Effects of methyldopa and nifedipine on uteroplacental and fetal hemodynamics in gestational hypertension.

OBJECTIVE: Investigation of methyldopa and nifedipine effects on maternal and fetal hemodynamics in women with mild gestational hypertension during the third pregnancy trimester. METHODS: A prospective cohort study. Methyldopa effects were followed in 28 patients, and nifedipine effects in another 28 patients. There were also 28 healthy controls. RESULTS: Uterine artery blood velocity waveform indices were improved only by nifedipine. Neither of the drugs affected the indices in umbilical and fetal middle cerebral artery. Both drugs normalized maternal blood pressure and pulse. CONCLUSIONS: Methyldopa and nifedipine did not show clinically significant influence on umbilical artery and fetal cerebral blood flow.

Public drug procurement: the lessons from a drug tender in a teaching hospital of a transition country.

INTRODUCTION: There are scarce descriptions of hospital drug procurement in the primary literature. The aim of this study was to analyse the drug tender led by a clinical pharmacologist in a 1200-bed university hospital in Serbia, a developing country in socio-economic transition, and to give recommendations for future steps in hospital drug policy. PROCEDURE AND OUTCOMES: Drug tendering was conducted according to the public procurement law from January to April 2003. Analysis included the method of defined daily doses and anatomical therapeutic chemical classification, as well as minimal tender prices, free market prices, essential drugs and domestic and foreign manufacturers. The drug tender list consisted of 548 products, 1,315,501 pharmaceutical units and 312 drug entities, among which 164 were essential. For purchasing purposes, 479 drug formulations were selected, costing approximately 1.4 million Euros (approximately 10% of hospital budget). Three-quarters of the expenditure consisted of antimicrobials (29.1%), cytotoxics (28.8%) and intravenous infusions (17.7%). The top 20 drugs consumed 62.2% of the total drug expenditure. Competition for the most expensive and/or most used drugs was the key for financial success of applicants, even when they offered a limited number of drugs. The tender achieved 4.6% and 17.2% cost savings in comparison with minimal tender price and free-market price, respectively. The tender did not provide a fair balance between domestic and foreign manufacturers. CONCLUSION: The drug tender is resource-consuming, laborious, and risky job. Aggregation of individual tenders, on a national level and/or regional ones, is probably the best choice for hospitals in transition countries at this time.

[Therapy of idiopathic sterility]. / Terapijski tretman idiopatskog steriliteta.

INTRODUCTION: During the period 1996-2000, we investigated 900 couples with infertility. In 71 (7.9%) couples no cause of sterility was revealed. These patients were divided according to age, parity and infertility duration. MATERIAL AND METHODS: We established the cumulative conception rate and cycle fecundity after three months without therapy, after three cycles of intrauterine insemination and after three cycles of in vitro fertilization (eventually intracytoplasmic sperm injection). Among patients with less than three years of infertility, cumulative conception rate was 34.8% after three months without therapy, 27.3% after three cycles of intrauterine insemination and 66.7% after three cycles of in vitro fertilization. RESULTS AND DISCUSSION: In patients with infertility longer than three years, cumulative conception rate without therapy was 12.5%, with intrauterine insemination 16.1% and with in vitro fertilization 40.5%. Differences regarding the age of patients were significant. Based on these findings, we proposed an optimal therapy regimen: three months therapy delay is desirable in patients under 30 years of age with infertility duration under three years. If there is no pregnancy in that period, intrauterine insemination is performed in three to four cycles. In case of intrauterine insemination failure in these women, in vitro fertilization and embryo transfer should be applied. In the group of women over 30 years of age, with infertility longer than three years, the possibility for occurrence of pregnancy with intrauterine insemination is slightly increased. If more than 4 follicles develop during preparations for intrauterine insemination, it is advisable to change the course to in vitro fertilization. In women older than 35, with primary or secondary infertility, in vitro fertilization should be performed from the very beginning.

Paying tuition and academic performance of students at Kragujevac University School of Medicine.

AIM: To assess whether the prospect of waiving tuition fees influenced the academic performance of students with the lowest admission test scores and consequent mandatory tuition. METHODS: We compared academic performance of 75 tuition-paying students with the students who did not have to pay tuition because they scored well on the 1996-1998 admission tests to the Kragujevac School of Medicine. We formed 3 control groups (high-, medium- and low-ranked students on the admission test), each with the similar number of students as the group of tuition-paying students. Students performance was assessed after the first two academic years on the basis of their average grades, number of tries to pass the same examination, the time needed to pass an examination after a course, and the number of repeated years. RESULTS: Of 75 tuition-paying students admitted to the School in the 1996-1998 period, 11 had their tuition permanently waived and were therefore excluded from the analysis after the first year. Tuition-paying students had the average grade of 6.8 +/- 3.2 (grade range 6-10), took each exam twice before passing it, needed more than four months of studying to pass an exam, and repeated 0.1 years per student. Their performance was statistically worse than the performance of the low-ranked group of control students in all parameters, except in the number of repeated years. The high-, medium-, and low-ranked student groups did not differ significantly in their performance, but all performed significantly better than the tuition-paying group in three following parameters: average grade (high-ranked group: 8.2 +/- 1.3), average number of tries to pass an exam (high-ranked group: 1.8 +/- 0.8), and average time of studying needed to pass an exam (high-ranked group: 119.6 +/- 65.9 days). CONCLUSION: The prospect of waiving tuition fees has no influence on students performance. The students rank on the admission test is a major predictor of their subsequent academic performance.