ABSTRACT
BACKGROUND: The dilation and evacuation (D&E) procedure was modified for use in a low-resource setting where access to electric vacuum aspiration is limited. METHOD: In this demonstration project, buccal misoprostol is used for cervical preparation, followed by evacuation using manual vacuum aspiration (MVA) and forceps. Senior physicians at the Hanoi Obstetrics and Gynecology Hospital were trained in D&E and subsequently conducted 439 D&E procedures. RESULTS: The primary outcomes were efficacy and safety. Secondary outcome measures include efficacy of buccal misoprostol for cervical preparation prior to D&E and the feasibility of MVA for use in the D&E procedure. CONCLUSION: Successful abortion took place in 100% of the cases. Three major complications occurred. This procedure may be appropriate in other low-resource settings lacking safe, effective abortion services in the second trimester.
Subject(s)
Abortifacient Agents, Nonsteroidal/administration & dosage , Abortion, Induced/methods , Dilatation and Curettage/methods , Misoprostol/administration & dosage , Vacuum Curettage/methods , Abortion, Induced/adverse effects , Administration, Buccal , Adolescent , Adult , Female , Humans , Middle Aged , Pregnancy , Pregnancy Trimester, Second , Treatment Outcome , VietnamABSTRACT
Food has been reported to increase the bioavailability of mefloquine in healthy volunteers, but its role in increasing blood mefloquine concentrations in malaria patients treated with mefloquine is unclear. In this study, we compared blood mefloquine concentrations after the administration of artesunate (8 mg/kg) and mefloquine (15 mg/kg) over 12h with either a low-fat (approximately 3g of fat) or high-fat (approximately 30 g of fat) meal for the treatment of Plasmodium falciparum malaria in 12 Vietnamese patients. No statistical differences were detected in the following kinetic parameters between the low-fat (n=6) and high-fat (n=6) groups, respectively: maximum blood mefloquine concentrations (2838+/-531 ng/ml and 2556+/-657 ng/ml, 95% CI -486 to 1050 ng/ml, P=0.43) and the area under the blood mefloquine concentration versus time curves (246.8+/-58.3 microg.h/ml and 238.3+/-28.4 microg.h/ml, 95% CI -50.5 to 67.5 microg.h/ml, P=0.75). A fatty meal does not appear to increase the bioavailability of mefloquine in malaria patients and should not affect the response of malaria infections to treatment.
