distintas aplicaciones anticonceptivas del RU-486, que también parece tener varios otros usos terapéuticos. El RU-486 y otros fármacos parecidos pueden contribuir a eliminar las complicaciones relacionadas con las actuales técnicas quirúrgicas del aborto. Estos fármacos son potencialmente menos costosos y más aceptables para muchas mujeres que el aborto quirúrgico. Hoy en día, los expertos en medicina recomiendan usar el RU-486 dentro de un período de tres semanas después de producido el atraso menstrual y administrarlo junto con otro fármaco, la prostaglandina, la cual aumenta mucho su efectividad. En vista de que a veces se presentan problemas de hemorragias y abortos incompletos, el RU-486 debe tomarse bajo supervisión médica. El RU-486 podría reducir enormemente las defunciones por abortos practicados en condiciones deficientes en los países en desarrollo. Pero como este fármaco se ha convertido en objeto de considerables controversias, es probable que en muchos países su disponibilidad dependa de factores políticos